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Napolitano A, Thway K, Huang P, Jones RL. Centralisation of care improves overall survival for sarcoma patients. Ann Oncol 2024; 35:338-339. [PMID: 38342185 DOI: 10.1016/j.annonc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/13/2024] Open
Affiliation(s)
- A Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London
| | - K Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London
| | - P Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, The Institute of Cancer Research, London, UK.
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Serrano C, Rothschild S, Villacampa G, Heinrich MC, George S, Blay JY, Sicklick JK, Schwartz GK, Rastogi S, Jones RL, Rutkowski P, Somaiah N, Navarro V, Evans D, Trent JC. Novel trial designs for patients with gastrointestinal stromal tumor. ESMO Open 2024; 9:102218. [PMID: 38194880 PMCID: PMC10837772 DOI: 10.1016/j.esmoop.2023.102218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- C Serrano
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona; Sarcoma Translational Research Program, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | | | - G Villacampa
- Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; The Institute of Cancer Research, London, UK
| | - M C Heinrich
- Portland VA Health Care System and Knight Cancer Institute, Oregon Health & Science University, Portland
| | - S George
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - J-Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon; Université Claude Bernard, Lyon, France
| | - J K Sicklick
- Department of Surgery, Division of Surgical Oncology, University of California San Diego, San Diego; Department of Pharmacology, University of California San Diego, San Diego
| | - G K Schwartz
- Case Comprehensive Cancer Center, Cleveland, USA
| | - S Rastogi
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - R L Jones
- The Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - N Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - V Navarro
- Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - D Evans
- The Life Raft Group, Wayne, USA
| | - J C Trent
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA
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3
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Blay JY, von Mehren M, Jones RL, Martin-Broto J, Stacchiotti S, Bauer S, Gelderblom H, Orbach D, Hindi N, Dei Tos A, Nathenson M. Synovial sarcoma: characteristics, challenges, and evolving therapeutic strategies. ESMO Open 2023; 8:101618. [PMID: 37625194 PMCID: PMC10470271 DOI: 10.1016/j.esmoop.2023.101618] [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: 04/18/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
Synovial sarcoma (SS) is a rare and aggressive disease that accounts for 5%-10% of all soft tissue sarcomas. Although it can occur at any age, it typically affects younger adults and children, with a peak incidence in the fourth decade of life. In >95% of cases, the oncogenic driver is a translocation between chromosomes X and 18 that leads to the formation of the SS18::SSX fusion oncogenes. Early and accurate diagnosis is often a challenge; optimal outcomes are achieved by referral to a specialist center for diagnosis and management by a multidisciplinary team as soon as SS is suspected. Surgery with or without radiotherapy and/or chemotherapy can be effective in localized disease, especially in children. However, the prognosis in the advanced stages is poor, with treatment strategies that have relied heavily on traditional cytotoxic chemotherapies. Therefore, there is an unmet need for novel effective management strategies for advanced disease. An improved understanding of disease pathology and its molecular basis has paved the way for novel targeted agents and immunotherapies that are being investigated in clinical trials. This review provides an overview of the epidemiology and characteristics of SS in children and adults, as well as the patient journey from diagnosis to treatment. Current and future management strategies, focusing particularly on the potential of immunotherapies to improve clinical outcomes, are also summarized.
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Affiliation(s)
- J-Y Blay
- Department of Medicine, Centre Léon Bérard & University Claude Bernard Lyon I & UNICANCER Lyon, France.
| | - M von Mehren
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - J Martin-Broto
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid; Department of Oncology, University Hospital General de Villalba, Madrid; Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - S Stacchiotti
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Bauer
- Department of Oncology, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - D Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, PSL University, Paris, France
| | - N Hindi
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid; Department of Oncology, University Hospital General de Villalba, Madrid; Instituto de Investigacion Sanitaria Fundacion Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - A Dei Tos
- Department of Medicine, University of Padua School of Medicine and Department of Integrated Diagnostics, Azienda Ospedale-Università Padova, Padua, Italy
| | - M Nathenson
- Oncology Clinical Development, Cell and Gene Therapy, GSK, Waltham, USA
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4
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Serrano C, Bauer S, Gómez-Peregrina D, Kang YK, Jones RL, Rutkowski P, Mir O, Heinrich MC, Tap WD, Newberry K, Grassian A, Shi H, Bialick S, Schöffski P, Pantaleo MA, von Mehren M, Trent JC, George S. Circulating tumor DNA analysis of the phase III VOYAGER trial: KIT mutational landscape and outcomes in patients with advanced gastrointestinal stromal tumor treated with avapritinib or regorafenib. Ann Oncol 2023; 34:615-625. [PMID: 37105265 PMCID: PMC10330293 DOI: 10.1016/j.annonc.2023.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The current treatment paradigm of imatinib-resistant metastatic gastrointestinal stromal tumor (GIST) does not incorporate KIT/PDGFRA genotypes in therapeutic drug sequencing, except for PDGFRA exon 18-mutant GIST that is indicated for avapritinib treatment. Here, circulating tumor DNA (ctDNA) sequencing was used to analyze plasma samples prospectively collected in the phase III VOYAGER trial to understand how the KIT/PDGFRA mutational landscape contributes to tyrosine kinase inhibitor (TKI) resistance and to determine its clinical validity and utility. PATIENTS AND METHODS VOYAGER (N = 476) compared avapritinib with regorafenib in patients with KIT/PDGFRA-mutant GIST previously treated with imatinib and one or two additional TKIs (NCT03465722). KIT/PDGFRA ctDNA mutation profiling of plasma samples at baseline and end of treatment was assessed with 74-gene Guardant360® CDx. Molecular subgroups were determined and correlated with outcomes. RESULTS A total of 386/476 patients with KIT/PDGFRA-mutant tumors underwent baseline (pre-trial treatment) ctDNA analysis; 196 received avapritinib and 190 received regorafenib. KIT and PDGFRA mutations were detected in 75.1% and 5.4%, respectively. KIT resistance mutations were found in the activation loop (A-loop; 80.4%) and ATP-binding pocket (ATP-BP; 40.8%); 23.4% had both. An average of 2.6 KIT mutations were detected per patient; 17.2% showed 4-14 different KIT resistance mutations. Of all pathogenic KIT variants, 28.0% were novel, including alterations in exons/codons previously unreported. PDGFRA mutations showed similar patterns. ctDNA-detected KIT ATP-BP mutations negatively prognosticated avapritinib activity, with a median progression-free survival (mPFS) of 1.9 versus 5.6 months for regorafenib. mPFS for regorafenib did not vary regardless of the presence or absence of ATP-BP/A-loop mutants and was greater than mPFS with avapritinib in this population. Secondary KIT ATP-BP pocket mutation variants, particularly V654A, were enriched upon disease progression with avapritinib. CONCLUSIONS ctDNA sequencing efficiently detects KIT/PDGFRA mutations and prognosticates outcomes in patients with TKI-resistant GIST treated with avapritinib. ctDNA analysis can be used to monitor disease progression and provide more personalized treatment.
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Affiliation(s)
- C Serrano
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona; Sarcoma Translational Research Laboratory, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | - S Bauer
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, DKTK-Partner-Site, University of Duisburg-Essen, Essen, Germany
| | - D Gómez-Peregrina
- Sarcoma Translational Research Laboratory, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Y-K Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - R L Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - P Rutkowski
- Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - O Mir
- Institut Gustave Roussy, Villejuif, France
| | - M C Heinrich
- Portland VA Health Care System and OHSU Knight Cancer Institute, Portland
| | - W D Tap
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York
| | - K Newberry
- Blueprint Medicines Corporation, Cambridge
| | - A Grassian
- Blueprint Medicines Corporation, Cambridge
| | - H Shi
- Blueprint Medicines Corporation, Cambridge
| | - S Bialick
- Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA
| | - P Schöffski
- Department of General Medicine Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - M A Pantaleo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - M von Mehren
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia
| | - J C Trent
- Department of Medicine, Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA
| | - S George
- Department of Medical Oncology, Sarcoma Center, Dana-Farber Cancer Institute, Boston, USA
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5
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Bauer S, Jones RL, George S, Gelderblom H, Schöffski P, von Mehren M, Zalcberg JR, Kang YK, Abdul Razak AR, Trent JC, Attia S, Le Cesne A, Reichmann W, Sprott K, Achour H, Sherman ML, Ruiz-Soto R, Blay JY, Heinrich MC. Mutational heterogeneity of imatinib resistance and efficacy of ripretinib vs sunitinib in patients with gastrointestinal stromal tumor: ctDNA analysis from INTRIGUE. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.36_suppl.397784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
397784 Background: Ripretinib, a switch-control tyrosine kinase inhibitor (TKI), is indicated for patients (pts) with gastrointestinal stromal tumor (GIST) who received prior treatment with ≥3 TKIs, including imatinib. Sunitinib is approved for advanced GIST after imatinib failure. Circulating tumor DNA (ctDNA) analysis may provide insight into the efficacy of these agents in second-line advanced GIST. Here, we present exploratory baseline ctDNA results from INTRIGUE. Methods: INTRIGUE is an open-label, phase 3 study that enrolled adult pts with advanced GIST who progressed on or had intolerance to imatinib (NCT03673501). Randomization was 1:1 to ripretinib 150 mg once daily (QD) or sunitinib 50 mg QD (4 wks on/2 wks off). Baseline peripheral whole blood was analyzed by Guardant360, a 74-gene ctDNA next-generation sequencing (NGS)-based assay. Only KIT mutations are reported here. Results: Of 453 pts in the overall intent-to-treat (ITT) population, 362 (80%) samples were analyzed. ctDNA was detected in 280/362 (77%), with KIT mutations detected in 213/280 (76%). Common resistance mutations were in the KIT activation loop (AL; exons 17/18; 89/213, 42%) and ATP-binding pocket (ATP-BP; exons 13/14; 81/213, 38%). Efficacy in pts with detectable ctDNA in the KIT exon 11 and overall ITT populations was consistent with the primary analysis based on tumor data used for randomization. Pts with KIT exon 11 + 17/18 (−9/13/14) mutations had superior progression-free survival (PFS), objective response rate (ORR), and overall survival (OS) with ripretinib vs sunitinib, whereas pts with exon 11 + 13/14 (−9/17/18) mutations had better PFS, ORR, and OS with sunitinib vs ripretinib (Table). Subgroup safety profiles were consistent with the primary analysis. Conclusions: While KIT ATP-BP mutations predicted clinical benefit from sunitinib vs ripretinib, pts harboring resistance mutations in the KIT AL derived meaningful clinical benefit from ripretinib but not sunitinib. This study demonstrates the value of ctDNA NGS-based sequencing of the complex landscape of KIT mutations to predict the clinical benefit of ripretinib or sunitinib as second-line therapy in pts with advanced GIST. Clinical trial information: NCT03673501 . [Table: see text]
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Affiliation(s)
- Sebastian Bauer
- Department of Medical Oncology and Sarcoma Center/West German Cancer Center, University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Robin Lewis Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | | | | | - Patrick Schöffski
- University Hospitals Leuven, Department of General Medical Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | | | - John Raymond Zalcberg
- Monash University School of Public Health and Preventive Medicine and Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - Yoon-Koo Kang
- Asan Medical Center, University of Ulsan, Seoul, Korea, Republic of (South)
| | | | - Jonathan C. Trent
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | | | | | | | - Kam Sprott
- Deciphera Pharmaceuticals, LLC, Waltham, MA
| | | | | | | | | | - Michael C. Heinrich
- Portland VA Health Care System and OHSU Knight Cancer Institute, Portland, OR
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Goggin C, Al-Badri B, Stansfeld A, Barquin E, Durand B, Nguyen TG, Mahalingam P, Ayeni E, Napolitano A, Zaidi S, Miah A, Jones RL, Benson C. Informed consent in clinical trials: Implementing methods to improve patient understanding in cancer research—A quality improvement initiative in a sarcoma trials unit. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.335] [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
335 Background: Clinical trials are considered the cornerstone of improving outcomes for cancer patients. The understanding of an individual patient of the trial on which they are enrolled can vary significantly, with some studies demonstrating poor patient understanding of their involvement in trials. This exploratory study aimed to improve patient understanding of clinical trials and patient experience of the informed consent process by implementing measures to present complex trial information in alternative formats. Methods: The project was undertaken in a sarcoma trials unit in a specialist cancer treatment centre. Baseline knowledge was assessed using an adapted version of the Quality of Informed Consent (QuIC) questionnaire. A decision-aid was created following focus group discussions with stakeholders, focussing on key trial questions for patients, such as consent, the research description, risks, benefits, and alternatives to the trial. A patient education video was produced by the research team, explaining general aspects of clinical trials in patient-friendly language. The decision-aids and videos were distributed during the informed consent process of trial recruitment over a 12-week period. The patient group was assessed with post-intervention questionnaires. Statistical analysis was descriptive due to the small numbers. Results: Thirty sarcoma patients participated in the project, including baseline assessment of 15 patients previously enrolled on study, and 15 patients considering participation in a trial who underwent the intervention. 100% (n = 15) of the interventional group found the video and decision-aid useful. 60% (n = 18) of patients had a university level education, indicating a well-educated population. A pre- and post-intervention comparison demonstrated an improved understanding of 10 key elements of clinical trial information as shown in Table. Conclusions: Our exploratory study has shown that patient education tools including decision-aids and patient videos can be successfully implemented to help improve patient understanding of clinical trial information and may be of benefit in other trials units. Further larger studies are required to confirm these findings.[Table: see text]
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Affiliation(s)
- Caitriona Goggin
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Bader Al-Badri
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Anna Stansfeld
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | - Eniola Ayeni
- Royal Marsden Hospital Chelsea, London, United Kingdom
| | | | - Shane Zaidi
- Royal Marsden Hospital, London, United Kingdom
| | - Aisha Miah
- The Royal Marsden Hospital, London, United Kingdom
| | - Robin Lewis Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Charlotte Benson
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
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7
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Johnston EW, Alves A, Messiou C, Napolitano A, Strauss D, Hayes A, Smith MJ, Benson C, Jones RL, Gennatas S, Fotiadis N. Percutaneous cryoablation for desmoid fibromatosis: initial experience at a UK centre. Clin Radiol 2022; 77:784-793. [PMID: 35850865 DOI: 10.1016/j.crad.2022.06.008] [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] [Received: 02/01/2022] [Revised: 05/13/2022] [Accepted: 06/11/2022] [Indexed: 11/03/2022]
Abstract
AIM To report the first UK experience of cryoablation in desmoid fibromatosis (DF) with particular focus on technique, safety, and efficacy. MATERIALS AND METHODS Patients were selected at multidisciplinary tumour board meetings at a specialist cancer hospital. Radiation dose, procedure duration, and number of cryoprobes were compared for small versus large tumours (>10 cm long axis). Response at magnetic resonance imaging (MRI) was evaluated using different criteria, and percentage agreement with clinical response as assessed in oncology clinic calculated. RESULTS Thirteen procedures were performed in 10 patients (eight women, median age 51 years, IQR 42-69 years) between February 2019 and August 2021. Procedures for large tumours had higher radiation dose (2,012 ± 1,012 versus 1,076 ± 519 mGy·cm, p=0.048) used more cryoprobes (13 ± 7 versus 4 ± 2, p=0.009), and were more likely to have residual unablated tumour (38 ± 37% versus 7.5 ± 10%, p=0.045). Adverse events were minor apart from one transient radial nerve palsy. Eight of 10 patients had symptomatic benefit at clinical follow-up (median 353 days, IQR 86-796 days), and three started systemic therapy mean 393 days later. All patients who had complete ablation demonstrated symptomatic response, with no instances of repeat treatment, recurrence, or need for systemic therapy during the study period. All progression occurred outside ablation zones. CONCLUSION Cryoablation for symptomatic DF is a reproducible technique with low, transient toxicity, where one or two treatments can achieve a meaningful response. Where possible, the ablation ice ball should fully cover DF tumours.
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Affiliation(s)
- E W Johnston
- Interventional Radiology, Royal Marsden Hospital, London, UK.
| | - A Alves
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - C Messiou
- Diagnostic Radiology, Royal Marsden Hospital, London, UK
| | - A Napolitano
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - D Strauss
- Academic Surgical Unit, Royal Marsden Hospital, London, UK
| | - A Hayes
- Academic Surgical Unit, Royal Marsden Hospital, London, UK
| | - M J Smith
- Academic Surgical Unit, Royal Marsden Hospital, London, UK
| | - C Benson
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - R L Jones
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - S Gennatas
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - N Fotiadis
- Interventional Radiology, Royal Marsden Hospital, London, UK.
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Janku F, Bauer S, Shoumariyeh K, Jones RL, Spreafico A, Jennings J, Psoinos C, Meade J, Ruiz-Soto R, Chi P. Efficacy and safety of ripretinib in patients with KIT-altered metastatic melanoma. ESMO Open 2022; 7:100520. [PMID: 35753087 PMCID: PMC9434165 DOI: 10.1016/j.esmoop.2022.100520] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ripretinib, a broad-spectrum KIT and platelet-derived growth factor receptor A switch-control tyrosine kinase inhibitor, is approved for the treatment of adult patients with advanced gastrointestinal stromal tumor as ≥ fourth-line therapy. We present the efficacy and safety of ripretinib in patients with KIT-altered metastatic melanoma enrolled in the expansion phase of the ripretinib phase I study. PATIENTS AND METHODS Patients with KIT-altered metastatic melanoma were enrolled and treated with ripretinib at the recommended phase II dose of 150 mg once daily in 28-day cycles. Investigator-assessed responses according to Response Evaluation Criteria In Solid Tumors version 1.1 were carried out on day 1 of cycles 3, 5, 7, every three cycles thereafter, and at a final study visit. RESULTS A total of 26 patients with KIT-altered metastatic melanoma (25 with KIT mutations, 1 with KIT-amplification) were enrolled. Patients had received prior immunotherapy (n = 23, 88%) and KIT inhibitor therapy (n = 9, 35%). Confirmed objective response rate (ORR) was 23% [95% confidence interval (CI) 9%-44%; one complete and five partial responses] with a median duration of response of 9.1 months (range, 6.9-31.3 months). Median progression-free survival (mPFS) was 7.3 months (95% CI 1.9-13.6 months). Patients without prior KIT inhibitor therapy had a higher ORR and longer mPFS (n = 17, ORR 29%, mPFS 10.2 months) than those who had received prior KIT inhibitor treatment (n = 9, ORR 11%, mPFS 2.9 months). The most common treatment-related treatment-emergent adverse events (TEAEs) of any grade in ≥15% of patients were increased lipase, alopecia, actinic keratosis, myalgia, arthralgia, decreased appetite, fatigue, hyperkeratosis, nausea, and palmar-plantar erythrodysesthesia syndrome. There were no grade ≥4 treatment-related TEAEs. CONCLUSIONS In this phase I study, ripretinib demonstrated encouraging efficacy and a well-tolerated safety profile in patients with KIT-altered metastatic melanoma, suggesting ripretinib may have a clinically meaningful role in treating these patients.
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Affiliation(s)
- F Janku
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - S Bauer
- Department of Medical Oncology, Sarcoma Center/West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - K Shoumariyeh
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - R L Jones
- Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - A Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, and Department of Medicine, University of Toronto, Toronto, Canada
| | - J Jennings
- Deciphera Pharmaceuticals, LLC, Waltham, USA
| | - C Psoinos
- Deciphera Pharmaceuticals, LLC, Waltham, USA
| | - J Meade
- Deciphera Pharmaceuticals, LLC, Waltham, USA
| | - R Ruiz-Soto
- Deciphera Pharmaceuticals, LLC, Waltham, USA
| | - P Chi
- Human Oncology and Pathogenesis Program/Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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9
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Smrke A, Frezza AM, Giani C, Somaiah N, Brahmi M, Czarnecka AM, Rutkowski P, Van der Graaf W, Baldi GG, Connolly E, Duffaud F, Huang PH, Gelderblom H, Bhadri V, Grimison P, Mahar A, Stacchiotti S, Jones RL. Systemic treatment of advanced clear cell sarcoma: results from a retrospective international series from the World Sarcoma Network. ESMO Open 2022; 7:100522. [PMID: 35717681 PMCID: PMC9271493 DOI: 10.1016/j.esmoop.2022.100522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Clear cell sarcoma (CCS) is a translocated aggressive malignancy with a high incidence of metastases and poor prognosis. There are few studies describing the activity of systemic therapy in CCS. We report a multi-institutional retrospective study of the outcomes of patients with advanced CCS treated with systemic therapy within the World Sarcoma Network (WSN). Materials and methods Patients with molecularly confirmed locally advanced or metastatic CCS treated with systemic therapy from June 1985 to May 2021 were included. Baseline demographic and treatment information, including response by Response Evaluation Criteria in Solid Tumours (RECIST) 1.1, was retrospectively collected by local investigators. Descriptive statistics were carried out. Results Fifty-five patients from 10 institutions were included. At diagnosis, the median age was 30 (15-73) years and 24% (n = 13/55) had metastatic disease. The median age at diagnosis was 30 (15-73) years. Most primary tumours were at aponeurosis (n = 9/55, 16%) or non-aponeurosis limb sites (n = 17/55, 31%). The most common fusion was EWSR1–ATF1 (n = 24/55, 44%). The median number of systemic therapies was 1 (range 1-7). The best response rate was seen for patients treated with sunitinib (30%, n = 3/10), with a median progression-free survival of 4 [95% confidence interval (CI) 1-7] months. The median overall survival for patients with advanced/metastatic disease was 15 months (95% CI 3-27 months). Conclusions Soft tissue sarcoma-type systemic therapies have limited benefit in advanced CCS and response rate was poor. International, multicentre prospective translational studies are required to identify new treatments for this ultra-rare subtype, and access to early clinical trial enrolment remains key for patients with CCS. This is the largest reported series of advanced CCS patients treated with systemic therapy. The activity of sarcoma-type systemic therapy is poor and modest responses were seen only with sunitinib. Effective therapies are needed to improve outcomes for patients with this ultra-rare sarcoma type.
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Affiliation(s)
- A Smrke
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; BC Cancer, Vancouver, Canada
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Giani
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - N Somaiah
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Brahmi
- Centre Leon Berard, Lyon, France
| | - A M Czarnecka
- Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - P Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | | | - G G Baldi
- Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - E Connolly
- Chris O'Brien Lifehouse, Camperdown, Australia
| | - F Duffaud
- La Timone Hospital and Aix-Marseille University (AMU), Marseilles, France
| | - P H Huang
- Institute of Cancer Research, London, UK
| | - H Gelderblom
- Leiden University Medical Center, Leiden, The Netherlands
| | - V Bhadri
- Chris O'Brien Lifehouse, Camperdown, Australia
| | - P Grimison
- Chris O'Brien Lifehouse, Camperdown, Australia
| | - A Mahar
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - S Stacchiotti
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R L Jones
- The Royal Marsden Hospital NHS Foundation Trust, London, UK.
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10
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Gelderblom H, Jones RL, Blay JY, George S, Schöffski P, von Mehren M, Zalcberg JR, Kang YK, Abdul Razak AR, Trent JC, Attia S, Le Cesne A, Harrow B, Becker C, Wang T, Sherman ML, Ruiz-Soto R, Heinrich MC, Bauer S. Patient reported outcomes and tolerability in patients receiving ripretinib versus sunitinib after imatinib treatment in INTRIGUE: A phase 3 open-label study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11541 Background: Ripretinib (R) is a switch-control tyrosine kinase inhibitor (TKI) indicated for the treatment of patients (pts) with advanced gastrointestinal stromal tumor (GIST) after prior treatment with ≥3 TKIs. In the INTRIGUE study (NCT03673501) there was no significant difference in median PFS (primary endpoint) between R and sunitinib (S). We present exploratory analyses of tolerability data and selected pt reported outcomes (PROs). Methods: Pts were randomized 1:1 to R 150 mg QD or S 50 mg QD 4 weeks on/2 weeks off.Dose modification was allowed for toxicity management. The event of interest was severe or life-threatening (grade ≥3) treatment-related adverse event prior to progression (sTRAE). Days with at least one sTRAE were summed for all treated pts and for pts with ≥1 sTRAE event. PROs were assessed using questions from EORTC QLQ-C30 and Dermatology Life Quality Index (DLQI) at cycle 1 (C1) day 1 (D1), D15, and D29; D1 and D29 of all other cycles; as well as at end of treatment. Differences in PRO scores between baseline and later assessments were calculated across visits. Long-term data will be presented. Results: Pts receiving R (n = 223) versus (vs) S (n = 221) experienced fewer sTRAEs (24% vs 51%, respectively). For all treated pts, the mean time with sTRAEs was 11 days for R and 42 days for S (ratio 0.27, P<0.0001). For pts with ≥1 sTRAE, the mean number of days with a sTRAE was 48 days for R vs 81 days for S (ratio 0.59, p = 0.037). Completion of PRO assessments across the two treatment arms was similar (baseline: R [n = 199], S [n = 199]; C1 D29: R [n = 167], S [n = 177]). Significant differences in self-reported functioning and symptoms were observed by C1 D29. For PROs relating to commonly reported sTRAEs, except constipation, pts in the R arm reported better outcomes than pts in the S arm. Pts in the R arm reported significantly (p<0.05) less decline compared to baseline in pt-reported role function as well as less increase, or improvement, in symptoms of fatigue, appetite loss, diarrhea, nausea/vomiting, and pain vs pts in the S arm. Moderate or severe effect of skin toxicity on pt life, as measured by DLQI in the R arm (n = 165) and in the S arm (n = 175), was observed in 6.6% of pts in the R arm vs 14.8% of pts in the S arm (p = 0.015). Conclusions: In the INTRIGUE study the total number of days with sTRAEs was fewer for pts receiving R vs S. Pts in the R arm also reported significantly less decline in pt-reported role function and less increase in symptoms related to commonly reported sTRAEs, except constipation, vs pts in the S arm. Medical writing provided by Costello Medical. Clinical trial information: NCT03673501.
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Affiliation(s)
- Hans Gelderblom
- LUMC Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Robin Lewis Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tao Wang
- Deciphera Pharmaceuticals, LLC, Waltham, MA
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11
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Stacchiotti S, Zuco V, Frezza AM, Pasquali S, Tortoreto M, Martini S, Barisella M, Dagrada G, Huang P, Jones RL, Casali PG, Leonard H, Gronchi A, Zaffaroni N. Epitheliod hemagioendothelioma (EHE) patient-derived model (PDX): Drug activity assessment and validation of novel biomarkers. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11566] [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
11566 Background: EHE is an ultra-rare sarcoma marked by two specific fusions, WWTR1-CAMTA1 (̃90%) and YAP1-TFE3 (̃10%). The clinical course of EHE ranges from indolent to highly aggressive, often associated with systemic paraneoplastic symptoms. Molecular predictors of clinical outcome are unknown. While surgery is the mainstay of treatment in the localized setting, management of advanced disease is challenging due to the rarity and poor sensitivity to conventional chemotherapy. This hampers the conduct of large prospective clinical trials. We report herein the first available EHE PDX (developed at the Istituto Nazionale Tumori, Milan, Italy) (INT), to assess the activity of old and new anticancer agents in EHE and inform future clinical studies. We also report on the preliminary results of a prospective observational study, ongoing in collaboration with The EHE Rare Cancer Charity (UK) and The EHE Foundation (US) aimed at identifying prognostic factors. Methods: A PDX of EHE in SCID mice was generated at INT from a patient (pt) suffering with the aggressive clinical variant, presenting with systemic symptoms. The PDX fully reproduces the originating clinical tumor in terms of morphology, biology ( WWTR1- CAMTA1 positive), overall transcriptomic profile. 2D (monolayer) and 3D (sferoids) cell cultures were established following PDX disaggregation. We have started assessing the comparative activity of currently available drugs (doxorubicin, sirolimus), while the efficacy of novel agents is undergoing. In parallel, we analyzed the presence of a selection of inflammatory cytokines in prospectively collected blood samples from EHE pts who entered an international observational study and we looked at their presence and modulation in the PDX model. Results: PDX experiments showed almost negligible activity of doxorubicin while sirolimus induced an 80% tumor volume inhibition. Biochemical analysis in tumors explanted from sirolimus-treated mice confirmed the down-regulation of mTOR downstream signaling. Among all cytokines, Growth and Differentiation Factor-15 (GDF-15) was found significantly over-expressed in serum of EHE pts (n = 23), particularly those with the most aggressive clinical variant, compared to healthy subjects (n = 23; p< 0.01). Consistently, EHE PDX and cell culture were found to release in the blood/culture medium GDF-15. Sirolimus was found to down-regulate GDF-15 release in both in vivo and in vitro EHE models. Conclusions: Our preliminary results indicate that this EHE PDX model is suitable i) for comparatively assessing the activity of anticancer drugs, and ii) for identifying and pre-clinically validating novel biomarkers. The role of GDF-15 in EHE progression deserves further investigation.
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Affiliation(s)
| | - Valentina Zuco
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Anna Maria Frezza
- Adult Mesenchymal and Rare Tumor Unit, Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sandro Pasquali
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Silvia Martini
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marta Barisella
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianpaolo Dagrada
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paul Huang
- Institute of Cancer Research, London, United Kingdom
| | - Robin Lewis Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Paolo G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Nadia Zaffaroni
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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12
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Chawla SP, Wasp GT, Shepard DR, Blay JY, Jones RL, Stacchiotti S, Reichardt P, Gelderblom H, Martin-Broto J, Eckelman B, Darling M, Andrianov V, Conley AP. A randomized, placebo-controlled, phase 2 trial of INBRX-109 in unresectable or metastatic conventional chondrosarcoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps11582] [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
TPS11582 Background: Chondrosarcomas (CS) are the third most common type of primary bone cancer after myeloma and osteosarcoma. Conventional CS represent 85–90% of all cases and are typically treated with surgical resection. However, there are no approved systemic treatment options for patients with unresectable or metastatic conventional CS, and outcomes remain poor. INBRX-109 is a precision-engineered, tetravalent death receptor 5 (DR5) agonist antibody designed to overcome the limitations of earlier-generation agonists and exploit the tumor-specific cell death induced by DR5 activation. DR5 is one of two pro-apoptotic receptors for the trimeric tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). Early clinical activity of INBRX-109 was observed in an ongoing phase 1 trial and warrants further investigation. INBRX-109 has been granted an FDA fast-track designation for conventional CS. Methods: This is a multicenter, randomized, blinded, placebo-controlled phase 2 study in patients with unresectable or metastatic conventional CS, measurable disease by RECIST 1.1, and radiologic disease progression within 6 months prior to screening. Any number of prior lines of therapy are allowed, except for prior DR5 agonists. Patients must be ≥18 years of age and have an ECOG performance status of 0/1 and have archival or fresh tissue available. Approximately 201 patients will be randomized (2:1) to INBRX-109 (3 mg/kg intravenously, every 21 days) or placebo, stratified by histologic grade (Grade 1/2 vs 3), isocitrate dehydrogenase (IDH)1 R132/IDH2 R172 status (wildtype vs mutation), and line of systemic therapy (none vs prior). Treatment will continue until disease progression/unacceptable toxicity. Patients treated with a placebo will have the option to cross over to INBRX-109 upon disease progression. The primary endpoint is progression-free survival (PFS) by independent radiology review. Secondary endpoints are overall survival, PFS by investigator assessment, quality of life, overall response rate, duration of response, disease control rate, safety, pharmacokinetics, and immunogenicity. Adverse events will be recorded and graded by NCI CTCAE Version 5.0. Median PFS of 7.0 months is projected for INBRX-109 and 4.0 months for placebo (corresponding hazard ratio of 0.571); INBRX-109 will be declared superior if the 1-sided p-value from the stratified log-rank test is <0.025. More than 50 sites are planned across the US/Europe. The study is actively enrolling. Clinical trial information: NCT04950075.
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Affiliation(s)
| | | | | | | | - Robin Lewis Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | | | - Peter Reichardt
- Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Javier Martin-Broto
- Medical Oncology Department, Fundacion Jimenez Diaz University Hospital, Madrid, Spain, Institute of Biomedicine of Seville, University of Seville, Seville, Spain
| | | | | | | | - Anthony Paul Conley
- University of Texas MD Anderson Cancer Center, Department of Sarcoma Medical Oncology, Houston, TX
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13
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Gounder MM, Schwartz GK, Jones RL, Chawla SP, Chua-Alcala VS, Stacchiotti S, Wagner AJ, Cote GM, Maki RG, Kosela-Paterczyk H, Shepard DR, Shah N, Bryce R, Doebele RC, Patel S. MANTRA: A randomized, multicenter, phase 3 study of the MDM2 inhibitor milademetan versus trabectedin in patients with de-differentiated liposarcomas. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps11589] [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
TPS11589 Background: Murine double minute 2 (MDM2) is a negative regulator of tumor suppressor protein p53. MDM2 induces degradation of p53 and promotes tumorigenesis. MDM2 amplification occurs in many cancers but is documented in up to 100% of well-differentiated or dedifferentiated liposarcomas (WD/DDLPS) [Cancer Genome Atlas Research Network. Cell 2017]. Inhibition of the MDM2-p53 interaction is a promising therapeutic approach to restore p53 tumor suppressor activity in WD/DDLPS. Milademetan (RAIN-32) is a small-molecule MDM2 inhibitor that inhibits the MDM2-p53 interaction and restores p53 function at nanomolar concentrations. In a phase 1 study, milademetan showed promising efficacy in 53 patients with WD/DDLPS when administered on an intermittent schedule (260 mg QD on Days 1–3 and 15–17 on a 28-day cycle), with a median progression-free survival (PFS) of 7.4 months [Gounder et al. AACR-NCI-EORTC 2020]. WD/DDLS are relatively resistant to chemotherapy, and systemic treatment options for patients with advanced disease are limited. MANTRA (RAIN-3201) is a randomized, multicenter, open-label, phase 3 registration study designed to evaluate the efficacy and safety of milademetan versus trabectedin in patients with unresectable or metastatic DDLPS with disease progression on ≥ 1 prior systemic therapies. Methods: Eligible patients are ≥ 18 years of age with histologically confirmed unresectable and/or metastatic DDLPS, with or without a WD component, who have received ≥ 1 prior systemic therapies, including ≥ 1 anthracycline-based regimen, with radiographic evidence of progression by RECIST v1.1 within 6 months before study entry. Prior treatment with trabectedin or an MDM2 inhibitor is not permitted. Patients will be randomly assigned (1:1) to receive milademetan (260 mg once daily orally Days 1–3 and 15–17 on a 28-day cycle) or trabectedin (1.5 mg/m2 as a 24-hour intravenous infusion every 3 weeks). Randomization is stratified by Eastern Cooperative Oncology Group performance status (0 or 1) and number of prior treatments for WD/DDLPS (≤ 2 or > 2). Tumor response will be evaluated by RECIST v1.1 at Weeks 8, 16, 24, and 32, and then every 12 weeks. Primary endpoint: PFS by blinded independent central review. Secondary endpoints: overall survival; disease control rate; objective response rate; duration of response; PFS by investigator assessment; safety; health-related quality of life. Exploratory endpoints: molecular markers in peripheral blood and/or tumor tissue; milademetan pharmacokinetics. To demonstrate a 3-month increase in PFS (from 3 to 6 months) corresponding to a hazard ratio of 0.5, approximately 160 patients will be required to observe 105 events with 93.9% power and 2-sided significance level of 5%. Clinical trial information: NCT04979442.
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Affiliation(s)
- Mrinal M. Gounder
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | | | - Robin Lewis Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Andrew J. Wagner
- Center for Sarcoma and Bone Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Robert G Maki
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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14
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Heinrich MC, Jones RL, Gelderblom H, George S, Schöffski P, von Mehren M, Zalcberg JR, Kang YK, Abdul Razak AR, Trent JC, Attia S, Le Cesne A, Su Y, Meade JN, Wang T, Sherman ML, Ruiz-Soto R, Blay JY, Bauer S. INTRIGUE: A phase III, randomized, open-label study to evaluate the efficacy and safety of ripretinib versus sunitinib in patients with advanced gastrointestinal stromal tumor previously treated with imatinib. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.36_suppl.359881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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
359881 Background: Sunitinib is approved for advanced gastrointestinal stromal tumor (GIST) after imatinib failure. Ripretinib, a broad-spectrum KIT and PDGFRA switch-control tyrosine kinase inhibitor (TKI), is indicated for the treatment of adult patients (pts) with GIST who received prior treatment with 3 or more TKIs, including imatinib. We compared the efficacy and safety of ripretinib vs sunitinib in pts with advanced GIST who progressed on or were intolerant to imatinib. Methods: This multicenter, global, randomized, open-label phase 3 study (NCT03673501) enrolled adult pts with GIST who progressed on or had intolerance to imatinib. Pts were randomized 1:1 to ripretinib 150 mg once daily (QD) or sunitinib 50 mg QD (4 wks on/2 wks off). Randomization was stratified by KIT mutational status and imatinib intolerance. The primary endpoint was progression-free survival (PFS) by independent radiologic review (IRR) using modified RECIST version 1.1. Key secondary endpoints were objective response rate (ORR) by IRR and overall survival (OS). Hierarchical testing was performed for primary and key secondary endpoints in a prespecified sequence; testing pts with a KIT exon 11 primary mutation (Ex11 intention-to-treat [ITT] population) preceded the all-patient (AP) ITT population. Data cutoff was 1 Sep 2021; final analyses of PFS and ORR and the first interim analysis of OS were conducted. Results: A total of 453 pts were randomized to ripretinib (n = 226; Ex11 ITT, n = 163) or sunitinib (n = 227; Ex11 ITT, n = 164). Median age was 60 yrs (range 18–88) and most pts were white (66.2%) males (62.0%). PFS was not statistically different between ripretinib and sunitinib in the Ex11 ITT (hazard ratio [HR] 0.88, 95% CI 0.66, 1.16; P = 0.36; median 8.3 vs 7.0 mos) or in the AP populations (HR 1.05, 95% CI 0.82, 1.33; P = 0.72; median 8.0 vs 8.3 mos). ORR was numerically higher for ripretinib vs sunitinib in the Ex11 ITT (23.9% vs 14.6%; difference 9.3%, 95% CI 0.7, 17.8; nominal P = 0.03) and AP ITT populations (21.7% vs 17.6%; difference 4.2%, 95% CI −3.2, 11.5; nominal P = 0.27). OS data was highly immature; median OS was not reached in either arm. Fewer pts in the ripretinib arm experienced Grade 3-4 (G3-4) treatment-emergent adverse events (TEAEs) vs sunitinib (41.3% vs 65.6%). Among G3-4 TEAEs with a difference ≥5% between arms, ripretinib had fewer events vs sunitinib (hypertension [8.5% vs 26.7%], palmar-plantar erythrodysesthesia [1.3% vs 10.0%], neutropenia [0% vs 6.3%], and neutrophil count decreased [0% vs 7.2%]). Conclusions: The PFS in both arms was longer than PFS achieved by sunitinib in its pivotal phase 3 trial. While the PFS for ripretinib did not meet the primary endpoint of superiority vs sunitinib, meaningful clinical activity and fewer G3-4 TEAEs were observed in pts with advanced GIST treated with ripretinib after imatinib failure. Clinical trial information: NCT03673501.
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Affiliation(s)
- Michael C. Heinrich
- Portland VA Health Care System and OHSU Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Robin Lewis Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Suzanne George
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
| | - Patrick Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - John Raymond Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | - Jonathan C. Trent
- University of Miami-Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, Miami, FL
| | | | | | - Ying Su
- Deciphera Pharmaceuticals, LLC, Waltham, MA
| | | | - Tao Wang
- Deciphera Pharmaceuticals, LLC, Waltham, MA
| | | | | | | | - Sebastian Bauer
- West German Cancer Center, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
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15
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Casali PG, Blay JY, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brodowicz T, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dufresne A, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Miah AB, Mir O, Montemurro M, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss SJ, Hall KS, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Gronchi A, Stacchiotti S. Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:20-33. [PMID: 34560242 DOI: 10.1016/j.annonc.2021.09.005] [Citation(s) in RCA: 179] [Impact Index Per Article: 89.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Oncology and Hemato-oncology University of Milan, Milan, Italy
| | - J Y Blay
- Centre Leon Berard and UCBL1, Lyon, France
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bauer
- Department of Medical Oncology, Interdisciplinary Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - E De Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Padova, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - A Dufresne
- Département d'Oncologie Médicale, Centre Leon Berard, Lyon, France
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - A Fedenko
- P. A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A M Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Gasperoni
- Department of Oncology and Robotic Surgery, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Gouin
- Centre Leon-Berard Lyon, Lyon, France
| | - G Grignani
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - A B Hassan
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | - N Hindi
- Department of Medical Oncology, Fundación Jimenez Diaz, University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - P Hohenberger
- Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - C Jungels
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | - B Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Kopeckova
- University Hospital Motol, Prague, Czech Republic
| | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - F Le Grange
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - E Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - A Lopez-Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin-Broto
- Department of Medical Oncology, Fundación Jimenez Diaz, University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - O Merimsky
- Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - A B Miah
- Department of Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - O Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - M Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - C Morosi
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - E Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria, di Bologna, Bologna, Italy
| | - R Piana
- Azienda Ospedaliero, Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padova, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D Strauss
- Department of Surgery, Royal Marsden Hospital, London, UK
| | - S J Strauss
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - M A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Frebourg
- Department of Genetics, Normandy Center for Genomic and Personalized Medicine, Normandie University, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - S Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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16
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Strauss SJ, Frezza AM, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, de Álava E, Dei Tos AP, Garcia Del Muro X, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Gaspar N, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Gronchi A, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, López Pousa A, Martin-Broto J, Merimsky O, Messiou C, Miah AB, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Ladenstein R, Casali PG, Stacchiotti S. Bone sarcomas: ESMO-EURACAN-GENTURIS-ERN PaedCan Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2021; 32:1520-1536. [PMID: 34500044 DOI: 10.1016/j.annonc.2021.08.1995] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- S J Strauss
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - A M Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bauer
- Department of Medical Oncology, Interdisciplinary Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - J Y Blay
- Centre Leon Berard and UCBL1, Lyon, France
| | - S Bolle
- Radiation Oncology Department, Gustave Roussy, Villejuif, France
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - B Brennan
- Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - E de Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital, CSIC, University of Sevilla, CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | | | - A Dufresne
- Département d'Oncologie Médicale Centre Leon Berard, Lyon, France
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Paediatric Onco-Haematology Department, Regina Margherita Children's Hospital, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Fedenko
- P.A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - N Gaspar
- Department of Oncology for Child and Adolescents, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - S Gasperoni
- Department of Oncology and Robotic Surgery, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Gouin
- Centre Leon-Berard Lyon, Lyon, France
| | - G Grignani
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - A B Hassan
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | | | - N Hindi
- Department of Medical Oncology, Fundación Jimenez Diaz, University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - P Hohenberger
- Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - C Jungels
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital and Children's Cancer Research Institute (CCRI), Department of Pediatrics and Medical University Vienna Children's Cancer Research Institute, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Kopeckova
- University Hospital Motol, Prague, Czech Republic
| | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - F Le Grange
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - E Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - A López Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin-Broto
- Department of Medical Oncology, Fundación Jimenez Diaz, University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - A B Miah
- Department of Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - O Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - M Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Morosi
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - E Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria, di Bologna, Bologna, Italy
| | - R Piana
- Azienda Ospedaliero, Universitaria Cita della Salute e della Scienza di Torino, Turin, Italy
| | | | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D Strauss
- Department of Surgery, Royal Marsden Hospital, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - M A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Frebourg
- Department of Genetics, Normandy Center for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - R Ladenstein
- University Medical Center Groningen, Groningen, The Netherlands
| | - P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Oncology and Hemato-oncology University of Milan, Milan, Italy
| | - S Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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17
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Gronchi A, Miah AB, Dei Tos AP, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Blay JY, Bolle S, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brennan B, Brodowicz T, Buonadonna A, De Álava E, Del Muro XG, Dufresne A, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Frezza AM, Gasperoni S, Gelderblom H, Gouin F, Grignani G, Haas R, Hassan AB, Hecker-Nolting S, Hindi N, Hohenberger P, Joensuu H, Jones RL, Jungels C, Jutte P, Kager L, Kasper B, Kawai A, Kopeckova K, Krákorová DA, Le Cesne A, Le Grange F, Legius E, Leithner A, Lopez-Pousa A, Martin-Broto J, Merimsky O, Messiou C, Mir O, Montemurro M, Morland B, Morosi C, Palmerini E, Pantaleo MA, Piana R, Piperno-Neumann S, Reichardt P, Rutkowski P, Safwat AA, Sangalli C, Sbaraglia M, Scheipl S, Schöffski P, Sleijfer S, Strauss D, Strauss S, Sundby Hall K, Trama A, Unk M, van de Sande MAJ, van der Graaf WTA, van Houdt WJ, Frebourg T, Casali PG, Stacchiotti S. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up ☆. Ann Oncol 2021; 32:1348-1365. [PMID: 34303806 DOI: 10.1016/j.annonc.2021.07.006] [Citation(s) in RCA: 345] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 02/08/2023] Open
Affiliation(s)
- A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - A B Miah
- Department of Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - J Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Bauer
- Department of Medical Oncology, Interdisciplinary Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - J Y Blay
- Centre Leon Berard and UCBL1, Lyon, France
| | - S Bolle
- Radiation Oncology Department, Gustave Roussy, Villejuif, France
| | - S Bonvalot
- Department of Surgery, Institut Curie, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - B Brennan
- Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - A Dufresne
- Département d'Oncologie Médicale, Centre Leon Berard, Lyon, France
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Paediatric Onco-Haematology Department, Regina Margherita Children's Hospital, Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Fedenko
- P. A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A M Frezza
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Gouin
- Centre Leon-Berard Lyon, Lyon, France
| | - G Grignani
- Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - A B Hassan
- Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford, UK
| | | | - N Hindi
- Department of Medical Oncology, Fundación Jimenez Diaz University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - P Hohenberger
- Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Helsinki University Hospital (HUH) and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - C Jungels
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Jutte
- University Medical Center Groningen, Groningen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital, Department of Pediatrics and Medical University Vienna Children's Cancer Research Institute, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim, Germany
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Kopeckova
- University Hospital Motol, Prague, Czech Republic
| | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - F Le Grange
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - E Legius
- Department for Human Genetics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - A Lopez-Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin-Broto
- Department of Medical Oncology, Fundación Jimenez Diaz University Hospital, Advanced Therapies in Sarcoma Lab, Madrid, Spain
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - C Messiou
- Department of Radiology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - O Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - M Montemurro
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - C Morosi
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - E Palmerini
- Department of Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria, di Bologna, Bologna, Italy
| | - R Piana
- Azienda Ospedaliero, Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedale Università Padova, Padua, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - D Strauss
- Department of Surgery, Royal Marsden Hospital, London, UK
| | - S Strauss
- Department of Oncology, University College London Hospitals NHS Foundation Trust (UCLH), London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - M A J van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Houdt
- Department of Surgical Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - T Frebourg
- Department of Genetics, Normandy Center for Genomic and Personalized Medicine, Normandie Univ, UNIROUEN, Inserm U1245 and Rouen University Hospital, Rouen, France
| | - P G Casali
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Oncology and Hemato-oncology University of Milan, Milan, Italy
| | - S Stacchiotti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Younger E, Jones RL, den Hollander D, Soomers VLMN, Desar IME, Benson C, Young RJ, Oosten AW, de Haan JJ, Miah A, Zaidi S, Gelderblom H, Steeghs N, Husson O, van der Graaf WTA. Priorities and preferences of advanced soft tissue sarcoma patients starting palliative chemotherapy: baseline results from the HOLISTIC study. ESMO Open 2021; 6:100258. [PMID: 34509803 PMCID: PMC8441156 DOI: 10.1016/j.esmoop.2021.100258] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Palliative chemotherapy is the principal treatment of patients with advanced soft tissue sarcomas (STS); however prognosis is limited (median overall survival 12-19 months). In this setting, patient values and priorities are central to personalised treatment decisions. PATIENTS AND METHODS The prospective HOLISTIC study was conducted in the UK and the Netherlands assessing health-related quality of life in STS patients receiving palliative chemotherapy. Participants completed a questionnaire before starting chemotherapy, including attitudes towards quality of life (QoL) versus length of life (LoL), decisional control preferences, and decisional conflict. Chi-square and Fisher's exact tests were used to evaluate associations between patient characteristics and preferences. RESULTS One hundred and thirty-seven patients with advanced STS participated (UK: n = 72, the Netherlands: n = 65). Median age was 62 (27-79) years. Preference for extended LoL (n = 66, 48%) was slightly more common than preference for QoL (n = 56, 41%); 12 patients (9%) valued LoL and QoL equally (missing: n = 3). Younger patients (age <40 years) prioritised LoL, whereas two-thirds of older patients (aged ≥65 years) felt that QoL was equally or more important than LoL (P = 0.020). Decisional conflict was most common in patients who prioritised QoL (P = 0.024). Most patients preferred an active (n = 45, 33%) or collaborative (n = 59, 44%) role in treatment decisions. Gender, performance status, and country were significantly associated with preferred role. Concordance between preferred and actual role in chemotherapy decision was high (n = 104, 76%). CONCLUSIONS Heterogeneous priorities and preferences among advanced STS patients support personalised decisions about palliative treatment. Considering individual differences during treatment discussions may enhance communication and optimise patient-centred care.
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Affiliation(s)
- E Younger
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - R L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - D den Hollander
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - V L M N Soomers
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - I M E Desar
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - C Benson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - R J Young
- Academic Unit of Clinical Oncology, The University of Sheffield, Sheffield, UK
| | - A W Oosten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J J de Haan
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - A Miah
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - S Zaidi
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - O Husson
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - W T A van der Graaf
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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19
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Roulleaux Dugage M, Jones RL, Trent J, Champiat S, Dumont S. Beyond the Driver Mutation: Immunotherapies in Gastrointestinal Stromal Tumors. Front Immunol 2021; 12:715727. [PMID: 34489967 PMCID: PMC8417712 DOI: 10.3389/fimmu.2021.715727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are a subtype of soft tissue sarcoma (STS), and have become a concept of oncogenic addiction and targeted therapies.The large majority of these tumors develop after a mutation in KIT or platelet derived growth factor receptor α (PDGFRα), resulting in uncontrolled proliferation. GISTs are highly sensitive to imatinib. GISTs are immune infiltrated tumors with a predominance of tumor-associated macrophages (TAMs) and T-cells, including many CD8+ T-cells, whose numbers are prognostic. The genomic expression profile is that of an inhibited Th1 response and the presence of tertiary lymphoid structures and B cell signatures, which are known as predictive to response to ICI. However, the microtumoral environment has immunosuppressive attributes, with immunosuppressive M2 macrophages, overexpression of indoleamine 2,3-dioxygenase (IDO) or PD-L1, and loss of major histocompatibility complex type 1. In addition to inhibiting the KIT oncogene, imatinib appears to act by promoting cytotoxic T-cell activity, interacting with natural killer cells, and inhibiting the expression of PD-L1. Paradoxically, imatinib also appears to induce M2 polarization of macrophages. There have been few immunotherapy trials with anti-CTLA-4 or anti-PD-L1drugs and available clinical data are not very promising. Based on this comprehensive analysis of TME, we believe three immunotherapeutic strategies must be underlined in GIST. First, patients included in clinical trials must be better selected, based on the identified driver mutation (such as PDGFRα D842V mutation), the presence of tertiary lymphoid structures (TLS) or PD-L1 expression. Moreover, innovative immunotherapeutic agents also provide great interest in GIST, and there is a strong rationale for exploring IDO targeting after disease progression during imatinib therapy. Finally and most importantly, there is a strong rationale to combine of c-kit inhibition with immune checkpoint inhibitors.
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Affiliation(s)
| | - Robin Lewis Jones
- Division of Clinical Studies, Institute of Cancer Research & Sarcoma Unit of the Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jonathan Trent
- Department of Medicine, Division of Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stéphane Champiat
- Département d’Innovation Thérapeutique et des Essais Précoces (DITEP), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Sarah Dumont
- Département d’Oncologie Médicale, Gustave Roussy, Université Paris Saclay, Villejuif, France
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20
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Stacchiotti S, Miah AB, Frezza AM, Messiou C, Morosi C, Caraceni A, Antonescu CR, Bajpai J, Baldini E, Bauer S, Biagini R, Bielack S, Blay JY, Bonvalot S, Boukovinas I, Bovee JVMG, Boye K, Brodowicz T, Callegaro D, De Alava E, Deoras-Sutliff M, Dufresne A, Eriksson M, Errani C, Fedenko A, Ferraresi V, Ferrari A, Fletcher CDM, Garcia Del Muro X, Gelderblom H, Gladdy RA, Gouin F, Grignani G, Gutkovich J, Haas R, Hindi N, Hohenberger P, Huang P, Joensuu H, Jones RL, Jungels C, Kasper B, Kawai A, Le Cesne A, Le Grange F, Leithner A, Leonard H, Lopez Pousa A, Martin Broto J, Merimsky O, Merriam P, Miceli R, Mir O, Molinari M, Montemurro M, Oldani G, Palmerini E, Pantaleo MA, Patel S, Piperno-Neumann S, Raut CP, Ravi V, Razak ARA, Reichardt P, Rubin BP, Rutkowski P, Safwat AA, Sangalli C, Sapisochin G, Sbaraglia M, Scheipl S, Schöffski P, Strauss D, Strauss SJ, Sundby Hall K, Tap WD, Trama A, Tweddle A, van der Graaf WTA, Van De Sande MAJ, Van Houdt W, van Oortmerssen G, Wagner AJ, Wartenberg M, Wood J, Zaffaroni N, Zimmermann C, Casali PG, Dei Tos AP, Gronchi A. Epithelioid hemangioendothelioma, an ultra-rare cancer: a consensus paper from the community of experts. ESMO Open 2021; 6:100170. [PMID: 34090171 PMCID: PMC8182432 DOI: 10.1016/j.esmoop.2021.100170] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
Epithelioid hemangioendothelioma (EHE) is an ultra-rare, translocated, vascular sarcoma. EHE clinical behavior is variable, ranging from that of a low-grade malignancy to that of a high-grade sarcoma and it is marked by a high propensity for systemic involvement. No active systemic agents are currently approved specifically for EHE, which is typically refractory to the antitumor drugs used in sarcomas. The degree of uncertainty in selecting the most appropriate therapy for EHE patients and the lack of guidelines on the clinical management of the disease make the adoption of new treatments inconsistent across the world, resulting in suboptimal outcomes for many EHE patients. To address the shortcoming, a global consensus meeting was organized in December 2020 under the umbrella of the European Society for Medical Oncology (ESMO) involving >80 experts from several disciplines from Europe, North America and Asia, together with a patient representative from the EHE Group, a global, disease-specific patient advocacy group, and Sarcoma Patient EuroNet (SPAEN). The meeting was aimed at defining, by consensus, evidence-based best practices for the optimal approach to primary and metastatic EHE. The consensus achieved during that meeting is the subject of the present publication. This consensus paper provides key recommendations on the management of epithelioid hemangioendothelioma (EHE). Recommendations followed a consensus meeting between experts and a representative of the EHE advocacy group and SPAEN. Authorship includes a multidisciplinary group of experts from different institutions from Europe, North America and Asia.
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Affiliation(s)
- S Stacchiotti
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - A B Miah
- The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - A M Frezza
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Messiou
- Department of Radiology, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - C Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - J Bajpai
- Medical Oncology Department, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - E Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Center/Brigham and Women's Hospital, Boston, USA
| | - S Bauer
- Department of Medical Oncology, West German Cancer Center, Sarcoma Center, University of Duisburg-Essen, University Hospital, Essen, Germany
| | - R Biagini
- Orthopaedic Department, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart - Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Pädiatrische Onkologie, Hämatologie, Immunologie, Stuttgart, Germany
| | - J Y Blay
- Department of Medical Oncology, Centre Leon Berard, Université Claude Bernard Lyon, Unicancer, Lyon, France
| | - S Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, Paris, France
| | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - T Brodowicz
- Medical University Vienna & General Hospital Department of Internal Medicine 1/Oncology, Vienna, Austria
| | - D Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - E De Alava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital/CSIC/University of Sevilla/CIBERONC, Seville, Spain; Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | | | - A Dufresne
- Department of Medical Oncology, Centre Leon Berard, Université Claude Bernard Lyon, Unicancer, Lyon, France
| | - M Eriksson
- Department of Oncology, Skane University Hospital and Lund University, Lund, Sweden
| | - C Errani
- Orthopaedic Service, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Fedenko
- Medical Oncology Division, P.A. Herzen Cancer Research Institute, Moscow, Russian Federation
| | - V Ferraresi
- Sarcomas and Rare Tumors Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C D M Fletcher
- Department of Pathology Brigham & Women's Hospital, Boston, USA
| | - X Garcia Del Muro
- University of Barcelona and Genitourinary Cancer and Sarcoma Unit Institut Català d'Oncologia, Hospitalet, Barcelona, Spain
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - R A Gladdy
- University of Toronto and Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
| | - F Gouin
- Department of Surgery, Centre Leon Berard, Lyon, France
| | - G Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Italy
| | - J Gutkovich
- The EHE Foundation, Wisconsin, USA; NUY Langone Medical Center, New York, USA
| | - R Haas
- Department of Radiotherapy, the Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiotherapy, the Leiden University Medical Center, Leiden, the Netherlands
| | - N Hindi
- Group of Advanced Therapies and Biomarkers in Sarcoma, Institute of Biomedicine of Seville (IBIS, HUVR, CSIC, Universidad de Sevilla), Seville, Spain
| | - P Hohenberger
- Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Heidelberg, Germany
| | - P Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - H Joensuu
- Department of Oncology, Helsinki University Hospital & Helsinki University, Helsinki, Finland
| | - R L Jones
- Department of Cancer, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - C Jungels
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - B Kasper
- University of Heidelberg, Mannheim University Medical Center, Sarcoma Unit, Mannheim, Germany
| | - A Kawai
- Musculoskeletal Oncology and Rehabilitation Medicine, Rare Cancer Center National Cancer Center Hospital, Tokyo, Japan
| | - A Le Cesne
- International Department, Gustave Roussy, Villejuif, France
| | - F Le Grange
- UCLH - University College London Hospitals NHS Foundation Trust, London, UK
| | - A Leithner
- Department of Orthopaedics and Trauma Medical University Graz, Graz, Austria
| | - H Leonard
- Chair of Trustees of the EHE Rare Cancer Charity (UK), Charity number 1162472
| | - A Lopez Pousa
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - J Martin Broto
- Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
| | - O Merimsky
- Unit of Soft Tissue and Bone Oncology, Division of Oncology, Tel-Aviv Medical Center affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Merriam
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - R Miceli
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - O Mir
- Sarcoma Group, Gustave Roussy, Villejuif, France
| | - M Molinari
- University of Pittsburgh Medical Center, Thomas Starzl Transplant Institute, Pittsburgh, USA
| | | | - G Oldani
- Division of Abdominal Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - E Palmerini
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M A Pantaleo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - S Patel
- Sarcoma Center, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | | | - C P Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, USA; Center for Sarcoma and Bone Oncology, Harvard Medical School, Boston, USA; Dana Farber Cancer Center, Harvard Medical School, Boston, USA
| | - V Ravi
- Sarcoma Center, The University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - A R A Razak
- Princess Margaret Cancer Centre and Sinai Healthcare System & Faculty of Medicine, University of Toronto, Toronto, Canada
| | - P Reichardt
- Helios Klinikum Berlin-Buch, Department of Oncology and Palliative Care, Berlin, Germany
| | - B P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, USA
| | - P Rutkowski
- Maria Sklodowska-Curie National Research Institute of Oncology, Department of Soft Tissue/Bone Sarcoma and Melanoma, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Denmark
| | - C Sangalli
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - G Sapisochin
- Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - M Sbaraglia
- Department of Pathology, Azienda Ospedaliera Università Padova, Padua, Italy
| | - S Scheipl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | | | - D Strauss
- Department of Surgery, The Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - S J Strauss
- University College London Hospital, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - W D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - A Trama
- Department of Research, Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A Tweddle
- Palliative Care, The Royal Marsden Hospital and The Institute of Cancer Research London
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M A J Van De Sande
- Department of Orthopedic Surgery Bone and Soft Tissue Tumor Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - W Van Houdt
- Sarcoma and Melanoma Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G van Oortmerssen
- Co-Chair of Sarcoma Patients EuroNet (SPAEN), Woelfersheim, Germany & Chairman of the Dutch organisation for sarcoma patients (Patiëntenplatform Sarcomen), Guest researcher at Leiden University (Leiden Institute for Advanced Computer Science), Leiden University, Leiden, The Netherlands
| | - A J Wagner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Wartenberg
- Chair of the Board of Directors of Sarcoma Patients EuroNet (SPAEN), Sarcoma Patients EuroNet (SPAEN), Woelfersheim, Germany
| | - J Wood
- The Royal Marsden NHS Foundation Trust, London, UK
| | - N Zaffaroni
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - C Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre and Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - P G Casali
- Adult Mesenchymal Tumor and Rare Cancer Unit, Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - A P Dei Tos
- Department of Pathology, Azienda Ospedaliera Università Padova, Padua, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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21
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Attia S, Villalobos VM, Hindi N, Van Tine BA, Wagner AJ, Chmielowski B, Levy DE, Ceccarelli M, Jones RL, Dickson MA. Phase (Ph) 1b/2 evaluation of olaratumab in combination with gemcitabine and docetaxel in advanced soft tissue sarcoma (STS). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11517] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11517 Background: Doxorubicin (doxo) remains standard first-line therapy for advanced STS. Doxo in combination with olaratumab (O) demonstrated superior clinical activity compared to doxo alone in a Ph 2 trial (NCT01185964), although this was not confirmed in the subsequent Ph 3 trial (NCT02451943). Gemcitabine (G) plus docetaxel (D) is a second line therapy for advanced STS. Here, we report a concurrent Ph 2 study that explored a second-line addition of O to G and D for advanced STS (ANNOUNCE 2 NCT02659020). Methods: Adult patients (pts) with unresectable locally advanced or metastatic STS, ≤ 2 prior lines of systemic therapy, and ECOG PS 0-1 were eligible. Pts were enrolled from 2 cohorts: O-naïve and O-pretreated. In both cohorts, pts were randomized 1:1 to either O, G plus D or placebo (PBO), G plus D. Pts received 21-day cycles of O (20 mg/ kg cycle 1 and 15 mg/kg other cycles, day (d) 1 and d8), G (900 mg/m2, d1 and d8) and D (75 mg/m2, d8). Pts continued treatment until progression, toxicity, or withdrawal. Randomization was stratified by histology (leiomyosarcoma [LMS] vs non-LMS), prior systemic therapy, ECOG PS, and prior pelvic radiation. The primary objective was overall survival (OS) in the O-naïve population using an alpha level of 0.20. Secondary endpoints included OS (O-pretreated) and other efficacy parameters, as well as safety and pharmacokinetics (PK). Results: 167 pts were enrolled in the O-naïve cohort and 89 pts in the O-pretreated cohort. Baseline patient characteristics were well balanced. OS for O-naïve pts was 16.8 vs 18.0 months (m) (hazard ratio [HR] = 0.95, 95% CI: 0.64-1.40; p = 0.78) for the investigational vs control arm, respectively. Other efficacy outcomes are presented in the table. Safety was manageable across treatment arms. PK parameter estimates for O were consistent with previous studies. Conclusions: There was no statistically significant difference in OS between the two arms in the O-naïve population. However, while not statistically significant, the combination of O, G and D demonstrated favorable OS in the O-pretreated cohort, and PFS and objective response rate (ORR) in both cohorts. For O-naïve pts, a clinically meaningful progression-free survival (PFS) improvement was observed. Further investigations in specific histological subtypes are ongoing. Clinical trial information: NCT02659020. [Table: see text]
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Affiliation(s)
| | | | - Nadia Hindi
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla and Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | | | - Andrew J. Wagner
- Department of Medical Oncology, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA
| | | | | | | | - Robin Lewis Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
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22
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Chawla SP, Falchook GS, Burgess MA, Chen JL, Jones RL, Chua VS, Tapia C, Ainscough J, Hamlett A, Merchant MS, Chugh R. Results of the phase 1b soft-tissue sarcoma (STS) portion of the global randomized, double-blind, placebo-controlled study of tazemetostat (TAZ) plus doxorubicin (DOX) as frontline therapy for advanced epithelioid sarcoma (ES). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11563] [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
11563 Background: ES is a rare, aggressive subtype of STS for which cytotoxic chemotherapy has limited effectiveness. TAZ, an FDA-approved EZH2 inhibitor, has shown single-agent clinical activity and a favorable safety profile in patients with metastatic or locally advanced ES. In preclinical studies, TAZ has shown synergistic antitumor activity with DOX, which is often used as frontline treatment for STS. Here, we present results of the phase 1b study (NCT04204941), designed to assess the recommended phase 3 dose (RP3D), safety, and efficacy of TAZ + DOX in patients with advanced STS. Methods: The open-label, phase 1b portion of this study enrolled adult patients with previously untreated advanced STS. A standard 3 + 3 design was used to assess TAZ 400 mg, 600 mg, and 800 mg orally twice daily in combination with DOX (75 mg/m2 intravenously on day 1 of each cycle, for up to 6 cycles) as frontline therapy. Dose-limiting toxicities (DLTs) were predefined in the protocol. The RP3D of TAZ was determined by Scientific Review Committee review of the safety and pharmacokinetic data from the phase 1b trial, with a target DLT rate of < 33%. Results: As of February 1, 2021, 16 patients are enrolled, including 2 with ES; 10 are still receiving TAZ + DOX and 6 have discontinued (5 due to disease progression, 1 due to patient withdrawal). The median age was 49.5 years (range, 2982) and all had unresectable STS. Median (range) time on treatment was 13 (0.151.1+) weeks across all dose levels evaluated. Two DLTs, both of febrile neutropenia, were observed, one in the TAZ 600 mg + DOX cohort (n = 1/6, 17%), and one in the TAZ 800 mg + DOX cohort (n = 1/3, 33%). When used in combination with DOX, the RP3D of TAZ was 800 mg. Grade 3 or 4 treatment-related treatment-emergent adverse events (TR-TEAEs) occurred in 13/16 (81.3%) patients. The most common (≥ 20%) TR-TEAEs were neutropenia (n = 11, 69%), anemia (n = 10, 63%), fatigue (n = 10, 63%), stomatitis (n = 9, 56%), nausea (n = 8, 50%), febrile neutropenia (n = 7, 44%), constipation (n = 6, 38%), vomiting (n = 6, 38%), and decreased appetite (n = 5, 31%). TR-TEAEs were defined as attributable to either study agent. Conclusions: The combination of TAZ + DOX was generally well tolerated in this dose finding study in patients with advanced STS. The RP3D to be tested in the phase 3 randomized, double blind, placebo controlled study is TAZ 800 mg twice daily + DOX. The safety profile of this combination is consistent with the respective safety information for TAZ and for DOX. The TR-TEAEs include known toxicities of DOX or TAZ. Further comparison with DOX + placebo in the phase 3 trial will aid in assessing efficacy and safety of the combination of TAZ + DOX. The global phase 3 confirmatory trial will enroll patients with ES who have unresectable disease and have had no prior systemic therapy. Clinical trial information: NCT04204941.
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Affiliation(s)
| | | | | | - James Lin Chen
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Robin Lewis Jones
- The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Victoria S. Chua
- Sarcoma Oncology Research Center, Cancer Center of Southern California, Santa Monica, CA
| | | | | | | | | | - Rashmi Chugh
- University of Michigan, Michigan Medicine, Ann Arbor, MI
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23
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Zalcberg JR, Heinrich MC, George S, Bauer S, Schoffski P, Serrano C, Jones RL, Gelderblom H, Attia S, D'Amato GZ, Chi P, Reichardt P, Somaiah N, Meade JN, REICHERT VIENNAL, Shi K, Sherman ML, Ruiz-Soto R, von Mehren M, Blay JY. Intra-patient dose escalation (IPDE) of ripretinib after disease progression in patients with advanced gastrointestinal stromal tumor (GIST): Analyses from the phase 3 INVICTUS study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11536] [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
11536 Background: Ripretinib is a switch-control tyrosine kinase inhibitor that broadly inhibits KIT and PDGFRA kinase signaling. In the INVICTUS study (NCT03353753), patients with advanced GIST (≥4th-line) receiving ripretinib had a median progression-free survival (mPFS) of 6.3 months vs 1.0 month for patients receiving placebo (HR = 0.15, p <0.0001). In an earlier phase 1 dose escalation study, the maximum tolerated dose was not reached with doses up to 200 mg twice daily (BID). Here, we report efficacy, safety, and pharmacokinetic data for IPDE patients initially randomized to ripretinib from the phase 3 INVICTUS study based on data as of 10 Aug 2020. Methods: A total of 129 patients were randomized 2:1 to ripretinib 150 mg once daily (QD; n = 85) or placebo (n = 44). Patients receiving ripretinib 150 mg QD who had progressive disease (PD) as assessed by blinded independent central review (BICR) using mRECIST were given the option for IPDE to 150 mg BID. Tumor response assessments were performed every 28 days for 4 cycles and every 56 days thereafter (including after IPDE). The primary endpoint was PFS. For this exploratory analysis, PFS1 for IPDE patients was defined as the time from randomization to PD; PFS2 for IPDE patients was the time from the first dose of ripretinib 150 mg BID to PD or death. PFS1 and PFS2 were based on BICR. Results: Of 85 patients treated with ripretinib 150 mg QD, 43 patients with BICR PD dose escalated to 150 mg BID. Baseline characteristics of IPDE patients at time of study entry were similar to those observed in the original ripretinib QD arm and similar to the 22 patients with BICR PD who either remained on 150 mg QD or discontinued treatment. IPDE patients had a mPFS1 of 4.6 months (95% CI, 2.7–6.4) and a mPFS2 of 3.7 months (95% CI, 3.1–5.3); mPFS2/mPFS1=80%. The IPDE dosing period was well tolerated without the emergence of new safety concerns. The most common new or worsening (unchanged or improving grades not included) treatment-emergent adverse event (TEAE) for IPDE patients during the BID period was abdominal pain (30.2% all grades and 7% Grade 3–4 vs 41.9% and 4.7% in QD period, respectively). The most common Grade 3–4 TEAE in the BID period was anemia (14% vs 2.3% in QD period). IPDE from QD to BID resulted in an approximately 2-fold increase in the steady state trough concentration. Conclusions: Similar to the phase 1 study wherein IPDE to 150 mg BID following PD provided clinical benefit with a mPFS1 of 5.5 months and mPFS2 of 4.6 months (mPFS2/mPFS1=84%) for patients with ≥4th-line GIST, these analyses from INVICTUS indicate that IPDE to ripretinib 150 mg BID can also provide additional meaningful clinical benefit and a similar tolerability profile to the 150 mg QD regimen for patients with ≥4th-line GIST that progressed following treatment with ripretinib 150 mg QD. Clinical trial information: NCT03353753.
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Affiliation(s)
| | | | | | | | | | - Cesar Serrano
- Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Robin Lewis Jones
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | | | | | - Gina Z. D'Amato
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
| | - Ping Chi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter Reichardt
- Sarcoma Center, Helios Klinikum Berlin Buch, Berlin, Germany
| | - Neeta Somaiah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Kelvin Shi
- Deciphera Pharmaceuticals, LLC, Waltham, MA
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Heseltine T, Murray SW, Jones RL, Fisher M, Ruzsics B. A comprehensive, contemporary assessment of the association between hepatosteatosis and coronary artery calcium scoring. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.234] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
onbehalf
Liverpool Multiparametric Imaging Collaboration
Background
Coronary artery calcium (CAC) score is a well-established technique for stratifying an individual’s cardiovascular disease (CVD) risk. Several well-established registries have incorporated CAC scoring into CVD risk prediction models to enhance accuracy. Hepatosteatosis (HS) has been shown to be an independent predictor of CVD events and can be measured on non-contrast computed tomography (CT). We sought to undertake a contemporary, comprehensive assessment of the influence of HS on CAC score alongside traditional CVD risk factors. In patients with HS it may be beneficial to offer routine CAC screening to evaluate CVD risk to enhance opportunities for earlier primary prevention strategies.
Methods
We performed a retrospective, observational analysis at a high-volume cardiac CT centre analysing consecutive CT coronary angiography (CTCA) studies. All patients referred for investigation of chest pain over a 28-month period (June 2014 to November 2016) were included. Patients with established CVD were excluded. The cardiac findings were reported by a cardiologist and retrospectively analysed by two independent radiologists for the presence of HS. Those with CAC of zero and those with CAC greater than zero were compared for demographic and cardiac risks. A multivariate analysis comparing the risk factors was performed to adjust for the presence of established risk factors. A binomial logistic regression model was developed to assess the association between the presence of HS and increasing strata of CAC.
Results
In total there were 1499 patients referred for CTCA without prior evidence of CVD. The assessment of HS was completed in 1195 (79.7%) and CAC score was performed in 1103 (92.3%). There were 466 with CVD and 637 without CVD. The prevalence of HS was significantly higher in those with CVD versus those without CVD on CTCA (51.3% versus 39.9%, p = 0.007). Male sex (50.7% versus 36.1% p= <0.001), age (59.4 ± 13.7 versus 48.1 ± 13.6, p= <0.001) and diabetes (12.4% versus 6.9%, p = 0.04) were also significantly higher in the CAC group compared to the CAC score of zero.
HS was associated with increasing strata of CAC score compared with CAC of zero (CAC score 1-100 OR1.47, p = 0.01, CAC score 101-400 OR:1.68, p = 0.02, CAC score >400 OR 1.42, p = 0.14). This association became non-significant in the highest strata of CAC score.
Conclusion
We found a significant association between the increasing age, male sex, diabetes and HS with the presence of CAC. HS was also associated with a more severe phenotype of CVD based on the multinomial logistic regression model. Although the association reduced for the highest strata of CAC (CAC score >400) this likely reflects the overall low numbers of patients within this group and is likely a type II error.
Based on these findings it may be appropriate to offer routine CVD risk stratification techniques in all those diagnosed with HS.
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Affiliation(s)
- T Heseltine
- The Royal Liverpool University Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - SW Murray
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - RL Jones
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Fisher
- Royal Liverpool University Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - B Ruzsics
- Royal Liverpool University Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
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25
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Demetri GD, Antonescu CR, Bjerkehagen B, Bovée JVMG, Boye K, Chacón M, Dei Tos AP, Desai J, Fletcher JA, Gelderblom H, George S, Gronchi A, Haas RL, Hindi N, Hohenberger P, Joensuu H, Jones RL, Judson I, Kang YK, Kawai A, Lazar AJ, Le Cesne A, Maestro R, Maki RG, Martín J, Patel S, Penault-Llorca F, Premanand Raut C, Rutkowski P, Safwat A, Sbaraglia M, Schaefer IM, Shen L, Serrano C, Schöffski P, Stacchiotti S, Sundby Hall K, Tap WD, Thomas DM, Trent J, Valverde C, van der Graaf WTA, von Mehren M, Wagner A, Wardelmann E, Naito Y, Zalcberg J, Blay JY. Diagnosis and management of tropomyosin receptor kinase (TRK) fusion sarcomas: expert recommendations from the World Sarcoma Network. Ann Oncol 2020; 31:1506-1517. [PMID: 32891793 PMCID: PMC7985805 DOI: 10.1016/j.annonc.2020.08.2232] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/22/2022] Open
Abstract
Sarcomas are a heterogeneous group of malignancies with mesenchymal lineage differentiation. The discovery of neurotrophic tyrosine receptor kinase (NTRK) gene fusions as tissue-agnostic oncogenic drivers has led to new personalized therapies for a subset of patients with sarcoma in the form of tropomyosin receptor kinase (TRK) inhibitors. NTRK gene rearrangements and fusion transcripts can be detected with different molecular pathology techniques, while TRK protein expression can be demonstrated with immunohistochemistry. The rarity and diagnostic complexity of NTRK gene fusions raise a number of questions and challenges for clinicians. To address these challenges, the World Sarcoma Network convened two meetings of expert adult oncologists and pathologists and subsequently developed this article to provide practical guidance on the management of patients with sarcoma harboring NTRK gene fusions. We propose a diagnostic strategy that considers disease stage and histologic and molecular subtypes to facilitate routine testing for TRK expression and subsequent testing for NTRK gene fusions.
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Affiliation(s)
- G D Demetri
- Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, USA
| | - C R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - B Bjerkehagen
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - J V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - M Chacón
- Oncology Service Chair, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - A P Dei Tos
- Department of Pathology, University of Padua, Padova, Italy
| | - J Desai
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - J A Fletcher
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - S George
- Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Hindi
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Sevilla, Spain; Medical Oncology Department, University Hospital Virgen del Rocio, Sevilla, Spain
| | - P Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - I Judson
- Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Y-K Kang
- Department of Oncology, University of Ulsan College of Medicine, Seoul, Korea
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center, Tokyo, Japan
| | - A J Lazar
- Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Le Cesne
- Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France
| | - R Maestro
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO Aviano) IRCCS, National Cancer Institute, Aviano, Italy
| | - R G Maki
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - J Martín
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Sevilla, Spain; Medical Oncology Department, University Hospital Virgen del Rocio, Sevilla, Spain
| | - S Patel
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - C Premanand Raut
- Division of Surgical Oncology, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - M Sbaraglia
- Department of Pathology, University of Padua, Padova, Italy
| | - I-M Schaefer
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - L Shen
- Department of GI Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - C Serrano
- Sarcoma Translational Research Program, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Stacchiotti
- Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - K Sundby Hall
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - W D Tap
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - D M Thomas
- The Kinghorn Cancer Centre and Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - J Trent
- Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine, Miami, USA
| | - C Valverde
- Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M von Mehren
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - A Wagner
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - E Wardelmann
- Gerhard Domagk Institute of Pathology, University of Münster, Münster, Germany
| | - Y Naito
- National Cancer Center Hospital East, Kashiwa, Japan
| | - J Zalcberg
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Medical Oncology, Alfred Health, Melbourne, Australia
| | - J-Y Blay
- Centre Léon Bérard, Unicancer, LYRICAN and Université Claude Bernard Lyon 1, Lyon, France.
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Baldi GG, Brahmi M, Lo Vullo S, Cojocaru E, Mir O, Casanova M, Vincenzi B, De Pas TM, Grignani G, Pantaleo MA, Blay JY, Jones RL, Le Cesne A, Frezza AM, Gronchi A, Collini P, Dei Tos AP, Morosi C, Mariani L, Casali PG, Stacchiotti S. The Activity of Chemotherapy in Inflammatory Myofibroblastic Tumors: A Multicenter, European Retrospective Case Series Analysis. Oncologist 2020; 25:e1777-e1784. [PMID: 32584482 DOI: 10.1634/theoncologist.2020-0352] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aimed to review the activity of cytotoxic chemotherapy in patients with inflammatory myofibroblastic tumors (IMTs) treated at nine European sarcoma reference centers. MATERIALS AND METHODS Patients of any age, with histologically proven IMT, treated with anthracycline-based methotrexate plus/minus vinorelbine/vinblastine (MTX-V) or other chemotherapeutic regimens between 1996 and 2018 were retrospectively reviewed. Diagnosis was confirmed at the local level by an expert pathologist. Response was retrospectively assessed by local investigators by RECIST v1.1. Progression-free survival (PFS), relapse-free survival (RFS), and overall survival (OS) were computed by Kaplan-Meier method. RESULTS Thirty-eight patients were included. Twenty-five patients (8 localized, 17 advanced disease) received an anthracycline-based regimen; 21 were evaluable for response. Overall response rate (ORR) was 10/21 (47.6%). At a 70.8-month median follow-up (FU), median RFS and median OS were not reached (NR) in patients with localized disease; median PFS and median OS were 6.3 (interquartile range [IQR]: 1.9-13.4) and 21.2 (IQR: 7.7-40.7) months in patients with advanced disease. Thirteen patients received MTX-V (4 localized, 9 advanced disease), all evaluable for response. ORR was 7/13 (53.8%). At a 56.6-month median FU, median RFS and median OS were 42.5 (IQR: 12.9-61.2) months and NR (no death events) in patients with localized disease, and NR (IQR: 24.9 to NR) and 83.4 months (IQR: 83.4 to NR) in patients with advanced disease. In the "other-regimens group," responses were seen in 3/4 patients treated with oral cyclophosphamide and 1/2 with docetaxel/gemcitabine. CONCLUSION Anthracycline-based and MTX-V regimens are very effective in IMT, with a similar ORR in both groups. MTX-V achieved a prolonged disease control. Responses were also seen with oral cyclophosphamide and docetaxel/gemcitabine, but few patients were treated with these schedules. IMPLICATIONS FOR PRACTICE Inflammatory myofibroblastic tumor (IMT) is an ultrarare sarcoma with known sensitivity to anaplastic lymphoma kinase (ALK) inhibitors in ALK-fused cases, although ALK inhibitors are not licensed in the disease. The current knowledge on the activity of cytotoxic chemotherapy is limited. This multi-institutional retrospective study on pediatric and adult patients with IMT shows that cytotoxic chemotherapy, and in particular anthracycline-based and methotrexate plus/minus vinorelbine/vinblastine regimens, represents a treatment option and can be considered in IMT patients irrespectively from ALK status. This study provides a benchmark for future studies on new medical therapies.
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Affiliation(s)
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Cojocaru
- Sarcoma Unit, Royal Marsden NHS Foundation Trust/ Institute of Cancer Research, Chelsea, London, United Kingdom
| | - Olivier Mir
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bruno Vincenzi
- Department of Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Tommaso Martino De Pas
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Maria Abbondanza Pantaleo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Jean Yves Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - Robin Lewis Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust/ Institute of Cancer Research, Chelsea, London, United Kingdom
| | - Axel Le Cesne
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Anna Maria Frezza
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Soft Tissue and Bone Pathology, Histopathology and Paediatric Pathology Unit, Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Giovanni Casali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Jones RL, Herzog TJ, Patel S, von Mehren M, Schuetze S, Van Tine BA, Coleman RL, Triantos S, Hu P, Shalaby W, McGowan T, Monk BJ, Demetri GD. Cardiac safety of trabectedin monotherapy and in combination with pegylated liposomal doxorubicin in patients with sarcomas and ovarian cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11547] [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
11547 Background: Trabectedin (T) is an established option as monotherapy for advanced soft tissue sarcomas (STS; Leiomyosarcomas and Liposarcomas in the USA) and in combination with pegylated liposomal doxorubicin (PLD) for recurrent ovarian cancer (ROC). This retrospective analysis evaluated the cardiac safety profile in over 1500 patients (pts) from clinical trials administering T monotherapy for STS or in combination with PLD (T+PLD) for ROC. Methods: Integrated cardiac safety data was analyzed from ten Phase 2 trials and one Phase 3 trial in STS (T) and two Phase 3 ROC trials (T+PLD). Cardiac-related treatment-emergent adverse events (TEAEs) were summarized using MedDRA terminology and by Kaplan-Meier analysis for time-to-event variables. Subgroup analyses were performed for cardiac-related TEAEs, including any significant decrease in LVEF. Results: Integrated data on T monotherapy included 982 pts (Table). Of these, 110 (11.2%) pts who received ≥1 dose of T experienced a cardiac-related TEAE, including tachycardia (3.1%), palpitations (1.5%), LVEF decrease (1.3%), sinus tachycardia (1.0%), and/or congestive cardiac failure (1.0%). A multivariate analysis revealed factors associated with increased risk to be cardiovascular medical history (risk ratio [RR]: 1.90; 95% CI: 1.24-2.91; p = 0.003) and age > 65 years (RR: 1.78; 95% CI: 1.12,2.83; p = 0.014). Cardiac-related TEAEs were reported in 78 (12.6%) of 619 pts receiving T+PLD (Table). Incidence of cardiac-related TEAEs was greater with T+PLD compared with PLD monotherapy (12.6% vs 5.6%). A multivariate analysis showed that pts were at increased risk for experiencing cardiac-related TEAEs when treated with T+PLD compared to PLD monotherapy (RR: 2.70; 95% CI: 1.75,4.17; p < 0.0001) and when there was a history of prior cardiac medication (RR: 1.88; 95% CI: 1.16,3.05; p = 0.010). Conclusions: Although infrequent, patients receiving T after prior anthracyclines or in combination with PLD are at risk for cardiac dysfunction, and appropriate clinical awareness and monitoring is encouraged to optimize patient outcomes. [Table: see text]
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Affiliation(s)
- Robin Lewis Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
| | - Thomas J. Herzog
- University of Cincinnati, University of Cincinnati Cancer Institute, Cincinnati, OH
| | | | | | | | | | | | | | - Peter Hu
- Janssen Research & Development, LLC, Raritan, NJ
| | | | | | - Bradley J. Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Phoenix, AZ
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28
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Vincenzi B, Napolitano A, Nannini M, Fumagalli E, Grignani G, Martin Broto J, Hindi N, Italiano A, Rutkowski P, Hohenberger P, Brunello A, Gasperoni S, Joensuu H, Badalamenti G, Gennatas S, De Pas TM, Gronchi A, Dei Tos AP, Jones RL, Bauer S. Role of adjuvant imatinib dose in radically resected GIST harboring KIT exon 9 mutations. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11533] [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
11533 Background: Gastrointestinal stromal tumors (GIST) with a driver mutation in KIT exon 9 (Ex9) represent about 10% of all newly diagnosed cases. In the metastatic setting, Ex9-mutated GIST patients benefit from higher doses of imatinib (800 mg/day vs standard 400 mg/day). The additional therapeutic benefit from a higher dose of imatinib in the adjuvant setting in this molecular subgroup has not been confirmed. Methods: We retrospectively identified 105 patients (pts) with resected Ex9-mutated GIST treated with adjuvant imatinib (800 mg/day or 400 mg/day) in 15 different European centers. Disease-Free Survival (DFS) and Imatinib Failure-Free Survival (IFFS) were calculated and analyzed according to the daily dose of imatinib and relevant clinical and pathological variables. Kaplan–Meier curves were used to estimate survival in univariate analyses, and the log-rank test was used to compare the groups. Hazard Ratios (HR) with 95% confidence intervals (CI) were calculated using a univariable Cox model. A multivariate Cox regression model was also performed. Results: Of the 105 pts who met the inclusion criteria, 69 (65.7%) were treated with 400 mg/day and 36 (34.3%) with 800 mg/day. The risk score (AFIP-Miettinen criteria) between the two dose groups was not statistically different (P = 0.29). Median DFS was 73.0 months (mo) in the 400 mg/day group and 61.9 mo in the 800 mg/day group (HR = 0.82, 95% CI: 0.47-1.47; P = 0.50). Median IFFS was 156.8 mo in the 400/day mg group and 117.4 mo in the 800 mg/day group (HR = 0.66, 95% CI: 0.34-1.29; P = 0.19). In a multivariable analysis, the variables statistically associated with DFS were mitotic count, the longest tumor diameter and the duration of adjuvant therapy. Mitotic count and the duration of adjuvant therapy were also associated with IFFS. Importantly, the daily imatinib dose was not associated with survival in either analysis (Table). Conclusions: This is the largest reported cohort of pts with Ex9-mutated GIST treated with either the 400 mg/day or the 800 mg/day dose of adjuvant imatinib. Although retrospective in nature, the data confirm the prognostic value of mitotic count and suggest that patients with Ex9-mutated GIST derive no additional survival benefit from the 800 mg/day dose. [Table: see text]
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Affiliation(s)
- Bruno Vincenzi
- Policlinico Universitario Campus, Bio-Medico, Rome, Italy
| | - Andrea Napolitano
- Department of Medical Oncology, Campus Bio-Medico of Rome University, Rome, Italy
| | | | - Elena Fumagalli
- Adult mesenchymal tumour & Rare cancer Medical Oncology Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - Nadia Hindi
- Institute of Biomedicine Research (IBIS)-Universitary Hospital Virgen del Rocio/CSIC/Universidad de Sevilla, Seville, Spain
| | | | - Piotr Rutkowski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Centre, University of Heidelberg, Mannheim, Germany
| | - Antonella Brunello
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Heikki Joensuu
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological, and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Spyridon Gennatas
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Tommaso Martino De Pas
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Robin Lewis Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
| | - Sebastian Bauer
- West German Cancer Center, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
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29
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Palmerini E, Pasello M, Jones RL, Manara MC, Fagioli F, Grignani G, Longhi A, Cesari M, Abate ME, Paioli A, Setola E, Hakim R, D'Ambrosio L, Parra A, Sebastian AD, Righi A, Morandi L, Donati DM, Ferrari S, Scotlandi K. Irinotecan and temozolomide upfront and in relapsed Ewing sarcoma: A translational study on MGMT (O6-methylguanine–DNA methyltransferase) and ABCG2 (MGMTLiberati). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e23564] [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
e23564 Background: Activity of temozolomide (TEM) and irinotecan (IRI) in recurrent Ewing sarcoma (EWS) was demonstrated. Few data are available on TEMIRI use upfront. Biological predictive factors are lacking. Methods: This multi-institutional retrospective study (NCT03542097) included 59 patients with EWS. 8 patients with very high risk (HR) EWS (multivisceral ± bone marrow) received TEMIRI (TEM 100 mg/m2/day oral, and IRI 40 mg/m2/day intravenous, days 1-5, every 21 days) upfront, 51 patients after relapse (28% in 1st line, 72% ≥ 2nd line). Overall response rate (ORR: CR+PR), SD, and PD, progression-free (PFS) and overall survival (OS) were assessed. The relationship between pre-treatment expression of MGMT and ABCG2 (when FFPE tissue available) with ORR, PFS and OS was evaluated. Results: Median age was 27 years (range 4-62 years): 47 patients (80%) were adults (≥18 years), 35 (61%) had ECOG 0 and 42 (71%) presented with multivisceral disease (+ bone marrow in 5). MGMT was positive in 16/30 (53%), ABCG2 in 4/33 (12%). ORR for upfront TEMIRI (n = 8) was 50% (CR + PR = 1 + 3), with SD 50%, while in recurrent EWS (n = 49, 2 patients no measurable by RECIST) ORR was 31% (CR + PR = 4 + 11), SD 38%, and PD 31%. A better ORR was observed in adult (p = 0.008) & ECOG 0 (p = 0.001) patients; MGMT & ABCG2 expression did not influence ORR. 6-mos PFS was 87% after TEMIRI upfront, 43% at recurrence (p = 0.06), and 65% vs 28% (p = 0.02) for ECOG 0 vs ECOG 1-2, respectively. 6-mos PFS was 62% in MGMT+ vs 33% in MGMT- (p = 0.4) and 75% in ABCG2+ vs 50% in ABCG2- (p = 0.7). Median time to progression (TTP) with upfront TEMIRI was 9 months (range 5-28 months), with 1 patient with ongoing CR at 56 months; median TTP at relapse was 3 months (1-29 months). MGMT and ABCG2 expression did not influence 1-yr OS, whereas ECOG (0 vs 1-2) did (88% vs 31% p < 0.001). Grade 3-4 diarrhea, neutropenia, and thrombocytopenia incidence was < 5%, 1 patient with recurrent kidney EWS died of acute liver failure. Conclusions: TEMIRI showed promising activity in a very unfavorable cohort of EWS patients, with manageable toxicity. Performance status correlated with 6-month PFS & OS whereas MGMT & ABCG2 did not. Clinical trial information: NCT03542097 .
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Affiliation(s)
| | | | - Robin Lewis Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
| | | | - Franca Fagioli
- Pediatric Onco-Hematology, A.O.U Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni Grignani
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | - Alessandra Longhi
- Chemotherapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Massimo Eraldo Abate
- Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, Napoli, Italy
| | - Anna Paioli
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | - Lorenzo D'Ambrosio
- Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo (TO), Italy
| | | | - Asaftei Dorin Sebastian
- Pediatric Onco-Hematology, A.O.U Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Luca Morandi
- Department of Biomedical and Neuromotor Sciences, Functional MR Unit, IRCCS Istituto delle Scienze Neurologiche, University of Bologna, Bologna, Italy
| | - Davide Maria Donati
- Third Orthopedic Clinic and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Jones RL, Macarulla T, Charlson JA, Van Tine BA, Goyal L, Italiano A, Massard C, Rosenthal M, De La Fuente MI, Roxburgh P, Kundranda MN, Blay JY, Yoo C, Lipford K, Forsyth S, Guichard SM, Mikhailov Y, Thomson B, Kelly PF, Duffaud F. A phase Ib/II study of olutasidenib in patients with relapsed/refractory IDH1 mutant solid tumors: Safety and efficacy as single agent. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16643] [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
e16643 Background: Isocitrate dehydrogenase 1 mutations (mIDH1) are present in a variety of solid tumors resulting in production and accumulation of (R)-2-hydroxyglutarate causing DNA hypermethylation and promoting tumorigenesis. Olutasidenib is an oral, potent and selective inhibitor of mutated IDH1 protein. We report preliminary results from the ongoing, first-in-human, Phase 1, open-label, single-arm study of olutasidenib in non-CNS solid tumors. Methods: Patients with advanced relapsed/refractory (R/R) mIDH1 solid tumors received olutasidenib 150 mg BID, orally. Following a dose confirmation cohort (Phase 1b), patients with intrahepatic cholangiocarcinoma (IHCC), chondrosarcoma (CS), or unspecified mIDH1 solid tumors (Other) were enrolled in a Phase 2 efficacy evaluation (NCT: 03684811). Results: As of 31-Oct-2019, 44 patients with relapsed or refractory mIDH1 solid tumors were treated with olutasidenib. Diagnosis included: IHCC (n = 26), CS (n = 13), and Other (n = 5). The median age was 58 years (range: 29-81) and 43% were male. Median number of prior treatments was 2 (1-10). mIDH1 status was locally determined (IHC, NGS or PCR): R132C (61%), R132G (7%), R132S (7%), R132H (2%), R132L (2%), Others (2%) & unspecified (18%). Fourteen patients discontinued treatment (disease progression [n = 6; 3 IHCC, 2 CS, 1 Other], AE [n = 4; 3 IHCC, 1 CS], PI decision [n = 3; IHCC] & withdraw consent [n = 1; IHCC]). Treatment emergent adverse events (all grades, regardless of attribution) that occurred in > 15% of pts were: nausea (43%), fatigue (25%), decreased appetite (22%), AST increase (18%), ALT increase (16%), and constipation (16%). No protocol-defined DLTs occurred. Best responses by tumor type are shown in the table. Conclusions: Single agent olutasidenib at 150 mg BID demonstrates acceptable safety and tolerability with preliminary clinical activity in patients with R/R mIDH1 solid tumors. Updated safety and clinical activity, as well as exploratory evaluations of PK/PD will be provided. Clinical trial information: 03684811 . [Table: see text]
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Affiliation(s)
- Robin Lewis Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | | | | | | | - Patricia Roxburgh
- The Beatson West of Scotland Cancer Centre/University of Glasgow, Glasgow, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Florence Duffaud
- CLIP2 CEPCM la Timone University Hospital and Aix-Marseille University (AMU), Marseille, France
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31
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Jones RL, Demetri GD, Schuetze SM, Milhem M, Elias A, Van Tine BA, Hamm J, McCarthy S, Wang G, Parekh T, Knoblauch R, Hensley ML, Maki RG, Patel S, von Mehren M. Efficacy and tolerability of trabectedin in elderly patients with sarcoma: subgroup analysis from a phase III, randomized controlled study of trabectedin or dacarbazine in patients with advanced liposarcoma or leiomyosarcoma. Ann Oncol 2019; 29:1995-2002. [PMID: 30084934 DOI: 10.1093/annonc/mdy253] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Treatment options for soft tissue sarcoma (STS) patients aged ≥65 years (elderly) can be limited by concerns regarding the increased risk of toxicity associated with standard systemic therapies. Trabectedin has demonstrated improved disease control in a phase III trial (ET743-SAR-3007) of patients with advanced liposarcoma or leiomyosarcoma after failure of anthracycline-based chemotherapy. Since previous retrospective analyses have suggested that trabectedin has similar safety and efficacy outcomes regardless of patient age, we carried out a subgroup analysis of the safety and efficacy observed in elderly patients enrolled in this trial. Patients and methods Patients were randomized 2 : 1 to trabectedin (n = 384) or dacarbazine (n = 193) administered intravenously every-3-weeks. The primary end point was overall survival (OS); secondary end points were progression-free survival (PFS), time-to-progression, objective response rate (ORR), duration of response, symptom severity, and safety. A post hoc analysis was conducted in the elderly patient subgroup. Results Among 131 (trabectedin = 94; dacarbazine = 37) elderly patients, disease characteristics were well-balanced and consistent with those of the total study population. Treatment exposure was longer in patients treated with trabectedin versus dacarbazine (median four versus two cycles, respectively), with a significantly higher proportion receiving prolonged therapy (≥6 cycles) in the trabectedin arm (43% versus 23%, respectively; P = 0.04). Elderly patients treated with trabectedin showed significantly improved PFS [4.9 versus 1.5 months, respectively; hazard ratio (HR)=0.40; P = 0.0002] but no statistically significant improvement in OS (15.1 versus 8.0 months, respectively; HR = 0.72; P = 0.18) or ORR (9% versus 3%, respectively; P = 0.43). The safety profile for elderly trabectedin-treated patients was comparable to that of the overall trabectedin-treated study population. Conclusions This subgroup analysis of the elderly population of ET743-SAR-3007 suggests that elderly patients with STS and good performance status can expect clinical benefit from trabectedin similar to that observed in younger patients. Trial registration www.clinicaltrials.gov, NCT01343277.
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Affiliation(s)
- R L Jones
- Seattle Cancer Care Alliance, Seattle
| | - G D Demetri
- Center for Sarcoma and Bone Oncology, Dana Farber Cancer Institute, Ludwig Center at Harvard, Boston
| | | | - M Milhem
- University of Iowa Hospitals and Clinics, Iowa City
| | - A Elias
- University of Colorado Cancer Center, Aurora
| | - B A Van Tine
- Division of Oncology, Washington University in St. Louis, St. Louis
| | - J Hamm
- Norton Cancer Institute, Louisville
| | - S McCarthy
- Clinical Oncology, Janssen Research and Development, Raritan
| | - G Wang
- Clinical Biostatistics, Janssen Research and Development, Raritan
| | - T Parekh
- Clinical Oncology, Janssen Research and Development, Raritan
| | - R Knoblauch
- Clinical Oncology, Janssen Research and Development, Raritan
| | - M L Hensley
- Memorial Sloan Kettering Cancer Center, New York
| | - R G Maki
- Monter Cancer Center, Northwell Health, Lake Success; Cold Spring Harbor Laboratory, Cold Spring Harbor
| | - S Patel
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, University of Texas M.D. Anderson Cancer Center, Houston
| | - M von Mehren
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA.
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32
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Lee ATJ, Chew W, Wilding CP, Guljar N, Smith MJ, Strauss DC, Fisher C, Hayes AJ, Judson I, Thway K, Jones RL, Huang PH. The adequacy of tissue microarrays in the assessment of inter- and intra-tumoural heterogeneity of infiltrating lymphocyte burden in leiomyosarcoma. Sci Rep 2019; 9:14602. [PMID: 31601875 PMCID: PMC6787212 DOI: 10.1038/s41598-019-50888-5] [Citation(s) in RCA: 20] [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: 09/06/2018] [Accepted: 09/23/2019] [Indexed: 12/28/2022] Open
Abstract
The characterisation and clinical relevance of tumour-infiltrating lymphocytes (TILs) in leiomyosarcoma (LMS), a subtype of soft tissue sarcoma that exhibits histological heterogeneity, is not established. The use of tissue microarrays (TMA) in studies that profile TIL burden is attractive but given the potential for intra-tumoural heterogeneity to introduce sampling errors, the adequacy of this approach is undetermined. In this study, we assessed the histological inter- and intra-tumoural heterogeneity in TIL burden within a retrospective cohort of primary LMS specimens. Using a virtual TMA approach, we also analysed the optimal number of TMA cores required to provide an accurate representation of TIL burden in a full tissue section. We establish that LMS have generally low and spatially homogenous TIL burdens, although a small proportion exhibit higher levels and more heterogeneous distribution of TILs. We show that a conventional and practical number (e.g. ≤3) of TMA cores is adequate for correct ordinal categorisation of tumours with high or low TIL burden, but that many more cores (≥11) are required to accurately estimate absolute TIL numbers. Our findings provide a benchmark for the design of future studies aiming to define the clinical relevance of the immune microenvironments of LMS and other sarcoma subtypes.
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Affiliation(s)
- A T J Lee
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.,Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - W Chew
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - C P Wilding
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - N Guljar
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - M J Smith
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - D C Strauss
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - C Fisher
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - A J Hayes
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - I Judson
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - K Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.,Division of Clinical Studies, The Institute of Cancer Research, London, SW3 6JB, UK
| | - P H Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK.
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33
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Drabbe C, Benson C, Younger E, Zaidi S, Jones RL, Judson I, Chisholm J, Mandeville H, Fisher C, Thway K, Al Muderis O, Messiou C, Strauss D, Husson O, Miah A, Van der Graaf WTA. Embryonal and Alveolar Rhabdomyosarcoma in Adults: Real-Life Data From a Tertiary Sarcoma Centre. Clin Oncol (R Coll Radiol) 2019; 32:e27-e35. [PMID: 31350181 DOI: 10.1016/j.clon.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
AIMS Embryonal and alveolar rhabdomyosarcoma (ERMS, ARMS) are subtypes of RMS that mainly occur in children, with relatively good outcomes. The incidence in adults is extremely low and survival is significantly worse compared with children. Data are scarce and literature generally combines all RMS subtypes, including pleomorphic RMS, which primarily occurs in adults and behaves more like undifferentiated pleomorphic sarcoma. The aim of this study was to evaluate patient and tumour characteristics, outcome and prognostic factors in adult patients with ERMS and ARMS. MATERIALS AND METHODS All adult (18 years or older) ERMS and ARMS patients (presenting 1990-2016) were identified from a prospectively maintained database and were included in this analysis. RESULTS Overall, 66 patients were included (42 men, 24 women). The median age at presentation was 28 years (range 18-71). The median overall survival for all ARMS (n = 42) and ERMS (n = 24) patients was 18 months, with a 5-year overall survival rate of 27%. Patients presenting with localised disease (n = 38, 58%) and metastatic disease (n = 25, 42%), had a 5-year overall survival rate of 36% and 11%, respectively. In univariate analysis we found alveolar subtype, fusion gene positivity, infiltrative tumour and metastatic presentation to be negative prognostic factors. CONCLUSION Survival in adult ERMS and ARMS patients is poor and the current data may be useful in the design of trials with novel agents. Ideally, paediatric and adult oncologists should set up trials together to get a better understanding of biological, genetic and clinically relevant factors in this disease.
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Affiliation(s)
- C Drabbe
- Royal Marsden Hospital, London, UK; Radboud University Medical Centre, Nijmegen, the Netherlands
| | - C Benson
- Royal Marsden Hospital, London, UK
| | | | - S Zaidi
- Royal Marsden Hospital, London, UK
| | - R L Jones
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - I Judson
- The Institute of Cancer Research, London, UK
| | - J Chisholm
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - H Mandeville
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - C Fisher
- The Institute of Cancer Research, London, UK
| | - K Thway
- Royal Marsden Hospital, London, UK
| | | | - C Messiou
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | | | - O Husson
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - A Miah
- Royal Marsden Hospital, London, UK
| | - W T A Van der Graaf
- Royal Marsden Hospital, London, UK; Radboud University Medical Centre, Nijmegen, the Netherlands; The Institute of Cancer Research, London, UK.
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Tap WD, Wagner AJ, Papai Z, Ganjoo KN, Yen CC, Schoffski P, Abdul Razak AR, Martin Broto J, Spira AI, Kawai A, Krarup-Hansen A, Le Cesne A, Van Tine B, Naito Y, Park SH, Soldatenkova V, Mo G, Shahir A, Wright J, Jones RL. ANNOUNCE: A randomized, placebo (PBO)-controlled, double-blind, phase (Ph) III trial of doxorubicin (dox) + olaratumab versus dox + PBO in patients (pts) with advanced soft tissue sarcomas (STS). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.18_suppl.lba3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA3 Background: Dox is standard therapy in STS. In a Ph 2 trial, olaratumab (a human IgG1 antibody targeting PDGFRα) + dox improved overall survival (OS) and progression-free survival (PFS) vs dox. ANNOUNCE aimed to confirm the OS benefit in advanced STS. Methods: Adult pts with unresectable locally advanced or metastatic STS, anthracycline-naïve, and ECOG PS 0-1 were eligible. Pts were randomized 1:1 to olaratumab (20mg/kg Cycle 1, 15mg/kg subsequent cycles) or PBO on Days 1 and 8 of each 21-day cycle combined with dox (75mg/m2) on Day 1 for up to 8 cycles. After 8 cycles, pts with disease control continued olaratumab or PBO until progression or toxicity. Randomization was stratified by histology, prior systemic therapy, ECOG PS, and geographic region. Dexrazoxane use was allowed to mitigate dox-related cardiotoxicity. Primary endpoints were OS in the intent-to-treat (ITT) population and/or leiomyosarcoma (LMS) subset of the ITT population; the study was designed to be positive if either primary endpoint was met. Secondary endpoints included PFS, response/disease control rates, safety, and pharmacokinetics. Results: 509 pts were randomized: 258 in the investigational and 251 in the control arm. Baseline pt characteristics were well balanced. Dexrazoxane was received by 63.0% vs 65.1% of pts (investigational vs control arm, respectively, for all data). In the ITT population, median OS was 20.4 vs 19.8 months (m) (HR=1.05, 95% CI: 0.84-1.30; p = 0.69) and was 21.6 vs 21.9 m in LMS pts (HR=0.95, 95% CI: 0.69-1.31; p = 0.76). Median PFS was lower in the investigational arm in the ITT population (5.4 vs 6.8 m; HR=1.23, 95% CI: 1.01-1.50; p = 0.04) and in LMS pts (4.3 vs 6.9 m, HR=1.22, 95% CI: 0.92-1.63; p = 0.17). Median dox exposure was 6 vs 7 cycles. Safety was similar between arms. Olaratumab serum concentrations reached levels expected from prior trials. Additional subgroup/biomarker results will be presented. Conclusions: ANNOUNCE did not confirm that olaratumab + dox, followed by olaratumab monotherapy, improves OS over dox in pts with advanced STS. Further analyses are warranted to explore the inconsistent outcomes between the Ph 3 and Ph 2 studies. Clinical trial information: NCT02451943.
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Affiliation(s)
| | | | - Zsuzsanna Papai
- Allami Egeszsegugyi Kozpont (State Health Center), Budapest, Hungary
| | | | | | - Patrick Schoffski
- Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | | | - Javier Martin Broto
- Virgen del Rocio University Hospital, Institute of Biomedicine Research (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | | | - Akira Kawai
- National Cancer Center Hospital, Tokyo, Japan
| | | | | | | | - Yoichi Naito
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Se Hoon Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Gary Mo
- Eli Lilly and Company, Indianapolis, IN
| | | | | | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
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Heinrich MC, Jones RL, von Mehren M, Bauer S, Kang YK, Schoffski P, Eskens F, Mir O, Cassier PA, Serrano C, Tap WD, Trent JC, Rutkowski P, Patel S, Chawla SP, Meiri E, Zhou T, Mamlouk KK, Roche M, George S. Clinical activity of avapritinib in ≥ fourth-line (4L+) and PDGFRA Exon 18 gastrointestinal stromal tumors (GIST). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11022 Background: Targeting oncogenic KIT and PDGFRA mutations revolutionized treatment of patients (pts) with advanced GIST; however, nearly all pts succumb to resistant disease. Avapritinib is a potent and selective kinase inhibitor with broad activity against oncogenic KIT/PDGFRA mutants, including PDGFRA D842V and other primary or secondary resistance mutations. Updated results from the phase 1 NAVIGATOR (NCT02508532) study of avapritinib in pts with advanced GIST are presented. Methods: Adult pts with unresectable PDGFRA D842V or other mutant GIST who progressed on imatinib and ≥ 1 other tyrosine kinase inhibitor (TKI) were treated with oral, daily, continuous avapritinib. Adverse events (AE) and response by mRECIST 1.1 per central radiology were assessed. Safety from the overall population (30-600 mg doses) and efficacy in the response evaluable 4L+ and PDGFRA Exon 18 (Ex 18) populations treated at the MTD (400 mg)/RP2D (300 mg) were analyzed. Results: As of 16 Nov 2018, 237 pts [172 KIT, 62 PDGFRA Ex 18 (56 D842V, 6 non-D842V), 2 PDGFRA N659K, 1 missing] were enrolled including 111 in the 4L+ population (primarily KIT, median 4 prior TKI) and 43 in the Ex 18 population (median 1 prior TKI). The 4L+ ORR was 22% [1 CR, 23 PR (1 pending)], and 52 SD with median duration of response (mDOR) of 10.2 months (95% CI: 7.2-NE). The Ex 18 ORR was 86% [3 CR, 34 PR (1 pending)] and 5 SD; mDOR was not reached (95% CI: 11.3-NE). Most AE were grade 1-2, most commonly nausea (63%), fatigue (58%), anemia (49%), periorbital edema (42%), diarrhea (40%), vomiting (40%), decreased appetite (38%), increased lacrimation (33%), peripheral edema (33%) and memory impairment (most common cognitive AE, 29%). 10% of pts discontinued due to a related AE. Grade 3-4 related AE ≥ 2% were anemia, fatigue, hypophosphatemia, hyperbilirubinemia, neutropenia, and diarrhea. Conclusions: Avapritinib has important clinical activity in pts with advanced GIST who have no effective therapies. The ORR and DOR of avapritinib in 4L+ exceeds that of approved 2nd and 3rd line therapies and shows unprecedented activity in D842V and other Ex 18 mutant PDGFRA GIST. Results suggest avapritinib has the potential to change the treatment paradigm of pts with advanced GIST. Clinical trial information: NCT02508532.
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Affiliation(s)
- Michael C. Heinrich
- Portland VA Health Care System and Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | | | - Sebastian Bauer
- West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - Patrick Schoffski
- Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ferry Eskens
- Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Cesar Serrano
- Vall d’Hebron Institute of Oncology, Vall d’ Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute-Oncology Center, Warsaw, Poland
| | | | | | - Eyal Meiri
- Cancer Treatment Centers of America, Newnan, GA
| | | | | | | | - Suzanne George
- Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA
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36
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Pollack S, Redman MW, Wagner M, Loggers ET, Baker KK, McDonnell S, Gregory J, Copeland VC, Hammer KJ, Johnson R, Moore R, Shahnazari M, Townson SM, Jones RL, Cranmer LD. A phase I/II study of pembrolizumab (Pem) and doxorubicin (Dox) in treating patients with metastatic/unresectable sarcoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11009 Background: Patients with advanced soft tissue sarcomas (STS) treated with single agent Dox have a median progression-free survival (PFS) of 4.6 months (mo) and response rate (RR) of 14%. Dox sensitizes tumors to Pem through calreticulin release and killing of immunosuppressive cells. Thus we hypothesize that combining Dox + Pem will improve patient outcomes. Methods: A phase I/II trial (NCT02888665) evaluating Dox+Pem was designed for Dox naïve STS and select bone sarcomas with a 1° endpoints of safety (CTCAE v4.03) and response rate (RR) by RECIST 1.1. Patients received one “priming” dose of Pem (200mg IV) prior to starting Dox+Pem Q3wks. Dox+Pem was continued for up to 6 cycles, followed by Pem monotherapy for up to 2 years or progression. The phase I portion used a 3+3 design with 2 Dox doses (45 & 75 mg/m2), followed by a Simon 2-stage expansion. A retrospective study of patients treated at our center on non-ifosfamide containing Dox trials (DoxT) was performed in order to compare our observed PFS with a comparable historic population. Results: Treatment was well tolerated; detailed safety data will be presented. No additional cardiac risk was observed. No DLTs were observed during phase I and 75mg/m2 was selected as the phase 2 Dox dose. The study met criteria for expansion to the 2nd stage. Though the planned enrollment was 41, the study closed after 37 as it was clear that the RR (22% , including phase I patients) would not meet the phase 2 RR target of 29%. However, 59% of patients had stable disease (disease control rate = 81%) with tumor regression in a majority of patients. The median PFS on Dox + Pem was 8.1 mo (95% CI: 6.3, 10.8). Patients treated with Dox + Pem had a significantly longer median PFS compared to the DoxT cohort (4.1 mo, 95%CI 3.0 – 6.6, p < 0.001). Conclusions: Dox+Pem is well-tolerated. While this study failed to meet its 1° RR endpoint, a highly significant improvement in PFS was observed compared with historical controls. This is consistent with findings in other cancers, such as head & neck, where improved clinical outcomes were observed without significant increase in RR by RECIST. A randomized trial of Dox +/- Pem should be carefully considered in light of recent negative trials in STS. Clinical trial information: NCT02888665.
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Affiliation(s)
- Seth Pollack
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mary Weber Redman
- SWOG Statistical Center; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Michael Wagner
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | | | | | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | - Lee D. Cranmer
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
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Gordon EM, Chua-Alcala VS, Kim K, Liu S, Angel N, Baby R, Brigham D, Tseng WW, Pollack S, Jones RL, Federman N, Srikureja AM, Jalas J, Chawla SP. SAINT: Results of a phase 1/2 study of safety/efficacy using safe amounts of ipilimumab, nivolumab, and trabectedin as first-line treatment of advanced soft tissue sarcoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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
11016 Background: Sarcoma cells are most immunogenic earlier in the disease course and prior to treatment when the immune system can recognize and destroy them. Hypothesis: Immune checkpoint inhibitors would be most effective when given as first line therapy. Methods: This is an IRB-approved dose-seeking Phase 1/2 protocol using defined doses of I (1 mg/kg i.v. q 12 weeks), N (3 mg/kg i.v. q 2 weeks) and escalating doses of T (1.0, 1.2, 1.5 mg/m2 i.v. q 3 weeks), employing the “Cohort of Three” design, followed by a Phase 2 using the MTD of trabectedin. Results: Nine subjects were treated in Phase 1 of the study, and 31 subjects in Phase 2. Safety analysis: at Dose 1: Grade 3 treatment-related adverse events (TRAEs) included fatigue (n = 1), increased TSH (n = 1). At Dose 2, Grade 4 TRAEs included thrombocytopenia with bleeding, DLT (n = 1), increased CK (n = 1); Grade 3 TRAEs included anemia (n = 1), myalgia (n = 1), increased TSH (n = 1), decreased TSH (n = 1), increased AST (n = 1). Efficacy analysis (evaluable patients): At Dose 1: Disease Control Rate (DCR = CR, PR, SD) was 67%, median PFS, 18 weeks; median OS, 50 weeks; At Dose 2: PR (n-1), DCR 60%, median PFS, 24 weeks; median OS, > 46 weeks. At Phase 2, MTD Dose 2 (PUPs): Safety analysis (n = 31): Grade 3 TRAEs included fatigue (n = 2), increased ALT (n = 6), increased AST (n = 4), hypernatremia (n = 1), hyponatremia (n = 1), dehydration (n = 1), rash (n = 1), port cellulitis (n = 1), psoriasis exacerbation (n = 1), increased TSH (n = 1), decreased hemoglobin (n = 2), neutropenia (n = 1). Efficacy analysis (N = 23 evaluable): PR (n-5; 2 UPS, 1 synovial sarcoma, 1 liposarcoma, 1 leiomyosarcoma,), BORR 22%, DCR 96%. Median PFS and OS not yet reached. After 4 treatment cycles, one resected tumor showed 80% necrosis and a greater number (30%) of CD8+ killer T cells, in the TME compared to archived pre-treatment tumor. Conclusions: These data suggest that the SAINT protocol (1) is safe with manageable adverse events, with no additive toxicity, and (2) may control tumor growth. Phase 2 of the study is on-going. Clinical trial information: NCT03138161.
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Affiliation(s)
| | | | | | - Seiya Liu
- Sarcoma Oncology Research Center, Santa Monica, CA
| | | | - Rekha Baby
- Sarcoma Oncology Research Center, Cancer Center of Southern California, Santa Monica, CA
| | | | | | - Seth Pollack
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | - Noah Federman
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - John Jalas
- Providence Saint Johns Medical Center, Santa Monica, CA
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Schroeder BA, He C, Zhang Y, Wagner M, Jones RL, Cranmer LD, Pollack S. A single-center retrospective study of patients treated with trabectedin (TRB) with long-term follow up. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11061] [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
11061 Background: TRB is FDA approved drug for the treatment of liposarcoma (Lipo) and leiomyosarcoma (LMS). The aim of this study was to evaluate potential biomarkers associated with prolonged benefit in patients treated with TRB at our center prior to 2016. Methods: We performed a retrospective search of UW/FHCRC CASIS database to identify patients treated with TRB prior to 2016. Demographic variables and clinical variables (such as histology and treatment) were retrieved. Statistics were performed with R 3.4.1 software. Pairwise Pearson’s correlation was calculated for the # of prior chemotherapy regimens with # of TRB cycles. The Kaplan-Meir method was used to evaluate overall survival (OS). Log-rank test was conducted to compare groups in terms of OS. Results: 145 sarcoma patients treated with TRB were identified with a mean follow up of 5 years (generally on NCT01427582 or NCT01343277). Patients averaged 1.9 prior chemotherapy regimens prior to TRB (range 0-7 regimens) and received an average of 5.6 TRB doses (range 1-25 doses). Subtypes are listed on table. The # of prior regimens was negatively correlated with the # of TRB cycles that patients received (pairwise correlation coefficient = -1.77; p=0.034), suggesting that multiple prior treatment lines either made TRB less tolerable or made sarcoma less sensitive to TRB. The median OS for this heavily treated metastatic population was 0.5 years. However, patients who were able to stay on TRB for more than 5 cycles had a significantly higher OS (p=0.001). While only 23% of patients who received less than 5 cycles of TRB were alive at 5 years (95% CI: 0.15, 0.32), 53% of those who received 5 or more cycles of (95% CI: 0.39, 0.65) were alive at 5 years. Conclusions: TRB may be more effective when administered as an earlier line of therapy. Patients who are able to stay on TRB for a longer duration had a significant improvement in OS. Detailed subset analysis will be presented as will initial findings of our biomarker work. These retrospective data warrant further evaluation. Clinical trial information: NCT01427582 or NCT01343277. [Table: see text]
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Affiliation(s)
| | - Chad He
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Michael Wagner
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | - Lee D. Cranmer
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Seth Pollack
- Fred Hutchinson Cancer Research Center, Seattle, WA
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Chawla SP, Chua-Alcala VS, Kim K, Assudani N, Al-Shihabi A, Moradkhani A, Quon D, Wong S, Tseng WW, Pollack S, Srikureja AM, Jalas J, Jones RL, Gordon EM. The SAINT: Initial results of a phase I/II study of safety/efficacy using safe amounts of ipilimumab, nivolumab, and trabectedin as first-line treatment of advanced soft tissue sarcoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
22 Background: Sarcoma cells are most immunogenic at the onset of cancer. Hypothesis: Immune checkpoint inhibitors would be most effective when given as first line therapy. Objectives: (1) To evaluate the safety of ipilimumab (I), a CTLA4 inhibitor, nivolumab (N), a PD-1 inhibitor, and escalating doses of trabectedin (T), a marine-derived natural alkaloid, in advanced soft tissue sarcomas (STS), (2) To investigate the BORR, DCR, PFS and OS, and (3) to correlate response with immune cell trafficking in the tumor microenvironment. Methods: This is an IRB-approved dose-seeking phase 1/2 study using defined doses of I (1 mg/kg IV q 12 weeks), N (3 mg/kg IV q 2 weeks) and escalating doses of T (1.0, 1.3, 1.5 mg/m2 IV q 3 weeks), employing “cohort of three” design, with a Phase 2 component using the MTD of T. Results: Phase 1 safety analysis: At Dose 1: Grade 3 treatment related adverse events (TRAEs): fatigue (n = 1), increased TSH (n = 1). At Dose 2, Grade 4 TRAEs: thrombocytopenia with bleeding, DLT (n = 1), increased CK (n = 1); Grade 3 TRAEs: anemia (n = 1), myalgia (n = 1), increased TSH (n = 1), decreased TSH (n = 1), increased AST (n = 1). At Phase 2, Grade 4 TRAEs: increased CK (n = 1); Grade 3 TRAEs: increased ALT (n = 4), anemia (n = 3) neutropenia (n = 1), portal cellulitis (n = 1). Efficacy analysis: Phase 1 (n = 9): At Dose 1: DCR 67%, median PFS, 18 weeks; median OS, 50 weeks; At Dose 2: PR (n-1, rhabdomyosarcoma), DCR 60%, median PFS, > 42 weeks; median OS, > 47 weeks. Phase 2 (n = 16): PR (n = 3; 1 liposarcoma, 1 leiomyosarcoma, 1UPS); BORR 18.75%, DCR 87.5%, median PFS, > 19 weeks; median OS, > 26 weeks. Surgical resection was undertaken in 1 patient with SD after 4 cycles. The surgical specimen showed 80% necrosis and greater number (30%) of CD8+ killer T cells, 10% PD-L1+ cells in the TME compared to that of archived pre-treatment tumor. Conclusions: Taken together, these data suggest that the SAINT protocol (1) is safe with manageable adverse events, with no additive toxicity, and (2) may control tumor growth. The phase 2 part of the study is on-going. Clinical trial information: NCT03138161.
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Affiliation(s)
| | | | | | | | | | | | - Doris Quon
- Sarcoma Oncology Research Center, Santa Monica, CA
| | - Steven Wong
- Sarcoma Oncology Research Center, Santa Monica, CA
| | | | - Seth Pollack
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - John Jalas
- Providence Saint Johns Medical Center, Santa Monica, CA
| | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv68-iv78. [PMID: 29846513 DOI: 10.1093/annonc/mdy095] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso 'S.Maria di Cà Foncello', Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals, London, UK
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Institute of Scientific Hospital Care (IRCCS), Regina Elena National Cancer Institute, Rome
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Issels
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna
| | - R Piana
- Azienda Ospedaliero, Universitaria Cita della Salute e della Scienza di Torino, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | | | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Whelan
- University College Hospital, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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Casali PG, Bielack S, Abecassis N, Aro HT, Bauer S, Biagini R, Bonvalot S, Boukovinas I, Bovee JVMG, Brennan B, Brodowicz T, Broto JM, Brugières L, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Dhooge C, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gaspar N, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hecker-Nolting S, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kager L, Kasper B, Kopeckova K, Krákorová DA, Ladenstein R, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Morland B, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Strauss SJ, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Bone sarcomas: ESMO-PaedCan-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv79-iv95. [PMID: 30285218 DOI: 10.1093/annonc/mdy310] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Brennan
- Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - L Brugières
- Gustave Roussy Cancer Campus, Villejuif, France
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso "S.Maria di Cà Foncello", Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - C Dhooge
- Ghent University Hospital (Pediatric Hematology-Oncology & Stem Cell Transplantation), Ghent, Belgium
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - N Gaspar
- Gustave Roussy Cancer Campus, Villejuif, France
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - R Issels
- Department of Medicine III, University Hospital Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital & Children's Cancer Research Institute, Medical University Vienna, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Ladenstein
- St. Anna Children's Hospital & Children's Cancer Research Institute, Medical University Vienna, Vienna, Austria
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute-Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology University Hospital of Lausanne, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna, Italy
| | - R Piana
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute-Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - S J Strauss
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - W T A van der Graaf
- Royal Marsden Hospital, London
- Radboud University Medical Center, Nijmegen, The Netherlands
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - J Whelan
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv267. [PMID: 30188977 DOI: 10.1093/annonc/mdy320] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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43
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv268-iv269. [PMID: 30285214 DOI: 10.1093/annonc/mdy321] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
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44
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv51-iv67. [PMID: 29846498 DOI: 10.1093/annonc/mdy096] [Citation(s) in RCA: 414] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso "S.Maria di Cà Foncello", Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals, London, UK
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Institute of Scientific Hospital Care (IRCCS), Regina Elena National Cancer Institute, Rome
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Issels
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna
| | - R Piana
- Azienda Ospedaliero, Universitaria Cita della Salute e della Scienza di Torino, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'hospital de la SANTA CREU I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | | | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Whelan
- University College Hospital, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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Ravi V, Brohl AS, Chawla SP, Attia S, Riedel RF, Liebner DA, Thornton KA, Basu Mallick A, Davis DW, Cervantes M, Liu W, Zhu K, Alvarez D, Theuer CP, Robinson SI, Penel N, Stacchiotti S, Tap WD, Jones RL, Maki RG. Detection of endoglin-expressing CTCs in patients enrolled in an adaptive enrichment phase 3 trial of TRC105 and pazopanib versus pazopanib alone in patients with advanced angiosarcoma (TAPPAS). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e23570] [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)
- Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - Katherine Anne Thornton
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | | | | | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | - Robert G. Maki
- Monter Cancer Center, Northwell Health and Cold Spring Harbor Laboratory, Lake Success, NY
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Younger E, Papai Z, Van Tine BA, Attia S, Ballman KV, Lu Y, Reinke DK, Schoffski P, Tap WD, Jones RL. Subgroup analysis of elderly patients treated within the randomized phase 3 doxorubicin versus doxorubicin plus evofosfamide (SARC021) trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.11575] [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)
| | - Zsuzsanna Papai
- Allami Egeszsegugyi Kozpont (State Health Center), Budapest, Hungary
| | | | | | | | - Yao Lu
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | | | - Patrick Schoffski
- Department of General Medical Oncology Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
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Bulusu VR, Casey R, Giger O, Maher E, Hardwick R, Carroll N, Leahy MG, Jones RL, Benson C, Dileo P, Judson IR. Paediatric, adolescent, wild type, syndromic gastrointestinal stromal tumours (PAWS-GIST): Report from United Kingdom PAWS-GIST clinic. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e23519] [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)
| | | | - Olivier Giger
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - Eamonn Maher
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - Richard Hardwick
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | | | - Palma Dileo
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Sebio A, Antoniou G, Thway K, Miah A, Zaidi S, Benson C, van der Graaf WTA, Jones RL. Gemcitabine re-challenge in metastatic soft tissue sarcoma: A therapeutic option for selected patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.11559] [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)
- Ana Sebio
- Hospital de la Santa Creu i Sant Pau, Medical Oncology Department, Barcelona, Spain
| | | | - Khin Thway
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Aisha Miah
- The Royal Marsden Hospital, London, United Kingdom
| | - Shane Zaidi
- Royal Marsden Hospital, London, United Kingdom
| | | | | | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
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49
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Sankhala KK, Jones RL, Chua VS, Kim K, Andrali SS, Quon DV, Wong SG, Lee JH, Rabizadeh S, Sachdev E, Chawla SP. Lack of cardiac toxicity in patients treated with aldoxrubicin with doxorubicin equivalent doses beyond 1000mg/m2. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.11585] [Citation(s) in RCA: 1] [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
Affiliation(s)
| | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
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50
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Ravi V, Brohl AS, Chawla SP, Attia S, Riedel RF, Liebner DA, Thornton KA, Basu Mallick A, Mehta CR, Liu L, Alvarez D, Theuer CP, Robinson SI, Penel N, Stacchiotti S, Tap WD, Jones RL, Maki RG. TAPPAS: An adaptive enrichment phase 3 trial of TRC105 and pazopanib versus pazopanib alone in patients with advanced angiosarcoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps11590] [Citation(s) in RCA: 1] [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
Affiliation(s)
- Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - Katherine Anne Thornton
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | - Silvia Stacchiotti
- Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - William D. Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Lewis Jones
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | - Robert G. Maki
- Monter Cancer Center, Northwell Health and Cold Spring Harbor Laboratory, Lake Success, NY
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