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Schöffski P, Wozniak A, Kasper B, Aamdal S, Leahy MG, Rutkowski P, Bauer S, Gelderblom H, Italiano A, Lindner LH, Hennig I, Strauss S, Zakotnik B, Anthoney A, Albiges L, Blay JY, Reichardt P, Sufliarsky J, van der Graaf WTA, Debiec-Rychter M, Sciot R, Van Cann T, Marréaud S, Raveloarivahy T, Collette S, Stacchiotti S. Activity and safety of crizotinib in patients with alveolar soft part sarcoma with rearrangement of TFE3: European Organization for Research and Treatment of Cancer (EORTC) phase II trial 90101 'CREATE'. Ann Oncol 2019; 29:758-765. [PMID: 29216400 DOI: 10.1093/annonc/mdx774] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Alveolar soft part sarcoma (ASPS) is an orphan malignancy associated with a rearrangement of transcription factor E3 (TFE3), leading to abnormal MET gene expression. We prospectively assessed the efficacy and safety of the MET tyrosine kinase inhibitor crizotinib in patients with advanced or metastatic ASPS. Patients and methods Eligible patients with reference pathology-confirmed ASPS received oral crizotinib 250 mg bd. By assessing the presence or absence of a TFE3 rearrangement, patients were attributed to MET+ and MET- sub-cohorts. The primary end point was the objective response rate (ORR) according to local investigator. Secondary end points included duration of response, disease control rate (DCR), progression-free survival (PFS), progression-free rate, overall survival (OS) and safety. Results Among 53 consenting patients, all had a centrally confirmed ASPS and 48 were treated. A total of 45 were eligible, treated and assessable. Among 40 MET+ patients, 1 achieved a confirmed partial response (PR) that lasted 215 days and 35 had stable disease (SD) as best response (ORR: 2.5%, 95% CI 0.6% to 80.6%). Further efficacy end points in MET+ cases were DCR: 90.0% (95% CI 76.3% to 97.2%), 1-year PFS rate: 37.5% (95% CI 22.9% to 52.1%) and 1-year OS rate: 97.4% (95% CI 82.8% to 99.6%). Among 4 MET- patients, 1 achieved a PR that lasted 801 days and 3 had SD (ORR: 25.0%, 95% CI 0.6% to 80.6%) for a DCR of 100% (95% CI 39.8% to 100.0%). The 1-year PFS rate in MET- cases was 50% (95% CI 5.8% to 84.5%) and the 1-year OS rate was 75% (95% CI 12.8% to 96.1%). One patient with unknown MET status due to technical failure achieved SD but stopped treatment due to progression after 17 cycles. The most common crizotinib-related adverse events were nausea [34/48 (70.8%)], vomiting [22/48 (45.8%)], blurred vision [22/48 (45.8%)], diarrhoea (20/48 (41.7%)] and fatigue [19/48 (39.6%)]. Conclusion According to European Organization for Research and Treatment of Cancer (EORTC) efficacy criteria for soft tissue sarcoma, our study demonstrated that crizotinib has activity in TFE3 rearranged ASPS MET+ patients. Clinical trial number EORTC 90101, NCT01524926.
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Affiliation(s)
- P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium.
| | - A Wozniak
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - B Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, Mannheim, Germany
| | - S Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - M G Leahy
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - S Bauer
- Department of Internal Medicine, West German Cancer Center, University Hospital, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Italiano
- Sarcoma Unit, Institut Bergonié, Bordeaux, France
| | - L H Lindner
- Medical Clinic III, University Hospital of Munich, Munich, Germany
| | - I Hennig
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Strauss
- Department of Oncology, University College Hospital, London, UK
| | - B Zakotnik
- Department of Medical Oncology, The Institute of Oncology, Ljubljana, Slovenia
| | - A Anthoney
- Institute of Oncology, Leeds Teaching Hospitals National Health Service Trust, St. James's University Hospital, Leeds, UK
| | - L Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif
| | - J-Y Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Université Claude Bernard Lyon I, Lyon, France
| | - P Reichardt
- Department of Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | | | - W T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Debiec-Rychter
- Department of Human Genetics, KU Leuven, Leuven, Belgium; University Hospitals Leuven, Leuven, Belgium
| | - R Sciot
- University Hospitals Leuven, Leuven, Belgium; Department of Pathology, KU Leuven; Leuven, Belgium
| | - T Van Cann
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - S Marréaud
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - T Raveloarivahy
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - S Collette
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - S Stacchiotti
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milano, Italy
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Schöffski P, Wozniak A, Stacchiotti S, Rutkowski P, Blay JY, Lindner LH, Strauss SJ, Anthoney A, Duffaud F, Richter S, Grünwald V, Leahy MG, Reichardt P, Sufliarsky J, van der Graaf WT, Sciot R, Debiec-Rychter M, van Cann T, Marréaud S, Lia M, Raveloarivahy T, Collette L, Bauer S. Activity and safety of crizotinib in patients with advanced clear-cell sarcoma with MET alterations: European Organization for Research and Treatment of Cancer phase II trial 90101 'CREATE'. Ann Oncol 2019; 30:344. [PMID: 29741569 PMCID: PMC6386024 DOI: 10.1093/annonc/mdx823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schöffski P, Wozniak A, Stacchiotti S, Rutkowski P, Blay JY, Lindner LH, Strauss SJ, Anthoney A, Duffaud F, Richter S, Grünwald V, Leahy MG, Reichardt P, Sufliarsky J, van der Graaf WT, Sciot R, Debiec-Rychter M, van Cann T, Marréaud S, Lia M, Raveloarivahy T, Collette L, Bauer S. Activity and safety of crizotinib in patients with advanced clear-cell sarcoma with MET alterations: European Organization for Research and Treatment of Cancer phase II trial 90101 'CREATE'. Ann Oncol 2018; 28:3000-3008. [PMID: 28950372 DOI: 10.1093/annonc/mdx527] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Clear-cell sarcoma (CCSA) is an orphan malignancy, characterized by a specific t(12;22) translocation, leading to rearrangement of the EWSR1 gene and overexpression of MET. We prospectively investigated the efficacy and safety of the tyrosine kinase inhibitor crizotinib in patients with advanced or metastatic CCSA. Patients and methods Patients with CCSA received oral crizotinib 250 mg twice daily. Primary end point was objective response rate (ORR), secondary end points included duration of response, disease control rate (DCR), progression-free survival (PFS), progression-free rate (PFR), overall survival (OS), OS rate and safety. The study design focused on MET+ disease with documented rearrangement of the EWSR1 gene by fluorescence in situ hybridization. Results Among 43 consenting patients with the local diagnosis of CCSA, 36 had centrally confirmed CCSA, 28 of whom were eligible, treated and assessable. Twenty-six out of the 28 patients had MET+ disease, of whom one achieved a confirmed partial response and 17 had stable disease (SD) (ORR 3.8%, 95% confidence interval: 0.1-19.6). Further efficacy end points in MET+ CCSA were DCR: 69.2% (48.2% to 85.7%), median PFS: 131 days (49-235), median OS: 277 days (232-442). The 3-, 6-, 12- and 24-month PFR was 53.8% (34.6-73.0), 26.9% (9.8-43.9), 7.7% (1.3-21.7) and 7.7% (1.3-21.7), respectively. Among two assessable MET- patients, one had stable disease and one had progression. The most common treatment-related adverse events were nausea [18/34 (52.9%)], fatigue [17/34 (50.0%)], vomiting [12/34 (35.3%)], diarrhoea [11/34 (32.4%)], constipation [9/34 (26.5%)] and blurred vision [7/34 (20.6%)]. Conclusions The PFS with crizotinib in MET+ CCSA is similar to results achieved first-line in non-selected metastatic soft tissue sarcomas with single-agent doxorubicin. The PFS is similar to results achieved with pazopanib in previously treated sarcoma patients. Clinical trial number EORTC 90101, EudraCT number 2011-001988-52, NCT01524926.
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Affiliation(s)
- P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven.,Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - A Wozniak
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - S Stacchiotti
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milano, Italy
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute, Warsaw.,Oncology Center, Warsaw, Poland
| | - J-Y Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I, Lyon, France
| | - L H Lindner
- Medical Clinic III, University Hospital of Munich, Munich, Germany
| | - S J Strauss
- Department of Oncology, University College London Hospital NHS Trust, London
| | - A Anthoney
- Institute of Oncology, Leeds Teaching Hospitals National Health Service Trust, St. James's University Hospital, Leeds, UK
| | - F Duffaud
- Department of Medical Oncology, CHU la Timone Boulevard J Moulin Marseille, Marseille.,Aix Marseille University (AMU), Marseille, France
| | - S Richter
- University Cancer Center, Dresden.,Medical Department I, University Hospital Carl Gustav Carus, Dresden
| | - V Grünwald
- Department of Haematology, Haemostasis and Oncology, Hannover Medical School, Hannover, Germany
| | - M G Leahy
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Reichardt
- HELIOS Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany
| | | | - W T van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.,The Institute of Cancer Research, London, UK
| | - R Sciot
- Department of Pathology, University Hospitals Leuven, Leuven
| | | | - T van Cann
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven.,Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - S Marréaud
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - M Lia
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - T Raveloarivahy
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - L Collette
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - S Bauer
- Department of Internal Medicine, West German Cancer Center, University Hospital, University of Duisburg-Essen, Duisburg, Germany
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Verschoor A, Litière S, Marréaud S, Judson I, Toulmonde M, Wardelmann E, van der Graaf W, Le Cesne A, Gronchi A, Gelderblom H. Prognostic relevance of distant metastases versus locally advanced disease in soft tissue sarcomas: An EORTC-STBSG database study. Eur J Cancer 2018; 94:187-198. [DOI: 10.1016/j.ejca.2018.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 02/03/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
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Touati N, Schöffski P, Litière S, Judson I, Sleijfer S, van der Graaf WT, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marréaud S, Gronchi A. European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Experience with Advanced/Metastatic Epithelioid Sarcoma Patients Treated in Prospective Trials: Clinical Profile and Response to Systemic Therapy. Clin Oncol (R Coll Radiol) 2018; 30:448-454. [PMID: 29550245 DOI: 10.1016/j.clon.2018.02.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/01/2022]
Abstract
AIMS Epithelioid sarcoma is a soft tissue sarcoma associated with a high rate of local recurrence after wide resection and high incidence of distant metastasis. Little is known about the clinical course and response to systemic treatments in epithelioid sarcoma patients. We carried out a retrospective analysis of clinical data from epithelioid sarcoma patients to provide a reference for the design of future epithelioid sarcoma-specific studies. PATIENTS AND METHODS Data from patients with epithelioid sarcoma entered in prospective multi-sarcoma phase II/III trials were pooled: EORTC trial 62012 (doxorubicin versus doxorubicin/ifosfamide), 62043 (pazopanib), 62072 (pazopanib versus placebo) and 62091 (doxorubicin versus trabectedin). Patients had either a local or a centrally confirmed diagnosis of epithelioid sarcoma, had inoperable/metastatic disease at study entry and were eligible for the according trial. Response was assessed according to RECIST 1.1. Progression-free survival (PFS) and overall survival were calculated from date of entry. RESULTS Among 976 patients with advanced sarcomas, 27 epithelioid sarcoma patients (2.8%) were eligible for the analysis (17 men, median age at diagnosis 50 years, range 19-72). Eighteen (66.7%) received chemotherapy as first-line treatment (five doxorubicin, eight doxorubicin/ifosfamide, two pazopanib, three trabectedin) and nine (33.3%) received pazopanib as second line or later. The primary tumour was located in the lower extremity (n = 8; 29.6%), upper extremity (n = 5; 18.5%), retro/intra-abdominal (n = 4; 14.8%) and in other locations (n = 10; 37.0%). At entry, metastases were mainly found in lung (n = 17; 63%), lymph nodes (n = 9; 33.3%), bone (n = 8; 29.6%) and soft tissue (n = 7; 25.9%). The best response for first-line patients was four partial responses (22.2%), 10 stable disease (55.6%) and four progressive disease (22.2%). In subsequent lines, pazopanib achieved one partial response (11.1%), four stable disease (44.4%) and four progressive disease (44.4%). All patients but one progressed on treatment. The median PFS and overall survival were 3.8 (95% confidence interval 2.2-4.8) and 10.8 months (95% confidence interval 8.1-21.3), respectively. Five patients were still alive at the time of the according trial analysis. CONCLUSION With all limitations of such a rare disease and small data set, objective response and survival outcomes are similar in epithelioid sarcoma to non-selected sarcoma populations. The clinical testing of novel systemic treatments for epithelioid sarcoma remains an unmet medical need and a high priority.
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Affiliation(s)
- N Touati
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Litière
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - S Sleijfer
- Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - W T van der Graaf
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - N Isambert
- Centre Georges-François Leclerc, Dijon, France
| | - T Gil
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - J Y Blay
- Centre Léon Bérard, Lyon, France
| | - D Stark
- Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - T Brodowicz
- Medical University Vienna, General Hospital, Vienna, Austria
| | - S Marréaud
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Benson C, Ray-Coquard I, Sleijfer S, Litière S, Blay JY, Le Cesne A, Papai Z, Judson I, Schöffski P, Chawla S, Gil T, Piperno-Neumann S, Marréaud S, Dewji MR, van der Graaf WTA. Outcome of uterine sarcoma patients treated with pazopanib: A retrospective analysis based on two European Organisation for Research and Treatment of Cancer (EORTC) Soft Tissue and Bone Sarcoma Group (STBSG) clinical trials 62043 and 62072. Gynecol Oncol 2016; 142:89-94. [PMID: 27012429 DOI: 10.1016/j.ygyno.2016.03.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Uterine sarcomas are a group of mesenchymal tumours comprising several histologies. They have a high recurrence rate following surgery, modest outcome to systemic therapy, and poor overall survival. Pazopanib is a multi-targeted tyrosine kinase inhibitor approved for non-adipocytic advanced soft tissue sarcomas (STS). Here we investigated whether response to pazopanib in patients with uterine sarcomas differs from that of patients with non-uterine sarcomas. PATIENTS AND METHODS Uterine sarcoma patients were retrieved from all soft tissue sarcoma patients treated with pazopanib in EORTC Phase II (n=10) and Phase III (PALETTE) (n=34) studies. Patient and tumour characteristics, response, progression free and overall survival data were compared. RESULTS Forty-four patients with uterine sarcoma were treated with pazopanib. The majority of patients had uterine leiomyosarcoma (LMS) (n=39, 88.6%) with high grade tumours (n=37, 84.1%) compared to 54.8% (n=164) in the non-uterine population. The median age was 55years (range 33-79) and median follow up was 2.3years. Uterine patients were heavily pre-treated, 61.3% having ≥2 lines of chemotherapy prior to pazopanib compared to 40.8% in the non-uterine population. Five patients (11%), all LMS, had a partial response (95% CI 3.8-24.6). Median progression free survival (PFS) 3.0months (95% CI 2.5-4.7) in uterine versus 4.5 (95% CI 3.7-5.1) in non-uterine STS. Median overall survival (OS) was 17.5months (95% CI 11.1-19.6), longer than the non-uterine population, 11.1months (95% CI 10.2-12.0) (p=0.352). CONCLUSIONS Despite heavy pre-treatment, pazopanib shows signs of activity in patients with uterine sarcoma with the similar outcomes to patients with non-uterine STS.
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Affiliation(s)
- C Benson
- Royal Marsden NHS Foundation Trust, London, UK.
| | - I Ray-Coquard
- Centre Leon Berard, University Claude Bernard, Lyon, France
| | - S Sleijfer
- Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S Litière
- EORTC Headquarters, Brussels, Belgium
| | - J-Y Blay
- Centre Leon Berard, University Claude Bernard, Lyon, France
| | - A Le Cesne
- Institut Gustave Roussy, Villejuif, France
| | - Z Papai
- Military Hospital-State Health Centre, Budapest, Hungary
| | - I Judson
- Royal Marsden NHS Foundation Trust, London, UK
| | - P Schöffski
- University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - S Chawla
- Sarcoma Oncology Centre, Santa Monica, USA
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | | | | | - M R Dewji
- Novartis Pharma AG, Basel, Switzerland
| | - W T A van der Graaf
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
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Bui-Nguyen B, Butrynski JE, Penel N, Blay JY, Isambert N, Milhem M, Kerst JM, Reyners AKL, Litière S, Marréaud S, Collin F, van der Graaf WTA. A phase IIb multicentre study comparing the efficacy of trabectedin to doxorubicin in patients with advanced or metastatic untreated soft tissue sarcoma: the TRUSTS trial. Eur J Cancer 2015; 51:1312-20. [PMID: 25912752 DOI: 10.1016/j.ejca.2015.03.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 03/17/2015] [Accepted: 03/26/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate whether trabectedin as first-line chemotherapy for advanced/metastatic soft tissue sarcoma prolongs progression-free survival (PFS), compared to doxorubicin and, in the phase IIb part here, to select the most appropriate trabectedin treatment schedule (3-hour or 24-hour infusion) in terms of safety, convenience and efficacy. PATIENTS AND METHODS In this randomised multicentre prospective dose-selection phase IIb superiority trial, 133 patients were randomised between doxorubicin (n=43), trabectedin (3-hour infusion, T3h) (n=47) and trabectedin (24-hour infusion, T24h) (n=43). PFS was defined as time from random assignment until objective progression by response evaluation criteria in solid tumours (RECIST 1.1), a global deterioration of the health status requiring discontinuation of the treatment, or death from any cause. RESULTS The study was terminated due to lack of superiority in both trabectedin treatment arms as compared to the doxorubicin control arm. Median PFS was 2.8months in the T3h arm, 3.1months in the T24h arm and 5.5months in the doxorubicin arm. No significant improvements in PFS were observed in the trabectedin arms as compared to the doxorubicin arm (T24h versus doxorubicin: hazard ratio (HR) 1.13, 95% confidence interval (CI) 0.67-1.90, P=.675; T3h versus doxorubicin: HR 1.50, 95% CI 0.91-2.48, P=.944). Only one toxic death occurred in the T3h arm, but treatment had to be stopped due to toxicity in 7 (15.2%) (T3h), 8 (19.5%) (T24h) and 1 (2.5%) doxorubicin patients. CONCLUSION Doxorubicin continues to be the standard treatment in eligible patients with advanced/metastatic soft-tissue sarcoma (STS). Trabectedin 1.5mg/m(2)/24-hour infusion is the overall proven approach to delivering this agent in the second-line setting for patients with advanced or metastatic STS.
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Affiliation(s)
- B Bui-Nguyen
- Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, F-33076 Bordeaux, France.
| | | | - N Penel
- Centre Oscar Lambret, 59020 Lille Cedex, France
| | - J Y Blay
- Université Claude Bernard & Centre Léon Bérard, Lyon, France
| | - N Isambert
- Centre G-F Leclerc, 1 rue du Pr Marion, 21079 Dijon Cedex, France
| | - M Milhem
- University of Iowa Hospital and Clinics, Iowa City, USA
| | - J M Kerst
- The Netherlands Cancer Institute (NKI) - Antoni van Leeuwenhoekziekenhuis, Amsterdam, The Netherlands
| | - A K L Reyners
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S Litière
- EORTC Headquarters, Brussels, Belgium
| | | | - F Collin
- Centre G-F Leclerc, 1 rue du Pr Marion, 21079 Dijon Cedex, France
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Theodore C, Skoneczna I, Bodrogi I, Leahy M, Kerst J, Collette L, Ven K, Marréaud S, Oliver R. A phase II multicentre study of irinotecan (CPT 11) in combination with cisplatin (CDDP) in metastatic or locally advanced penile carcinoma (EORTC PROTOCOL 30992). Ann Oncol 2008; 19:1304-1307. [DOI: 10.1093/annonc/mdn149] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lacombe DA, Caponigro F, Anthoney A, Bauer J, Govaerts A, Milano A, Marréaud S, Twelves C. A phase I study of bortezomib in combination with 5FU/LV plus oxaliplatin in patients (pts) with advanced colorectal cancer (CRC): EORTC 16029. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4090 Background: Bortezomib is a potent and reversible inhibitor of the ubiquitin-mediated proteasome pathway, whose inhibition results in the stabilization of p53, p21Cip1, p27Kip1, Bax, in cell-cycle dysregulation and, finally, apoptosis. A phase I study of the combination of 5FU/LV and bortezomib has shown a significant stable disease rate in advanced CRC (Iqbal, ASCO 2004). Methods: In this phase I study bortezomib was given as an IV push over 3 to 5 seconds on days 1, 8 and 15 in combination with standard FOLFOX-4 every 28 days in chemo-naïve pts with advanced CRC. Bortezomib starting dose level was 1.3 mg/m2. A 3+3 study design was utilized at predefined dose levels (DL). Dose-limiting-toxicity (DLT) was assessed during cycle 1. Exploratory pharmacogenetics research was conducted. Results: 15 pts were treated and 46 cycles given. At DL2 (1.6 mg/m2), 2/4 pts experienced a DLT: G3 febrile neutropenia causing treatment delay and bortezomib dose reduction in 1pt and one bortezomib dose skipped due to persistent G2 peripheral neuropathy and myalgia in 1pt. At DL1 (1.3 mg/m2), 2/6 pts had a DLT. Both pts experienced a G3 neutropenia on day 15, which prevented treatment from being given as scheduled. DL-1 (1 mg/m2) was therefore investigated and no DLT was observed among 5 pts. The most frequently reported toxicities in cycle 1 were γGT (64%), nausea, fatigue and sensory neuropathy (53%), pain (33%), diarrhea and fever (27%), vomiting (20%), anorexia, dyspnea and mucositis (13%) and neutropenia 29% (G2,3). 12 pts are currently evaluable for response; 6 had a partial response, 3 stable disease and 3 disease progression. Conclusion: The toxicity profile of this combination is predictable and early evidence of clinical activity has been observed. The recommended bortezomib dose for further investigation within this regimen is 1 mg/m2. No significant financial relationships to disclose.
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Affiliation(s)
- D. A. Lacombe
- EORTC Data Center, Brussels, Belgium; National Cancer Institute Fondazione G. Pascale, Naples, Italy; St. James’s Universiry Hospital, Leeds, United Kingdom; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - F. Caponigro
- EORTC Data Center, Brussels, Belgium; National Cancer Institute Fondazione G. Pascale, Naples, Italy; St. James’s Universiry Hospital, Leeds, United Kingdom; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A. Anthoney
- EORTC Data Center, Brussels, Belgium; National Cancer Institute Fondazione G. Pascale, Naples, Italy; St. James’s Universiry Hospital, Leeds, United Kingdom; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - J. Bauer
- EORTC Data Center, Brussels, Belgium; National Cancer Institute Fondazione G. Pascale, Naples, Italy; St. James’s Universiry Hospital, Leeds, United Kingdom; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A. Govaerts
- EORTC Data Center, Brussels, Belgium; National Cancer Institute Fondazione G. Pascale, Naples, Italy; St. James’s Universiry Hospital, Leeds, United Kingdom; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A. Milano
- EORTC Data Center, Brussels, Belgium; National Cancer Institute Fondazione G. Pascale, Naples, Italy; St. James’s Universiry Hospital, Leeds, United Kingdom; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - S. Marréaud
- EORTC Data Center, Brussels, Belgium; National Cancer Institute Fondazione G. Pascale, Naples, Italy; St. James’s Universiry Hospital, Leeds, United Kingdom; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - C. Twelves
- EORTC Data Center, Brussels, Belgium; National Cancer Institute Fondazione G. Pascale, Naples, Italy; St. James’s Universiry Hospital, Leeds, United Kingdom; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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de Jonge MJA, Dumez H, Verweij J, Yarkoni S, Snyder D, Lacombe D, Marréaud S, Yamaguchi T, Punt CJA, van Oosterom A. Phase I and pharmacokinetic study of halofuginone, an oral quinazolinone derivative in patients with advanced solid tumours. Eur J Cancer 2006; 42:1768-74. [PMID: 16815702 DOI: 10.1016/j.ejca.2005.12.027] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2005] [Revised: 12/16/2005] [Accepted: 12/16/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE Halofuginone (tempostatin) is a synthetic derivative of a quinazolinone alkaloid showing anti-angiogenic, anti-metastatic and anti-proliferative effects in preclinical studies. The objectives of this phase I study were to assess the dose-limiting toxicities (DLTs), to determine the maximum tolerated dose (MTD) and to study the pharmacokinetics (PKs) of halofuginone when administered once or twice daily orally to patients with advanced solid tumours. METHODS Patients were treated with escalating doses of halofuginone at doses ranging from 0.5 to 3.5 mg/day. For pharmacokinetic analysis plasma sampling was performed during the first and second course and assayed using a validated high-performance liquid chromatographic assay with mass spectrometric detection. RESULTS Twenty-four patients received a total of 106 courses. The 'acute' MTD was reached at 3.5 mg/day, with nausea, vomiting, and fatigue as DLT. The recommended dose for chronic administration was defined as 0.5mg/day with the requirement of 5HT3 antagonists to control nausea and vomiting considered as DLT. Several patients experienced bleeding complications on treatment with halofuginone in which a causal relationship could not be excluded. The PKs of halofuginone were linear over the dose range studied with a large interpatient variability. CONCLUSIONS In this study the DLT of halofuginone was nausea, vomiting, and fatigue. The recommended dose for phase II studies of halofuginone is 0.5mg administered orally, once daily.
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Affiliation(s)
- M J A de Jonge
- Department of Medical Oncology, Erasmus Medical Center/Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam, The Netherlands.
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