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Lin DD, Wu Y, Toom S, Sheth N, Becker K, Burdette-Radoux S, D'Silva J, Huang Y, Lipshitz J, Meghal T, Mo L, Murthy P, Rubin P, Natarajan V, Donahue B, Xu Y. Clinical Determinants Differentiating the Severity of SARS-CoV-2 Infection in Cancer Patients: Hospital Care or Home Recovery. Front Med (Lausanne) 2021; 8:604221. [PMID: 33665196 PMCID: PMC7921307 DOI: 10.3389/fmed.2021.604221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Cancer patients may carry a worse prognosis with SARS-CoV-2 infection. Most of the previous studies described the outcomes of hospitalized cancer patients. We aimed to study the clinical factors differentiating patients requiring hospital care vs. home recovery, and the trajectory of their anti-cancer treatment. Methods: This study was conducted in a community cancer center in New York City. Eligible patients were those who had cancer history and were diagnosed of SARS-CoV-2 infection between March 1 and May 30, 2020, with confirmatory SARs-CoV-2 virus test or antibody test. Four groups were constructed: (A) hospitalized and survived, (B) hospitalized requiring intubation and/or deceased, (C) non-hospitalized, asymptomatic, with suspicious CT image findings, close exposure, or positive antibody test, and (D) non-hospitalized and symptomatic. Results: One hundred and six patients were included in the analysis. Thirty-five patients (33.0%) required hospitalization and 13 (12.3%) died. Thirty (28.3%) patients were asymptomatic and 41 (38.7%) were symptomatic and recovered at home. Comparing to patients who recovered at home, hospitalized patients were composed of older patients (median age 71 vs. 63 years old, p = 0.000299), more who received negative impact treatment (62.9 vs. 32.4%, p = 0.0036) that mostly represented myelosuppressive chemotherapy (45.7 vs. 23.9%, p = 0.0275), and more patients with poorer baseline performance status (PS ≥ 2 25.7 vs. 2.8%, p = 0.0007). Hypoxemia (35% in group A vs. 73.3% in group B, p = 0.0271) at presentation was significant to predict mortality in hospitalized patients. The median cumulative hospital stay for discharged patients was 16 days (range 5–60). The median duration of persistent positivity of SARS-CoV-2 RNA was 28 days (range 10–86). About 52.9% of patients who survived hospitalization and required anti-cancer treatment reinitiated therapy. Ninety-two percent of the asymptomatic patients and 51.7% of the symptomatic patients who recovered at home continued treatment on schedule and almost all reinitiated treatment after recovery. Conclusions: Cancer patients may have a more severe status of SARS-CoV-2 infection after receiving myelosuppressive chemotherapy. Avoidance should be considered in older patients with poor performance status. More than two thirds of patients exhibit minimal to moderate symptoms, and many of them can continue or restart their anti-cancer treatment upon recovery.
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Affiliation(s)
- Dong D Lin
- Department of Volunteers and Student Services, Maimonides Medical Center, Brooklyn, NY, United States
| | - Yunhong Wu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sudhamshi Toom
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Niki Sheth
- Department of Radiation Oncology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States
| | - Kevin Becker
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Susan Burdette-Radoux
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - James D'Silva
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Yiwu Huang
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Jay Lipshitz
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Trishala Meghal
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Lan Mo
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Pooja Murthy
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Philip Rubin
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Vijaya Natarajan
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Bernadine Donahue
- Department of Radiation Oncology, Maimonides Medical Center, Brooklyn, NY, United States
| | - Yiqing Xu
- Department of Medicine, Division of Hematology/Oncology, Maimonides Medical Center, Brooklyn, NY, United States
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Ruades Ninfea JI, Burdette-Radoux S, Sands MO, Levis JE, Rincon M, Holmes CE, Wood M. Low dose metronomic cyclophosphamide, methotrexate (LDCM) and aspirin for patients with residual disease after neoadjuvant chemotherapy for stage II-III breast cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e12040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Belur A, Arumugam Raajasekar AK, Burdette-Radoux S. Pathologic complete response after neoadjuvant paclitaxel and carboplatin chemotherapy for stage II-III breast cancer: A community cancer center experience. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.28_suppl.43] [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
43 Background: To evaluate the efficacy and safety of neoadjuvant carboplatin and weekly paclitaxel in locally advanced breast cancer. Methods: In a retrospective study, 15 patients receiving neoadjuvant chemotherapy with carboplatin and paclitaxel from 2008 to 2013 were identified with breast cancer stages IIA to IIIB. Patients received carboplatin at 6 times the area under the curve (AUC 6) every 4 weeks and paclitaxel 80 mg/m2 weekly for 16 weeks. Weekly trastuzumab was added for human epidermal growth factor receptor 2 (HER2) positive status. The primary endpoint was pathologic complete response (pCR) rate, defined as the absence of invasive cancer in breast and axillary lymph nodes. Partial response was defined as downstaging from clinical to pathologic stage. Results: 15 patients were identified. Median age was 57 years (range, 33 to 80 years). 6 women were African American, 3 Hispanic, 2 Asian and 3 Caucasian. 4 patients had stage IIIB disease, 5 had stage IIIA, 5 had Stage IIB and one had stage IIA. 2 patients had inflammatory cancer. 8 patients underwent modified radical mastectomy, 2 bilateral mastectomy and 4 lumpectomy. The tumor was estrogen receptor positive (ER+) in 8 patients, triple negative in 7 patients and HER2 positive in 2 patients. There were two episodes of febrile neutropenia and one death from sepsis. There was one episode of grade 4 thrombocytopenia requiring dose reduction of carboplatin to AUC 4. There were two instances of grade 3 peripheral neuropathy. One of these patients received a dose reduction of paclitaxel to 70 mg/m2. 10 patients received additional dose dense chemotherapy with doxorubicin and cyclophosphamide. Overall, the pCR rate was 0. Partial response was seen in 9 patients (60%). 14 patients received postoperative radiation; one patient declined radiation therapy. Conclusions: In cooperative group trials, neoadjuvant carboplatin and paclitaxel has been shown to achieve high pCR rates in patients with triple negative and HER2 positive breast cancer without exposure to an anthracycline. In our ethnically diverse patient population at a community cancer center, no pathologic complete responses were seen.
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Burdette-Radoux S, Holmes CE, Khan FB, Dittus K, Wilson KM, Wood M. Low-dose metronomic cyclophosphamide/methotrexate (LDCM) and aspirin for patients without pathologic complete response (pCR) after neoadjuvant treatment for stage II-III breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.26_suppl.163] [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
163 Background: Patients (pts) who fail to achieve pCR after neoadjuvant chemotherapy have a 20% risk of recurrence at two years. Data for effective postsurgical chemotherapy in this population is lacking. LDCM is an all-oral chemotherapy regimen with anti-angiogenic activity and acceptable toxicity in metastatic breast cancer. Aspirin is associated with a lower risk of breast cancer recurrence in retrospective studies and has anti-angiogenic activity. Here we combine LDCM and aspirin for high risk pts with poor response to neoadjuvant chemotherapy. Methods: Pts with stage II-III HER-2 negative breast cancer who had residual invasive cancer after neoadjuvant chemotherapy were eligible. Pts completed surgery and radiotherapy prior to enrolment and began study treatment within 180 days of surgery. Pts received four 28-day cycles of LDCM (cyclophosphamide 50 mg po daily, and methotrexate 2.5 mg po twice daily on days 1 and 2 each week ). Aspirin 325 mg daily was added on cycles 3 and 4. Pts were evaluated for the primary endpoint of toxicity and safety every 28 days. Secondary endpoint was 2 year relapse free survival. Results: 10 of 13 planned pts were evaluable for toxicity as of May 4, 2013. Pathologic stage ranged from T2N0 to T3N3. 70% of tumors were chemoresistant (stable or upstaged at time of surgery). 60% of pts had hormone receptor positive tumors and received concurrent hormonal therapy. Median age was 59 years (range 38-76). All pts completed 4 cycles of study treatment without dose reduction. There were no grade 3 or 4 related toxicities. Worst hematologic toxicity was grade 2 leukopenia. Worst nonhematologic toxicity was grade 2 fatigue; all other related toxicities were grade 1. 9 pts were evaluable for recurrence and one had recurred at a median followup of 16 months (range 10-26). Conclusions: This antiangiogenic regimen is well tolerated in patients at high risk for recurrence after neoadjuvant chemotherapy, resulting in one recurrence at 16 months median followup, and it may be a candidate for future trials in this setting. Subsequent analyses will include longer term followup and biomarkers for angiogenesis. Clinical trial information: NCT01612247.
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Affiliation(s)
| | | | - Farrah B. Khan
- University of Vermont College of Medicine, Burlington, VT
| | - Kim Dittus
- University of Vermont College of Medicine, Burlington, VT
| | | | - Marie Wood
- University of Vermont College of Medicine, Burlington, VT
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Burdette-Radoux S, Holmes CE, Khan FB, Dittus K, Wilson KM, Wood ME. Low-dose metronomic cyclophosphamide/methotrexate (LDCM) and aspirin for patients who fail to achieve pathologic complete response (pCR) after neoadjuvant treatment for stage II-III breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e12000] [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
e12000 Background: Patients (pts) who fail to achieve pCR after neoadjuvant chemotherapy have a 20% risk of recurrence at two years. Data for effective postsurgical chemotherapy in this population is lacking. LDCM is an all-oral chemotherapy regimen with anti-angiogenic activity and acceptable toxicity in metastatic breast cancer. Aspirin is associated with a lower risk of breast cancer recurrence in retrospective studies and has anti-angiogenic activity. Here we combine LDCM and aspirin for high risk pts with poor response to neoadjuvant chemotherapy. Methods: Pts with stage II-III HER-2 negative breast cancer who had residual invasive cancer after neoadjuvant chemotherapy were eligible. Pts completed surgery and radiotherapy prior to enrolment and began study treatment within 180 days of surgery. Pts received four 28-day cycles of LDCM (cyclophosphamide 50 mg po daily, and methotrexate 2.5 mg po twice daily on days 1 and 2 each week ). Aspirin 325 mg daily was added on cycles 3 and 4. Pts were evaluated for the primary endpoint of toxicity and safety every 28 days. Secondary endpoint was 2 year relapse free survival. Results: 10 of 13 planned pts were evaluable for toxicity as of Jan 24, 2013. Pathologic stage ranged from T2N0 to T3N3. 70% of tumors were chemoresistant (stable or upstaged at time of surgery). 60% of pts had hormone receptor positive tumors and received concurrent hormonal therapy. Median age was 59 years (range 38-76). All pts completed 4 cycles of study treatment without dose reduction. There were no grade 3 or 4 related toxicities. Worst hematologic toxicity was grade 2 leukopenia. Worst nonhematologic toxicity was grade 2 fatigue; all other related toxicities were grade 1. 9 pts were evaluable for recurrence and none had recurred at a median followup of 13 months (range 7-23). Conclusions: This antiangiogenic regimen is well tolerated in patients at high risk for recurrence after neoadjuvant chemotherapy, resulting in no recurrences at 13 months followup, and suggesting it may be a candidate for future trials in this setting. Subsequent analyses will include longer term followup and biomarkers for angiogenesis. Clinical trial information: NCT01612247.
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Affiliation(s)
| | | | - Farrah B. Khan
- University of Vermont College of Medicine, Burlington, VT
| | - Kim Dittus
- University of Vermont College of Medicine, Burlington, VT
| | | | - Marie E. Wood
- University of Vermont College of Medicine, Burlington, VT
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Burdette-Radoux S, Muss HB. A question of duration: do patients with early-stage breast cancer need more than five years of adjuvant endocrine therapy? Clin Breast Cancer 2009; 9 Suppl 1:S37-41. [PMID: 19561005 DOI: 10.3816/cbc.2009.s.004] [Citation(s) in RCA: 8] [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]
Abstract
Women with hormone receptor-positive breast cancer continue to be at risk for recurrence and mortality for many years after diagnosis. Previous clinical trials established 5 years of endocrine therapy as a standard of care for both premenopausal and postmenopausal women, resulting in long-lasting benefit over shorter durations of treatment. Until recently, trials testing durations of tamoxifen longer than 5 years have not shown additional benefit, but the ATLAS (Adjuvant Tamoxifen, Longer Against Shorter) trial, reported in 2007, showed a small but significant reduction in risk of recurrence with 10 compared with 5 years of tamoxifen therapy. Aromatase inhibitors (AIs) improve relapse-free survival (RFS) in postmenopausal women when they are used sequentially with, or replace, tamoxifen for a total of 5 years of therapy. Extension of endocrine therapy to 10 years in the National Cancer Institute of Canada Clinical Trials Group MA.17 trial demonstrated that 5 years of letrozole therapy following 5 years of tamoxifen therapy results in an improvement in RFS, but not overall survival, in postmenopausal women. Trials testing durations of AI therapy for longer than 5 years are ongoing. Selection of candidates for extended endocrine therapy should balance recurrence risk, toxicity of treatment, and comorbidities that might impact life expectancy and risk of side effects.
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Affiliation(s)
- Susan Burdette-Radoux
- Hematology/Oncology Unit, University of Vermont and Vermont Cancer Center, Burlington, VT 05405, USA.
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Reardon DA, Fink KL, Mikkelsen T, Cloughesy TF, O'Neill A, Plotkin S, Glantz M, Ravin P, Raizer JJ, Rich KM, Schiff D, Shapiro WR, Burdette-Radoux S, Dropcho EJ, Wittemer SM, Nippgen J, Picard M, Nabors LB. Randomized Phase II Study of Cilengitide, an Integrin-Targeting Arginine-Glycine-Aspartic Acid Peptide, in Recurrent Glioblastoma Multiforme. J Clin Oncol 2008; 26:5610-7. [DOI: 10.1200/jco.2008.16.7510] [Citation(s) in RCA: 412] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PurposeCilengitide, an inhibitor of αvβ3 and αvβ5 integrin receptors, demonstrated minimal toxicity and durable activity across a wide range of doses administered to adults with recurrent glioblastoma multiforme (GBM) in a prior phase I study. The current multicenter phase II study was conducted to evaluate the activity and safety of cilengitide in GBM patients at first recurrence.Patients and MethodsEligible patients were randomly assigned to receive either 500 or 2,000 mg of cilengitide twice weekly on a continuous basis. Patients were assessed every 4 weeks. The primary end point was 6-month progression-free survival (PFS) rate. Secondary end points included PFS, overall survival (OS), and radiographic response, as well as quality-of-life and pharmacokinetic assessments.ResultsEighty-one patients were enrolled, including 41 on the 500-mg arm and 40 on the 2,000-mg arm. The safety profile of cilengitide was excellent, with no significant reproducible toxicities observed on either arm. Antitumor activity was observed in both treatment cohorts but trended more favorably among patients treated with 2,000 mg, including a 6-month PFS of 15% and a median OS of 9.9 months.ConclusionCilengitide monotherapy is well tolerated and exhibits modest antitumor activity among recurrent GBM patients. Additional studies integrating cilengitide into combinatorial regimens for GBM are warranted.
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Affiliation(s)
- David A. Reardon
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Karen L. Fink
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Tom Mikkelsen
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Timothy F. Cloughesy
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Alison O'Neill
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Scott Plotkin
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Michael Glantz
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Paula Ravin
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Jeffrey J. Raizer
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Keith M. Rich
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - David Schiff
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - William R. Shapiro
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Susan Burdette-Radoux
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Edward J. Dropcho
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Sabine M. Wittemer
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Johannes Nippgen
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - Martin Picard
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
| | - L. Burt Nabors
- From the Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow
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Grunberg SM, Dugan M, Muss H, Wood M, Burdette-Radoux S, Weisberg T, Siebel M. Effectiveness of a single-day three-drug regimen of dexamethasone, palonosetron, and aprepitant for the prevention of acute and delayed nausea and vomiting caused by moderately emetogenic chemotherapy. Support Care Cancer 2008; 17:589-94. [PMID: 19037667 DOI: 10.1007/s00520-008-0535-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 11/07/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Chemotherapy-induced nausea and vomiting includes both Acute (0-24 h) and Delayed (24-120 h) components with different physiologic mechanisms. A combination of a serotonin antagonist, a corticosteroid, and an NK-1 antagonist has proven effective against this problem. However, standard antiemetic regimens require administration over 3-4 days after chemotherapy. The present study evaluated a more convenient single-day three-drug antiemetic regimen for patients receiving moderately emetogenic chemotherapy. MATERIALS AND METHODS Chemotherapy-naïve patients with solid tumors receiving cyclophosphamide and/or doxorubicin were eligible. Patients could not have pre-existing etiologies for vomiting. Prior to chemotherapy, patients received a single dose of aprepitant 285 mg p.o., dexamethasone 20 mg p.o., and palonosetron 0.25 mg i.v. A daily patient diary recording episodes of emesis and severity of nausea was then kept for 5 days. Any further antiemetics were considered rescue medication. RESULTS Forty-one eligible and evaluable patients (40 women, one man) with breast cancer were entered on study. Most were receiving adjuvant chemotherapy. Complete Response (no vomiting, no rescue medication) was seen in 51% of patients, including 76% with Complete Response for the Acute period and 66% for the Delayed period. No emesis was reported for 100% of patients in the Acute period and 95% in the Delayed period. No Nausea was seen in 32% of patients. No untoward toxicities were seen. CONCLUSION A single-day three-drug antiemetic regimen is feasible and effective for protection against both Acute and Delayed vomiting after moderately emetogenic chemotherapy. Formal comparison to a standard multi-day antiemetic regimen is warranted.
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Affiliation(s)
- Steven M Grunberg
- Division of Hematology/Oncology, Vermont Cancer Center, 89 Beaumont Avenue-Given Bldg E214, Burlington, VT 05405, USA.
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Middleton M, Hauschild A, Thomson D, Anderson R, Burdette-Radoux S, Gehlsen K, Hellstrand K, Naredi P. Results of a multicenter randomized study to evaluate the safety and efficacy of combined immunotherapy with interleukin-2, interferon-{alpha}2b and histamine dihydrochloride versus dacarbazine in patients with stage IV melanoma. Ann Oncol 2007; 18:1691-7. [PMID: 17709802 DOI: 10.1093/annonc/mdm331] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The safety and efficacy of immunotherapy with histamine dihydrochloride (HDC), interleukin-2 (IL-2) and interferon-alpha2b (IFN) compared with dacarbazine (DTIC) in adult patients with stage IV melanoma was evaluated. PATIENTS AND METHODS Two hundred and forty-one patients were randomized to either receive repeated 4-week cycles of IFN [3 MIU, s.c., once daily for 7 days], IL-2 (2.4 MIU/m(2), s.c., twice a day for 5 days) and HDC (1 mg, s.c., twice a day for 5 days) or DTIC 850 mg/m(2) i.v. every 3 weeks. The primary endpoint was overall survival. RESULTS Median survival was longer for patients receiving HDC/IL-2/IFN (271 days) than for patients receiving DTIC (231 days), but this did not achieve statistical significance. Four patients receiving HDC/IL-2/IFN and nine receiving DTIC experienced at least one grade 4 adverse event. Striking differences in overall survival were observed between countries participating in the study. CONCLUSION Treatment with HDC/IL-2/IFN was safely administered on an outpatient basis, but this immunotherapeutic regimen did not improve upon the response rate and overall survival seen with DTIC.
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Affiliation(s)
- M Middleton
- Department of Medical Oncology, Christie Hospital, Manchester, UK
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Grunberg SM, Dugan M, Muss HB, Wood M, Burdette-Radoux S, Weisberg T. Efficacy of a 1-day 3-drug antiemetic regimen for prevention of acute and delayed nausea and vomiting induced by moderately emetogenic chemotherapy. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9111] [Citation(s) in RCA: 3] [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
9111 Background: Serotonin antagonists, NK-1 antagonists (NKA) and corticosteroids (C) have all shown efficacy against chemotherapy-induced nausea and vomiting. However these agents are commonly used in cumbersome and inconvenient multiple day regimens that can also raise questions of compliance. Palonosetron is a serotonin antagonist with a 40 hour half-life, requiring only one dose for several days of exposure. Single high doses of NKA and C can also be used to simulate drug exposures achieved with a multiple day regimen. We have therefore evaluated a 1-day 3-drug antiemetic regimen for 5 day efficacy against moderately emetogenic chemotherapy. Methods: Patients with solid tumors receiving their first cycle of cyclophosphamide and/or doxorubicin were eligible to receive a single pre-treatment dose of palonosetron 0.25 mg IV/dexamethasone 20 mg PO/aprepitant 285 mg PO. Nausea and vomiting were evaluated over the following 5 days with a patient diary including vomiting episodes, use of rescue medication, and daily nausea visual analogue scale (VAS). Patients were urged to begin rescue medication for nausea, vomiting, or related discomfort. Endpoints included Complete Response (CR) (no emesis or rescue), No Emesis (NE), and No Significant Nausea (NSN) (VAS<25) during the acute period (A) (Day 1), the delayed period (D) (Days 2–5), and the overall period (O) (Days 1–5). Adverse events were recorded and tabulated for at least 14 days. Results: 32 of 40 planned patients have been entered on study. 31 women and 1 man with breast cancer receiving adjuvant chemotherapy with median age 52 years (range 34–74) have been treated and all are evaluable. CR for A/D/O was 78%/59%/50%. However NE for A/D/O was 100%/97%/97%, and NSN for A/D/O was 75%/62%/56%. Only 8 patients had more than one day of Significant Nausea. The most common treatment-related adverse events were fatigue and mild headache. Conclusions: A 1-day 3-drug antiemetic regimen is feasible and effective, and should be tested against a multiple day standard antiemetic regimen. [Table: see text]
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Affiliation(s)
- S. M. Grunberg
- Fletcher Allen Health Care, Burlington, VT; Maine Center for Cancer Medicine, Scarborough, ME
| | - M. Dugan
- Fletcher Allen Health Care, Burlington, VT; Maine Center for Cancer Medicine, Scarborough, ME
| | - H. B. Muss
- Fletcher Allen Health Care, Burlington, VT; Maine Center for Cancer Medicine, Scarborough, ME
| | - M. Wood
- Fletcher Allen Health Care, Burlington, VT; Maine Center for Cancer Medicine, Scarborough, ME
| | - S. Burdette-Radoux
- Fletcher Allen Health Care, Burlington, VT; Maine Center for Cancer Medicine, Scarborough, ME
| | - T. Weisberg
- Fletcher Allen Health Care, Burlington, VT; Maine Center for Cancer Medicine, Scarborough, ME
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Burdette-Radoux S, Wood ME, Olin JJ, Laughlin RS, Crocker AM, Ashikaga T, Muss HB. Phase I/II Trial of Adjuvant Dose-Dense Docetaxel/Epirubicin/Cyclophosphamide (TEC) in Stage II and III Breast Cancer. Breast J 2007; 13:274-80. [PMID: 17461902 DOI: 10.1111/j.1524-4741.2007.00421.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED This phase I/II trial investigates the safety and feasibility of six cycles of concurrent taxane, anthracycline and cyclophosphamide on a dose dense schedule. Patients with stage II/III breast cancer were treated with docetaxel (T) 75 mg/m(2), epirubicin (E) 75 mg/m(2) (cohort 1, n = 3) or 100 mg/m(2) (cohort 2, n = 12), and cyclophosphamide (C) 500 mg/m(2) IV on day 1, with pegfilgrastim 6 mg subcutaneously on day 2, every 2 weeks for six cycles. Patients were assessed for toxicity every 2 weeks; cardiac function and response (if neoadjuvant) were assessed after six cycles. All patients in cohort 1 received 100% planned dose intensity; in cohort 2, five of twelve patients received 100% and 11/12 received >80%. There were no dose reductions or delays for day 1 myelotoxicity. Dose reductions as a result of febrile neutropenia (FN) occurred in cohort 2, with six of twelve patients experiencing FN in seven of sixty-nine cycles. Six patients had anemia > or =grade 3; five received RBC transfusion and seven received an erythropoietic growth factor. Four patients required dose reductions for nonhematologic toxicity (two mucositis; one neurotoxicity; one diarrhea + cellulitis). Four patients developed thrombophlebitis, which was associated with FN in one of four. Two of fourteen evaluable patients had asymptomatic decreases in LVEF >10%; all remained within normal range. All four patients receiving neoadjuvant TEC had significant clinical responses (one CR, three PR). No pathologic CRs were seen. CONCLUSIONS Dose dense TEC chemotherapy is feasible, has acceptable toxicity at doses equivalent to TAC (docetaxel 75 mg/m(2), epirubicin 75 mg/m(2), cyclophosphamide 600 mg/m(2)), and has moderate but manageable toxicity using a higher epirubicin dose of 100 mg/m(2), with FN occurring in six of twelve patients at the higher dose.
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12
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Abstract
As the elderly population continues to grow, adjuvant chemotherapy treatment in the elderly is becoming an increasingly important issue for the practicing oncologist. Decisions regarding adjuvant treatment involve a careful assessment of the risk for recurrent disease and side effects from treatment, balancing these risks against the beneficial effects of treatment. In this review, we discuss methods for assessing the elderly patient in terms of life expectancy, comorbid disease, and functional capacity. This assessment can then be used to help identify appropriate candidates for adjuvant chemotherapy. Tools for estimating the risk for relapse and mortality and the reduction in these risks with various forms of treatment are useful for clarifying treatment options. Elderly patients have been underrepresented in clinical trials, and patients are often given less intense and possibly inferior standard treatment as a function of age. Ongoing clinical trials targeting the elderly patient may help answer questions about the relative risks and benefits of adjuvant treatment in this age group. Recent data show that most fit elderly patients derive a benefit from standard adjuvant chemotherapy regimens that is equal to that of younger patients.
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Affiliation(s)
- Susan Burdette-Radoux
- Hematology/Oncology Unit, University of Vermont, Fletcher Allen Health Care, UHC Campus, St. Joseph 3400, One South Prospect Street, Burlington, Vermont 05401, USA.
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13
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Krag DN, Shukla GS, Shen GP, Pero S, Ashikaga T, Fuller S, Weaver DL, Burdette-Radoux S, Thomas C. Selection of Tumor-binding Ligands in Cancer Patients with Phage Display Libraries. Cancer Res 2006; 66:7724-33. [PMID: 16885375 DOI: 10.1158/0008-5472.can-05-4441] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Phage display has been used extensively in vitro and in animal models to generate ligands and to identify cancer-relevant targets. We report here the use of phage-display libraries in cancer patients to identify tumor-targeting ligands. Eight patients with stage IV cancer, including breast, melanoma, and pancreas, had phage-displayed random peptide or scFv library (1.6 x 10(8)-1 x 10(11) transducing units/kg) administered i.v.; tumors were excised after 30 minutes; and tumor-homing phage were recovered. In three patients, repeat panning was possible using phage recovered and amplified from that same patient's tumor. No serious side effects, including allergic reactions, were observed with up to three infusions. Patients developed antiphage antibodies that reached a submaximal level within the 10-day protocol window for serial phage administration. Tumor phage were recoverable from all the patients. Using a filter-based ELISA, several clones from a subset of the patients were identified that bound to a tumor from the same patient in which clones were recovered. The clone-binding to tumor was confirmed by immunostaining, bioassay, and real-time PCR-based methods. Binding studies with noncancer and cancer cell lines of the same histology showed specificity of the tumor-binding clones. Analysis of insert sequences of tumor-homing peptide clones showed several motifs, indicating nonrandom accumulation of clones in human tumors. This is the first reported series of cancer patients to receive phage library for serial panning of tumor targeting ligands. The lack of toxicity and the ability to recover clones with favorable characteristics are a first step for further research with this technology in cancer patients.
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Affiliation(s)
- David N Krag
- Department of Surgery and Vermont Cancer Center, University of Vermont College of Medicine, E309 89 Beaumont Avenue, Burlington, VT 05405, USA
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14
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Burdette-Radoux S, Wood ME, Olin JJ, Broom R, Crocker A, Ashikaga T, Muss HB. Phase I/II feasibility trial of adjuvant dose-dense (DD) docetaxel/epirubicin/cyclophosphamide (TEC) in stage II/III breast cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.813] [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)
| | - M. E. Wood
- Vermont Cancer Ctr, Univ of Vermont, Burlington, VT
| | - J. J. Olin
- Vermont Cancer Ctr, Univ of Vermont, Burlington, VT
| | - R. Broom
- Vermont Cancer Ctr, Univ of Vermont, Burlington, VT
| | - A. Crocker
- Vermont Cancer Ctr, Univ of Vermont, Burlington, VT
| | - T. Ashikaga
- Vermont Cancer Ctr, Univ of Vermont, Burlington, VT
| | - H. B. Muss
- Vermont Cancer Ctr, Univ of Vermont, Burlington, VT
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Burdette-Radoux S, Tozer RG, Lohmann RC, Quirt I, Ernst DS, Walsh W, Wainman N, Colevas AD, Eisenhauer EA. Phase II trial of flavopiridol, a cyclin dependent kinase inhibitor, in untreated metastatic malignant melanoma. Invest New Drugs 2004; 22:315-22. [PMID: 15122079 DOI: 10.1023/b:drug.0000026258.02846.1c] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To test the activity of the cyclin dependent kinase (cdk) inhibitor flavopiridol in malignant melanoma, a disease with frequent abnormalities of the cyclin dependent kinase system. PATIENTS AND METHODS Patients had histologically proven, unidimensionally measurable malignant melanoma, incurable by standard therapy. Prior adjuvant immunotherapy was allowed, but patients were otherwise untreated for advanced disease. Flavopiridol was administered at a dose of 50 mg/m(2) IV over 1 hour daily x 3 days every 3 weeks. Patients were assessed for response every 2 cycles. RESULTS 17 patients were accrued over 5 months. No objective responses were documented in the 16 patients evaluable for response. Seven patients (44%) had stable disease after 2 cycles, with a median of 2.8 months (range 1.8-9.2). The most common treatment-related non-hematologic toxicities were diarrhea (82%), nausea (47%), fatigue (41%), anorexia (35%) and vomiting (29%). Most treatment-related toxicities were mild, except for diarrhea (grade 3 in 3 patients, grade 4 in 1 patient), nausea (grade 3 in 1 patient) and tumor pain (grade 3 in 1 patient). Hematologic toxicities were minimal, none worse than grade 2. Eighty-eight percent of patients received >/=90% planned dose intensity; 2 patients had dose reductions for gastrointestinal (GI) toxicity. CONCLUSIONS Flavopiridol is well tolerated at the dose regimen used in this study, with an acceptable (primarily GI) toxicity profile. Although 7 of the 16 patients had stable disease ranging from 1.8 to 9.2 months in duration, there was no evidence of significant clinical activity in malignant melanoma by objective response criteria.
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Abstract
OBJECTIVE To estimate the cost-utility of adjuvant high-dose interferon in high-risk melanoma patients in Quebec compared to a watchful waiting strategy. METHOD A Markov model was developed that replicates the findings of the pivotal E1684 trial. It was then used to extrapolate survival over a period of 35 years. Costs of medical resources used during the first year were derived through a detailed analysis of a sample (n = 13) of patients treated in a leading academic hospital. Follow-up costs were assessed through a medical decision algorithm. Utilities were derived from a population-based survey (n = 104) in different locations in Quebec using the time trade-off method. RESULTS The mean incremental cost per quality-adjusted life-year of adjuvant Interferon therapy is equal to 55,090 CAN dollars over a follow-up of 7 years but drops down to 14,003 CAN dollars when extrapolated over 35 years. CONCLUSIONS Estimates of the cost-effectiveness of high-dose interferon in melanoma patients show an acceptable cost-effectiveness ratio if long-term survival is taken into account. Estimates are, however, strongly influenced by the observed trial differences in survival, the utility associated to health states, and the discount rate.
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Affiliation(s)
- R Crott
- Faculty of Pharmacy, University of Montreal, Canada.
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17
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Rose C, Vtoraya O, Pluzanska A, Davidson N, Gershanovich M, Thomas R, Johnson S, Caicedo JJ, Gervasio H, Manikhas G, Ben Ayed F, Burdette-Radoux S, Chaudri-Ross HA, Lang R. An open randomised trial of second-line endocrine therapy in advanced breast cancer. Eur J Cancer 2003; 39:2318-27. [PMID: 14556923 DOI: 10.1016/s0959-8049(03)00630-0] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
It was previously shown that letrozole (Femara) was significantly more potent than anastrozole (Arimidex) in inhibiting aromatase activity in vitro and in inhibiting total body aromatisation in patients with breast cancer. The objective of this study was to compare letrozole (2.5 mg per day) and anastrozole (1 mg per day) as endocrine therapy in postmenopausal women with advanced breast cancer previously treated with an anti-oestrogen. This randomised, multicentre and multinational open-label phase IIIb/IV study enrolled 713 patients. Treatment was for advanced breast cancer that had progressed either during anti-oestrogen therapy or within 12 months of completing that therapy. Patients had tumours that were either positive for oestrogen and/or progesterone receptors (48%) or of unknown receptor status (52%). The primary efficacy endpoint was time to progression (TTP). Secondary endpoints included objective response, duration of response, rate and duration of overall clinical benefit (responses and long-term stable disease), time to treatment failure, and overall survival, as well as general safety. There was no difference between the treatment arms in TTP; median times were the same for both treatments. Letrozole was significantly superior to anastrozole in the overall response rate (ORR) (19.1% versus 12.3%, P=0.013), including in predefined subgroups (receptor status-unknown, and soft-tissue- and viscera-dominant site of disease). There were no significant differences between the treatment arms in the rate of clinical benefit, median duration of response, duration of clinical benefit, time to treatment failure or overall survival. Both agents were well tolerated and there were no significant differences in safety. These results support previous data documenting the greater aromatase-inhibiting activity of letrozole and indicate that advanced breast cancer is more responsive to letrozole than to anastrozole as second-line endocrine therapy.
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Affiliation(s)
- C Rose
- Department of Oncology, Lund University Hospital, 221 85, Lund, Sweden.
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18
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Bélanger K, MacDonald D, Cairncross G, Gertler S, Forsyth P, Burdette-Radoux S, Bergeron J, Soulières D, Ludwin S, Wainman N, Eisenhauer E. A phase II study of topotecan in patients with anaplastic oligodendroglioma or anaplastic mixed oligoastrocytoma. Invest New Drugs 2003; 21:473-80. [PMID: 14586216 DOI: 10.1023/a:1026211620793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To determine the efficacy and toxicity of a novel chemotherapeutic approach with topotecan, a camptothecin analog, for progressive or recurring anaplastic oligodendroglioma or mixed oligoastrocytoma.Patients from seven centers with recurrent or progressive disease were treated with topotecan, 1.5 mg/m(2) intravenously (i.v.), 30 min dailyx5 days every 3 weeks. Efficacy and toxicity were assessed clinically and radiologically. The study was planned to accrue up to 30 evaluable patients if there was at least one response among the first 15 patients treated. Sixteen eligible patients entered the study. No response was documented in 14 evaluable patients. Eleven patients had stable disease of a median of 3.8 months and three had progressive disease. Sixteen patients were evaluable for toxicity. The most significant toxic effect was myelosuppression. Grade 3 or 4 granulocytopenia was experienced by 15 of 16 patients and led to dose reduction in nearly half of the cycles delivered. Other adverse effects were fatigue, nausea, stomatitis, alopecia, and vomiting.Topotecan, delivered in the dailyx5 regimen, is relatively well tolerated. We could not demonstrate significant activity among the population studied to justify completing accrual to 30 patients. Topotecan did not demonstrate, with this small sample size, efficacy as a salvage chemotherapy monotherapy after exposure to procarbazine, CCNU and vincristine. Further trials with different agents in this indication are certainly warranted.
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Affiliation(s)
- Karl Bélanger
- Department of Hematology, CHUM-Hôpital Notre-Dame, Montreal, Quebec, Canada.
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19
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Abstract
Anthracyclines have been incorporated into adjuvant chemotherapy regimens for breast cancer since the 1980s. A metaanalysis confirmed that regimens containing anthracyclines result in better disease-free and overall survival than standard CMF (cyclophosphamide/methotrexate/5-fluorouracil), with a proportional reduction of 11% in risk of death at 10 years with the addition of these agents. Dose escalation of doxorubicin results in outcome improvement up to a threshold dose beyond which no further improvement is seen. Epirubicin, with its better toxicity profile, can be escalated to higher doses than doxorubicin, with better outcomes associated with higher dose levels. Tumors expressing HER2/neu may respond better to anthracycline-containing regimens than to standard CMF, but this remains controversial. Newer regimens combining anthracyclines with taxanes may offer a slight additional advantage in terms of disease-free and overall survival in some patient populations. The scheduling of treatment is important, with recent results of dose-dense scheduling showing a greater survival benefit than conventional scheduling. Ongoing clinical trials should further define the best choice of anthracycline and the optimal dose and schedule of treatment.
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Affiliation(s)
- Susan Burdette-Radoux
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05401, USA.
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20
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Tozer RG, Burdette-Radoux S, Berlanger K, Davis ML, Lohmann RC, Rusthoven JR, Wainman N, Zee B, Seymour L. A randomized phase II study of two schedules of bryostatin-1 (NSC339555) in patients with advanced malignant melanoma: A National Cancer Institute of Canada Clinical Trials Group study. Invest New Drugs 2002; 20:407-12. [PMID: 12448658 DOI: 10.1023/a:1020694425356] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE This study addressed the efficacy and toxicity of the novel compound Bryostatin-1 (NSC 339555), a novel agent with antineoplastic, hematopoietic and immunomodulatory activity in a variety of in vitro and in vivo systems. PATIENTS AND METHODS This phase II study randomly assigned chemotherapy-naïve patients with untreated metastatic melanoma and measurable disease to two schedules of treatment: Arm A, 25 microg/m2 bryostatin-1 given as a 24 hour continuous infusion weekly or Arm B, 120 microg/m2 bryostatin-1 given as a 72 hour continuous infusion every 2 weeks. Although objective response was assessed using standard NCIC CTG criteria, antitumour activity was assessed using a multivariate endpoint incorporating both response (CR and PR) and early progression (PD at < or = 8 weeks). Seventeen patients were randomized to each arm. RESULTS Arm A was better tolerated with 86.7% of 15 evaluable patients receiving > or = 90% of planned dose intensity versus 76.5% of 17 evaluable patients in Arm B. On Arm B, three patients experienced serious adverse events and three patients had to be removed from protocol therapy due to toxicity. The most common side effect was myalgia (33% grade 1-2 on Arm A versus 65% on Arm B with 5 patients experiencing grade 3 and one patient grade 4). Lethargy was more common on Arm A but more severe on Arm B. Other side effects such as nausea, diarrhea and headache were generally mild to moderate in nature and occurred with a similar frequency on both arms. Hematologic and biochemical toxicity were minimal. This trial was closed early because the protocol-stopping rule was met based on lack of required responses and on the number of early progressions on both arms. No partial or complete responses were seen; 3 patients randomized to Arm A had stable disease (duration 9-24 weeks) as did 4 patients (duration 10-38 weeks) randomized to Arm B. CONCLUSION Arm A was better tolerated than Arm B. We conclude that bryostatin-1 has little efficacy in the treatment of metastatic melanoma with either of the schedules studied.
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Affiliation(s)
- R G Tozer
- Cancer Care Ontario-Hamilton, Regional Cancer Centre, Canada
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21
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Abstract
A prospective open-label study was designed to evaluate the safety, efficacy, and impact on quality of life of recombinant human erythropoietin (rHuEPO, epoetin alfa) therapy for cancer-related anemia. Of the 401 patients enrolled at 34 centers from across Canada, a cohort of 183 patients did not receive chemotherapy during the 16-week study period. All patients received epoetin alfa 150 IU/kg subcutaneously 3 times per week. The dose was increased to 300 IU/kg if the hemoglobin level did not increase by at least 1.0 g/dL after 4 weeks. Epoetin alfa therapy significantly increased hemoglobin levels and reduced transfusion requirements. Moreover, epoetin alfa provided statistically significant and clinically meaningful improvements in quality of life as measured by the Functional Assessment of Cancer Therapy-Anemia and Linear Analog Scale Assessment (also known as Cancer Linear Analog Scale). Increases in hemoglobin were correlated significantly with improvements in quality of life as well as Eastern Cooperative Oncology Group performance status. Treatment with epoetin alfa was well tolerated. These results demonstrate that epoetin alfa therapy is effective and safe in cancer patients with anemia, regardless of whether they are or are not receiving chemotherapy.
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Affiliation(s)
- Ian Quirt
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada
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22
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Quirt I, Robeson C, Lau CY, Kovacs M, Burdette-Radoux S, Dolan S, Tang SC, McKenzie M, Couture F. Epoetin alfa therapy increases hemoglobin levels and improves quality of life in patients with cancer-related anemia who are not receiving chemotherapy and patients with anemia who are receiving chemotherapy. J Clin Oncol 2001; 19:4126-34. [PMID: 11689580 DOI: 10.1200/jco.2001.19.21.4126] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate efficacy, safety, and quality of life (QOL) changes with epoetin alfa therapy for anemia in patients with nonmyeloid malignancies. PATIENTS AND METHODS Anemic cancer patients were enrolled onto this prospective, open-label study from 34 centers across Canada. The trial had two cohorts: patients who were and were not receiving chemotherapy during the 16-week study. All patients initially received epoetin alfa 150 IU/kg subcutaneously three times per week. The dose was doubled after 4 weeks for patients who did not experience sufficient response. RESULTS Of the 183 patients enrolled in the nonchemotherapy cohort, statistically significant and clinically relevant improvements in QOL were observed with epoetin alfa therapy using both the FACT-An questionnaire and linear analog scale assessment. Hemoglobin levels increased significantly (P <.001; mean increase 2.5 g/dL from baseline to end of study) and these increases were positively correlated with improved QOL and change in Eastern Cooperative Oncology Group (ECOG) scores. There was a significant reduction in the percentage of patients who required blood transfusions. The 218 patients in the chemotherapy cohort also experienced significant improvements in QOL, decreased transfusion use, and increased hemoglobin levels that correlated with QOL improvements and change in ECOG scores. Epoetin alfa was well-tolerated in both cohorts. CONCLUSION Epoetin alfa administered to patients with cancer-related anemia for up to 16 weeks resulted in significantly improved QOL, increased hemoglobin levels, and decreased transfusion use. These benefits were observed in cancer patients who were not receiving chemotherapy as well as those who were.
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Affiliation(s)
- I Quirt
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Canada.
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23
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Belanger K, Tozer R, Burdette-Radoux S, Davis M, Lohmann R, Zee B, Wainman N, Seymour L. Results of a randomized phase II study of two schedules of bryostatin-I in patients with malignant melanoma: experience with the multivariate stopping rule. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)81937-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
The current phase III studies of chemotherapy in advanced colorectal cancer include 60% to 85% of patients with the liver as a site of metastatic disease. Within the past 10 years, various modulatory combinations of 5-fluorouracil (5-FU) with agents such as leucovorin, interferon, N-(phosphonacetyl)-L-aspartate (PALA), and methotrexate have produced higher response rates than 5-FU alone. A major seven-arm study, conducted by the Southwestern Oncology Group and reported in 1995, suggested that single-agent, continuous-infusion 5-FU demonstrated the most encouraging results. Nine of 12 reported randomized studies comparing the combination of 5-FU and leucovorin with 5-FU alone report significant increases in response rates; two studies reported significant increases in survival. The meta-analysis project involving 1381 patients confirmed the increase in response rate with the combination (23%) vs. 5-FU alone (11%) but did not demonstrate any significant difference in median survival. The current issues involving 5-FU administration largely concentrate on the best approach (modulation vs. scheduling) and comprehensive evaluation of end points (quality of life, survival, and pharmacoeconomics). The current literature examining quality-of-life issues suggests that 5-FU and low-dose leucovorin produce the best overall improvement in symptoms. Others argue that continuous-infusion scheduling is also associated with a very good quality of life (although the increased cost and morbidity of continuous-infusion administration has to be factored into this consideration). An important phase III study is currently being conducted by the National Cancer Institute of Canada comparing immediate vs. delayed (until symptomatic) chemotherapy in patients with advanced colorectal cancer. Of the new approaches to therapy, perhaps the most immediately applicable are the new thymidylate synthase inhibitors (in particular, Tomudex, which produces a response rate equivalent to that of 5-FU plus leucovorin with less toxicity and a more convenient schedule).
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Affiliation(s)
- B Leyland-Jones
- Department of Oncology, McGill University, Montreal, Quebec, Canada
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25
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Rusthoven JJ, Quirt IC, Iscoe NA, McCulloch PB, James KW, Lohmann RC, Jensen J, Burdette-Radoux S, Bodurtha AJ, Silver HK, Verma S, Armitage GR, Zee B, Bennett K. Randomized, double-blind, placebo-controlled trial comparing the response rates of carmustine, dacarbazine, and cisplatin with and without tamoxifen in patients with metastatic melanoma. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1996; 14:2083-90. [PMID: 8683240 DOI: 10.1200/jco.1996.14.7.2083] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE We designed and conducted a randomized, double-blind, placebo-controlled trial to compare the response rates and survival of patients with metastatic melanoma who received carmustine (BCNU), dacarbazine (DTIC), and cisplatin with tamoxifen, or the same chemotherapy with placebo. PATIENTS AND METHODS Eligible patients with metastatic melanoma received either BCNU 150 mg/m2 intravenously (i.v.) on day 1, DTIC 220 mg/m2 i.v. daily on days 1 to 3 and on days 22 to 24, and cisplatin 25 mg/m2 i.v. daily on days 1 to 3 and on days 22 to 24 with placebo every 6 weeks, or the same chemotherapy with tamoxifen 160 mg orally daily for 7 days before chemotherapy and 40 mg orally daily throughout the remainder of the treatment cycle. Patients were treated on protocol for up to three cycles depending on the type of response. Assuming that a minimum increase in response rate of 20% would be necessary to conclude that tamoxifen conferred a clinically important benefit, we designed the study with an 80% chance of detecting that difference at the 5% level (two-sided). RESULTS Between February 1992 and January 1995, 211 patients were accrued, 199 of whom were considered assessable for response and toxicity. The overall response rate was 21% in the placebo group and 30% in the tamoxifen group (P = .187). Complete and partial responses were 3% and 27%, respectively, for the tamoxifen group and 6% and 14%, respectively, for the placebo group. Poor performance status and liver involvement were associated with a reduced likelihood to respond to treatment. Major toxicities were similar in both groups with no statistically significant difference in the rates of deep vein thrombosis, pulmonary thromboembolus, grade 4 neutropenia, or grade 4 thrombocytopenia. CONCLUSION These results demonstrate that the addition of high doses of tamoxifen to this chemotherapy regimen does not increase the response rate compared with chemotherapy alone in unselected patients with metastatic melanoma.
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Affiliation(s)
- J J Rusthoven
- Department of Medical Oncology, Hamilton Regional Cancer Centre, Ontario, Canada
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