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Jerusalem G, Farah S, Courtois A, Chirgwin J, Aebi S, Karlsson P, Neven P, Hitre E, Graas MP, Simoncini E, Abdi E, Kamby C, Thompson A, Loibl S, Gavilá J, Kuroi K, Marth C, Müller B, O'Reilly S, Gombos A, Ruhstaller T, Burstein HJ, Rabaglio M, Ruepp B, Ribi K, Viale G, Gelber RD, Coates AS, Loi S, Goldhirsch A, Regan MM, Colleoni M. Continuous versus intermittent extended adjuvant letrozole for breast cancer: final results of randomized phase III SOLE (Study of Letrozole Extension) and SOLE Estrogen Substudy. Ann Oncol 2021; 32:1256-1266. [PMID: 34384882 DOI: 10.1016/j.annonc.2021.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Late recurrences in postmenopausal women with hormone receptor-positive breast cancers remain an important challenge. Avoidance or delayed development of resistance represents the main objective in extended endocrine therapy (ET). In animal models, resistance was reversed with restoration of circulating estrogen levels during interruption of letrozole treatment. This phase III, randomized, open-label Study of Letrozole Extension (SOLE) studied the effect of extended intermittent letrozole treatment in comparison with continuous letrozole. In parallel, the SOLE estrogen substudy (SOLE-EST) analyzed the levels of estrogen during the interruption of treatment. PATIENTS AND METHODS SOLE enrolled 4884 postmenopausal women with hormone receptor-positive, lymph node-positive, operable breast cancer between December 2007 and October 2012 and among them, 104 patients were enrolled in SOLE-EST. They must have undergone local treatment and have completed 4-6 years of adjuvant ET. Patients were randomized between continuous letrozole (2.5 mg/day orally for 5 years) and intermittent letrozole treatment (2.5 mg/day for 9 months followed by a 3-month interruption in years 1-4 and then 2.5 mg/day during all of year 5). RESULTS Intention-to-treat population included 4851 women in SOLE (n = 2425 in the intermittent and n = 2426 in the continuous letrozole groups) and 103 women in SOLE-EST (n = 78 in the intermittent and n = 25 in the continuous letrozole groups). After a median follow-up of 84 months, 7-year disease-free survival (DFS) was 81.4% in the intermittent group and 81.5% in the continuous group (hazard ratio: 1.03, 95% confidence interval: 0.91-1.17). Reported adverse events were similar in both groups. Circulating estrogen recovery was demonstrated within 6 weeks after the stop of letrozole treatment. CONCLUSIONS Extended adjuvant ET by intermittent administration of letrozole did not improve DFS compared with continuous use, despite the recovery of circulating estrogen levels. The similar DFS coupled with previously reported quality-of-life advantages suggest intermittent extended treatment is a valid option for patients who require or prefer a treatment interruption.
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Affiliation(s)
- G Jerusalem
- International Breast Cancer Study Group, Bern, Switzerland; Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium.
| | - S Farah
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA
| | - A Courtois
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium
| | - J Chirgwin
- Breast Cancer Trials-Australia and New Zealand, University of Newcastle, Callaghan, Australia; Box Hill and Maroondah Hospitals, Monash University, Clayton, Australia
| | - S Aebi
- Division of Medical Oncology, Cancer Center, Lucerne Cantonal Hospital, Lucerne, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Neven
- Gynecologic Oncology and Multidisciplinary Breast Center, University Hospitals UZ-Leuven, KU Leuven, Leuven, Belgium
| | - E Hitre
- Department of Medical Oncology and Clinical Pharmacology "B", National Institute of Oncology, Budapest, Hungary
| | | | - E Simoncini
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Abdi
- The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - C Kamby
- Danish Breast Cancer Group and Rigshospitalet, Copenhagen, Denmark
| | - A Thompson
- Scottish Cancer Trials Breast Group and Division of Surgical Oncology, Baylor College of Medicine, Houston, USA
| | - S Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - J Gavilá
- SOLTI Group and Fundación Instituto Valenciano de Oncologia, Valencia, Spain
| | - K Kuroi
- Japan Breast Cancer Research Group and Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - C Marth
- Austrian Breast & Colorectal Cancer Study Group and Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Providencia, Santiago, Chile
| | - S O'Reilly
- Cancer Trials Ireland, Dublin, Ireland; University College Cork, Cork University Hospital, Cork, Ireland
| | - A Gombos
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - T Ruhstaller
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Breast Center St. Gallen, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - H J Burstein
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium; Harvard Medical School, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Rabaglio
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Ruepp
- International Breast Cancer Study Group, Bern, Switzerland
| | - K Ribi
- International Breast Cancer Study Group, Bern, Switzerland
| | - G Viale
- Department of Pathology, University of Milan, Milan, Italy; IEO European Institute of Oncology IRCCS, Milan, Italy
| | - R D Gelber
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard TH Chan School of Public Health, Boston, USA; Frontier Science Foundation, Boston, USA
| | - A S Coates
- International Breast Cancer Study Group, Bern, Switzerland; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - S Loi
- International Breast Cancer Study Group, Bern, Switzerland; Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group, Bern, Switzerland; IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Colleoni
- International Breast Cancer Study Group, Bern, Switzerland; Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Jerusalem G, Onesti C, Generali D, Harbeck N, Wildiers H, Curigliano G, Campone M, Tjan-Heijnen V, Martin M, Cristofanilli M, Pusztai L, Bartsch R, Peeters M, Berchem G, Tagliamento M, Cortés J, Ruhstaller T, Ciruelos E, Rottey S, Rugo H. LBA76_PR Expected medium and long term impact of the COVID-19 outbreak in oncology. Ann Oncol 2020. [PMCID: PMC7506324 DOI: 10.1016/j.annonc.2020.08.2317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Weber W, Henke G, Ribi K, Hayoz S, Seiler S, Maddox C, Ruhstaller T, Zwahlen D, Muenst S, Ackerknecht M, Fitzal F, Matrai Z, Újhelyi M, Kurzeder C, Lelièvre L, Tausch C, Heil J, Knauer M. 126TiP Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (SAKK 23/16 / IBCSG 57-18 / ABCSG-53 / GBG 101 - TAXIS): A multicenter randomized phase III trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ruhstaller T, Thuss-Patience P, Hayoz S, Schacher S, Knorrenschild JR, Schnider A, Plasswilm L, Budach W, Eisterer W, Hawle H, Mariette C, Hess V, Mingrone W, Montemurro M, Girschikofsky M, Schmidt SC, Bitzer M, Bedenne L, Brauchli P, Stahl M. Neoadjuvant chemotherapy followed by chemoradiation and surgery with and without cetuximab in patients with resectable esophageal cancer: a randomized, open-label, phase III trial (SAKK 75/08). Ann Oncol 2019; 29:1386-1393. [PMID: 29635438 DOI: 10.1093/annonc/mdy105] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background This open-label, phase III trial compared chemoradiation followed by surgery with or without neoadjuvant and adjuvant cetuximab in patients with resectable esophageal carcinoma. Patients and methods Patients were randomly assigned (1 : 1) to two cycles of chemotherapy (docetaxel 75 mg/m2, cisplatin 75 mg/m2) followed by chemoradiation (45 Gy, docetaxel 20 mg/m2 and cisplatin 25 mg/m2, weekly for 5 weeks) and surgery, with or without neoadjuvant cetuximab 250 mg/m2 weekly and adjuvant cetuximab 500 mg/m2 fortnightly for 3 months. The primary end point was progression-free survival (PFS). Results In total, 300 patients (median age, 61 years; 88% male; 63% adenocarcinoma; 85% cT3/4a, 90% cN+) were assigned to cetuximab (n = 149) or control (n = 151). The R0-resection rate was 95% for cetuximab versus 97% for control. Postoperative treatment-related mortality was 6% in both arms. Median PFS was 2.9 years [95% confidence interval (CI), 2.0 to not reached] with cetuximab and 2.0 years (95% CI, 1.5-2.8) with control [hazard ratio (HR), 0.79; 95% CI, 0.58-1.07; P = 0.13]. Median overall survival (OS) time was 5.1 years (95% CI, 3.7 to not reached) versus 3.0 years (95% CI, 2.2-4.2) for cetuximab and control, respectively (HR, 0.73; 95% CI, 0.52-1.01; P = 0.055). Time to loco-regional failure after R0-resection was significantly longer for cetuximab (HR 0.53; 95% CI, 0.31-0.90; P = 0.017); time to distant failure did not differ between arms (HR, 1.01; 95% CI, 0.64-1.59, P = 0.97). Cetuximab did not increase adverse events in neoadjuvant or postoperative settings. Conclusion Adding cetuximab to multimodal therapy significantly improved loco-regional control, and led to clinically relevant, but not-significant improvements in PFS and OS in resectable esophageal carcinoma. Clinical trial information NCT01107639.
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Affiliation(s)
- T Ruhstaller
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
| | | | - S Hayoz
- SAKK Coordinating Center, Berne, Switzerland
| | - S Schacher
- Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | | | - A Schnider
- City Hospital Triemli, Zürich, Switzerland
| | - L Plasswilm
- Cantonal Hospital of St. Gallen, St. Gallen, Switzerland; University of Berne, Berne, Switzerland
| | - W Budach
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - W Eisterer
- Medical University of Innsbruck, Innsbruck, Austria
| | - H Hawle
- SAKK Coordinating Center, Berne, Switzerland
| | - C Mariette
- Hôpital Universitaire C. Huriez, Lille, France
| | - V Hess
- University Hospital of Basel, Basel, Switzerland
| | - W Mingrone
- Cantonal Hospital of Olten, Olten, Switzerland
| | - M Montemurro
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - S C Schmidt
- Charité - University Medicine, Berlin, Germany
| | - M Bitzer
- University Hospital of Tübingen, Tübingen, Germany
| | - L Bedenne
- Hospital Center Regional University of Dijon, Dijon, France
| | - P Brauchli
- SAKK Coordinating Center, Berne, Switzerland
| | - M Stahl
- Kliniken Essen-Mitte, Essen, Germany
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Ruhstaller T, Langer R, Thuss-Patience P, Eisterer W, Stahl M. Reply to the letter to the editor 'Anti-EGFR therapy in oesophagogastric cancer: precise but not enough' by M. Salati and S. Cascinu. Ann Oncol 2018; 29:2026. [PMID: 32138979 DOI: 10.1093/annonc/mdy238] [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: 11/13/2022] Open
Affiliation(s)
- T Ruhstaller
- Department of Oncology and Haematology, Cantonal Hospital of St. Gallen, St. Gallen.
| | - R Langer
- Institute of Pathology, University Hospital of Berne, Berne, Switzerland
| | - P Thuss-Patience
- Department of Haematology, Oncology and Tumorimmunology, University Medicine, Berlin, Germany
| | - W Eisterer
- Medical Department, Medical University, Innsbruck, Austria
| | - M Stahl
- Medical Oncology, Kliniken Essen-Mitte, Essen, Germany
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Ribi K, Luo W, Colleoni M, Karlsson P, Chirgwin J, Aebi S, Jerusalem G, Neven P, Di Lauro V, Gomez HL, Ruhstaller T, Abdi E, Di Leo A, Müller B, Maibach R, Gelber RD, Goldhirsch A, Coates AS, Regan MM, Bernhard J. Abstract P5-18-01: Extended continuous vs intermittent adjuvant letrozole in postmenopausal women with lymph node-positive, early breast cancer (IBCSG 37-05/BIG 1-07 SOLE): Impact on patient-reported symptoms and quality of life. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-18-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: SOLE efficacy results presented at ASCO 2017 showed that extended intermittent vs continuous letrozole for 5 years did not improve disease-free survival in postmenopausal women who had received 4-6 years of adjuvant endocrine therapy for hormone-receptor positive (HR+), lymph-node positive breast cancer. Previous studies showed that the burden by symptoms related to endocrine therapy can be substantial. Even if symptoms improve during the treatment course, extending treatment implies continuation of symptoms. We compared differences in patient-reported symptoms (PRS) and quality of life (QoL) between extended continuous and intermittent letrozole over the first two years of trial treatment.
Methods: From Nov 2007 to Dec 2010, 956 postmenopausal women who were disease-free following 4-6 years of prior adjuvant endocrine therapy for HR+, node-positive breast cancer were enrolled in the QoL substudy of the randomized phase III trial SOLE at selected centers. Patients receive extended continuous letrozole (2.5 mg daily) for 5 years or intermittent letrozole, taken for the first 9 months of years 1-4, and 12 months in year 5. 955 patients completed the 18-item Breast Cancer Prevention Trial (BCPT) Symptom Scales and further symptom-specific and global QoL indicators at baseline, and at 6, 12, 18 and 24 months after randomization. Differences in change of PRS and QoL from baseline between the two administration schedules were tested at 12 and 24 months for 8 symptom scales, 4 additional symptom and 4 global QoL indicators using mixed models with repeated measures.
Results: Small changes in PRS and QoL scores were observed between baseline and 12 months after randomization, i.e. at the end of the first treatment-free interval in the intermittent arm. These changes showed a consistent pattern of greater worsening for patients receiving continuous compared to patients receiving intermittent letrozole. Patients receiving continuous letrozole reported a significantly greater worsening in vaginal problems (p<.02), musculoskeletal pain (p<.03), sleep disturbance (p<.01), physical wellbeing (p<.01) and mood (p<.03). At 24 months (after 2nd treatment-free interval) patients with intermittent letrozole reported a greater improvement in hot flushes (p<.03) than those with continuous letrozole. Changes in the other outcomes did not significantly differ between arms at 24 months.
Conclusion: Although changes in PRS and QoL were small, there was a consistent pattern favoring the intermittent arm. For several symptoms and global QoL indicators, significantly less worsening was observed with the intermittent administration, mainly during the first year of extended treatment, due to small improvements during the treatment-free interval. Froma QoL perspective, women who suffer from endocrine side-effects in the extended setting may benefit from an intermittent administration.
Citation Format: Ribi K, Luo W, Colleoni M, Karlsson P, Chirgwin J, Aebi S, Jerusalem G, Neven P, Di Lauro V, Gomez HL, Ruhstaller T, Abdi E, Di Leo A, Müller B, Maibach R, Gelber RD, Goldhirsch A, Coates AS, Regan MM, Bernhard J. Extended continuous vs intermittent adjuvant letrozole in postmenopausal women with lymph node-positive, early breast cancer (IBCSG 37-05/BIG 1-07 SOLE): Impact on patient-reported symptoms and quality of life [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-18-01.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group, Breast International Group
| | - W Luo
- International Breast Cancer Study Group, Breast International Group
| | - M Colleoni
- International Breast Cancer Study Group, Breast International Group
| | - P Karlsson
- International Breast Cancer Study Group, Breast International Group
| | - J Chirgwin
- International Breast Cancer Study Group, Breast International Group
| | - S Aebi
- International Breast Cancer Study Group, Breast International Group
| | - G Jerusalem
- International Breast Cancer Study Group, Breast International Group
| | - P Neven
- International Breast Cancer Study Group, Breast International Group
| | - V Di Lauro
- International Breast Cancer Study Group, Breast International Group
| | - HL Gomez
- International Breast Cancer Study Group, Breast International Group
| | - T Ruhstaller
- International Breast Cancer Study Group, Breast International Group
| | - E Abdi
- International Breast Cancer Study Group, Breast International Group
| | - A Di Leo
- International Breast Cancer Study Group, Breast International Group
| | - B Müller
- International Breast Cancer Study Group, Breast International Group
| | - R Maibach
- International Breast Cancer Study Group, Breast International Group
| | - RD Gelber
- International Breast Cancer Study Group, Breast International Group
| | - A Goldhirsch
- International Breast Cancer Study Group, Breast International Group
| | - AS Coates
- International Breast Cancer Study Group, Breast International Group
| | - MM Regan
- International Breast Cancer Study Group, Breast International Group
| | - J Bernhard
- International Breast Cancer Study Group, Breast International Group
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Schmid S, Klingbiel D, Goldhirsch A, Oehlschlegel C, Munzone E, Nolè F, Pestalozzi B, Aebi S, Rochlitz C, von Moos R, Zaman K, Mamot C, Weder P, Thuerlimann B, Pagani O, Ruhstaller T. Long-term responders to trastuzumab monotherapy in the first-line metastatic setting: characteristics and survival data (SAKK 22/99 Trial). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Regan MM, Walley BA, Francis PA, Fleming GF, Láng I, Gómez HL, Colleoni M, Tondini C, Pinotti G, Salim M, Spazzapan S, Parmar V, Ruhstaller T, Abdi EA, Gelber RD, Coates AS, Goldhirsch A, Pagani O. Concurrent and sequential initiation of ovarian function suppression with chemotherapy in premenopausal women with endocrine-responsive early breast cancer: an exploratory analysis of TEXT and SOFT. Ann Oncol 2017; 28:2225-2232. [PMID: 28911092 PMCID: PMC5834112 DOI: 10.1093/annonc/mdx285] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent breast cancer treatment guidelines recommend that higher-risk premenopausal patients should receive ovarian function suppression (OFS) as part of adjuvant endocrine therapy. If chemotherapy is also given, it is uncertain whether to select concurrent or sequential OFS initiation. DESIGN AND METHODS We analyzed 1872 patients enrolled in the randomized phase III TEXT and SOFT trials who received adjuvant chemotherapy for hormone receptor-positive, HER2-negative breast cancer and upon randomization to an OFS-containing adjuvant endocrine therapy, initiated gonadotropin-releasing-hormone-agonist triptorelin. Breast cancer-free interval (BCFI) was compared between patients who received OFS concurrently with chemotherapy in TEXT (n = 1242) versus sequentially post-chemotherapy in SOFT (n = 630). Because timing of trial enrollment relative to adjuvant chemotherapy differed, we implemented landmark analysis re-defining BCFI beginning 1 year after final dose of chemotherapy (median, 15.5 and 8.1 months from enrollment to landmark in TEXT and SOFT, respectively). As a non-randomized treatment comparison, we implemented comparative-effectiveness propensity score methodology with weighted Cox modeling. RESULTS Distributions of several clinico-pathologic characteristics differed between groups. Patients who were premenopausal post-chemotherapy in SOFT were younger on average. The median duration of adjuvant chemotherapy was 18 weeks in both groups. There were 231 (12%) BC events after post-landmark median follow-up of about 5 years. Concurrent use of triptorelin with chemotherapy was not associated with a significant difference in post-landmark BCFI compared with sequential triptorelin post-chemotherapy, either in the overall population (HR = 1.11, 95% CI 0.72-1.72; P = 0.72; 4-year BCFI 89% in both groups), or in the subgroup of 692 women <40 years at diagnosis (HR = 1.13, 95% CI 0.69-1.84) who are less likely to develop chemotherapy-induced amenorrhea. CONCLUSION Based on comparative-effectiveness modeling of TEXT and SOFT after about 5 years median follow-up, with limited statistical power especially for the subgroup <40 years, neither detrimental nor beneficial effect of concurrent administration of OFS with chemotherapy on the efficacy of adjuvant therapy that includes chemotherapy was detected. CLINICALTRIALS.GOV NCT00066690 and NCT00066703.
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Affiliation(s)
- M. M. Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
- International Breast Cancer Study Group Statistical Center, Boston, USA
| | - B. A. Walley
- University of Calgary and Canadian Cancer Trials Group, Calgary, Canada
| | - P. A. Francis
- Division of Cancer Medicine, Peter MacCallum Cancer Center, St Vincent’s Hospital, University of Melbourne, Melbourne
- Australia & New Zealand Breast Cancer Trials Group and International Breast Cancer Study Group, Melbourne, Australia
| | - G. F. Fleming
- The University of Chicago Medical Center and Alliance for Clinical Trials in Oncology, Chicago, USA
| | - I. Láng
- National Institute of Oncology and International Breast Cancer Study Group, Medical Oncology, Budapest, Hungary
| | - H. L. Gómez
- Division of Medicine, Instituto Nacional de Enfermedades Neoplásicas and International Breast Cancer Study Group, Lima, Peru
| | - M. Colleoni
- Division of Medical Senology, European Institute of Oncology and International Breast Cancer Study Group, Milan
| | - C. Tondini
- Medical Oncology, Ospedale Papa Giovanni XXIII and International Breast Cancer Study Group, Bergamo
| | - G. Pinotti
- Medical Oncology, ASST Sette Laghi-Ospedale di Circolo and Fondazione Macchi and International Breast Cancer Study Group, Varese, Italy
| | - M. Salim
- Allan Blair Cancer Center, Regina, Canada
| | - S. Spazzapan
- Medical Oncology, Centro di Riferimento Oncologico and International Breast Cancer Study Group, Aviano, Italy
| | - V. Parmar
- Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre and International Breast Cancer Study Group, Mumbai, India
| | - T. Ruhstaller
- Breast Center St. Gallen, Swiss Group for Clinical Cancer Research (SAKK) , St. Gallen
- International Breast Cancer Study Group, St. Gallen, Switzerland
| | - E. A. Abdi
- Australia & New Zealand Breast Cancer Trials Group and International Breast Cancer Study Group, The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - R. D. Gelber
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston
- Harvard T.H. Chan School of Public Health, Frontier Science and Technology Research Foundation, Boston, USA
| | - A. S. Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - A. Goldhirsch
- European Institute of Oncology and International Breast Cancer Study Group, Milan, Italy
| | - O. Pagani
- Oncology Institute of Southern Switzerland, Swiss Group for Clinical Cancer Research (SAKK), Bellinzona
- International Breast Cancer Study Group, Lugano, Viganello, Switzerland
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Fehr M, Hawle H, Hayoz S, Thuss-Patience P, Schacher S, Riera Knorrenschild J, Dürr D, Knoefel W, Rumpold H, Bitzer M, Zweifel M, Samaras P, Mey U, Winterhalden R, Kueng M, Eisterer W, Hess V, Gerard MA, Stahl M, Ruhstaller T. High thromboembolic event rate in patients with locally advanced esophageal cancer during perioperative therapy: A pre-planned analysis of the intergroup phase III trial SAKK 75/08. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pagani O, Klingbiel D, Ruhstaller T, Nolè F, Eppenberger S, Oehlschlegel C, Bernhard J, Brauchli P, Hess D, Mamot C, Munzone E, Pestalozzi B, Rabaglio M, Aebi S, Ribi K, Rochlitz C, Rothgiesser K, Thürlimann B, von Moos R, Zaman K, Goldhirsch A. Do all patients with advanced HER2 positive breast cancer need upfront-chemo when receiving trastuzumab? Randomized phase III trial SAKK 22/99. Ann Oncol 2017; 28:305-312. [DOI: 10.1093/annonc/mdw622] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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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Matter-Walstra K, Ruhstaller T, Klingbiel D, Schwenkglenks M, Dedes KJ. Palbociclib as a first-line treatment in oestrogen receptor-positive, HER2-negative, advanced breast cancer not cost-effective with current pricing: a health economic analysis of the Swiss Group for Clinical Cancer Research (SAKK). Breast Cancer Res Treat 2016; 158:51-57. [PMID: 27277747 DOI: 10.1007/s10549-016-3822-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 12/14/2022]
Abstract
Endocrine therapy continues to be the optimal systemic treatment for metastatic ER(+)HER2(-) breast cancer. The CDK4/6 inhibitor palbociclib combined with letrozole has recently been shown to significantly improve progression-free survival. Here we examined the cost-effectiveness of this regimen for the Swiss healthcare system. A Markov cohort simulation based on the PALOMA-1 trial (Finn et al. in Lancet Oncol 16:25-35, 2015) was used as the clinical course. Input parameters were based on summary trial data. Costs were assessed from the Swiss healthcare system perspective. Adding palbociclib to letrozole (PALLET) compared to letrozole monotherapy was estimated to cost an additional CHF342,440 and gain 1.14 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio (ICER) of CHF301,227/QALY gained. In univariate sensitivity analyses, no tested variation in key parameters resulted in an ICER below a willingness-to-pay threshold of CHF100,000/QALY. PALLET had a 0 % probability of being cost-effective in probabilistic sensitivity analyses. Lowering PALLET's price by 75 % resulted in an ICER of CHF73,995/QALY and a 73 % probability of being cost-effective. At current prices, PALLET would cost the Swiss healthcare system an additional CHF155 million/year. Palbociclib plus letrozole cannot be considered cost-effective for the first-line treatment of patients with metastatic breast cancer in the Swiss healthcare system.
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Affiliation(s)
- K Matter-Walstra
- Institute of Pharmaceutical Medicine (ECPM), University Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland. .,Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, 3008, Bern, Switzerland.
| | - T Ruhstaller
- Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, 3008, Bern, Switzerland.,Breast Centre, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St.Gallen, Switzerland
| | - D Klingbiel
- Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, 3008, Bern, Switzerland
| | - M Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - K J Dedes
- Swiss Group of Clinical Cancer Research (SAKK) Coordinating Centre, Effingerstrasse 40, 3008, Bern, Switzerland.,Department of Gynaecology, University Hospital Zürich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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12
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Panje C, Höng L, Henke G, Ruhstaller T, Guckenberger M, Baracos V, Plasswilm L. EP-1261: Impact of sarcopenia on adverse effects in trimodality therapy for esophageal carcinoma. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Pestalozzi B, Tausch C, Dedes K, Rochlitz C, Zimmermann S, Von Moos R, Winterhalder R, Ruhstaller T, Mueller A, Buser K, Borner M, Novak U, Uhlmann Nussbaum C, Seifert B, Bigler M, Bize V, Berardi Vilei S, Rageth C, Aebi S. 1943 Adjuvant treatment recommendations for ER+ early breast cancer patients by Swiss tumor boards (SAKK 26/10). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30891-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Jonat W, Bachelot T, Ruhstaller T, Kuss I, Reimann U, Robertson J. Randomized phase II study of lonaprisan as second-line therapy for progesterone receptor-positive breast cancer. Ann Oncol 2013; 24:2543-2548. [DOI: 10.1093/annonc/mdt216] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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15
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Koeberle D, Ruhstaller T, Jost L, Pagani O, Zaman K, von Moos R, Oehlschlegel C, Crowe S, Pilop C, Thuerlimann B. Combination of trastuzumab and letrozole after resistance to sequential trastuzumab and aromatase inhibitor monotherapies in patients with estrogen receptor-positive, HER-2-positive advanced breast cancer: a proof-of-concept trial (SAKK 23/03). Endocr Relat Cancer 2011; 18:257-64. [PMID: 21317203 DOI: 10.1530/erc-10-0317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A sequential treatment design was chosen in this trial to ensure complete resistance to single-agent non-steroidal aromatase inhibitor (AI) and trastuzumab both given as monotherapy before receiving the combination of a non-steroidal AI and trastuzumab. Key eligibility criteria included postmenopausal patients with advanced, measurable, human epidermal growth factor receptor-2 (HER-2)-positive disease (assessed by FISH, ratio (≥2)), hormone receptor (HR)-positive disease, and progression on prior treatment with a non-steroidal AI, e.g. letrozole or anastrozole, either in the adjuvant or in the advanced setting. Patients received standard dose trastuzumab monotherapy in step 1 and upon disease progression continued trastuzumab in combination with letrozole in step 2. The primary endpoint was clinical benefit rate (CBR) in step 2. Totally, 13 patients were enrolled. In step 1, six patients (46%) achieved CBR. Median time to progression (TTP) was 161 days (95% confidence interval (CI): 82-281). In step 2, CBR was observed in eight out of the 11 evaluable patients (73%), including one patient with partial response. Median TTP for all the 11 patients was 188 days (95% CI: 77-not reached). Results of this proof-of-concept trial suggest that complete resistance to both AI and trastuzumab can be overcome in a proportion of patients by combined treatment of AI and trastuzumab, as all patients served as their own control. Our results appear promising for a new treatment strategy that offers a chemotherapy-free option for at least a subset of patients with HR-positive, HER-2-positive breast cancer over a clinically relevant time period.
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Affiliation(s)
- D Koeberle
- Division of Oncology/Hematology, Department of Internal Medicine, Kantonsspital St Gallen, CH-9007 St Gallen, Switzerland.
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16
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Rochlitz C, Ruhstaller T, Lerch S, Spirig C, Huober J, Suter T, Bühlmann M, Fehr M, Schönenberger A, von Moos R, Winterhalder R, Rauch D, Müller A, Mannhart-Harms M, Herrmann R, Cliffe B, Mayer M, Zaman K. Combination of bevacizumab and 2-weekly pegylated liposomal doxorubicin as first-line therapy for locally recurrent or metastatic breast cancer. A multicenter, single-arm phase II trial (SAKK 24/06). Ann Oncol 2011; 22:80-85. [DOI: 10.1093/annonc/mdq319] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Zaman K, Rochlitz C, Ruhstaller T, Thürlimann B, Aebi S, von Moos R, Mamot C, Gabriel N, Rossier-Pansier L, Stupp R, Crowe S, Ruegg C. Abstract P2-16-07: hMMP9 as Predictive Factor for Response and Progression Free Survival in Breast Cancer Patients Treated with Bevacizumab and Pegylated Liposomal Doxorubicin (PLD). Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-16-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The anti-angiogenic drug, bevacizumab (Bv), is currently used in the treatment of different malignancies including breast cancer. Many angiogenesis-associated molecules are found in the circulation of cancer patients. Until now, there are no prognostic or predictive factors identified in breast cancer patients treated with Bv. We present here the first results of the prospective monitoring of 6 angiogenesis-related molecules in the peripheral blood of breast cancer patients treated with a combination of Bv and PLD in the phase II trial, SAKK 24/06. Methods: Patients were treated with PLD (20 mg/m2) and Bv (10 mg/kg) on days 1 and 15 of each 4-week cycle for a maximum of 6 cycles, followed by Bv monotherapy maintenance (10 mg/m2 q2 weeks) until progression or severe toxicity. Plasma and serum samples were collected at baseline, after 2 months of therapy, then every 3 months and at treatment discontinuation. Enzyme-linked immunosorbent assays (Quantikine, R&D Systems and Reliatech) were used to measure the expression levels of human vascular endothelial growth factor (hVEGF), placental growth factor (hPlGF), matrix metalloproteinase 9 (hMMP9) and soluble VEGF receptors hsVEGFR-1, hsVEGFR-2 and hsVEGFR-3. The log-transformed data (to reduce the skewness) for each marker was analyzed using an analysis of variance (ANOVA) model to determine if there was a difference between the mean of the subgroups of interest (where α = 0.05). The untransformed data was also analyzed in the same manner as a “sensitivity” check.
Results: 132 blood samples were collected in 41 out of 43 enrolled patients. Baseline levels of the molecules were compared to disease status according to RECIST. There was a statistically significant difference in the mean of the log-transformed levels of hMMP9 between responders [CR+PR] versus the mean in patients with PD (p-value=0.0004, log fold change=0.7536), and between patients with disease control [CR+PR+SD] and those with PD (p-value=<0.0001, log fold change=0.81559), with the log-transformed level of hMMP9 being higher for the responder group. The mean of the log-transformed levels of hsVEGFR-1 was statistically significantly different between patients with disease control [CR+PR+SD] and those with PD (p-value=0.0068, log fold change=-0.6089), where the log-transformed level of hsVEGFR-1 was lower for the responder group. The log-transformed level of hMMP9 at baseline was identified as a significant prognostic factor in terms of progression free survival (PFS): p-value=0.0417, hazard ratio (HR)=0.574 with a corresponding 95% confidence interval (0.336 — 0.979)). No strong correlation was shown either between the log-transformed levels of hsVEGF, hPlGF, hsVEGFR-2 or hsVEGFR-3 and clinical response or the occurrence of severe toxicity, or between the levels of the different molecules.
Conclusions: Our results suggest that baseline plasma level of the matrix metalloproteinase, hMMP9, could predict tumor response and PFS in patients treated with a combination of Bv and PLD. These data justify further investigation in breast cancer patients treated with anti-angiogenic therapy.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-16-07.
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Affiliation(s)
- K Zaman
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - C Rochlitz
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - T Ruhstaller
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - B Thürlimann
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - S Aebi
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - R von Moos
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - C Mamot
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - N Gabriel
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - L Rossier-Pansier
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - R Stupp
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - S Crowe
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
| | - C. Ruegg
- CePO, University Hospital, Lausanne, Switzerland; University Hospital Basel, Switzerland; Kantonsspital St. Gallen, Switzerland; University Hospital Bern, Switzerland; Kantonsspital Chur, Switzerland; Kantonsspital Aarau, Switzerland; University Hospital Zürich, Switzerland; Statistics Unit, SAKK Coordination Center, Bern, Switzerland
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18
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Rao S, Starling N, Cunningham D, Sumpter K, Gilligan D, Ruhstaller T, Valladares-Ayerbes M, Wilke H, Archer C, Kurek R, Beadman C, Oates J. Matuzumab plus epirubicin, cisplatin and capecitabine (ECX) compared with epirubicin, cisplatin and capecitabine alone as first-line treatment in patients with advanced oesophago-gastric cancer: a randomised, multicentre open-label phase II study. Ann Oncol 2010; 21:2213-2219. [PMID: 20497967 DOI: 10.1093/annonc/mdq247] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical data showed promising antitumour activity with feasible tolerability for matuzumab plus epirubicin, cisplatin and capecitabine (ECX) chemotherapy in untreated advanced oesophago-gastric (OG) cancer. The aim was to evaluate the efficacy of matuzumab plus ECX versus ECX alone. PATIENTS AND METHODS In this multicentre, randomised open-label phase II study, 72 patients with metastatic OG cancer were randomly assigned to either 800 mg matuzumab weekly plus epirubicin 50 mg/m², cisplatin 60 mg/m² on day 1 and capecitabine 1250 mg/m² daily in a 21-day cycle (ECX) or the same ECX regimen alone. The primary end point was objective response. Secondary end points included progression-free survival (PFS), overall survival (OS), quality of life, safety and tolerability. RESULTS Following random assignment, 35 patients (median age 59 years) received ECX/matuzumab and 36 patients (median age 64 years) ECX. The addition of matuzumab to ECX did not improve objective response: 31% for ECX/matuzumab [95% confidence interval (CI) 17-49] compared with 58% for the ECX arm (95% CI 41-74) P = 0.994 (one sided). There was no significant difference in median PFS: 4.8 months (95% CI 2.9-8.1) for ECX/matuzumab versus 7.1 months (95% CI 4.4-8.5) for ECX, or in median OS: 9.4 months (95% CI 7.5-16.2), compared with 12.2 months (95% CI 9.8-13.8 months). Grade 3/4 treatment-related toxicity was observed in 27 and 25 patients in the ECX/matuzumab and ECX groups, respectively. CONCLUSION Matuzumab 800 mg weekly combined with ECX chemotherapy does not increase response or survival for patients with advanced OG cancer. Therefore, ECX/matuzumab should not be examined further in phase III trials.
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Affiliation(s)
- S Rao
- Gastrointestinal Unit, Royal Marsden Hospital, London and Surrey, UK
| | - N Starling
- Gastrointestinal Unit, Royal Marsden Hospital, London and Surrey, UK
| | - D Cunningham
- Gastrointestinal Unit, Royal Marsden Hospital, London and Surrey, UK.
| | - K Sumpter
- Oncology Department, Newcastle General Hospital, Newcastle, UK
| | - D Gilligan
- Oncology Department, Addenbrooke's NHS Trust, Cambridge, UK
| | - T Ruhstaller
- Department of Haematology and Oncology, St Gallen, Switzerland
| | - M Valladares-Ayerbes
- Department of Medical Oncology, Complejo Hospitalario Juan Canalejo, A Coruña, Spain
| | - H Wilke
- Oncology Department, Kliniken Essen-Mitte, Essen, Germany
| | - C Archer
- Oncology Department, St Mary's Hospital, Portsmouth, UK
| | - R Kurek
- Gastrointestinal Oncology, Merck Serono, Darmstadt, Germany
| | - C Beadman
- Gastrointestinal Oncology, Merck Serono, Darmstadt, Germany
| | - J Oates
- Gastrointestinal Unit, Royal Marsden Hospital, London and Surrey, UK
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19
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Ruhstaller T, Widmer L, Schuller J, Roth A, Hess V, Mingrone W, von Moos R, Borner M, Pestalozzi B, BalmerMajno S, Köberle D, Terraciano L, Schnider A, Bodis S, Popescu R. Multicenter phase II trial of preoperative induction chemotherapy followed by chemoradiation with docetaxel and cisplatin for locally advanced esophageal carcinoma (SAKK 75/02). Ann Oncol 2009; 20:1522-1528. [DOI: 10.1093/annonc/mdp045] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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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20
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Rochlitz C, Spirig C, Ruhstaller T, Suter T, Bühlmann M, Fehr M, Schönenberger A, Lerch S, Mayer M, Zaman K. Bevacizumab and pegylated liposomal doxorubicin as first-line therapy for locally recurrent or metastatic breast cancer: A multicenter, single-arm phase II trial of the Swiss Group for Clinical Cancer Research (SAKK). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1030] [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
1030 Background: Bevacizumab in combination with taxanes has become a standard first-line treatment of advanced breast cancer in some countries, but there is no information on its use in combination with pegylated lipsomal doxorubicin in metastatic breast cancer. Therefore, we performed a multicenter, single-arm phase II trial to evaluate the toxicity and efficacy of pegylated liposomal doxorubicin (PLD) and bevacizumab (B) as first-line treatment in advanced breast cancer. Methods: PLD at a dose of 20 mg/m2 and B at 10 mg/kg were infused on days 1 and 15 of each 4-week cycle for a maximum of 6 cycles. Thereafter, B monotherapy was continued at the same dose until progression or toxicity. Primary endpoint was the occurrence of specific toxic events known to strongly interfere with quality of life, i.e., severe cardiac toxicity, any grade 4/5 toxicity, and selected grade 3 nonhematological toxicities (hand-foot-syndrome, cognitive disturbance, CNS hemorrhage, and mucositis/stomatitis). Secondary endpoints included overall response, progression free survival (PFS), time to treatment failure, and duration of response. Eligibility criteria included documentation of metastatic or inoperable breast cancer; measurable disease according to RECIST; erbB2-negativity; LVEF of ≥ 55%; WHO performance status 0 or 1. The study used a Herndon's two-stage design with 14 and 29 patients for stages 1 and 2, respectively. The promising rate of primary toxicity was <15% and the uninteresting rate >33%. The type I error probability was 5% and the power 80%. Results: The trial had to be stopped prematurely because of toxicity after the enrollment of 41 evaluable patients. Among these patients, 16 (39%) had grade 3 hand-foot syndrome, 1 grade 3 mucositis and 1 grade 4 cardiac toxicity. Thus, a total of 18/41 (44%, exact 95% c.i. 28–60%) of all patients had a primary toxicity. Best overall response rate was 23.3% (exact 95% c.i. 12–39%), median PFS was 7.5 months (95% c.i. 4.6–8.1 months). Conclusions: The combination of 2-weekly PLD and B in advanced breast cancer is surprisingly toxic and only modestly active and should not be further investigated. [Table: see text]
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Affiliation(s)
- C. Rochlitz
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - C. Spirig
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - T. Ruhstaller
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - T. Suter
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - M. Bühlmann
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - M. Fehr
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - A. Schönenberger
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - S. Lerch
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - M. Mayer
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
| | - K. Zaman
- University Hospital, Basel, Switzerland; Brustzentrum, St. Gallen, Switzerland; Inselspital, Bern, Switzerland; University Hospital, Zürich, Switzerland; Kantonsspital, Aarau, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland
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Ruhstaller T, Pless M, Schuller JC, Kranzbühler H, von Moos R, Moosmann P, Rauch D, Montemurro M, Schneider PM, Hess V. Cetuximab in combination with chemoradiotherapy prior to surgery in patients with resectable, locally advanced esophageal carcinoma: A prospective, multicenter phase lb-ll trial of the Swiss Group for Clinical Cancer Research (SAKK 75/06). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4570 Background: Cetuximab significantly enhances efficacy of radiotherapy and chemotherapy in head and neck cancer. We investigated the safety and feasibility of adding cetuximab to neoadjuvant chemoradiation of locally advanced esophageal cancer. Methods: Pts with resectable, locally advanced squamous cell carcinoma (SCC) or adenocarcinoma (AC) of the thoracic esophagus or gastroesophageal junction (staged by EUS, CT and PET scan) were treated with 2 cycles of induction chemotherapy (docetaxel 75mg/m2, cisplatin 75mg/m2 q3w and weekly cetuximab 250mg/m2), followed by concomitant chemo- immuno-radiation therapy (CIRT: docetaxel 20mg/m2, cisplatin 25mg/m2 and cetuximab 250mg/m2 weekly five times concomitant with 45 Gy radiotherapy in 25 fractions); followed by surgery 4–8 weeks later. The phase I part consisted of 2 cohorts of 7 patients each, without and with docetaxel during CIRT, respectively. Interpatient dose-escalation (adding docetaxel during CIRT) was possible if < 2 out of 7 pts of the 1st cohort experienced limiting toxicity. Having finished the phase 1 part, 13 additional patients were treated with docetaxel-containing CIRT in a phase II part. Pathological response was evaluated according to the Mandard classification. Results: 27 pts from 12 institutions were included. As of today, results from 20 pts are available (cohort 1: 7, cohort 2: 7, phase ll : 6). Median age was 64yrs (range 47–71). 11 AC; 9 SCC. 19 pts (95%) completed CIRT (1 pt stopped treatment during induction therapy due to sepsis). 17 pts underwent resection (no surgery: 1pt for PD, 1pt for cardiac reasons). Grade 3 toxicities during CIRT included anorexia 15%, dysphagia/esophagitis 15%, fatigue 10%, nausea 10%, pruritus 5%, dehydration 5%, nail changes 5% and rash 5% .1 pt suffered from pulmonary embolism. 13 pts (65%, intention-to-treat) showed a complete or near complete pathological remission (cohort 1: 5, cohort 2: 4, phase II: 4). Conclusions: Adding cetuximab to preoperative chemoradiation for esophageal cancer is safe and feasible in a community-based multicenter setting. Antineoplastic activity is encouraging with 65% pathological responders. [Table: see text]
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Affiliation(s)
- T. Ruhstaller
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - M. Pless
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - J. C. Schuller
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - H. Kranzbühler
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - R. von Moos
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - P. Moosmann
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - D. Rauch
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - M. Montemurro
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - P. M. Schneider
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - V. Hess
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
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Schuller JC, Balmer-Majno S, Mingrone W, Hess V, von Moos R, Borner M, Schnider A, Koeberle D, Popescu RA, Ruhstaller T. Preoperative induction chemotherapy with docetaxel-cisplatin followed by concurrent docetaxel-cisplatin and radiation therapy (RT) in patients with locally advanced esophageal cancer: Final results of the multicenter phase ll trial SAKK 75/02. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cathomas R, Köberle D, Ruhstaller T, Mayer G, Räss A, von Moos R. Heated oxaliplatin infusion (37°C) in combination with capecitabine for metastatic colorectal cancer: Can it reduce oxaliplatin-associated neuropathy? J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Borner M, Koeberle D, Von Moos R, Saletti P, Rauch D, Hess V, Trojan A, Helbling D, Pestalozzi B, Caspar C, Ruhstaller T, Roth A, Kappeler A, Dietrich D, Lanz D, Mingrone W. Adding cetuximab to capecitabine plus oxaliplatin (XELOX) in first-line treatment of metastatic colorectal cancer: a randomized phase II trial of the Swiss Group for Clinical Cancer Research SAKK. Ann Oncol 2008; 19:1288-1292. [PMID: 18349029 DOI: 10.1093/annonc/mdn058] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To determine the activity and tolerability of adding cetuximab to the oxaliplatin and capecitabine (XELOX) combination in first-line treatment of metastatic colorectal cancer (MCC). PATIENTS AND METHODS In a multicenter two-arm phase II trial, patients were randomized to receive oxaliplatin 130 mg/m(2) on day 1 and capecitabine 1000 mg/m(2) twice daily on days 1-14 every 3 weeks alone or in combination with standard dose cetuximab. Treatment was limited to a maximum of six cycles. RESULTS Seventy-four patients with good performance status entered the trial. Objective partial response rates after external review and radiological confirmation were 14% and 41% in the XELOX and in the XELOX + Cetuximab arm, respectively. Stable disease has been observed in 62% and 35% of the patients, with 76% disease control in both arms. Cetuximab led to skin rash in 65% of the patients. The median overall survival was 16.5 months for arm A and 20.5 months for arm B. The median time to progression was 5.8 months for arm A and 7.2 months for arm B. CONCLUSION Differences in response rates between the treatment arms indicate that cetuximab may improve outcome with XELOX. The correct place of the cetuximab, oxaliplatin and fluoropyrimidine combinations in first-line treatment of MCC has to be assessed in phase III trials.
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Affiliation(s)
- M Borner
- Institute of Medical Oncology, Inselspital, Bern, Switzerland.
| | - D Koeberle
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - R Von Moos
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - P Saletti
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Rauch
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - V Hess
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Trojan
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Helbling
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - B Pestalozzi
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - C Caspar
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - T Ruhstaller
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Roth
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - A Kappeler
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Dietrich
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - D Lanz
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
| | - W Mingrone
- Institute of Medical Oncology, Inselspital, Bern, Switzerland
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- Institute of Medical Oncology, Inselspital, Bern, Switzerland
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Koeberle D, Saletti P, Borner M, Caspar C, Strasser F, Ruhstaller T, Mora O, Dietrich D, Gerber D, Herrmann R. 3524 POSTER High rate of clinical benefit response in patients with advanced biliary tract cancer receiving gemcitabine plus capecitabine. A prospective, multicenter phase II trial of the Swiss Group for Clinical Cancer Research (SAKK 44/02). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Köberle D, Burkhard R, Von Moos R, Winterhalder R, Hess V, Heitzmann F, Ruhstaller T, Terraciano L, Bieri G, Töpfer M. 3029 POSTER A Swiss multicentre phase II study of capecitabine plus oxaliplatin (CAPOX) in combination with preoperative pelvic radiotherapy in patients (pts) with locally advanced rectal cancer. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Jost C, Schuller JC, Meyenberger C, Bauerfeind P, Moosmann P, Frossard JL, von Moos R, Koeberle D, Metzger U, Ruhstaller T. Response evaluation with endoscopic ultrasound (EUS) measuring maximum tumor thickness to predict pathological response after neoadjuvant chemoradiation therapy (CRT) in patients with locally advanced esophageal cancer (EC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15009] [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
15009 Background: EUS does not accurately assess T-stage after neoadjuvant CRT due to inflammation, necrosis and fibrosis. We evaluated whether maximum tumor thickness (MTT) can predict pathological response (tumor regression grade, TRG) after CRT. Methods: Patients (pts) with resectable, locally advanced EC, were treated with 2 cycles of docetaxel/cisplatin (DC) q3w followed by CRT (DC weekly x5 with concomitant 45 Gy radiation therapy) and surgery. Radial scan EUS (7.5MHz) measured MTT at baseline and 3–5 weeks after CRT completion. We prospectively hypothesized that MTT =6mm in the second EUS predicts complete and subtotal pathological response (TRG1 and 2), tested by logistic regression. The effect of >50% reduction of MTT was analysed as well. Results: 66 pts from 11 institutions were treated; median age 61y (35–70y); adenocarcinoma (AC) 53%; squamous cell carcinoma 46%; 40 pts were eligible for the EUS project (10 no surgery, 10 tumor stenosis prohibiting EUS, 5 MTT not measured, 1 intolerant to EUS). Initial EUS staging: 9 uT2N1, 3 uT3N0, 27 uT3N1, 1 uT3Nx; Siewert-type-1 in 13 of 22 AC. Reduction of MTT to =6mm correctly predicted TRG1/2 with sensitivity (sens) 45%, specificity (spec) 90%, negative predictive value (NPV) 62%, and positive predictive value (PPV) 82%, the Iogistic regression model showed a trend predicting response only (OR 0.80; C.I. 0.62–1.03; p=0.082). Reduction of MTT >50% predicted TRG1/2 with sens 40%, spec 75%, NPV 56% and PPV 62%. Conclusions: The absolute value of maximum tumor thickness =6mm in the second EUS correctly predicts a good response to CRT in 82% (spec 90%) - rather than the relative reduction of MTT >50% -, but does not identify all responders. Feasibility in this multicenter setting was limited by exclusions due to tumor stenosis and incomplete measurements. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- C. Jost
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - J. C. Schuller
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - C. Meyenberger
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - P. Bauerfeind
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - P. Moosmann
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - J. L. Frossard
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R. von Moos
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D. Koeberle
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - U. Metzger
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
| | - T. Ruhstaller
- Swiss Group of Clinical Cancer Research (SAKK), Bern, Switzerland
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Ribi K, Nitzsche E, Schuller J, Klaeser B, Hany T, Roth A, Hess V, Zuend M, Lombriser N, Ruhstaller T. PET scanning and patient reported dysphagia before and after chemotherapy (CT) for prediction of pathological response after CT and chemoradiotherapy (CRT) in patients with locally advanced esophageal cancer (EC): A multicenter phase ll trial of the Swiss. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4587 Background: Only responding patients (pts) ultimately benefit from preoperative therapy for locally advanced EC. To predict response quality after CRT and detect non-responders earlier, we evaluated changes from baseline in FDG uptake by PET scans and patient reported dysphagia after two cycles of CT. Methods: Pts with resectable, locally advanced squamous cell carcinoma or adenocarcinoma of the esophagus were treated with 2 cycles of CT with docetaxel/cisplatin (DC) q3w followed by CRT (DC weekly x5 with concomitant 45 Gy RT) and surgery. PET imaging using [F]-deoxyglucose (FDG) uptake and subjective dysphagia assessment using a quality of life module specific to EC (EORTC QLQ-OES24) were performed at baseline and after the 2nd cycle of CT. 40% decrease of FDG uptake was prospectively hypothesized to be an early predictor for a pathological complete remission (tumor regression grade 1, TRG) and subtotal regression (TRG 2) after the CRT. The predictive value of improvement in dysphagia was tested by analysis of covariance with baseline dysphagia as covariate. Results: Out of included 66 pts, 56 completed preoperative therapy and surgery. Dysphagia scores (range 0–100) were available in 51 pts, mean changes were 14 (n=13), 12 (n=16) and 12 (n=22) for pts with TRG 1, 2 or >2, respectively, lacking any significance. 44 pts had two PET scans (5: centers not participating, 3: no FDG-uptake at baseline, 4: second scan too late or not done). Mean FDG-decrease was 49% (n=7), 44% (n=17), 15% (n=20) for pts with TRG 1, 2 or >2, respectively. Less than 40% reduction in FDG uptake predicted non-response (TRG>2) with sensitivity 70%, specificity 50%, negative predictive value 70% and positive predictive value 50%. FDG- uptake reduction indicated reduced risk of TRG>2 in a logistic regression model (p<0.01, 95%-CI 2–273). Conclusions: Decreased FDG uptake in sequential PET scans strongly correlates with tumor response, but is not accurate enough to early identify non- responders. Early improvement of dysphagia after 2 cycles CT did not predict TRG after CRT. No significant financial relationships to disclose.
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Affiliation(s)
- K. Ribi
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - E. Nitzsche
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - J. Schuller
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - B. Klaeser
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - T. Hany
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - A. Roth
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - V. Hess
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - M. Zuend
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - N. Lombriser
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - T. Ruhstaller
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
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Ruhstaller T, Widmer L, Balmer Majno S, Mingrone W, Hess V, von Moos R, Borner M, Schnider A, Koeberle D, Popescu R. Preoperative induction chemotherapy with docetaxel-cisplatin followed by concurrent docetaxel-cisplatin and radiation therapy in patients with locally advanced esophageal cancer: A prospective, multicenter phase ll trial of the Swiss Group for Clinical Cancer Research. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4562] [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
4562 Background: The role of preoperative therapy in patients (pts) with locally advanced esophageal cancer remains unclear. Non-randomized and randomized studies were often performed in single and highly specialized centers. The purpose of this study was to investigate 1) the efficacy and toxicity of preoperative docetaxel-cisplatin together with radiation therapy (RT) 2) the feasibility of a complex preoperative strategy in a community-based multicenter setting. Methods: Eligibility criteria: resectable, locally advanced (uT3 or uN1, T4 if deemed resectable) squamous cell carcinoma (SCC) or adenocarcinoma (AC) of the thoracic esophagus or gastroesophageal junction (Siewert type l); staged by EUS, CT and PET scan; age 18–70y; PS <2; normal organ functions. Treatment: 2 cycles of docetaxel 75mg/m2 and cisplatin 75mg/m2 q3w, followed by weekly x5 docetaxel 20mg/m2 and cisplatin 25mg/m2 with concomitant 45 Gy RT in 25 fractions; surgery 3- 8 weeks after RT. A two stage-design was used with two primary endpoints: 1) efficacy (TRG : tumor regression grade ); 2) feasibility (successful completion of entire therapy and being alive 30 days after surgery). Results: 66 pts, 56 males, were included from 11 institutions; median age 61y (35–70y); AC 53%; SCC 46%; 53 pts (80%) completed the preoperative therapy, underwent resection and were alive 30 days after surgery; 10 pts (15%) had no resection (4 progressive disease, 4 medical reasons, 2 patient’s refusal). Of 56 (85%) pts who had surgery, 51 pts had RO-resection (91%), 5 pts (9%) died due to complications after surgery (3 after > 30 days). Conclusion: Our trimodality treatment shows encouraging antineoplastic activity with 57% histopathological responders (TRG1 and 2) and acceptable feasibility in a community-based multicenter setting. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- T. Ruhstaller
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - L. Widmer
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - S. Balmer Majno
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - W. Mingrone
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - V. Hess
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R. von Moos
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - M. Borner
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - A. Schnider
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - D. Koeberle
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - R. Popescu
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
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Ribi K, Bernhard J, Rufibach K, Thürlimann B, von Moos R, Ruhstaller T, Glaus A, Böhme C. Endocrine symptom assessment in women with breast cancer: what a simple “yes” means. Support Care Cancer 2007; 15:1349-56. [PMID: 17530302 DOI: 10.1007/s00520-007-0258-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/20/2006] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
Abstract
GOALS OF WORK To investigate the self-reported symptoms related to endocrine therapy in women with early or advanced breast cancer and the impact of these symptoms on quality of life (QL) indicators. MATERIALS AND METHODS Symptom occurrence was assessed by the Checklist for Patients on Endocrine Therapy (C-PET) and symptom intensity was assessed by linear analogue self-assessment (LASA) indicators. Patients also responded to global LASA indicators for physical well-being, mood, coping effort and treatment burden. Associations between symptoms and these indicators were analysed by linear regression models. MAIN RESULTS Among 373 women, the distribution of symptom intensity showed considerable variation in patients reporting a symptom as present. Even though patients recorded a symptom as absent, some patients reported having experienced that symptom when responding to symptom intensity, as seen for decreased sex drive, tiredness and vaginal dryness. Six of 13 symptoms and lower age had a detrimental impact on the global indicators, particularly tiredness and irritability. CONCLUSIONS Patients' experience of endocrine symptoms needs to be considered both in patient care and research, when interpreting the association between symptoms and QL.
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Affiliation(s)
- K Ribi
- International Breast Cancer Study Group, Coordinating Center, Effingerstrasse 40, 3008, Bern, Switzerland.
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Von Moos R, Dummer R, Inauen R, Ruhstaller T, Meier S, Skalsky J, Hitz F, Korte W, Cerny T, Gillessen S. Randomized phase II study of low (100mg) versus intermediate (400mg) doses of thalidomide (Thal) plus DTIC in metastatic melanoma (MM). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8048] [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
8048 Background: Single agent DTIC is the standard therapy for MM. In an effort to improve the response rate (DTIC 7–13%), Thal, a molecule with antiangiogenic effect was added in two different dosages to DTIC. Methods: Eligibility: Stage IV MM, ECOG performance status 0–2, no prior treatment with DTIC or Thal. Design: Randomized multicenter phase II Bryant and Day 2-stage optimal design with 20 patients (pats) per arm. Treatment regimens: DTIC 200mg/m2 d1–5 q3w plus Thal (100 versus 400mg per day). Responses were assessed every two cycles. Endpoints: Toxicity, feasibility, response rate (RR) and time to treatment failure (TTF). Results: 26 pats (12 male/ 14 female) at a median age of 58 years (range 24–82) with stage IV melanoma (M1a-2, M1b-2, M1c-22) were enrolled between 2001–2005 and received a median of 4 cycles (1–6). All the pats were evaluated for toxicity, 25 (96%) were assessable for objective response (WHO criteria). The overall response rate of the evaluable patients was 27% (100mg, RR 25%; 400mg, RR 33%), one patient (4%) had a complete response, 6 pats (23%) had a partial response, 11 pats had stable disease (42%), and 7 pats (27%) progressed. The median TTF was 5.2 months. Using NCI 2.0 Common Toxicity Criteria, grade 3 haematological toxicity was 12% (anemia-1, leucopenia-1, thrombocytopenia-1). Cumulative non-haematological toxicity grade 3/4 was 35% including fatigue in 5 pats (all on 400mg Thal arm), thromboembolic events in 2 (1 each treatment arm) and bleeding in 2 (1 cerebral). Polyneuropathy and constipation were a minor problem (no grade 3/4). The 400mg Thal arm was stopped according to the protocol because of intolerable fatigue in 5 out of 6 patients. Two of the first 14 pats suffered from pulmonary embolism. Thromboprophylaxis with low molecular weight heparin (LMWH) was mandatory after an amendment . Thereafter no thromboembolic events were seen but one fatal cerebral bleeding occurred in one patient. Conclusions: 400mg Thal in combination with DTIC was not feasible due to toxicity. 100mg Thal was well tolerated and showed significant clinical activity. Using our low dose Thal regimen prophylactic LMWH is necessary to prevent severe thromboembolic events. No significant financial relationships to disclose.
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Affiliation(s)
- R. Von Moos
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - R. Dummer
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - R. Inauen
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - T. Ruhstaller
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - S. Meier
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - J. Skalsky
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - F. Hitz
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - W. Korte
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - T. Cerny
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
| | - S. Gillessen
- Medical Oncology, Chur, Switzerland; University Hospital, Zurich, Switzerland; Medical Oncology, Kantonsspital, St. Gallen, Switzerland; Institut für Klinische Chemie und Haematologie, Kantonsspital, St. Gallen, Switzerland
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Glaus A, Boehme C, Thürlimann B, Ruhstaller T, Hsu Schmitz SF, Morant R, Senn HJ, von Moos R. Fatigue and menopausal symptoms in women with breast cancer undergoing hormonal cancer treatment. Ann Oncol 2006; 17:801-6. [PMID: 16507565 DOI: 10.1093/annonc/mdl030] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hormonal treatment for women with breast cancer is frequently proposed in the adjuvant as well as in the palliative setting. Therefore, many women are confronted with early menopause and prolonged oestrogen deprivation and consequently with a variety of quality of life issues, such as menopausal symptoms and fatigue. PATIENTS AND METHODS It was the aim of this study to explore the occurrence and frequency of menopausal symptoms in women with breast cancer, undergoing hormonal cancer treatment and to investigate their relationship with fatigue. A cross-sectional, quantitative approach was used in this multi-centre study. The Checklist for Patients with Endocrine Therapy (C-PET) and the International Breast Cancer Study Group (IBCSG) Linear Analogue Scales for patients with endocrine treatment were used. Descriptive statistics, as well as cluster analyses were performed. RESULTS Most frequent menopausal symptoms involved hot flashes/sweats, tiredness, weight gain, vaginal dryness and decreased sexual interest. There were significant differences between the fatigued and the non-fatigued population regarding the intensity of menopausal symptoms, emotional irritability and general coping. Cluster analyses supported a menopausal symptom cluster. CONCLUSIONS Fatigue accompanies menopausal symptoms and an association can be expected. Methods for routine screening for menopausal symptoms, including fatigue, are suggested as a relevant research issue in women with breast cancer undergoing hormonal treatment.
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Affiliation(s)
- A Glaus
- Tumorzentrum ZeTuP, Diagnostik, Behandlung und Prävention, St. Gallen, Switzerland.
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Herrmann R, Bodoky G, Ruhstaller T, Glimelius B, Saletti P, Bajetta E, Schueller J, Bernhard J, Dietrich D, Scheithauer W. Gemcitabine (G) plus capecitabine (C) versus G alone in locally advanced or metastatic pancreatic cancer. A randomized phase III study of the Swiss Group for Clinical Cancer Research (SAKK) and the Central European Cooperative Oncology Group (CECOG). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.lba4010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Herrmann
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - G. Bodoky
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - T. Ruhstaller
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - B. Glimelius
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - P. Saletti
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - E. Bajetta
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - J. Schueller
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - J. Bernhard
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - D. Dietrich
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
| | - W. Scheithauer
- Univ Hosp, Basel, Switzerland; St. Laszlo Hosp, Budapest, Hungary; Cantonal Hosp, St. Gallen, Switzerland; Univ Hosp, Uppsala, Sweden; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; National Cancer Institute, Milano, Italy; Rudolfstiftung, Vienna, Austria; Univ Hosp, Zürich, Switzerland; SAKK Coordinating Ctr, Bern, Switzerland; Univ Hosp, Vienna, Austria
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Seium Y, Stupp R, Ruhstaller T, Gervaz P, Mentha G, Philippe M, Allal A, Trembleau C, Bauer J, Morant R, Roth AD. Oxaliplatin combined with irinotecan and 5-fluorouracil/leucovorin (OCFL) in metastatic colorectal cancer: a phase I–II study. Ann Oncol 2005; 16:762-6. [PMID: 15817597 DOI: 10.1093/annonc/mdi154] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [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: 11/13/2022] Open
Abstract
BACKGROUND A phase I-II multicenter trial was conducted to define the maximal tolerated dose and describe the activity of an OCFL combination using oxaliplatin (OHP), irinotecan (CPT-11) and 5-fluorouracil (FU)/leucovorin (LV) in metastatic colorectal cancer (CRC). PATIENTS AND METHODS CRC patients not pretreated with palliative chemotherapy, with performance status < or =1 and adequate haematological, kidney and liver function, were eligible. Treatment consisted in weekly 24-h infusion 5-FU (2300 mg/m(2))/LV (30 mg) and alternating OHP (70-85 mg/m(2), days 1 and 15) and CPT-11 (80-140 mg/m(2), days 8 and 22) repeated every 5 weeks. OHP and CPT-11 were escalated in cohorts of three to six patients. RESULTS Thirty patients received a median of five cycles. Dose-limiting toxicity occurred at dose level 3, and the recommended dose was OHP 70 mg/m(2), CPT-11 100 mg/m(2), LV 30 mg and 5-FU 2300 mg/m(2)/24 h. Grade > or =3 toxicities were diarrhea 23%, neutropenia 20%, fatigue 7%, and neurologic 7%. Two febrile neutropenia episodes (one fatal) were recorded. Among 28 patients with measurable disease (90%), we observed two complete and 20 partial responses; overall RR was 78% (95% CI, 59% to 92%). Median time to progression and overall survival were 9.5 and 25.4 months, respectively. Seven patients underwent liver metastases resection. CONCLUSION OCFL is an overall well tolerated regimen with very high efficacy, which makes it most suitable for tumour control before surgery of metastatic disease.
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Affiliation(s)
- Y Seium
- Oncosurgery, Services of Visceral Surgery and Radiooncology, Geneva University Hospital, Geneva, Switzerland
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