Health-related quality of life in genotype 1 treatment-naïve chronic hepatitis C patients receiving telaprevir combination treatment in the ADVANCE study

BACKGROUND

Chronic hepatitis C virus (HCV) infection and its treatment impact patients' health-related quality of life (HRQL).

AIM

To report on treatment impact and predictors of HRQL among treatment-naïve patients with genotype 1 chronic HCV infection who received 12-week telaprevir (T) with 24 (T12PR24) or 48 weeks (T12PR48) peginterferon alpha-2a/ribavirin (PR), or 48 weeks of PR in the ADVANCE study.

METHODS

The EQ-5D-3L (EQ-5D) questionnaire (index range: 0-1) was completed at baseline and weeks 4, 12, 24, 36, 48 and 72. Patients indicated their health state on five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Descriptive statistics for the EQ-5D index and descriptive system and area under the curve from baseline to week 12 were calculated. Predictors of EQ-5D index were identified using multivariate analyses.

RESULTS

Data from 722 patients were included. The mean EQ-5D index decreased during the first 12 weeks and returned to baseline by week 72 (T12PR24 by week 36) across treatments. In multivariate analysis, sustained virological response (SVR) at week 72 was associated (P < 0.0001) with improved EQ-5D index [mean; SVR+ (0.90), SVR- (0.86)], a 4% difference, within the published range of minimal clinically important difference.

CONCLUSIONS

Post hoc analyses of data from ADVANCE suggested that HRQL worsened during the first 12 weeks of therapy and returned to baseline by week 72 across treatments. Improvements were observed early following completion of a 24-week treatment (T12PR24). Telaprevir combination therapy was associated with slightly higher reductions in HRQL during the first 12 weeks (vs. PR). SVR was a statistically significant and meaningful predictor of HRQL at week 72.

Phase I study of pemetrexed (P) plus gemcitabine (G) in advanced solid tumors (ST)

14055

Background: P is active in multiple ST types, and preclinical data support P synergy with G. Methods: Eligible advanced ST patients (pts) with no prior P or G, no prior radiotherapy (RT) to ≡ 25% of the marrow, Karnofsky Performance Status ≡ 70%, and adequate organ function enrolled in cohorts (C) of 3, expanding to 6 if dose-limiting toxicity (DLT) occurred. P was given at 300 (C1), 400 (C2), 500 (C3) or 600 (C4) mg/m2 followed by G at 1500 mg/m2 q 14 days (d) without granulocyte-colony stimulating factor. Vitamin B12 and folate supplementation were given. Response was assessed by RECIST Results: 29 pts (median number prior regimens 2, range 1–5; 66% with prior RT) enrolled and are evaluable for safety; 23 are evaluable for response. There were no DLTs in C1. One pt in C2 was replaced after 1 cycle for progression of disease (PD). Among the next 6 pts, 2 had DLTs (1 G3 thrombocytopenia [TP] treatment delay; 1 neutropenic fever [NF]). C2-R (C2, Revised) re-opened after amendment permitting ≡ 2 prior cytotoxic regimens, no history of brain metastases/brain RT. C2-R enrolled 8 pts with 1 DLT (G3 TP with treatment delay) and 2 pts replaced (1 early PD, 1 no documented duration of neutropenia [NP]). C3 had 0/3 pts with DLT. C4 had 2/3 pts with DLTs (1 G4 hyponatremia; 1 herpes zoster-related treatment delay). C3 has been expanded to 5 of 6 planned patients, one with DLT (NF, G4 TP). Toxicities per cycle (n= 189 cycles, 29 patients): include NP-G3 (23%), G4 (14%); TP-G3 (2%); WBC-G3 (30%), G4 (4%); lymphopenia-G3 (11%), Hgb-G3 (4%); G3-NF (1%). 3/23 (13%) had objective partial responses (2 head and neck squamous cell cancer, HNSCC; 1 nasopharyngeal cancer, NPC), 4 stable disease (SD), 16 PD. (1 pt, no measurable disease at baseline; 5 pts, too early for response assesment). Conclusions: G + P is well-tolerated, and yields objective responses in HNSCC and NPC. C3 (P 500 mg/m2 + G 1500 mg/m2 q 14 d) was the phase II recommended dose in another phase I study of this regimen (Melemed ASCO 2005). Our final results will be available for ASCO 2007.

No significant financial relationships to disclose.

A phase I study of pemetrexed (P) plus gemcitabine (G) in relapsed ovarian cancer (OC): Dosing results and evidence of activity

5083

Background: High expression of folate receptors on ovarian cancer cells may provide excellent targets for P. Preclinical data support synergism with G. Optimal doses of q 14 day P+G with vitamin support in pre-treated OC pts are not known. We sought to determine the maximally tolerated doses (MTD) and to assess for toxicity and activity in relapsed OC. Methods: Pts with relapsed OC, no prior P or G, KPS ≥ 70, and adequate organ function were eligible. Pts were enrolled in cohorts of 3, expanding to 6 if dose-limiting toxicity (DLT) was observed during the first 4 cycles. Pts received P at 300 (cohort 1) or 400 (cohort 2) or 500 (cohort 3) or 600 (cohort 4) mg/m2 followed by G 1500 mg/m2 q 14 d without GCSF. B12 and folic acid were given 1 week prior and continued throughout. DLT was defined as grade (gr) 4 neutropenia (ANC) lasting >7d or neutropenic fever (NF); gr 4 thrombocytopenia or gr 3 with bleeding; ≥gr 3 nonhematologic toxicity, except ALT, AST, alopecia, fatigue; treatment delay ≥1 week due to any unresolved toxicity. Response assessed by RECIST. Results: 16 pts (median age 55, range 43–75; median number prior cytotoxic regimens 2, range 1–4) have enrolled in 4 cohorts. 15 are evaluable for response (1 treated after resection of recurrence); 13 of these15 had a platinum-free interval <6 months. 1 pt in cohort 1 had global deterioration during cycle 1 and was replaced, with best response counted as progressive disease (PD). 1 pt in cohort 3 had dose delay ≥1 week, meeting DLT criteria. Cohort 3 was expanded to 6 pts with no further DLT. 3 pts enrolled in cohort 4 with no DLTs observed. Toxicities per cycle (n = 108): gr 3 ANC 31%; gr 4 ANC 27%; gr 3 dehydration 0.9%; gr 3 platelets 0.9%; 0 pts had NF. Median # cycles/pt was 6, range 1–16, median cycle length 14 d. Objective response was observed in 27% (4/15 pts: 4 PR; 7 SD; 4 PD). All 4 responses were among pts with platinum resistant disease. >50% decrease in CA125 for more than two measurements was observed in 9/15 (60%) pts with evaluable CA125s. Median time to progression is 15 wks (95% confidence interval 10–32 wks). Conclusions: MTD is not yet reached. P 500 mg/m2 + G 1500 mg/m2 with vitamin supplementation is safe in pts with previously treated OC. 27% of patients with platinum-resistant disease had objective responses.

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