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Koch R, Haveman L, Ladenstein R, Brichard B, Jürgens H, Cyprova S, van den Berg H, Hassenpflug W, Raciborska A, Ek T, Baumhoer D, Egerer G, Kager L, Renard M, Hauser P, Burdach S, Bovee JVMG, Hong AM, Reichardt P, Kruseova J, Streitbürger A, Kühne T, Kessler T, Bernkopf M, Butterfaß-Bahloul T, Dhooge C, Bauer S, Kiss J, Paulussen M, Bonar F, Ranft A, Timmermann B, Rascon J, Vieth V, Kanerva J, Faldum A, Hartmann W, Hjorth L, Bhadri VA, Metzler M, Gelderblom H, Dirksen U. Zoledronic Acid Add-on Therapy for Standard-Risk Ewing Sarcoma Patients in the Ewing 2008R1 Trial. Clin Cancer Res 2023; 29:5057-5068. [PMID: 37843857 DOI: 10.1158/1078-0432.ccr-23-1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/22/2023] [Accepted: 10/12/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE The phase III, open-label, prospective, multicenter, randomized Ewing 2008R1 trial (EudraCT2008-003658-13) was conducted in 12 countries to evaluate the effect of zoledronic acid (ZOL) maintenance therapy compared with no add-on regarding event-free survival (EFS, primary endpoint) and overall survival (OS) in standard-risk Ewing sarcoma (EWS). PATIENTS AND METHODS Eligible patients had localized EWS with either good histologic response to induction chemotherapy and/or small tumors (<200 mL). Patients received six cycles of VIDE induction and eight cycles of VAI (male) or eight cycles of VAC (female) consolidation. ZOL treatment started parallel to the sixth consolidation cycle. Randomization was stratified by tumor site (pelvis/other). The two-sided adaptive inverse-normal four-stage design (planned sample size 448 patients, significance level 5%, power 80%) was changed after the first interim analysis using the Müller-Schäfer method. RESULTS Between April 2010 and November 2018, 284 patients were randomized (142 ZOL/142 no add-on). With a median follow-up of 3.9 years, EFS was not significantly different between ZOL and no add-on group in the adaptive design (HR, 0.74; 95% CI, 0.43-1.28, P = 0.27, intention-to-treat). Three-year EFS rates were 84.0% (95% CI, 77.7%-90.8%) for ZOL vs. 81.7% (95% CI, 75.2%-88.8%) for no add-on. Results were similar in the per-protocol collective. OS was not different between groups. The 3-year OS was 92.8% (95% CI, 88.4%-97.5%) for ZOL and 94.6% (95% CI, 90.9%-98.6%) for no add-on. Noticeable more renal, neurologic, and gastrointestinal toxicities were observed for ZOL (P < 0.05). Severe renal toxicities occurred more often in the ZOL arm (P = 0.003). CONCLUSIONS In patients with standard-risk localized EWS, there is no additional benefit from maintenance treatment with ZOL.
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Affiliation(s)
- Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Lianne Haveman
- Department of Solid tumors, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Ruth Ladenstein
- Studies and Statistics for Integrated Research and Projects, St. Anna Children's Hospital, Department of Paediatrics and Children's Cancer Research Institute (CCRI), Medical University of Vienna, Vienna, Austria
| | - Benedicte Brichard
- Cliniques Universitaires Saint Luc, Department of Pediatric Haematology and Oncology, Université Catholique de Louvain, Brussels, Belgium
| | - Heribert Jürgens
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Germany
| | - Sona Cyprova
- Charles University, Motol Children's Hospital, Prague, Czech Republic
| | - Henk van den Berg
- Amsterdam UMC location University of Amsterdam, Emma Children's Hospital, Department of pediatric oncology, Amsterdam, the Netherlands
| | - Wolf Hassenpflug
- Pediatric Hematology and Oncology, University Hospital Eppendorf, Hamburg, Germany
| | - Anna Raciborska
- Mother and Child Institute, Department of Oncology and Surgical Oncology for Children and Youth, Warsaw, Poland
| | - Torben Ek
- Childhood Cancer Center, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Daniel Baumhoer
- Bone Tumor Reference Center at the Institute of Medical Genetics and Pathology, University Hospital Basel and University of Basel, Switzerland
| | - Gerlinde Egerer
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Leo Kager
- St Anna Children's Hospital and Children's Cancer Research Institute; Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Marleen Renard
- Pediatric Hematology and Oncology, University Hospital Leuven Gasthuisberg, Leuven, Belgium
| | - Peter Hauser
- Pediatric Oncology and Transplantation Unit, Velkey László Child's Health Center, Borsod-Abaúj-Zemplén County University Teaching Hospital, Miskolc, Hungary
- 2nd Dept of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Stefan Burdach
- Department of Pediatrics and Children's Cancer Research Center (CCRC), Technische Universität München, Munich, Germany
| | - Judith V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Angela M Hong
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, Australia
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Peter Reichardt
- Department of Oncology and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Jarmila Kruseova
- Charles University, Motol Children's Hospital, Prague, Czech Republic
| | - Arne Streitbürger
- Department of Orthopedic Oncology, University Hospital Essen, Essen, Germany
| | - Thomas Kühne
- Department of Oncology and Hematology, University Children's Hospital Basel, Basel, Switzerland
| | - Torsten Kessler
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Marie Bernkopf
- St Anna Children's Hospital and Children's Cancer Research Institute; Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Catharina Dhooge
- Department of Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplantation, Princess Elisabeth Children's Hospital, Ghent University, Ghent, Belgium
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, University of Duisburg-Essen, Essen, Germany
- West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - János Kiss
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Michael Paulussen
- General Pediatrics, Oncology and Hematology, Vestische Kinder- und Jugendklinik Datteln, Witten/Herdecke University, Datteln, Germany
| | - Fiona Bonar
- Douglass Hanly Moir Pathology, Notre Dame Medical School, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andreas Ranft
- West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
- Paediatrics III, University Hospital Essen, Essen, Germany
- German Consortium for Translational Cancer Research (DKTK), German Cancer Research Centre, Essen, Germany
| | - Beate Timmermann
- West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
- German Consortium for Translational Cancer Research (DKTK), German Cancer Research Centre, Essen, Germany
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Volker Vieth
- Department of Clinical Radiology, Klinikum Ibbenbüren, Ibbenburen, Germany
| | - Jukka Kanerva
- Division of Hematology-Oncology and Stem Cell Transplantation, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Lars Hjorth
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Vivek A Bhadri
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Markus Metzler
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Uta Dirksen
- West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
- Paediatrics III, University Hospital Essen, Essen, Germany
- German Consortium for Translational Cancer Research (DKTK), German Cancer Research Centre, Essen, Germany
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2
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Bielack SS, Blattmann C, Hassenpflug W, Kager L, Kuhne T, Kevric M, Schlegel PG, Mettmann V, Sorg B, Hecker-Nolting S. Osteosarcoma Arising After Ewing Sarcoma or Vice Versa: A Report of 20 Affected Patients from the Cooperative Osteosarcoma Study Group (COSS). Anticancer Res 2023; 43:4975-4981. [PMID: 37909999 DOI: 10.21873/anticanres.16696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM Ewing sarcoma can arise in patients after osteosarcoma or vice versa. Our aim was to learn more about which patients develop these secondary tumors, which treatments may be effective, and which patients might survive. PATIENTS AND METHODS The database of the Cooperative Osteosarcoma Study Group (1980-09/2022) was searched for all patients with an osteosarcoma (including undifferentiated pleomorphic sarcoma of the bone) who also suffered from Ewing sarcoma (incl. peripheral neuroectodermal tumor) at any time, previously or thereafter. The identified patients were then analyzed for patient, tumor, and treatment-related variables as well as their disease- and survival-status at the last follow-up. RESULTS A total of 20 eligible patients [17 Ewing sarcoma prior to osteosarcoma, 3 vice versa; 10 males, 10 females; median age at 1st cancer 10.5 (2.4-20.6), at 2nd cancer 20.5 (9.9-42.4) years] were identified. None of the patients developed a 3rd cancer and none had a known tumor-predisposition syndrome. Sixteen/17 secondary osteosarcomas and no secondary Ewing sarcoma developed in sites that had previously been irradiated. Nineteen/20 (95%) patients received primary multi-agent chemotherapy for their 1st and 2nd cancers. Actuarial overall and event-free survival probabilities at five years after the diagnosis of the secondary cancer were 69% and 42%, respectively. CONCLUSION Secondary osteosarcoma arising after Ewing sarcoma is almost exclusively associated with radiation. This is not the case vice versa. Either way, long-term survival is a realistic possibility with appropriate multidisciplinary treatment; thus, therapeutic negligence is clearly inadequate.
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Affiliation(s)
- Stefan S Bielack
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany;
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster, Münster, Germany
| | - Claudia Blattmann
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Wolf Hassenpflug
- Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Leo Kager
- St. Anna Kinderspital, Universitätsklinik für Kinder- und Jugendheilkunde der Medizinischen Universität Wien, Vienna, Austria
- St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Thomas Kuhne
- Abteilung für Pädiatrische Onkologie / Hämatologie, Universitäts-Kinderspital beider Basel, Basel, Switzerland
| | - Matthias Kevric
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Paul-Gerhardt Schlegel
- Pädiatrische Hämatologie und Onkologie, KIONET center, Kinderklinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Vanessa Mettmann
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Benjamin Sorg
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - Stefanie Hecker-Nolting
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
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Bielack SS, Blattmann C, Borkhardt A, Csóka M, Hassenpflug W, Kabíčková E, Kager L, Kessler T, Kratz C, Kühne T, Kevric M, Lehrnbecher T, Mayer-Steinacker R, Mettmann V, Metzler M, Reichardt P, Rossig C, Sorg B, von Luettichau I, Windhager R, Hecker-Nolting S. Osteosarcoma and causes of death: A report of 1520 deceased patients from the Cooperative Osteosarcoma Study Group (COSS). Eur J Cancer 2022; 176:50-57. [PMID: 36191386 DOI: 10.1016/j.ejca.2022.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Most aspects of osteosarcoma have been addressed in detail, but there is no comprehensive analysis of deceased patients and causes of death. METHODS The database of the Cooperative Osteosarcoma Study Group COSS (1980-03/31/2021; 4475 registered high-grade central osteosarcoma patients) was searched deaths from any cause. Affected patients were analyzed for demographic and baseline variables and disease-status at the time of demise. Deaths from causes other than osteosarcoma were analyzed in detail. RESULTS A total of 1520 deceased patients were identified (median age (range) at osteosarcoma diagnosis 16 (2-78) years; 908 (59.7%) male, 612 (40.3%) female; primary tumor: extremities 1263 (83.1%), trunk 208 (13.7%), craniofacial 47 (3.1%) (site unknown 2); metastases at registration: absent 1.051 (69.1%), present 466 (30.7%) (3 no data). The median time from diagnosis to death was 2.22 (0.08-32.02) years. 1286 (84.6%) patients succumbed to osteosarcoma (370 without achieving complete remission, 488 first, 428 more than one recurrences), 146 (9.6%) to other, 88 (5.8%) to unknown causes. Chemotherapy-related infections (40), secondary malignancies (39), and perioperative complications (19) were among the most frequent potentially treatment-related causes, and high-dose methotrexate (19), doxorubicin (17), and ifosfamide (15) were the drugs most commonly held responsible. Patients with unknown causes of death had an unusually long median follow-up. CONCLUSION The major cause of death of patients after osteosarcoma is this malignancy, mostly from one of its multiple relapses. However, almost 10% of fatalities are due to other documented causes. Some of these deaths may be preventable with the knowledge gained from comprehensive analyses such as this.
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Affiliation(s)
- Stefan S Bielack
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany; Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster, Münster, Germany.
| | - Claudia Blattmann
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Arndt Borkhardt
- Kinderklinik, Klinik für Pädiatrische Onkologie u. Hämatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Wolf Hassenpflug
- Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Edita Kabíčková
- Klinika Dětské Hematologie a Onkologie UK 2. LF a FN Motol (KDHO), Prague, Czech Republic
| | - Leo Kager
- St. Anna Kinderspital, Universitätsklinik für Kinder- und Jugendheilkunde der Medizinischen, Universität Wien and St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Thorsten Kessler
- Klinik für Innere Medizin A: Hämatologie, Hämostaseologie, Onkologie und Pneumologie, Universitätsklinikum Münster, Münster, Germany
| | - Christian Kratz
- Pädiatrische Hämatologie und Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Thomas Kühne
- Abteilung für Pädiatrische Onkologie/Hämatologie, Universitäts-Kinderspital beider Basel, Basel, Switzerland
| | - Matthias Kevric
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Thomas Lehrnbecher
- Klinik für Kinder- und Jugendmedizin, Schwerpunkt Onkologie, Hämatologie und Hämostaseologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | | | - Vanessa Mettmann
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Markus Metzler
- Kinder- und Jugendklinik, Pädiatrische Onkologie und Hämatologie, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter Reichardt
- Onkologie und Palliativmedizin, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Claudia Rossig
- Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster, Münster, Germany
| | - Benjamin Sorg
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Irene von Luettichau
- Kinderklinik München Schwabing, Department of Pediatrics and Children's Cancer Research Center, TUM School of Medicine, Technische Universität München, Munich, Germany
| | - Reinhard Windhager
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Vienna, Austria
| | - Stefanie Hecker-Nolting
- Cooperative Osteosarcoma Study Group, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
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4
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Koch R, Gelderblom H, Haveman L, Brichard B, Jürgens H, Cyprova S, van den Berg H, Hassenpflug W, Raciborska A, Ek T, Baumhoer D, Egerer G, Eich HT, Renard M, Hauser P, Burdach S, Bovee J, Bonar F, Reichardt P, Kruseova J, Hardes J, Kühne T, Kessler T, Collaud S, Bernkopf M, Butterfaß-Bahloul T, Dhooge C, Bauer S, Kiss J, Paulussen M, Hong A, Ranft A, Timmermann B, Rascon J, Vieth V, Kanerva J, Faldum A, Metzler M, Hartmann W, Hjorth L, Bhadri V, Dirksen U. High-Dose Treosulfan and Melphalan as Consolidation Therapy Versus Standard Therapy for High-Risk (Metastatic) Ewing Sarcoma. J Clin Oncol 2022; 40:2307-2320. [PMID: 35427190 DOI: 10.1200/jco.21.01942] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Ewing 2008R3 was conducted in 12 countries and evaluated the effect of treosulfan and melphalan high-dose chemotherapy (TreoMel-HDT) followed by reinfusion of autologous hematopoietic stem cells on event-free survival (EFS) and overall survival in high-risk Ewing sarcoma (EWS). METHODS Phase III, open-label, prospective, multicenter, randomized controlled clinical trial. Eligible patients had disseminated EWS with metastases to bone and/or other sites, excluding patients with only pulmonary metastases. Patients received six cycles of vincristine, ifosfamide, doxorubicin, and etoposide induction and eight cycles of vincristine, actinomycin D, and cyclophosphamide consolidation therapy. Patients were randomly assigned to receive additional TreoMel-HDT or no further treatment (control). The random assignment was stratified by number of bone metastases (1, 2-5, and > 5). The one-sided adaptive-inverse-normal-4-stage-design was changed after the first interim analysis via Müller-Schäfer method. RESULTS Between 2009 and 2018, 109 patients were randomly assigned, and 55 received TreoMel-HDT. With a median follow-up of 3.3 years, there was no significant difference in EFS between TreoMel-HDT and control in the adaptive design (hazard ratio [HR] 0.85; 95% CI, 0.55 to 1.32, intention-to-treat). Three-year EFS was 20.9% (95% CI, 11.5 to 37.9) in TreoMel-HDT and 19.2% (95% CI, 10.8 to 34.4) in control patients. The results were similar in the per-protocol collective. Males treated with TreoMel-HDT had better EFS compared with controls: median 1.0 years (95% CI, 0.8 to 2.2) versus 0.6 years (95% CI, 0.5 to 0.9); P = .035; HR 0.52 (0.28 to 0.97). Patients age < 14 years benefited from TreoMel-HDT with a 3-years EFS of 39.3% (95% CI, 20.4 to 75.8%) versus 9% (95% CI, 2.4 to 34); P = .016; HR 0.40 (0.19 to 0.87). These effects were similar in the per-protocol collective. This observation is supported by comparable results from the nonrandomized trial EE99R3. CONCLUSION In patients with very high-risk EWS, additional TreoMel-HDT was of no benefit for the entire cohort of patients. TreoMel-HDT may be of benefit for children age < 14 years.
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Affiliation(s)
- Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lianne Haveman
- Department of Solid Tumors, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Benedicte Brichard
- Department of Pediatric Haematology and Oncology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Heribert Jürgens
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Sona Cyprova
- Charles University, Motol Children's Hospital, Prague, Czech Republic
| | - Henk van den Berg
- Department of Pediatrics/Oncology, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Wolf Hassenpflug
- Pediatric Hematology and Oncology, University Hospital Eppendorf, Hamburg, Germany
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Mother and Child Institute, Warsaw, Poland
| | - Torben Ek
- Childhood Cancer Center, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Daniel Baumhoer
- Bone Tumor Reference Center at the Institute of Medical Genetics and Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gerlinde Egerer
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany
| | - Marleen Renard
- Pediatric Hematology and Oncology, University Hospital Leuven Gasthuisberg, Leuven Belgium
| | - Peter Hauser
- Head of the Pediatric Oncology and Transplantation Unit, Velkey László Child's Health Center, Borsod-Abaúj-Zemplén County University Teaching Hospital, Miskolc, Hungary.,2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Stefan Burdach
- Department of Pediatrics and Children's Cancer Research Center (CCRC), Technische Universität München, Munich, Germany.,British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Judith Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fiona Bonar
- Douglass Hanly Moir Pathology, Macquarie Park, Australia
| | - Peter Reichardt
- Department of Oncology and Palliative Care, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Jarmila Kruseova
- Charles University, Motol Children's Hospital, Prague, Czech Republic
| | - Jendrik Hardes
- Clinic of Orthopedics, University Hospital Essen, West German Cancer Centre, Essen, Germany
| | - Thomas Kühne
- Department of Oncology and Hematology, University Children's Hospital Basel, Basel, Switzerland
| | - Torsten Kessler
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Stephane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University Hospital Essen, Essen, Germany
| | - Marie Bernkopf
- Department of Pediatrics, St Anna Children's Hospital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria
| | | | - Catharina Dhooge
- Department of Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplantation, Princess Elisabeth Children's Hospital, Ghent University, Ghent, Belgium
| | - Sebastian Bauer
- Department of Medical Oncology, Sarcoma Center, University of Duisburg-Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - János Kiss
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Michael Paulussen
- General Pediatrics, Oncology and Hematology, Vestische Kinder und Jugendklinik Datteln, Witten/Herdecke University, Datteln, Germany
| | - Angela Hong
- Chris O'Brien Lifehouse, Camperdown, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Andreas Ranft
- West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany.,Paediatrics III, University Hospital Essen, Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), German Cancer Research Centre, Essen, Germany
| | - Beate Timmermann
- West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany.,German Consortium for Translational Cancer Research (DKTK), German Cancer Research Centre, Essen, Germany.,Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Jelena Rascon
- Center for Pediatric Oncology and Hematology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Volker Vieth
- Department of Clinical Radiology, Klinikum Ibbenbüren, Ibbenbüren, Germany
| | - Jukka Kanerva
- Hematology and Stem Cell Transplantation, New Children's Hospital, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Markus Metzler
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Lars Hjorth
- Department of Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - Vivek Bhadri
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Uta Dirksen
- West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany.,Paediatrics III, University Hospital Essen, Essen, Germany.,German Consortium for Translational Cancer Research (DKTK), German Cancer Research Centre, Essen, Germany
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5
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Olivieri M, Halimeh S, Wermes C, Hassenpflug W, Holstein K, von Mackensen S. [Impact of COVID-19 Pandemic on Medical Care of Patients with Inherited Bleeding Disorders]. Gesundheitswesen 2021; 83:282-290. [PMID: 33831972 PMCID: PMC8043719 DOI: 10.1055/a-1399-9166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic diseases, such as inherited bleeding disorders (IBD) are often associated with high costs of medical care. COVID-19 containment measures, including isolation and triage, led to restrictions in the health care of chronically ill patients. The aim of the present study was to investigate the effects of the COVID-19 pandemic on the health care of IBD patients. METHODS In this multicentre cross-sectional study to evaluate the effects of COVID-19 on the mental health and quality of care of patients with inherited bleeding disorder, an ad hoc questionnaire was sent to 586 patients/parents of children with haemophilia A, B or von Willebrand syndrome type 3. In addition to demographic and clinical data, patients/parents of patients with inherited bleeding disorders were asked about their thoughts, concerns and experiences regarding their medical care during the COVID-19 pandemic. Differences between clinical subgroups were calculated. RESULTS Significant differences were found between subgroups (severity, type of therapy, product class, comorbidities) with regard to the transmission of COVID-19 through plasma products, the effects of COVID-19 positive test results, fear of getting COVID-19, delayed drug supply and physiotherapy treatment. DISCUSSION The medical care of patients with inherited bleeding disorders, who need a continuous supply of essential drugs, is a particular challenge in times of pandemics. Therefore, worries and fears of IBD patients should be taken seriously and innovative communication channels established to maintain therapy standards and quality of care.
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Affiliation(s)
- Martin Olivieri
- Abteilung für pädiatrische Hämostaseologie, Pädiatrisches Hämophiliezentrum, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, LMU Klinikum, München, Deutschland
| | | | - Cornelia Wermes
- HämoZentrum Hildesheim-Hannover-Osnabrück, Osnabrück, Deutschland
| | - Wolf Hassenpflug
- Klinik für Kinderheilkunde, Hämatologie und Onkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Katharina Holstein
- II. Mediziinische Abteilung, Hämophiliezentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Sylvia von Mackensen
- Institut für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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6
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Mackensen S, Halimeh S, Siebert M, Wermes C, Hassenpflug W, Holstein K, Olivieri M. Impact of COVID‐19 pandemic on mental health of patients with inherited bleeding disorders in Germany. Haemophilia 2020; 26:e272-e281. [DOI: 10.1111/hae.14130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Sylvia Mackensen
- Department of Medical Psychology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Susan Halimeh
- Coagulation and Thrombosis Centre (GZRR) Duisburg Germany
| | | | | | - Wolf Hassenpflug
- Department of Paediatrics, Haematology and Oncology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Katharina Holstein
- II. Medical Department Haemophilia Centre University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Martin Olivieri
- Paediatric Haemostasis and Thrombosis Unit Department of Paediatrics Paediatric Haemophilia Centre Dr. von Hauner Children's Hospital University HospitalLMU Munich Munich Germany
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7
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Scobioala S, Ranft A, Wolters H, Jabar S, Paulussen M, Timmermann B, Juergens H, Hassenpflug W, Klingebiel T, Elsayad K, Eich HT, Dirksen U. Impact of Whole Lung Irradiation on Survival Outcome in Patients With Lung Relapsed Ewing Sarcoma. Int J Radiat Oncol Biol Phys 2018; 102:584-592. [PMID: 30244879 DOI: 10.1016/j.ijrobp.2018.06.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 04/23/2018] [Revised: 06/20/2018] [Accepted: 06/24/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE There is no standard treatment procedure for relapsed Ewing sarcoma (EwS). This retrospective analysis evaluates the survival outcome in patients with an isolated pulmonary relapse of EwS treated with whole lung irradiation (WLI) in addition to second line chemotherapy (Ctx). METHODS AND MATERIALS In our study, 136 patients with pulmonary relapsed EwS who were registered in the relapse register of the Cooperative Ewing Sarcoma Study group or the Sarcoma Relapse Registry for relapsed sarcoma of bone and soft tissues were analyzed. All patients received relapse Ctx or an additional total resection of lung metastasis. Of these patients, 88 (median age, 21 years; range, 7-52 years) achieved a second remission by the relapse treatment. Of these 88 patients, 48 patients received an additional WLI. The 3-year progression-free survival (PFS) and 3-year overall survival (OS) were analyzed (median follow-up, 3 years; range, 7 months to 11 years and 9 months). Additional prognostic factors for survival outcomes, including the response of lung metastases to Ctx, were also estimated. RESULTS The survival outcome was significantly improved after WLI when analyzing the entire group of pulmonary relapsed patients: 3-year PFS 36% (+WLI) versus 14% (-WLI) (P = .001); 3- year OS 47% (+WLI) versus 33% (-WLI) (P = .007). The 3-year PFS in patients with complete remission of lung relapse receiving WLI (n = 48) compared with those without WLI (n = 40), was 37% (+WLI) versus 21% (-WLI) (P = .18). The site of the primary tumor and the response of pulmonary lesions to Ctx were significant prognostic indicators for survival in patients treated with WLI. No severe pulmonary function disorders or lung toxicities were observed after WLI treatment in both pediatric and adult patients. CONCLUSIONS The WLI does not correlate with improved OS in patients with pulmonary relapsed EwS. However, a marginal trend toward superior PFS and improved local control of pulmonary disease suggests the application of WLI in patients with EwS with isolated lung relapse and second clinical remission.
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Affiliation(s)
- Sergiu Scobioala
- Department of Radiotherapy and Radiooncology, University Hospital of Muenster, Muenster, Germany
| | - Andreas Ranft
- Pediatrics III, Hematology/ Oncology, West German Cancer Center and German Cancer Research Center, University Hospital Essen, Essen, Germany
| | - Heidi Wolters
- Department of Radiotherapy and Radiooncology, University Hospital of Muenster, Muenster, Germany
| | - Susanne Jabar
- Pediatrics III, Hematology/ Oncology, West German Cancer Center and German Cancer Research Center, University Hospital Essen, Essen, Germany
| | - Michael Paulussen
- Pediatrics, Hematology/Oncology, University Hospital Witten/Herdecke, Medical Centre Datteln, Datteln, Germany
| | - Beate Timmermann
- Department for Particle Therapy, University Hospital Essen, West German Proton Therapy Center Essen, West German Cancer Center, German Cancer Consortium, Germany
| | - Heribert Juergens
- Pediatrics, Hematology/Oncology, University Hospital Muenster, Muenster, Germany
| | - Wolf Hassenpflug
- Pediatrics, Hematology/Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Klingebiel
- Pediatrics, Hematology/Oncology, University Medical Center Frankfurt, Frankfurt, Germany
| | - Khaled Elsayad
- Department of Radiotherapy and Radiooncology, University Hospital of Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiotherapy and Radiooncology, University Hospital of Muenster, Muenster, Germany
| | - Uta Dirksen
- Pediatrics III, Hematology/ Oncology, West German Cancer Center and German Cancer Research Center, University Hospital Essen, Essen, Germany.
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8
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Heinemann M, Ranft A, Langer T, Jürgens H, Kreyer J, Vieth V, Schäfers M, Weckesser M, Simon T, Hassenpflug W, Corbacioglu S, Bielack S, Mayer-Steinacker R, Kühne T, van den Berg H, Gelderblom H, Bauer S, Stegger L, Dirksen U. Recurrence of Ewing sarcoma: Is detection by imaging follow-up protocol associated with survival advantage? Pediatr Blood Cancer 2018; 65:e27011. [PMID: 29480574 DOI: 10.1002/pbc.27011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/24/2018] [Accepted: 01/24/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Cooperative Ewing Sarcoma Study and the Late Effects Surveillance System of the Society for Paediatric Oncology and Haematology recommend a structured follow-up imaging protocol (FUIP) for patients with Ewing sarcoma (EwS) with decreasing frequency of imaging over the first 5 years. The present study aims to assess the effectiveness of the FUIP for EwS patients regarding survival after relapse. PATIENTS AND METHODS A retrospective multicenter analysis on 160 eligible patients with EwS recurrence was performed. Potential survival differences following recurrence diagnosis between patients with protocol-detected and symptomatic relapse were investigated using the Kaplan-Meier method. Additional subgroup analyses were performed on the relapse type. Overall survival (OS) was calculated from diagnosis of relapse to last follow-up or death. RESULTS In the multicenter analysis, recurrence was detected by FUIP in 77 of 160 patients (48%) and due to symptoms in 83 patients (52%). Regarding the entire study population, OS was significantly superior in patients with protocol-detected relapse compared to patients with symptomatic relapse (median, 2.4 vs. 1.2 years; P < 0.001). In the subgroup analyses, patients whose lung recurrences were detected by the FUIP experienced longer survival after recurrence than those whose recurrences were detected symptomatically (P = 0.023). In the 83 symptomatic patients, pain was the most prevalent symptom of relapse (72%). CONCLUSION FUIP may benefit survival in EwS relapse, especially in lung recurrence. Pain was the leading symptom of relapse.
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Affiliation(s)
- Melina Heinemann
- University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany.,Department of Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Ranft
- University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany.,Paediatrics III, West German Cancer Centre, University Hospital of Essen, Essen, Germany
| | - Thorsten Langer
- Paediatric Oncology and Haematology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Herbert Jürgens
- Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | - Justus Kreyer
- Department of Orthopaedic and Trauma Surgery, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Volker Vieth
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Thorsten Simon
- Department of Paediatric Oncology and Haematology, University Children's Hospital of Cologne, Cologne, Germany
| | - Wolf Hassenpflug
- Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Selim Corbacioglu
- Department of Paediatric Haematology, Oncology, and Stem Cell Transplantation, Children's Hospital Regensburg, University of Regensburg, Regensburg, Germany
| | - Stefan Bielack
- Paediatrics 5 (Oncology, Haematology, and Immunology), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | | | - Thomas Kühne
- Department of Oncology and Haematology, University Children's Hospital Basel, Basel, Switzerland
| | - Henk van den Berg
- Paediatric Oncology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Gelderblom
- Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sebastian Bauer
- Sarcoma Centre, West German Cancer Centre, University Hospital of Essen, Essen, Germany.,German Cancer Research Centre, Essen, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Muenster, Muenster, Germany
| | - Uta Dirksen
- University Hospital Muenster, Westphalian-Wilhelms University, Muenster, Germany.,Paediatrics III, West German Cancer Centre, University Hospital of Essen, Essen, Germany.,Sarcoma Centre, West German Cancer Centre, University Hospital of Essen, Essen, Germany.,German Cancer Research Centre, Essen, Germany
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9
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Kularatne SA, Deshmukh V, Ma J, Tardif V, Lim RKV, Pugh HM, Sun Y, Manibusan A, Sellers AJ, Barnett RS, Srinagesh S, Forsyth JS, Hassenpflug W, Tian F, Javahishvili T, Felding-Habermann B, Lawson BR, Kazane SA, Schultz PG. A CXCR4-targeted site-specific antibody-drug conjugate. Angew Chem Int Ed Engl 2014; 53:11863-7. [PMID: 25213874 DOI: 10.1002/anie.201408103] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [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: 08/08/2014] [Indexed: 01/31/2023]
Abstract
A chemically defined anti-CXCR4-auristatin antibody-drug conjugate (ADC) was synthesized that selectively eliminates tumor cells overexpressing the CXCR4 receptor. The unnatural amino acid p-acetylphenylalanine (pAcF) was site-specifically incorporated into an anti-CXCR4 immunoglobulin G (IgG) and conjugated to an auristatin through a stable, non-cleavable oxime linkage to afford a chemically homogeneous ADC. The full-length anti-CXCR4 ADC was selectively cytotoxic to CXCR4(+) cancer cells in vitro (half maximal effective concentration (EC50 )≈80-100 pM). Moreover, the anti-CXCR4 ADC eliminated pulmonary lesions from human osteosarcoma cells in a lung-seeding tumor model in mice. No significant overt toxicity was observed but there was a modest decrease in the bone-marrow-derived CXCR4(+) cell population. Because CXCR4 is highly expressed in a majority of metastatic cancers, a CXCR4-auristatin ADC may be useful for the treatment of a variety of metastatic malignancies.
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Affiliation(s)
- Sumith A Kularatne
- Department of Chemistry and The Skaggs Institute for Chemical Biology, The Scripps Research Institute, 10550 N. Torrey Pines Rd, La Jolla, CA 92037 (USA)
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10
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Kularatne SA, Deshmukh V, Ma J, Tardif V, Lim RKV, Pugh HM, Sun Y, Manibusan A, Sellers AJ, Barnett RS, Srinagesh S, Forsyth JS, Hassenpflug W, Tian F, Javahishvili T, Felding-Habermann B, Lawson BR, Kazane SA, Schultz PG. A CXCR4-Targeted Site-Specific Antibody-Drug Conjugate. Angew Chem Int Ed Engl 2014. [DOI: 10.1002/ange.201408103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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11
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Goswami RK, Bajjuri KM, Forsyth JS, Das S, Hassenpflug W, Huang ZZ, Lerner RA, Felding-Habermann B, Sinha SC. Chemically programmed antibodies targeting multiple alpha(v) integrins and their effects on tumor-related functions in vitro. Bioconjug Chem 2011; 22:1535-44. [PMID: 21774545 PMCID: PMC3277862 DOI: 10.1021/bc2000879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Integrins αvβ3 and αvβ6 are highly expressed on tumor cells and/or by the tumor vasculature of many human cancers, and represent promising targets for anticancer therapy. Novel chemically programmed antibodies (cpAbs) targeting these integrins were prepared using the catalytic aldolase Antibody (Ab) programming strategy. The effects of the cpAbs on cellular functions related to tumor progression were examined in vitro using tumor cell lines and their cognate integrin ligands, fibronectin and osteopontin. The inhibitory functions of the conjugates and their specificity were examined based on interference with cell-cell and cell-ligand interactions related to tumor progression. Cell binding analyses of the anti-integrin cpAbs revealed high affinity for tumor cells that overexpressed αvβ3 and αvβ6 integrins, and weak interactions with αvβ1 and αvβ8 integrins, in vitro. Functional analyses demonstrated that the cpAbs strongly inhibited cell-cell interactions through osteopontin binding, and they had little or no immediate effects on cell viability and proliferation. On the basis of these characteristics, the cpAbs are likely to have a broad range of activities in vivo, as they can target and antagonize one or multiple αv integrins expressed on tumors and tumor vasculatures. Presumably, these conjugates may inhibit the establishment of metastastatic tumors in distant organs through interfering with cell adhesion more effectively than antibodies or compounds targeting one integrin only. These anti-integrin cpAbs may also provide useful reagents to study combined effect of multiple αv integrins on cellular functions in vitro, on pathologies, including tumor angiogenesis, fibrosis, and epithelial cancers, in vivo.
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12
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Lehmberg K, Klaassen I, Hillebrand G, Zylla S, Kutscha C, Hassenpflug W, Schneppenheim R, Singer D. Kongenitale thrombotisch-thrombozytopenische Purpura (Upshaw-Schulman-Syndrom): Differenzialdiagnose der neonatalen Sepsis mit disseminierter intravasaler Gerinnung. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Abstract
Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathic disorder with high morbidity and significant mortality. The primary form of TTP is caused by severe deficiency, acquired or hereditary, of the von Willebrand factor cleaving protease (VWF-CP), ADAMTS-13. Because TTP occurs less frequently in children, general pediatricians are not well informed about the spectrum of clinical symptoms and altered laboratory values, increasing the risk of nondiagnosis and possible fatal outcome. If renal involvement is present, the condition can easily be misdiagnosed as hemolytic-uremic syndrome (HUS). We present a case series of children with severe VWF-CP deficiency with emphasis on the clinical heterogeneity responsible for misdiagnosis and inappropriate treatment. The inherited form may involve onset of symptoms ranging from isolated thrombocytopenia to the full clinical picture characteristic of classical TTP. The most common assumed diagnoses of oligosymptomatic forms are immune thrombocytopenia (ITP) and Evans syndrome, respectively. Accordingly, this article is directed towards pediatricians on neonatal and intensive care units, as well as their colleagues specializing in nephrology, hematology, and neurology.
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Affiliation(s)
- Reinhard Schneppenheim
- Clinic of Paediatric Haematology and Oncology, University Hospital Hamburg-Eppendorf, Germany
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14
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Schneppenheim R, Budde U, Oyen F, Angerhaus D, Aumann V, Drewke E, Hassenpflug W, Häberle J, Kentouche K, Kohne E, Kurnik K, Mueller-Wiefel D, Obser T, Santer R, Sykora KW. von Willebrand factor cleaving protease and ADAMTS13 mutations in childhood TTP. Blood 2003; 101:1845-50. [PMID: 12393505 DOI: 10.1182/blood-2002-08-2399] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is caused by the persistence of the highly reactive high-molecular-weight multimers of von Willebrand factor (VWF) due to deficiency of the specific VWF-cleaving protease (VWF-CP) ADAMTS13, resulting in microangiopathic disease. The acquired form is caused by autoantibodies against VWF-CP, whereas homozygous or compound heterozygous mutations of ADAMTS13 are responsible for recessively inherited TTP. We investigated 83 children with hemolytic or thrombocytopenic episodes with or without additional neurologic symptoms or renal failure. The presumed diagnosis was chronic idiopathic thrombocytopenic purpura (ITP; n = 50), TTP (n = 8), hemolytic uremic syndrome (HUS; n = 24), and Evans syndrome (n = 1). A severe deficiency of VWF-CP (< or = 5%) was found in all investigated patients with TTP and in none of those with HUS. Additionally, 2 of 50 patients with a prior diagnosis of ITP were deficient for VWF-CP. Antibodies against VWF-CP were found in 4 children. Mutation analysis of the ADAMTS13 gene in the patients deficient in VWF-CP by direct sequencing of all 29 exons identified 8 different mutations, suggesting the hereditary form of TTP in 1 patient with ITP, in the patient with Evans syndrome, and in 5 of the 8 patients with TTP. The phenotype of TTP in childhood can be rather variable. Besides the classical clinical picture, oligosymptomatic forms may occur that can delay the identification of patients at risk.
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MESH Headings
- ADAM Proteins
- ADAMTS13 Protein
- Amino Acid Substitution
- Antibody Specificity
- Autoantibodies/blood
- Autoantibodies/immunology
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/enzymology
- Autoimmune Diseases/genetics
- Autoimmune Diseases/immunology
- Child
- Child, Preschool
- Codon, Nonsense
- DNA Mutational Analysis
- Diagnosis, Differential
- Diagnostic Errors
- Female
- Genetic Heterogeneity
- Genotype
- Hemolytic-Uremic Syndrome/diagnosis
- Hemolytic-Uremic Syndrome/enzymology
- Hemolytic-Uremic Syndrome/genetics
- Humans
- Infant
- Male
- Metalloendopeptidases/deficiency
- Metalloendopeptidases/genetics
- Metalloendopeptidases/immunology
- Mutation, Missense
- Phenotype
- Point Mutation
- Protein Structure, Tertiary
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/enzymology
- Purpura, Thrombotic Thrombocytopenic/congenital
- Purpura, Thrombotic Thrombocytopenic/diagnosis
- Purpura, Thrombotic Thrombocytopenic/enzymology
- Purpura, Thrombotic Thrombocytopenic/genetics
- Syndrome
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Affiliation(s)
- Reinhard Schneppenheim
- Children's University Hospital, Hamburg-Eppendorf; Lab Association Prof Arndt and Partners, Coagulation Laboratory, Hamburg, Germany.
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