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Roddie C, Lekakis LJ, Marzolini MAV, Ramakrishnan A, Zhang Y, Hu Y, Peddareddigari VGR, Khokhar N, Chen R, Basilico S, Raymond M, Vargas FA, Duffy K, Brugger W, O’Reilly MA, Wood L, Linch DC, Peggs KS, Bachier C, Budde EL, Lee Batlevi C, Bartlett N, Irvine D, Tholouli E, Osborne W, Ardeshna KM, Pule MA. Dual targeting of CD19 and CD22 with bicistronic CAR-T cells in patients with relapsed/refractory large B-cell lymphoma. Blood 2023; 141:2470-2482. [PMID: 36821767 PMCID: PMC10646794 DOI: 10.1182/blood.2022018598] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 10/11/2022] [Revised: 01/13/2023] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Relapse after CD19-directed chimeric antigen receptor T-cell (CAR-T) therapy for large B-cell lymphoma (LBCL) is commonly ascribed to antigen loss or CAR-T exhaustion. Multiantigen targeting and programmed cell death protein-1 blockade are rational approaches to prevent relapse. Here, we test CD19/22 dual-targeting CAR-T (AUTO3) plus pembrolizumab in relapsed/refractory LBCL (NCT03289455). End points include toxicity (primary) and response rates (secondary). Fifty-two patients received AUTO3 and 48/52 received pembrolizumab. Median age was 59 years (range, 27-83), 46/52 had stage III/ IV disease and median follow-up was 21.6 months. AUTO3 was safe; grade 1-2 and grade 3 cytokine release syndrome affected 18/52 (34.6%) and 1/52 (1.9%) patients, neurotoxicity arose in 4 patients (2/4, grade 3-4), and hemophagocytic lymphohistiocytosis affected 2 patients. Outpatient administration was tested in 20 patients, saving a median of 14 hospital days per patient. Overall response rates were 66% (48.9%, complete response [CR]; 17%, partial response). Median duration of remission (DOR) for CR patients was not reached and for all responding patients was 8.3 months (95% confidence interval [CI]: 3.0-not evaluable). 54.4% (CI: 32.8-71.7) of CR patients and 42.6% of all responding patients were projected to remain progression-free at ≥12 months. AUTO3 ± pembrolizumab for relapsed/refractory LBCL was safe and delivered durable remissions in 54.4% of complete responders, associated with robust CAR-T expansion. Neither dual-targeting CAR-T nor pembrolizumab prevented relapse in a significant proportion of patients, and future developments include next-generation-AUTO3, engineered for superior expansion in vivo, and selection of CAR binders active at low antigen densities.
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Affiliation(s)
- Claire Roddie
- Cancer Institute, University College London, London, United Kingdom
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Lazaros J. Lekakis
- Department of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Maria A. V. Marzolini
- Department of Haematology, University College London Hospital, London, United Kingdom
| | | | - Yiyun Zhang
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Yanqing Hu
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | | | - Nushmia Khokhar
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Robert Chen
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Silvia Basilico
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Meera Raymond
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | | | - Kevin Duffy
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Wolfram Brugger
- Department of Haematology, Autolus Ltd, London, United Kingdom
| | - Maeve A. O’Reilly
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Leigh Wood
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - David C. Linch
- Cancer Institute, University College London, London, United Kingdom
| | - Karl S. Peggs
- Cancer Institute, University College London, London, United Kingdom
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Carlos Bachier
- Department of Hematology, Methodist Hospital, San Antonio, TX
| | | | - Connie Lee Batlevi
- Department of Hematology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy Bartlett
- Department of Hematology, Washington University School of Medicine, St Louis, MO
| | - David Irvine
- Department of Haematology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Eleni Tholouli
- Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Wendy Osborne
- Department of Haematology, Freeman Hospital, Newcastle, United Kingdom
| | - Kirit M. Ardeshna
- Department of Haematology, University College London Hospital, London, United Kingdom
| | - Martin A. Pule
- Cancer Institute, University College London, London, United Kingdom
- Department of Haematology, Autolus Ltd, London, United Kingdom
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Rummelt C, Grishina O, Schmoor C, Crysandt M, Heuser M, Götze KS, Schlenk RF, Döhner K, Salih HR, Heil G, Müller-Tidow C, Brugger W, Kündgen A, De Wit M, Giagounidis A, Scholl S, Neubauer A, Krauter J, Bug G, Al-Ali HK, Wäsch R, Becker H, May AM, Duyster J, Hackanson B, Ganser A, Döhner H, Lübbert M. Activity of decitabine combined with all-trans retinoic acid in oligoblastic AML: Results from a randomized 2x2 phase II trial (DECIDER). Haematologica 2023. [PMID: 36601981 PMCID: PMC10388266 DOI: 10.3324/haematol.2022.282258] [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] [Received: 10/10/2022] [Indexed: 01/06/2023] Open
Abstract
Not available.
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Affiliation(s)
- Christoph Rummelt
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Olga Grishina
- Clinical Trials Unit, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Claudia Schmoor
- Clinical Trials Unit, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen University, Aachen
| | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover
| | - Katharina S Götze
- Department of Medicine III, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Munich, München
| | - Richard F Schlenk
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany; National Center of Tumor Diseases, NCT-Trial Center, German Cancer Research Center, Heidelberg
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital of Ulm, Ulm
| | - Helmut R Salih
- Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Tübingen, Tuebingen
| | - Gerhard Heil
- Department of Hematology/Oncology, Klinikum Luedenscheid, Luedenscheid
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Heidelberg, Heidelberg, Germany; Department of Medicine A, University Hospital of Münster, Münster
| | - Wolfram Brugger
- Department of Hematology, Hospital Villingen-Schwenningen, Villingen-Schwenningen
| | - Andrea Kündgen
- Department of Hematology, Oncology and Clinical Immunology, Heinrich- Heine-University, Faculty of Medicine, Düsseldorf, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Düsseldorf, Düsseldorf
| | - Maike De Wit
- Department of Hematology and Oncology, Vivantes Klinikum Neukölln, Berlin
| | - Aristoteles Giagounidis
- Clinic for Oncology, Hematology and Palliative Medicine, Marien-Hospital Düsseldorf, Düsseldorf
| | - Sebastian Scholl
- Department of Hematology and Oncology, Universitätsklinikum Jena, Klinik für Innere Medizin II, Jena
| | - Andreas Neubauer
- Department of Hematology and Oncology, University Clinic Gießen/Marburg, Marburg
| | - Jürgen Krauter
- Department of Internal Medicine III, Städtisches Klinikum Braunschweig, Braunschweig
| | - Gesine Bug
- Department of Medicine II, Hematology and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Frankfurt, Frankfurt
| | | | - Ralph Wäsch
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Heiko Becker
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Freiburg, Freiburg
| | - Annette M May
- Institute for Surgical Pathology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg
| | - Justus Duyster
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Freiburg, Freiburg
| | - Björn Hackanson
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Hematology/Oncology, Universitätsklinikum Augsburg, Augsburg
| | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover
| | - Hartmut Döhner
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
| | - Michael Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg.
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Culshaw A, Vargas FA, Toledo GS, Roddie C, Shaughnessy P, Duffy K, Brugger W, Merges M, Pule M. Industrialization of an Academic Miltenyi Prodigy-Based CAR T Process. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00408-0] [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: 10/18/2022]
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Staber PB, Jurczak W, Greil R, Vucinic V, Middeke JM, Montillo M, Munir T, Neumeister P, Schetelig J, Stilgenbauer S, Striebel F, Dirnberger-Hertweck M, Weirather J, Brugger W, Kelemen P, Wendtner CM, Woyach JA. Tafasitamab combined with idelalisib or venetoclax in patients with CLL previously treated with a BTK inhibitor. Leuk Lymphoma 2021; 62:3440-3451. [PMID: 34414843 DOI: 10.1080/10428194.2021.1964020] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with relapsed/refractory chronic lymphocytic leukemia (R/R CLL) whose treatment failed with a Bruton's tyrosine kinase inhibitor have poor outcomes. We investigated tafasitamab plus idelalisib (cohort A) or venetoclax (cohort B) in this patient population in a phase II study (NCT02639910). In total, 24 patients were enrolled (cohort A: n = 11, median time on study, 7.4 months; cohort B: n = 13, median time on study, 15.6 months). The most common treatment-emergent adverse event (TEAE) in cohort A was anemia (63.6%) and in cohort B was infusion-related reaction (53.8%). The most common severe TEAE was neutropenia (cohort A: 45.5%; cohort B: 46.2%). The best overall response rate was 90.9% (cohort A) and 76.9% (cohort B). Undetectable minimal residual disease in peripheral blood was achieved in 2/8 patients (cohort A) and 6/7 patients (cohort B). Overall, these results suggest that anti-CD19 antibody-based combinations may be important in the treatment of patients with CLL.
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Affiliation(s)
- Philipp Bernhard Staber
- Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Wojciech Jurczak
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
| | - Richard Greil
- Laboratory for Immunological and Molecular Cancer Research, Salzburg Cancer Research Institute, Salzburg, Austria
| | - Vladan Vucinic
- Department of Hematology and Internal Oncology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Jan Moritz Middeke
- Medical Clinic 1, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Marco Montillo
- Hematology Department, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - Talha Munir
- Clinical Hematology, The Leeds Teaching Hospital, Leeds, UK
| | - Peter Neumeister
- Clinical Department of Hematology, Medical University of Graz, Graz, Austria
| | - Johannes Schetelig
- Medical Clinic 1, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | | | | | | | | | - Clemens-Martin Wendtner
- Department of Hematology, Oncology, Immunology, Palliative Medicine, Infectious Diseases, and Tropical Medicine, Munich Clinic Schwabing, Munich, Germany
| | - Jennifer Ann Woyach
- Division of Hematology, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Klisovic RB, Leung WH, Brugger W, Dirnberger-Hertweck M, Winderlich M, Ambarkhane SV, Jabbour EJ. A phase 2a, single-arm, open-label study of tafasitamab, a humanized, Fc-modified, anti-CD19 antibody, in patients with relapsed/refractory B-precursor cell acute lymphoblastic leukemia. Cancer 2021; 127:4190-4197. [PMID: 34343354 PMCID: PMC9292493 DOI: 10.1002/cncr.33796] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 12/31/2022]
Abstract
Background B‐precursor cell acute lymphoblastic leukemia (B‐ALL) in adults is an aggressive and challenging condition, and patients with relapsed/refractory (R/R) disease after allogeneic stem cell transplantation (SCT), or noncandidates for SCT, have a particularly poor prognosis. The authors investigated the activity of the Fc‐modified anti‐CD19 antibody tafasitamab in adults with R/R B‐ALL (NCT01685021). Methods Adults with R/R B‐ALL received single‐agent tafasitamab 12 mg/kg weekly for up to four 28‐day cycles. Patients with complete remission (with or without neutrophil/platelet recovery; complete remission [CR] or complete remission with incomplete count recovery [CRi]) after cycles 2, 3, or 4 could continue tafasitamab every 2 weeks for up to 3 further months. The primary end point was overall response rate (ORR). Results Twenty‐two patients were treated (median, 2 prior lines of therapy; range, 1‐8). Six patients completed 2 cycles, and 2 of these patients responded for an ORR of 9%; 16 patients (73%) progressed before their first response assessment. Responses lasted 8 and 4 weeks in the 2 patients with CR and minimal residual disease (MRD)–negative CRi, respectively. Tafasitamab produced rapid B‐cell/blast depletion in 21 of 22 patients within 1 to 2 weeks of first administration. Tafasitamab was well tolerated, with the most frequent adverse events being infusion‐related reactions (59.1%) and fatigue (40.9%). Grade 3 to 4 febrile neutropenia (22.7%) was the most common hematologic adverse event. Conclusions Tafasitamab monotherapy was associated with clinical activity in a subset of patients with R/R B‐ALL, including short‐lasting CR and MRD‐negative CRi. Given its favorable tolerability profile, further development of tafasitamab in chemoimmunotherapy combinations and MRD settings should be explored. In patients with relapsed/refractory B‐precursor acute lymphoblastic leukemia, monotherapy treatment with the Fc‐modified anti‐CD19 antibody tafasitamab was associated with clinical activity, including short‐lasting complete remission and minimal residual disease (MRD)–negative complete remission with incomplete count recovery. In conjuntion with its favorable tolerability profile, further exploration of tafasitamab in chemoimmunotherapy combinations and MRD settings is warranted.
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Affiliation(s)
- Rebecca B Klisovic
- Department of Hematology and Medical Oncology, Emory School of Medicine, Atlanta, Georgia
| | - Wing H Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | | | - Elias J Jabbour
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Straka C, Salwender H, Knop S, Vogel M, Müller J, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Bassermann F, Gramatzki M, Rösler W, Wolf HH, Brugger W, Engelhardt M, Fischer T, Liebisch P, Einsele H. Full or intensity-reduced high-dose melphalan and single or double autologous stem cell transplant with or without bortezomib consolidation in patients with newly diagnosed multiple myeloma. Eur J Haematol 2021; 107:529-542. [PMID: 34270825 DOI: 10.1111/ejh.13690] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE A post hoc subgroup analysis of two phase III trials (NCT00416273, NCT00416208) was carried out to investigate the influence of 100/140 and 200 mg/m² melphalan as well as single/double autologous stem cell transplantation (ASCT) on progression-free survival (PFS). Additionally, the effect of bortezomib consolidation on PFS was analyzed. METHODS Following induction therapy and high-dose melphalan with subsequent ASCT, patients with newly diagnosed multiple myeloma (NDMM) were randomized 1:1 to either four 35-day cycles of bortezomib consolidation (1.6 mg/m² IV on days 1, 8, 15, 22) or observation. RESULTS Of the 340 patients included in this analysis, 13.5% received 1 × MEL100/140, 22.9% 2 × MEL100/140, 31.2% 1 × MEL200, and 32.4% 2 × MEL200. With higher cumulative melphalan dose, PFS improved (P = .0085). PFS curves of patients treated with 2 × MEL100/140 and 1 × MEL200 were very similar. The superior dose effect of MEL200 over MEL100/140 was non-existent in the bortezomib consolidation arm but pronounced in the observation arm (P = .0015). Similarly, double ASCT was only beneficial in patients without bortezomib consolidation (P = .0569). CONCLUSIONS Full dose melphalan and double transplantation seem advantageous only as long as patients are not receiving bortezomib consolidation afterwards.
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Affiliation(s)
| | - Hans Salwender
- Asklepios Tumorzentrum, AK Altona und AK St. Georg, Hamburg, Germany
| | - Stefan Knop
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
| | | | | | - Bernd Metzner
- Universitätsklinik für Innere Medizin II, Oldenburg, Germany
| | - Christian Langer
- Universitätsklinikum Ulm, Klinik für Innere Medizin II, Ulm, Germany
| | - Herbert Sayer
- Universitätsklinikum Jena, Klinik für Innere Medizin II, Jena, Germany
| | - Wolfram Jung
- Universitätsmedizin Göttingen, Göttingen, Germany
| | | | - Florian Bassermann
- Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | | | - Wolf Rösler
- Universitätsklinikum Erlangen, Erlangen, Germany
| | | | | | | | | | - Peter Liebisch
- Universitätsklinikum Ulm, Klinik für Innere Medizin II, Ulm, Germany
| | - Hermann Einsele
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Würzburg, Germany
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Belada D, Kopeckova K, Bergua Burgues JM, André M, Pérez Persona E, Pichler P, Klöpfer P, Brackertz B, Lohrmann E, Lahiry A, Shah N, Brugger W, Burke JM, Nowakowski GS. FIRST‐MIND: A PHASE IB, OPEN‐LABEL, RANDOMIZED STUDY TO ASSESS SAFETY OF TAFASITAMAB OR TAFASITAMAB + LENALIDOMIDE IN ADDITION TO R‐CHOP IN PATIENTS WITH NEWLY DIAGNOSED DLBCL. Hematol Oncol 2021. [DOI: 10.1002/hon.149_2880] [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: 11/05/2022]
Affiliation(s)
- D Belada
- University Hospital and Faculty of Medicine 4th Department of Internal Medicine – Hematology Hradec Králové Czech Republic
| | - K Kopeckova
- 2nd Faculty of Medicine, Charles University and Motol University Hospital Department of Oncology Prague Czech Republic
| | | | - M André
- Université Catholique de Louvain Department of Haematology CHU UCL Namur Yvoir Belgium
| | - E Pérez Persona
- Osakidetza Basque Health Service, Araba University Hospital, Hematology Vitoria‐ Gasteiz Spain
| | - P Pichler
- University Hospital of St. Pölten Department of Internal Medicine St. Pölten Austria
| | - P Klöpfer
- MorphoSys AG Clinical Development Planegg Germany
| | - B Brackertz
- MorphoSys AG Global Patient Safety Planegg Germany
| | - E Lohrmann
- MorphoSys AG Global Patient Safety Planegg Germany
| | - A Lahiry
- MorphoSys AG Biostatistics and Data Management Planegg Germany
| | - N Shah
- MorphoSys AG Biostatistics and Data Management Planegg Germany
| | - W Brugger
- MorphoSys AG Clinical Development Planegg Germany
| | - J. M Burke
- US Oncology Research and Rocky Mountain Cancer Centers, Hematology, Aurora Colorado USA
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Belada D, Kopeckova K, Bergua JM, André M, Perez Persona E, Pichler P, Klöpfer P, Brackertz B, Lohrmann E, Lahiry A, Shah N, Brugger W, Burke JM, Nowakowski GS. First-MIND: A phase Ib, open-label, randomized study to assess safety of tafasitamab (tafa) or tafa + lenalidomide (LEN) in addition to R-CHOP in patients with newly diagnosed DLBCL. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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
7540 Background: Tafasitamab is a humanized, Fc-modified anti-CD19 monoclonal antibody that enhances antibody-dependent cellular cytotoxicity and phagocytosis. It is FDA-approved with LEN for adult patients (pts) with relapsed/refractory (R/R) DLBCL ineligible for autologous stem cell transplantation. First-MIND (NCT04134936) is a Phase Ib, open-label, randomized study of tafa + R-CHOP or tafa + LEN + R-CHOP in newly diagnosed DLBCL. Methods: Eligible pts were ≥18 years, treatment-naïve, with histologically confirmed DLBCL not otherwise specified, international prognostic index (IPI) 2–5 and ECOG performance status (PS) 0–2. Pts with known double- or triple-hit and transformed lymphoma were excluded. Treatment (Tx) comprised six 21-day cycles of tafa (12 mg/kg IV, Day [D] 1, 8, 15) + R-CHOP (arm A) or tafa (12 mg/kg IV, D1, 8, 15) + LEN (25 mg orally, D1–10) + R-CHOP (arm B). G-CSF and VTE prophylaxis was mandatory. Primary objective is safety; secondary objectives are ORR, PET-CR rate at end of Tx, PFS, long-term safety, pharmacokinetics, immunogenicity. Results: From Dec 2019 to Aug 2020, 83 pts were screened in Europe and the US; 66 were randomized (33 per arm). Data cut-off for this analysis: 9 Dec 2020; study is ongoing. Median age was 64.5 years (range 20–86). Overall, 30% (20/66) of pts were ≥70 years and many had high-risk disease: IPI 2 29%, IPI 3 46%, IPI 4 26%. ECOG PS: 47% of pts were ECOG PS 0, 44% PS 1, 9% PS 2. Most pts had stage III/IV disease (92%); 46% had bulky disease. All pts experienced a treatment-emergent adverse event (TEAE). Grade ≥3 neutropenia and thrombocytopenia occurred in 54.5% and 12.1% (arm A) and 66.7% and 30.3% (arm B) of pts, respectively (Table). Serious TEAEs occurred in 42.4% (arm A) and 51.5% (arm B) of pts. There were three deaths, unrelated to tafa and/or LEN (sepsis, urosepsis, and COVID-19 pneumonia). R-CHOP dose intensity was maintained in both arms. Among 60 pts who completed tumor assessments after cycle 3, ORR was 89.7% (arm A) and 93.5% (arm B). Conclusions: These data suggest R-CHOP + tafa or tafa + LEN is tolerable in pts with Tx-naïve DLBCL and that R-CHOP dosing is not affected. Toxicities are similar to those expected with R-CHOP or R-CHOP + LEN. Updated safety and early efficacy data will be presented at the conference. Clinical trial information: NCT04134936. [Table: see text]
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Affiliation(s)
- David Belada
- 4th Department of Internal Medicine–Hematology, University Hospital and Faculty of Medicine, Hradec Králové, Czech Republic
| | - Katerina Kopeckova
- Department of Oncology of the 2nd Faculty of Medicine of Charles University and University Hospital in Motol, Prague, Czech Republic
| | | | - Marc André
- Department of Haematology, Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Ernesto Perez Persona
- Bioaraba, [Onco-Hematology Research Group],Vitoria-Gasteiz, Spain, Osakidetza Basque Health Service, Araba University Hospital,[Hematology Department], Vitoria-Gasteiz, Spain
| | - Petra Pichler
- Department of Internal Medicine, University Hospital of St. Pölten, Karl Landsteiner University of Health Sciences, Karl Landsteiner Institute for Nephrology and Hemato Oncology, St. Pölten, Austria
| | | | | | | | | | | | | | - John M. Burke
- US Oncology Research and Rocky Mountain Cancer Centers, Aurora, CO
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9
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Lübbert M, Grishina O, Schmoor C, Schlenk RF, Jost E, Crysandt M, Heuser M, Thol F, Salih HR, Schittenhelm MM, Germing U, Kuendgen A, Götze KS, Lindemann HW, Müller-Tidow C, Heil G, Scholl S, Bug G, Schwaenen C, Giagounidis A, Neubauer A, Krauter J, Brugger W, De Wit M, Wäsch R, Becker H, May AM, Duyster J, Döhner K, Ganser A, Hackanson B, Döhner H. Valproate and Retinoic Acid in Combination With Decitabine in Elderly Nonfit Patients With Acute Myeloid Leukemia: Results of a Multicenter, Randomized, 2 × 2, Phase II Trial. J Clin Oncol 2019; 38:257-270. [PMID: 31794324 DOI: 10.1200/jco.19.01053] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE DNA-hypomethylating agents are studied in combination with other epigenetic drugs, such as histone deacetylase inhibitors or differentiation inducers (eg, retinoids), in myeloid neoplasias. A randomized, phase II trial with a 2 × 2 factorial design was conducted to investigate the effects of the histone deacetylase inhibitor valproate and all-trans retinoic acid (ATRA) in treatment-naive elderly patients with acute myeloid leukemia (AML). PATIENTS AND METHODS Two hundred patients (median age, 76 years; range, 61-92 years) ineligible for induction chemotherapy received decitabine (20 mg/m2 intravenously, days 1 to 5) alone (n = 47) or in combination with valproate (n = 57), ATRA (n = 46), or valproate + ATRA (n = 50). The primary endpoint was objective response, defined as complete and partial remission, tested at a one-sided significance level of α = .10. Key secondary endpoints were overall survival, event-free survival, and progression-free survival and safety. RESULTS The addition of ATRA resulted in a higher remission rate (21.9% with ATRA v 13.5% without ATRA; odds ratio, 1.80; 95% CI, 0.86 to 3.79; one-sided P = .06). For valproate, no effect was observed (17.8% with valproate v 17.2% without valproate; odds ratio, 1.06; 95% CI, 0.51 to 2.21; one-sided P = .44). Median overall survival was 8.2 months with ATRA v 5.1 months without ATRA (hazard ratio, 0.65; 95% CI, 0.48 to 0.89; two-sided P = .006). Improved survival was observed across risk groups, including patients with adverse cytogenetics, and was associated with longer response duration. With valproate, no survival difference was observed. Toxicities were predominantly hematologic, without relevant differences between the 4 arms. CONCLUSION The addition of ATRA to decitabine resulted in a higher remission rate and a clinically meaningful survival extension in these patients with difficult-to-treat disease, without added toxicity.
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Affiliation(s)
- Michael Lübbert
- Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Freiburg, Germany
| | - Olga Grishina
- Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Claudia Schmoor
- Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Richard F Schlenk
- University Hospital of Ulm, Ulm, Germany.,Heidelberg University Hospital, Heidelberg, Germany
| | - Edgar Jost
- University Hospital Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Martina Crysandt
- University Hospital Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | | | | | - Helmut R Salih
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Tübingen, Germany
| | | | - Ulrich Germing
- Faculty of Medicine, Heinrich-Heine University, Düsseldorf, Germany
| | - Andrea Kuendgen
- Faculty of Medicine, Heinrich-Heine University, Düsseldorf, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Düsseldorf, Germany
| | - Katharina S Götze
- Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Munich, Germany
| | | | - Carsten Müller-Tidow
- Heidelberg University Hospital, Heidelberg, Germany.,University Hospital of Münster, Münster, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Gesine Bug
- University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Frankfurt, Germany
| | - Carsten Schwaenen
- Hospital Esslingen, Esslingen, Germany.,Offenburg Hospital, Offenburg, Germany
| | | | | | - Jürgen Krauter
- Städtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Wolfram Brugger
- Hospital Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | | | - Ralph Wäsch
- Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Heiko Becker
- Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Freiburg, Germany
| | - Annette M May
- Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Justus Duyster
- Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Freiburg, Germany
| | | | | | - Björn Hackanson
- Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Universitätsklinikum Augsburg, Augsburg, Germany
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10
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Banerjee S, Lewsley LA, Clamp A, krell J, Herbertson R, Glasspool R, Orbegoso C, Green C, Kristeleit R, Gourley C, Cambell C, Banerji U, Shepherd C, Brugger W, Chudleigh L, Hanif A, McNeish I, Paul J. OCTOPUS: A randomised, multi-centre phase II umbrella trial of weekly paclitaxel+/- novel agents in platinum-resistant ovarian cancer: Vistusertib. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Straka C, Knop S, Vogel M, Müller J, Kropff M, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Salwender H, Wandt H, Bassermann F, Gramatzki M, Rösler W, Wolf H, Brugger W, Fischer T, Liebisch P, Engelhardt M, Einsele H. Bortezomib consolidation following autologous transplant in younger and older patients with newly diagnosed multiple myeloma in two phase III trials. Eur J Haematol 2019; 103:255-267. [DOI: 10.1111/ejh.13281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 01/10/2023]
Affiliation(s)
| | - Stefan Knop
- Medizinische Klinik und Poliklinik II Julius Maximilians Universität Würzburg Würzburg Germany
| | | | | | | | - Bernd Metzner
- Universitätsklinik für Innere Medizin – Onkologie und Hämatologie Klinikum Oldenburg Oldenburg Germany
| | | | - Herbert Sayer
- Klinik für Innere Medizin II [Hämatologie/Onkologie] Universitätsklinikum Jena Jena Germany
| | - Wolfram Jung
- Onkologie Universitätsmedizin Göttingen Göttingen Germany
| | | | | | - Hannes Wandt
- Medizinische Klinik 5 Paracelsus Medizinische Privatuniversität Nürnberg Nürnberg Germany
| | - Florian Bassermann
- Klinikum rechts der Isar, III. Medizinische Klinik Technische Universität München München Germany
| | | | - Wolf Rösler
- Universitätsklinkum Erlangen Erlangen Germany
| | | | | | | | - Peter Liebisch
- Zentrum für Innere Medizin Universitätsklinikum Ulm Ulm Germany
| | | | - Hermann Einsele
- Medizinische Klinik und Poliklinik II Julius Maximilians Universität Würzburg Würzburg Germany
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12
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Griesinger F, Radke S, Lüers A, Deschler-Baier B, Kimmich M, Sebastian M, Schulz C, Brugger W, Wiewrodt R, Pirker R, Früh M, Gautschi O, Wolf J. [Strategies to Overcome Acquired Resistance to EGFR-TKI Therapy Based on T790M Specific Substances using Osimertinib as an Example]. Pneumologie 2018; 72:774-781. [PMID: 30408830 DOI: 10.1055/a-0647-9835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) of the epidermal growth factor receptor (EGFR) are widely used in non-small cell lung cancer patients harboring activating EGFR mutations. However, resistance mechanisms, particularly the T790 M mutation, hamper longer-term therapeutic success of first and second generation EGFR-TKIs. To address this unmet medical need, EGFR-TKIs of the third generation are under clinical development. Relevant clinical efficacy with mainly mild to moderate class-specific side effects has been shown for third-generation EGFR-TKIs. Molecular testing is of major importance in deciding for treatment with third generation EGFR-TKIs. This article elucidates the developmental state of third generation EGFR-TKIs with its focus on Osimertinib, the first and currently the only compound in this class which is approved in Germany. Additionally, the medical importance of molecular diagnosis using tumor tissue and circulating tumor DNA is discussed.
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Affiliation(s)
- F Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Universitätsmedizin Oldenburg, Universitätsklinik Innere Medizin - Onkologie, Oldenburg
| | - S Radke
- AstraZeneca, Medical Affairs, Wedel
| | - A Lüers
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Universitätsmedizin Oldenburg, Universitätsklinik Innere Medizin - Onkologie, Oldenburg
| | - B Deschler-Baier
- Comprehensive Cancer Center Mainfranken, Universitätsklinikum Würzburg, Würzburg
| | - M Kimmich
- Abteilung für Pneumologie und Pneumologische Onkologie, Robert-Bosch-Krankenhaus Klinik Schillerhöhe, Gerlingen
| | - M Sebastian
- Abteilung für Hämatologie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt/Main
| | - C Schulz
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg
| | - W Brugger
- Medizinische Klinik II, Hämatologie/Onkologie, Schwarzwald-Baar Klinikum, Akad. Lehrkrankenhaus der Univ. Freiburg, Villingen-Schwenningen
| | - R Wiewrodt
- Medizinische Klinik A, Universitätsklinikum Münster, Münster
| | - R Pirker
- Klinische Abteilung für Onkologie, Allgemeines Krankenhaus-Universitätskliniken Wien
| | - M Früh
- Klinik für Hämatologie/Onkologie, Kantonsspital St. Gallen, St. Gallen
| | - O Gautschi
- Abteilung für Medizinische Onkologie, Kantonsspital Luzern, Luzern
| | - J Wolf
- Klinik I für Innere Medizin, Centrum für Integrierte Onkologie, Uniklinik Köln, Köln
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13
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de Bono J, Hansen A, Choudhury A, Cook N, Heath E, Higano C, Linch M, Martin-Liberal J, Rathkopf D, Wisinski K, Barry S, de Bruin E, Brugger W, Colebrook S, Klinowska T, Moschetta M, Mortimer P, Siu L, Shapiro G. AZD8186, a potent and selective inhibitor of PI3Kβ/δ, as monotherapy and in combination with abiraterone acetate plus prednisone (AAP), in patients (pts) with metastatic castrate-resistant prostate cancer (mCRPC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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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14
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Basu B, Krebs MG, Sundar R, Wilson RH, Spicer J, Jones R, Brada M, Talbot DC, Steele N, Ingles Garces AH, Brugger W, Harrington EA, Evans J, Hall E, Tovey H, de Oliveira FM, Carreira S, Swales K, Ruddle R, Raynaud FI, Purchase B, Dawes JC, Parmar M, Turner AJ, Tunariu N, Banerjee S, de Bono JS, Banerji U. Vistusertib (dual m-TORC1/2 inhibitor) in combination with paclitaxel in patients with high-grade serous ovarian and squamous non-small-cell lung cancer. Ann Oncol 2018; 29:1918-1925. [PMID: 30016392 PMCID: PMC6158767 DOI: 10.1093/annonc/mdy245] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background We have previously shown that raised p-S6K levels correlate with resistance to chemotherapy in ovarian cancer. We hypothesised that inhibiting p-S6K signalling with the dual m-TORC1/2 inhibitor in patients receiving weekly paclitaxel could improve outcomes in such patients. Patients and methods In dose escalation, weekly paclitaxel (80 mg/m2) was given 6/7 weeks in combination with two intermittent schedules of vistusertib (dosing starting on the day of paclitaxel): schedule A, vistusertib dosed bd for 3 consecutive days per week (3/7 days) and schedule B, vistusertib dosed bd for 2 consecutive days per week (2/7 days). After establishing a recommended phase II dose (RP2D), expansion cohorts in high-grade serous ovarian cancer (HGSOC) and squamous non-small-cell lung cancer (sqNSCLC) were explored in 25 and 40 patients, respectively. Results The dose-escalation arms comprised 22 patients with advanced solid tumours. The dose-limiting toxicities were fatigue and mucositis in schedule A and rash in schedule B. On the basis of toxicity and pharmacokinetic (PK) and pharmacodynamic (PD) evaluations, the RP2D was established as 80 mg/m2 paclitaxel with 50 mg vistusertib bd 3/7 days for 6/7 weeks. In the HGSOC expansion, RECIST and GCIG CA125 response rates were 13/25 (52%) and 16/25 (64%), respectively, with median progression-free survival (mPFS) of 5.8 months (95% CI: 3.28-18.54). The RP2D was not well tolerated in the SqNSCLC expansion, but toxicities were manageable after the daily vistusertib dose was reduced to 25 mg bd for the following 23 patients. The RECIST response rate in this group was 8/23 (35%), and the mPFS was 5.8 months (95% CI: 2.76-21.25). Discussion In this phase I trial, we report a highly active and well-tolerated combination of vistusertib, administered as an intermittent schedule with weekly paclitaxel, in patients with HGSOC and SqNSCLC. Clinical trial registration ClinicialTrials.gov identifier: CNCT02193633.
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Affiliation(s)
- B Basu
- Department of Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - M G Krebs
- Manchester Academic Health Science Centre, The University of Manchester and The Christie NHS Foundation Trust, Manchester
| | - R Sundar
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Department of Haematology-Oncology, National University Health System, Singapore
| | - R H Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast and Belfast City Hospital, Belfast
| | - J Spicer
- School of Cancer and Pharmaceutical Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London
| | - R Jones
- Cardiff University and Velindre Cancer Centre, Cardiff
| | - M Brada
- University of Liverpool and Clatterbridge Cancer Centre NHS Foundation Trust, Wirral
| | - D C Talbot
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - N Steele
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow
| | - A H Ingles Garces
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - W Brugger
- Oncology, IMED Biotech Unit AstraZeneca, Cambridge
| | | | - J Evans
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - H Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - F M de Oliveira
- Division of Clinical Studies, The Institute of Cancer Research, London
| | - S Carreira
- Division of Clinical Studies, The Institute of Cancer Research, London
| | - K Swales
- Division of Cancer Therapeutics, The Institute of Cancer Research, London
| | - R Ruddle
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, London
| | - F I Raynaud
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, London
| | - B Purchase
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - J C Dawes
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - M Parmar
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - A J Turner
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - N Tunariu
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - S Banerjee
- Department of Gynae-Oncology, The Royal Marsden, London, UK
| | - J S de Bono
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London
| | - U Banerji
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London; Division of Cancer Therapeutics, The Institute of Cancer Research, London.
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15
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Johnson ML, Wang JSZ, Falchook GS, Charlton J, MacDonald A, Strickland D, Jones SF, Pease EJ, Brugger W, Burris HA. A phase I, open-label, multicenter dose escalation study to assess the safety, tolerability, and pharmacokinetics of AZD2811 nanoparticle in patients with advanced solid tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
| | | | | | | | | | | | | | | | - Wolfram Brugger
- Oncology IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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16
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Heymach J, Thomas M, Besse B, Forde PM, Awad MM, Goss GD, Park K, Rizvi NA, Lao-Sirieix SH, Patel SI, Mortimer PG, Ambrose H, Jewsbury PJ, Sachsenmeier K, Khoja L, Brugger W. An open-label, multidrug, biomarker-directed, multicentre phase II umbrella study in patients with non-small cell lung cancer, who progressed on an anti-PD-1/PD-L1 containing therapy (HUDSON). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps3120] [Citation(s) in RCA: 5] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- John Heymach
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Thomas
- Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | - Patrick M. Forde
- Johns Hopkins Kimmel Comprehensive Cancer Center and Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, MD
| | | | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | - Sabina I Patel
- Precision Medicine and Genomics, IMED Biotech Unit, AstraZeneca, Melbourn, United Kingdom
| | | | | | | | | | - Leila Khoja
- Oncology IMED Biotech Unit, AstraZeneca, Melbourn, United Kingdom
| | - Wolfram Brugger
- Oncology IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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17
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Rule S, Kater AP, Brümmendorf TH, Fegan C, Kaiser M, Radford JA, Stilgenbauer S, Kayser S, Dyer MJS, Brossart P, Cidado J, Drew L, Birkett J, Davies A, Shao W, Brugger W. A phase 1, open-label, multicenter, non-randomized study to assess the safety, tolerability, pharmacokinetics, and preliminary antitumor activity of AZD4573, a potent and selective CDK9 inhibitor, in subjects with relapsed or refractory hematological malignancies. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps7588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Simon Rule
- Department of Haematology, Derriford Hospital, Plymouth, United Kingdom
| | - Arnon P. Kater
- Department of Hematology, Academic Medical Center Amsterdam, University of Amsterdam, on behalf of the HOVON CLL Working Group, Amsterdam, Netherlands
| | | | - Chris Fegan
- University Hospital of Wales, Cardiff, United Kingdom
| | - Martin Kaiser
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - John A. Radford
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Sabine Kayser
- Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | | | - Peter Brossart
- University Hospital Bonn, Center for Integrated Oncology, Bonn, Germany
| | - Justin Cidado
- Bioscience, IMED Biotech Unit, AstraZeneca, Waltham, MA
| | - Lisa Drew
- Bioscience, IMED Biotech Unit, AstraZeneca, Waltham, MA
| | | | - Andrew Davies
- Cancer Research UK Centre, Cancer Sciences Division, University of Southampton, Southampton, United Kingdom
| | - Wenlin Shao
- Oncology IMED Biotech Unit, AstraZeneca, Waltham, MA
| | - Wolfram Brugger
- Oncology IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
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18
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Westin SN, Litton JK, Williams RA, Shepherd CJ, Brugger W, Pease EJ, Soliman PT, Frumovitz MM, Levenback CF, Sood A, Meyer L, Moulder SL, Valero V, Saleem S, Rodriguez AM, Cyriac A, Engerman L, Samuel C, Mills GB, Coleman RL. Phase I trial of olaparib (PARP inhibitor) and vistusertib (mTORC1/2 inhibitor) in recurrent endometrial, ovarian and triple negative breast cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5504] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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)
| | | | | | | | - Wolfram Brugger
- Oncology IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | | | | | | | | | - Anil Sood
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larissa Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Vicente Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sadia Saleem
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Annies Cyriac
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Gordon B. Mills
- The University of Texas MD Anderson Cancer Center, Houston, TX
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19
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Abstract
Aims and background There are only limited data on the safety and efficacy of panitumumab in patients who experienced severe infusion reactions during cetuximab antibody therapy. Case report We report the case of a 69-year-old woman with chemotherapy-refractory metastatic colorectal cancer who received single-agent cetuximab treatment but experienced a severe reaction during the first infusion, despite premedication with corticosteroids/antihistamines. Cetuximab was discontinued and treatment with panitumumab initiated approximately 14 days later (without premedication); no infusion reactions occurred and there was a rapid improvement in her general condition. She experienced a partial response that was sustained for 7 months before progression. Conclusions This case supports the use of panitumumab in patients with chemotherapy-refractory metastatic colorectal cancer and suggests that panitumumab may be used in some patients with prior infusion reactions to cetuximab.
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Affiliation(s)
- Wolfram Brugger
- Schwarzwald-Baar Clinic, Villingen-Schwenningen, Teaching Hospital, University of Freiburg, Germany
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20
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Ashton S, Floch N, Taylor P, Howes C, Ferguson D, Ling M, Hattersley M, Wen S, Maratea K, Hughes A, Redmond S, Brugger W, Smith S, MacDonald A, Parry K, Burris H, Song YH, Nolan J, Pease E, Barry ST. Abstract 311: Development of AZD2811, an aurora kinase B inhibitor, incorporated into an AccurinTM nanoparticle for use in haematological and solid cancers. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-311] [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
A nanoparticle formulation of AZD2811, a selective aurora kinase B inhibitor, is currently under clinical development for the treatment of both haematological and solid tumour disease. AZD2811 is the active derivative of the prodrug Barasertib (AZD1152) which gave promising clinical activity in elderly AML patients delivered as a 7-day infusion (Kantarjian et al, Cancer, 119, 2611-2619, 2013). To address the limitations associated with the clinical utility of Barasertib and other cell cycle inhibitors in the clinic, AZD2811 has been incorporated into an AccurinTM nanoparticle using a pamoic acid ion pairing approach to optimise drug release rate (Song et al, Journal of Controlled Release, 229, 106-119, 2016), improve the drug exposure to tumour and reduce the duration of administration. A proof of principle formulation of AZD2811 as an AccurinTM nanoparticle established the principle that anti-tumour activity and improved therapeutic index could be achieved (Ashton et al, Science Translational Medicine, 325, 1-10, 2016). The clinical nanoparticle formulation of AZD2811 has been optimised for drug loading and release rate. In pre-clinical models, the clinical formulation can be used flexibly to optimise drug delivery for use in both haematological disease such as AML, or in solid tumour settings. Anti-tumour activity in solid tumours can be achieved at doses where bone marrow toxicity is reduced compared to Barasertib. In sensitive xenograft and PDX solid tumour models greater than 90% tumour regression is observed after a total dose of 50mg/kg with no tumour progression for greater than 40 days. In contrast, for AML, increasing the dose intensity by 2-4 fold leads to neutropenia and to complete tumour regression in a range of AML xenograft models for greater than 60 days. These data establish the concept that drug delivery using nanoparticles is able to resolve therapeutic index challenges, and is able to do so across different disease types. AZD2811 is currently in Phase 1 clinical trial (D6130C0000). The current pre-clinical and clinical data with this novel approach to inhibition of the cell cycle will be discussed.
Citation Format: Susan Ashton, Nicholas Floch, Paula Taylor, Colin Howes, Doug Ferguson, Matthew Ling, Maureen Hattersley, Shenghua Wen, Kim Maratea, Adina Hughes, Sean Redmond, Wolfram Brugger, Simon Smith, Alexander MacDonald, Keith Parry, Howard Burris, Young-Ho Song, Jim Nolan, Elizabeth Pease, Simon T. Barry. Development of AZD2811, an aurora kinase B inhibitor, incorporated into an AccurinTM nanoparticle for use in haematological and solid cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 311. doi:10.1158/1538-7445.AM2017-311
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Affiliation(s)
- Susan Ashton
- 1AstraZeneca, Macclesfield Cheshire, United Kingdom
| | | | - Paula Taylor
- 1AstraZeneca, Macclesfield Cheshire, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | - Keith Parry
- 5Sarah Cannon Research Institute, London, United Kingdom
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Rummel MJ, Maschmeyer G, Ganser A, Heider A, von Gruenhagen U, Losem C, Heil G, Welslau M, Balser C, Kaiser U, Weidmann E, Dürk HA, Ballo H, Stauch M, Blau W, Burchardt A, Barth J, Kauff F, Brugger W. Bendamustine plus rituximab (B-R) versus CHOP plus rituximab (CHOP-R) as first-line treatment in patients with indolent lymphomas: Nine-year updated results from the StiL NHL1 study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7501] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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
7501 Background: This multicenter, randomized, phase III study compared B-R and CHOP-R as first-line treatment in patients (pts) with indolent lymphomas or mantle cell lymphoma and was first published in The Lancet in 2013. The final analysis demonstrated a significantly prolonged progression-free survival (PFS) in the B-R group compared to the CHOP-R group, with a median PFS of 69.5 vs. 31.2 months, respectively. In the current analysis, we present updated results for overall survival (OS), time-to-next-treatment (TTNT), and secondary malignancies (sNPL) with a median follow-up of 113 months for patients with indolent lymphomas (excluding MCL). Methods: 447 pts with indolent lymphomas were randomized to receive B-R or CHOP-R for a maximum of 6 cycles. The primary endpoint was PFS; secondary endpoints included OS, TTNT, and sNPL. Results: Patient characteristics were well balanced between arms; median age was 64 years. The difference in OS between the two treatment arms was not statistically significant, with 60 deaths in the B-R group vs 68 deaths with CHOP-R (HR 0.82, 95% CI 0.58 – 1.15, p = 0.249). The estimated 10-year survival rates were 71% for B-R and 66% for CHOP-R. TTNT was significantly prolonged with B-R compared with CHOP-R (HR 0.52, 95% CI 0.38 – 0.69, p < 0.001). Median TTNT was not yet reached in the B-R group (95% CI 124.9 – n.y.r) vs. 56 months in the CHOP-R group (95% CI 39.1 – 82.0). Patients treated initially with B-R needed fewer second-line treatments due to disease progression compared to CHOP-R treated pts: 73 pts (34%) in the B-R group received salvage treatment compared with 106 pts (52%) in the CHOP-R group. For B-R pts, CHOP-R was used as second-line therapy 26 times (36%), whereas B-R was used for pts initially treated with CHOP-R 49 times (46%). 36 pts with sNPL were observed in the B-R group compared with 39 in the CHOP-R group, with 7 hematological malignancies in both groups to date. Conclusions: In pts with previously untreated indolent lymphomas, B-R demonstrates a PFS and TTNT benefit over CHOP-R. Clinical trial information: NCT00991211.
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Affiliation(s)
- Mathias J. Rummel
- Department of Haematology and Oncology, Justus-Liebig Universität, Giessen, Germany
| | | | - Arnold Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | | | | | - Christoph Losem
- Praxis Hematologie and Oncologie Dtes Losem/Plewe, Neuss, Germany
| | - Gerhard Heil
- Kreiskrankenhaus Lüdenscheid, Luedenscheid, Germany
| | | | | | | | | | | | | | - Martina Stauch
- Onkologische Schwerpunktpraxis Kronach, Kronach, Germany
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Burris HA, Wang JSZ, Johnson ML, Falchook GS, Jones SF, Strickland DK, Greenlees C, Brugger W, Charlton J, Pease E, MacDonald A. A phase I, open-label, first-time-in-patient dose escalation and expansion study to assess the safety, tolerability, and pharmacokinetics of nanoparticle encapsulated Aurora B kinase inhibitor AZD2811 in patients with advanced solid tumours. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps2608] [Citation(s) in RCA: 3] [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
TPS2608 Background: Aurora kinase B performs key roles in the regulation of the cell cycle and represents a potential target for anticancer therapy. AZD2811, formerly designated AZD1152 hydroxy-quinazoline pyrazole anilide (AZD1152 hQPA), is a potent and selective inhibitor of Aurora B kinase activity and has been incorporated into a polymer nanoparticle carrier for intravenous (IV) administration. The phosphate pro-drug of AZD2811, known as AZD1152 (barasertib), reached Phase II of clinical development as a continuous IV infusion. While promising efficacy was seen with barasertib in elderly acute myeloid leukaemia (AML) patients ( Kantarjian HG et al., Cancer 2013;119:2611-19), continuous intravenous drug delivery precluded subsequent development in this disease setting and there were limited clinical responses in solid tumour patients due to dose-limiting myelotoxicity. AZD2811 nanoparticle has been designed to overcome these issues. Methods: Patients with relapsed advanced solid malignancies with no standard treatments are eligible for the part A dose escalation. Primary endpoint is to determine the maximum tolerated dose of AZD2811 nanoparticle using a 3+3 design. Patients with refractory/relapsed small cell lung cancer (SCLC) will be eligible for the part B expansion, where the safety, PK and anti-tumour activity of AZD2811 nanoparticle will be assessed as monotherapy and in combination with chemotherapy. Study enrolment is ongoing. Clinical trial information: NCT02579226.
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Hansen AR, Shapiro G, Do KT, Kumar R, Martin-Liberal J, Higano CS, Wisinski KB, Dean EJ, Heath EI, Rathkopf DE, Linch MD, Barry ST, Brugger W, De Bruin E, Colebrook S, Klinowska T, Mitchell PD, Moorthy G, De Bono JS, Siu LL. A first in human phase I study of AZD8186, a potent and selective inhibitor of PI3K in patients with advanced solid tumours as monotherapy and in combination with the dual mTORC1/2 inhibitor vistusertib (AZD2014) or abiraterone acetate. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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
2570 Background: Loss of PTEN function leads to increased PI3Kβ signalling. AZD8186 (AZD) exhibits significant anti-tumour activity in PTEN-deficient preclinical models, particularly when combined with anti-androgens or the dual mTORC1/2 inhibitor vistusertib (AZD2014). Here we report on the dose-finding part of this Phase 1 study. Methods: AZD single agent was administered twice daily (BD) in 3 different schedules (5 days on/ 2 days off, 2 days on/ 5 days off and continuous). Escalating doses of AZD were evaluated in cohorts of 3-6 patients treated until progression, unacceptable toxicity, or consent withdrawal. Accrual is ongoing in the combination arms with vistusertib or abiraterone acetate. Results: As of 16 Jan 2017, 87 patients have received AZD at doses of 30–360 mg BD, with 28 confirmed as PTEN deficient (IHC). The selected RP2D for the 5 days on/2 days off monotherapy schedule is 60 mg BD. PK parameters show that systemic exposures to AZD and its major active metabolite increase in a dose proportional manner. 69 serious adverse events (SAEs) were reported in 31 patients on AZD monotherapy with 23 SAEs considered possibly related to AZD. In the 5/2 schedule: 5 dose limiting toxicities (G3 rash with ≥G2 fever and/or chills) were observed in 5 patients at doses of 120-360mg. Adverse events ≥G1 in > 20% included diarrhoea, nausea, fatigue, LFT elevations and decreased appetite. 20 patients remained on study for > 100 days. Dose-dependent target inhibition has been demonstrated in surrogate tissue (platelets). Evaluation of direct tumour target engagement in paired biopsies is currently ongoing. Preliminary efficacy: Confirmed PRs seen in a CRPC patient (BRCA2 and androgen receptor mutant) treated in combination with vistusertib (on study for 411 days) and in one ongoing monotherapy PTEN-deficient colorectal cancer patient (on study > 329 days). Updated data will be presented. Conclusions: AZD has potential for treatment of PTEN-deficient tumours. Investigation of the safety/tolerability and preliminary efficacy in combination with vistusertib or abiraterone acetate is continuing. Clinical trial information: NCT01884285.
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Affiliation(s)
| | | | - Khanh T Do
- Dana-Farber Cancer Institute, Boston, MA
| | - Rajiv Kumar
- Royal Marsden Hospital, Surrey, United Kingdom
| | - Juan Martin-Liberal
- Medical Oncology Department, Vall d'Hebron University Hospital, Molecular Therapeutics Research Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Emma Jane Dean
- University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Elisabeth I. Heath
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | | | | | | | | | | | | | | | | | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
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Rummel M, Kim T, Aversa F, Brugger W, Capochiani E, Plenteda C, Re F, Trask P, Osborne S, Smith R, Grigg A. Preference for subcutaneous or intravenous administration of rituximab among patients with untreated CD20+ diffuse large B-cell lymphoma or follicular lymphoma: results from a prospective, randomized, open-label, crossover study (PrefMab). Ann Oncol 2017; 28:836-842. [DOI: 10.1093/annonc/mdw685] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/15/2016] [Indexed: 01/06/2023] Open
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Mey UJM, Brugger W, Schwarb H, Pederiva S, Schwarzer A, Dechow T, Jehner P, Rauh J, Taverna CJ, Schmid M, Schmidt-Hieber M, Doerfel S, Fischer N, Ruefer A, Ziske C, Knauf W, Cathomas R, von Moos R, Hitz F, Sauter R, Hiendlmeyer E, Cantoni N, Bargetzi M, Driessen C. Bendamustine, lenalidomide and dexamethasone (BRd) has high activity as 2nd-line therapy for relapsed and refractory multiple myeloma - a phase II trial. Br J Haematol 2016; 176:770-782. [DOI: 10.1111/bjh.14481] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/10/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Ulrich J. M. Mey
- Medical Oncology and Haematology; Kantonsspital Graubünden; Chur Switzerland
| | - Wolfram Brugger
- Haematology/Oncology; Schwarzwald-Baar-Klinikum; Villingen-Schwenningen Germany
| | - Heike Schwarb
- Department of Oncology; Kantonsspital Baden; Baden Switzerland
| | | | | | | | - Paul Jehner
- Haemato-Onkologische Praxis Moers; Moers Germany
| | - Jacqueline Rauh
- Fachinternistische Gemeinschaftspraxis und Therapiezentrum; Witten Germany
| | | | - Mathias Schmid
- Department of Medical Oncology and Haematology; Stadtspital Triemli; Zuerich Switzerland
| | - Martin Schmidt-Hieber
- Haematology, Oncology and Tumourimmunology; Helios Clinic Berlin-Buch; Berlin Germany
| | | | | | - Axel Ruefer
- Department of Haematology; Kantonsspital Luzern; Luzern Switzerland
| | - Carsten Ziske
- Haemato-Onkologische Schwerpunktpraxis Troisdorf; Troisdorf Germany
| | - Wolfgang Knauf
- Onkologische Gemeinschaftspraxis Frankfurt; Frankfurt Germany
| | - Richard Cathomas
- Medical Oncology and Haematology; Kantonsspital Graubünden; Chur Switzerland
| | - Roger von Moos
- Medical Oncology and Haematology; Kantonsspital Graubünden; Chur Switzerland
| | - Felicitas Hitz
- Department of Medical Oncology; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Rafael Sauter
- Clinical Trials Unit; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Elke Hiendlmeyer
- Clinical Trials Unit; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Nathan Cantoni
- Division of Haematology and Transfusion Medicine; Kantonsspital Aarau; Aarau Switzerland
| | - Mario Bargetzi
- Division of Haematology and Transfusion Medicine; Kantonsspital Aarau; Aarau Switzerland
| | - Christoph Driessen
- Department of Medical Oncology; Kantonsspital St. Gallen; St. Gallen Switzerland
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Lillian S, De Bono J, Higano C, Shapiro G, Brugger W, Mitchell P, Colebrook S, Klinowska T, Barry S, Dean E, Martin-Mills J, Wisinski K, Moorthy G, Mills J, Cruzalegui F, Tolaney S, Lang J, Jose De Miquel Luken M, Kunar R, Chatta G. AZD8186 study 1: Phase I study to assess the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD) and preliminary anti-tumour activity of AZD8186 in patients with advanced castration-resistant prostate cancer (CRPC), squamous non-small cell lung cancer, triple negative breast cancer and with PTEN-deficient/mutated or PIK3CB mutated/amplified malignancies, as monotherapy and in combination with vistusertib (AZD2014) or abiraterone acetate. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32637-5] [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: 10/20/2022]
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Faehling M, Achenbach J, Staib P, Steffen U, Tessen H, Brugger W. Erlotinib in routine clinical practice for first-line maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.62] [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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Klughammer B, Brugger W, Cappuzzo F, Ciuleanu T, Mok T, Reck M, Tan EH, Delmar P, Klingelschmitt G, Yin AY, Spleiss O, Wu L, Shames DS. Examining Treatment Outcomes with Erlotinib in Patients with Advanced Non–Small Cell Lung Cancer Whose Tumors Harbor Uncommon EGFR Mutations. J Thorac Oncol 2016; 11:545-55. [DOI: 10.1016/j.jtho.2015.12.107] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 02/08/2023]
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Rummel M, Kaiser U, Balser C, Stauch M, Brugger W, Welslau M, Niederle N, Losem C, Boeck HP, Weidmann E, von Gruenhagen U, Mueller L, Sandherr M, Hahn L, Vereshchagina J, Kauff F, Blau W, Hinke A, Barth J. Bendamustine plus rituximab versus fludarabine plus rituximab for patients with relapsed indolent and mantle-cell lymphomas: a multicentre, randomised, open-label, non-inferiority phase 3 trial. Lancet Oncol 2015; 17:57-66. [PMID: 26655425 DOI: 10.1016/s1470-2045(15)00447-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fludarabine-based chemoimmunotherapy with rituximab is frequently used in patients with indolent and mantle-cell lymphomas who relapse after alkylating chemotherapy. We aimed to compare the efficacy and safety of rituximab with bendamustine or fludarabine in patients with relapsed, indolent, non-Hodgkin lymphoma and mantle-cell lymphoma. METHODS For this randomised, non-inferiority, open-label, phase 3 trial, we recruited patients from 55 centres in Germany, who were subsequently randomised centrally according to prespecified randomisation lists with permuted blocks of randomly variable block size to rituximab (375 mg/m(2), day 1) plus either bendamustine (90 mg/m(2), days 1 and 2) or fludarabine (25 mg/m(2), days 1-3) every 28 days for a maximum of six 28-day cycles. Patients were aged 18 years or older with a WHO performance status of 0-2 and had relapsed or refractory indolent or mantle-cell lymphoma; patients refractory to regimens that included rituximab, bendamustine, or purine analogue drugs were excluded. Patients were stratified by histological subtypes of lymphoma and by their latest previous therapies. Treatment allocation was not masked. The primary endpoint was progression-free survival and the final analysis was completed per protocol. Non-inferiority of bendamustine plus rituximab versus fludarabine plus rituximab was defined as a difference of less than 15% in 1-year progression-free survival. The protocol was amended in July, 2006, after approval of rituximab maintenance (375 mg/m(2) every 3 months for up to 2 years), which was then given to patients achieving a response to either trial treatment. This study is registered with ClinicalTrials.gov, number NCT01456351 (closed to enrolment, follow-up is ongoing). FINDINGS Between Oct 8, 2003, and Aug 5, 2010, we randomly assigned 230 patients to treatment groups (116 bendamustine plus rituximab, 114 fludarabine plus rituximab). 11 patients were excluded for protocol violations and were not followed up further (two in the bendamustine plus rituximab group and nine in the fludarabine plus rituximab group). Thus, 219 patients were included in the per-protocol analysis (114 bendamustine plus rituximab, 105 fludarabine plus rituximab). 1-year progression-free survival with bendamustine plus rituximab was 0·76 (95% CI 0·68-0·84) and 0·48 (0·39-0·58) with fludarabine plus rituximab (non-inferiority p<0·0001). At a median follow-up of 96 months (IQR 73·2-112·9), median progression-free survival with bendamustine plus rituximab was 34·2 months (95% CI 23·5-52·7) and 11·7 months (8·0-16·1) with fludarabine plus rituximab (hazard ratio [HR] 0·54 [95% CI 0·38-0·72], log-rank test p<0·0001). Safety outcomes were similar in both groups, with 46 serious adverse events recorded (23 in the bendamustine plus rituximab group and 23 in the fludarabine plus rituximab group), most commonly myelosuppression and infections. INTERPRETATION In combination with rituximab, bendamustine was more effective than fludarabine, suggesting that bendamustine plus rituximab may be the preferred treatment option for patients with relapsed indolent and mantle-cell lymphomas. FUNDING Roche Pharma AG, Ribosepharm GmbH, Mundipharma GmbH, Studiengruppe indolente Lymphome (StiL).
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Affiliation(s)
- Mathias Rummel
- Department of Haematology and Oncology, Justus-Liebig Universität, Giessen, Germany.
| | - Ulrich Kaiser
- Innere Medizin II, St Bernward Krankenhaus, Hildesheim, Germany
| | | | | | - Wolfram Brugger
- Schwarzwald-Baar Klinikum, Akad, Lehrkrankenhaus der University Freiburg, Villingen-Schwenningen, Germany
| | | | | | | | | | - Eckhart Weidmann
- Department of Hematology and Oncology, Krankenhaus Nordwest, Frankfurt, Germany
| | | | | | | | | | - Julia Vereshchagina
- Department of Haematology and Oncology, Justus-Liebig Universität, Giessen, Germany
| | - Frank Kauff
- Department of Haematology and Oncology, Justus-Liebig Universität, Giessen, Germany
| | - Wolfgang Blau
- Department of Haematology and Oncology, Justus-Liebig Universität, Giessen, Germany
| | - Axel Hinke
- Wissenschaftlicher Service Pharma (WISP) Research Institute, Langenfeld, Germany
| | - Juergen Barth
- Department of Haematology and Oncology, Justus-Liebig Universität, Giessen, Germany
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Cheson BD, Brugger W, Damaj G, Dreyling M, Kahl B, Kimby E, Ogura M, Weidmann E, Wendtner CM, Zinzani PL. Optimal use of bendamustine in hematologic disorders: Treatment recommendations from an international consensus panel - an update. Leuk Lymphoma 2015; 57:766-82. [PMID: 26592922 PMCID: PMC4840280 DOI: 10.3109/10428194.2015.1099647] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Bendamustine has achieved widespread international regulatory approval and is a standard agent for the treatment for chronic lymphocytic leukemia (CLL), indolent non-Hodgkin lymphoma and multiple myeloma. Since approval, the number of indications for bendamustine has expanded to include aggressive non-Hodgkin lymphoma and Hodgkin lymphoma and novel targeted therapies, based on new bendamustine regimens/combinations, are being developed against CLL and lymphomas. In 2010, an international panel of bendamustine experts met and published a set of recommendations on the safe and effective use of bendamustine in patients suffering from hematologic disorders. In 2014, this panel met again to update these recommendations since the clarification of issues including optimal dosing and management of bendamustine-related toxicities. The aim of this report is to communicate the latest consensus on the use of bendamustine, permitting the expansion of its safe and effective administration, particularly in new combination therapies.
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Affiliation(s)
- Bruce D Cheson
- a Lombardi Comprehensive Cancer Center, Georgetown University Hospital , Washington , DC , USA
| | - Wolfram Brugger
- b Schwarzwald-Baar Clinic, University of Freiburg , Villingen-Schwenningen , Germany
| | - Gandhi Damaj
- c University Hospital, University of Basse-Normandie , Caen , France
| | - Martin Dreyling
- d Medical Clinic, University Hospital of Munich , Munich , Germany
| | - Brad Kahl
- e University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Eva Kimby
- f Center for Hematology, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Michinori Ogura
- g Department of Hematology , Tokai Central Hospital , Gifu , Japan
| | - Eckhart Weidmann
- h Department of Oncology and Hematology , Krankenhaus Nordwest , Frankfurt , Germany
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Rittig SM, Haentschel M, Weimer KJ, Heine A, Müller MR, Brugger W, Horger MS, Maksimovic O, Stenzl A, Hoerr I, Rammensee HG, Holderried TA, Kanz L, Pascolo S, Brossart P. Long-term survival correlates with immunological responses in renal cell carcinoma patients treated with mRNA-based immunotherapy. Oncoimmunology 2015; 5:e1108511. [PMID: 27467913 PMCID: PMC4910748 DOI: 10.1080/2162402x.2015.1108511] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 01/05/2023] Open
Abstract
Renal cell carcinoma (RCC) is an immunogenic tumor for which immunotherapeutic approaches could be associated with clinically relevant responses. It was recently shown, that induction of T-cell responses against multiple tumor-associated antigen (TAA) epitopes results in prolonged overall survival in RCC patients. In 2003–2005, we performed a phase I/II trial testing an mRNA-based vaccine formulation consisting of a mixture of in vitro transcribed RNA coding for six different TAAs (MUC1, CEA, Her2/neu, telomerase, survivin, MAGE-A1) in 30 metastatic RCC (mRCC) patients. In the first 14 patients, vaccinations were applied i.d. on days 0, 14, 28, and 42. In the consecutive 16 patients, an intensified protocol consisting of i.d. injections (daily on days 0–3, 7–10, 28, and 42) was used. After the respective induction periods, patients in both cohorts were vaccinated monthly until tumor progression. At survival update performed in July 2015, one of the 30 patients was still alive. One patient was lost to follow-up. Median survival of 24.5 mo (all patients) and 89 mo (favorable risk patients) exceeded predicted survival according to Memorial Sloan Kettering Cancer Center (MSKCC) risk score. Impressively, long-term survivors displayed immunological responses to the applied antigens while vice versa no patient without detectable immune response had survived more than 33 mo. The current survival update shows a clear correlation between survival and immunological responses to TAAs encoded by the naked mRNA vaccine. This is one of the first vaccination studies and the only RNA trial that reports on safety and efficacy after a follow-up of more than 10 y.
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Affiliation(s)
- Susanne M Rittig
- Department of Hematology, Oncology, Rheumatology, Immunology and Pulmology, University of Tuebingen , Tuebingen, Germany
| | - Maik Haentschel
- Department of Hematology, Oncology, Rheumatology, Immunology and Pulmology, University of Tuebingen , Tuebingen, Germany
| | - Katrin J Weimer
- Department of Hematology, Oncology, Rheumatology, Immunology and Pulmology, University of Tuebingen , Tuebingen, Germany
| | - Annkristin Heine
- Department of Hematology and Oncology, University of Bonn , Bonn, Germany
| | - Martin R Müller
- Department of Hematology, Oncology, Rheumatology, Immunology and Pulmology, University of Tuebingen , Tuebingen, Germany
| | - Wolfram Brugger
- Department of Hematology and Oncology, Schwarzwald-Baar Clinic, Academic Teaching Hospital, University of Freiburg, Villingen-Schwenningen, Germany; AstraZeneca UK Limited R&D. Early Clinical Development / Oncology Translational Medicine Unit, Melbourn, UK
| | - Marius S Horger
- Department of Radiology, University of Tuebingen , Tuebingen, Germany
| | - Olga Maksimovic
- Department of Hematology, Oncology, Rheumatology, Immunology and Pulmology, University of Tuebingen , Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tuebingen , Tuebingen, Germany
| | | | | | | | - Lothar Kanz
- Department of Hematology, Oncology, Rheumatology, Immunology and Pulmology, University of Tuebingen , Tuebingen, Germany
| | - Steve Pascolo
- Department of Dermatology, University Hospital Zurich , Zurich, Switzerland
| | - Peter Brossart
- Department of Hematology and Oncology, University of Bonn , Bonn, Germany
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Stein A, Atanackovic D, Hildebrandt B, Stübs P, Brugger W, Hapke G, Steffens CC, Illerhaus G, Bluemner E, Stöhlmacher J, Bokemeyer C. Upfront FOLFOXIRI+bevacizumab followed by fluoropyrimidin and bevacizumab maintenance in patients with molecularly unselected metastatic colorectal cancer. Br J Cancer 2015; 113:872-7. [PMID: 26335608 PMCID: PMC4578090 DOI: 10.1038/bjc.2015.299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 07/02/2015] [Accepted: 07/27/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The addition of bevacizumab (BEV) to standard doublet chemotherapy improves outcomes compared with chemotherapy alone in patients with metastatic colorectal cancer (mCRC). The OPAL study examined the effect of BEV+FOLFOXIRI followed by 5FU/LV and BEV maintenance on progression-free survival (PFS) in patients with previously untreated unresectable mCRC. METHODS Eligible patients had histologically confirmed mCRC, ECOG performance status ⩽1 and were 18-70 years old. Patients received up to 12 cycles of FOLFOXIRI+BEV q2w (induction phase) followed by up to ⩽40 cycles of 5FU/LV+BEV q2w (maintenance phase). Median PFS was the primary end point; secondary end points included response, OS, secondary resection rate, safety and prognostic value of pharmacogenetic profiling. RESULTS Ninety-seven patients were enrolled. Of these, 90 received study medication and formed the safety population: 64 males; median age 58 (range 28-71) years; ECOG performance status 0/1 in 54%/46% patients; and liver only disease in 35 patients. Relative dose intensities were 79-85% for all four drugs. The incidence of adverse events (AEs) was as previously reported and there were no new safety signals. In total, 87 serious AEs occurred in 39 patients (43%). Median PFS was 11.1 months (95% CI 9.4-12.0) and did thus not meet the primary objective of 12 months. Median OS was 32.2 months (95% CI 22.6-36.9). Fifty-two patients were pharmacogenetically profiled. CONCLUSIONS FOLFOXIRI+BEV was feasible in this molecularly unselected mCRC patient population, showing a high efficacy in terms of survival, overall response and secondary resection rate. Pharmacogenomic profiling revealed no clinically relevant marker.
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Affiliation(s)
- Alexander Stein
- University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Djordje Atanackovic
- University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
| | - Bert Hildebrandt
- Charité Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, Berlin 10117, Germany
| | - Patrick Stübs
- University Hospital Magdeburg, Leipziger Strasse 44, Magdeburg 39120, Germany
| | - Wolfram Brugger
- Schwarzwald-Baar Klinikum, Klinikstrasse 11, Villingen-Schwenningen 78052, Germany
| | - Gunnar Hapke
- Marienkrankenhaus, Alfredstrasse 9, Hamburg 22087, Germany
| | | | - Gerald Illerhaus
- Klinikum Stuttgart, Kriegsbergstraße 60, Stuttgart 70174, Germany
| | - Ernst Bluemner
- Ecron Acunova GmbH, Hahnstrasse 70, Frankfurt 60528, Germany
| | - Jan Stöhlmacher
- Tumorgenetik Bonn, Maximilianstrasse 28d, Bonn 53111, Germany
| | - Carsten Bokemeyer
- University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany
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Straka C, Vogel M, Müller J, Kropff M, Metzner B, Langer C, Sayer H, Jung W, Dürk HA, Wandt H, Bassermann F, Gramatzki M, Rösler W, Knop S, Wolf HH, Brugger W, Engelhardt MM, Fischer T, Einsele H. Results from two phase III studies of bortezomib (BTZ) consolidation vs observation (OBS) post-transplant in patients (pts) with newly diagnosed multiple myeloma (NDMM). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8511] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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)
| | | | | | - Martin Kropff
- Medizinische Klinik A, Universitätsklinikum Münster, Münster, Germany
| | | | - Christian Langer
- Klinik für Innere Medizin III, Zentrum für Innere Medizin, Universitätsklinikum Ulm, Ulm, Germany
| | - Herbert Sayer
- Klinik for Innere Medizin II, Hematologie und Onkologie, University Hospital Jena, Jena, Germany
| | - Wolfram Jung
- Klinik für Hämatologie und Medizinische Onkologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | | | | | | | - Martin Gramatzki
- Sektion für Stammzell- und Immuntherapie, II. Medizinische Klinik, Kiel, Germany
| | - Wolf Rösler
- Universitätsklinkum Erlangen, Medizinische Klinik 5 - Hämatologie und Internistische, Erlangen, Germany
| | - Stefan Knop
- Medizinische Klinik und Poliklinik II, Julius Maximilians Universität Würzburg, Würzburg, Germany
| | | | - Wolfram Brugger
- Schwarzwald-Baar Klinikum, Klinik für Innere Medizin II, Villingen-Schwenningen, Germany
| | | | - Thomas Fischer
- Department of Hematology/Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Hermann Einsele
- Medizinische Klinik und Poliklinik II, Julius Maximilians Universität Würzburg, Würzburg, Germany
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Bergmann L, Brugger W, Herr W, Mackensen A, Multhoff G. [What opportunities does Immuno-oncology indicate for overarching long-term survival?]. Oncol Res Treat 2015; 38 Suppl 3:6-11. [PMID: 25966812 DOI: 10.1159/000381363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lothar Bergmann
- Medizinische Klinik II: Hämatologie/Onkologie, Universitätsklinikum Frankfurt, Frankfurt/M., Deutschland
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Henkes M, Finke J, Warnatz K, Ammann S, Stadt UZ, Janka G, Brugger W. Late-onset hemophagocytic lymphohistiocytosis (HLH) in an adult female with Griscelli syndrome type 2 (GS2). Ann Hematol 2014; 94:1057-60. [PMID: 25544030 DOI: 10.1007/s00277-014-2284-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/14/2014] [Indexed: 01/15/2023]
Affiliation(s)
- Martin Henkes
- Department of Hematology and Oncology, Schwarzwald-Baar Clinic, Academic Teaching Hospital University of Freiburg, Klinikstr. 11, 78052, Villingen-Schwenningen, Germany,
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Stein A, Atanackovic D, Stoehlmacher J, Hildebrandt B, Stübs P, Steffens C, Brugger W, Hapke G, Illerhaus G, Bluemner E, Bokemeyer C. Folfoxiri + Bevacizumab (Bev) in Patients (Pts) with Previously Untreated Metastatic Colorectal Cancer (Mcrc): Final Survival and Pharmacogenomic Profiling Results from the Opal Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.22] [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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Plönes T, Dango S, Brugger W, Ludwig C, Stoelben E. [Potentially curative surgical therapy in oligometastatic non-small cell lung cancer]. Dtsch Med Wochenschr 2014; 139:538-42. [PMID: 24595711 DOI: 10.1055/s-0033-1360099] [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: 10/25/2022]
Abstract
Lung cancer is a leading cause of cancer related death worldwide. Non-small cell lung cancer (NSCLC) represents 85 % of all lung cancer cases and approximately 40 % of all patients impress with a metastatic disease at the time of diagnosis. Stage IV NSCLC has a poor prognosis and is incurable. The recommended standard therapy in this case is a palliative supportive systemic chemotherapy. However, a distinctive subgroup of patients with stage IV NSCLC appear clinically with an oligometastatic disease and may qualify for surgical therapy. There is evidence that patients with synchronous or metachronus solitary satellite nodules, either located intrapulmonary or extrapulmonary, benefit from surgical resection.
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Affiliation(s)
- T Plönes
- Klinik für Thoraxchirurgie, Lungenklinik Köln-Merheim, Klinikum der Universität Witten/Herdecke, Campus Köln
| | - S Dango
- Klinik für Allgemein und Viszeralchirurgie, Universitätklinikum Göttingen
| | - W Brugger
- Schwarzwald-Baar Klinikum, Akademisches Lehrkrankenhaus der Universität Freiburg, Villingen-Schwenningen
| | - C Ludwig
- Klinik für Thoraxchirurgie, Lungenklinik Köln-Merheim, Klinikum der Universität Witten/Herdecke, Campus Köln
| | - E Stoelben
- Klinik für Thoraxchirurgie, Lungenklinik Köln-Merheim, Klinikum der Universität Witten/Herdecke, Campus Köln
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Mazières J, Brugger W, Cappuzzo F, Middel P, Frosch A, Bara I, Klingelschmitt G, Klughammer B. Evaluation of EGFR protein expression by immunohistochemistry using H-score and the magnification rule: re-analysis of the SATURN study. Lung Cancer 2013; 82:231-7. [PMID: 23972450 DOI: 10.1016/j.lungcan.2013.07.016] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [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: 04/23/2013] [Revised: 06/28/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The phase III SATURN study demonstrated that first-line maintenance erlotinib extended progression-free survival (PFS) and overall survival (OS) versus placebo in patients with advanced non-small cell lung cancer (NSCLC). Analysis of epidermal growth factor receptor (EGFR) expression by immunohistochemistry (IHC) found no significant interaction between EGFR IHC status and PFS (p = 0.63) or OS (p = 0.52). The FLEX study of first-line cetuximab plus chemotherapy demonstrated that EGFR IHC expression was predictive of improved OS with cetuximab when assessed by H-score with a magnification rule. This novel method was used to reassess samples from SATURN. METHODS The H-score method assigned a score of 0-300 to each patient, based on the percentage of cells stained at different intensities viewed at various magnifications. The discriminatory threshold was set at 200, per the FLEX study, and existing samples were re-read and classed as low (H-score < 200) or high (≥200) EGFR expression. PFS and OS were re-analyzed based on these new classifications. RESULTS In the overall and EGFR wild-type populations, erlotinib provided a consistent survival benefit versus placebo. Hazard ratios (HRs) in the overall population were similar between EGFR IHC-positive and -negative patients for median PFS (HR 0.68 [95% confidence interval (CI) 0.53-0.86] and 0.76 [95% CI 0.62-0.93], respectively) and OS (HR 0.80 [95% CI 0.62-1.05] and 0.80 [95% CI 0.64-1.01] for IHC-positive and IHC-negative, respectively). In the EGFR wild-type population, HRs were again similar between EGFR IHC-positive and -negative subpopulations for PFS (HR 0.69 [95% CI 0.51-0.95] and 0.84 [95% CI 0.63-1.12], respectively) and OS (HR 0.78 [95% CI 0.55-1.10] and 0.76 [95% CI 0.55-1.05], respectively). CONCLUSIONS These data suggest that EGFR IHC does not have value as a marker to predict erlotinib benefit in the first-line maintenance setting for advanced NSCLC.
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Affiliation(s)
- Julien Mazières
- Service de Pneumologie, Hôpital Larrey, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse III (Paul Sabatier), Toulouse 31059, France.
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Abstract
For patients with advanced indolent non-Hodgkin's lymphoma (NHL) or elderly patients with mantle cell lymphoma (MCL), the recently reported results of the German StiL NHL-1 2003 and the international BRIGHT phase III trials showed that, as first-line treatment, the combination of bendamustine and rituximab is at least as effective as rituximab/cyclophosphamide/doxorubicin/vincristine/prednisone or rituximab/cyclophosphamide/vincristine/prednisone, possibly with a better therapeutic index. Bendamustine is therefore increasingly used in clinical practice. Because bendamustine has been used for many years in Germany and in Switzerland, our institutions have had extensive experience with bendamustine, both as a single agent and in combination with rituximab. In this comprehensive review, we summarize the most important clinical data from phase II/III trials with bendamustine in patients with indolent NHL and MCL, both in the relapsed/refractory setting and in the first-line setting. In addition, this review provides practical advice on how to optimally manage bendamustine therapy in patients with NHL.
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Affiliation(s)
- Wolfram Brugger
- Department of Hematology, Oncology, and Palliative Care, Schwarzwald-Baar Clinic, Academic Teaching Hospital, University of Freiburg, Villingen-Schwenningen, Germany.
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Rummel MJ, Niederle N, Maschmeyer G, Banat GA, von Grünhagen U, Losem C, Kofahl-Krause D, Heil G, Welslau M, Balser C, Kaiser U, Weidmann E, Dürk H, Ballo H, Stauch M, Roller F, Barth J, Hoelzer D, Hinke A, Brugger W. Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: an open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet 2013; 381:1203-10. [PMID: 23433739 DOI: 10.1016/s0140-6736(12)61763-2] [Citation(s) in RCA: 1015] [Impact Index Per Article: 92.3] [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: 12/22/2022]
Abstract
BACKGROUND Rituximab plus chemotherapy, most often CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), is the first-line standard of care for patients with advanced indolent lymphoma, and for elderly patients with mantle-cell lymphoma. Bendamustine plus rituximab is effective for relapsed or refractory disease. We compared bendamustine plus rituximab with CHOP plus rituximab (R-CHOP) as first-line treatment for patients with indolent and mantle-cell lymphomas. METHODS We did a prospective, multicentre, randomised, open-label, non-inferiority trial at 81 centres in Germany between Sept 1, 2003, and Aug 31, 2008. Patients aged 18 years or older with a WHO performance status of 2 or less were eligible if they had newly diagnosed stage III or IV indolent or mantle-cell lymphoma. Patients were stratified by histological lymphoma subtype, then randomly assigned according to a prespecified randomisation list to receive either intravenous bendamustine (90 mg/m(2) on days 1 and 2 of a 4-week cycle) or CHOP (cycles every 3 weeks of cyclophosphamide 750 mg/m(2), doxorubicin 50 mg/m(2), and vincristine 1.4 mg/m(2) on day 1, and prednisone 100 mg/day for 5 days) for a maximum of six cycles. Patients in both groups received rituximab 375 mg/m(2) on day 1 of each cycle. Patients and treating physicians were not masked to treatment allocation. The primary endpoint was progression-free survival, with a non-inferiority margin of 10%. Analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00991211, and the Federal Institute for Drugs and Medical Devices of Germany, BfArM 4021335. FINDINGS 274 patients were assigned to bendamustine plus rituximab (261 assessed) and 275 to R-CHOP (253 assessed). At median follow-up of 45 months (IQR 25-57), median progression-free survival was significantly longer in the bendamustine plus rituximab group than in the R-CHOP group (69.5 months [26.1 to not yet reached] vs 31.2 months [15.2-65.7]; hazard ratio 0.58, 95% CI 0.44-0.74; p<0.0001). Bendamustine plus rituximab was better tolerated than R-CHOP, with lower rates of alopecia (0 patients vs 245 (100%) of 245 patients who recieved ≥3 cycles; p<0.0001), haematological toxicity (77 [30%] vs 173 [68%]; p<0.0001), infections (96 [37%] vs 127 [50%]); p=0.0025), peripheral neuropathy (18 [7%] vs 73 [29%]; p<0.0001), and stomatitis (16 [6%] vs 47 [19%]; p<0.0001). Erythematous skin reactions were more common in patients in the bendamustine plus rituximab group than in those in the R-CHOP group (42 [16%] vs 23 [9%]; p=0.024). INTERPRETATION In patients with previously untreated indolent lymphoma, bendamustine plus rituximab can be considered as a preferred first-line treatment approach to R-CHOP because of increased progression-free survival and fewer toxic effects. FUNDING Roche Pharma AG, Ribosepharm/Mundipharma GmbH.
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Affiliation(s)
- Mathias J Rummel
- Medizinische Klinik IV, Hospital of the Justus-Liebig-University, Giessen, Germany.
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Stein A, Atanackovic D, Hildebrandt B, Stuebs P, Steffens CC, Brugger W, Hapke G, Illerhaus G, Bluemner E, Bokemeyer C. FOLFOXIRI plus bevacizumab (BEV) in patients (pts) with previously untreated metastatic colorectal cancer (mCRC): Preliminary safety results from the OPAL study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.515] [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
515 Background: The addition of BEV to standard doublet chemotherapy (CT) improves outcomes vs CT alone in pts with mCRC. Use of more intensive triplet CT may prolong overall survival (OS), progression-free survival (PFS), increase response rates and improve resectability rates but at the expense of greater toxicity. The OPAL study examined the effect of BEV + FOLFOXIRI on PFS in pts with previously untreated unresectable mCRC. Here we report preliminary safety findings. Methods: Eligible pts had histologically confirmed mCRC, ECOG PS ≤1 and were 18–70 years old. Pts received ≤12 cycles of FOLFOXIRI (infusional 5-fluorouracil [FU] 3200 mg/m2, folinic acid [FA] 200 mg/m2, oxaliplatin 85 mg/m2, irinotecan 165 mg/m2) + BEV 5 mg/kg q2w (induction phase) followed by ≤40 cycles of 5-FU/FA + BEV q2w (maintenance phase). PFS was the primary endpoint; secondary endpoints included OS, proportion of pts achieving resectability and safety. Results: 96 pts were enrolled. Of these, 90 received study medication and formed the safety population: 64 male, 26 female; median age 58 (range 28–71) years; ECOG performance status 0/1 in 49/41 pts. All pts have completed induction treatment and the study is ongoing. In total, 61 serious AEs occurred in 34 pts (38%). AEs resulting in death occurred in 3 pts (3%); these were not considered treatment-related by the investigators. The incidence of AEs of special interest with BEV was low. Main AEs reported during the induction phase are summarised in the table. Conclusions: BEV + FOLFOXIRI was generally well tolerated in this mCRC pt population. The incidence of AEs was as previously reported [Falcone et al. ASCO 2010] and there were no new safety signals. Clinical trial information: NCT00940303. [Table: see text]
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Affiliation(s)
| | | | - Bert Hildebrandt
- Charité Universitätsmedizin Berlin Campus Virchow Klinikum GmbH, Berlin, Germany
| | - Patrick Stuebs
- Universitätsklinikum Magdeburg A.ö.R, Magdeburg, Germany
| | | | - Wolfram Brugger
- Schwarzwald-Baar Klinikum GmbH, Villingen-Schwenningen, Germany
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Rummel MJ, Niederle N, Maschmeyer G, Banat AG, von Gruenhagen U, Losem C, Kofahl-Krause D, Heil G, Welslau M, Balser C, Kaiser U, Weidmann E, Duerk HA, Ballo H, Stauch M, Barth J, Hinke A, Brugger W. Bendamustine plus rituximab (B-R) versus CHOP plus rituximab (CHOP-R) as first-line treatment in patients with indolent and mantle cell lymphomas (MCL): Updated results from the StiL NHL1 study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.18_suppl.3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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
3 Background: This multicenter, randomized, phase III study compared B-R and CHOP-R as first-line treatment in indolent lymphoma and MCL and was presented at ASH 2009 including a comprehensive safety analysis. Here we present an updated analysis with a cut-off date for 31 Oct 2011. Methods: 549 patients (pts) with indolent or MCL were randomized to receive B-R or CHOP-R for a max of 6 cycles. The primary endpoint was PFS. Results: 514 pts randomized pts were evaluable (261 B-R; 253 CHOP-R). Patient characteristics were well balanced between arms; median age was 64 years. At a median follow-up of 45 months, PFS was significantly prolonged with B-R compared with CHOP-R (HR 0.58, 95% CI 0.44–0.74; P<0.001). Median PFS was 69.5 versus 31.2 months, respectively. The PFS benefit with B-R was maintained in all histological subtypes except marginal zone lymphoma. The PFS benefit with B-R was independent of age; HR 0.52 (P=0.002) in pts ≤60 years (n=199), and HR 0.62 (P=0.002) in pts >60 years (n=315). In pts with normal LDH (62%), PFS was significantly prolonged with B-R compared with CHOP-R (P<0.001), while in the elevated LDH group (38%) PFS was numerically, but not significantly increased with B-R compared with CHOP-R (P=0.118). In patients with follicular lymphoma, FLIPI subgroups defined by 0–2 factors (favorable) and 3–5 factors (unfavorable) had a longer PFS with B-R than with CHOP-R (P=0.043 and P=0.068 for the favorable and unfavorable FLIPI subgroups, respectively). Seventy four salvage treatments had been initiated in the B-R group; compared with 116 in the CHOP-R group, of those in the CHOP-R group 52 pts received B-R as salvage regimen. Overall survival did not differ between the treatment arms, with 43 and 45 deaths in the B-R and CHOP-R arms, respectively. Twenty secondary malignancies were observed in the B-R group compared with 23 in the CHOP-R group, with 1 hematological malignancy in each group (1 MDS in B-R, 1 AML in CHOP-R). Conclusions: In patients with previously untreated indolent lymphoma, and elderly patients with MCL, B-R demonstrates a PFS benefit and improved tolerability compared with CHOP-R.
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Affiliation(s)
| | | | | | | | | | | | | | - Gerhard Heil
- Kreiskrankenhaus Lüdenscheid, Luedenscheid, Germany
| | | | | | | | | | | | | | | | | | - Axel Hinke
- WisP Clinical Research Organisation, Langenfeld, Germany
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Rummel MJ, Niederle N, Maschmeyer G, Banat AG, von Gruenhagen U, Losem C, Kofahl-Krause D, Heil G, Welslau M, Balser C, Kaiser U, Weidmann E, Duerk HA, Ballo H, Stauch M, Barth J, Hinke A, Brugger W. Bendamustine plus rituximab (B-R) versus CHOP plus rituximab (CHOP-R) as first-line treatment in patients with indolent and mantle cell lymphomas (MCL): Updated results from the StiL NHL1 study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3 The full, final text of this abstract will be available at abstract.asco.org at 12:01 AM (EDT) on Sunday, June 3, 2012, and in the Annual Meeting Proceedings online supplement to the June 20, 2012, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Sunday edition of ASCO Daily News.
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Affiliation(s)
| | | | | | | | | | | | | | - Gerhard Heil
- Kreiskrankenhaus Lüdenscheid, Luedenscheid, Germany
| | | | | | | | | | | | | | | | | | - Axel Hinke
- WisP Clinical Research Organisation, Langenfeld, Germany
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Metzelder SK, Schroeder T, Finck A, Scholl S, Fey M, Götze K, Linn YC, Kröger M, Reiter A, Salih HR, Heinicke T, Stuhlmann R, Müller L, Giagounidis A, Meyer RG, Brugger W, Vöhringer M, Dreger P, Mori M, Basara N, Schäfer-Eckart K, Schultheis B, Baldus C, Neubauer A, Burchert A. High activity of sorafenib in FLT3-ITD-positive acute myeloid leukemia synergizes with allo-immune effects to induce sustained responses. Leukemia 2012; 26:2353-9. [PMID: 22504140 DOI: 10.1038/leu.2012.105] [Citation(s) in RCA: 191] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Preliminary evidence suggests that the multikinase inhibitor sorafenib has clinical activity in FLT3-ITD-positive (FLT3-ITD) acute myeloid leukemia (AML). However, the quality and sustainability of achievable remissions and clinical variables that influence the outcome of sorafenib monotherapy are largely undefined. To address these questions, we evaluated sorafenib monotherapy in 65 FLT3-ITD AML patients treated at 23 centers. All but two patients had relapsed or were chemotherapy-refractory after a median of three prior chemotherapy cycles. Twenty-nine patients (45%) had undergone prior allogeneic stem cell transplantation (allo-SCT). The documented best responses were: hematological remission in 24 patients (37%), bone marrow remission in 5 patients (8%), complete remission (with and without normalization of peripheral blood counts) in 15 patients (23%) and molecular remission with undetectable FLT3-ITD mRNA in 10 patients (15%), respectively. Seventeen of the patients without prior allo-SCT (47%) developed sorafenib resistance after a median treatment duration of 136 days (range, 56-270 days). In contrast, allo-SCT patients developed sorafenib resistance less frequently (38%) and significantly later (197 days, range 38-225 days; P=0.03). Sustained remissions were seen exclusively in the allo-SCT cohort. Thus, sorafenib monotherapy has significant activity in FLT3-ITD AML and may synergize with allogeneic immune effects to induce durable remissions.
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Affiliation(s)
- S K Metzelder
- Philipps Universität Marburg, Universitätsklinikum Gießen und Marburg, Standort Marburg, Klinik für Hämatologie, Onkologie und Immunologie, Marburg, Germany
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Walter S, Weinschenk T, Stenzl A, Zdrojowy R, Pluzanska A, Szczylik C, Staehler M, Brugger W, Dietrich PY, Hilf N, Schoor O, Fritsche J, Mahr A, Mendrzyk R, Maurer D, Vass V, Trautwein C, Lewandrowski P, Flohr C, Pohla H, Stanczak JJ, Bronte V, Mandruzzato S, Biedermann T, Pawelec G, Derhovanessian E, Yamagishi H, Miki T, Hongo F, Takaha N, Hirakawa K, Tanaka H, Stevanovic S, Rammensee HG, Frisch J, Mayer-Mokler A, Kirner A, Finke J, Rini B, Reinhardt C, Singh H. Abstract 5365: Prolonged survival of patients with advanced renal cancer responding to multi-peptide vaccine IMA901 after single-dose cyclophosphamide. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-5365] [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
Translational research and the clinical development of therapeutic cancer vaccines requires stronger scientific rationalization. Here we demonstrate how immune response markers as well as biomarkers defining the immune regulatory environment were utilized as guiding tools from discovery to advanced clinical trials of IMA901, a novel therapeutic vaccine for the treatment of renal cell carcinoma (RCC). IMA901 consists of multiple tumor-associated peptides (TUMAPs) confirmed to be naturally presented in human RCC tissue by mass spectrometry, selected using differential transcriptomics and preclinically validated by systematic analysis of immunogenicity with artificial antigen-presenting cells. Two consecutive independent clinical studies in a total of 96 HLA-A*02+ advanced/metastatic RCC patients were conducted. The phase I study revealed that T-cell responses to multiple IMA901 antigens were significantly associated with disease control and negatively associated with the presence of FoxP3+ regulatory T cells (Tregs). The subsequent randomized phase II study demonstrated that pre-treatment with a single low dose of cyclophosphamide (Cy) reduced Treg frequencies and prolonged overall survival (OS) in patients who mounted an immune response to the IMA901 vaccine. Additionally, T-cell responses to multiple IMA901 antigens were again associated with clinical benefit. Furthermore, a comprehensive prognostic and predictive biomarker program was conducted. Among cellular biomarkers, highly significantly elevated levels of myeloid-derived suppressor cells (MDSC), IL-17-/IL-10-secreting T cells and dysfunctional T cells in RCC patients vs. healthy individuals were found. Two MDSC populations (CD14+ HLA-DR- and CD14- CD11b+ CD15+) were significantly negatively associated with survival in vaccinated RCC patients. Interestingly, both MDSC populations were also found to be negatively associated with OS in an independent trial in colorectal cancer patients (N=79) implying a broader role for these MDSC species. Additionally, among over 300 serum biomarkers tested, apolipoprotein A-I (ApoA1) and the chemokine CCL17 were found to be predictive for both immune responses to IMA901 and survival of the RCC patients. The knowledge acquired in these trials was used to design a randomized phase III study. In this ongoing study, IMA901 is combined with the tyrosine kinase inhibitor sunitinib based on the findings that sunitinib downmodulates the two MDSC populations described above. Furthermore, in this phase III study, the relevance of ApoA1/CCL17 will be explored by prospectively defined subgroup analyses.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5365. doi:1538-7445.AM2012-5365
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Affiliation(s)
| | | | | | | | | | | | - Michael Staehler
- 6Ludwigs Maximilian University and Helmholtz Zentrum CCG Immune Monitoring, Munich, Germany
| | | | | | - Norbert Hilf
- 1Immatics Biotechnologies GmbH, Tuebingen, Germany
| | | | | | - Andrea Mahr
- 1Immatics Biotechnologies GmbH, Tuebingen, Germany
| | | | | | - Verona Vass
- 1Immatics Biotechnologies GmbH, Tuebingen, Germany
| | | | | | | | - Heike Pohla
- 6Ludwigs Maximilian University and Helmholtz Zentrum CCG Immune Monitoring, Munich, Germany
| | | | | | | | | | | | | | | | - Tsuneharu Miki
- 11Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiya Hongo
- 11Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Natsuki Takaha
- 11Kyoto Prefectural University of Medicine, Kyoto, Japan
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Brugger W, Thomas M. EGFR-TKI resistant non-small cell lung cancer (NSCLC): new developments and implications for future treatment. Lung Cancer 2012; 77:2-8. [PMID: 22281074 DOI: 10.1016/j.lungcan.2011.12.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/23/2011] [Accepted: 12/24/2011] [Indexed: 10/14/2022]
Abstract
Treatment with receptor-tyrosine kinase inhibitors (TKIs) has improved progression-free and overall survival in patients with advanced non-small cell lung cancer (NSCLC). One major target for treatment with TKI is the epidermal growth factor receptor (EGFR), particularly in patients harboring activating mutations. However, despite initial responses and long lasting remissions, the development of secondary resistance inevitably leads to treatment failure. Analyzing recent data from various phase II/III trials it seems obvious that the single mode of action of gefitinib or erlotinib can provide temporary success only. Both preclinical and clinical evidence suggest that irreversible TKIs such as afatinib or PF00299804, or combined approaches using multiple kinase inhibition (e.g. EGFR and MET) and vertical inhibition by combination of small molecules and antibodies, seem to be more promising and will be the prevailing concepts to overcome secondary EGFR-TKI resistance for the near future.
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Affiliation(s)
- Wolfram Brugger
- Medical Center II, Department of Hematology/Oncology, Schwarzwald-Baar Clinic, Academic Teaching Hospital University of Freiburg, Villingen-Schwenningen, Germany.
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Brugger W. Molecular marker analyses from the SATURN trial. Clin Adv Hematol Oncol 2012; 10:33-34. [PMID: 22398805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Wolfram Brugger
- Schwarzwald-Baar Klinikum, Academic Teaching Hospital, University of Freiburg, Villingen-Schwenningen, Germany
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Lübbert M, Rüter BH, Claus R, Schmoor C, Schmid M, Germing U, Kuendgen A, Rethwisch V, Ganser A, Platzbecker U, Galm O, Brugger W, Heil G, Hackanson B, Deschler B, Döhner K, Hagemeijer A, Wijermans PW, Döhner H. A multicenter phase II trial of decitabine as first-line treatment for older patients with acute myeloid leukemia judged unfit for induction chemotherapy. Haematologica 2011; 97:393-401. [PMID: 22058219 DOI: 10.3324/haematol.2011.048231] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The treatment of acute myeloid leukemia of older, medically non-fit patients still poses a highly unmet clinical need, and only few large, prospective studies have been performed in this setting. Given the established activity of hypomethylating agents such as 5-aza-2'-deoxycytidine (decitabine) in myelodysplastic syndromes and acute myeloid leukemia with 20-30% bone marrow blasts, we investigated whether this drug is also active in patients with more than 30% blasts. DESIGN AND METHODS To evaluate the efficacy and toxicity of decitabine in patients over 60 years old with untreated acute myeloid leukemia ineligible for induction chemotherapy, 227 patients (median age, 72 years), many with comorbidities, adverse cytogenetics and/or preceding myelodysplastic syndrome were treated with this hypomethylating agent. During the initial decitabine treatment (135 mg/m(2) total dose infused intravenously over 72 hours every 6 weeks), a median of two cycles was administered (range, 1-4). All-trans retinoic acid was administered to 100 patients during course 2. Fifty-two patients who completed four cycles of treatment subsequently received a median of five maintenance courses (range, 1-19) with a lower dose of decitabine (20 mg/m(2)) infused over 1 hour on 3 consecutive days every 4-6 weeks. RESULTS The complete and partial remission rate was 26%, 95% CI (20%, 32%), and an antileukemic effect was noted in 26% of patients. Response rates did not differ between patients with or without adverse cytogenetics; patients with monosomal karyotypes also responded. The median overall survival from the start of decitabine treatment was 5.5 months (range, 0-57.5+) and the 1-year survival rate was 28%, 95%CI (22%,34%). Toxicities were predominantly hematologic. CONCLUSIONS Decitabine is well tolerated by older, medically non-fit patients with acute myeloid leukemia; myelosuppression is the major toxicity. The response rate and overall survival were not adversely influenced by poor-risk cytogenetics or myelodysplastic syndrome. Because of these encouraging results, randomized studies evaluating single-agent decitabine versus conventional treatment are warranted. The study is registered with the German Clinical Trials Registry, number DRKS00000069.
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Affiliation(s)
- Michael Lübbert
- Dept. of Medicine, Div. Hematology/Oncology, University of Freiburg Medical Center, Hugstetter Str. 55, D-79106 Freiburg, Germany.
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Brugger W, Triller N, Blasinska-Morawiec M, Curescu S, Sakalauskas R, Manikhas GM, Mazieres J, Whittom R, Ward C, Mayne K, Trunzer K, Cappuzzo F. Prospective molecular marker analyses of EGFR and KRAS from a randomized, placebo-controlled study of erlotinib maintenance therapy in advanced non-small-cell lung cancer. J Clin Oncol 2011; 29:4113-20. [PMID: 21969500 DOI: 10.1200/jco.2010.31.8162] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [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 The phase III, randomized, placebo-controlled Sequential Tarceva in Unresectable NSCLC (SATURN; BO18192) study found that erlotinib maintenance therapy extended progression-free survival (PFS) and overall survival in patients with advanced non-small-cell lung cancer (NSCLC) who had nonprogressive disease following first-line platinum-doublet chemotherapy. This study included prospective analysis of the prognostic and predictive value of several biomarkers. PATIENTS AND METHODS Mandatory diagnostic tumor specimens were collected before initiating first-line chemotherapy and were tested for epidermal growth factor receptor (EGFR) protein expression by using immunohistochemistry (IHC), EGFR gene copy number by using fluorescent in situ hybridization (FISH), and EGFR and KRAS mutations by using DNA sequencing. An EGFR CA simple sequence repeat in intron 1 (CA-SSR1) polymorphism was evaluated in blood. RESULTS All 889 randomly assigned patients provided tumor samples. EGFR IHC, EGFR FISH, KRAS mutation, and EGFR CA-SSR1 repeat length status were not predictive for erlotinib efficacy. A profound predictive effect on PFS of erlotinib relative to placebo was observed in the EGFR mutation-positive subgroup (hazard ratio [HR], 0.10; P < .001). Significant PFS benefits were also observed with erlotinib in the wild-type EGFR subgroup (HR, 0.78; P = .0185). KRAS mutation status was a significant negative prognostic factor for PFS. CONCLUSION This large prospective biomarker study found that patients with activating EGFR mutations derive the greatest PFS benefit from erlotinib maintenance therapy. No other biomarkers were predictive for outcomes with erlotinib, although the study was not powered for clinical outcomes in biomarker subgroups other than EGFR IHC-positive [corrected]. KRAS mutations were prognostic for reduced PFS. The study demonstrated the feasibility of prospective tissue collection for biomarker analyses in NSCLC.
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Affiliation(s)
- Wolfram Brugger
- Schwarzwald-Baar Klinikum, Academic Teaching Hospital, University of Freiburg, Voehrenbacher Str 23, Villingen-Schwenningen, Germany 78050.
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Sequist LV, von Pawel J, Garmey EG, Akerley WL, Brugger W, Ferrari D, Chen Y, Costa DB, Gerber DE, Orlov S, Ramlau R, Arthur S, Gorbachevsky I, Schwartz B, Schiller JH. Randomized phase II study of erlotinib plus tivantinib versus erlotinib plus placebo in previously treated non-small-cell lung cancer. J Clin Oncol 2011; 29:3307-15. [PMID: 21768463 DOI: 10.1200/jco.2010.34.0570] [Citation(s) in RCA: 343] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE c-MET (MET) receptor activation is associated with poor prognosis and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) resistance in non-small-cell lung cancer (NSCLC). This global, randomized phase II trial examined erlotinib plus tivantinib (ARQ 197; ArQule, Woburn, MA), a novel MET inhibitor. METHODS Previously treated patients with EGFR TKI-naive advanced NSCLC were randomly assigned to receive oral erlotinib (150 mg daily) plus oral tivantinib (360 mg twice daily) or erlotinib plus placebo (EP). The primary end point was progression-free survival (PFS). At the time of progression, cross-over from EP to erlotinib plus tivantinib (ET) was permitted. Archival tumor tissue specimens were required. RESULTS One hundred sixty-seven patients were randomly assigned to ET (n = 84) and to EP (n = 83). Median PFS was 3.8 months for ET and 2.3 months for EP (hazard ratio [HR], 0.81; 95% CI, 0.57 to 1.16; P = .24). Exploratory analysis revealed that the small cohort with KRAS mutations achieved a PFS HR of 0.18 (95% CI, 0.05 to 0.70; interaction P = .006). Objective responses were seen in 10% of patients on ET, 7% of patients on EP, and in two patients who crossed over from EP to ET, including one with EGFR mutation and MET gene copy number greater than 5. There were no significant differences in adverse events between study arms. CONCLUSION The combination of the MET inhibitor tivantinib and erlotinib is well-tolerated. Although the study did not meet its primary end point, evidence of activity was demonstrated, especially among patients with KRAS mutations. Additional study of tivantinib and erlotinib in patients with NSCLC is planned.
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Affiliation(s)
- Lecia V Sequist
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA.
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