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Freyer G, Martinez-Jañez N, Kukielka-Budny B, Ulanska M, Bourgeois H, Muñoz M, Morales S, Calero JB, Cortesi L, Pintér T, Palácová M, Cherciu N, Petru E, Ettl J, de Almeida C, Villanova G, Raymond R, Minh CTT, Rodrigues A, Cazzaniga ME. Single-agent metronomic versus weekly oral vinorelbine as first-line chemotherapy in patients with HR-positive/HER2-negative advanced breast cancer: The randomized Tempo Breast study. Breast 2024; 74:103681. [PMID: 38377732 PMCID: PMC10891320 DOI: 10.1016/j.breast.2024.103681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Single-agent oral vinorelbine is a standard of care for hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer (ABC) that has progressed on endocrine therapy. Metronomic administration may offer a better balance of efficacy and safety than standard regimens, but data from previous trials are scarce. METHODS In this open-label, multicenter, phase II trial, patients were randomized to oral vinorelbine administered on a metronomic (50 mg three times weekly) or weekly (60 mg/m2 in cycle 1, increasing to 80 mg/m2 if well tolerated) schedule. Treatment was continued until disease progression or intolerance. The primary endpoint was disease control rate (DCR, the proportion of patients with a best overall confirmed response of CR, PR, or stable disease lasting 6 months or more). RESULTS One-hundred sixty-three patients were randomized and treated. The DCR was 63.4% (95% confidence interval [CI]: 52.0-73.8) with metronomic vinorelbine and 72.8% (95% CI: 61.8-82.1) with weekly vinorelbine. Weekly vinorelbine was also associated with longer progression-free survival (5.6 vs 4.0 months) and overall survival (26.7 vs 22.3 months) than metronomic vinorelbine, but was associated with more adverse events. CONCLUSIONS In this randomized phase II trial, single-agent metronomic oral vinorelbine was effective and well tolerated as first-line chemotherapy for patients with HR-positive/HER2-negative ABC. Formal comparisons are not done in this phase II study and one can simply observe that confidence intervals of all endpoints overlap. When deciding for a chemotherapy after failure of endocrine therapy and CDK 4/6 inhibitors, oral vinorelbine might be an option to be given with either schedule. CLINICAL TRIAL REGISTRATION NUMBER EudraCT 2014-003860-19.
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Affiliation(s)
- Gilles Freyer
- Medical Oncology Department, Institut de Cancérologie des HCL, 165 chemin du Grand Revoyet, 69495 Pierre-Bénite & Université de Lyon, Lyon, France.
| | - Noelia Martinez-Jañez
- Oncology Department, Hospital Universitario Ramón y Cajal, Carretera De Colmenar Viejo km. 9,1, 28034 Madrid, Spain.
| | - Bożena Kukielka-Budny
- Oncology Department, Centrum Onkologii Ziemi Lubelskiej, Ul. Jaczewskiego 7, 20-090 Lublin, Poland.
| | - Malgorzata Ulanska
- Oncology Department, Centrum Terapii Wspolczesnej, Ul. Kopcinskiego 21, 90-242 Łódź, Poland.
| | - Hugues Bourgeois
- Oncology Department, Centre Jean-Bernard, 9 rue Beauverger, 72015 Le Mans, France.
| | - Montserrat Muñoz
- Oncology Department, Hospital Clinic i Provincial de Barcelona, 170 Esc.2, pl. 5(a), 08036 Barcelona, Spain.
| | - Serafin Morales
- Oncology Department, Hospital Universitario Arnau De Vilanova, Avenida Alcalde Rovira Roure, 80, 25198 Lleida, Spain.
| | - Juan Bayo Calero
- Oncology Department, Hospital Juan Ramón Jiménez, C/ Ronda Norte, s/n, 21005 Huelva, Spain.
| | - Laura Cortesi
- Hematology and Oncology Department, AOU Policlinico di Modena, Via del Pozzo, 71, 41125 Modena, Italy.
| | - Tamás Pintér
- Oncology Department, Petz Aladár County Hospital, Vasvári Pál u. 2-4, 9024 Győr, Hungary.
| | - Markéta Palácová
- Oncology Department, Masakikuv Oncologicky Ustav, Zluty Kopek 7, 656 53 Brno, Czech Republic.
| | - Nelli Cherciu
- Oncology Department, SC Oncolab SRL, Str. Bujorului, Nr. 7, 200385 Craiova, Romania.
| | - Edgar Petru
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz, 15, 8036 Graz, Austria.
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 Munich, Germany.
| | - Cécilia de Almeida
- Pierre Fabre Medicament, Medical & Patient/Consumer Department, 33 Av. Emile Zola, 92100 Boulogne Billancourt, France.
| | - Gustavo Villanova
- Pierre Fabre Medicament, Medical & Patient/Consumer Department, 33 Av. Emile Zola, 92100 Boulogne Billancourt, France.
| | - Romain Raymond
- Pierre Fabre Medicament, Medical & Patient/Consumer Department, 33 Av. Emile Zola, 92100 Boulogne Billancourt, France.
| | - Christine Ta Thanh Minh
- Pierre Fabre Medicament, Medical & Patient/Consumer Department, 33 Av. Emile Zola, 92100 Boulogne Billancourt, France.
| | - Ana Rodrigues
- Oncology Department, Instituto Portugues de Oncologia do Porto Francisco Gentil, EPE, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
| | - Marina E Cazzaniga
- Phase 1 Clinical Research Unit, ASST Monza, via Pergolesi 33, 20052 Monza, Italy; Medical Oncology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy.
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Owada Y, Okazaki M, Ikeda T, Yamamoto R, Minami K, Takahashi K, Hirato T, Mita Y, Yamamoto T, Tanizawa K, Sonoda H, Sato Y. Pharmacokinetics and pharmacodynamics of once- weekly administration of JR-142, a long-acting albumin-fused human growth hormone: A rondemized, placebo-controlled phase 1 study. Growth Horm IGF Res 2022; 67:101500. [PMID: 36113378 DOI: 10.1016/j.ghir.2022.101500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Under clinical development for patients with growth hormone deficiency, JR-142 is a long-acting growth hormone with a half-life extended by fusion with modified serum albumin. We conducted a Phase 1 study to investigate the safety, tolerability, and pharmacokinetic (PK) and pharmacodynamic (PD) profiles of once-weekly subcutaneous administrations of JR-142. The study consisted of two parts: an open-label single ascending dosing study (Part 1), and a randomized, placebo-controlled, assessor-blinded multiple ascending dosing study (Part 2). DESIGN A total of 31 healthy Japanese male participants were enrolled. In Part 1, seven of them received a single subcutaneous injection of JR-142 each at dosages of 0.15 mg/kg (n = 1), 0.25 mg/kg (n = 2), 0.5 mg/kg (n = 2), or 1.0 mg/kg (n = 2). In Part 2, one weekly subcutaneous injection of JR-142 at 0.25 mg/kg, 0.5 mg/kg, 1.0 mg/kg or a placebo were given for four weeks to each of the other 24 participants (six in each group). Plasma JR-142 and serum insulin-like growth factor-1 (IGF-1) concentrations were measured for PK and PD assessments. Safety was evaluated on the basis of adverse events (AEs), laboratory tests, and other measures. RESULTS JR-142 induced dose-dependent increases in the maximum plasma JR-142 concentration (Cmax) and the area under the plasma concentration-time curve from time 0 to τ (AUC0-τ). A similar dose-response relationship was observed in serum IGF-1 concentrations. All trough IGF-1 levels were well sustained one week after the final administrations of JR-142 at the three dosages, while the peak concentrations of IGF-1 remained mildly elevated. No serious AEs were observed, and laboratory tests, including assessment of anti-drug antibodies, uncovered no significant safety issues. CONCLUSIONS Once-weekly subcutaneous injections of JR-142 produced positive dose-dependent PK and PD profiles over the dosage range. Drug accumulation was observed after the four-week administration period but did not raise safety concerns, indicating that JR-142 is well-tolerated in healthy participants. The PD profiles observed in terms of IGF-1 concentrations were also positive, and we believe the encouraging results of this study warrant substantiation in further clinical trials in patients with GHD. ETHICS This clinical study was conducted at one investigational site in Osaka, Japan, where the clinical study and the non-clinical data of JR-142 were reviewed and approved by its Institutional Review Board on 9th May 2019. The study was conducted in compliance with the approved study protocol, the Declaration of Helsinki, 1964, as revised in 2013, and Good Clinical Practice.
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Affiliation(s)
- Yasuko Owada
- Medical Corporation Heishinkai OPHAC Hospital, Osaka, Japan
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Rajput R, Pathak V. The Effect of Daily versus Weekly Levothyroxine Replacement on Thyroid Function Test in Hypothyroid Patients at a Tertiary Care Centre in Haryana. Eur Thyroid J 2017; 6:250-254. [PMID: 29071237 PMCID: PMC5649268 DOI: 10.1159/000477348] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/04/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We compare the effect of daily versus weekly levothyroxine (LT4) replacement on thyroid function test (TFT) in hypothyroid patients at a tertiary care centre in Haryana. MATERIALS AND METHODS This was a randomised crossover study in which 100 hypothyroid patients on a stable LT4 dose were divided into 2 groups of 50 each. In group I, patients were given daily therapy for 6 weeks and then shifted to weekly therapy for the next 6 weeks. In group II, patients were given LT4 once a week for 6 weeks and then switched to daily therapy for the next 6 weeks. TFT, quality of life (QOL), and hyperthyroidism symptom scale (HSS) score of patients were compared in each group at 0, 6, and 12 weeks. RESULTS TFT remained within the normal range, but TSH increased (group I, daily 2.8 ± 1.4 mIU/L, weekly 3.9 ± 1.1 mIU/L, p = 0.001; group II, weekly 4.6 ± 1.1 mIU/L, daily 2.7 ± 1.2 mIU/L, p = <0.001) and T3/T4 decreased with weekly therapy as compared to daily therapy. No significant difference in HSS score was found between daily and weekly administration of LT4. With weekly therapy, QOL showed improvement in bodily pain, vitality, mental health, and social functioning. CONCLUSION Once-weekly LT4 administration is a reasonable alternative for patients, especially for those who have issues with compliance.
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Affiliation(s)
- Rajesh Rajput
- *Dr. Rajesh Rajput, Department of Endocrinology and Medicine Unit V, PGIMS, Rohtak, Haryana 124001 (India), E-Mail
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