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Liu H, Zheng Q, Li M, Kou J, Wei J, Feng W. Dose-dependent bidirectional pharmacological effects of vinorelbine-based metronomic combination chemotherapy on tumor growth and metastasis and mechanisms in melanoma mouse model. Fundam Clin Pharmacol 2024; 38:99-112. [PMID: 37458143 DOI: 10.1111/fcp.12939] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/25/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND There is evidence that the empirical setting of doses and schedules of antineoplastic agents in metronomic chemotherapy (MC) might lead to undesirable outcomes, such as promoting tumor growth or metastasis at certain low doses. However, details about the dose effect of antineoplastic agents in MC have not been fully known yet. OBJECTIVES Vinorelbine combined with cisplatin or fluorouracil (VNR/CDDP or VNR/FU) was selected to investigate its effects on tumor growth or metastasis as well as mechanisms. METHODS Experimental techniques, including immunohistochemistry, western blot, immunofluorescence, and flow cytometry, were used to explore the mechanisms, along with cell proliferation, apoptosis, migration, and invasion. RESULTS The results showed that VNR/CDDP or VNR/FU promoted tumor growth and metastasis at low doses and inhibited them at high ones. Except that expressions of apoptotic proteins were elevated at both low and high doses, low-dose treatments enhanced angiogenesis and promoted the mobilization and recruitment of myeloid-derived suppressor cells (MDSCs), while high-dose treatments reversed these effects. Additionally, low concentrations of VNR/CDDP or VNR/FU stimulated tumor cell functions such as anti-apoptosis, migration, and invasion, but high concentrations only suppressed cell proliferation and increased apoptosis. CONCLUSION This study elucidated a bidirectional action mode regulated by multiple mechanisms at different doses in MC and also highlighted the risks of low-dose metronomic administration of antineoplastic agents in the clinic. More preclinical and clinical studies focusing on the dose-effect of metronomic regimens are urgently needed because an effective therapeutic regimen should be an optimal setting of drugs, doses, schedules, or combinations.
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Affiliation(s)
- Hua Liu
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Qiaowei Zheng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Min Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Jianrong Kou
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Junsong Wei
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Weiyi Feng
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
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Munzone E, Regan MM, Cinieri S, Montagna E, Orlando L, Shi R, Campadelli E, Gianni L, Palleschi M, Petrelli F, Bengala C, Generali D, Collovà E, Puglisi F, Cretella E, Zamagni C, Chini C, Ruepp B, Loi S, Colleoni M. Efficacy of Metronomic Oral Vinorelbine, Cyclophosphamide, and Capecitabine vs Weekly Intravenous Paclitaxel in Patients With Estrogen Receptor-Positive, ERBB2-Negative Metastatic Breast Cancer: Final Results From the Phase 2 METEORA-II Randomized Clinical Trial. JAMA Oncol 2023; 9:1267-1272. [PMID: 37440239 PMCID: PMC10346502 DOI: 10.1001/jamaoncol.2023.2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/04/2023] [Indexed: 07/14/2023]
Abstract
Importance In spite of the effectiveness of endocrine therapy plus cyclin-dependent kinase (CDK) 4/6 inhibitors as the first-line treatment for estrogen receptor (ER)-positive, erb-b2 receptor tyrosine kinase 2 (ERBB2 [formerly HER2/neu])-negative (ER+/ERBB2-) metastatic breast cancer (MBC), patients eventually develop resistance, and eventually most will receive chemotherapy. The METEORA-II trial compared a metronomic all-oral treatment with intravenous (IV) chemotherapy. Objective To compare the efficacy of the oral vinorelbine plus cyclophosphamide plus capecitabine (VEX) regimen vs weekly IV paclitaxel among patients with ER+/ERBB2- MBC who are candidates for chemotherapy. Design, Setting, and Participants This phase 2 randomized clinical trial including 140 women 18 years and older (randomized 1:1) with ER+/ERBB2- MBC was carried out from September 13, 2017, to January 14, 2021 at 15 centers in Italy. Eligible patients could have received 1 prior line of chemotherapy for MBC and/or 2 lines of endocrine therapy (including CDK4/6 inhibitors). Interventions In 4-week cycles, patients received either metronomic oral VEX or weekly IV paclitaxel. Main Outcomes and Measures The primary end point was investigator-assessed time to treatment failure (TTF) defined as the interval between the date of randomization to the end of treatment (because of disease progression or lack of tolerability or because further trial treatment was declined). Secondary end points included progression-free survival (PFS), overall survival (OS), and disease control rate (complete or partial response or stable disease lasting for at least 24 weeks). Results In total, 133 patients received either VEX (n = 70) or paclitaxel (n = 63) in 4-weekly cycles. The median age was 61 (range, 30-80) years. The VEX treatment significantly prolonged TTF vs paclitaxel (hazard ratio [HR], 0.61; 95% CI, 0.42-0.88; P = .008), median TTF was 8.3 (95% CI, 5.6-11.1) months for VEX vs 5.7 (95% CI, 4.1-6.1) months for paclitaxel, and the 12-month TTF was 34.3% for VEX vs 8.6% for paclitaxel. The median PFS was 11.1 (95% CI, 8.3-13.8) months vs 6.9 (95% CI, 5.4-10.1) months favoring VEX (HR, 0.67; 95% CI, 0.46-0.96, P = .03). The 12-month PFS was 43.5% for VEX vs 21.9% for paclitaxel. No difference in OS was found. The TF event for 55.6% of patients was progression of disease; for 23% it was AEs. More patients assigned to VEX had at least 1 grade 3 or 4 targeted adverse event (VEX, 42.9%; 95% CI, 31.1%-55.3% vs paclitaxel, 28.6%; 95% CI, 17.9%-41.3%), but essentially no alopecia. Conclusion and Relevance This randomized clinical trial found significantly prolonged TTF and PFS for oral VEX but no improvement in OS compared with intravenous paclitaxel, despite increased but still manageable toxic effects. The VEX regimen may provide more prolonged disease control than weekly paclitaxel for ER+/ERBB2- MBC. Trial Registration ClinicalTrials.gov Identifier: NCT02954055.
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Affiliation(s)
- Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Meredith M. Regan
- IBCSG Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Saverio Cinieri
- Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Emilia Montagna
- Division of Medical Senology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Laura Orlando
- Department of Medical Oncology, Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Ruichao Shi
- IBCSG Statistical Center, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Lorenzo Gianni
- Department of Medical Oncology, Ospedale Infermi, AUSL Della Romagna, Rimini, Italy
| | - Michela Palleschi
- Department of Oncology, IRCCS, Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori,” Meldola, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Carmelo Bengala
- Division of Medical Oncology, Department of Medical Oncology, Department of Oncology, Azienda USL Toscana, Misericordia Hospital, Grosseto, Italy
| | - Daniele Generali
- Women’s Cancer Center, Azienda Socio-Sanitaria Territoriale di Cremona and University of Trieste, Cremona, Italy
| | - Elena Collovà
- Medical Oncology Unit, ASST Ovest Milanese Legnano, Milan, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, CRO di Aviano, National Cancer Institute, IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Elisabetta Cretella
- Department of Medical Oncology, Azienda Sanitaria Dell’Alto Adige, Bolzano, Italy
| | - Claudio Zamagni
- IRCCS Azienda Ospedaliero-universitaria di Bologna, Bologna, Italy
| | - Claudio Chini
- Department of Medical Oncology, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Sherene Loi
- ETOP IBCSG Partners Foundation, Bern, Switzerland
- Peter MacCallum Cancer Centre, Division of Cancer Research, The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marco Colleoni
- Division of Medical Senology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- ETOP IBCSG Partners Foundation, Bern, Switzerland
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Levin I. Magic bullet or simply nice to have: safety and tolerability of oral vinorelbine for ectopic pregnancy. Fertil Steril 2023; 120:697-698. [PMID: 37385396 DOI: 10.1016/j.fertnstert.2023.06.027] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Ishai Levin
- Department of Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
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Chowdary P, Hastie R, Lino T, Middleton A, Capes G, Humphries A, Abed-Ali A, Anderson M, Mol BWJ, Horne A, Lim E, Andrew P, Brownfoot F, Tong S. Oral vinorelbine to treat women with ectopic pregnancy: a phase 1 clinical safety and tolerability study. Fertil Steril 2023; 120:695-696. [PMID: 37245616 DOI: 10.1016/j.fertnstert.2023.05.161] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Prathima Chowdary
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia; Clinical Trials Unit, Department of Obstetrics and Gynaecology, The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
| | - Roxanne Hastie
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Tu'uhevaha Lino
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Anna Middleton
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Gwyneth Capes
- Clinical Trials Unit, Department of Obstetrics and Gynaecology, The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Aimee Humphries
- Clinical Trials Unit, Department of Obstetrics and Gynaecology, The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Abir Abed-Ali
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh, United Kingdom
| | - Marti Anderson
- New Zealand Institute for Advanced Study, Massey University, Albany, Auckland, New Zealand
| | | | - Andrew Horne
- Department of Obstetrics and Gynaecology, Waitemata District Health Board, Auckland, New Zealand
| | - Eugene Lim
- Institute of Innovation and Improvement, Waitemata District Health Board, Auckland, New Zealand
| | - Penny Andrew
- Clinical Trials Unit, Department of Obstetrics and Gynaecology, The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Fiona Brownfoot
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Stephen Tong
- Obstetric Diagnostics and Therapeutics Group, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia; Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
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Kindler HL, Novello S, Bearz A, Ceresoli GL, Aerts JGJV, Spicer J, Taylor P, Nackaerts K, Greystoke A, Jennens R, Calabrò L, Burgers JA, Santoro A, Cedrés S, Serwatowski P, Ponce S, Van Meerbeeck JP, Nowak AK, Blumenschein G, Siegel JM, Kasten L, Köchert K, Walter AO, Childs BH, Elbi C, Hassan R, Fennell DA. Anetumab ravtansine versus vinorelbine in patients with relapsed, mesothelin-positive malignant pleural mesothelioma (ARCS-M): a randomised, open-label phase 2 trial. Lancet Oncol 2022; 23:540-552. [PMID: 35358455 PMCID: PMC10512125 DOI: 10.1016/s1470-2045(22)00061-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Few treatment options exist for second-line treatment of malignant pleural mesothelioma. We aimed to assess the antibody-drug conjugate anetumab ravtansine versus vinorelbine in patients with unresectable locally advanced or metastatic disease overexpressing mesothelin who had progressed on first-line platinum-pemetrexed chemotherapy with or without bevacizumab. METHODS In this phase 2, randomised, open-label study, done at 76 hospitals in 14 countries, we enrolled adults (aged ≥18 years) with unresectable locally advanced or metastatic malignant pleural mesothelioma, an Eastern Cooperative Oncology Group performance status of 0-1, and who had progressed on first-line platinum-pemetrexed chemotherapy with or without bevacizumab. Participants were prospectively screened for mesothelin overexpression (defined as 2+ or 3+ mesothelin membrane staining intensity on at least 30% of viable tumour cells by immunohistochemistry) and were randomly assigned (2:1), using an interactive voice and web response system provided by the sponsor, to receive intravenous anetumab ravtansine (6·5 mg/kg on day 1 of each 21-day cycle) or intravenous vinorelbine (30 mg/m2 once every week) until progression, toxicity, or death. The primary endpoint was progression-free survival according to blinded central radiology review, assessed in the intention-to-treat population, with safety assessed in all participants who received any study treatment. This study is registered with ClinicalTrials.gov, NCT02610140, and is now completed. FINDINGS Between Dec 3, 2015, and May 31, 2017, 589 patients were enrolled and 248 mesothelin-overexpressing patients were randomly allocated to the two treatment groups (166 patients were randomly assigned to receive anetumab ravtansine and 82 patients were randomly assigned to receive vinorelbine). 105 (63%) of 166 patients treated with anetumab ravtansine (median follow-up 4·0 months [IQR 1·4-5·5]) versus 43 (52%) of 82 patients treated with vinorelbine (3·9 months [1·4-5·4]) had disease progression or died (median progression-free survival 4·3 months [95% CI 4·1-5·2] vs 4·5 months [4·1-5·8]; hazard ratio 1·22 [0·85-1·74]; log-rank p=0·86). The most common grade 3 or worse adverse events were neutropenia (one [1%] of 163 patients for anetumab ravtansine vs 28 [39%] of 72 patients for vinorelbine), pneumonia (seven [4%] vs five [7%]), neutrophil count decrease (two [1%] vs 12 [17%]), and dyspnoea (nine [6%] vs three [4%]). Serious drug-related treatment-emergent adverse events occurred in 12 (7%) patients treated with anetumab ravtansine and 11 (15%) patients treated with vinorelbine. Ten (6%) treatment-emergent deaths occurred with anetumab ravtansine: pneumonia (three [2%]), dyspnoea (two [1%]), sepsis (two [1%]), atrial fibrillation (one [1%]), physical deterioration (one [1%]), hepatic failure (one [1%]), mesothelioma (one [1%]), and renal failure (one [1%]; one patient had 3 events). One (1%) treatment-emergent death occurred in the vinorelbine group (pneumonia). INTERPRETATION Anetumab ravtansine showed a manageable safety profile and was not superior to vinorelbine. Further studies are needed to define active treatments in relapsed mesothelin-expressing malignant pleural mesothelioma. FUNDING Bayer Healthcare Pharmaceuticals.
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Affiliation(s)
- Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA.
| | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano, Turin, Italy
| | - Alessandra Bearz
- Department of Medical Oncology and Immune-Related Cancers, CRO-IRCCS Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - Giovanni L Ceresoli
- Department of Medical Oncology, Oncology Unit, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Centre, Rotterdam, Netherlands
| | - James Spicer
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Paul Taylor
- Department of Medical Oncology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kristiaan Nackaerts
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, Universitair Ziekenhuis Leuven, KU Leuven, Leuven, Belgium
| | - Alastair Greystoke
- Department of Medical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - Ross Jennens
- Epworth Cancer Services Clinical Institute, Epworth Healthcare, Richmond, VIC, Australia
| | - Luana Calabrò
- Department of Oncology, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Jacobus A Burgers
- Department of Thoracic Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Armando Santoro
- Humanitas University, Milan, Italy; Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Susana Cedrés
- Department of Medical Oncology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Piotr Serwatowski
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Santiago Ponce
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jan P Van Meerbeeck
- Department of Thoracic Oncology, Antwerp University and University Hospital and European Reference Network for Rare or Low Prevalence Complex Disease (ERN-LUNG), Antwerp, Belgium
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, WA, Australia; National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA, Australia
| | - George Blumenschein
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan M Siegel
- Clinical Statistics Oncology, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Linda Kasten
- Statistics, Syneos Health Clinical Solutions, Morrisville, NC, USA
| | - Karl Köchert
- Biomarker and Data Insights, Bayer AG Pharma, Berlin, Germany
| | - Annette O Walter
- Translational Medicine Oncology, Bayer AG Pharma, Berlin, Germany
| | - Barrett H Childs
- Oncology Development, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Cem Elbi
- Global Clinical Development, Oncology, Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Raffit Hassan
- Department of Thoracic and GI Malignancies, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dean A Fennell
- Leicester Cancer Research Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK.
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Abstract
INTRODUCTION Metronomic chemotherapy (MCT) is based on frequent dosing of the drug. . This leads to pharmacologically active but low plasma concentrations that reduce toxicity. MCT seems to work primarily via indirect effects on tumor cells and their microenvironment, rather than direct antitumor effects. Oral vinorelbine is one of the most widely studied MCT approaches in both advanced breast cancer and non-small cell lung cancer. EXPERT OPINION MCT with vinorelbine has proven efficacy, tolerability and quality of life benefits both as monotherapy and in combination with other MCTs or targeted agents, in first-line therapy and in previously treated patients. Key populations are emerging who may be particularly well suited to metronomic vinorelbine, including those with indolent disease, older individuals, and those with multiple comorbidities and/or bone metastases. Ongoing trials should help to further delineate these target groups. Additional work is needed to better understand the optimal vinorelbine regimen, particularly when used in combination or in non-Caucasian patients. Markers are also required to help identify individuals who are most likely to respond. Nonetheless, the efficacy and tolerability of MCT, allied to improved patient convenience, reduced need for medical engagement and lower cost, make it an appealing option - particular in resource-constrained healthcare environments.
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Affiliation(s)
- Binghe Xu
- Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences , Beijing, P.R. China
| | - Tao Sun
- Department of Medical Oncology, Cancer Hospital of Liaoning Province , shenyang, Liaoining, P.R. China
| | - Shusen Wang
- Department of Medical Oncology, Cancer Center, Sun Yat-sen university , Guang, China
| | - Yingcheng Lin
- Department of Medical Oncology, Shantou University Medical College Cancer Hospital , China
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Macpherson IR, Spiliopoulou P, Rafii S, Saggese M, Baird RD, Garcia-Corbacho J, Italiano A, Bonneterre J, Campone M, Cresti N, Posner J, Takeda Y, Arimura A, Spicer J. A phase I/II study of epertinib plus trastuzumab with or without chemotherapy in patients with HER2-positive metastatic breast cancer. Breast Cancer Res 2019; 22:1. [PMID: 31892325 PMCID: PMC6938617 DOI: 10.1186/s13058-019-1178-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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] [Received: 01/29/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Epertinib (S-222611) is a potent reversible inhibitor of HER2, EGFR and HER4. This trial evaluated the safety, tolerability, pharmacokinetics and antitumour activity of daily oral epertinib combined with trastuzumab (arm A), with trastuzumab plus vinorelbine (arm B) or with trastuzumab plus capecitabine (arm C), in patients with HER2-positive metastatic breast cancer (MBC). METHODS Eligible patients, with or without brain metastases, had received prior HER2-directed therapy. A dose-escalation phase determined the tolerability of each combination and established a dose for further study. Further, patients were recruited to expansion cohorts in each of the 3 arms to further explore efficacy and safety. RESULTS The recommended doses of epertinib were 600 mg, 200 mg and 400 mg in arms A, B and C, respectively. The most frequent grade 3/4 adverse event (AE) was diarrhoea in all arms, which was manageable with medical intervention and dose modification. The objective response rate (complete response [CR] plus partial response [PR]) in heavily pre-treated HER2-positive MBC patients at the recommended doses of epertinib combined with trastuzumab was 67% (N = 9), with trastuzumab plus vinorelbine was 0% (N = 5) and with trastuzumab plus capecitabine was 56% (N = 9). Notably, 4 of 6 patients previously treated with T-DM1 responded in the arm A expansion cohort (epertinib plus trastuzumab). In the arm C expansion cohort (epertinib plus trastuzumab plus capecitabine), 4 of 7 patients responded despite previous exposure to capecitabine. Measurable regression of brain metastases was observed in patients with CNS target lesions treated in both arms A and C. CONCLUSION We observed safety, tolerability and encouraging antitumour activity of epertinib combined with trastuzumab, or with trastuzumab plus capecitabine. This supports further evaluation of these combinations in patients with pre-treated HER2-positive MBC, with or without brain metastases. TRIAL REGISTRATION EudraCT Number: 2013-003894-87; registered 09-September-2013.
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Affiliation(s)
| | | | - Saeed Rafii
- Sarah Cannon Research Institute UK, London, UK
| | | | | | | | | | | | - Mario Campone
- Institut de cancérologie de l’Ouest Site René Gauducheau, Saint Herblain, France
| | - Nicola Cresti
- Newcastle upon Tyne and Sir Bobby Robson Cancer Trials Research Centre, Freeman Hospital, Newcastle University, Newcastle Upon Tyne, UK
| | | | | | | | - James Spicer
- School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Hospital, 3rd Floor, Bermondsey Wing, St Thomas Street, London, SE1 9RT UK
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Bisogno G, De Salvo GL, Bergeron C, Gallego Melcón S, Merks JH, Kelsey A, Martelli H, Minard-Colin V, Orbach D, Glosli H, Chisholm J, Casanova M, Zanetti I, Devalck C, Ben-Arush M, Mudry P, Ferman S, Jenney M, Ferrari A. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2019; 20:1566-1575. [PMID: 31562043 DOI: 10.1016/s1470-2045(19)30617-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [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: 05/25/2019] [Revised: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND For more than three decades, standard treatment for rhabdomyosarcoma in Europe has included 6 months of chemotherapy. The European paediatric Soft tissue sarcoma Study Group (EpSSG) aimed to investigate whether prolonging treatment with maintenance chemotherapy would improve survival in patients with high-risk rhabdomyosarcoma. METHODS RMS 2005 was a multicentre, open-label, randomised, controlled, phase 3 trial done at 102 hospitals in 14 countries. We included patients aged 6 months to 21 years with rhabdomyosarcoma who were considered to be at high risk of relapse: those with non-metastatic incompletely resected embryonal rhabdomyosarcoma occurring at unfavourable sites with unfavourable age (≥10 years) or tumour size (>5 cm), or both; those with any non-metastatic rhabdomyosarcoma with nodal involvement; and those with non-metastatic alveolar rhabdomyosarcoma but without nodal involvement. Patients in remission after standard treatment (nine cycles of ifosfamide, vincristine, dactinomycin with or without doxorubicin, and surgery or radiotherapy, or both) were randomly assigned (1:1) to stop treatment or continue maintenance chemotherapy (six cycles of intravenous vinorelbine 25 mg/m2 on days 1, 8, and 15, and daily oral cyclophosphamide 25 mg/m2, on days 1-28). Randomisation was done by use of a web-based system and was stratified (block size of four) by enrolling country and risk subgroup. Neither investigators nor patients were masked to treatment allocation. The primary outcome was disease-free survival in the intention-to-treat population. Secondary outcomes were overall survival and toxicity. This trial is registered with EudraCT, number 2005-000217-35, and ClinicalTrials.gov, number NCT00339118, and follow-up is ongoing. FINDINGS Between April 20, 2006, and Dec 21, 2016, 371 patients were enrolled and randomly assigned to the two groups: 186 to stop treatment and 185 to receive maintenance chemotherapy. Median follow-up was 60·3 months (IQR 32·4-89·4). In the intention-to-treat population, 5-year disease-free survival was 77·6% (95% CI 70·6-83·2) with maintenance chemotherapy versus 69·8% (62·2-76·2) without maintenance chemotherapy (hazard ratio [HR] 0·68 [95% CI 0·45-1·02]; p=0·061), and 5-year overall survival was 86·5% (95% CI 80·2-90·9) with maintenance chemotherapy versus 73·7% (65·8-80·1) without (HR 0·52 [95% CI 0·32-0·86]; p=0·0097). Toxicity was manageable in patients who received maintenance chemotherapy: 136 (75%) of 181 patients had grade 3-4 leucopenia, 148 (82%) had grade 3-4 neutropenia, 19 (10%) had anaemia, two (1%) had thrombocytopenia, and 56 (31%) had an infection. One (1%) patient had a grade 4 non-haematological toxicity (neurotoxicity). Two treatment-related serious adverse events occurred: one case of inappropriate antidiuretic hormone secretion and one of a severe steppage gait with limb pain, both of which resolved. INTERPRETATION Adding maintenance chemotherapy seems to improve survival for patients with high-risk rhabdomyosarcoma. This approach will be the new standard of care for patients with high-risk rhabdomyosarcoma in future EpSSG trials. FUNDING Fondazione Città della Speranza, Association Léon Berard Enfant Cancéreux, Clinical Research Hospital Program (French Ministry of Health), and Cancer Research UK.
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Affiliation(s)
- Gianni Bisogno
- Haematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy.
| | - Gian Luca De Salvo
- Clinical Research Unit, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Soledad Gallego Melcón
- Servicio de Oncología y Hematología Pediatrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Johannes H Merks
- Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands; Department of Paediatric Oncology, Emma Children's Hospital-Academic Medical Center Amsterdam, Netherlands
| | - Anna Kelsey
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | - Helene Martelli
- Department of Paediatric Surgery, Hôpital Bicêtre-Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | | | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | - Heidi Glosli
- Department of Paediatric Research and Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Julia Chisholm
- Children and Young Peoples Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Zanetti
- Haematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Christine Devalck
- Paediatric Haematology and Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Myriam Ben-Arush
- Joan and Sanford Weill Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Peter Mudry
- University Children's Hospital Brno, Czech Republic
| | - Sima Ferman
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, UK
| | - Andrea Ferrari
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Roviello G, Corona SP, Conca R, Petrioli R, Rosellini P, Bonetta A, Aieta M. Is there still a place for vinorelbine in advanced metastatic castration resistant prostate cancer? Medicine (Baltimore) 2019; 98:e16249. [PMID: 31261590 PMCID: PMC6616091 DOI: 10.1097/md.0000000000016249] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this paper was to evaluate the activity and tolerability of oral vinorelbine in patients with advanced castration resistant prostate cancer (CRPC) who progressed after a minimum of three lines including: abiraterone acetate, docetaxel, cabazitaxel, and enzalutamide.Treatment consisted of weekly oral vinorelbine 60 mg/m. Chemotherapy was administered until disease progression or unacceptable toxicity.Twenty-six patients received vinorelbine: their median age was 74 years (range 58-84 years). Twenty-four (92.3%) patients had bone metastases. A decrease in PSA levels ≥50% was observed in 2 patients (7.7%). Among the subjects who were symptomatic at baseline, pain was reduced in 3 patients (13.6%) with a significant decrease in analgesic use. Median progression-free survival was 9 weeks (95% CI: 7 to 11) and median overall survival was 17 weeks (95% CI: 12 to 22). Treatment was well tolerated, and no grade 4 toxicities were observed.Our findings do not suggest the use of oral vinorelbine on a weekly schedule, in CRPC heavily pre-treated.
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Affiliation(s)
- Giandomenico Roviello
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
| | - Silvia Paola Corona
- Peter MacCallum Cancer Centre, Radiation Oncology Department, Moorabbin Campus, East Bentleigh Victoria, Australia
| | - Raffaele Conca
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
| | - Roberto Petrioli
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico “Le Scotte”, Siena
| | - Pietro Rosellini
- Department of Medicine, Surgery and Neurosciences, Medical Oncology Unit, University of Siena, Viale Bracci - Policlinico “Le Scotte”, Siena
| | - Alberto Bonetta
- Radiotherapy department, ASST Cremona, Viale Concordia 1, Cremona, Italy
| | - Michele Aieta
- Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROB, Referral Cancer Center of Basilicata, via Padre Pio 1, Rionero, Vulture (PZ), Italy
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10
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Gong J, Cho M, Gupta R, Synold TW, Frankel P, Ruel C, Fakih M, Chung V, Lim D, Chao J. A Pilot Study of Vinorelbine Safety and Pharmacokinetics in Patients with Varying Degrees of Liver Dysfunction. Oncologist 2019; 24:1137-1145. [PMID: 30710067 PMCID: PMC6693729 DOI: 10.1634/theoncologist.2018-0336] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/03/2019] [Indexed: 12/31/2022] Open
Abstract
Vinorelbine tartrate is a semi‐synthetic vinca alkaloid and an inhibitor of microtubule polymerization with demonstrated antitumor properties across a spectrum of cancers. The pharmacokinetics of vinorelbine may be altered in individuals with liver dysfunction, considering that hepatic metabolism serves as the predominant route of drug elimination. This article reports the pharmacokinetics and safety of vinorelbine in patients with varying degrees of hepatic impairment, including dosing recommendations in this population. Background. Vinorelbine has demonstrated anticancer activity and is primarily metabolized in the liver. This single‐institution, phase I pilot study describes the safety and pharmacokinetics of vinorelbine in patients with varying degrees of hepatic impairment. Materials and Methods. Patients with treatment‐refractory solid tumors were enrolled into treatment arms based on vinorelbine dose (weekly infusions of 7.5–30 mg/m2) and liver function (normal liver function, mild, moderate, or severe liver dysfunction). Vinorelbine pharmacokinetics were evaluated to describe its relationship with liver function. Indocyanine green (ICG) clearance was assessed for correlation with pharmacokinetics. Results. Forty‐seven patients were enrolled, and a total of 108 grade 3–4 treatment‐related adverse events (AEs) occurred. Of these, grade 3–4 myelosuppression was the most common (34.3%). Thirty‐three (30.6%), 22 (20.4%), and 9 (8.3%) grade 3–4 AEs were observed in the vinorelbine 20 mg/m2/severe, 15 mg/m2/moderate, and 7.5 mg/m2/severe liver dysfunction groups, respectively, with the majority being nonhematologic toxicities. ICG clearance decreased as liver function worsened. Vinorelbine pharmacokinetics were not correlated with ICG elimination or the degree of liver dysfunction. Conclusion. For patients with severe liver dysfunction (bilirubin >3.0 mg/dL), vinorelbine doses ≥7.5 mg/m2 are poorly tolerated. The high incidence of grade 3–4 AEs with 15 mg/m2 vinorelbine in moderate liver dysfunction (bilirubin 1.5–3.0 mg/dL) raises concerns for its safety in this population. Vinorelbine pharmacokinetics are not affected by liver dysfunction; however, levels of the active metabolite 4‐O‐deacetylvinorelbine were not measured and may be higher in patients with liver dysfunction if its elimination is impacted by liver impairment to a greater degree than the parent drug. Implications for Practice. Vinorelbine remains widely prescribed in advanced malignancies and is under development in immunotherapy combinations. Given vinorelbine is primarily hepatically metabolized, understanding its safety and pharmacokinetics in liver dysfunction remains paramount. In this phase I pilot study, weekly vinorelbine at doses ≥7.5 mg/m2 is poorly tolerated in those with severe liver dysfunction. Furthermore, a high incidence of grade 3–4 toxicities was observed with vinorelbine at 15 mg/m2 in those with moderate liver dysfunction. Vinorelbine pharmacokinetics do not appear affected by degree of liver dysfunction. Further evaluation of levels of the free drug and active metabolites in relationship to liver function are warranted.
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Affiliation(s)
- Jun Gong
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
- Department of Internal Medicine, Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - May Cho
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
- Department of Internal Medicine, Division of Hematology and Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Rohan Gupta
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Timothy W Synold
- Department of Cancer Biology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Paul Frankel
- Division of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Christopher Ruel
- Division of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Vincent Chung
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Dean Lim
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Joseph Chao
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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