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Xenidis N, Perraki M, Apostolaki S, Agelaki S, Kalbakis K, Vardakis N, Kalykaki A, Xyrafas A, Kakolyris S, Mavroudis D, Georgoulias V. Differential effect of adjuvant taxane-based and taxane-free chemotherapy regimens on the CK-19 mRNA-positive circulating tumour cells in patients with early breast cancer. Br J Cancer 2013; 108:549-56. [PMID: 23329233 PMCID: PMC3593552 DOI: 10.1038/bjc.2012.597] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: To determine the effect of adjuvant taxane-free and taxane-based chemotherapy regimens on the elimination of circulating tumour cells (CTCs) in patients with early breast cancer. Methods: The presence of CK-19 mRNA-positive CTCs in the peripheral blood was evaluated before and after chemotherapy, using a real-time RT–PCR assay, in a historical comparison of two cohorts of women with stage I–III breast cancer treated with adjuvant taxane-free (N=211; FE75C or E75C) and taxane-based (N=334; T/E75C or T/E75) chemotherapy. Results: Taxane-based chemotherapy resulted in a higher incidence of CTCs' elimination than taxane-free regimens since 49.7% (74 of 149) and 33.0% (29 of 88) of patients with detectable CTCs before chemotherapy, respectively, turned negative post-chemotherapy (P=0.015). Patients treated with taxane-free regimens had a significantly lower disease-free survival (DFS) (P=0.035) than patients treated with taxane-based regimens; this difference was observed in patients with but not without detectable CTCs before chemotherapy (P=0.018 and P=0.481, respectively). The incidence of deaths was significantly higher in the taxane-free cohort of patients with but not without detectable CTCs before chemotherapy compared with that of the taxane-based cohort (P=0.002). Multivariate analysis revealed that the chemotherapy regimen was significantly associated with prolonged DFS (HR: 2.00; 95% CI=1.20–3.34). Conclusion: Elimination of CK-19 mRNA-positive CTCs during adjuvant chemotherapy seems to be an efficacy indicator of treatment and is associated with a favourable clinical outcome of patients with detectable CTCs before chemotherapy.
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Affiliation(s)
- N Xenidis
- Department of Medical Oncology, University Hospital of Heraklion, PO Box 1352, 711 10 Heraklion, Crete, Greece
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Vamvakas L, Karampeazis⁎ A, Nikolaou C, Ardavanis A, Saloustros E, Kalbakis K, Zafeiriou Z, Stoltidis D, Kalykaki A, Georgoulias V, Mavroudis D. Paclitaxel and bevacizumab as first-line treatment in elderly women with HER-2 negative locally advanced or metastatic breast cancer: Preliminary results a multicenter phase II trial from Hellenic Oncology Research Group. J Geriatr Oncol 2012. [DOI: 10.1016/j.jgo.2012.10.012] [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: 11/30/2022]
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Kontopodis E, Christophylakis C, Kentepozidis N, Boukovinas I, Giassas S, Saloustros E, Kalykaki A, Bozionelou V, Georgoulias V, Mavroudis D. Docetaxel (D), Gemcitabine (G) and Bevacizumab (BEV) as Salvage Chemotherapy (CT) for HER-2 Negative Metastatic Breast Cancer (MBC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32961-6] [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: 10/25/2022] Open
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Karachaliou N, Ziras N, Syrigos K, Tryfonidis K, Papadimitraki E, Kontopodis E, Bozionelou V, Kalykaki A, Georgoulias V, Mavroudis D. A multicenter phase II trial of docetaxel and capecitabine as salvage treatment in anthracycline- and taxane-pretreated patients with metastatic breast cancer. Cancer Chemother Pharmacol 2012; 70:169-76. [PMID: 22669571 DOI: 10.1007/s00280-012-1901-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/21/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of docetaxel plus capecitabine (DC) combination as salvage treatment in anthracycline- and taxane-pretreated patients with metastatic breast cancer (MBC). PATIENTS AND TREATMENT Patients with MBC who had disease progression after initial chemotherapy with anthracyclines (n = 29; 100 %) and taxanes (n = 11; 37.9 %) were treated with oral capecitabine 950 mg/m(2) twice daily on days 1-14 and docetaxel 75 mg/m(2) on day 1 every 3 weeks. Nineteen (65.5 %) patients received this regimen as second line and 10 (34.5 %) as ≥3rd line of therapy. All patients were evaluable for response and toxicity. RESULTS Complete response occurred in two (6.9 %) patients and partial response in eleven (37.9 %) for an overall response rate of 44.8 % (95 % CI 26.7-62.9 %). Eleven women (37.9 %) had stable disease and five (17.2 %) progressive disease. Of the eleven patients previously treated with anthracyclines and taxanes, five (45.5 %) responded to DC combination. The median duration of response was 5.7 months (range 3.4-64.2), the median time to disease progression 9.3 months (range 1.2-58), and the median overall survival 25.5 months. No toxic death occurred. Neutropenia grade 4 occurred in 58.6 % of patients and three of them (10.3 %) developed neutropenic fever. Non-hematological toxicities were manageable with grade 3 hand-foot syndrome occurring in 6.9 % of the patients, fatigue in 3.4 %, and neurotoxicity in 3.4 %. CONCLUSION The DC combination is a valuable regimen as salvage treatment in anthracycline- or anthracycline and taxane-pretreated patients with MBC.
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Affiliation(s)
- N Karachaliou
- Hellenic Oncology Research Group (HORG), 55 Lomvardou str, 11470 Athens, Greece
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Kentepozidis N, Soultati A, Giassas S, Vardakis N, Kalykaki A, Kotsakis A, Papadimitraki E, Pantazopoulos N, Bozionellou V, Georgoulias V. Paclitaxel in combination with carboplatin as salvage treatment in patients with castration-resistant prostate cancer: a Hellenic oncology research group multicenter phase II study. Cancer Chemother Pharmacol 2012; 70:161-8. [DOI: 10.1007/s00280-012-1896-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/14/2012] [Indexed: 11/25/2022]
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Xenidis N, Perraki M, Apostolaki S, Agelaki S, Kalbakis K, Vardakis NK, Kalykaki A, Xyrafas A, Kakolyris S, Mavroudis D, Georgoulias V. Differential effect of adjuvant taxane-based and taxane-free chemotherapy regimens on the CK-19 mRNA-positive circulating tumor cells in patients with early breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10554] [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: 11/20/2022] Open
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Saloustros E, Kalbakis K, Vardakis N, Kalykaki A, Milaki G, Rovithi M, Agelaki S, Saridaki Z, Georgoulias V, Mavroudis D. Metronomic vinorelbine plus bevacizumab as salvage therapy for patients with metastatic breast cancer. J BUON 2011; 16:215-218. [PMID: 21766488] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Continuous administration of oral vinorelbine, given 3 times a week (metronomic), is feasible and exceptionally well tolerated at doses up to 50 mg with clinical activity against refractory tumors. In this phase II study oral metronomic vinorelbine and bevacizumab were evaluated as salvage therapy in women with pretreated metastatic breast cancer (MBC). METHODS Patients received oral vinorelbine (50 mg 3 times a week) and bevacizumab (10 mg/kg) biweekly in cycles of 28 days. The primary endpoint was objective response rate (ORR). A preplanned analysis was performed when the first 13 patients were evaluated for tumor response. RESULTS One patient (7.7%) achieved partial response (PR) and 6 (46.1%) stable disease (SD). The combination was very well tolerated but, as per protocol, the study was closed prematurely due to lack of efficacy. CONCLUSION The combination of oral metronomic vinorelbine and bevacizumab has good tolerance but minimal activity in terms of objective responses in pretreated patients with MBC.
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Affiliation(s)
- E Saloustros
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
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Pallis AG, Karampeazis A, Vamvakas L, Vardakis N, Kotsakis A, Bozionelou V, Kalykaki A, Hatzidaki D, Mavroudis D, Georgoulias V. Efficacy and treatment tolerance in older patients with NSCLC: a meta-analysis of five phase III randomized trials conducted by the Hellenic Oncology Research Group. Ann Oncol 2011; 22:2448-2455. [PMID: 21393380 DOI: 10.1093/annonc/mdq772] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Approximately 50% of newly diagnosed cases of non-small-cell lung cancer (NSCLC) are observed in patients >65 years, while 30%-40% of cases occur in patients >70 years. PATIENTS AND METHODS The objective of the current study was to determine (i) the number of elderly (>70 years) patients with advanced/metastatic NSCLC enrolled in phase III trials of the Hellenic Oncology Research Group, (ii) the treatment-related toxicity observed in these patients compared with their younger counterparts, and (iii) the differences in terms of response rate, time to tumor progression (TTP), and overall survival (OS) between younger and older patients. RESULTS Pooled data from five clinical trials including 1845 patients were analyzed; 1421 (77%) and 424 (23%) were <70 years and ≥70 years, respectively. No difference was observed in terms of the overall response rate and TTP. There was an OS difference between young and older patients, with higher risk for death in older patients. However, when the analysis was carried out after omitting a trial that showed a different trend, no difference was observed. Older patients experienced higher toxicity. CONCLUSIONS This report supports the feasibility of chemotherapy treatment for older NSCLC patients. Optimization of treatment of older NSCLC patients requires the design of prospective older-specific phase III trials for these patients.
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Affiliation(s)
- A G Pallis
- Hellenic Oncology Research Group (HORG), Athens, Greece.
| | - A Karampeazis
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - L Vamvakas
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - N Vardakis
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - A Kotsakis
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - V Bozionelou
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - A Kalykaki
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - D Hatzidaki
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - D Mavroudis
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - V Georgoulias
- Hellenic Oncology Research Group (HORG), Athens, Greece
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Xenidis N, Kotsakis A, Kalykaki A, Christophyllakis C, Giassas S, Kentepozidis N, Polyzos A, Chelis L, Vardakis N, Vamvakas L, Georgoulias V, Kakolyris S. Etoposide plus cisplatin followed by concurrent chemo-radiotherapy and irinotecan plus cisplatin for patients with limited-stage small cell lung cancer: A multicenter phase II study. Lung Cancer 2010; 68:450-4. [DOI: 10.1016/j.lungcan.2009.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/11/2009] [Accepted: 08/12/2009] [Indexed: 11/25/2022]
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Polyzos A, Kalbakis K, Giassas S, Kalykaki A, Vardakis NK, Bozionelou V, Saloustros ES, Kontopodis E, Mavroudis D, Georgoulias V. Salvage treatment in metastatic breast cancer (MBC) with weekly paclitaxel (P) plus biweekly bevacizumab (B). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ziras N, Polyzos A, Xenidis N, Kalykaki A, Androulakis NE, Papakotoulas P, Kentepozidis NK, Makrantonakis P, Xynogalos S, Sougklakos I. CAPIRI plus bevacizumab (CAPIRI-B) versus FOLFIRI plus bevacizumab (FOLFIRI-B) for the treatment of patients with metastatic colorectal cancer (mCRC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Saloustros ES, Kalbakis K, Vardakis NK, Kalykaki A, Milaki G, Rovithi M, Agelaki S, Saridaki Z, Georgoulias V, Mavroudis D. Vinorelbine metronomic plus bevacizumab as salvage therapy for patients with metastatic breast cancer (MBC): A multicenter phase II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1133] [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: 11/20/2022] Open
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Kotsakis A, Agelaki S, Vardakis N, Vamvakas L, Kalykaki A, Kentepozidis N, Kontopodis E, Sfakiotaki G, Mavroudis D, Georgoulias V. 9075 Phase I study of the combination of docetaxel (D) and pemetrexed (P) in patients with advanced unresectable or metastatic non small cell lung cancer (NSCLC). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71788-4] [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: 11/16/2022] Open
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Kalykaki A, Agelaki S, Kotsakis A, Vamvakas L, Bozionelou V, Kalbakis K, Androulakis N, Georgoulias V, Mavroudis D. A phase I study of oral metronomic vinorelbine plus capecitabine in patients with metastatic breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1127] [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
1127 Background: The combination of capecitabine plus intravenous vinorelbine has shown substantial activity in anthracycline and/or taxane pretreated patients with metastatic breast cancer (MBC). The metronomic administration may be associated with reduced toxicity and enhanced efficacy. We conducted a phase I study to determine the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of capecitabine plus oral vinorelbine administered metronomically in patients with MBC. Methods: Patients were treated with vinorelbine (30–60 mg total dose) p.o three times per week continuously and capecitabine (800–1250 mg/m2 twice a day) from day 1 to 14 in three week cycles. DLT was defined during the first cycle as grade (G) 4 neutropenia or thrombocytopenia, febrile neutropenia, any ≥ G 3 non-hematological toxicity, and any delay of treatment due to toxicity. Results: To date 27 patients have been enrolled on 7 different dose levels. Treatment was first line for 16 and second line for 11 patients. DLTs included G3 febrile neutropenia and treatment delay due to G2 neutropenia occurring in 1 patient each, at dose level 4 and G3 diarrhea and treatment delay due to G2 neutropenia in 1 patient each, at dose level 7. The MTD has not yet been reached. Hematologic and nonhematological toxicities were generally mild to moderate. Most common were myelosuppression, asthenia, nausea, and diarrhea. Nine objective responses were observed with 2 complete and 7 partial. Conclusions: Vinorelbine 60 mg three times a week in combination with capecitabine 1250mg/m2 twice a day, has been well tolerated. Enrollment is ongoing. Updated data will be presented at the meeting. No significant financial relationships to disclose.
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Affiliation(s)
- A. Kalykaki
- Department of Medical Oncology, University Hospital, Heraklion, Greece
| | - S. Agelaki
- Department of Medical Oncology, University Hospital, Heraklion, Greece
| | - A. Kotsakis
- Department of Medical Oncology, University Hospital, Heraklion, Greece
| | - L. Vamvakas
- Department of Medical Oncology, University Hospital, Heraklion, Greece
| | - V. Bozionelou
- Department of Medical Oncology, University Hospital, Heraklion, Greece
| | - K. Kalbakis
- Department of Medical Oncology, University Hospital, Heraklion, Greece
| | - N. Androulakis
- Department of Medical Oncology, University Hospital, Heraklion, Greece
| | - V. Georgoulias
- Department of Medical Oncology, University Hospital, Heraklion, Greece
| | - D. Mavroudis
- Department of Medical Oncology, University Hospital, Heraklion, Greece
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Gioulbasanis I, Giannousi Z, Saloustros E, Vamvakas L, Karambeazis A, Androulakis N, Kalbakis K, Kotsakis A, Kalykaki A, Vardakis N. Prognostic value of Mini Nutritional Assessment (MNA) score in elderly lung-cancer patients. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70109-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pallis AG, Agelaki S, Kakolyris S, Kotsakis A, Kalykaki A, Vardakis N, Papakotoulas P, Agelidou A, Geroyianni A, Agelidou M, Hatzidaki D, Mavroudis D, Georgoulias V. Chemotherapy-induced neutropenia as a prognostic factor in patients with advanced non-small cell lung cancer treated with front-line docetaxel-gemcitabine chemotherapy. Lung Cancer 2008; 62:356-63. [PMID: 18501466 DOI: 10.1016/j.lungcan.2008.03.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 03/26/2008] [Accepted: 03/29/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Front-line docetaxel-gemcitabine (DG) combination represents an alternative to platinum-based chemotherapy in patients with advanced NSCLC. One of its more common side effects is neutropenia. The association between the grade of DG-induced neutropenia and the clinical outcome was analyzed. PATIENTS AND METHODS Eight hundred fifty-eight patients with locally advanced/metastatic NSCLC, treated with front-line DG were retrospectively analyzed. Patients were categorized into three groups according to the presented worst neutropenia grade: absent (grade 0), mild (grades I/II) and severe (grades III/IV). RESULTS Response rate, median time to tumor progression (TTP) and median overall survival (OS) were significantly better in patients developing any grade of neutropenia compared with those without neutropenia. The median TTPs were 3.0, 5.4 and 5.6 months for the groups with absent, mild and severe neutropenia, respectively; the median OSs were 7.9, 12.5 and 11.2 months for the same groups, respectively. Multivariate analysis revealed that both mild and severe chemotherapy-induced neutropenia were independent factors associated with a better TTP and OS survival. CONCLUSION Although DG-induced neutropenia was emerged as an independent prognostic factor, it remains to be demonstrated in prospective studies that dose escalation of chemotherapy drugs in patients who do not develop neutropenia may improve the clinical efficacy.
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Affiliation(s)
- A G Pallis
- Department of Medical Oncology, University General Hospital of Heraklion, P.O. Box 1352, 71110 Heraklion, Crete, Greece
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Gioulbasanis I, Kalykaki A, Vamvakas L, Pallis A, Vardakis N, Saloustros E, Karampeazis A, Sfakiotaki G, Kalbakis K, Mavroudis D. Evaluation of mini nutritional assessment (MNA) in metastatic lung cancer patients: Correlation of laboratory values indicating malnutrition, inflammation, and cachexia with clinical data. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.19062] [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: 11/20/2022] Open
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18
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Kalykaki A, Vamvakas L, Agelaki S, Kalbakis K, Vardakis N, Sfakiotaki G, Ignatiadis M, Saridaki Z, Karampeazis A, Karabeazis A, Mavroudis D, Georgoulias V. A Dose Escalation Study of Gemcitabine plus Pemetrexed Administered Biweekly in Patients with Solid Tumors. Oncology 2007; 71:197-203. [PMID: 17641541 DOI: 10.1159/000106069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 09/28/2006] [Accepted: 04/28/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE The study aimed to determine the maximum tolerated doses (MTDs) and identify the dose-limiting toxicities of the biweekly administration of pemetrexed plus gemcitabine in patients with solid tumors. PATIENTS AND METHODS Patients with advanced malignancies were treated with escalated doses of gemcitabine and pemetrexed (starting doses 1,250 and 300 mg/m(2), respectively) both given on days 1 and 15 in cycles of 4 weeks. RESULTS Forty-one patients were treated at 7 dose levels. The MTD was reached at the dose of 1,750 mg/m(2) for gemcitabine and 450 mg/m(2) for pemetrexed. Dose-limiting events were grade IV neutropenia, febrile neutropenia and treatment delay due to grade III hematological toxicities. One partial response in a pretreated patient with ovarian cancer was observed, while 4 other patients experienced stable disease. CONCLUSIONS The biweekly administration of gemcitabine plus pemetrexed at the recommended MTDs is safe, well tolerated and demonstrates antitumor activity which merits further evaluation in phase II studies.
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Affiliation(s)
- A Kalykaki
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
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Kotsakis A, Kouroussis C, Androulakis N, Agelaki S, Kalbakis K, Vamvakas L, Vardakis N, Kalykaki A, Polyzos A, Georgoulias V, Mavroudis D. A dose-escalation study of pegylated liposomal Doxorubicin and oxaliplatin in patients with advanced solid tumors. Oncology 2007; 71:190-6. [PMID: 17641537 DOI: 10.1159/000106068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/15/2006] [Accepted: 04/28/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE A phase I study was conducted to determine the maximum tolerated doses (MTDs) and dose-limiting toxicities (DLTs) of the pegylated liposomal doxorubicin (PLD) and oxaliplatin combination in patients with advanced solid tumors. PATIENTS AND METHODS Forty-five patients with advanced-stage solid tumors received escalating doses of PLD 25-50 mg/m(2) as 60-min intravenous (i.v.) infusion and oxaliplatin 80-130 mg/m(2) as 2- to 4-hour i.v. infusion on day 1 every 3 weeks without growth factors. RESULTS MTD was defined at PLD 45 mg/m(2) and oxaliplatin 130 mg/m(2). Eleven dose levels were evaluated and DLTs were grade 2-3 neutropenia resulting in treatment delays, grade 3 neurotoxicity and nausea/vomiting. A total of 187 cycles were administered with two episodes of febrile neutropenia and one toxic death due to sepsis. Two (4%) and 6 (13%) patients developed grade 4 and 3 neutropenia, respectively, 2 (4%) and 1 (2%) grade 4 and 3 thrombocytopenia, and 1 (2%) grade 4 anemia. The most common nonhematological toxicities were grade 2-3 nausea/vomiting and asthenia observed in 27 (60%) and 16 (36%) of patients, respectively. One complete and eight partial responses were observed. CONCLUSION The combination of PLD and oxaliplatin has an acceptable toxicity profile with promising activity and merits further evaluation in phase II studies.
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Affiliation(s)
- A Kotsakis
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
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Karampeazis A, Vamvakas L, Agelidou A, Chandrinos V, Tsiafaki X, Christophylakis C, Chainis K, Kakolyris S, Kalykaki A, Mavroudis D. Docetaxel compared with vinorelbine in elderly patients with advanced non-small cell lung cancer (NSCLC): A randomized phase II Hellenic Oncology Research Group trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7615] [Citation(s) in RCA: 4] [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
7615 Background: To compare docetaxel versus vinorelbine as front-line treatment of elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods: Chemotherapy-naive patients >65 years, with stage histologically or cytologically documented IIIB/IV NSCLC and performance status (PS) 0–3 were randomly assigned to receive docetaxel 38 mg/m2 (days 1 and 8) or vinorelbine 25 mg/m2 (days 1 and 8) every 21 days. Treatment was continued for a maximum of six cycles and was interrupted in case of disease progression or unacceptable toxicity. Results: A total of 112 patients with median age of 76 years (range, 66–87) were enrolled onto the study. PS 2–3 had 39 (35%) patients. The two treatment groups were well balanced. There was no statistical difference between the 2 arms in median overall survival (6.27 months vs 3.97 months; p=0.129), in median time to progression (2.2 months vs 2 months; p=0.863.) and in overall response rate (5.3% vs 11.3%; p=0.247). Docetaxel conferred a statistically significant survival benefit compared to vinorelbine only in patients with PS 0–1 (11.4 months vs 4.3 months; p=0.009). Among patients treated with docetaxel there was a significant difference in median overall survival for patients with PS 0–1 compared with patients with PS 2–3 (11.4 months vs 2.5 months; p=0.004) while there was no statistical difference in the vinorelbine arm (4.3 months vs 2.8 months; p=0.970).The most common grade 3 and 4 toxicity was neutropenia (3.4% for docetaxel; 27.8% for vinorelbine; p=0.0001). Other toxicities were mild, well tolerated and similar for both groups with the exception of asthenia grade 2 (8.6% for docetaxel; 24.1% for vinorelbine; p=0.026). Conclusions: Docetaxel improves survival compared with vinorelbine in elderly patients with advanced non-small-cell lung cancer and good performance status without increasing toxicity. No significant financial relationships to disclose.
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Affiliation(s)
| | - L. Vamvakas
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - A. Agelidou
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - V. Chandrinos
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - X. Tsiafaki
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | | | - K. Chainis
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - S. Kakolyris
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - A. Kalykaki
- Hellenic Oncology Research Group (HORG), Athens, Greece
| | - D. Mavroudis
- Hellenic Oncology Research Group (HORG), Athens, Greece
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21
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Souglakos J, Kalbakis K, Vamvakas N, Kalykaki A, Kotsakis A, Agelaki S, Karampeazis A, Gioulbasanis J, Georgoulias V. Cetuximab plus bevacizumab in patients (pts) with metastatic colorectal cancer (mCRC) who have failed on irinotecan, oxaliplatin and fluoropyrimidines-based chemotherapy. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14576] [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: 11/20/2022] Open
Abstract
14576 Background: Bevacizumab (AVASTIN®) and Cetuximab (ERBITUX®) are IgG1 monoclonal antibodies targeting the Vascular Endothelial Growth Factor (VEGF) and Epidermal Growth Factor Receptor (EGFR), respectively. Both are active in mCRC pts as first and/or second line treatment. Preclinical data suggest potentially synergistic effect for the combination of the two antibodies. This phase II trial evaluates the safety and efficacy of cetuximab combined with Bevacizumab in the treatment of mCRC pts who have failed on Irinotecan, Oxaliplatin and Fluoropyrimidines-based chemotherapy. Methods: mCRC pts with ECOG PS = 2 who had refractory disease to all three active chemotherapeutic drugs were enrolled. Determination of EGFR status was not mandatory. Cetuximab was given at an initial dose of 400mg/m2, then 250mg/m2 iv weekly; Bevacizumab was administered at a dose of 10 mg/kg on d1 every 2 weeks. Results: From June 2005 to November 2006, 14 pts were enrolled. Median age was 65 years, and median PS was 1. Treatment was 3rd-line in 5 pts, and = 4th-line for 7 patients. 12 pts had received prior treatment with Cetuximab and 6 were Bevacizumab. Thirty-nine cycles were administered with a median of 3 cycles/patient. All pts were evaluable for toxicity and response. No grade 3–4 hematological toxicity was observed. Non-hematological toxicities included grade 3 fatigue (7.1%), grade 2 diarrhea (7.1%), grade 2 allergic reactions (14.1%). Amongst the 14 patients evaluable for response, there was 1 objective PR (7.1%; 95% CI: 6- 24%), and 2 (14.2%) SD (tumor growth control rate, TGCR: 21.3%). The median time to progression was 2.4 months and the median survival has not yet been reached. The estimated probability for 1-year survival was 65.7%. Conclusions: The combination of Cetuximab plus Bevacizumab in patients with mCRC refractory or resistant all active chemotherapeutic drugs is safe and has promising activity. No significant financial relationships to disclose.
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Affiliation(s)
- J. Souglakos
- University General Hospital of Herakion, Heraklion, Greece
| | - K. Kalbakis
- University General Hospital of Herakion, Heraklion, Greece
| | - N. Vamvakas
- University General Hospital of Herakion, Heraklion, Greece
| | - A. Kalykaki
- University General Hospital of Herakion, Heraklion, Greece
| | - A. Kotsakis
- University General Hospital of Herakion, Heraklion, Greece
| | - S. Agelaki
- University General Hospital of Herakion, Heraklion, Greece
| | - A. Karampeazis
- University General Hospital of Herakion, Heraklion, Greece
| | | | - V. Georgoulias
- University General Hospital of Herakion, Heraklion, Greece
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22
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Bozionelou V, Vamvakas L, Pappas P, Agelaki S, Androulakis N, Kalykaki A, Nikolaidou M, Kentepozidis N, Giassas S, Marselos M, Georgoulias V, Mavroudis D. A dose escalation and pharmacokinetic study of biweekly pegylated liposomal doxorubicin, paclitaxel and gemcitabine in patients with advanced solid tumours. Br J Cancer 2007; 97:43-9. [PMID: 17551496 PMCID: PMC2359662 DOI: 10.1038/sj.bjc.6603832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the maximum tolerated doses (MTDs) and dose-limiting toxicities (DLTs) of pegylated liposomal doxorubicin (PLD), paclitaxel (PCX) and gemcitabine (GEM) combination administered biweekly in patients with advanced solid tumours. Twenty-two patients with advanced-stage solid tumours were treated with escalated doses of PLD on day 1 and PCX plus GEM on day 2 (starting doses: 10, 100 and 800 mg m−2, respectively) every 2 weeks. DLTs and pharmacokinetic (PK) parameters of all drugs were determined during the first cycle of treatment. All but six (73%) patients had previously received at least one chemotherapy regimen. The DLT dose level was reached at PLD 12 mg m−2, PCX 110 mg m−2 and GEM 1000 mg m−2 with neutropaenia being the dose-limiting event. Of the 86 chemotherapy cycles delivered, grade 3 and 4 neutropaenia occurred in 20% with no cases of febrile neutropaenia. Non-haematological toxicities were mild. The recommended MTDs are PLD 12 mg m−2, PCX 100 mg m−2 and GEM 1000 mg m−2 administered every 2 weeks. The PK data revealed no obvious drug interactions. Biweekly administration of PLD, PCX and GEM is a well-tolerated chemotherapy regimen, which merits further evaluation in various types of solid tumours.
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Affiliation(s)
- V Bozionelou
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - L Vamvakas
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - P Pappas
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - S Agelaki
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - N Androulakis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - A Kalykaki
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - M Nikolaidou
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - N Kentepozidis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - S Giassas
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - M Marselos
- Department of Pharmacology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - V Georgoulias
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
| | - D Mavroudis
- Department of Medical Oncology, University General Hospital of Heraklion, Crete, Greece
- Department of Medical Oncology, University General Hospital of Heraklion, PO Box 1352, 711 10 Heraklion, Crete, Greece. E-mail:
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Apostolaki S, Perraki M, Pallis A, Bozionelou V, Agelaki S, Kanellou P, Kotsakis A, Politaki E, Kalbakis K, Kalykaki A, Vamvakas L, Georgoulias V, Mavroudis D. Circulating HER2 mRNA-positive cells in the peripheral blood of patients with stage I and II breast cancer after the administration of adjuvant chemotherapy: evaluation of their clinical relevance. Ann Oncol 2007; 18:851-8. [PMID: 17301075 DOI: 10.1093/annonc/mdl502] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic value of circulating tumor cells (CTCs) expressing HER2 messenger RNA (mRNA) after the administration of adjuvant chemotherapy in women with operable breast cancer. PATIENTS AND METHODS HER2 mRNA-positive CTCs were detected by nested RT-PCR in the peripheral blood of 214 patients with stage I and II breast cancer after the completion of adjuvant chemotherapy. RESULTS HER2 mRNA-positive CTCs were detected in 45 (21%) patients. Adjuvant chemotherapy could eliminate HER2 mRNA-positive CTCs in 16 (30.2%) prechemotherapy-positive patients. Moreover, HER2 mRNA-positive CTCs were detected in eight (5%) of 161 prechemotherapy-negative patients. The detection of HER2 mRNA-positive CTCs after chemotherapy was associated with reduced disease-free interval (DFI) (P = 0.006) but not with overall survival (P = 0.2); this effect was mainly observed in node-negative patients (P = 0.04) and to a lesser extent in node-positive (P = 0.06). Multivariate analysis revealed that the detection of HER2 mRNA-positive CTCs was an independent predictive factor for DFI (hazard ratio 3.238, P < 0.0005). CONCLUSIONS The detection of HER2 mRNA-positive CTCs after the completion of adjuvant chemotherapy may provide clinically useful information concerning the efficacy of treatment and the prognosis of patients with operable breast cancer.
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Affiliation(s)
- S Apostolaki
- Laboratory of Tumor Cell Biology, School of Medicine, University of Crete, Crete, Greece
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24
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Vamvakas L, Androulakis N, Syrigos K, Polyzos A, Ziras N, Athanasiadis A, Kakolyris S, Tsousis S, Kouroussis C, Kalykaki A, Samonis G, Mavroudis D, Georgoulias V, Souglakos J. O12 FOLFOXIRI versus FOLFIRI as first line treatment in metastatic colorectal cancer (MCC): a subgroup analysis for elderly patients of a multicenter randomized phase III trial from the Hellenic Oncology Research Group (HORG). Crit Rev Oncol Hematol 2006. [DOI: 10.1016/s1040-8428(13)70069-6] [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: 10/27/2022] Open
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25
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Souglakos J, Kalykaki A, Vamvakas L, Androulakis N, Kalbakis K, Agelaki S, Vardakis N, Tzardi M, Kotsakis AP, Gioulbasanis J, Tsetis D, Sfakiotaki G, Chatzidaki D, Mavroudis D, Georgoulias V. Phase II trial of capecitabine and oxaliplatin (CAPOX) plus cetuximab in patients with metastatic colorectal cancer who progressed after oxaliplatin-based chemotherapy. Ann Oncol 2006; 18:305-10. [PMID: 17079693 DOI: 10.1093/annonc/mdl392] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cetuximab is an IgG1 monoclonal antibody targeting the epidermal growth factor receptor and is able to reverse the resistance to irinotecan in patients with metastatic colorectal cancer (mCRC). This phase II trial evaluates the safety and efficacy of cetuximab combined with capecitabine and oxaliplatin (CAPOX) in the treatment of patients with mCRC progressing under oxaliplatin-based chemotherapy. PATIENTS AND TREATMENT Forty patients with mCRC were treated with cetuximab (loading dose 400 mg/m(2) and then 250 mg/m(2) i.v. weekly) in combination with CAPOX (d(1): L-OHP 85 mg/m(2) and d(1-7) capecitabine 2000 mg/m(2) every 2 weeks). Thirty-one (77.5%) and nine (22.5%) patients had oxaliplatin-refractory and -resistant disease, respectively; in addition, 32 (80%) patients had also progressed on prior irinotecan-based chemotherapy. RESULTS One hundred and thirty-four cycles were administered (median of four cycles per patient). Main toxic effects included grade 3-4 neutropenia (12.5%), grade 3/4 diarrhea (7.5%), grade 3 fatigue (2.5%), and grade 2-3 neurotoxicity (22.5%). One (2.5%) complete and seven (17.5%) partial responses were achieved [overall objective response rate (ORR): 20%; 95% confidence interval (CI): 9% to 32%)], whereas 11 (27.5%) patients had stable disease [disease control rate (DCR): 47.5%; 95% CI: 30.2% to 64.5%]. The ORR and DCR were 18.7% and 46.8%, respectively, in patients with oxaliplatin-refractory disease. The median time to tumor progression was 3 months, the median survival 10.7 months and the probability of 1-year survival rate 53.4%. CONCLUSIONS The combination of cetuximab plus CAPOX is safe and has a promising activity in patients with mCRC refractory or resistant to oxaliplatin.
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Affiliation(s)
- J Souglakos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Crete, Greece
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26
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Boukovinas I, Androulakis N, Vamvakas L, Papakotoulas P, Ziras N, Polyzos A, Kalykaki A, Kotsakis A, Xenidis N, Gioulmbasanis I, Mavroudis D, Georgoulias V. Sequential gemcitabine and cisplatin followed by docetaxel as first-line treatment of advanced urothelial carcinoma: a multicenter phase II study of the Hellenic Oncology Research Group. Ann Oncol 2006; 17:1687-92. [PMID: 16968872 DOI: 10.1093/annonc/mdl286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the toxicity and efficacy of the sequential administration of gemcitabine (GMB) in combination with cisplatin (CDDP) followed by docetaxel (Taxotere) as first-line treatment of advanced urothelial carcinoma. PATIENTS AND METHODS Patients [aged </=70 years and performance status (PS) (Eastern Cooperative Oncology Group) 0-2] with previously untreated locally advanced/recurrent or metastatic urothelial carcinoma were eligible. Study treatment consisted of GMB (1000 mg/m(2), days 1 and 8) and CDDP (70 mg/m(2), day 1) (GP regimen), every 21 days for a total of four cycles followed by docetaxel (D; 100 mg/m(2), day 1) every 21 days for four cycles. RESULTS Thirty-eight patients with a median age of 67 years were enrolled; 67% of them had PS 0 and 87% stage IV disease. Patients received a median of four GP and four D cycles per patient. Grade 3-4 neutropenia occurred in 27% and 63% patients with GP and D, respectively. Grade 3-4 thrombocytopenia occurred in 11% of patients, only with the GP regimen. Other toxic effects were mild. There was no toxic death. The objective response rate was 55.2% [95% CI: 39.45%-71.07%]. Five patients had complete response (13.15%) and 16 patients had partial response (42.1%), while nine patients had disease stabilization (23.7%) (intention-to-treat analysis). After a median follow-up period of 13 months (range 1.5-40.5 months), the median time to progression was 6.8 months (range 1-40.5 months), the median overall survival 13 months (range 1.5-40.5 months), and the 1-year survival rate 55.3%. CONCLUSION The sequential administration of GP followed by D is active and well tolerated as first-line treatment of advanced urothelial carcinoma and merits to be further evaluated.
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Affiliation(s)
- I Boukovinas
- Second Department of Medical Oncology, "Theagenion" Cancer Hospital of Thessaloniki, Thessaloniki, Greece.
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27
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Pallis AG, Christofillakis C, Tselepatiotis E, Agelaki S, Vamvakas L, Souglakos J, Vardakis N, Kalykaki A, Kotsakis A, Argiraki A, Mavroudis D, Georgoulias V. Sequential administration of docetaxel followed by maintenance gefitinib, as salvage treatment in patients with advanced NSCLC: a multicenter phase II trial. Lung Cancer 2006; 55:101-7. [PMID: 17049673 DOI: 10.1016/j.lungcan.2006.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 07/12/2006] [Revised: 08/30/2006] [Accepted: 08/31/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the activity and toxicity of the sequential administration of docetaxel followed by gefitinib in patients with advanced non-small cell lung cancer (NSCLC). PATIENTS AND TREATMENT Forty-one patients pre-treated with at least one prior chemotherapy regimen (platinum- or taxane-based) for advanced/metastatic NSCLC received three cycles of docetaxel 30 mg/m2, administered as a 1-h IV infusion, on days 1, 8 and 15 of each 4-week cycle followed by gefitinib 250 mg daily po. Gefitinib treatment was continued until disease progression, development of unacceptable toxicity, or withdrawal of patients consent. RESULTS Two (4.9%) patients achieved a partial response and 10 (24.4%) stable disease, for a disease control rate of 29.3% (95% CI: 15.3%-43.2%) while on weekly docetaxel treatment. Additionally, progressive disease (PD) was observed in 29 (70.7%). No objective responses were observed during the gefitinib maintenance therapy; however, 17 (41.5%) patients presented stable disease maintained for more than 2 months. Median time to progression was 3.0 months (range: 1-38.3 months; 95% CI: 2.4-3.6); median overall survival 6.9 months (range: 1.2-40.2 months; 95% CI: 5.34-8.52) while the 1-year survival was 28.8%. Therapy was generally well tolerated with diarrhea and rash being the most frequent toxicities. CONCLUSIONS The sequential administration of docetaxel and gefitinib was well tolerated and moderately active against advanced pre-treated NSCLC.
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Affiliation(s)
- A G Pallis
- Department of Medical Oncology, University General Hospital of Heraklion, P.O. Box 1352, 71110 Heraklion, Crete, Greece
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28
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Androulakis N, Boukovinas I, Bozionelou V, Kalykaki A, Potamianou A, Pallis A, Vamvakas L, Gkioulbasanis I, Souglakos I, Sfakiotaki G. Sequential administration of cisplatin (c), gemcitabine (g) and docetaxel (d), as first-line treatment in patients with advanced transitional cell carcinoma (TCC) of the urothelial tract: A multicenter phase II study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14574] [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
14574 Background: The GC combination has become a standard of care for advanced TCC. D has demonstrated broad single agent activity in many solid tumors including bladder cancer. We evaluated the safety and the activity of their sequential administration in patients (pts) with locally advanced or metastatic TCC who have not received prior chemotherapy. Methods: Chemotherapy-naïve pts with histologically proven locally advanced or metastatic TCC were enrolled. G 1100 mg/m2 was administered over 30-minutes IV on days 1 and 15, C 80 mg/m2 on day 1 with the adequate hydration and D 80 mg/m2 over 1 h on day 15. Results: From 4/2004–12/2005, 26 pts (25 male, 1 female), median age 65.5 years (range, 48–75), (PS 0/1/2: 16/8/2) were enrolled onto the study. The majority (19pts, 73.1%) had metastatic disease. A median of 4 cycles (range 1–9) was given for a total of 113 cycles. There were 12 delayed cycles due to toxicity and 15 dose reductions. Three (16.7%) complete responses (CRs) and 6 (33.3%) partial responses (PRs) [2 of them were converted to CR with additional surgery] were observed in 18 evaluable pts [overall RR of 50%; 95% CI 26.9%-3.1%]. The median time to progression was 7.9, and the months while median survival has not yet reached. The 1-year survival is 68.86%. Gr III-IV hematologic toxicity included neutropenia (61.5%), febrile neutropenia (11.5%), anemia (7.7%) and thrombocytopenia (7.6%). Non hematologic toxicity was mild (grade III vomiting and diarrhea in 7.7% and 3.8% of the pts, respectively). There was no neutropenic sepsis or toxic death. Conclusions: The sequential administration of cisplatin, gemcitabine and docetaxel is an active treatment for pts with advanced TCC. Toxicity is not manageable and this regimen warrants further investigation. No significant financial relationships to disclose.
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Affiliation(s)
- N. Androulakis
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
| | - I. Boukovinas
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
| | - V. Bozionelou
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
| | - A. Kalykaki
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
| | - A. Potamianou
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
| | - A. Pallis
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
| | - L. Vamvakas
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
| | | | - I. Souglakos
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
| | - G. Sfakiotaki
- Hellenic Oncology Cooperative Group (HORG), Heraklion, Greece
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Kalykaki A, Agelaki S, Kalbakis K, Kotsakis A, Kentepozidis N, Christophyllakis C, Giassas S, Vamvakas L, Vardakis N, Mavroudis D. Phase I study of gemcitabine (GEM) and premetrexed (ptx) in the treatment of advanced solid tumors. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.12025] [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
12025 Background: GEM has activity against a wide range of tumors and ptx is a multitargeted antifolate agent with activity in mesothelioma and non small lung cancer (NSCLC). A phase I study of a combination of GEM plus ptx for advanced malignancies was conducted. Methods: Patients with advanced malignancies were enrolled in this accelerated dose escalation trial. Both patients with or without prior chemotherapy were also eligible. They were treated with Gem followed by ptx on days 1 and 15 every 4 weeks. The starting dose was GEM 1250 mg/m2 and ptx 300 mg/m2. The dose of each drug was escalated alternately by 250 mg for GEM and 50 mg for ptx at each dose level. Results: A total of 41 patients (9 female/32 males) with median age of 60 years were enrolled at 6 dose levels. A total of 93 cycles were conducted with a median number of 2 cycles/pt. 35 patients were assessable for efficacy and all courses were assessable for toxicity. Grade 3/4 neutropenia was observed in 8 cycles whereas grade 3 /4 anemia and grade 3/4 thrombocytopenia in 3 and 2 cycles respectively. Grade 3 febrile neutropenia occurred in 1 cycle. Other ≥ grade 3 non-hematological toxicities were observed in only 3 cycles [grade 3/4 asthenia: in 2 cy; grade 3 edema: in 1 cy). The MTD was 1750 mg/m2 for GEM and 450 mg/m2 for ptx. Dose limiting toxicities were grade IV neutropenia, grade III thrombocytopenia and febrile neutropenia. Two partial responses (1 patient with ovarian cancer and 1 with NSCLC) were observed and stable disease in 4. Conclusions: The recommended doses for further phase II studies are GEM (1750 mg/m2) followed by ptx (450 mg/m2) biweekly. No significant financial relationships to disclose.
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Affiliation(s)
- A. Kalykaki
- University General Hospital, Heraklion, Greece
| | - S. Agelaki
- University General Hospital, Heraklion, Greece
| | - K. Kalbakis
- University General Hospital, Heraklion, Greece
| | - A. Kotsakis
- University General Hospital, Heraklion, Greece
| | | | | | - S. Giassas
- University General Hospital, Heraklion, Greece
| | - L. Vamvakas
- University General Hospital, Heraklion, Greece
| | - N. Vardakis
- University General Hospital, Heraklion, Greece
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30
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Makrantonakis P, Ziotopoulos P, Agelidou A, Polyzos A, Ziras A, Chandrinos V, Vossos A, Kalykaki A, Androulakis N, Geroyianni A, Georgoulias V. Vinorelbine and cisplatin combination in pretreated patients with advanced non-small cell lung cancer pretreated with a taxane-based regimen: a multicenter phase II study. Lung Cancer 2006; 53:85-90. [PMID: 16720058 DOI: 10.1016/j.lungcan.2006.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 06/20/2005] [Revised: 02/16/2006] [Accepted: 02/26/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the efficacy and tolerance of the vinorelbine/cisplatin combination in non-small cell lung cancer patients pre-treated with a taxane-based regimen. PATIENTS AND METHODS Among the 32 enrolled patients, 28 (87.5%) had a PS (WHO) of 0-1 and 13 (40.6%) have previously received both platinum compounds and taxanes. Vinorelbine (25 mg/m2 on days 1 and 8) was given by a rapid i.v. infusion and cisplatin (80 mg/m2 on day 8) after appropriate hydration. The treatment was repeated every 3 weeks. RESULTS A partial response was achieved in six patients (ORR=18.8%; 95% confidence interval: 5.23-32.27); 13 (44.8%) and 10 (34.5%) patients had stable and progressive disease, respectively (intention-to-treat analysis). Four partial responses were observed in patients who were previously treated with taxanes/platinum-containing regimens. The median time to tumor progression was 4.7 months (range, 1.3-15.4). After a median follow-up period of 6.3 months (range, 1.3-15.4) the median overall survival was 7.6 months and the 1-year survival rate 17.7%. Grade 3 and 4 granulocytopenia was observed in 11 (34.4%) patients and grade 4 thrombocytopenia in one (3.1%). Eleven (34.4%) patients presented grade 2 and 3 anemia. Febrile neutropenia occurred in one (3.1%) patient. Grade 3 and 4 nausea/vomiting was reported in one (9.3%) patient each and grade 2 fatigue in four (12.5%). CONCLUSIONS The combination of vinorelbine and cisplatin is an active and well tolerated salvage regimen in NSCLC patients pre-treated with taxane-based chemotherapy.
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Affiliation(s)
- P Makrantonakis
- Department of Medical Oncology, University General Hospital of Heraklion, PO Box 1352, 71100 Heraklion, Crete, Greece
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Souglakos J, Androulakis N, Syrigos K, Polyzos A, Ziras N, Athanasiadis A, Kakolyris S, Tsousis S, Kouroussis C, Vamvakas L, Kalykaki A, Samonis G, Mavroudis D, Georgoulias V. FOLFOXIRI (folinic acid, 5-fluorouracil, oxaliplatin and irinotecan) vs FOLFIRI (folinic acid, 5-fluorouracil and irinotecan) as first-line treatment in metastatic colorectal cancer (MCC): a multicentre randomised phase III trial from the Hellenic Oncology Research Group (HORG). Br J Cancer 2006; 94:798-805. [PMID: 16508637 PMCID: PMC2361370 DOI: 10.1038/sj.bjc.6603011] [Citation(s) in RCA: 266] [Impact Index Per Article: 14.8] [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: 10/05/2005] [Revised: 01/19/2006] [Accepted: 01/23/2006] [Indexed: 11/09/2022] Open
Abstract
To compare the efficacy and toxicity of oxaliplatin (L-OHP) in combination with irinotecan (CPT-11), 5-fluorouracil (5-FU) and leucovorin (LV) (FOLFOXIRI) vs irinotecan and 5-FU/LV (FOLFIRI) as first-line treatment of patients with metastatic colorectal cancer (MCC). A total of 283 chemotherapy-naïve patients with MCC were enrolled (FOLFIRI arm: n=146; FOLFOXIRI arm: n=137). In the FOLFOXIRI arm, CPT-11 (150 mg m(-2)) was given on d1, L-OHP (65 mg m(-2)) on d2, LV (200 mg m(-2)) on days 2 and 3 and 5-FU (400 mg m(-2) as i.v. bolus and 600 mg m(-2) as 22 h i.v. continuous infusion) on days 2 and 3. In the FOLFIRI arm, CPT-11 (180 mg m(-2)) was given on d1 whereas LV and 5-FU were administered in the same way as in the FOLFOXIRI regimen. Both regimens were administered every 2 weeks. There was no difference in terms of overall survival (median OS: 19.5 and 21.5 months, for FOLFIRI and FOLFOXIRI, respectively; P=0.337), median time to disease progression (FOLFIRI: 6.9 and FOLFOXIRI: 8.4 months; P=0.17), response rates (33.6 and 43% for FOLFIRI and FOLFOXIRI, respectively; P=0.168). Patients treated with FOLFOXIRI had a significantly higher incidence of alopecia (P=0.0001), diarrhoea (P=0.0001) and neurosensory toxicity (P=0.001) compared with patients treated with FOLFIRI. The present study failed to demonstrate any superiority of the FOLFOXIRI combination compared with the FOLFIRI regimen, although the observed median OS is one of the best ever reported in the literature.
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Affiliation(s)
- J Souglakos
- Department of Medical Oncology, University General Hospital of Heraklion, PO Box 1352, Heraklion, Crete 71110, Greece.
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Kouroussis C, Androulakis N, Vamvakas L, Kalykaki A, Spiridonakou S, Kentepozidis N, Saridaki Z, Xiropoulou E, Georgoulias V. Phase I study of weekly docetaxel and liposomal doxorubicin in patients with advanced solid tumors. Oncology 2005; 69:202-7. [PMID: 16127289 DOI: 10.1159/000087908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 01/14/2005] [Accepted: 04/17/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the maximum-tolerated doses (MTDs) and the dose-limiting toxicities (DLTs) of the weekly administration of docetaxel and pegylated liposomal doxorubicin (PEG-LD) in patients with advanced solid tumors. PATIENTS AND METHODS Forty-eight patients with solid tumors were enrolled in the study. Dose escalations of both drugs were given on a weekly basis for 3 consecutive weeks in cycles of 4 weeks. The starting dose for docetaxel was 20 mg/m(2)/week and for PEG-LD 6 mg/m(2)/week. RESULTS The MTD was 35 mg/m(2)/week for docetaxel and 14 mg/m(2)/week for PEG-LD. The DLTs at this level were grade 3 diarrhea (n=1 patient) and grade 3 mucositis (n=2 patients). There was no grade 4 hematologic or non-hematologic toxicity. Grade 3 neutropenia and thrombocytopenia occurred only in 1 and 2 patients, respectively. The non-hematologic toxicity was also mild with grade 2/3 fatigue in 8 patients, grade 2/3 neurotoxicity in 4, grade 2/3 mucositis in 8, grade 2/3 diarrhea in 4 and grade 2/3 nausea and vomiting in 5 patients. Two (5.7%) complete and 6 (17%) partial responses (overall response rate=22.7%; 95% confidence interval 9.6--32.4%) were observed among 35 evaluable patients. In 12 (63%) of 19 patients with hormone-refractory prostate cancer, a decline in serum levels of prostate-specific antigen of >50% was observed. CONCLUSIONS The weekly administration of docetaxel with PEG-LD is a well-tolerated regimen that merits further evaluation.
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Affiliation(s)
- Ch Kouroussis
- First Department of Medical Oncology, 'Theagenion' Anticancer Hospital, Thessaloniki, Greece
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Xenidis N, Mavroudis D, Kouroussis CH, Kalmanti L, Pallis A, Kanellou P, Sfakiotaki G, Perraki M, Apostolaki S, Kalykaki A, Georgoulias V. Effect of adjuvant tamoxifen and letrozol on the fate of peripheral blood CK-19 mRNA+ cells in patients with early breast cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.754] [Citation(s) in RCA: 3] [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)
- N. Xenidis
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | - D. Mavroudis
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | | | - L. Kalmanti
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | - A. Pallis
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | - P. Kanellou
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | - G. Sfakiotaki
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | - M. Perraki
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | - S. Apostolaki
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | - A. Kalykaki
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
| | - V. Georgoulias
- Dept of Medcl Oncology, Univ Gen Hosp, Heraklion, Greece
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Mavroudis D, Efstathiou E, Polyzos A, Athanasiadis A, Milaki G, Kastritis E, Kalykaki A, Saridaki Z, Dimopoulos A, Georgoulias V. A phase I-II trial of gefitinib in combination with vinorelbine and oxaliplatin as salvage therapy in women with advanced ovarian cancer (AOC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5020] [Citation(s) in RCA: 2] [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: 11/20/2022] Open
Affiliation(s)
- D. Mavroudis
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - E. Efstathiou
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - A. Polyzos
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - A. Athanasiadis
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - G. Milaki
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - E. Kastritis
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - A. Kalykaki
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - Z. Saridaki
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - A. Dimopoulos
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
| | - V. Georgoulias
- University General Hospital of Heraklion, Crete, Greece; Alexandras Hospital, Athens, Greece; Laikon Hospital, Athens, Greece; General Hospital, Larissa, Greece
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