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Ersek JL, Graff SL, Arena FP, Denduluri N, Kim ES. Critical Aspects of a Sustainable Clinical Research Program in the Community-Based Oncology Practice. Am Soc Clin Oncol Educ Book 2019; 39:176-184. [PMID: 31099620 DOI: 10.1200/edbk_238485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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]
Abstract
Increasing enrollment into clinical trials is a top priority across the field of oncology. Because the vast majority of those afflicted with cancer receive their care in the community, creating strong clinical research programs in the community-based setting is important. This article comprehensively outlines the most important elements of creating and sustaining a successful community-based research program. Establishing a clear mission and defining the scope of the research program in collaboration with key physicians and administrative leadership are critical to success. Standard operating procedures should detail operational processes. Ensuring sound financial planning and protected physician time are crucial for a healthy program. Providing mentorship opportunities to investigators and other team members will provide necessary guidance for junior investigators and long-term program stability. Prioritizing provider and patient volunteer engagement through education and awareness will potentially improve enrollment and research ownership. Incorporating administrative and clinical research staff and health care providers, including physicians, advanced practice providers, and pharmacists, will result in a multidisciplinary and unified approach and may also promote research as a routine part of patient care. Regular safety and scientific meetings will reduce regulatory complications and, most importantly, improve patient care. Other keys to a successful program include establishing a diverse trial portfolio, collaboration between different institutions, and ensuring appropriate technological infrastructure. Serial programmatic review provides opportunities to refine suboptimal practices and recognize successful strategies. Community-based research programs are critical to improve access to optimal cancer care. Implementation of successful programs is possible with a collaborative and multidisciplinary approach.
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Affiliation(s)
| | - Stephanie L Graff
- 2 Sarah Cannon Cancer Center at HCA Midwest Health, Overland Park, KS
| | - Francis P Arena
- 3 Department of Medicine, New York University Medical College, Lake Success, NY
| | | | - Edward S Kim
- 1 Levine Cancer Institute, Atrium Health, Charlotte, NC
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Schwartzberg LS, Arena FP, Bienvenu BJ, Kaplan EH, Camacho LH, Campos LT, Waymack JP, Tagliaferri MA, Chen MM, Li D. A Randomized, Open-Label, Safety and Exploratory Efficacy Study of Kanglaite Injection (KLTi) plus Gemcitabine versus Gemcitabine in Patients with Advanced Pancreatic Cancer. J Cancer 2017; 8:1872-1883. [PMID: 28819385 PMCID: PMC5556651 DOI: 10.7150/jca.15407] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/22/2017] [Indexed: 01/05/2023] Open
Abstract
Background: This study was designed to assess the safety and preliminary efficacy of KLTi plus gemcitabine in patients with locally advanced or metastatic pancreatic cancer. Methods: In a randomized, open-label study, patients with locally advanced or metastatic pancreatic cancer were randomized 2:1 to receive KLTi plus gemcitabine or gemcitabine monotherapy. Three sequential cohorts were tested at 30 g/day, 50 g/day, and 30 g/day. Gemcitabine was administered at 1000 mg/m2 on days 1, 8 and 15 of each 28 day cycle. KLTi was administered on days 1-5, 8-12, and 15-19 of each 28 day cycle. Patients received study treatment until disease progression. The primary endpoint was progression-free survival in the ITT population. Safety evaluation was based on patients who received any study treatment. ClinicalTrials.gov identifier NCT00733850. Results: Eighty-five patients were randomized including 41 (28:13) in Cohort 1, 18 (12:6) in Cohort 2, and 26 (17:9) in Cohort 3. Due to a different dose and/or shift in patient populations in Cohort 2 and 3, efficacy data for the 30 gm dose are presented in this manuscript for Cohort 1 alone, and for the combination of Cohort 1+3. The 30 gm KLTi + gemcitabine group had a statistically significant improvement in progression-free survival (PFS) as assessed by blinded independent radiology review in the ITT population, with a median of 112 days, versus 58 days in the gemcitabine group (HR 0.50; 95% CI: 0.27, 0.92), p = 0.0240. The incidence rates of TEAEs, CTCAE Grade 3 or higher TEAEs, and SAEs were similar between the two arms. There were no deaths related to KLTi + gemcitabine treatment. Conclusion: Kanglaite Injection (30 g/day) plus a standard regimen of gemcitabine demonstrated encouraging clinical evidence of anti-neoplastic activity and a well-tolerated safety profile.
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Verma U, Arriaga YE, Lenz HJ, Henderson CA, Fuloria J, Cartwright TH, Khojasteh A, Stella PJ, Saltzman M, Cohn AL, Philip PA, Kappeler C, Kalmus J, Grothey A, Van Cutsem E, Hochster HS, Arena FP. Regorafenib for previously treated metastatic colorectal cancer (mCRC): A subgroup analysis of 364 patients in the USA treated in the international, open-label phase IIIb CONSIGN study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.735] [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
735 Background: In the phase III CORRECT study, regorafenib significantly improved overall survival and progression-free survival (PFS) vs placebo in patients with treatment-refractory mCRC. CONSIGN (NCT01538680) was a large phase IIIb study that included 2872 patients from 25 countries; it was designed to provide continued access to regorafenib for patients with mCRC who failed standard therapy and to further characterize the safety of regorafenib. In CONSIGN, adverse events (AEs) and PFS were consistent with those reported in phase III studies. We present a retrospective subgroup analysis of patients enrolled in CONSIGN in the USA. Methods: Patients with mCRC who progressed on standard therapies and had an ECOG PS 0─1 received regorafenib 160 mg QD for the first 3 weeks of each 4-week cycle. Treatment was continued until disease progression, death, or unacceptable toxicity. The primary endpoint was safety. PFS (per investigator) was the only efficacy variable assessed. Results: A total of 364 patients in the USA were assigned to treatment (all evaluable for safety). The median age was 60 years; 38% and 62% had ECOG PS 0 and 1, respectively. KRAS mutation was present in 59%, KRAS wt in 38%; 74% had ≥ 3 prior regimens for metastatic disease. Median duration of treatment was 2.3 months (range: 0–30). Median PFS (95% CI) was 2.3 (2.0–2.6) months (2.1 months KRAS wt; 2.3 months KRAS mutant). NCI-CTCAE v4.0 grade ≥ 3 AEs occurred in 81% of patients and were considered drug-related in 53% (Table). Grade ≥ 3 hepatobiliary disorders occurred in 2%. Grade ≥ 3 treatment-emergent laboratory toxicities included bilirubin (9%), AST (6%), and ALT (3%). Conclusions: In patients from the USA enrolled in CONSIGN, the safety profile of regorafenib was consistent with that of the overall population and the known safety profile of regorafenib in mCRC. Median PFS was in the range of that reported in phase III trials. Clinical trial information: NCT01538680. [Table: see text]
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Affiliation(s)
- Udit Verma
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | - Ali Khojasteh
- Columbia Comprehensive Cancer Care Clinic, Columbia, MO
| | | | - Marc Saltzman
- Innovative Medical Research of South Florida, Aventura, FL
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Chiorean EG, Von Hoff DD, Reni M, Arena FP, Infante JR, Bathini VG, Wood TE, Mainwaring PN, Muldoon RT, Clingan PR, Kunzmann V, Ramanathan RK, Tabernero J, Goldstein D, McGovern D, Lu B, Ko A. CA19-9 decrease at 8 weeks as a predictor of overall survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer. Ann Oncol 2016; 27:654-60. [PMID: 26802160 PMCID: PMC4803454 DOI: 10.1093/annonc/mdw006] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/23/2015] [Indexed: 12/17/2022] Open
Abstract
Any CA19-9 decline at week 8 and radiologic response by week 8 each predicted longer OS in both treatment arms. In the nab-P + Gem arm, the higher proportion of patients with week 8 CA19-9 decrease [82% (206/252); median OS 13.2 months] than a RECIST-defined response [16% (40/252); median OS 13.7 months] suggests that CA19-9 decline is a predictor of OS applicable to a larger population. Background A phase I/II study and subsequent phase III study (MPACT) reported significant correlations between CA19-9 decreases and prolonged overall survival (OS) with nab-paclitaxel plus gemcitabine (nab-P + Gem) treatment for metastatic pancreatic cancer (MPC). CA19-9 changes at week 8 and potential associations with efficacy were investigated as part of an exploratory analysis in the MPACT trial. Patients and methods Untreated patients with MPC (N = 861) received nab-P + Gem or Gem alone. CA19-9 was evaluated at baseline and every 8 weeks. Results Patients with baseline and week-8 CA19-9 measurements were analyzed (nab-P + Gem: 252; Gem: 202). In an analysis pooling the treatments, patients with any CA19-9 decline (80%) versus those without (20%) had improved OS (median 11.1 versus 8.0 months; P = 0.005). In the nab-P + Gem arm, patients with (n = 206) versus without (n = 46) any CA19-9 decrease at week 8 had a confirmed overall response rate (ORR) of 40% versus 13%, and a median OS of 13.2 versus 8.3 months (P = 0.001), respectively. In the Gem-alone arm, patients with (n = 159) versus without (n = 43) CA19-9 decrease at week 8 had a confirmed ORR of 15% versus 5%, and a median OS of 9.4 versus 7.1 months (P = 0.404), respectively. In the nab-P + Gem and Gem-alone arms, by week 8, 16% (40/252) and 6% (13/202) of patients, respectively, had an unconfirmed radiologic response (median OS 13.7 and 14.7 months, respectively), and 79% and 84% of patients, respectively, had stable disease (SD) (median OS 11.1 and 9 months, respectively). Patients with SD and any CA19-9 decrease (158/199 and 133/170) had a median OS of 13.2 and 9.4 months, respectively. Conclusion This analysis demonstrated that, in patients with MPC, any CA19-9 decrease at week 8 can be an early marker for chemotherapy efficacy, including in those patients with SD. CA19-9 decrease identified more patients with survival benefit than radiologic response by week 8.
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Affiliation(s)
- E G Chiorean
- Department of Medicine/Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle
| | - D D Von Hoff
- HonorHealth and The Translational Genomics Research Institute (TGen), Scottsdale, USA
| | - M Reni
- Department of Radiation Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - F P Arena
- Department of Oncology, NYU Langone Arena Oncology, Lake Success
| | - J R Infante
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville
| | - V G Bathini
- Cancer Center of Excellence, University of Massachusetts Medical School, Worcester
| | - T E Wood
- UAB Comprehensive Cancer Center, Birmingham, USA
| | - P N Mainwaring
- Mater Private Centre for Haematology & Oncology, South Brisbane, Australia
| | - R T Muldoon
- Department of Oncology, Genesis Cancer Center, Hot Springs, USA
| | - P R Clingan
- Southern Medical Day Care Centre, Wollongong, Australia
| | - V Kunzmann
- Medizinische Klinik und Poliklinik II, University of Wuerzburg, Wuerzburg, Germany
| | - R K Ramanathan
- HonorHealth and The Translational Genomics Research Institute (TGen), Scottsdale, USA
| | - J Tabernero
- Medical of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Goldstein
- Department of Oncology, Prince of Wales Hospital, Sydney, Australia
| | | | - B Lu
- Celgene Corporation, Summit, USA
| | - A Ko
- Celgene Corporation, Summit, USA
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Yardley DA, Weaver R, Melisko ME, Saleh MN, Arena FP, Forero A, Cigler T, Stopeck A, Citrin D, Oliff I, Bechhold R, Loutfi R, Garcia AA, Cruickshank S, Crowley E, Green J, Hawthorne T, Yellin MJ, Davis TA, Vahdat LT. EMERGE: A Randomized Phase II Study of the Antibody-Drug Conjugate Glembatumumab Vedotin in Advanced Glycoprotein NMB-Expressing Breast Cancer. J Clin Oncol 2015; 33:1609-19. [PMID: 25847941 DOI: 10.1200/jco.2014.56.2959] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Glycoprotein NMB (gpNMB), a negative prognostic marker, is overexpressed in multiple tumor types. Glembatumumab vedotin is a gpNMB-specific monoclonal antibody conjugated to the potent cytotoxin monomethyl auristatin E. This phase II study investigated the activity of glembatumumab vedotin in advanced breast cancer by gpNMB expression. PATIENTS AND METHODS Patients (n = 124) with refractory breast cancer that expressed gpNMB in ≥ 5% of epithelial or stromal cells by central immunohistochemistry were stratified by gpNMB expression (tumor, low stromal intensity, high stromal intensity) and were randomly assigned 2:1 to glembatumumab vedotin (n = 83) or investigator's choice (IC) chemotherapy (n = 41). The study was powered to detect overall objective response rate (ORR) in the glembatumumab vedotin arm between 10% (null) and 22.5% (alternative hypothesis) with preplanned investigation of activity by gpNMB distribution and/or intensity (Stratum 1 to Stratum 3). RESULTS Glembatumumab vedotin was well tolerated as compared with IC chemotherapy (less hematologic toxicity; more rash, pruritus, neuropathy, and alopecia). ORR was 6% (five of 83) for glembatumumab vedotin versus 7% (three of 41) for IC, without significant intertreatment differences for predefined strata. Secondary end point revealed ORR of 12% (10 of 83) versus 12% (five of 41) overall, and 30% (seven of 23) versus 9% (one of 11) for gpNMB overexpression (≥ 25% of tumor cells). Unplanned analysis showed ORR of 18% (five of 28) versus 0% (0 of 11) in patients with triple-negative breast cancer (TNBC), and 40% (four of 10) versus 0% (zero of six) in gpNMB-overexpressing TNBC. CONCLUSION Glembatumumab vedotin is well tolerated in heavily pretreated patients with breast cancer. Although the primary end point in advanced gpNMB-expressing breast cancer was not met for all enrolled patients (median tumor gpNMB expression, 5%), activity may be enhanced in patients with gpNMB-overexpressing tumors and/or TNBC. A pivotal phase II trial (METRIC [Metastatic Triple-Negative Breast Cancer]) is underway.
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Affiliation(s)
- Denise A Yardley
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Robert Weaver
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Michelle E Melisko
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Mansoor N Saleh
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Francis P Arena
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Andres Forero
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Tessa Cigler
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Alison Stopeck
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Dennis Citrin
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Ira Oliff
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Rebecca Bechhold
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Randa Loutfi
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Agustin A Garcia
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Scott Cruickshank
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Elizabeth Crowley
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Jennifer Green
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Thomas Hawthorne
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Michael J Yellin
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Thomas A Davis
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Linda T Vahdat
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ.
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6
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Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, Seay T, Tjulandin SA, Ma WW, Saleh MN, Harris M, Reni M, Dowden S, Laheru D, Bahary N, Ramanathan RK, Tabernero J, Hidalgo M, Goldstein D, Van Cutsem E, Wei X, Iglesias J, Renschler MF. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 2013; 369:1691-703. [PMID: 24131140 PMCID: PMC4631139 DOI: 10.1056/nejmoa1304369] [Citation(s) in RCA: 4368] [Impact Index Per Article: 397.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In a phase 1-2 trial of albumin-bound paclitaxel (nab-paclitaxel) plus gemcitabine, substantial clinical activity was noted in patients with advanced pancreatic cancer. We conducted a phase 3 study of the efficacy and safety of the combination versus gemcitabine monotherapy in patients with metastatic pancreatic cancer. METHODS We randomly assigned patients with a Karnofsky performance-status score of 70 or more (on a scale from 0 to 100, with higher scores indicating better performance status) to nab-paclitaxel (125 mg per square meter of body-surface area) followed by gemcitabine (1000 mg per square meter) on days 1, 8, and 15 every 4 weeks or gemcitabine monotherapy (1000 mg per square meter) weekly for 7 of 8 weeks (cycle 1) and then on days 1, 8, and 15 every 4 weeks (cycle 2 and subsequent cycles). Patients received the study treatment until disease progression. The primary end point was overall survival; secondary end points were progression-free survival and overall response rate. RESULTS A total of 861 patients were randomly assigned to nab-paclitaxel plus gemcitabine (431 patients) or gemcitabine (430). The median overall survival was 8.5 months in the nab-paclitaxel-gemcitabine group as compared with 6.7 months in the gemcitabine group (hazard ratio for death, 0.72; 95% confidence interval [CI], 0.62 to 0.83; P<0.001). The survival rate was 35% in the nab-paclitaxel-gemcitabine group versus 22% in the gemcitabine group at 1 year, and 9% versus 4% at 2 years. The median progression-free survival was 5.5 months in the nab-paclitaxel-gemcitabine group, as compared with 3.7 months in the gemcitabine group (hazard ratio for disease progression or death, 0.69; 95% CI, 0.58 to 0.82; P<0.001); the response rate according to independent review was 23% versus 7% in the two groups (P<0.001). The most common adverse events of grade 3 or higher were neutropenia (38% in the nab-paclitaxel-gemcitabine group vs. 27% in the gemcitabine group), fatigue (17% vs. 7%), and neuropathy (17% vs. 1%). Febrile neutropenia occurred in 3% versus 1% of the patients in the two groups. In the nab-paclitaxel-gemcitabine group, neuropathy of grade 3 or higher improved to grade 1 or lower in a median of 29 days. CONCLUSIONS In patients with metastatic pancreatic adenocarcinoma, nab-paclitaxel plus gemcitabine significantly improved overall survival, progression-free survival, and response rate, but rates of peripheral neuropathy and myelosuppression were increased. (Funded by Celgene; ClinicalTrials.gov number, NCT00844649.).
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Affiliation(s)
- Daniel D Von Hoff
- From the Translational Genomics Research Institute, Phoenix, and Virginia G. Piper Cancer Center, Scottsdale - both in Arizona (D.D.V.H., R.K.R.); Cancer Specialists, Fort Myers, FL (T.E.); Arena Oncology Associates, Lake Success (F.P.A.), and Roswell Park Cancer Institute, Buffalo (W.W.M.) - both in New York; University of Washington, Seattle (E.G.C.); Sarah Cannon Research Institute-Tennessee Oncology, Nashville (J. Infante); Princess Margaret Hospital, Toronto (M.M.); Atlanta Cancer Care (T.S.) and Georgia Cancer Specialists (M.N.S.) - both in Atlanta; Blokhin Cancer Research Center, Moscow (S.A.T.); Southern Health, East Bentleigh, VIC (M.H.), Prince of Wales Hospital, Sydney (D.G.), and Bionomics, Thebarton, SA (J. Iglesias) - all in Australia; San Raffaele Scientific Institute, Milan (M.R.); Tom Baker Cancer Centre, Calgary, AB, Canada (S.D.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (D.L.); University of Pittsburgh Medical Center, Pittsburgh (N.B.); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (J.T.); Centro Integral Oncológico Clara Campal, Madrid (M.H.); University Hospitals Leuven and Katholieke Universiteit Leuven, Leuven, Belgium (E.V.C.); and Celgene, Summit, NJ (X.W., M.F.R.)
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7
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Yardley DA, Noguchi S, Pritchard KI, Burris HA, Baselga J, Gnant M, Hortobagyi GN, Campone M, Pistilli B, Piccart M, Melichar B, Petrakova K, Arena FP, Erdkamp F, Harb WA, Feng W, Cahana A, Taran T, Lebwohl D, Rugo HS. Everolimus plus exemestane in postmenopausal patients with HR(+) breast cancer: BOLERO-2 final progression-free survival analysis. Adv Ther 2013; 30:870-84. [PMID: 24158787 PMCID: PMC3898123 DOI: 10.1007/s12325-013-0060-1] [Citation(s) in RCA: 364] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Indexed: 02/07/2023]
Abstract
Introduction Effective treatments for hormone-receptor-positive (HR+) breast cancer (BC) following relapse/progression on nonsteroidal aromatase inhibitor (NSAI) therapy are needed. Initial Breast Cancer Trials of OraL EveROlimus-2 (BOLERO-2) trial data demonstrated that everolimus and exemestane significantly prolonged progression-free survival (PFS) versus placebo plus exemestane alone in this patient population. Methods BOLERO-2 is a phase 3, double-blind, randomized, international trial comparing everolimus (10 mg/day) plus exemestane (25 mg/day) versus placebo plus exemestane in postmenopausal women with HR+ advanced BC with recurrence/progression during or after NSAIs. The primary endpoint was PFS by local investigator review, and was confirmed by independent central radiology review. Overall survival, response rate, and clinical benefit rate were secondary endpoints. Results Final study results with median 18-month follow-up show that median PFS remained significantly longer with everolimus plus exemestane versus placebo plus exemestane [investigator review: 7.8 versus 3.2 months, respectively; hazard ratio = 0.45 (95% confidence interval 0.38–0.54); log-rank P < 0.0001; central review: 11.0 versus 4.1 months, respectively; hazard ratio = 0.38 (95% confidence interval 0.31–0.48); log-rank P < 0.0001] in the overall population and in all prospectively defined subgroups, including patients with visceral metastases, patients with recurrence during or within 12 months of completion of adjuvant therapy, and irrespective of age. The incidence and severity of adverse events were consistent with those reported at the interim analysis and in other everolimus trials. Conclusion The addition of everolimus to exemestane markedly prolonged PFS in patients with HR+ advanced BC with disease recurrence/progression following prior NSAIs. These results further support the use of everolimus plus exemestane in this patient population. ClinicalTrials.gov #NCT00863655. Electronic supplementary material The online version of this article (doi:10.1007/s12325-013-0060-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN, 37203, USA,
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8
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Yardley DA, Campone M, Lebrun F, Noguchi S, Pritchard KI, Burris HA, Beck JT, Ito Y, Bachelot T, Pistilli B, Melichar B, Petrakova K, Arena FP, Erdkamp F, Harb WA, Litton JK, Brechenmacher T, El-Hashimy M, Taran T, Gnant M. Characterization of patients who received prior chemotherapy for advanced breast cancer (ABC) in BOLERO-2. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.26_suppl.151] [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
151 Background: In patients with hormone receptor–positive (HR+) breast cancer, endocrine therapy is the standard of care both in the adjuvant setting and as front-line therapy for ABC. Chemotherapy (CT) is commonly used for HR+ ABC patients if disease burden is high and rapid symptom control is required (Barrios CH. GAMO. 2010). In the phase III BOLERO-2 study (NCT00863655), first-line of prior CT in the ABC setting was allowed. This subset analysis examined disease characteristics and the efficacy of everolimus (EVE) + exemestane (EXE) in patients who received CT for ABC prior to BOLERO-2 study entry. Methods: In BOLERO-2, 724 patients with HR+, human epidermal growth factor receptor 2–negative (HER2–) ABC whose disease recurred or progressed during/after a nonsteroidal aromatase inhibitor were randomized 2:1 to EVE (10 mg/d) + EXE (25 mg/d) or placebo (PBO) + EXE. The primary endpoint was progression-free survival (PFS) by local investigator review (confirmed by blinded independent central review). Results: A total of 186 patients (26%) received prior CT for ABC (125 in the EVE + EXE group and 61 in PBO + EXE). In this subset, 54% (67 of 125) of EVE+ EXE patients received prior CT in the advanced setting only while 46% (58 of 125) of EVE + EXE patients received prior CT in both the neoadjuvant/adjuvant and advanced settings. Visceral metastases (67% vs. 56%), multiple metastases (79% vs. 66%), and ≥ 4 metastatic sites (18% vs. 15%) were more frequent in ABC patients with prior CT for ABC at study entry compared with those with no prior CT for ABC. History of disease recurrence <6 months from initial diagnosis was recorded in 32% (n = 60) of prior CT patients versus 17% (n = 93) of patients with no prior CT. Median PFS (by local assessment) in patients who received prior CT for ABC was substantially longer with EVE + EXE versus PBO + EXE (6.1 vs. 2.7 mo; hazard ratio = 0.38; 95% CI, 0.27-0.53). PFS by central review showed similar results (7.1 vs. 2.8 mo, respectively; hazard ratio = 0.42; 95% CI, 0.27-0.65). Conclusions: These results demonstrate that patients with HR+, HER2 ABC who received previous CT in the advanced setting had a higher tumor burden but derived significant and clinically meaningful benefit from combination therapy with EVE + EXE. Clinical trial information: NCT00863655.
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Affiliation(s)
| | - Mario Campone
- Institut de Cancérologie de l'Ouest/René Gauducheau, Saint-Herblain, France
| | | | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University, Osaka, Japan
| | | | | | | | - Yoshinori Ito
- Cancer Institute Hospital, Japanese Foundation for Cancer Research Breast Medical Oncology, Breast Oncology Center, Tokyo, Japan
| | | | | | - Bohuslav Melichar
- Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | | | | | | | | | | | | | | | | | - Michael Gnant
- Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria
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9
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Campone M, Lebrun F, Noguchi S, Pritchard KI, Burris HA, Beck JT, Ito Y, Yardley DA, Bachelot TD, Pistilli B, Melichar B, Petrakova K, Arena FP, Erdkamp F, Harb WA, Litton JK, Panneerselvam A, El-Hashimy M, Taran T, Gnant M. Characterization of patients who received prior chemotherapy for advanced breast cancer (ABC) in BOLERO-2. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.557] [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
557 Background: In patients with hormone-receptor–positive (HR+) breast cancer, endocrine therapy is the standard of care both in the adjuvant setting and as first-line treatment for ABC. For selected HR+ patients with ABC, chemotherapy (CT) may be utilized if disease burden is high and rapid symptom control is required (Barrios CH. GAMO.2010). In the phase 3 BOLERO-2 study (NCT00863655), 1 line of prior CT in the ABC setting was allowed. This subset analysis examined disease characteristics and the efficacy of everolimus (EVE) plus exemestane (EXE) in patients who received CT for ABC prior to BOLERO-2 study entry. Methods: In BOLERO-2, 724 patients with HR+, human epidermal growth factor receptor-2–negative (HER2–) ABC whose disease recurred or progressed during/after a nonsteroidal aromatase inhibitor were randomized 2:1 to EVE (10 mg/d) + EXE (25 mg/d) or placebo (PBO) + EXE. The primary endpoint was progression-free survival (PFS) by local investigator review and confirmed by blinded independent central review. Results: A subset of 186 patients (26%) received prior CT for ABC: 125 in the EVE + EXE group and 61 in PBO + EXE. In this subset, 54% (67 of 186) of patients received prior CT only in the advanced setting and 46% (58 of 186) of patients received prior CT in both the neoadjuvant/adjuvant and advanced settings. Incidences of visceral metastases (67% vs 56%), multiple metastases (79% vs 66%), and ≥ 4 metastatic sites (18.3% vs 15%) were higher in ABC patients with prior CT for ABC at study entry versus those with no prior CT for ABC. Disease recurrence < 6 months from initial diagnosis was recorded in 32.2% (n = 60) of prior CT patients versus 17.3% (n = 93) of patients with no prior CT. Median PFS (by local assessment) in patients who received prior CT for ABC was substantially longer with EVE + EXE versus PBO + EXE (6.1 vs 2.7 mo; HR = 0.38; 95% CI, 0.27-0.53). PFS by central review showed similar results (7.1 vs 2.8 mo, respectively; HR = 0.42; 95% CI, 0.27-0.65). Conclusions: These results demonstrate that patients with HR+, HER2– ABC who received previous CT in the advanced setting had a higher tumor burden and derived clinically significant benefit from combination treatment with EVE + EXE. Clinical trial information: NCT00863655.
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Affiliation(s)
- Mario Campone
- CLCC René Gauducheau, Centre de Recherche en Cancerologie, Nantes Saint Herblain, France
| | | | - Shinzaburo Noguchi
- Department of Breast and Endocrine Surgery, Osaka University, Osaka, Japan
| | - Kathleen I. Pritchard
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | | | | | - Yoshinori Ito
- Cancer Institute Hospital, Japanese Foundation for Cancer Research Breast Medical Oncology, Breast Oncology Center, Tokyo, Japan
| | | | | | | | - Bohuslav Melichar
- Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | | | | | | | | | | | | | | | - Tanya Taran
- Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Perez AT, Rugo HS, Baselga J, Hart L, Pritchard KI, Arena FP, Eakle JF, Geberth M, Hortobagyi GN, Csõszi T, Gnant M, Chouinard EE, Noguchi S, Srimuninnimit V, Puttawibul P, Heng DYC, Panneerselvam A, Taran T, Sahmoud T, Burris HA. Clinical management and resolution of stomatitis in BOLERO-2. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.558] [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
558 Background: In BOLERO-2, adding everolimus (EVE) to exemestane (EXE) more than doubled progression-free survival without affecting quality of life vs EXE alone in postmenopausal women with hormone-receptor–positive advanced breast cancer who had recurrence or progression on/after nonsteroidal aromatase inhibitor therapy. Although mTOR inhibitors are generally well tolerated, stomatitis is one of their most clinically relevant and potentially dose-limiting toxicities (Sonis Cancer2010). The incidence, grade, and clinical course of stomatitis among patients (pts) participating in the BOLERO-2 study are described. Methods: Pts were randomized 2:1 to receive EVE+EXE or placebo (PBO)+EXE. Stomatitis incidence, severity, consequent dose interruptions/adjustments, study drug discontinuations, and time to resolution were recorded. Results: The median duration of EVE+EXE treatment exposure was 30 wk (range, 1-123 wk). Stomatitis (any grade) occurred more frequently with EVE+EXE than with PBO+EXE (59% vs 12%, respectively). Grade 3 stomatitis occurred in 8% vs 1% of pts receiving EVE+EXE vs PBO+EXE, respectively; no grade 4 was reported. Onset of grade ≥2 stomatitis after treatment initiation was earlier in the EVE+EXE arm vs the PBO+EXE arm: median time was 15d vs 24d, respectively. In the EVE+EXE arm, 97% of pts with grade 3 stomatitis (n=38) improved to ≤1 after a median of 13 d. Complete resolution was observed in 82% of these pts after a median of 38 d. In the PBO+EXE arm, all pts with grade 3 stomatitis (n=2) improved to ≤1 after a median of 18 d. Complete resolution was observed after a median of 29 d. Overall, 24% of pts in the EVE+EXE arm required dose interruptions/adjustments vs 1% of pts in the PBO+EXE arm, and 3% of pts (n=13) discontinued EVE+EXE vs <1% of pts (n=1) discontinuing PBO+EXE, all related to stomatitis. Conclusions: The BOLERO-2 data foster a new era of combining targeted and endocrine therapies. In the study, treatment-emergent stomatitis was of mild to moderate intensity, occurred shortly after treatment initiation, and was generally reversible. Most incidents were successfully managed with palliative interventions and temporary dose modifications. Oral hygiene and other preventive measures are recommended. Clinical trial information: NCT00863655.
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Affiliation(s)
| | - Hope S. Rugo
- University of California, San Francisco, San Francisco, CA
| | - José Baselga
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | - Kathleen I. Pritchard
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | | | - J F Eakle
- Florida Cancer Specialists, Fort Myers, FL
| | - M Geberth
- SPGO-Mannheim, Schwerupunktpraxis fuer Gynaekologische Onkologie, Mannheim, Germany
| | | | - Tibor Csõszi
- Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelointezet, Szolnok, Hungary
| | - Michael Gnant
- Comprehensive Cancer Center, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Puttisak Puttawibul
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | | | | | | | - Tarek Sahmoud
- Global Oncology Development, Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | - Howard A. Burris
- Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN
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Chiorean EG, Von Hoff DD, Ervin TJ, Arena FP, Infante JR, Bathini VG, Wood TE, Mainwaring PN, Muldoon RT, Clingan PR, Kunzmann V, Ramanathan RK, Tabernero J, Goldstein D, Ko A, Lu B. CA19-9 decrease at 8 weeks as a predictor of overall survival (OS) in a randomized phase III trial (MPACT) of weekly nab-paclitaxel (nab-P) plus gemcitabine (G) versus G alone in patients with metastatic pancreatic cancer (MPC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4058^ Background: nab-P + G showed promising efficacy in a phase I/II study in MPC, and decreases in CA19-9 correlated with OS. In MPACT, patients (pts) who received nab-P + G vs G had improved median OS (8.5 vs 6.7 mo; HR 0.72; p = 0.000015), PFS (5.5 vs 3.7 mo; HR 0.69; p = 0.000024) and ORR (23% vs 7%; p = 1.1 × 10−10). Here we present a prespecified exploratory analysis of CA19-9 from the MPACT trial. Methods: 861 previously untreated pts with MPC were randomized 1:1 to receive nab-P 125 mg/m2 + G 1000 mg/m2 days 1, 8, and 15 every 4 weeks or G alone 1000 mg/m2 weekly for 7 weeks followed by a week of rest (cycle 1) and then days 1, 8, and 15 every 4 weeks (cycle ≥ 2). CA19-9 was evaluated at baseline and then every 8 weeks. OS comparisons at different CA19-9 criteria were performed by stratified Cox proportional hazards model (P by stratified log-rank test using randomization criteria). Results: 750 pts had an evaluable CA19-9 at baseline. More pts in the nab-P + G arm vs the G arm demonstrated a best CA19-9 decrease from baseline of ≥ 20% and ≥ 90% (61% vs 44% and 31% vs 14%, respectively; Table). At the first postbaseline assessment (week 8), greater proportions of pts in the nab-P + G arm vs the G arm had CA19-9 decreases of ≥ 20% and ≥ 90% (Table). At that time point, for pts with a decrease of ≥ 20% in CA19-9, nab-P + G demonstrated a significantly longer OS vs G. The risk reduction for pts with a ≥ 90% decrease was greater than in pts with a ≥ 20% decrease. In pts with an 8-week CA19-9 decrease < 20%, median OS for nab-P + G vs G was 8.3 vs 8.0 mo (HR 0.92; p = 0.705). The relationship of CA19-9 kinetics with OS will also be examined. Conclusions: Higher proportions of pts in the nab-P + G arm had CA 19-9 responses of ≥ 20% and ≥ 90% vs the G arm. Pts who achieved a CA19-9 decrease at 8 weeks of ≥ 20% or ≥ 90% had significantly longer OS with nab-P + G than with G. Clinical trial information: NCT00844649. [Table: see text]
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Affiliation(s)
| | - Daniel D. Von Hoff
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale, AZ
| | | | | | | | - Venu Gopal Bathini
- Cancer Center of Excellence, University of Massachusetts Medical School, Worcester, MA
| | | | - Paul N. Mainwaring
- Mater Private Centre for Haematology & Oncology, South Brisbane, Australia
| | | | | | - Volker Kunzmann
- Medizinische Klinik und Poliklinik II, University of Wuerzburg, Würzburg, Germany
| | - Ramesh K. Ramanathan
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale, AZ
| | | | | | - Amy Ko
- Celgene Corporation, Summit, NJ
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12
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O'Regan R, Ozguroglu M, Andre F, Toi M, Jerusalem GHM, Wilks S, Isaacs C, Xu B, Masuda N, Arena FP, Yardley DA, Yap YS, Mukhopadhyay P, Douma S, El-Hashimy M, Taran T, Sahmoud T, Lebwohl DE, Gianni L. Phase III, randomized, double-blind, placebo-controlled multicenter trial of daily everolimus plus weekly trastuzumab and vinorelbine in trastuzumab-resistant, advanced breast cancer (BOLERO-3). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.505] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
505 Background: Everolimus (EVE) is an inhibitor of mammalian target of rapamycin (mTOR), a protein kinase central to a number of signaling pathways regulating cell growth and proliferation. Data from preclinical and phase 1/2 clinical studies indicated that adding EVE to trastuzumab (TRAS) plus chemotherapy may restore sensitivity to and enhance efficacy of human epidermal growth factor receptor 2 (HER2)-targeted therapy. The international BOLERO-3 phase 3 study is being conducted to evaluate the addition of EVE to TRAS plus vinorelbine. Methods: Adult women with HER2+ advanced breast cancer and who received prior taxane therapy and experienced recurrence or progression on TRAS were randomized 1:1 to receive either EVE or placebo (5 mg/day) in combination with weekly TRAS and vinorelbine (25 mg/m2). The primary endpoint is progression-free survival (PFS). Secondary endpoints included overall survival, response rate, clinical benefit rate, safety, quality of life, and pharmacokinetics. Final analysis will be conducted after approximately 417 PFS events. Results: The trial accrued 569 patients between October 2009 and May 2012. Previous therapy included TRAS (100%), a taxane (100%), and lapatinib (28%). The median age was 54 years, and 76% of patients had visceral metastases, 5% had stable brain metastases, 56% had hormone-receptor–positive disease, 33% had Eastern Cooperative Oncology Group performance status of 1 or 2, and 41% had 3 or more metastatic sites. The median number of prior chemotherapy lines in the metastatic setting was 1. As of February 4, 2013, a total of 396 PFS events were reported. Conclusions: Final PFS analysis will be performed in early May 2013; primary and secondary efficacy endpoints will be presented. Clinical trial information: NCT01007942.
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Affiliation(s)
- Ruth O'Regan
- Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | | | | | - Masakazu Toi
- Graduate School of Medicine Kyoto University, Kyoto, Japan
| | | | - Sharon Wilks
- Cancer Care Centers of South Texas, San Antonio, TX
| | | | - Binghe Xu
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | | | | | - Yoon Sim Yap
- National Cancer Centre Singapore, Singapore, Singapore
| | | | | | | | | | - Tarek Sahmoud
- Global Oncology Development, Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | | | - Luca Gianni
- San Raffaele Scientific Institute, Milan, Italy
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13
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Moore MJ, Von Hoff DD, Ervin TJ, Arena FP, Chiorean EG, Infante JR, Hon JK, Biakhov MY, Hingorani SR, Ganju V, Weekes CD, Scheithauer W, Ramanathan RK, Tabernero J, Goldstein D, Wei X, Romano A. Prognostic factors (PFs) of survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel ( nab-P) plus gemcitabine (G) versus G alone in patients (pts) with metastatic pancreatic cancer (MPC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4059^ Background: In MPACT, pts who received nab-P + G vs G had improved overall survival (OS; median 8.5 vs 6.7 mo; HR 0.72; p= 0.000015). Here we assessed potential PFs of OS. Methods: 861 pts with MPC were randomized 1:1, stratified by region, presence of liver metastases, and Karnofsky performance status (KPS), to nab-P + G or G. OS was described in subgroups. A step-wise multivariate analysis (with significance level for entry of 0.20 and for stay of 0.10) was performed to evaluate the treatment effect and identify possible predictors of OS. Results: Pts with poorer PFs had a shorter median OS, consistent with the literature, and OS consistently favored nab-P + G in pts with these PFs (Table). Region of Eastern Europe, age ≥ 65 years, poorer KPS, presence of liver metastases, and number of metastatic sites all predicted OS (increased risk of death). The treatment effect remained significant (HR 0.72; 95% CI, 0.605 - 0.849; p < 0.0001, Cox proportional hazards [CPH] model). In another multivariate analysis in which baseline CA19-9 was added to the final model described above, the treatment effect HR was 0.67 (95% CI, 0.573 - 0.794; p < 0.0001, CPH model). Baseline CA19-9, a predictor of OS by univariate analysis, was not predictive after correction for the above factors. Conclusions: In MPACT, the most important predictors of OS were KPS, age, presence of liver metastases, number of metastatic sites, and region. After correcting for these factors, assignment to nab-P + G was an independent significant predictor of improved survival. Clinical trial information: NCT00844649. [Table: see text]
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Affiliation(s)
| | - Daniel D. Von Hoff
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, AZ
| | | | | | | | | | | | | | | | - Vinod Ganju
- Peninsula Oncology Centre, Frankston, Australia
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Tagliaferri MA, Schwartzberg LS, Chen MM, Camacho LH, Kaplan EH, Arena FP, Bienvenu BJ, North SE, Patel H, Li D. A phase IIb trial of coix seed injection for advanced pancreatic cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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
e15023 Background: Kanglaite injection (KLTi) is a purified botanical extract injection tested for pancreatic cancer. KLTi is derived from Coix seed of the plant Coix lacrama-jobi. KLTi demonstrated growth inhibitory effects in vitro. In xenograft models with PANC-1 cell lines in BALB/C mice, KLTi combined with gemcitabine had synergistic tumor inhibitory activity greater than gemcitabine alone. KLTi is approved and widely used in China to treat non-small cell lung cancer and primary liver cancer. We report final cohort 1 results from a US phase 2b clinical trial. Methods: Eligible patients with histologically confirmed unresectable pancreatic cancer were randomized to a regimen of either KLTi 30g/day plus a standard course of gemcitabine or a standard course of gemcitabine only. The two groups were compared in efficacy, measure by progression-free survival (PFS), and safety. Results: Forty-one patients were randomized to cohort 1 and 38 patients received treatment: 26 received KLTi plus gemcitabine, 12 received gemcitabine only, and 3 received no treatment. The KLTi plus gemcitabine group had a median PFS of 114 days, significantly longer than the median PFS of 57.5 days in the gemcitabine only group (HR 0.338, 95% CI: 0.145, 0.788, p=0.008). The overall response rates were 15.5% (4/26) and 8.3% (1/12) for KLTi plus gemcitabine and gemcitabine only, respectively. Two serious adverse events were possibly related to KLTi; one subject had a pulmonary embolism and the other experienced transient confusion. The adverse events were similar between the groups and consistent with gemcitabine toxicities. Conclusions: Combined with gemcitabine, KLTi injection showed favorable tolerability and encouraging clinical activity for the treatment of advanced pancreatic cancer. Clinical trial information: NCT00733850.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Dapeng Li
- Zhejiang Kanglaite Pharmaceutical Co., Hangzhou, China
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15
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Von Hoff DD, Ervin TJ, Arena FP, Chiorean EG, Infante JR, Moore MJ, Seay TE, Tjulandin S, Ma WW, Saleh MN, Harris M, Reni M, Ramanathan RK, Tabernero J, Hidalgo M, Van Cutsem E, Goldstein D, Wei X, Iglesias JL, Renschler MF. Results of a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone for patients with metastatic adenocarcinoma of the pancreas with PET and CA19-9 correlates. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4005] [Citation(s) in RCA: 11] [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: 11/20/2022] Open
Abstract
4005^ Background: nab-paclitaxel (nab-P; 130 nm albumin-bound paclitaxel) has demonstrated both single-agent activity and synergy with gemcitabine (G) in preclinical models of pancreatic cancer (PC). nab-P + G also demonstrated promising efficacy in a phase I/II study in metastatic PC (J Clin Oncol. 2011:4548-4554), warranting a phase III study of nab-P + G vs G for metastatic PC. Methods: 861 patients (pts) with metastatic PC and a Karnofsky performance status (KPS) ≥ 70 were randomized at 151 community and academic centers 1:1 to receive nab-P 125 mg/m2 + G 1000 mg/m2 days 1, 8, and 15 every 4 weeks or G alone 1000 mg/m2weekly for 7 weeks followed by 1 week of rest (cycle 1) and then days 1, 8, and 15 every 4 weeks (cycle ≥ 2). The primary endpoint was OS; secondary endpoints were PFS and ORR by independent review. Results: The median age was 63 years (range 27 - 88). KPS was 100 (16%), 90 (44%), 80 (32%), and 70 (7%). Pts had advanced disease with liver metastases (84%), ≥ 3 metastatic sites (46%), and CA19-9 ≥ 59 × ULN (46%). nab-P + G was superior to G for all efficacy endpoints: median OS was 8.5 vs. 6.7 mo (HR 0.72; 95% CI, 0.617 - 0.835; P = 0.000015); median PFS was 5.5 vs. 3.7 mo (HR 0.69; 95% CI, 0.581 - 0.821; P = 0.000024), and ORR was 23% vs. 7% (P = 1.1 × 10−10) by RECIST v1.0. Metabolic response by PET in 257 patients was 63% for nab-P + G vs 38% for G (P = 0.000051). CA19-9 response (≥ 90% decrease) was 31% for nab-P + G vs. 14% for G (P < 0.0001). Grade ≥ 3 AEs with nab-P + G vs. G included neutropenia (38% vs. 27%), fatigue (17 % vs. 7%), diarrhea (6% vs 1%), and febrile neutropenia (3% vs. 1%). Grade ≥ 3 peripheral neuropathy (PN) occurred in 17% vs. 1% of pts who received nab-P + G vs. G, respectively; for nab-P + G, PN improved to grade ≤ 1 in a median 29 days, and 44% of patients resumed nab-P treatment. The median duration of treatment was 3.9 mo for nab-P + G and 2.8 mo for G. Conclusions: MPACT was a large, international study performed at community and academic centers. nab-P + G was superior to G across all efficacy endpoints, had an acceptable toxicity profile, and is a new standard for the treatment of metastatic PC that could become the backbone for new regimens. Clinical trial information: NCT00844649.
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Affiliation(s)
- Daniel D. Von Hoff
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale, AZ
| | | | | | | | | | | | | | - Sergei Tjulandin
- N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia
| | - Wen Wee Ma
- Roswell Park Cancer Institute, Buffalo, NY
| | | | | | - Michele Reni
- Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
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Von Hoff DD, Ervin TJ, Arena FP, Chiorean EG, Infante JR, Moore MJ, Seay TE, Tjulandin S, Ma WW, Saleh MN, Harris M, Reni M, Ramanathan RK, Tabernero J, Hidalgo M, Van Cutsem E, Goldstein D, Wei X, Iglesias JL, Renschler MF. Randomized phase III study of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic adenocarcinoma of the pancreas (MPACT). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.lba148] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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
LBA148 Background: nab-Paclitaxel (nab-P, 130 nm albumin-bound paclitaxel) provides tumor selective localization via transcytosis across the endothelium, potential tumor uptake via macropinocytosis, and improved pharmacokinetics vs cremophor-paclitaxel. In vitro, nab-P increased tumoral gemcitabine (G) levels, and in a phase I/II study in metastatic pancreatic cancer (mPC) nab-P + G showed promising activity. Methods: Patients (pts) with mPC were randomized to nab-P 125 mg/m2, followed by G 1000 mg/m2 on days 1, 8, and 15 every 4 weeks or G 1000 mg/m2 weekly for 7 weeks (cycle 1), then on days 1, 8, and 15 every 4 weeks (≥ cycle 2). For the primary endpoint of overall survival (OS), 608 events from 842 patients provided a power of 0.9 to detect a HR of 0.769 (2-side α = 0.049). Results: 861 pts received therapy. Baseline pt characteristics were well balanced. Median age was 63 years, Karnofsky performance status was 90-100 in 60% and ≤80 in 40% of pts, 43% had head of pancreas lesions, 84% had liver and 39% had lung metastases, and 52% of pts had CA19-9 ≥59 x ULN. Treatment duration was 4 vs 3 months in nab-P + G vs G. The relative protocol G dose was 75% vs 85% in nab-P + G vs G; nab-P dose was 81%. OS, progression-free survival (PFS), time to treatment failure (TTF), and overall response rate (ORR) were significantly improved in the nab-P + G arm (Table). Most common grade ≥3 AEs were neutropenia (38% vs 27%), fatigue (17% vs 7%), and neuropathy (17% vs 1%) in the nab-P + G vs G arms. Grade ≥3 neuropathy improved to grade ≤1 in 29 days. Febrile neutropenia was reported in 3% (nab-P + G) vs 1% (G) pts. Conclusions: In this multinational, multiinstitutional study, nab-P + G was well tolerated and superior to G with statistically significant and clinically meaningful results in all endpoints and across subgroups. Clinical trial information: NCT00844649. [Table: see text]
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Affiliation(s)
- Daniel D. Von Hoff
- Virginia G. Piper Cancer Center at Scottsdale Healthcare/TGen, Scottsdale, AZ
| | | | | | | | | | - Malcolm J. Moore
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | | | - Sergei Tjulandin
- N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences, Moscow, Russia
| | - Wen Wee Ma
- Roswell Park Cancer Institute, Buffalo, NY
| | | | | | | | | | | | - Manuel Hidalgo
- START-Madrid, Centro Integral Oncológico Clara Campal, Madrid, Spain
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Arena FP, Noguchi S, Pritchard KI, Burris HA, Rugo HS, Gnant M, Hortobagyi GN, Latini L, Yardley DA, Melichar B, Petrakova K, Harb W, Feng W, Cahana A, Taran T, Campone M, Baselga J, Sahmoud T, Lebwohl DE, Piccart-Gebhart MJ. Everolimus for postmenopausal women with advanced breast cancer: Updated results of the BOLERO-2 phase III trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.27_suppl.99] [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
99 Background: Current treatment options for postmenopausal patients with estrogen-receptor–positive breast cancer (BC) who relapse or progress on a nonsteroidal aromatase inhibitor (NSAI) are limited. The BOLERO-2 trial supports the activity of everolimus (EVE; an oral mammalian target of rapamycin [mTOR] inhibitor) added to the steroidal aromatase inhibitor exemestane (EXE) to prolong progression-free survival (PFS) in this patient population. Long-term PFS and survival data are awaited. Methods: BOLERO-2 is a phase 3, double-blind, randomized, international trial comparing EVE (10 mg once daily) + EXE (25 mg once daily) vs. placebo (PBO) + EXE in postmenopausal women with advanced estrogen-receptor–positive BC progressing or recurring after NSAIs (letrozole or anastrozole). Patients were randomized (2:1) to EVE + EXE or PBO + EXE. The primary endpoint was PFS by local investigator assessment. Main secondary endpoints included centrally assessed PFS, overall survival (OS), safety, bone turnover, and overall response rate. Results: Baseline disease characteristics including tumor burden and prior cancer therapy were well balanced between treatment arms (N = 724). Median PFS was doubled and response rates were consistently improved with EVE + EXE (n = 485) vs PBO + EXE (n = 239) in interim analyses. Median PFS by local assessment was ~3 mo with PBO + EXE vs 6.9 mo (hazard ratio [HR], 0.43; P < .0001) and 7.4 mo (HR, 0.44; P < .0001) with EVE + EXE at 7.5 mo and 12.5 mo follow-up, respectively. Fewer deaths were reported with EVE + EXE (17.2%) vs PBO + EXE (22.7%) at 12.5 mo follow-up. Safety profiles were consistent with previous reports for mTOR inhibitors. PFS data including 528 events (protocol-specified final analysis), and updated OS and safety data will be presented. Conclusions: Adding EVE to EXE markedly prolonged PFS in patients with NSAI-refractory advanced estrogen-receptor–positive BC. There were fewer deaths among patients receiving EVE, and further follow-up will evaluate the effect of EVE on OS.
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Affiliation(s)
| | | | | | | | - Hope S. Rugo
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | - Wael Harb
- Horizon Oncoloy Center, Lafayette, IN
| | | | | | | | - Mario Campone
- Institut de Cancérologie de l’Ouest - René Gauducheau, Nantes Saint Herblain, France
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18
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Piccart-Gebhart MJ, Noguchi S, Pritchard KI, Burris HA, Rugo HS, Gnant M, Hortobagyi GN, Melichar B, Petrakova K, Arena FP, Xu C, Cahana A, Taran T, Sahmoud T, Lebwohl DE, Campone M, Baselga J. Everolimus for postmenopausal women with advanced breast cancer: Updated results of the BOLERO-2 phase III trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.559] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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
559 Background: Current treatment options for postmenopausal patients with estrogen-receptor–positive (ER+) breast cancer (BC) who relapse or progress on a nonsteroidal aromatase inhibitor (NSAI) are limited. The BOLERO-2 trial supports the activity of everolimus (EVE; an oral mammalian target of rapamycin [mTOR] inhibitor) added to the steroidal aromatase inhibitor exemestane (EXE) to prolong progression-free survival (PFS) in this patient population. Long-term PFS and survival data are awaited. Methods: BOLERO-2 is a phase III double-blind, randomized, international trial comparing EVE (10 mg once daily) plus EXE (25 mg once daily) versus placebo (PBO) plus EXE in postmenopausal women with advanced ER+ BC progressing or recurring after NSAIs (letrozole or anastrozole). Patients were randomized (2:1) to EVE + EXE or PBO + EXE. The primary endpoint was PFS by local investigator assessment. Main secondary endpoints included centrally assessed PFS, overall survival (OS), safety, bone turnover, and overall response rate (ORR). Results: Baseline disease characteristics including tumor burden and prior cancer therapy were well balanced between treatment arms (N = 724). Median PFS was doubled and response rates were consistently improved with EVE + EXE (n = 485) vs PBO + EXE (n = 239) in interim analyses. Median PFS by local assessment was ~3 mo with PBO + EXE vs 6.9 mo (hazard ratio [HR] = 0.43; P < .0001) and 7.4 mo (HR = 0.44; P < .0001) with EVE + EXE at 7.5 mo and 12.5 mo follow-up, respectively. Fewer deaths were reported with EVE + EXE (17.2%) vs PBO + EXE (22.7%) at 12.5 mo follow-up. Safety profiles were consistent with previous reports for mTOR inhibitors. PFS data including 528 events (protocol-specified final analysis), and updated OS and safety data will be presented. Conclusions: Adding EVE to EXE markedly prolonged PFS in patients with NSAI-refractory advanced ER+ BC. There were fewer deaths among patients receiving EVE, and further follow-up will evaluate the effect of EVE on OS.
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Affiliation(s)
| | - Shinzaburo Noguchi
- Osaka University, Department of Breast and Endocrine Surgery, Osaka, Japan
| | | | | | - Hope S. Rugo
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Department of Surgery, Vienna, Austria
| | | | - Bohuslav Melichar
- Palacki University Medical School and Teaching Hospital, Olomuc, Czech Republic
| | | | | | - Cindy Xu
- Novartis Pharmaceuticals, East Hanover, NJ
| | | | | | | | | | - Mario Campone
- Institut de Cancérologie de l'Ouest - René Gauducheau, Centre de Recherche en Cancérologie, Saint Herblain-Nantes, France
| | - José Baselga
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
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Evans TJ, Van Cutsem E, Moore MJ, Purvis JD, Strauss LC, Rock EP, Lee J, Lin C, Rosemurgy A, Arena FP, Gara M, Armstrong E, O'Dwyer PJ. Dasatinib combined with gemcitabine (Gem) in patients (pts) with locally advanced pancreatic adenocarcinoma (PaCa): Design of CA180-375, a placebo-controlled, randomized, double-blind phase II trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps4134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4134 Background: Dasatinib, a potent oral BCR-ABL and SRC family kinase (SFK) inhibitor, is approved for first- and second-line therapy of Philadelphia chromosome-positive chronic phase chronic myeloid leukemia (CML) in pts with newly diagnosed CML or CML resistant/intolerant to prior therapy. SRC expression and activity is upregulated in PaCa and correlates with reduced survival in resected high-grade PaCa (Morton, Gastroenterology 2010) and resistance to Gem, a PaCa standard of care (Duxbury, J Am Coll Surg 2004). In preclinical PaCa studies, inhibition of SFKs with dasatinib reduces tumor cell proliferation, migration, and invasion; increases apoptosis; sensitizes cells to Gem; and inhibits development of metastases in vivo either alone or in combination with Gem (Duxbury, Clin Cancer Res 2004; Duxbury, J Am Coll Surg 2004; Nagaraj, Mol Cancer Ther 2010; Morton, op cit). Phase I clinical studies of dasatinib and Gem therapy in PaCa have demonstrated feasibility and suggested efficacy of the combination (Uronis, ASCO 2009, abstract e15506). Methods: This double-blind phase II study tests whether addition of dasatinib to Gem is tolerable and improves efficacy in pts with histologically/cytologically confirmed unresectable locally advanced nonmetastatic PaCa. Eligible pts, aged ≥18 years with Eastern Cooperative Oncology Group performance status ≤1 and adequate organ function, are randomized 1:1 to Gem 1000 mg/m2 IV once weekly (Weeks 1–3 of a 4-week cycle) plus either dasatinib 100 mg once daily or matched placebo. Pts are treated until progression, unacceptable toxicity, withdrawal of consent, or study termination. The primary endpoint is OS, and secondary endpoints are progression-free survival and safety. Exploratory endpoints include freedom from distant metastases, measures of pain and fatigue, overall response rate, and carbohydrate antigen 19-9. Final study analysis will be conducted after 135 deaths; all pts will be followed for survival. To date, 23/200 pts have enrolled; estimated primary completion date is March 2013. ClinicalTrials.gov identifier: NCT01395017.
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Affiliation(s)
| | | | - Malcolm J. Moore
- Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | - Peter J. O'Dwyer
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
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Schwartzberg LS, Arena FP, Mintzer DM, Epperson AL, Walker MS. Phase II Multicenter Trial of Albumin-Bound Paclitaxel and Capecitabine in First-Line Treatment of Patients With Metastatic Breast Cancer. Clin Breast Cancer 2012; 12:87-93. [DOI: 10.1016/j.clbc.2011.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/03/2011] [Indexed: 10/14/2022]
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Cristofanilli M, Valero V, Mangalik A, Royce M, Rabinowitz I, Arena FP, Kroener JF, Curcio E, Watkins C, Bacus S, Cora EM, Anderson E, Magill PJ. Phase II, randomized trial to compare anastrozole combined with gefitinib or placebo in postmenopausal women with hormone receptor-positive metastatic breast cancer. Clin Cancer Res 2010; 16:1904-14. [PMID: 20215537 DOI: 10.1158/1078-0432.ccr-09-2282] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This phase II randomized trial evaluated the efficacy and tolerability of anastrozole combined with gefitinib or anastrozole with placebo in women with hormone receptor-positive metastatic breast cancer (MBC). EXPERIMENTAL DESIGN Postmenopausal women with hormone receptor-positive measurable or evaluable MBC who had not received prior endocrine therapy for this disease stage or who developed metastatic disease during/after adjuvant tamoxifen were eligible. The primary response variable was progression-free survival (PFS) and secondary response variables included clinical benefit rate, objective response rate, overall survival, safety and tolerability, and pharmacokinetics. Tumor biomarker evaluation was an exploratory objective. RESULTS Forty-three patients were randomized to anastrozole plus gefitinib and 50 patients were randomized to anastrozole plus placebo of a planned total of 174 patients (enrollment was prematurely discontinued due to slow recruitment). PFS for patients receiving the combination of anastrozole and gefitinib was longer than for patients receiving anastrozole plus placebo [hazard ratio (gefitinib/placebo), 0.55; 95% confidence interval, 0.32-0.94; median PFS, 14.7 versus 8.4 months]. The clinical benefit rate was 49% versus 34%, and the objective response rate was 2% versus 12% with anastrozole plus gefitinib and anastrozole plus placebo, respectively. No evidence of interaction between baseline biomarker levels and relative treatment effect was found. No unexpected adverse events were observed. CONCLUSION This small randomized study showed that anastrozole in combination with gefitinib is associated with a marked advantage in PFS compared with anastrozole plus placebo, and that the combination was tolerated in postmenopausal women with hormone receptor-positive MBC. Further investigation of epidermal growth factor receptor inhibition in combination with endocrine therapy may be warranted.
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Affiliation(s)
- Massimo Cristofanilli
- Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-1439, USA.
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Abstract
Bortezomib is a proteosome inhibitor with good clinical activity in multiple myeloma. Frequently described side effects are gastrointestinal symptoms, neuropathy, and thrombocytopenia. Even though pneumonia is listed as an infrequent toxicity, severe pneumonitis leading to respiratory distress had not been described until recently. This report was from a single institution in Japan. All these patients had received bone marrow transplant before therapy with bortezomib. To the authors knowledge, this is the first report of life-threatening pulmonary toxicity after bortezomib in a non-Japanese patient and without history of prior autologous peripheral stem cell transplant.
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Affiliation(s)
- Anju Ohri
- Arena Oncology Associates, Lake Success, New York 11042, USA.
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Loscalzo JJ, Cooper DJ, Arena FP, Llovera I. Do families understand "do not resuscitate" orders? Oncology (Williston Park) 1996; 10:504, 507, 511. [PMID: 8723280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J J Loscalzo
- Division of Hematology/Oncology, North Shore University Hospital, Cornell Medical College, Manhasset, NY, USA
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Arena FP, Sherlock S. Doxorubicin hypersensitivity and clindamycin. Ann Intern Med 1990; 112:150. [PMID: 2294825 DOI: 10.7326/0003-4819-112-2-150_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Arena FP, Perlin M, Brahman H, Weiser B, Armstrong D. Fever, rash, and myalgias of dissseminated candidiasis during antifungal therapy. Arch Intern Med 1981; 141:1233. [PMID: 6942791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
A "code-no code" resuscitation classification was recently instituted at Memorial Sloan Kettering Cancer Center. Physician compliance was voluntary. Of 48 subsequent cardiopulmonary arrests, 7 patients (14.6%) were discharged from hospital. They included 4 of 17 patients (23.5%) previously assigned "code" status and 1 of 27 patients (3%) whose resuscitation status had not been designated. Reluctance on the part of the primary physician to withhold resuscitation was clearly evident in this group, of whom more than half had widespread malignancy. Stage of disease did not influence the 50% rate of successful resuscitations but no patient with metastatic or uncontrolled cancer left hospital. The discharge rate among arrest patients with recently diagnosed or localized cancer was 32%. These observations justify continued efforts to restrict cardiopulmonary resuscitation (CPR) to those with a reasonable prognosis for worthwhile palliation or cure.
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Abstract
Two patients had fatal episodes of massive hemoptysis secondary to invasive aspergillosis, complicating in one with acute leukemia and in the other with lung carcinoma. Review of the literature reveals that these cases are among the very few in which invasive aspergillosis has been documented as the etiology of massive hemoptysis in cancer patients. Both patients had been previously treated with corticosteroids and/or other immunosuppressive agents. In one of the two patients, the diagnosis was made ante mortem and antifungal therapy instituted, but dissemination progressed despite treatment.
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Fenton MR, Burke JP, Tursi FD, Arena FP. Effect of a zinc-deficient diet on the growth of an IgM-secreting plasmacytoma (TEPC-183). J Natl Cancer Inst 1980; 65:1271-2. [PMID: 6933272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A diet deficient in zinc resulted in a significant decrease in the number of inbred BALB/c female mice developing transplantable plasmacytoma TEPC-183 compared to pair-fed and ad libitum-fed control mice. The size of the tumor relative to body weight was decreased in the zinc-deficient group. Whereas the uptake of [3H]thymidine into tumor cells did not differ between the groups, the incorporation of [3H]thymidine into tumor cells was significantly reduced in the animals maintained on a zinc-deficient diet.
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Rubenstein S, Christodoulou JP, Arena FP, Arditi LI, Scheidt S. Coexisting hypertrophic heart disease and mitral valve prolapse. A continuum of hereditary cardiac disease? Chest 1980; 78:51-4. [PMID: 7193556 DOI: 10.1378/chest.78.1.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The finding at autopsy of typical pathologic features of hypertrophic heart disease (idiopathic hypertrophic subaortic stenosis, IHSS) and mitral valve prolapse (MVP) in a single patient prompted study of a number of close relatives of this patient. Several additional cases of IHSS or MVP were found. The HLA typing of this kindred revealed that four out of seven members tested had the Bw 35 antigen. Although the association might be due to chance, this kindred, together with prior reports of similar bizarre myocardial cellular disarray in HISS and MVP, suggest the hypothesis that in some instances, IHSS and MVP may represent a continuum of hereditary cardiac disorders.
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Arena FP, Dugowson C, Saudek CD. Salicylate-induced hypoglycemia and ketoacidosis in a nondiabetic adult. Arch Intern Med 1978; 138:1153-4. [PMID: 666481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A 78-year-old nondiabetic woman was admitted to the hospital with salicylate-induced hypoglycemia. Ketosis was present with a moderate metabolic acidosis and primary respiratory alkalosis. The patient's mental status improved immediately following intravenous administration of glucose. The case illustrates salicylate's hypoglycemic activity, and that the metabolic acidosis may have exacerbated symptoms of cerebral glucopenia.
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Guttentag OE, Lappé M, FitzGerald JA, Schweitzer PE, Arena FP, Fletcher J. Genetic control. N Engl J Med 1972; 286:48-50. [PMID: 5006932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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