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Kantidakis G, Litiere S, Neven A, Vinches M, Judson I, Blay JY, Wardelmann E, Stacchiotti S, D'Ambrosio L, Marreaud S, van der Graaf W, Kasper B, Fiocco M, Gelderblom H. 1491MO New benchmarks for designing clinical trials in advanced or metastatic liposarcoma (LPS) or synovial sarcoma (SS): An EORTC soft tissue and bone sarcoma group meta-analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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2
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Demetri GD, Antonescu CR, Bjerkehagen B, Bovée JVMG, Boye K, Chacón M, Dei Tos AP, Desai J, Fletcher JA, Gelderblom H, George S, Gronchi A, Haas RL, Hindi N, Hohenberger P, Joensuu H, Jones RL, Judson I, Kang YK, Kawai A, Lazar AJ, Le Cesne A, Maestro R, Maki RG, Martín J, Patel S, Penault-Llorca F, Premanand Raut C, Rutkowski P, Safwat A, Sbaraglia M, Schaefer IM, Shen L, Serrano C, Schöffski P, Stacchiotti S, Sundby Hall K, Tap WD, Thomas DM, Trent J, Valverde C, van der Graaf WTA, von Mehren M, Wagner A, Wardelmann E, Naito Y, Zalcberg J, Blay JY. Diagnosis and management of tropomyosin receptor kinase (TRK) fusion sarcomas: expert recommendations from the World Sarcoma Network. Ann Oncol 2020; 31:1506-1517. [PMID: 32891793 PMCID: PMC7985805 DOI: 10.1016/j.annonc.2020.08.2232] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/22/2022] Open
Abstract
Sarcomas are a heterogeneous group of malignancies with mesenchymal lineage differentiation. The discovery of neurotrophic tyrosine receptor kinase (NTRK) gene fusions as tissue-agnostic oncogenic drivers has led to new personalized therapies for a subset of patients with sarcoma in the form of tropomyosin receptor kinase (TRK) inhibitors. NTRK gene rearrangements and fusion transcripts can be detected with different molecular pathology techniques, while TRK protein expression can be demonstrated with immunohistochemistry. The rarity and diagnostic complexity of NTRK gene fusions raise a number of questions and challenges for clinicians. To address these challenges, the World Sarcoma Network convened two meetings of expert adult oncologists and pathologists and subsequently developed this article to provide practical guidance on the management of patients with sarcoma harboring NTRK gene fusions. We propose a diagnostic strategy that considers disease stage and histologic and molecular subtypes to facilitate routine testing for TRK expression and subsequent testing for NTRK gene fusions.
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Affiliation(s)
- G D Demetri
- Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, USA
| | - C R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - B Bjerkehagen
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - J V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - K Boye
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - M Chacón
- Oncology Service Chair, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - A P Dei Tos
- Department of Pathology, University of Padua, Padova, Italy
| | - J Desai
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - J A Fletcher
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - S George
- Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - N Hindi
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Sevilla, Spain; Medical Oncology Department, University Hospital Virgen del Rocio, Sevilla, Spain
| | - P Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany
| | - H Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - R L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - I Judson
- Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Y-K Kang
- Department of Oncology, University of Ulsan College of Medicine, Seoul, Korea
| | - A Kawai
- Department of Musculoskeletal Oncology, National Cancer Center, Tokyo, Japan
| | - A J Lazar
- Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Le Cesne
- Medical Oncology, Insitut Gustave Roussy, Villejuif, Ile-de-France, France
| | - R Maestro
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO Aviano) IRCCS, National Cancer Institute, Aviano, Italy
| | - R G Maki
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - J Martín
- Institute of Biomedicine of Sevilla (IBIS, HUVR, CSIC, Universidad de Sevilla), Sevilla, Spain; Medical Oncology Department, University Hospital Virgen del Rocio, Sevilla, Spain
| | - S Patel
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - C Premanand Raut
- Division of Surgical Oncology, Brigham and Women's Hospital, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Safwat
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - M Sbaraglia
- Department of Pathology, University of Padua, Padova, Italy
| | - I-M Schaefer
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - L Shen
- Department of GI Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - C Serrano
- Sarcoma Translational Research Program, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Stacchiotti
- Cancer Medicine Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - K Sundby Hall
- Department of Oncology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - W D Tap
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - D M Thomas
- The Kinghorn Cancer Centre and Cancer Theme, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - J Trent
- Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine, Miami, USA
| | - C Valverde
- Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M von Mehren
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, USA
| | - A Wagner
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - E Wardelmann
- Gerhard Domagk Institute of Pathology, University of Münster, Münster, Germany
| | - Y Naito
- National Cancer Center Hospital East, Kashiwa, Japan
| | - J Zalcberg
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Medical Oncology, Alfred Health, Melbourne, Australia
| | - J-Y Blay
- Centre Léon Bérard, Unicancer, LYRICAN and Université Claude Bernard Lyon 1, Lyon, France.
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Stacchiotti S, Van der Graaf W, Doms H, Sanfilippo R, Marreaud S, Van Houdt W, Judson I, Kasper B, Litiere S, Gelderblom H. 1629MO First-line chemotherapy (CT) in advanced well-differentiated/dedifferentiated liposarcoma (WD/DD LPS): An EORTC Soft Tissue and Bone Sarcoma Group (STBSG) retrospective analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kantidakis G, Litiere S, Neven A, Vinches M, Judson I, Schöffski P, Stacchiotti S, D’Ambrosio L, Marreaud S, Van Der Graaf W, Fiocco M, Kasper B, Gelderblom H. 1628MO A new benchmark for designing phase II trials for advanced or metastatic leiomyosarcoma (LMS) patients using progression free survival (PFS) as primary endpoint – an EORTC Soft Tissue and Bone Sarcoma Group (STBSG) meta-analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lee ATJ, Chew W, Wilding CP, Guljar N, Smith MJ, Strauss DC, Fisher C, Hayes AJ, Judson I, Thway K, Jones RL, Huang PH. The adequacy of tissue microarrays in the assessment of inter- and intra-tumoural heterogeneity of infiltrating lymphocyte burden in leiomyosarcoma. Sci Rep 2019; 9:14602. [PMID: 31601875 PMCID: PMC6787212 DOI: 10.1038/s41598-019-50888-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/23/2019] [Indexed: 12/28/2022] Open
Abstract
The characterisation and clinical relevance of tumour-infiltrating lymphocytes (TILs) in leiomyosarcoma (LMS), a subtype of soft tissue sarcoma that exhibits histological heterogeneity, is not established. The use of tissue microarrays (TMA) in studies that profile TIL burden is attractive but given the potential for intra-tumoural heterogeneity to introduce sampling errors, the adequacy of this approach is undetermined. In this study, we assessed the histological inter- and intra-tumoural heterogeneity in TIL burden within a retrospective cohort of primary LMS specimens. Using a virtual TMA approach, we also analysed the optimal number of TMA cores required to provide an accurate representation of TIL burden in a full tissue section. We establish that LMS have generally low and spatially homogenous TIL burdens, although a small proportion exhibit higher levels and more heterogeneous distribution of TILs. We show that a conventional and practical number (e.g. ≤3) of TMA cores is adequate for correct ordinal categorisation of tumours with high or low TIL burden, but that many more cores (≥11) are required to accurately estimate absolute TIL numbers. Our findings provide a benchmark for the design of future studies aiming to define the clinical relevance of the immune microenvironments of LMS and other sarcoma subtypes.
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Affiliation(s)
- A T J Lee
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.,Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - W Chew
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - C P Wilding
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - N Guljar
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - M J Smith
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - D C Strauss
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - C Fisher
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - A J Hayes
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - I Judson
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - K Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK.,Division of Clinical Studies, The Institute of Cancer Research, London, SW3 6JB, UK
| | - P H Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK.
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6
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Drabbe C, Benson C, Younger E, Zaidi S, Jones RL, Judson I, Chisholm J, Mandeville H, Fisher C, Thway K, Al Muderis O, Messiou C, Strauss D, Husson O, Miah A, Van der Graaf WTA. Embryonal and Alveolar Rhabdomyosarcoma in Adults: Real-Life Data From a Tertiary Sarcoma Centre. Clin Oncol (R Coll Radiol) 2019; 32:e27-e35. [PMID: 31350181 DOI: 10.1016/j.clon.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
AIMS Embryonal and alveolar rhabdomyosarcoma (ERMS, ARMS) are subtypes of RMS that mainly occur in children, with relatively good outcomes. The incidence in adults is extremely low and survival is significantly worse compared with children. Data are scarce and literature generally combines all RMS subtypes, including pleomorphic RMS, which primarily occurs in adults and behaves more like undifferentiated pleomorphic sarcoma. The aim of this study was to evaluate patient and tumour characteristics, outcome and prognostic factors in adult patients with ERMS and ARMS. MATERIALS AND METHODS All adult (18 years or older) ERMS and ARMS patients (presenting 1990-2016) were identified from a prospectively maintained database and were included in this analysis. RESULTS Overall, 66 patients were included (42 men, 24 women). The median age at presentation was 28 years (range 18-71). The median overall survival for all ARMS (n = 42) and ERMS (n = 24) patients was 18 months, with a 5-year overall survival rate of 27%. Patients presenting with localised disease (n = 38, 58%) and metastatic disease (n = 25, 42%), had a 5-year overall survival rate of 36% and 11%, respectively. In univariate analysis we found alveolar subtype, fusion gene positivity, infiltrative tumour and metastatic presentation to be negative prognostic factors. CONCLUSION Survival in adult ERMS and ARMS patients is poor and the current data may be useful in the design of trials with novel agents. Ideally, paediatric and adult oncologists should set up trials together to get a better understanding of biological, genetic and clinically relevant factors in this disease.
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Affiliation(s)
- C Drabbe
- Royal Marsden Hospital, London, UK; Radboud University Medical Centre, Nijmegen, the Netherlands
| | - C Benson
- Royal Marsden Hospital, London, UK
| | | | - S Zaidi
- Royal Marsden Hospital, London, UK
| | - R L Jones
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - I Judson
- The Institute of Cancer Research, London, UK
| | - J Chisholm
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - H Mandeville
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - C Fisher
- The Institute of Cancer Research, London, UK
| | - K Thway
- Royal Marsden Hospital, London, UK
| | | | - C Messiou
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | | | - O Husson
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - A Miah
- Royal Marsden Hospital, London, UK
| | - W T A Van der Graaf
- Royal Marsden Hospital, London, UK; Radboud University Medical Centre, Nijmegen, the Netherlands; The Institute of Cancer Research, London, UK.
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7
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv68-iv78. [PMID: 29846513 DOI: 10.1093/annonc/mdy095] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso 'S.Maria di Cà Foncello', Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals, London, UK
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Institute of Scientific Hospital Care (IRCCS), Regina Elena National Cancer Institute, Rome
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Issels
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna
| | - R Piana
- Azienda Ospedaliero, Universitaria Cita della Salute e della Scienza di Torino, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | | | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Whelan
- University College Hospital, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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8
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Casali PG, Bielack S, Abecassis N, Aro HT, Bauer S, Biagini R, Bonvalot S, Boukovinas I, Bovee JVMG, Brennan B, Brodowicz T, Broto JM, Brugières L, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Dhooge C, Eriksson M, Fagioli F, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gaspar N, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hecker-Nolting S, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kager L, Kasper B, Kopeckova K, Krákorová DA, Ladenstein R, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Morland B, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Strauss SJ, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Bone sarcomas: ESMO-PaedCan-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv79-iv95. [PMID: 30285218 DOI: 10.1093/annonc/mdy310] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - B Brennan
- Royal Manchester Children's Hospital, Manchester, UK
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - L Brugières
- Gustave Roussy Cancer Campus, Villejuif, France
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso "S.Maria di Cà Foncello", Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - C Dhooge
- Ghent University Hospital (Pediatric Hematology-Oncology & Stem Cell Transplantation), Ghent, Belgium
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - F Fagioli
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - N Gaspar
- Gustave Roussy Cancer Campus, Villejuif, France
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - R Issels
- Department of Medicine III, University Hospital Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Kager
- St. Anna Children's Hospital & Children's Cancer Research Institute, Medical University Vienna, Vienna, Austria
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - R Ladenstein
- St. Anna Children's Hospital & Children's Cancer Research Institute, Medical University Vienna, Vienna, Austria
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute-Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology University Hospital of Lausanne, Lausanne, Switzerland
| | - B Morland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna, Italy
| | - R Piana
- Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute-Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - S J Strauss
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - W T A van der Graaf
- Royal Marsden Hospital, London
- Radboud University Medical Center, Nijmegen, The Netherlands
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - J Whelan
- Sarcoma Unit, University College London Hospitals NHS Trust, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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9
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Gastrointestinal stromal tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv267. [PMID: 30188977 DOI: 10.1093/annonc/mdy320] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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10
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv268-iv269. [PMID: 30285214 DOI: 10.1093/annonc/mdy321] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
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11
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Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JVMG, Brodowicz T, Broto JM, Buonadonna A, De Álava E, Dei Tos AP, Del Muro XG, Dileo P, Eriksson M, Fedenko A, Ferraresi V, Ferrari A, Ferrari S, Frezza AM, Gasperoni S, Gelderblom H, Gil T, Grignani G, Gronchi A, Haas RL, Hassan B, Hohenberger P, Issels R, Joensuu H, Jones RL, Judson I, Jutte P, Kaal S, Kasper B, Kopeckova K, Krákorová DA, Le Cesne A, Lugowska I, Merimsky O, Montemurro M, Pantaleo MA, Piana R, Picci P, Piperno-Neumann S, Pousa AL, Reichardt P, Robinson MH, Rutkowski P, Safwat AA, Schöffski P, Sleijfer S, Stacchiotti S, Sundby Hall K, Unk M, Van Coevorden F, van der Graaf WTA, Whelan J, Wardelmann E, Zaikova O, Blay JY. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29:iv51-iv67. [PMID: 29846498 DOI: 10.1093/annonc/mdy096] [Citation(s) in RCA: 414] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- P G Casali
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - N Abecassis
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - H T Aro
- Turku University Hospital (Turun Yliopistollinen Keskussairaala), Turlu, Finland
| | - S Bauer
- University Hospital Essen, Essen, Germany
| | - R Biagini
- Department of Oncological Orthopedics, Musculoskeletal Tissue Bank, IFO, Regina Elena National Cancer Institute, Rome, Italy
| | - S Bielack
- Klinikum Stuttgart-Olgahospital, Stuttgart, Germany
| | | | | | - J V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - T Brodowicz
- Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - J M Broto
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A Buonadonna
- Centro di Riferimento Oncologico di Aviano, Aviano
| | - E De Álava
- Hospital Universitario Virgen del Rocio-CIBERONC, Seville, Spain
| | - A P Dei Tos
- Ospedale Regionale di Treviso "S.Maria di Cà Foncello", Treviso, Italy
| | - X G Del Muro
- Integrated Unit ICO Hospitalet, HUB, Barcelona, Spain
| | - P Dileo
- Sarcoma Unit, University College London Hospitals, London, UK
| | - M Eriksson
- Skane University Hospital-Lund, Lund, Sweden
| | - A Fedenko
- N. N. Blokhin Russian Cancer Research Center, Moscow, Russian Federation
| | - V Ferraresi
- Institute of Scientific Hospital Care (IRCCS), Regina Elena National Cancer Institute, Rome
| | - A Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - S Ferrari
- Istituto Ortopedico Rizzoli, Bologna
| | - A M Frezza
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - S Gasperoni
- Azienda Ospedaliera Universitaria Careggi Firenze, Florence, Italy
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | - G Grignani
- Candiolo Cancer Institute, FPO IRCCS, Candiolo, Italy
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - R L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam and Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Hassan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - R Issels
- Department of Medicine III, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - H Joensuu
- Helsinki University Central Hospital (HUCH), Helsinki, Finland
| | | | - I Judson
- The Institute of Cancer Research, London, UK
| | - P Jutte
- University Medical Center Groningen, Groningen
| | - S Kaal
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - B Kasper
- Mannheim University Medical Center, Mannheim
| | | | - D A Krákorová
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - A Le Cesne
- Gustave Roussy Cancer Campus, Villejuif, France
| | - I Lugowska
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - O Merimsky
- Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel
| | - M Montemurro
- Medical Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | - M A Pantaleo
- Azienda Ospedaliera, Universitaria, Policlinico S Orsola-Malpighi Università di Bologna, Bologna
| | - R Piana
- Azienda Ospedaliero, Universitaria Cita della Salute e della Scienza di Torino, Turin, Italy
| | - P Picci
- Istituto Ortopedico Rizzoli, Bologna
| | | | - A L Pousa
- Fundacio de Gestio Sanitaria de L'hospital de la SANTA CREU I Sant Pau, Barcelona, Spain
| | - P Reichardt
- Helios Klinikum Berlin Buch, Berlin, Germany
| | - M H Robinson
- YCRC Department of Clinical Oncology, Weston Park Hospital NHS Trust, Sheffield, UK
| | - P Rutkowski
- Maria Sklodowska Curie Institute, Oncology Centre, Warsaw, Poland
| | - A A Safwat
- Aarhus University Hospital, Aarhus, Finland
| | | | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - S Stacchiotti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy
| | - K Sundby Hall
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - M Unk
- Institute of Oncology of Ljubljana, Ljubljana, Slovenia
| | - F Van Coevorden
- Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Whelan
- University College Hospital, London, UK
| | - E Wardelmann
- Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Münster, Germany
| | - O Zaikova
- Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - J Y Blay
- Centre Leon Bernard and UCBL1, Lyon, France
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12
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Zhang AY, Judson I, Benson C, Wunder JS, Ray-Coquard I, Grimer RJ, Quek R, Wong E, Miah AB, Ferguson PC, Dufresne A, Teh JYH, Stockler M, Tattersall MHN. Author Correction: Chemotherapy with radiotherapy influences time-to-development of radiation-induced sarcomas: a multicenter study. Br J Cancer 2018; 118:1682. [PMID: 29808016 PMCID: PMC6008468 DOI: 10.1038/s41416-018-0079-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Since the publication of this paper, the authors noticed an error in Fig. 1. The X-axis on all the figure panels should read 'Time (years)', not 'Time (months)'. The corrected Fig. 1 is shown below.
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Affiliation(s)
- A Y Zhang
- The University of Sydney, Sydney, 2006, Australia. .,Chris O'Brien Lifehouse, Sydney, 2050, Australia.
| | - I Judson
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - C Benson
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - J S Wunder
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Department of Surgery, University of Toronto, Toronto, ON, M5S, Canada
| | - I Ray-Coquard
- Centre Léon Bérard, University Claude Bernard, Lyon, 69100, France
| | - R J Grimer
- The Royal Orthopaedic Hospital NHS Trust, Birmingham, B31 2AP, UK
| | - R Quek
- National Cancer Centre, Singapore, 169610, Singapore
| | - E Wong
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - A B Miah
- Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK
| | - P C Ferguson
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.,Department of Surgery, University of Toronto, Toronto, ON, M5S, Canada
| | - A Dufresne
- Centre Léon Bérard, University Claude Bernard, Lyon, 69100, France
| | - J Y H Teh
- National Cancer Centre, Singapore, 169610, Singapore
| | - M Stockler
- Chris O'Brien Lifehouse, Sydney, 2050, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, 2006, Australia
| | - M H N Tattersall
- The University of Sydney, Sydney, 2006, Australia.,Chris O'Brien Lifehouse, Sydney, 2050, Australia
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13
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Libertini M, Mitra I, van der Graaf WTA, Miah AB, Judson I, Jones RL, Thomas K, Moskovic E, Szucs Z, Benson C, Messiou C. Aggressive fibromatosis response to tamoxifen: lack of correlation between MRI and symptomatic response. Clin Sarcoma Res 2018; 8:13. [PMID: 29785261 PMCID: PMC5950191 DOI: 10.1186/s13569-018-0100-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 01/20/2018] [Accepted: 04/04/2018] [Indexed: 01/22/2023] Open
Abstract
Background One of the commonly used systemic agents for the treatment of aggressive fibromatosis is the anti-oestrogen drug tamoxifen. However, data on efficacy and optimum methods of response assessment are limited, consisting mainly of small case series and reports. Methods A retrospective database was used to identify consecutive patients diagnosed with aggressive fibromatosis (AF) and treated with tamoxifen plus/minus non-steroidal anti-inflammatory drugs at our tertiary referral centre between 2007 and 2014. MRI and symptom changes were recorded. Results Thirty-two patients (13 male 19 female, median age 41 years) were included. Median duration of treatment with tamoxifen was 316 days. Of 9 patients with progressive disease by RECIST 1.1 (28%): 4 patients experienced worsening symptoms; 3 patients had improved symptoms and 2 had no change in symptoms. Of 22 patients with stable disease (69%): 11 had no change in symptoms; 6 had improved symptoms and 5 patients had worsening symptoms. One patient achieved a partial response with improved symptoms. Conclusions No relationship was identified between symptomatic benefit and response by RECIST 1.1 on MRI. Prospective studies in AF should incorporate endpoints focusing on patient symptoms.
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Affiliation(s)
- M Libertini
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - I Mitra
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,2Department of Radiology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK
| | - W T A van der Graaf
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - A B Miah
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - I Judson
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - R L Jones
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - K Thomas
- 2Department of Radiology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK
| | - E Moskovic
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,3Institute of Cancer Research, Sutton, UK
| | - Z Szucs
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - C Benson
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - C Messiou
- 1Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK.,2Department of Radiology, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ UK.,3Institute of Cancer Research, Sutton, UK
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14
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Verschoor A, Litière S, Marréaud S, Judson I, Toulmonde M, Wardelmann E, van der Graaf W, Le Cesne A, Gronchi A, Gelderblom H. Prognostic relevance of distant metastases versus locally advanced disease in soft tissue sarcomas: An EORTC-STBSG database study. Eur J Cancer 2018; 94:187-198. [DOI: 10.1016/j.ejca.2018.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 02/03/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
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15
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Touati N, Schöffski P, Litière S, Judson I, Sleijfer S, van der Graaf WT, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marréaud S, Gronchi A. European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Experience with Advanced/Metastatic Epithelioid Sarcoma Patients Treated in Prospective Trials: Clinical Profile and Response to Systemic Therapy. Clin Oncol (R Coll Radiol) 2018; 30:448-454. [PMID: 29550245 DOI: 10.1016/j.clon.2018.02.065] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 12/01/2022]
Abstract
AIMS Epithelioid sarcoma is a soft tissue sarcoma associated with a high rate of local recurrence after wide resection and high incidence of distant metastasis. Little is known about the clinical course and response to systemic treatments in epithelioid sarcoma patients. We carried out a retrospective analysis of clinical data from epithelioid sarcoma patients to provide a reference for the design of future epithelioid sarcoma-specific studies. PATIENTS AND METHODS Data from patients with epithelioid sarcoma entered in prospective multi-sarcoma phase II/III trials were pooled: EORTC trial 62012 (doxorubicin versus doxorubicin/ifosfamide), 62043 (pazopanib), 62072 (pazopanib versus placebo) and 62091 (doxorubicin versus trabectedin). Patients had either a local or a centrally confirmed diagnosis of epithelioid sarcoma, had inoperable/metastatic disease at study entry and were eligible for the according trial. Response was assessed according to RECIST 1.1. Progression-free survival (PFS) and overall survival were calculated from date of entry. RESULTS Among 976 patients with advanced sarcomas, 27 epithelioid sarcoma patients (2.8%) were eligible for the analysis (17 men, median age at diagnosis 50 years, range 19-72). Eighteen (66.7%) received chemotherapy as first-line treatment (five doxorubicin, eight doxorubicin/ifosfamide, two pazopanib, three trabectedin) and nine (33.3%) received pazopanib as second line or later. The primary tumour was located in the lower extremity (n = 8; 29.6%), upper extremity (n = 5; 18.5%), retro/intra-abdominal (n = 4; 14.8%) and in other locations (n = 10; 37.0%). At entry, metastases were mainly found in lung (n = 17; 63%), lymph nodes (n = 9; 33.3%), bone (n = 8; 29.6%) and soft tissue (n = 7; 25.9%). The best response for first-line patients was four partial responses (22.2%), 10 stable disease (55.6%) and four progressive disease (22.2%). In subsequent lines, pazopanib achieved one partial response (11.1%), four stable disease (44.4%) and four progressive disease (44.4%). All patients but one progressed on treatment. The median PFS and overall survival were 3.8 (95% confidence interval 2.2-4.8) and 10.8 months (95% confidence interval 8.1-21.3), respectively. Five patients were still alive at the time of the according trial analysis. CONCLUSION With all limitations of such a rare disease and small data set, objective response and survival outcomes are similar in epithelioid sarcoma to non-selected sarcoma populations. The clinical testing of novel systemic treatments for epithelioid sarcoma remains an unmet medical need and a high priority.
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Affiliation(s)
- N Touati
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium.
| | - P Schöffski
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - S Litière
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - S Sleijfer
- Erasmus MC - Cancer Institute, Rotterdam, the Netherlands
| | - W T van der Graaf
- The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | | | - N Isambert
- Centre Georges-François Leclerc, Dijon, France
| | - T Gil
- Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - J Y Blay
- Centre Léon Bérard, Lyon, France
| | - D Stark
- Leeds Teaching Hospitals NHS Trust, St James University Hospital, Leeds, UK
| | - T Brodowicz
- Medical University Vienna, General Hospital, Vienna, Austria
| | - S Marréaud
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - A Gronchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Touati N, Schoffski P, Litière S, Judson I, Sleijfer S, van der Graaf W, Italiano A, Isambert N, Gil T, Blay JY, Stark D, Brodowicz T, Marreaud S, Gronchi A. EORTC experience with advanced/metastatic epithelioid sarcoma patients treated in prospective trials: Clinical profile and response to systemic therapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx387.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Casali P, Le Cesne A, Poveda A, Kotasek D, Rutkowski P, Hohenberger P, Fumagalli E, Judson I, Italiano A, Gelderblom H, Penel N, Kopp HG, Goldstein D, Broto JM, Gronchi A, Wardelmann E, Marreaud S, Zalcberg J, Litière S, Blay JY. Time to definitive failure to the first tyrosine kinase inhibitor in localized gastrointestinal stromal tumors (GIST) treated with imatinib as an adjuvant: Final results of the EORTC STBSG, AGITG, UNICANCER, FSG, ISG, and GEIS randomized trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cohen-Hallaleh RB, Smith HG, Smith RC, Stamp GF, Al-Muderis O, Thway K, Miah A, Khabra K, Judson I, Jones R, Benson C, Hayes AJ. Radiation induced angiosarcoma of the breast: outcomes from a retrospective case series. Clin Sarcoma Res 2017; 7:15. [PMID: 28794852 PMCID: PMC5547463 DOI: 10.1186/s13569-017-0081-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 06/16/2017] [Accepted: 07/29/2017] [Indexed: 01/04/2023] Open
Abstract
Background Radiation induced angiosarcoma (RIAS) of the breast is a rare and aggressive complication of radiotherapy. Due to the rarity of this disease, much of the evidence for its management is based on case reports or small retrospective series. We sought to describe the management and outcomes of RIAS in a large single-institution series. Methods All patients diagnosed with RIAS between January 2000 and January 2014 were identified from an institutional database. Results A total of 49 patients were identified. Median age at diagnosis was 72 years (range 51–93). Median time from completion of radiotherapy to diagnosis of RIAS was 7.5 years. Median tumour size at presentation was 5.0 cm (1.5–19.0). The majority of patients presented with localised disease (47, 95.9%). Of these, 35 (74.5%) were suitable for surgery and underwent surgery with curative intent. Twelve patients presented with localised irresectable disease. Of these, 7 received systemic chemotherapy, with a sufficient response to facilitate surgery in 3 patients. Following potentially curative surgery, 2-year local recurrence-free was 55.2%. Survival was significantly prolonged in patients presenting with resectable disease (2-year overall survival 71.1% vs 33.3%, p < 0.001). Tumour size >5 cm was prognostic of distant metastases-free survival and overall survival. Conclusion RIAS are rare, aggressive soft-tissue lesions with limited treatment options and high-rates of both local and systemic relapse.
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Affiliation(s)
- R B Cohen-Hallaleh
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - H G Smith
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R C Smith
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - G F Stamp
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - O Al-Muderis
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - K Thway
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - A Miah
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - K Khabra
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - I Judson
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R Jones
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - C Benson
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - A J Hayes
- The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Fresneau B, Hackshaw A, Hawkins DS, Paulussen M, Anderson JR, Judson I, Litière S, Dirksen U, Lewis I, van den Berg H, Gaspar N, Gelderblom H, Whelan J, Boddy AV, Wheatley K, Pignon JP, De Vathaire F, Le Deley MC, Le Teuff G. Investigating the heterogeneity of alkylating agents' efficacy and toxicity between sexes: A systematic review and meta-analysis of randomized trials comparing cyclophosphamide and ifosfamide (MAIAGE study). Pediatr Blood Cancer 2017; 64. [PMID: 28111876 DOI: 10.1002/pbc.26457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND A marginal interaction between sex and the type of alkylating agent was observed for event-free survival in the Euro-EWING99-R1 randomized controlled trial (RCT) comparing cyclophosphamide and ifosfamide in Ewing sarcoma. To further evaluate this interaction, we performed an individual patient data meta-analysis of RCTs assessing cyclophosphamide versus ifosfamide in any type of cancer. METHODS A literature search produced two more eligible RCTs (EICESS92 and IRS-IV). The endpoints were progression-free survival (PFS, main endpoint) and overall survival (OS). The hazard ratios (HRs) of the treatment-by-sex interaction and their 95% confidence interval (95% CI) were assessed using stratified multivariable Cox models. Heterogeneity of the interaction across age categories and trials was explored. We also assessed this interaction for severe acute toxicity using logistic models. RESULTS The meta-analysis comprised 1,528 pediatric and young adult sarcoma patients from three RCTs: Euro-EWING99-R1 (n = 856), EICESS92 (n = 155), and IRS-IV (n = 517). There were 224 PFS events in Euro-EWING99-R1 and 200 in the validation set (EICESS92 + IRS-IV), and 171 and 154 deaths in each dataset, respectively. The estimated treatment-by-sex interaction for PFS in Euro-EWING99-R1 (HR = 1.73, 95% CI = 1.00-3.00) was not replicated in the validation set (HR = 0.97, 95% CI = 0.55-1.72), without heterogeneity across trials (P = 0.62). In the pooled analysis, the treatment-by-sex interaction was not significant (HR = 1.31, 95% CI = 0.89-1.95, P = 0.17), without heterogeneity across age categories (P = 0.88) and trials (P = 0.36). Similar results were observed for OS. No significant treatment-by-sex interaction was observed for leucopenia/neutropenia (P = 0.45), infection (P = 0.64), or renal toxicity (P = 0.20). CONCLUSION Our meta-analysis did not confirm the hypothesis of a treatment-by-sex interaction on efficacy or toxicity outcomes.
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Affiliation(s)
- Brice Fresneau
- Department of Pediatric oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - A Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, United Kingdom
| | - D S Hawkins
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - M Paulussen
- Vestische Kinder-und Jugendklinik Datteln, Witten/Herdecke University, Datteln, Germany
| | - J R Anderson
- Merck Research Laboratories-Oncology, North Wales, Pennsylvania
| | - I Judson
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - S Litière
- Statistics Department, EORTC Headquarters, Brussels, Belgium
| | - U Dirksen
- Department of Pediatric Hematology and Oncology, University Hospital, Muenster, Germany
| | - I Lewis
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - H van den Berg
- Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - N Gaspar
- Department of Pediatric oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Whelan
- Cancer Medicine and Consultant Medical Oncologist, The London Sarcoma Service, University College Hospital, London, United Kingdom
| | - A V Boddy
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
| | - K Wheatley
- Cancer Research UK, Cancer Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - J P Pignon
- Departments of Biostatistics and Epidemiology, Gustave-Roussy, Paris, France
- Paris-Saclay and Paris-SudUniversities, CESP, INSERM, Villejuif, France
- Gustave Roussy, Ligue Nationale Contre le Cancer Meta-analysis Platform, Villejuif, France
| | - F De Vathaire
- Radiation EpidemiologyGroup, INSERM, UMR1018, Villejuif, France
| | - M C Le Deley
- Departments of Biostatistics and Epidemiology, Gustave-Roussy, Paris, France
- Paris-Saclay and Paris-SudUniversities, CESP, INSERM, Villejuif, France
| | - G Le Teuff
- Departments of Biostatistics and Epidemiology, Gustave-Roussy, Paris, France
- Paris-Saclay and Paris-SudUniversities, CESP, INSERM, Villejuif, France
- Gustave Roussy, Ligue Nationale Contre le Cancer Meta-analysis Platform, Villejuif, France
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Constantinidou A, Selfe J, Khin T, Popov S, Missiaglia E, Aladowicz E, Al-Saadi R, Olmos D, Jones R, Strauss D, Hayes A, van der Graaf W, Judson I, Shipley J. Epigenetic modulation in well differentiated (WD) and dedifferentiated (DD) liposarcoma (LPS): a novel therapeutic approach. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw388.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Noujaim J, Payne LS, Judson I, Jones RL, Huang PH. Phosphoproteomics in translational research: a sarcoma perspective. Ann Oncol 2016; 27:787-94. [PMID: 26802162 DOI: 10.1093/annonc/mdw030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/11/2016] [Indexed: 02/11/2024] Open
Abstract
Phosphoproteomics has been extensively used as a preclinical research tool to characterize the phosphorylated components of the cancer proteome. Advances in the field have yielded insights into new drug targets, mechanisms of disease progression and drug resistance, and biomarker discovery. However, application of this technology to clinical research has been challenging because of practical issues relating to specimen integrity and tumour heterogeneity. Beyond these limitations, phosphoproteomics has the potential to play a pivotal role in translational studies and contribute to advances in different tumour groups, including rare disease sites like sarcoma. In this review, we propose that deploying phosphoproteomic technologies in translational research may facilitate the identification of better defined predictive biomarkers for patient stratification, inform drug selection in umbrella trials and identify new combinations to overcome drug resistance. We provide an overview of current phosphoproteomic technologies, such as affinity-based assays and mass spectrometry-based approaches, and discuss their advantages and limitations. We use sarcoma as an example to illustrate the current challenges in evaluating targeted kinase therapies in clinical trials. We then highlight useful lessons from preclinical studies in sarcoma biology to demonstrate how phosphoproteomics may address some of these challenges. Finally, we conclude by offering a perspective and list the key measures required to translate and benchmark a largely preclinical technology into a useful tool for translational research.
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Affiliation(s)
- J Noujaim
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - L S Payne
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - I Judson
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK Division of Clinical Studies
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK Division of Clinical Studies
| | - P H Huang
- Division of Cancer Biology, The Institute of Cancer Research, London, UK
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22
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Benson C, Ray-Coquard I, Sleijfer S, Litière S, Blay JY, Le Cesne A, Papai Z, Judson I, Schöffski P, Chawla S, Gil T, Piperno-Neumann S, Marréaud S, Dewji MR, van der Graaf WTA. Outcome of uterine sarcoma patients treated with pazopanib: A retrospective analysis based on two European Organisation for Research and Treatment of Cancer (EORTC) Soft Tissue and Bone Sarcoma Group (STBSG) clinical trials 62043 and 62072. Gynecol Oncol 2016; 142:89-94. [PMID: 27012429 DOI: 10.1016/j.ygyno.2016.03.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Uterine sarcomas are a group of mesenchymal tumours comprising several histologies. They have a high recurrence rate following surgery, modest outcome to systemic therapy, and poor overall survival. Pazopanib is a multi-targeted tyrosine kinase inhibitor approved for non-adipocytic advanced soft tissue sarcomas (STS). Here we investigated whether response to pazopanib in patients with uterine sarcomas differs from that of patients with non-uterine sarcomas. PATIENTS AND METHODS Uterine sarcoma patients were retrieved from all soft tissue sarcoma patients treated with pazopanib in EORTC Phase II (n=10) and Phase III (PALETTE) (n=34) studies. Patient and tumour characteristics, response, progression free and overall survival data were compared. RESULTS Forty-four patients with uterine sarcoma were treated with pazopanib. The majority of patients had uterine leiomyosarcoma (LMS) (n=39, 88.6%) with high grade tumours (n=37, 84.1%) compared to 54.8% (n=164) in the non-uterine population. The median age was 55years (range 33-79) and median follow up was 2.3years. Uterine patients were heavily pre-treated, 61.3% having ≥2 lines of chemotherapy prior to pazopanib compared to 40.8% in the non-uterine population. Five patients (11%), all LMS, had a partial response (95% CI 3.8-24.6). Median progression free survival (PFS) 3.0months (95% CI 2.5-4.7) in uterine versus 4.5 (95% CI 3.7-5.1) in non-uterine STS. Median overall survival (OS) was 17.5months (95% CI 11.1-19.6), longer than the non-uterine population, 11.1months (95% CI 10.2-12.0) (p=0.352). CONCLUSIONS Despite heavy pre-treatment, pazopanib shows signs of activity in patients with uterine sarcoma with the similar outcomes to patients with non-uterine STS.
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Affiliation(s)
- C Benson
- Royal Marsden NHS Foundation Trust, London, UK.
| | - I Ray-Coquard
- Centre Leon Berard, University Claude Bernard, Lyon, France
| | - S Sleijfer
- Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S Litière
- EORTC Headquarters, Brussels, Belgium
| | - J-Y Blay
- Centre Leon Berard, University Claude Bernard, Lyon, France
| | - A Le Cesne
- Institut Gustave Roussy, Villejuif, France
| | - Z Papai
- Military Hospital-State Health Centre, Budapest, Hungary
| | - I Judson
- Royal Marsden NHS Foundation Trust, London, UK
| | - P Schöffski
- University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - S Chawla
- Sarcoma Oncology Centre, Santa Monica, USA
| | - T Gil
- Institut Jules Bordet, Brussels, Belgium
| | | | | | - M R Dewji
- Novartis Pharma AG, Basel, Switzerland
| | - W T A van der Graaf
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
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23
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Rieu R, Benson C, Dunlop A, Khabra K, Al-Muderis O, Jones R, Van der Graaf W, Fisher C, Thway K, Messiou C, Judson I, Miah A, Zaidi S. PO-0765: Management of primary cardiac and great vessel sarcomas, The RMH experience 2000-2015. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Khan KH, Yap TA, Ring A, Molife LR, Bodla S, Thomas K, Zivi A, Smith A, Judson I, Banerji U, de Bono JS, Kaye SB. Phase I trial outcomes in older patients with advanced solid tumours. Br J Cancer 2016; 114:262-8. [PMID: 26757260 PMCID: PMC4742590 DOI: 10.1038/bjc.2015.477] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 01/20/2023] Open
Abstract
Background: This study had two aims: (a) to test the hypothesis that advanced age is associated with lower levels of tolerability and clinical benefit to experimental Phase I trial agents; (b) to assess the validity of the Royal Marsden Hospital (RMH) prognostic score as a patient selection tool in older patients. Methods: Clinico-pathological characteristics and treatment outcomes of all patients treated consecutively from 2005 to 2009 in phase I trials at the RMH were recorded. All toxicity and clinical outcome data were compared between patients aged below and above 65 years of age. Results: One thousand and four patients were treated in 30 Phase I trials, with 315 (31%) patients aged 65 years and older. Grade 3–5 toxicities (22.8% vs 24.8% (P=0.52)), trial discontinuation (6% vs 4% P=0.33), and dose interruptions (8.0% vs 8.0% (P=0.96)) were observed at similar rates in patients below and above 65 years of age, respectively. The overall response rate 5.2% vs 4.1%, progression-free survival (PFS) 1.9 vs 3.5 months and clinical benefit rate (CBR) at 6 months 15.2% vs 14.3% were comparable in both groups. To avoid bias due to the potential therapeutic benefit of abiraterone, comparisons were repeated excluding prostate cancer patients with similar results (ORR 4.6% vs 4%, PFS 1.8 vs 3.0 months, CBR at 6 months 13.5% vs 9.5%). Multivariate analysis indicated that the previously identified RMH score (including albumin and lactate dehydrogenase levels) was an accurate predictor of outcome. Conclusions: Phase I clinical trials should be considered in patients with advanced cancers regardless of age, as older patients who enter these have similar safety and efficacy outcomes as their younger counterparts. The RMH prognostic score can assist in the selection of suitable older patients.
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Affiliation(s)
- K H Khan
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK.,Gastrointestinal Cancers Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - T A Yap
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK.,Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - A Ring
- Breast Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - L R Molife
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - S Bodla
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - K Thomas
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - A Zivi
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - A Smith
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - I Judson
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK
| | - U Banerji
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK.,Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - J S de Bono
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK.,Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
| | - S B Kaye
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, UK.,Division of Clinical Studies, The Institute of Cancer Research, Sutton SM2 5NG, UK
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25
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Arouri F, Lee A, Harris S, Jones R, Miah A, Benson C, Judson I. 3444 Low dose oral cyclophosphamide (LDOC) with prednisolone in the treatment of advanced adult soft tissue sarcoma (STS). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Grünwald V, Litiere S, Young R, Messiou C, Michela L, Wardelmann E, Van der Graaf W, Gronchi A, Judson I. 3401 Absence of progression, not extent of remission defines prognosis in soft tissue sarcoma - an analysis of the EORTC 62012 study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31876-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Duffaud F, Sleijfer S, Litière S, Ray-Coquard I, Le Cesne A, Papai Z, Judson I, Schöffski P, Chawla SP, Dewji R, Marreaud S, Verweij J, van der Graaf WT. Hypertension (HTN) as a potential biomarker of efficacy in pazopanib-treated patients with advanced non-adipocytic soft tissue sarcoma. A retrospective study based on European Organisation for Research and Treatment of Cancer (EORTC) 62043 and 62072 trials. Eur J Cancer 2015; 51:2615-23. [PMID: 26321011 DOI: 10.1016/j.ejca.2015.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Reliable biomarkers of pazopanib's efficacy in soft tissue sarcoma (STS) are lacking. Hypertension (HTN) is an on-target effect of vascular endothelial growth factor (VEGF)-receptor inhibitors such as pazopanib. We evaluated the association of pazopanib-induced HTN with antitumour efficacy in patients with metastatic non-adipocytic STS. METHODS Associations between pazopanib-induced-HTN and antitumour efficacy were retrospectively assessed across 2 prospective studies (European Organisation for Research and Treatment of Cancer (EORTC) study 62043 and 62072) in metastatic STS patients who received pazopanib 800 mg daily. Only patients with baseline blood pressure (BP)<150/90 mmHg, were included. BP was measured monthly. HTN was reported according to National Cancer Institute-Common Toxicity Criteria Adverse Events (NCI-CTC AE) grading (v3.0), and as absolute differences compared to baseline. The effect of HTN developing in patients without baseline anti-hypertensive medication was assessed on progression-free (PFS) and overall survival (OS) using a landmark analysis stratified by study; univariately using the Kaplan-Meier method and a log-rank test, and in a multivariate Cox regression model after adjustment for important prognostic factors. RESULTS Of the 337 patients eligible for this analysis, 21.7% received anti-hypertensive medication at baseline and had a similar PFS and OS compared to those who did not. In patients without baseline anti-hypertensive medication, 38.6% developed HTN. As the majority of patients developing HTN did so within 5 weeks after initiation of pazopanib (68.6%), this time point was used as landmark. Univariately, there was no effect on PFS or OS from occurrence of HTN within 5 weeks of treatment expressed either in NCI-CTC AE criteria or as maximal differences from baseline in systolic and diastolic BP. Also in multivariate analysis, after adjusting for important prognostic factors, the occurrence of HTN expressed in the different parameters was not associated with PFS and OS. CONCLUSIONS In this retrospective analysis, pazopanib-induced HTN did not correlate with outcome in pazopanib-treated STS patients. The occurrence of HTN cannot serve as biomarker in this setting.
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Affiliation(s)
- F Duffaud
- La Timone University Hospital & Aix-Marseille University (AMU), Marseilles, France.
| | - S Sleijfer
- Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - S Litière
- EORTC Headquarters, Brussels, Belgium
| | - I Ray-Coquard
- Centre Leon Bérard & University Lyon I, Lyon, France
| | - A Le Cesne
- Institut Gustave Roussy, Villejuif, France
| | - Z Papai
- Military Hospital - State Health Centre, Budapest, Hungary
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - P Schöffski
- Department of General Medical Oncology and Laboratory of Experimental Oncology, University Hospitals, Leuven, Belgium
| | - S P Chawla
- Sarcoma Oncology center, Santa Monica, CA, USA
| | - R Dewji
- GlaxoSmithKline - Oncology R&D, Uxbridge, UK
| | | | - J Verweij
- Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
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28
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Wilkinson MJ, Fitzgerald JEF, Strauss DC, Hayes AJ, Thomas JM, Messiou C, Fisher C, Benson C, Tekkis PP, Judson I. Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib. Br J Surg 2015; 102:965-71. [PMID: 25970743 DOI: 10.1002/bjs.9818] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/01/2015] [Accepted: 03/03/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumours (GISTs) of the rectum often require radical surgery to achieve complete resection. This study investigated the management and outcome of surgery for rectal GISTs and the role of imatinib. METHODS A cohort study was undertaken of patients identified from a database at one tertiary sarcoma referral centre over a continuous period, from January 2001 to January 2013. RESULTS Over 12 years, 19 patients presented with a primary rectal GIST. Median age was 57 (range 30-77) years. Neoadjuvant imatinib was used in 15 patients, significantly reducing mean tumour size from 7·6 (95 per cent c.i. 6·1 to 9·0) to 4·1 (2·8 to 5·3) cm (P < 0·001). Nine of these patients underwent surgical resection. Imatinib therapy enabled sphincter-preserving surgery to be undertaken in seven patients who would otherwise have required abdominoperineal resection or pelvic exenteration for tumour clearance. Neoadjuvant imatinib treatment also led to a significant reduction in mean(s.d.) tumour mitotic count from 16(16) to 4(9) per 50 high-power fields (P = 0·015). Imatinib was used only as adjuvant treatment in two patients. There were three deaths, all from unrelated causes. Eleven of the 13 patients who underwent resection were alive without evidence of recurrence at latest follow-up, with a median disease-free survival of 38 (range 20-129) months and overall survival of 62 (39-162) months. CONCLUSION The use of neoadjuvant imatinib for rectal GISTs significantly decreased both tumour size and mitotic activity, which permitted less radical sphincter-preserving surgery.
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Affiliation(s)
- M J Wilkinson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - J E F Fitzgerald
- Colorectal Surgery Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - D C Strauss
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - A J Hayes
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - J M Thomas
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - C Messiou
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - C Fisher
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - C Benson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - P P Tekkis
- Colorectal Surgery Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - I Judson
- Sarcoma and Melanoma Unit, Department of Academic Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK
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29
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Jönsson L, Justo N, Musayev A, Krishna A, Burke T, Pellissier J, Judson I, Staddon A, Blay JY. Cost of treatment in patients with metastatic soft tissue sarcoma who respond favourably to chemotherpy. The SArcoma treatment and Burden of Illness in North America and Europe (SABINE) study. Eur J Cancer Care (Engl) 2015; 25:466-77. [PMID: 25923192 DOI: 10.1111/ecc.12322] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 12/01/2022]
Abstract
Treatment of metastatic soft tissue sarcoma (mSTS) commonly includes multiple lines of chemotherapy, until a decline in performance status precludes further treatment. The primary objective of this study was to describe the lifetime healthcare resource utilisation and cost among mSTS patients with favourable response to chemotherapy. SABINE was a multi-centre (n = 25), multi-country (n = 9) retrospective chart review study of mSTS patients with favourable response to chemotherapy following 4 cycles. Healthcare resource utilisation was collected from first line until death or end of follow-up. Costs were analysed by health states (defined by treatment line, chemotherapy use and disease progression) and estimated by multiplying the mean weekly cost per health state by the expected number of weeks spent in each health state. Expected per-patient lifetime medical cost was €65 616 (95% CI: €51 454-€85 003); comprised of IV chemotherapy (31.7%), inpatient care (24.8%), concomitant medication (11.0%), oral chemotherapy (8.9%), outpatient visits (8.8%), radiotherapy (6.3%), hospice (4.0%), imaging (3.7%) and laboratory (0.7%). Weekly costs were 280-330% higher during chemotherapy treatment periods than off-chemotherapy, especially after disease progression. Per-patient costs were highest in the USA and lowest in the Netherlands and UK. The economic burden of mSTS is considerable and the amount of resources devoted to its treatment varies across countries.
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Affiliation(s)
- L Jönsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institut, Stockholm
| | - N Justo
- Mapi Group, Stockholm, Sweden
| | | | - A Krishna
- Novartis Pharmaceuticals Corporation, Florham Park, NJ, USA
| | - T Burke
- Global Health Outcomes, Oncology, Global Health Outcomes, Merck, Whitehouse Station, NJ, USA
| | - J Pellissier
- Merck Research Laboratories, Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - I Judson
- Royal Marsden Hospital, London, UK
| | - A Staddon
- Abramson Cancer Center, Pennsylvania Hospital, Philadelphia, PA, 19106, USA
| | - J Y Blay
- Centre Léon Bérard, University Claude Bernard Lyon I, Lyon Cedex, France
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van der Graaf W, Le Cesne A, Mir O, Gelderblom H, Italiano A, Marreaud S, Judson I, Litiere S. Outcome of First-Line Treatment of Elderly Advanced Soft Tissue Sarcoma (Sts) Patients: a Pooled Analysis of Eleven Eortc Soft Tissue and Bone Sarcoma Group Trials. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu354.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cassier PA, Polivka V, Judson I, Soria JC, Penel N, Marsoni S, Verweij J, Schellens JH, Morales-Barrera R, Schöffski P, Voest EE, Gomez-Roca C, Evans TRJ, Plummer R, Gallerani E, Kaye SB, Olmos D. Outcome of patients with sarcoma and other mesenchymal tumours participating in phase I trials: a subset analysis of a European Phase I database. Ann Oncol 2014; 25:1222-8. [PMID: 24608201 DOI: 10.1093/annonc/mdu108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although sarcomas account for only 1% of all solid tumours, patients with sarcomas comprise a larger proportion of patients entering phase I trials, due to the limited number of registered or active drugs for these diseases. To help in patient selection, we evaluated the utility of the predictive Royal Marsden Score which had been derived in carcinoma patients. In addition, we analysed efficacy and toxicity regarding the sarcoma population enrolled in phase I trials. PATIENTS AND METHODS We used data from a European Database comprising 2182 patients treated in phase I trials in 14 European institutions between 2005 and 2007. RESULTS One hundred and seventy-eight patients diagnosed with advanced sarcoma or other mesenchymal tumours were identified and accounted for 217 phase I trial participations during the study period. Histological type, class of drug, number of metastatic sites, high serum lactate dehydrogenase activity (LDH), low albumin and high white blood cell count were independent prognostic factors. Poor performance status (PS), liver metastases and high leucocyte count were associated with increased risk of early death. The class of drug used was the strongest predictor of progression-free survival (PFS) duration, inhibitors of angiogenesis and histone deacetylase giving the best results. Poor PS, high serum LDH and low lymphocyte count correlated with shorter PFS. In this heterogeneous population, PFS with investigational agents appeared comparable with that previously published for patients receiving standard treatments beyond first line. CONCLUSION Prognostic factors in sarcoma patients do not differ from a broader phase I population. Efficacy measures suggest that some patients with sarcoma derive benefit from therapy in this setting which could therefore be considered for patients with no remaining standard therapeutic option.
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Affiliation(s)
- P A Cassier
- Drug Development Unit, The Royal Marsden National Health Service Foundation Trust, Sutton The Institute of Cancer Research, Sutton, UK Departments of Medical Oncology
| | - V Polivka
- Biostatistics, Centre Léon Bérard, Lyon
| | - I Judson
- Drug Development Unit, The Royal Marsden National Health Service Foundation Trust, Sutton The Institute of Cancer Research, Sutton, UK
| | - J-C Soria
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - N Penel
- Department of General Cancer, Centre Oscar Lambret, Lille, France
| | - S Marsoni
- Southern Europe New Drug Organization Foundation, Milan, Italy
| | - J Verweij
- Erasmus University Medical Center, Cancer Institute, Rotterdam
| | - J H Schellens
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R Morales-Barrera
- Research Unit for Molecular Therapy of Cancer, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - E E Voest
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Gomez-Roca
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - T R J Evans
- The Beatson West of UK Cancer Centre, Glasgow
| | - R Plummer
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - E Gallerani
- Department of Oncology, Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
| | - S B Kaye
- Drug Development Unit, The Royal Marsden National Health Service Foundation Trust, Sutton The Institute of Cancer Research, Sutton, UK
| | - D Olmos
- Drug Development Unit, The Royal Marsden National Health Service Foundation Trust, Sutton The Institute of Cancer Research, Sutton, UK
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Cananzi FCM, Judson I, Lorenzi B, Benson C, Mudan S. Multidisciplinary care of gastrointestinal stromal tumour: a review and a proposal for a pre-treatment classification. Eur J Surg Oncol 2013; 39:1171-8. [PMID: 24063969 DOI: 10.1016/j.ejso.2013.08.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 07/31/2013] [Accepted: 08/28/2013] [Indexed: 12/15/2022] Open
Abstract
The introduction of receptor tyrosine kinase inhibitors (TKIs) has revolutionized the management of gastrointestinal stromal tumour (GIST). Strong evidence supports the use of imatinib as first-line treatment in metastatic or unresectable tumours and its efficacy in the post-operative adjuvant setting has been confirmed by phase III trials. There are a number of reports concerning the administration of imatinib in the pre-operative setting, however, the heterogeneity of the terminology used and the indications for pre-operative treatment make it difficult to determine the true value of pre-operative imatinib. Larger studies, or a phase III trial could be helpful but patient accrual and standardization of care could be difficult. We propose a pre-treatment classification of GIST in order to facilitate the comparison and collection of data from different institutions, and overcome the difficulties related to accrual. Moreover, in the current era of multidisciplinary treatment of GIST, an appropriate classification is mandatory to properly design clinical trials and plan stage-adapted treatment.
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Affiliation(s)
- F C M Cananzi
- Department of Surgery, The Royal Marsden, Fulham Road, London SW3 6JJ, UK.
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Bulusu VR, Fullarton J, Leahy M, Morgan C, Rasheed A, Taniere P, Toh S, Verrill M, White J, Judson I. Rationale and design of a UK database for a rare cancer type: the GEM Registry for gastrointestinal stromal tumours. Br J Cancer 2013; 109:1403-7. [PMID: 23963143 PMCID: PMC3776973 DOI: 10.1038/bjc.2013.406] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/23/2013] [Accepted: 06/26/2013] [Indexed: 01/15/2023] Open
Abstract
Background: Despite advances in the management of and changes in clinical practice, little is known about the epidemiology, patterns of care and outcomes of gastrointestinal stromal tumour (GIST) patients in the UK. Patient registries are receiving increasing attention as they can provide important information on clinical practice and patient outcomes. The rationale and study design of the GIST Epidemiology and Management (GEM) Registry, which forms part of the routine clinical practice for GISTs in several UK centres, are described. Methods: The GEM Registry is a secure web-based registry system designed around a Microsoft Access core using SQL interface. Demographic, surgical, histopathological and clinical data will be captured including treatment outcomes and survival. The registry was piloted in six centres and following further fine tuning of the data sets, ethical committee submission and approval was completed. Results: The GEM National Registry is the first of its kind to be implemented in rare cancers in UK. The registry is being rolled out initially in selected centres with the aim to expand to other centres. The first publication reporting analyses of the central data set is anticipated for the summer of 2013. Conclusion: GEM Registry will enable us to obtain a clear picture of incidence/prevalence of GISTS in UK. Clinicians will be able to review the prognostic and predictive value of variables in a large prospective data set. The data can be used for planning the delivery and improving the quality of care. This information is likely to inform clinical practice and, in years to come, guide the development and implementation of clinical trials for novel tyrosine kinase inhibitors. The results will not only benefit the GIST community, but also serve as a basis for the study of other rare tumour types.
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Affiliation(s)
- V R Bulusu
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Penel N, Demetri GD, Blay JY, Cousin S, Maki RG, Chawla SP, Judson I, von Mehren M, Schöffski P, Verweij J, Casali P, Rodenhuis S, Schütte HJ, Cassar A, Gomez J, Nieto A, Zintl P, Pontes MJ, Le Cesne A. Growth modulation index as metric of clinical benefit assessment among advanced soft tissue sarcoma patients receiving trabectedin as a salvage therapy. Ann Oncol 2013; 24:537-542. [PMID: 23117071 PMCID: PMC4271084 DOI: 10.1093/annonc/mds470] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/23/2012] [Accepted: 08/08/2012] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The growth modulation index (GMI) is the ratio of time to progression with the nth line (TTP(n)) of therapy to the TTP(n)(-1) with the n-1th line. GMI >1.33 is considered as a sign of activity in phase II trials. PATIENTS AND METHODS This retrospective analysis evaluated the concordance between the GMI and the efficacy outcomes in 279 patients with advanced soft tissue sarcoma (ASTS) treated with trabectedin 1.5 mg/m² (24-h infusion every 3 weeks) in four phase II trials. RESULTS One hundred and forty-two (51%) patients received one prior line and 137 ≥ 2 lines. The median TTP(n) was 2.8 months (range 0.2-26.8), whereas the median TTP(n)(-1) was 4.0 months (0.3-79.5). The median GMI was 0.6 (0.0-14.4). Overall, 177 patients (63%) had a GMI <1; 21 (8%) a GMI equal to 1-1.33 and 81 (29%) a GMI >1.33, which correlated with the median overall survival in those patients (9.1, 13.9 and 23.8 months, respectively, P = 0.0005). A high concordance rate between the GMI and response rate (P < 0.0001) and progression-free survival (PFS, P < 0.0001) was observed. Good performance status (PS) was the only factor associated with GMI >1.33 (PS = 0; P < 0.04). CONCLUSIONS A high GMI was associated with favorable efficacy outcomes in patients treated with trabectedin. Further research is needed to assess GMI as an indicator in this setting.
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Affiliation(s)
- N Penel
- Medical Oncology Department, Centre Oscar Lambret, Lille, France.
| | - G D Demetri
- Medical Oncology Department, Ludwig Center at Dana-Farber Cancer Institute, Boston, USA
| | - J Y Blay
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - S Cousin
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - R G Maki
- Medical Oncology Department,Mount Sinai School of Medicine, New York
| | - S P Chawla
- Medical Oncology Department, Santa Monica Oncology Center Santa Monica, USA
| | - I Judson
- Medical Oncology Department, Royal Marsden Hospital, London, UK
| | - M von Mehren
- Medical Oncology Department, Fox Chase Cancer Center, Philadelphia, USA
| | - P Schöffski
- Medical Oncology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - J Verweij
- Medical Oncology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P Casali
- Medical Oncology Department, Istituto Nazionale Tumori, Milan, Italy
| | - S Rodenhuis
- Medical Oncology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H J Schütte
- Medical Oncology Department, Marien Hospital, Dûsseldorf, Deutschland
| | - A Cassar
- Scientific liaison office, Novex Pharma, Levallois-Perret, France
| | - J Gomez
- Statistics Department & Medical affairs, Pharmamar, Madrid, Spain
| | - A Nieto
- Statistics Department & Medical affairs, Pharmamar, Madrid, Spain
| | - P Zintl
- Statistics Department & Medical affairs, Pharmamar, Madrid, Spain
| | - M J Pontes
- Statistics Department & Medical affairs, Pharmamar, Madrid, Spain
| | - A Le Cesne
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
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Leahy M, Garcia del Muro X, Reichardt P, Judson I, Staddon A, Verweij J, Baffoe-Bonnie A, Jönsson L, Musayev A, Justo N, Burke T, Blay J. Chemotherapy treatment patterns and clinical outcomes in patients with metastatic soft tissue sarcoma. The SArcoma treatment and Burden of Illness in North America and Europe (SABINE) study. Ann Oncol 2012; 23:2763-2770. [DOI: 10.1093/annonc/mds070] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Judson I. Why were IGF-1R Inhibitors Disappointing? Can we Improve Activity by Better Patient Selection or Use of Combinations? Ann Oncol 2012. [DOI: 10.1093/annonc/mds388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gough N, Smith C, Ross J, Riley J, Judson I. A Prognostic Score to Guide Appropriate Delivery of First Line Palliative Chemotherapy for Advanced Soft Tissue Sarcoma. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)34044-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Leach MO, Morgan B, Tofts PS, Buckley DL, Huang W, Horsfield MA, Chenevert TL, Collins DJ, Jackson A, Lomas D, Whitcher B, Clarke L, Plummer R, Judson I, Jones R, Alonzi R, Brunner T, Koh DM, Murphy P, Waterton JC, Parker G, Graves MJ, Scheenen TWJ, Redpath TW, Orton M, Karczmar G, Huisman H, Barentsz J, Padhani A. Imaging vascular function for early stage clinical trials using dynamic contrast-enhanced magnetic resonance imaging. Eur Radiol 2012; 22:1451-64. [PMID: 22562143 DOI: 10.1007/s00330-012-2446-x] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/23/2012] [Accepted: 02/28/2012] [Indexed: 12/11/2022]
Abstract
Many therapeutic approaches to cancer affect the tumour vasculature, either indirectly or as a direct target. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become an important means of investigating this action, both pre-clinically and in early stage clinical trials. For such trials, it is essential that the measurement process (i.e. image acquisition and analysis) can be performed effectively and with consistency among contributing centres. As the technique continues to develop in order to provide potential improvements in sensitivity and physiological relevance, there is considerable scope for between-centre variation in techniques. A workshop was convened by the Imaging Committee of the Experimental Cancer Medicine Centres (ECMC) to review the current status of DCE-MRI and to provide recommendations on how the technique can best be used for early stage trials. This review and the consequent recommendations are summarised here. Key Points • Tumour vascular function is key to tumour development and treatment • Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can assess tumour vascular function • Thus DCE-MRI with pharmacokinetic models can assess novel treatments • Many recent developments are advancing the accuracy of and information from DCE-MRI • Establishing common methodology across multiple centres is challenging and requires accepted guidelines.
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Affiliation(s)
- M O Leach
- Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research & Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2, 5PT, UK.
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Arkenau HT, Plummer R, Molife LR, Olmos D, Yap TA, Squires M, Lewis S, Lock V, Yule M, Lyons J, Calvert H, Judson I. A phase I dose escalation study of AT9283, a small molecule inhibitor of aurora kinases, in patients with advanced solid malignancies. Ann Oncol 2012; 23:1307-1313. [PMID: 22015452 DOI: 10.1093/annonc/mdr451] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AT9283 is an inhibitor of aurora kinases A and B with antitumor activity in preclinical models. This a First in Human phase I study assessed the safety, tolerability, pharmacokinetic and pharmacodynamic properties and preliminary efficacy of AT9283. PATIENTS AND METHODS Patients with advanced tumors received AT9283 as a continuous central venous infusion over 3 days in cohorts of three to six patients starting at 1.5 mg/m(2)/day (equivalent to 4.5 mg/m(2)/72 h). The oral bioavailability of AT9283 was assessed in a cohort of seven patients. Pharmacodynamic analysis of biomarkers included phosphorylation of histone H3 on serine 10, proliferating cell nuclear antigen, Ki67, M30 and M65 in skin and plasma. RESULTS Forty patients were included in all analyses. AT9283 was generally well tolerated with main toxic effects of reversible dose-related myelosuppression, gastrointestinal disturbance, fatigue and alopecia. The dose-limiting toxicity of AT9283 was grade 3 febrile neutropenia in two patients at 36 mg/m(2)/72 h and the maximum tolerated dose (MTD) was established at 27 mg/m(2)/72 h. Systemic exposure was dose proportional. The mean oral bioavailability of a 0.9 mg/m(2) dose was 29.4% (range 11.2%-36.7%). Pharmacodynamic analyses indicated antiproliferative and apoptotic activity of AT9283. Four patients with esophageal, non-small-cell lung cancer (n = 2) and colorectal cancer demonstrated RECIST stable disease ≥ 6 months. CONCLUSION AT9283 was well tolerated up to the MTD of 27 mg/m(2)/72 h. AT9283 is currently assessed in phase II trials.
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Affiliation(s)
- H-T Arkenau
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Surrey, London
| | - R Plummer
- Northern Centre for Cancer Treatment, Newcastle upon Tyne
| | - L R Molife
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Surrey, London
| | - D Olmos
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Surrey, London
| | - T A Yap
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Surrey, London
| | - M Squires
- Astex Therapeutics Ltd, Cambridge, UK
| | - S Lewis
- Astex Therapeutics Ltd, Cambridge, UK
| | - V Lock
- Astex Therapeutics Ltd, Cambridge, UK
| | - M Yule
- Astex Therapeutics Ltd, Cambridge, UK
| | - J Lyons
- Astex Therapeutics Ltd, Cambridge, UK
| | - H Calvert
- Northern Centre for Cancer Treatment, Newcastle upon Tyne
| | - I Judson
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Surrey, London.
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Abstract
Soft tissue sarcomas are rare cancers but because of their association with characteristic chromosomal translocations and activating mutations they may be particularly susceptible to molecularly targeted therapies. Gastrointestinal stromal tumour (GIST) became the paradigm for targeted therapy in solid tumours owing to the success of imatinib, which has transformed the prognosis in this disease. Translocation-driven tumours have proved harder to target, but the impact of fusion proteins on gene expression is beginning to be understood and may also reveal new targets for therapy, such as insulin-like growth factor 1 receptor, now that effective inhibitors have been discovered. Angiogenesis inhibition also appears to be a promising area for research in sarcomas and many new targets are emerging at the same time as agents capable of investigating them in the clinic are being developed. It is not unrealistic to hope that targeted therapies will play an increasing role in the management of sarcomas in the near future.
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Affiliation(s)
- I Judson
- Sarcoma Unit, Royal Marsden Hospital, Fulham Road, London, UK.
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Affiliation(s)
- I Judson
- Sarcoma Unit Royal Marsden Hospital Fulham Road London SW3 6JJ UK
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Abstract
Purpose: The aim of this study was to assess treatment and outcome with respect to clinical and pathological features. Patients and methods: Thirty-nine patients were identified (range 7–66 years, mean 23). Initial treatment comprised local
excision in 11 patients and wide excision in 14. Post-operative external beam radiotherapy was prescribed in 22 patients
with a total dose of 60 Gy, delivered in two phases. Results: The cause-specific survival for the entire group was 79, 63, 56 and 45% at 1, 3, 5 and 10 years, respectively. A distal
limb location was associated with a better prognosis than proximal limb location (P = 0.04). Conclusions: Our data favour treatment with wide functional excision followed by radical dose radiotherapy in attempt to
minimize risk of local recurrence, especially when primary tumours are bigger than 3 cm. Our data also suggest the same
treatment for local recurrence, when technically possible, to avoid amputation.
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Affiliation(s)
- L Livi
- Radiotherapy Department Florence University Florence Italy
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Lee CP, Payne GS, Oregioni A, Ruddle R, Tan S, Raynaud FI, Eaton D, Campbell MJ, Cross K, Halbert G, Tracy M, McNamara J, Seddon B, Leach MO, Workman P, Judson I. A phase I study of the nitroimidazole hypoxia marker SR4554 using 19F magnetic resonance spectroscopy. Br J Cancer 2009; 101:1860-8. [PMID: 19935799 PMCID: PMC2788261 DOI: 10.1038/sj.bjc.6605425] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: SR4554 is a fluorine-containing 2-nitroimidazole, designed as a hypoxia marker detectable with 19F magnetic resonance spectroscopy (MRS). In an initial phase I study of SR4554, nausea/vomiting was found to be dose-limiting, and 1400 mg m−2 was established as MTD. Preliminary MRS studies demonstrated some evidence of 19F retention in tumour. In this study we investigated higher doses of SR4554 and intratumoral localisation of the 19F MRS signal. Methods: Patients had tumours ⩾3 cm in diameter and ⩽4 cm deep. Measurements were performed using 1H/19F surface coils and localised 19F MRS acquisition. SR4554 was administered at 1400 mg m−2, with subsequent increase to 2600 mg m−2 using prophylactic metoclopramide. Spectra were obtained immediately post infusion (MRS no. 1), at 16 h (MRS no. 2) and 20 h (MRS no. 3), based on the SR4554 half-life of 3.5 h determined from a previous study. 19Fluorine retention index (%) was defined as (MRS no. 2/MRS no. 1)*100. Results: A total of 26 patients enrolled at: 1400 (n=16), 1800 (n=1), 2200 (n=1) and 2600 mg m−2 (n=8). SR4554 was well tolerated and toxicities were all ⩽grade 1; mean plasma elimination half-life was 3.7±0.9 h. SR4554 signal was seen on both unlocalised and localised MRS no. 1 in all patients. Localised 19F signals were detected at MRS no. 2 in 5 out of 9 patients and 4 out of 5 patients at MRS no. 3. The mean retention index in tumour was 13.6 (range 0.6–43.7) compared with 4.1 (range 0.6–7.3) for plasma samples taken at the same times (P=0.001) suggesting 19F retention in tumour and, therefore, the presence of hypoxia. Conclusion: We have demonstrated the feasibility of using 19F MRS with SR4554 as a potential method of detecting hypoxia. Certain patients showed evidence of 19F retention in tumour, supporting further development of this technique for detection of tumour hypoxia.
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Affiliation(s)
- C P Lee
- Cancer Research UK Centre for Cancer Therapeutics, Cancer Research UK Clinical Magnetic Resonance Research Group and Section of Medicine, The Institute of Cancer Research and Drug Development Unit, The Royal Marsden Hospital, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
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Ranson M, Shaw H, Wolf J, Hamilton M, McCarthy S, Dean E, Reid A, Judson I. A phase I dose-escalation and bioavailability study of oral and intravenous formulations of erlotinib (Tarceva®, OSI-774) in patients with advanced solid tumors of epithelial origin. Cancer Chemother Pharmacol 2009; 66:53-8. [DOI: 10.1007/s00280-009-1133-3] [Citation(s) in RCA: 27] [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: 07/22/2009] [Accepted: 09/07/2009] [Indexed: 11/29/2022]
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Gardner K, Judson I, Leahy M, Barquin E, Marotti M, Collins B, Young H, Scurr M. 9404 A Phase II study of cediranib in patients with metastatic gastrointestinal stromal tumours (GIST) and metastatic soft tissue sarcoma (STS) (including alveolar soft part sarcoma [ASPS]). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71992-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Demetri G, Blay J, Yovine A, Judson I, Maki R, Schuetze S, von Mehren M, Chawla S, Lebedinsky C, Le Cesne A. 9402 Efficacy and safety of trabectedin in soft tissue sarcoma (STS) are independent of patient age. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71990-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gardner K, Judson I, Leahy M, Barquin E, Marotti M, Collins B, Young H, Scurr M. Activity of cediranib, a highly potent and selective VEGF signaling inhibitor, in alveolar soft part sarcoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10523] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [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
10523 Background: Alveolar soft part sarcoma (ASPS) is a rare entity making up <1% of soft tissue sarcomas (STS). It is typically indolent but with a high incidence of metastatic disease, usually to lungs, but also to sites such as the brain. Response to conventional chemotherapy is poor (overall response rates are approximately 7% [Reichardt P et al,Eur J Cancer.2003;39:1511–1516]). This is a preliminary report of the activity of cediranib, a highly potent and selective VEGF signaling inhibitor, in this disease. Methods: Efficacy and tolerability data were collected for seven patients with ASPS. One patient was treated in a phase II randomized trial of cediranib ± prophylactic antihypertensive therapy and six were treated in a Phase II study in patients with imatinib-refractory gastrointestinal stromal tumors or other STS. Cediranib was administered orally, once daily at an initial dose of 45 mg. Response was assessed using RECIST (Response Evaluation Criteria in Solid Tumors). Results: Median age at diagnosis was 39 years (range: 26–49). All patients had pulmonary metastases and two had additional sites of disease (brain, bone, intra-abdominal) at study entry. Adverse events were generally CTC grade 1–2 and manageable. The most common adverse events were fatigue (n = 6), diarrhea (n = 5), stomatitis (n = 4), headache (n = 3), and hypertension (n = 3). Four patients had a best response of partial response, two patients had a confirmed reduction in maximum tumor diameter of ≥10% and <30% and one patient experienced stable disease. As of November 2008, three patients remain on treatment with a median (range) time on study of 61 weeks (49–74). Time to progression and progression-free survival will be calculated and available at the time of presentation. Conclusions: These data demonstrate the promising preliminary activity and safety of chronic administration of cediranib in this disease. Further investigation is warranted, particularly as there is no effective systemic treatment for patients with advanced ASPS. [Table: see text]
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Affiliation(s)
- K. Gardner
- Royal Marsden Hospital, London, United Kingdom; The Christie Hospital, Manchester, United Kingdom; AstraZeneca, Alderley Park, Macclesfield, United Kingdom
| | - I. Judson
- Royal Marsden Hospital, London, United Kingdom; The Christie Hospital, Manchester, United Kingdom; AstraZeneca, Alderley Park, Macclesfield, United Kingdom
| | - M. Leahy
- Royal Marsden Hospital, London, United Kingdom; The Christie Hospital, Manchester, United Kingdom; AstraZeneca, Alderley Park, Macclesfield, United Kingdom
| | - E. Barquin
- Royal Marsden Hospital, London, United Kingdom; The Christie Hospital, Manchester, United Kingdom; AstraZeneca, Alderley Park, Macclesfield, United Kingdom
| | - M. Marotti
- Royal Marsden Hospital, London, United Kingdom; The Christie Hospital, Manchester, United Kingdom; AstraZeneca, Alderley Park, Macclesfield, United Kingdom
| | - B. Collins
- Royal Marsden Hospital, London, United Kingdom; The Christie Hospital, Manchester, United Kingdom; AstraZeneca, Alderley Park, Macclesfield, United Kingdom
| | - H. Young
- Royal Marsden Hospital, London, United Kingdom; The Christie Hospital, Manchester, United Kingdom; AstraZeneca, Alderley Park, Macclesfield, United Kingdom
| | - M. Scurr
- Royal Marsden Hospital, London, United Kingdom; The Christie Hospital, Manchester, United Kingdom; AstraZeneca, Alderley Park, Macclesfield, United Kingdom
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Pacey SC, Wilson R, Walton M, Eatock M, Zetterlund A, Arkenau H, Beecham R, Raynaud F, Workman P, Judson I. A phase I trial of the HSP90 inhibitor, alvespimycin (17-DMAG) administered weekly, intravenously, to patients with advanced, solid tumours. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3534] [Citation(s) in RCA: 7] [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
3534 Background: alvespimycin (17-dimethylaminoethylamino-17-demethoxygeldanamycin, 17-DMAG) inhibits N-terminal ATPase activity of Heat Shock Protein 90 (HSP90). Chaperone interactions are altered such that client proteins are targeted for degradation. The plethora of HSP90 client proteins offers the potential of simultaneous blockade across multiple, oncogenic signalling pathways. Methods: the maximum tolerated dose, at which ≤ 1/6 patients experienced dose limiting toxicity (DLT) was determined by dose-doubling (3+3) design. PK and PD biomarker data were used to define a biologically effective dose (BED). PK (LC/MS/MS) and PD (western blot) assays were validated and compliant with European clinical trial legislation. Cancer Research UK and the NCI were co-sponsors. Results: twenty five patients, median age 58 (range 38–78) years, received 475 infusions at doses between 2.5 and 106 mg/m2. Dose doubling was possible to 80mg/m2 when grade 2 toxicity, including dry eye and blurred vision (2/5 patients) occurred. At 106mg/m2 DLT were observed (grade 3 fatigue, diarrhoea, dehydration and grade 4 hypotension, AST rise) in 2/4 patients, one patient died from cardiac arrest. PK data were as follows; plasma t = 24.6 ± 8.6 hr, Vss 468 ± 383 L (mean ± SD) and clearance 27.7 L/hr (range 8.26 - 153). Maximum plasma concentration increased proportionally with alvespimycin dose, area under the curve was only linear ≤ 80 mg/m2. PD changes (HSP72 induction) in peripheral blood mononuclear cells were detected ≥ 20 mg/m2. HSP90 inhibition (client protein depletion and HSP72 induction) was not readily detected until 106 mg/m2. Tumour samples confirmed HSP90 inhibition 24 hours after 17-DMAG in 1/1 and 2/4 patients given 106 and 80 mg/m2, respectively. Two partial responses one, confirmed, in a patient with hormone refractory prostate cancer and one, investigator assessed, in a patient with melanoma occurred. Both remain on study after 27 and 18 months, respectively. Nine patients (36%) have been on trial ≥16 weeks. Conclusions: The recommended phase II dose of alvespimycin is 80 mg/m2 weekly. PK and PD data support this as a BED. No significant financial relationships to disclose.
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Affiliation(s)
- S. C. Pacey
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - R. Wilson
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - M. Walton
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - M. Eatock
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - A. Zetterlund
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - H. Arkenau
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - R. Beecham
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - F. Raynaud
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - P. Workman
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
| | - I. Judson
- The Institute of Cancer Research, Belmont Surrey, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Cancer Research UK, London, United Kingdom
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Van Glabbeke MM, Verweij J, Casali P, Zalcberg J, Le Cesne A, Reichardt P, Issels R, Judson I, Debiec-Rychter M, Blay J. Type of progression in patients treated with imatinib for advanced gastrointestinal stromal tumor (GIST): A study based on the EORTC-ISG-AGITG trial 62005. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10536] [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
10536 Background: Development of resistance in GIST patients responding to targeted agents is heterogeneous, and different types of mutations may be observed in different lesions of the same patient. Progressive disease (PD) is defined as increase in size of initial lesions, occurrence of new lesions, or both (RECIST): mixed progression (MXPD), were new lesions develop when old lesions are still responding could represent a different type of biological event. We evaluated the impact of progression type and time to first PD (TTP) on survival after progression (SAP) in a randomized phase III trial comparing two doses of imatinib as first line treatment of GIST in 946 patients. Methods: PD was classified into 5 categories: PD in old lesion without new lesions (PD-), and new lesions associated with CR (CR+), PR (PR+), NC (NC+) and finally PD (PD+); MXPD was defined as CR+ or PR+. We investigated the correlations between type of PD, baseline patients’ characteristics, imatinib dose, TTP and SAP with univariate (UVA) and multivariate (MVA) analysis. Results: Currently, 516 patients with PD have been radiologically documented. PD-, CR+, PR+, NC+, and PD+ were observed respectively in 47%, 2%, 10%, 8%, and 33% of the cases. MXPD was more frequent in patients without prior chemotherapy (15% vs 8%), or with a long TTP (0–6 m: 1%; 6–12 m: 8%; 12–24 m: 12%; 24–60 m: 19%; 60+ m: 25%). MXPD was less frequent in KIT exon 9 mutants (7%) and wild types (4%) than in KIT exon 11 mutants (17%) (UVA), but this is entirely explained by their shorter TTP (MVA). No other correlation was found with imatinib dose or baseline factors. SAP was shown to increases with TTP (P<0.0001), and was independently (and adversely) affected by PD of old lesions and development of new lesions: when compared to PD- patients, TTP adjusted SAP hazard ratio for patients with new lesions were 0.28 (CR+), 1.07 (PR+), 1.32 (NC+) and 1.61 (PD+). SAP was longer after MXPD (UVA), but this is explained by their longer TTP (MVA). Conclusions: In GIST patients treated with imatinib, survival after first progression increases with time to progression and decreases with “severity” of progression. Mixed progressions occur later than other types of progression, and therefore lead to a longer further survival. [Table: see text]
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Affiliation(s)
- M. M. Van Glabbeke
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - J. Verweij
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - P. Casali
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - J. Zalcberg
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - A. Le Cesne
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - P. Reichardt
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - R. Issels
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - I. Judson
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - M. Debiec-Rychter
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
| | - J. Blay
- EORTC Headquarters, Brussels, Belgium; Erasmus University Medical Center, Rotterdam, Netherlands; Istituto Nazionale dei Tumori, Milan, Italy; Peter MacCallum Cancer Institute, East Melbourne, Australia; Institut Gustave Roussy, Villejuif, France; HELIOS Klinikum Berlin-Buch, Berlin, Germany; Klinikum Grosshadern, Muenchen, Germany; Royal Marsden Hospital, London, United Kingdom; U.Z. Gasthuisberg, Leuven, Belgium; Center Leon Berard, Lyon, France
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Constantinidou A, Scurr M, Jones R, Al-Muderis O, Judson I. Treatment of aggressive fibromatosis with pegylated liposomal doxorubicin: The Royal Marsden Hospital experience. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.10519] [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
10519 Background: Aggressive fibromatosis (AF) or desmoid tumors are monoclonal proliferations which are locally invasive but do not metastasise. Sporadic tumors are usually associated with mutations in the beta-catenin gene CTNNB1whereas those occurring in the context of familial adenomatous polyposis usually have inactivating mutations in APC. Histologically they are characterised by nuclear expression of beta-catenin. When surgery and radiotherapy are not applicable or fail to control the disease, systemic treatment with anti-oestrogens, non steroidal anti-inflammatory drugs (NSAIDs) and chemotherapy can be used. A variety of regimens are reported to have activity including methotrexate/vinblastine and doxorubicin/dacarbazine. Recent reports indicate that single agent pegylated liposomal doxorubicin (Caelyx, C) is also effective. Methods: Ten patients with AF received C between June 2006 and December 2008. C was administered intravenously at 50 mg/m2 over 1 hour every 4 weeks. Results: The female/male ratio was 9:1 and the median age at presentation was 39.5 years (range 18–53). All patients had progressive fibromatosis. Fifty percent had previously been treated with surgery/radiotherapy or both. All but one had previous systemic therapy which comprised tamoxifen/toremifene (6), NSAIDs (1), chemotherapy (1) and imatinib (1). C was well tolerated with mucositis (6/10), palmar-plantar erythema (4/10) and fatigue (2/10) being the main toxicities. A dose reduction to 40 mg/m2 was required in 50% of cases hence the optimal dose lies between 40 and 50 mg/m2. One patient is currently receiving treatment and is too early to assess. For the nine patients who have completed treatment the median number of C cycles was 6 (range 4–6). Objective response according to RECIST was achieved in 4/10 patients and in 5 patients the best response was stable disease. Clinical benefit (pain relief, improved mobility) was observed in all patients. The duration of response ranged from 4 to 28 months. Conclusions: This is the largest series of patients with AF receiving C presented to date. C as single agent therapy has acceptable toxicity and highly promising activity in unresectable AF and may provide long term clinical benefit in some patients. No significant financial relationships to disclose.
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Affiliation(s)
| | - M. Scurr
- The Royal Marsden Hospital, London, United Kingdom
| | - R. Jones
- The Royal Marsden Hospital, London, United Kingdom
| | | | - I. Judson
- The Royal Marsden Hospital, London, United Kingdom
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