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Mezger NCS, Feuchtner J, Griesel M, Hämmerl L, Seraphin TP, Zietsman A, Péko JF, Tadesse F, Buziba NG, Wabinga H, Nyanchama M, Borok MZ, Kéita M, N'da G, Lorenzoni CF, Akele-Akpo MT, Gottschick C, Binder M, Mezger J, Jemal A, Parkin DM, Wickenhauser C, Kantelhardt EJ. Clinical presentation and diagnosis of adult patients with non-Hodgkin lymphoma in Sub-Saharan Africa. Br J Haematol 2020; 190:209-221. [PMID: 32181503 DOI: 10.1111/bjh.16575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/16/2019] [Revised: 02/16/2020] [Accepted: 02/20/2020] [Indexed: 12/24/2022]
Abstract
Non-Hodgkin lymphoma (NHL) is the sixth most common cancer in Sub-Saharan Africa (SSA). Comprehensive diagnostics of NHL are essential for effective treatment. Our objective was to assess the frequency of NHL subtypes, disease stage and further diagnostic aspects. Eleven population-based cancer registries in 10 countries participated in our observational study. A random sample of 516 patients was included. Histological confirmation of NHL was available for 76.2% and cytological confirmation for another 17.3%. NHL subclassification was determined in 42.1%. Of these, diffuse large B cell lymphoma, chronic lymphocytic leukaemia and Burkitt lymphoma were the most common subtypes identified (48.8%, 18.4% and 6.0%, respectively). We traced 293 patients, for whom recorded data were amended using clinical records. For these, information on stage, human immunodeficiency virus (HIV) status and Eastern Cooperative Oncology Group Performance Status (ECOG PS) was available for 60.8%, 52.6% and 45.1%, respectively. Stage at diagnosis was advanced for 130 of 178 (73.0%) patients, HIV status was positive for 97 of 154 (63.0%) and ECOG PS was ≥2 for 81 of 132 (61.4%). Knowledge about NHL subclassification and baseline clinical characteristics is crucial for guideline-recommended treatment. Hence, regionally adapted investments in pathological capacity, as well as standardised clinical diagnostics, will significantly improve the therapeutic precision for NHL in SSA.
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Affiliation(s)
- Nikolaus C S Mezger
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jana Feuchtner
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Mirko Griesel
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lucia Hämmerl
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias P Seraphin
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Annelle Zietsman
- African Cancer Registry Network, Oxford, UK.,Dr AB May Cancer Care Centre, Windhoek, Namibia
| | - Jean-Félix Péko
- African Cancer Registry Network, Oxford, UK.,Registre des Cancers de Brazzaville, Brazzaville, Republic of the Congo
| | - Fisihatsion Tadesse
- African Cancer Registry Network, Oxford, UK.,Division of Hematology, Department of Internal Medicine, University and Black Lion Hospital, Addis Ababa, Ethiopia
| | - Nathan G Buziba
- African Cancer Registry Network, Oxford, UK.,Eldoret Cancer Registry, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Henry Wabinga
- African Cancer Registry Network, Oxford, UK.,Kampala Cancer Registry, Makerere University School of Medicine, Kampala, Uganda
| | - Mary Nyanchama
- African Cancer Registry Network, Oxford, UK.,National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Margaret Z Borok
- African Cancer Registry Network, Oxford, UK.,Zimbabwe National Cancer Registry, Harare, Zimbabwe
| | - Mamadou Kéita
- African Cancer Registry Network, Oxford, UK.,Service du Laboratoire d'Anatomie et Cytologie Pathologique, CHU du point G, Bamako, Mali
| | - Guy N'da
- African Cancer Registry Network, Oxford, UK.,Registre des Cancers d'Abidjan, Abidjan, Côte d'Ivoire
| | - Cesaltina F Lorenzoni
- African Cancer Registry Network, Oxford, UK.,Departamento de Patologia, Faculdade de Medicina Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Marie-Thérèse Akele-Akpo
- African Cancer Registry Network, Oxford, UK.,Département d'Anatomo-Pathologie, Faculté des Sciences de la Santé, Cotonou, Benin
| | - Cornelia Gottschick
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology and Hematology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | | | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Donald M Parkin
- African Cancer Registry Network, Oxford, UK.,Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claudia Wickenhauser
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Eva J Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.,Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Roubaud E, Mezger J. La nourriture larvaire n’influe pas sur le développement de l’autogénèse, chez les races de Culex pipiens spécifiquement anautogènes. ACTA ACUST UNITED AC 2017. [DOI: 10.1051/parasite/1934125340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Spigel D, Bondarenko I, Losonczy G, Mezger J, Kalofonos H, Reck M, Palmero R, Jang T, Natale R, Sanborn R, Lai J, Kallinteris N, Tang M, Shan J, Gerber D. Top-line results from SUNRISE: A phase III, randomized, double-blind, placebo-controlled multicenter trial of bavituximab plus docetaxel in patients with previously treated stage IIIb/iv non-squamous non-small cell lung cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.44] [Citation(s) in RCA: 2] [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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Wirtz H, Lang S, Mezger J, Hammerschmidt S, Gaska T, Lerchenmueller C, Reck M, Haas S, Reichert D, Hoeffken G. Bevacizumab in routine clinical practice for first-line therapy with platinum-based chemotherapy of patients with advanced adenocarcinoma of the lung in Germany. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.77] [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: 11/13/2022] Open
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Reck M, Thomas M, Kropf-Sanchen C, Mezger J, Socinski MA, Depenbrock H, Soldatenkova V, Brown J, Krause T, Thatcher N. Necitumumab plus Gemcitabine and Cisplatin as First-Line Therapy in Patients with Stage IV EGFR- Expressing Squamous Non-Small-Cell Lung Cancer: German Subgroup Data from an Open-Label, Randomized Controlled Phase 3 Study (SQUIRE). Oncol Res Treat 2016; 39:539-47. [PMID: 27614872 DOI: 10.1159/000448085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the SQUIRE study, adding the anti-epidermal growth factor receptor (EGFR) IgG1 antibody necitumumab to first-line gemcitabine and cisplatin (GC + N) in advanced squamous non-small-cell lung cancer (sqNSCLC) significantly improved overall survival (OS); the safety profile was acceptable. We explored data for the German subpopulation (N = 96) of SQUIRE patients with EGFR-expressing tumors. PATIENT AND METHODS Patients with stage IV sqNSCLC were randomized 1:1 to up to 6 cycles of open-label GC + N or GC alone. GC + N patients with no progression continued on necitumumab monotherapy until disease progression or intolerable toxicity. The primary endpoint was OS; the secondary endpoints included progression-free survival (PFS), safety and health-related quality of life (EQ-5D, Lung Cancer Symptom Scale (LCSS)). RESULTS The 96 German SQUIRE patients with EGFR-expressing tumors (GC + N 42, GC 54) received a median of 4 GC cycles; the GC + N patients received 5 cycles of necitumumab. Adding necitumumab was associated with 41% risk reduction of death (hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.37-0.94, p = 0.026) and 44% risk reduction of progression (HR 0.56, 95% CI 0.33-0.95, p = 0.029). Adverse events typically associated with EGFR antibody treatment (including rash, hypomagnesemia) were more common with GC + N. The time to deterioration of the EQ-5D and LCSS scores showed no notable differences between the treatment arms, except for appetite loss (delayed for GC + N). CONCLUSION The survival benefit from adding necitumumab to first-line GC was more pronounced in the German SQUIRE subpopulation with EGFR-expressing tumors than in the overall (intention-to-treat) population; toxicity was manageable and consistent with the overall population.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN), German Center for Lung Research (DZL), German Center for Lung Research (DZL), LungenClinic Grosshansdorf, Grosshansdorf, Germany
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Wirtz H, Mezger J, Gaska T, Lerchenmueller C, Reck M, Reichert D. 3032 A non-comparative, single-arm observational study conducted as a non-interventional study (NIS) to monitor the routine clinical practice of bevacizumab in combination with platinum-based chemotherapy in patients with unresectable advanced, metastatic or recurrent adenocarcinoma of the lung in Germany. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mezger J. Exemption: Promyelocytic Leukemia. Dtsch Arztebl Int 2015; 112:505. [PMID: 26249254 PMCID: PMC4555063 DOI: 10.3238/arztebl.2015.0505b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Jörg Mezger
- *Medizinischen Klinik 2–Hämatologie, Onkologie, Immunologie, Palliativmedizin, St. Vincentius-Kliniken Karlsruhe,
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Behringer K, Goergen H, Hitz F, Zijlstra JM, Greil R, Markova J, Sasse S, Fuchs M, Topp MS, Soekler M, Mathas S, Meissner J, Wilhelm M, Koch P, Lindemann HW, Schalk E, Semrau R, Kriz J, Vieler T, Bentz M, Lange E, Mahlberg R, Hassler A, Vogelhuber M, Hahn D, Mezger J, Krause SW, Skoetz N, Böll B, von Tresckow B, Diehl V, Hallek M, Borchmann P, Stein H, Eich H, Engert A. Omission of dacarbazine or bleomycin, or both, from the ABVD regimen in treatment of early-stage favourable Hodgkin's lymphoma (GHSG HD13): an open-label, randomised, non-inferiority trial. Lancet 2015; 385:1418-27. [PMID: 25539730 DOI: 10.1016/s0140-6736(14)61469-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The role of bleomycin and dacarbazine in the ABVD regimen (ie, doxorubicin, bleomycin, vinblastine, and dacarbazine) has been questioned, especially for treatment of early-stage favourable Hodgkin's lymphoma, because of the drugs' toxicity. We aimed to investigate whether omission of either bleomycin or dacarbazine, or both, from ABVD reduced the efficacy of this regimen in treatment of Hodgkin's lymphoma. METHODS In this open-label, randomised, multicentre trial (HD13) we compared two cycles of ABVD with two cycles of the reduced-intensity regimen variants ABV (doxorubicin, bleomycin, and vinblastine), AVD (doxorubicin, vinblastine, and dacarbazine), and AV (doxorubicin and vinblastine), in patients with newly diagnosed, histologically proven, classic or nodular, lymphocyte predominant Hodgkin's lymphoma. In each treatment group, 30 Gy involved-field radiotherapy (IFRT) was given after both cycles of chemotherapy were completed. From Jan 28, 2003, patients were centrally randomly assigned (1:1:1:1) with a minimisation method to the four groups. Because of high event rates, assignment to the AV and ABV groups stopped early, on Sept 30, 2005, and Feb 10, 2006; assignment to ABVD and AVD continued (1:1) until Sept 30, 2009. Our primary objective was to show non-inferiority of the experimental variants compared with ABVD in terms of freedom from treatment failure (FFTF), by excluding a difference of 6% after 5 years corresponding to a hazard ratio (HR) of 1.72, via a 95% CI. Analyses reported here include qualified patients only, and between-group comparisons include only patients recruited during the same period. The trial was registered, number ISRCTN63474366. FINDINGS Of 1502 qualified patients, 566, 198, 571, and 167 were randomly assigned to receive ABVD, ABV, AVD, or AV, respectively. 5 year FFTF was 93.1%, 81.4%, 89.2%, and 77.1% with ABVD, ABV, AVD, and AV, respectively. Compared with ABVD, inferiority of the dacarbazine-deleted variants was detected with 5 year differences of -11.5% (95% CI -18.3 to -4.7; HR 2.06 [1.21 to 3.52]) for ABV and -15.2% (-23.0 to -7.4; HR 2.57 [1.51 to 4.40]) for AV. Non-inferiority of AVD compared with ABVD could also not be detected (5 year difference -3.9%, -7.7 to -0·1; HR 1.50, 1.00 to 2.26). 178 (33%) of 544 patients given ABVD had WHO grade III or IV toxicity, compared with 53 (28%) of 187 given ABV, 142 (26%) of 539 given AVD, and 40 (26%) of 151 given AV. Leucopenia was the most common event, and highest in the groups given bleomycin. INTERPRETATION Dacarbazine cannot be omitted from ABVD without a substantial loss of efficacy. With respect to our predefined non-inferiority margin, bleomycin cannot be safely omitted either, and the standard of care for patients with early-stage favourable Hodgkin's lymphoma should remain ABVD followed by IFRT. FUNDING Deutsche Krebshilfe and Swiss State Secretariat for Education and Research.
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Affiliation(s)
- Karolin Behringer
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Helen Goergen
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Felicitas Hitz
- Cantonal Hospital of St Gallen, St Gallen, Switzerland and SAKK Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | - Richard Greil
- Third Medical Department, Paracelcus Medical University, Salzburg, Austria
| | - Jana Markova
- University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stephanie Sasse
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Michael Fuchs
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Max S Topp
- University Hospital Würzburg, Würzburg, Germany
| | | | - Stephan Mathas
- Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | | | | | - Peter Koch
- University Hospital Münster, Münster, Germany
| | | | - Enrico Schalk
- Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Semrau
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Jan Kriz
- University Hospital Münster, Münster, Germany
| | - Tom Vieler
- Medizinische Klinik, Universitätsklinik Schleswig-Holstein, Kiel, Germany
| | - Martin Bentz
- Medizinische Klinik, Städtisches Klinikum Karlsruhe, Germany
| | - Elisabeth Lange
- Medizinische Klinik, Hämatologie/Onkologie, Evangelisches Krankenhaus, Hamm, Germany
| | - Rolf Mahlberg
- Medizinische Klinik, Krankenanstalt Mutterhaus d. Borromäerinnen, Trier, Germany
| | - Andre Hassler
- Zentrum für Innere Medizin, Hämatologie/Onkologie, Charité Campus Mitte, Berlin, Germany
| | - Martin Vogelhuber
- Medizinische Klinik, Universitätsklinik Regensburg, Regensburg, Germany
| | - Dennis Hahn
- Klinik für Onkologie, Katharinenhospital, Stuttgart, Germany
| | - Jörg Mezger
- Medizinische Klinik-Hämatologie, Onkologie, Immunologie, Palliativmedizin, St. Vincentius-Kliniken gAG, Karlsruhe, Germany
| | - Stefan W Krause
- Department of Internal Medicine 5, Haematology/Oncology, University of Erlangen, Germany
| | - Nicole Skoetz
- Cochrane Haematological Malignancies Group, Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Boris Böll
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Volker Diehl
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Michael Hallek
- Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Peter Borchmann
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany
| | - Harald Stein
- Berlin Reference Center for Lymphoma and Haematopathology, Berlin, Germany
| | - Hans Eich
- University Hospital Münster, Münster, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department of Internal Medicine 1, University Hospital of Cologne, Cologne, Germany.
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Paz-Ares L, Mezger J, Ciuleanu TE, Fischer JR, von Pawel J, Provencio M, Kazarnowicz A, Losonczy G, de Castro G, Szczesna A, Crino L, Reck M, Ramlau R, Ulsperger E, Schumann C, Miziara JEA, Lessa ÁE, Dediu M, Bálint B, Depenbrock H, Soldatenkova V, Kurek R, Hirsch FR, Thatcher N, Socinski MA. Necitumumab plus pemetrexed and cisplatin as first-line therapy in patients with stage IV non-squamous non-small-cell lung cancer (INSPIRE): an open-label, randomised, controlled phase 3 study. Lancet Oncol 2015; 16:328-37. [PMID: 25701171 DOI: 10.1016/s1470-2045(15)70046-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Necitumumab is a second-generation recombinant human immunoglobulin G1 EGFR monoclonal antibody that competitively inhibits ligand binding. We aimed to compare necitumumab plus pemetrexed and cisplatin with pemetrexed and cisplatin alone in patients with previously untreated, stage IV, non-squamous non-small-cell lung cancer (NSCLC). METHODS We did this randomised, open-label, controlled phase 3 study at 103 sites in 20 countries. Patients aged 18 years or older, with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 and adequate organ function, were randomly assigned 1:1 to treatment with a block randomisation scheme (block size of four) via a telephone-based interactive voice-response system or interactive web-response system. Patients received either cisplatin 75 mg/m(2) and pemetrexed 500 mg/m(2) on day 1 of a 3-week cycle for a maximum of six cycles alone, or with necitumumab 800 mg on days 1 and 8. Necitumumab was continued after the end of chemotherapy until disease progression or unacceptable toxic effects. Randomisation was stratified by smoking history, ECOG performance status, disease histology, and geographical region. Patients and study investigators were not masked to group assignment. The primary endpoint was overall survival. Efficacy analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00982111. FINDINGS Between Nov 11, 2009, and Feb 2, 2011, we randomly assigned 633 patients to receive either necitumumab plus pemetrexed and cisplatin (n=315) or pemetrexed and cisplatin alone (n=318). Enrolment was stopped on Feb 2, 2011, after a recommendation from the independent data monitoring committee. There was no significant difference in overall survival between treatment groups, with a median overall survival of 11·3 months (95% CI 9·5-13·4) in the necitumumab plus pemetrexed and cisplatin group versus 11·5 months (10·1-13·1) in the pemetrexed and cisplatin group (hazard ratio 1·01 [95% CI 0·84-1·21]; p=0·96). The incidence of grade 3 or worse adverse events, including deaths, was higher in the necitumumab plus pemetrexed and cisplatin group than in the pemetrexed and cisplatin group; in particular, deaths regarded as related to study drug were reported in 15 (5%) of 304 patients in the necitumumab group versus nine (3%) of 312 patients in the pemetrexed and cisplatin group. Serious adverse events were likewise more frequent in the necitumumab plus pemetrexed and cisplatin group than in the pemetrexed and cisplatin group (155 [51%] of 304 vs 127 [41%] of 312 patients). Patients in the necitumumab plus pemetrexed and cisplatin group had more grade 3-4 rash (45 [15%] of 304 vs one [<1%] of 312 patients in the pemetrexed and cisplatin alone group), hypomagnesaemia (23 [8%] vs seven [2%] patients), and grade 3 or higher venous thromboembolic events (23 [8%] vs 11 [4%] patients) than did those in the pemetrexed and cisplatin alone group. INTERPRETATION Our findings show no evidence to suggest that the addition of necitumumab to pemetrexed and cisplatin increases survival of previously untreated patients with stage IV non-squamous NSCLC. Unless future studies identify potentially useful predictive biomarkers, necitumumab is unlikely to provide benefit in this patient population when combined with pemetrexed and cisplatin. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Luis Paz-Ares
- Instituto de Biomedicina de Sevilla-IBIS (Hospital Virgen del Rocío/Universidad de Sevilla/CSIC), Sevilla, Spain; Hospital Universitario Doce de Octubre and CNIO Lung Cancer Unit, Madrid, Spain.
| | | | - Tudor E Ciuleanu
- Institute of Oncology and University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | | | | | - Andrzej Kazarnowicz
- Samodzielny Publiczny Zespól Gruźlicy i Chorób Pluc w Olsztynie, Olsztyn, Poland
| | | | | | | | - Lucio Crino
- Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Rodryg Ramlau
- Poznan University of Medical Sciences, Wielkopolskie Centrum Pulmonologii i Torakochirurgii, Poznan, Poland
| | | | - Christian Schumann
- Department of Internal Medicine II, University Clinic Ulm, Ulm, Germany; Klinik für Pneumologie, Thoraxonkologie, Schlaf-und Beatmungsmedizin, Kempten-Oberallgäu, Germany
| | | | - Álvaro E Lessa
- Hospital Santa Izabel-Santa Casa de Misericordia da Bahia, Nazare, Nazare, Brazil
| | - Mircea Dediu
- Institute of Oncology Bucharest, Bucharest, Romania
| | - Beatrix Bálint
- Csongrád Megye Mellkasi Betegségek Szakkórháza, Deszk, Hungary
| | | | | | | | - Fred R Hirsch
- University of Colorado, Division of Medical Oncology, Aurora, CO, USA
| | - Nick Thatcher
- The Christie Hospital, National Health Services Trust, Manchester, UK
| | - Mark A Socinski
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA, USA
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von Pawel J, Jotte R, Spigel DR, O'Brien ME, Socinski MA, Mezger J, Steins M, Bosquée L, Bubis J, Nackaerts K, Trigo JM, Clingan P, Schütte W, Lorigan P, Reck M, Domine M, Shepherd FA, Li S, Renschler MF. Randomized Phase III Trial of Amrubicin Versus Topotecan As Second-Line Treatment for Patients With Small-Cell Lung Cancer. J Clin Oncol 2014; 32:4012-9. [DOI: 10.1200/jco.2013.54.5392] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Amrubicin, a third-generation anthracycline and potent topoisomerase II inhibitor, showed promising activity in small-cell lung cancer (SCLC) in phase II trials. This phase III trial compared the safety and efficacy of amrubicin versus topotecan as second-line treatment for SCLC. Patients and Methods A total of 637 patients with refractory or sensitive SCLC were randomly assigned at a ratio of 2:1 to 21-day cycles of amrubicin 40 mg/m2 intravenously (IV) on days 1 to 3 or topotecan 1.5 mg/m2 IV on days 1 to 5. Primary end point was overall survival (OS); secondary end points included overall response rate (ORR), progression-free survival (PFS), and safety. Results Median OS was 7.5 months with amrubicin versus 7.8 months with topotecan (hazard ratio [HR], 0.880; P = .170); in refractory patients, median OS was 6.2 and 5.7 months, respectively (HR, 0.77; P = .047). Median PFS was 4.1 months with amrubicin and 3.5 months with topotecan (HR, 0.802; P = .018). ORR was 31.1% with amrubicin and 16.9% with topotecan (odds ratio, 2.223; P < .001). Grade ≥ 3 treatment-emergent adverse events in the amrubicin and topotecan arms were: neutropenia (41% v 54%; P = .004), thrombocytopenia (21% v 54%; P < .001), anemia (16% v 31%; P < .001), infections (16% v 10%; P = .043), febrile neutropenia (10% v 3%; P = .003), and cardiac disorders (5% v 5%; P = .759); transfusion rates were 32% and 53% (P < .001), respectively. NQO1 polymorphisms did not influence safety outcomes. Conclusion Amrubicin did not improve survival when compared with topotecan in the second-line treatment of patients with SCLC. OS did not differ significantly between treatment groups, although an improvement in OS was noted in patients with refractory disease treated with amrubicin.
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Affiliation(s)
- Joachim von Pawel
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Robert Jotte
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - David R. Spigel
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Mary E.R. O'Brien
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Mark A. Socinski
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Jörg Mezger
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Martin Steins
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Léon Bosquée
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Jeffrey Bubis
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Kristiaan Nackaerts
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - José M. Trigo
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Philip Clingan
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Wolfgang Schütte
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Paul Lorigan
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Martin Reck
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Manuel Domine
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Frances A. Shepherd
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Shaoyi Li
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
| | - Markus F. Renschler
- Joachim von Pawel, Asklepios Fachkliniken München-Gauting, Gauting; Jörg Mezger, St Vincentius-Kliniken Karlsruhe, Karlsruhe; Martin Steins, Thoraxklinik am Universitätsklinikum, Heidelberg; Wolfgang Schütte, Krankenhaus Martha-Maria Halle-Dölau, Halle; Martin Reck, Krankenhaus Großhansdorf, Großhansdorf, Germany; Robert Jotte, Rocky Mountain Cancer Center, Denver, CO, and US Oncology, Houston, TX; David R. Spigel, Sarah Cannon Research Institute, Nashville, TN; Mary E.R. O'Brien, Royal Marsden National
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Mezger J. Peter Graeme Arblaster. Assoc Med J 2012. [DOI: 10.1136/bmj.e4527] [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: 11/04/2022]
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Pawel JV, Jotte R, Spigel DR, Socinski MA, O'Brien MER, Paschold E, Mezger J, Steins M, Bosquée L, Bubis J, Nackaerts K, Trigo JM, Clingan P, Schuette W, Lorigan P, Reck M, Domine M, Shepherd F, McNally R, Renschler M. Randomized phase 3 trial of amrubicin versus topotecan as second-line treatment for small cell lung cancer (SCLC). Pneumologie 2012. [DOI: 10.1055/s-0032-1302561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jotte R, Von Pawel J, Spigel DR, Socinski MA, O'Brien M, Paschold EH, Mezger J, Steins M, Bosquée L, Bubis JA, Nackaerts K, Trigo Perez JM, Clingan PR, Schuette W, Lorigan P, Reck M, Domine M, Shepherd FA, McNally R, Renschler MF. Randomized phase III trial of amrubicin versus topotecan (Topo) as second-line treatment for small cell lung cancer (SCLC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7000] [Citation(s) in RCA: 10] [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: 11/20/2022] Open
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Tiritiris I, Mezger J, Stoyanov EV, Kantlehner W. Orthoamides and Iminium Salts, LXXI. Capturing of Carbon Dioxide with Organic Bases (Part 2) - Reactions of Guanidines and omega-Aminoalkyl-guanidines with Carbon Dioxide (In German). Z Naturforsch B 2011. [DOI: 10.5560/znb.2011.66b0407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Reck M, von Pawel J, Zatloukal P, Ramlau R, Gorbounova V, Hirsh V, Leighl N, Mezger J, Archer V, Moore N, Manegold C. Overall survival with cisplatin-gemcitabine and bevacizumab or placebo as first-line therapy for nonsquamous non-small-cell lung cancer: results from a randomised phase III trial (AVAiL). Ann Oncol 2010; 21:1804-1809. [PMID: 20150572 PMCID: PMC2924992 DOI: 10.1093/annonc/mdq020] [Citation(s) in RCA: 485] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Bevacizumab, the anti-vascular endothelial growth factor agent, provides clinical benefit when combined with platinum-based chemotherapy in first-line advanced non-small-cell lung cancer. We report the final overall survival (OS) analysis from the phase III AVAiL trial. Patients and methods: Patients (n = 1043) received cisplatin 80 mg/m2 and gemcitabine 1250 mg/m2 for up to six cycles plus bevacizumab 7.5 mg/kg (n = 345), bevacizumab 15 mg/kg (n = 351) or placebo (n = 347) every 3 weeks until progression. Primary end point was progression-free survival (PFS); OS was a secondary end point. Results: Significant PFS prolongation with bevacizumab compared with placebo was maintained with longer follow-up {hazard ratio (HR) [95% confidence interval (CI)] 0.75 (0.64–0.87), P = 0.0003 and 0.85 (0.73–1.00), P = 0.0456} for the 7.5 and 15 mg/kg groups, respectively. Median OS was >13 months in all treatment groups; nevertheless, OS was not significantly increased with bevacizumab [HR (95% CI) 0.93 (0.78–1.11), P = 0.420 and 1.03 (0.86–1.23), P = 0.761] for the 7.5 and 15 mg/kg groups, respectively, versus placebo. Most patients (∼62%) received multiple lines of poststudy treatment. Updated safety results are consistent with those previously reported. Conclusions: Final analysis of AVAiL confirms the efficacy of bevacizumab when combined with cisplatin–gemcitabine. The PFS benefit did not translate into a significant OS benefit, possibly due to high use of efficacious second-line therapies.
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Affiliation(s)
- M Reck
- Department of Thoracic Oncology, Krankenhaus Grosshansdorf, Grosshansdorf.
| | - J von Pawel
- Pneumology Clinic, Asklepios Fachkliniken, München-Gauting, Germany
| | - P Zatloukal
- Department of Pneumology and Thoracic Surgery, 3rd Faculty of Medicine, Charles University, Faculty Hospital Bulovka and Postgraduate Medical School, Prague, Czech Republic
| | - R Ramlau
- Regional Center for Lung Disease, Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland
| | | | - V Hirsh
- Medical Oncology Department, McGill University Health Centre-Royal Victoria Hospital, Montreal
| | - N Leighl
- Division of Medical Oncology, Princess Margaret Hospital, Toronto, Canada
| | - J Mezger
- Medical Department II, St Vincentius-Kliniken, Karlsruhe, Germany
| | - V Archer
- Department of Late-Stage Clinical Development, F. Hoffmann-La Roche Ltd, Welwyn Garden City, UK
| | - N Moore
- Department of Biostatistics, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - C Manegold
- Department of Surgery, Interdisciplinary Thoracic Oncology, Heidelberg University Medical Center, Mannheim, Germany
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Mezger J, von Pawel J, Reck M. Bevacizumab (Bv) single-agent maintenance following Bv-based chemotherapy in patients with advanced non-small cell lung cancer (NSCLC): Results from an exploratory analysis of the AVAiL study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e19001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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
e19001 Background: The significant survival benefits observed with Bv plus chemotherapy in pivotal NSCLC trials were generated using treatment to progression. Given that little data on the use of single-agent Bv as maintenance therapy are currently available, we report here the results of an analysis focused on the maintenance phase of the AVAiL study. Methods: AVAiL, a randomized, international, placebo-controlled phase III trial, evaluated Bv plus cisplatin-gemcitabine (CG) in pts with previously untreated advanced, non-squamous NSCLC, with performance status 0/1. 1,043 pts (age 20–83) were randomized to C 80mg/m2 and G 1,250mg/m2 q3w for up to 6 cycles plus either Bv 7.5mg/kg q3w (Bv 7.5; n=345), Bv 15mg/kg q3w (Bv 15; n=351) or placebo (Pl; n=347). Bv/Pl was administered until disease progression. This retrospective analysis focused on progression-free survival (PFS) and overall survival (OS) of the 376 patients who received blinded Bv (n=174 and n=162 for Bv 7.5 and 15) or Pl monotherapy (n=41) after completing 6 cycles of CG + Bv or CG + Pl (as specified in the protocol; most patients received 6 cycles). PFS was measured from last day of last cycle of CG + Bv/Pl to disease progression or death. Results: In the overall population, Bv reduced the risk of progression or death by 25% vs Pl (PFS primary endpoint (HR=0.75 [0.64–0.87] and 0.85 [0.73–1] for Bv 7.5 and Bv 15, respectively). When analyzing the outcome of the post chemotherapy maintenance phase, the use of Bv as single agent yielded median PFS of 3.2 months (95%CI [3–5]) for Pl, 4.6 months (95%CI [4–6]) for Bv 7.5 and 4.6 months (95%CI [4–5]) for Bv 15.The OS results for this maintenance analysis are consistent with those from the overall population in which the PFS findings were not associated with an OS benefit. Conclusions: This post-hoc analysis, focused on the maintenance phase of AVAiL, suggests that Bv used as single-agent maintenance therapy appears to confer clinical benefit beyond the chemotherapy phase. This finding warrants further exploration in future studies. [Table: see text]
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Affiliation(s)
- J. Mezger
- St Vincentius-Kliniken, Karlsruhe, Germany; Asklepios Fachkliniken München, Munich, Germany; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - J. von Pawel
- St Vincentius-Kliniken, Karlsruhe, Germany; Asklepios Fachkliniken München, Munich, Germany; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - M. Reck
- St Vincentius-Kliniken, Karlsruhe, Germany; Asklepios Fachkliniken München, Munich, Germany; Hospital Grosshansdorf, Grosshansdorf, Germany
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Crino L, Mezger J, Griesinger F, Zhou C, Reck MM. MO19390 (SAiL): Safety and efficacy of first-line bevacizumab (Bv)-based therapy in advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8043] [Citation(s) in RCA: 8] [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
8043 Background: MO19390 (SAiL) is a single-arm, multicenter, international trial evaluating the safety and efficacy of first-line Bv in combination with a range of chemotherapy regimens in over 2,000 patients (pts). Methods: Primary endpoint was safety; secondary endpoints included time to disease progression (TTP) and overall survival (OS). Pts with untreated locally advanced, metastatic or recurrent non-squamous NSCLC (ECOG PS 0–2) received Bv (7.5 or 15mg/kg) with standard chemotherapy for up to six cycles, then non-progressors proceeded to receive Bv until disease progression. Results: This analysis (data cut-off July 2008) was based on 2,008 pts with a median age of 59. Pts (%) were: male 60.1; stage IIIB/IV 19.5/80.5 (no data 3 pts); adenocarcinoma/large cell/other 85.8/7.1/7.1; ECOG PS 0/1/2 38.1/56.1/5.8. Pts received a median of 6 Bv cycles and 4 chemotherapy cycles. 26.7% of pts experienced grade ≥3 serious adverse events (SAEs); 8.3% of pts experienced grade ≥3 SAEs related to Bv. Adverse events (AEs) of special interest (all grades) included bleeding (27.6%), hypertension (19.3%), proteinuria (14.6%), thromboembolism (8.6%), CHF (2.9%) and GI perforation (1.2%). The incidence of AEs of special interest (all grades) was comparable across the various types of chemotherapy regimens: carboplatin doublets (50.6%)/cisplatin doublets (49.9%)/non-platinum doublets (41.7%)/monotherapy (37.5%). No new safety signals were reported. Trial data were not deemed mature enough to provide efficacy results. Conclusions: SAiL confirms that Bv-based therapy has a well-established and manageable safety profile. Clinical outcomes obtained in this real-life population are consistent with those seen in the pivotal trials of bevacizumab (Avastin) in NSCLC (E4599 and AVAiL), and compare favorably with historical data. Updated efficacy results for 2,147 pts will be presented, based upon an additional 5 months’ follow-up. [Table: see text]
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Affiliation(s)
- L. Crino
- Silvestrini Hospital, Perugia, Italy; St. Vincentius-Kilinken, Karlsruhe, Germany; Pius-Hospital, Oldenburg, Germany; Shanghai Pulmonary Hospital, Shanghai, China; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - J. Mezger
- Silvestrini Hospital, Perugia, Italy; St. Vincentius-Kilinken, Karlsruhe, Germany; Pius-Hospital, Oldenburg, Germany; Shanghai Pulmonary Hospital, Shanghai, China; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - F. Griesinger
- Silvestrini Hospital, Perugia, Italy; St. Vincentius-Kilinken, Karlsruhe, Germany; Pius-Hospital, Oldenburg, Germany; Shanghai Pulmonary Hospital, Shanghai, China; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - C. Zhou
- Silvestrini Hospital, Perugia, Italy; St. Vincentius-Kilinken, Karlsruhe, Germany; Pius-Hospital, Oldenburg, Germany; Shanghai Pulmonary Hospital, Shanghai, China; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - M. M. Reck
- Silvestrini Hospital, Perugia, Italy; St. Vincentius-Kilinken, Karlsruhe, Germany; Pius-Hospital, Oldenburg, Germany; Shanghai Pulmonary Hospital, Shanghai, China; Hospital Grosshansdorf, Grosshansdorf, Germany
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Hirsh V, Ramlau R, von Pawel J, Zatloukal P, Vera G, Leighl N, Mezger J, Archer V, Reck M. Final safety results of BO17704 (AVAiL): A phase III randomized study of first-line bevacizumab (Bv) and cisplatin/gemcitabine (CG) in patients (pts) with advanced or recurrent nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8039] [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
8039 Background: AVAiL, an international placebo-controlled phase III trial, showed that Bv-based therapy significantly improved PFS and response rate in patients with advanced/recurrent NSCLC. This report summarizes overall safety findings from AVAiL. Methods: AVAiL randomized 1,043 patients with untreated locally advanced, metastatic or recurrent non-squamous NSCLC to C 80mg/m2 (d1) and G 1,250mg/m2 (d1 and d8) q3w for up to 6 cycles plus either Bv 7.5mg/kg q3w (n=331 with safety data), Bv 15mg/kg q3w (n=329) or placebo (n=326). Bv/placebo was administered until disease progression. Primary endpoint was PFS; secondary endpoints included OS, response rate, and safety. Safety was measured using NCI-CTC version 3.0 criteria for adverse events (AEs). Results: At final analysis, the median/maximum duration of Bv therapy was 4.9/28.5 mo (Bv 7.5) and 4.3/23.4 mo (Bv 15). The most common AEs overall were hematological and gastrointestinal (GI), and occurred in similar proportions of pts in the Bv and placebo arms. Grade ≥3 AEs occurred in 80%, 83%, and 77% of pts in the Bv 7.5, Bv 15 and placebo arms, respectively. The most common grade ≥3 adverse events were hematological, mainly neutropenia and thrombocytopenia. Neutropenia was reported in 43% (Bv 7.5), 40% (Bv 15) and 34% (placebo) of pts. Grade ≥3 AEs of special interest included hypertension (7%, 9% and 2%), proteinuria (2%, 3% and 0%), bleeding (4%, 5% and 2%) and hemoptysis (0.5%, 1.2% and 1.3%). The incidence of grade 5 hemoptysis was low (0.9%, 0.9% and 0% of pts, respectively). The incidence of GI perforations (<1%), thromboembolic events (≤8%), CHF (≤1%) and wound healing complications (<1%) was low and similar between treatment arms. The incidence of serious AEs was 39%, 45% and 36% in the Bv 7.5, Bv 15 and placebo arms, respectively. No new safety signals were reported. Conclusions: After E4599, AVAiL further demonstrated the efficacy of Bv in combination with platinum-based chemotherapy in the treatment of advanced NSCLC. Final safety data confirm the well established and manageable safety profile of Bv-based therapy in pts with advanced NSCLC. [Table: see text]
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Affiliation(s)
- V. Hirsh
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - R. Ramlau
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - J. von Pawel
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - P. Zatloukal
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - G. Vera
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - N. Leighl
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - J. Mezger
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - V. Archer
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - M. Reck
- McGill University Health Centre, Westmount, QC, Canada; Regional Centre of Lung Diseases, Poznan, Poland; Asklepios Klinikum Gauting, Gauting, Germany; Charles University, Praha, Czech Republic; Cancer Research Center, Moscow, Russian Federation; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
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Leighl NB, Zatloukal P, Mezger J, Ramlau R, Archer V, Moore N, Reck M. Efficacy and safety of first-line bevacizumab (Bv) and cisplatin/gemcitabine (CG) in elderly patients (pts) with advanced non-small cell lung cancer (NSCLC) in the BO17704 study (AVAiL). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8050] [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
8050 Background: AVAiL, an international, placebo-controlled, phase III trial, evaluated Bv plus CG in pts with previously untreated advanced, non-squamous NSCLC, with performance status 0/1. A retrospective analysis was performed to assess the efficacy and safety of Bv plus CG in the subpopulation of elderly pts (≥65 years [yrs]). Methods: 1,043 pts (age 20–83) were randomized to C 80mg/m2 and G 1,250mg/m2 q3w for up to 6 cycles plus either Bv 7.5mg/kg q3w (Bv 7.5; n=345), Bv 15mg/kg q3w (Bv 15; n=351) or placebo (Pl; n=347). Bv/Pl was administered until disease progression. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate (RR) and safety. Efficacy and safety were compared between pts <65 yrs vs ≥65 yrs. Results: Efficacy data were available for 304 pts ≥65 yrs (median age 68), and 739 pts <65 yrs (median age 55). Baseline characteristics were similar between the groups. In the Bv arms, 179 pts (93%) received ≥1 cycle of treatment; 85 (47.5%) completed >6 cycles. Bv-treated pts ≥65 yrs derived an improvement in PFS compared to Pl (Bv 7.5: HR 0.71, p 0.023; Bv 15: HR 0.84, p= 0.25). ORRs were 40%, 29% and 30% for pts ≥65 in the Bv 7.5, Bv 15 and Pl arms. Survival was similar in all treatment arms regardless of age, (pts ≥65 Bv 7.5 HR 0.84; Bv 15 HR 0.88, p=NS). Safety data were available for 284 pts ≥65 yrs and 702 pts <65 yrs. There were no safety signals of concern in older patients. Grade ≥3 toxicities occurred in 84%, 80% and 80% of older pts treated with Bv 7.5, Bv 15 and Pl. Pts ≥65 yrs had no episodes of severe hemoptysis, but in Bv 7.5 and Pl arms, were more likely to have other bleeding, compared to pts <65. The incidence of hypertension and febrile neutropenia were similar in pts ≥65 and <65 yrs. Treatment-related deaths were not increased in Bv-treated pts ≥65 yrs vs pts <65 yrs or in Bv-arms vs Pl. Conclusions: The PFS benefit from Bv-based treatment in the elderly subpopulation is similar to that observed in the overall patient population. No particular safety signals were identified in this population, suggesting acceptable tolerability of Bv in elderly pts in AVAiL. [Table: see text]
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Affiliation(s)
- N. B. Leighl
- Princess Margaret Hospital, Toronto, ON, Canada; Charles University, Praha, Czech Republic; St Vincentius-Kliniken Karlsruhe, Karlsruhe, Germany; Regional Centre of Lung Diseases, Poznan, Poland; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - P. Zatloukal
- Princess Margaret Hospital, Toronto, ON, Canada; Charles University, Praha, Czech Republic; St Vincentius-Kliniken Karlsruhe, Karlsruhe, Germany; Regional Centre of Lung Diseases, Poznan, Poland; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - J. Mezger
- Princess Margaret Hospital, Toronto, ON, Canada; Charles University, Praha, Czech Republic; St Vincentius-Kliniken Karlsruhe, Karlsruhe, Germany; Regional Centre of Lung Diseases, Poznan, Poland; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - R. Ramlau
- Princess Margaret Hospital, Toronto, ON, Canada; Charles University, Praha, Czech Republic; St Vincentius-Kliniken Karlsruhe, Karlsruhe, Germany; Regional Centre of Lung Diseases, Poznan, Poland; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - V. Archer
- Princess Margaret Hospital, Toronto, ON, Canada; Charles University, Praha, Czech Republic; St Vincentius-Kliniken Karlsruhe, Karlsruhe, Germany; Regional Centre of Lung Diseases, Poznan, Poland; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - N. Moore
- Princess Margaret Hospital, Toronto, ON, Canada; Charles University, Praha, Czech Republic; St Vincentius-Kliniken Karlsruhe, Karlsruhe, Germany; Regional Centre of Lung Diseases, Poznan, Poland; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
| | - M. Reck
- Princess Margaret Hospital, Toronto, ON, Canada; Charles University, Praha, Czech Republic; St Vincentius-Kliniken Karlsruhe, Karlsruhe, Germany; Regional Centre of Lung Diseases, Poznan, Poland; F. Hoffmann-La Roche, Basel, Switzerland; Hospital Grosshansdorf, Grosshansdorf, Germany
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Reck M, Pawel JV, Zatloukal P, Ramlau R, Gorbounova V, Hirsh V, Leighl N, Mezger J, Archer V, Manegold C. Bevacizumab in Kombination mit Cisplatin/Gemcitabin versus Cisplatin/Gemcitabin als Erstlinientherapie bei Patienten mit fortgeschrittenem nichtsquamösen nichtkleinzelligen Lungenkarzinom (NSCLC): eine randomisierte Phase III Studie (AVAiL). Pneumologie 2009. [DOI: 10.1055/s-0029-1213984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kimmich M, Reck M, Spengler W, Schneider CP, Eberhard W, Ko YD, Mezger J, Jäger E, Steppert C, Griesinger F, Kohlhäufl M. Safety of Avastin® in Lung Cancer (SAIL) – Ergebnisse einer aktualisierten Auswertung für Deutschland. Pneumologie 2009. [DOI: 10.1055/s-0029-1213926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reck M, von Pawel J, Zatloukal P, Ramlau R, Gorbounova V, Hirsh V, Leighl N, Mezger J, Archer V, Moore N, Manegold C. Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer: AVAil. J Clin Oncol 2009; 27:1227-34. [PMID: 19188680 DOI: 10.1200/jco.2007.14.5466] [Citation(s) in RCA: 1111] [Impact Index Per Article: 74.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor, improves survival when combined with carboplatin/paclitaxel for advanced nonsquamous non-small-cell lung cancer (NSCLC). This randomized phase III trial investigated the efficacy and safety of cisplatin/gemcitabine (CG) plus bevacizumab in this setting. PATIENTS AND METHODS Patients were randomly assigned to receive cisplatin 80 mg/m2 and gemcitabine 1,250 mg/m(2) for up to six cycles plus low-dose bevacizumab (7.5 mg/kg), high-dose bevacizumab (15 mg/kg), or placebo every 3 weeks until disease progression. The trial was not powered to compare the two doses directly. The primary end point was amended from overall survival (OS) to progression-free survival (PFS). Between February 2005 and August 2006, 1,043 patients were randomly assigned (placebo, n = 347; low dose, n = 345; high dose, n = 351). RESULTS PFS was significantly prolonged; the hazard ratios for PFS were 0.75 (median PFS, 6.7 v 6.1 months for placebo; P = .003) in the low-dose group and 0.82 (median PFS, 6.5 v 6.1 months for placebo; P = .03) in the high-dose group compared with placebo. Objective response rates were 20.1%, 34.1%, and 30.4% for placebo, low-dose bevacizumab, and high-dose bevacizumab plus CG, respectively. Duration of follow-up was not sufficient for OS analysis. Incidence of grade 3 or greater adverse events was similar across arms. Grade > or = 3 pulmonary hemorrhage rates were < or = 1.5% for all arms despite 9% of patients receiving therapeutic anticoagulation. CONCLUSION Combining bevacizumab (7.5 or 15 mg/kg) with CG significantly improved PFS and objective response rate. Bevacizumab plus platinum-based chemotherapy offers clinical benefit for bevacizumab-eligible patients with advanced NSCLC.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Hospital Grosshansdorf, Wohrendamm 80, 22927 Grosshansdorf, Germany.
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Manegold C, Gravenor D, Woytowitz D, Mezger J, Hirsh V, Albert G, Al-Adhami M, Readett D, Krieg AM, Leichman CG. Randomized phase II trial of a toll-like receptor 9 agonist oligodeoxynucleotide, PF-3512676, in combination with first-line taxane plus platinum chemotherapy for advanced-stage non-small-cell lung cancer. J Clin Oncol 2008; 26:3979-86. [PMID: 18711188 DOI: 10.1200/jco.2007.12.5807] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE This study assessed the efficacy of the combination of standard taxane plus platinum chemotherapy with the synthetic Toll-like receptor 9-activating oligodeoxynucleotide PF-3512676 in patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Chemotherapy-naive patients with stage IIIB to IV NSCLC were randomly assigned (one to two ratio) to receive four to six cycles of taxane/platinum chemotherapy alone or with 0.2 mg/kg of subcutaneous PF-3512676 on days 8 and 15 of each 3-week cycle. The primary end point was objective response rate (ORR). RESULTS Baseline demographics were similar between treatment arms, although significantly more patients in the PF-3512676 arm had stage IV disease (85% compared with 62% in the chemotherapy-alone arm). The modified intent-to-treat analysis (n = 111) demonstrated a 38% ORR (confirmed and unconfirmed) in the PF-3512676 arm (n = 74) and 19% in the chemotherapy-alone arm (n = 37) by investigator evaluation. Blinded, independent radiologic review for 90 patients showed a similar trend in confirmed response rate (19% and 11%, respectively). Median survival was 12.3 months in the PF-3512676 arm and 6.8 months in the chemotherapy-alone arm, and 1-year survival was 50% and 33%, respectively. Mild to moderate local injection site reactions and flu-like symptoms were the most common PF-3512676-related adverse events, but grade 3/4 neutropenia, thrombocytopenia, and anemia were all reported more commonly for patients in the PF-3512676 arm. CONCLUSION The addition of PF-3512676 to taxane plus platinum chemotherapy for first-line treatment of NSCLC improves objective response and may improve survival. Confirmatory phase III trials are ongoing.
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Affiliation(s)
- Christian Manegold
- University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
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Dansin E, Mezger J, Isla D, Barlesi F, Bearz A, Lopez PG, Laskin JJ, Pavlakis N, Thatcher N, Crinò L. Safety of bevacizumab-based therapy as first-line treatment of patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC): MO19390 (SAiL). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bennouna J, vonPawel J, Zatloukal P, Ramlau R, Gorbounova V, Hirsh V, Leighl N, Mezger J, Moore N, Manegold C. 6509 ORAL Management of hypertension (HTN) in patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC) receiving first-line cisplatin and gemcitabine with bevacizumab or placebo – results from randomised phase III trial BO17704. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71337-x] [Citation(s) in RCA: 4] [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: 10/22/2022] Open
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Eberhardt W, Reck M, vonPawel J, Zatloukal P, Ramlau R, Gorbounova V, Leighl N, Mezger J, Moore N, Manegold C. 6518 ORAL Subgroup results from a randomised, double-blind, multicentre phase III study of bevacizumab in combination with cisplatingemcitabine in chemotherapy-naive patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC): study BO17704. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71346-0] [Citation(s) in RCA: 3] [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: 11/25/2022] Open
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Manegold C, vonPawel J, Zatloukal P, Ramlau R, Gorbounova V, Hirsh V, Leighl N, Mezger J, Moore N, Reck M. 6503 ORAL Efficacy and safety results from BO17704, a randomised, placebo-controlled phase III study of bevacizumab in combination with cisplatin and gemcitabine in patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC). EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71331-9] [Citation(s) in RCA: 4] [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: 10/22/2022] Open
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Pilz LR, Thatcher N, Kortsik C, Koschel G, Mezger J, Schott von Römer K, Manegold C. Clinical prognostic factors in advanced non-small cell lung cancer (NSCLC): Cox regression analysis based on 789 patients treated in three consecutive randomized trials. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7648] [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
7648 Background: Treatment efficacy and toxicity of the three studies have been presented at ASCO (2006, Abstract # 7035). Patients (pts) received gemcitabine or docetaxel either as single agents in different schedules and doses or as a platinum free doublet. Our retrospective analysis is to identify the clinical factors which would influence patient prognosis. Methods: Patients eligibility criteria included histologically confirmed stage IIIB or IV, performance status (PS) 0–2, and no prior chemotherapy. Overall survival (OS) was similar in all three studies. 819 pts were enrolled in 1998–2004 and 798 pts of them were evaluable for this analysis: 85% of pts had stage IV disease and PS=1. Univariate and multivariate (stepwise) Cox regression analyses were performed to evaluate the impact of baseline characteristics and quality of life (QoL) on OS. Results: Factors which have a significant impact on OS are the laboratory parameters hemoglobin (HGB) and LDH (p<0.0001), WHO performance status (PS) (p=0.001) and the quality of life measure for lung cancer of the EORTC, LC13, (p=0.0006), respectively (see table ). Gender measured univariately also influences significantly OS (p=0.0085) but has less impact in the multivariate model (p=0.07). Age (<65 vs 65 and older) is not of prognostic value with OS (HR=0.92, p=0.39), as well as histology (adeno/sqamous/other) (HR=0.99, p=0.90). Other factors as tumor stage (wet IIIB vs IV), presence of extra-thoracic metastases, number of co-morbidities, and surgical and radiological pretreatment also have no prognostic influence on OS. Analysis for the effect of smoking on OS could not be performed since only few pts never smoked. Conclusions: Our retrospective analysis confirms the prognostic value of serum HGB, and LDH, WHO-PS, and QoL LC13 as clinical determinants for OS. [Table: see text] [Table: see text]
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Affiliation(s)
- L. R. Pilz
- German Cancer Research Center, Heidelberg, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; University Medical Center, Mannheim, Germany
| | - N. Thatcher
- German Cancer Research Center, Heidelberg, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; University Medical Center, Mannheim, Germany
| | - C. Kortsik
- German Cancer Research Center, Heidelberg, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; University Medical Center, Mannheim, Germany
| | - G. Koschel
- German Cancer Research Center, Heidelberg, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; University Medical Center, Mannheim, Germany
| | - J. Mezger
- German Cancer Research Center, Heidelberg, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; University Medical Center, Mannheim, Germany
| | - K. Schott von Römer
- German Cancer Research Center, Heidelberg, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; University Medical Center, Mannheim, Germany
| | - C. Manegold
- German Cancer Research Center, Heidelberg, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; University Medical Center, Mannheim, Germany
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Manegold C, von Pawel J, Zatloukal P, Ramlau R, Gorbounova V, Hirsch V, Leighl N, Mezger J, Archer V, Reck M. Randomised, double-blind multicentre phase III study of bevacizumab in combination with cisplatin and gemcitabine in chemotherapy-naïve patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC): BO17704. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.lba7514] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA7514 Background: The ECOG 4599 phase III trial demonstrated that the addition of bevacizumab (B) to carboplatin/paclitaxel improved overall and progression-free survival (PFS) in patients (pts) with advanced NSCLC [Sandler et al. NEJM 2006]. Cisplatin/gemcitabine (CG) is a common combination in regions outside of the US. Methods: This randomised, placebo-controlled phase III study compared two doses of B plus CG versus CG plus placebo. The primary endpoint was PFS; secondary endpoints include overall survival, response rate (RR) and safety. Eligibility criteria: histologically or cytologically documented previously untreated advanced or recurrent non- squamous NSCLC; ECOG PS 0–1; no brain metastases. Between 2/05 and 8/06 1,043 pts were randomised to: C 80mg/m2 on d1 and G 1,250mg/m2 on d1 and d8 every 3 wks for up to 6 cycles plus B continued to progression at 7.5mg/kg every 3 wks, or 15mg/kg every 3 wks or placebo. The study was designed to include the number of patients required to observe a 30% reduction in the risk of a PFS event in the B arms compared with control using a two-sided logrank test (a=2.5%) with 80% power. Results: PFS was significantly prolonged as analysed both in a primary analysis (without censoring for non-protocol anti-neoplastic therapy [NPT] prior to progression) and in a prespecified analysis with censoring for NPT. The RR and response duration were also increased. Overall survival is immature due to short duration of follow up. Conclusions: Both doses of B significantly improved PFS and RR, consistent with the results of the earlier phase III trial E4599. No unexpected safety signals were detected. [Table: see text] [Table: see text]
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Affiliation(s)
- C. Manegold
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - J. von Pawel
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - P. Zatloukal
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - R. Ramlau
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - V. Gorbounova
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - V. Hirsch
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - N. Leighl
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - J. Mezger
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - V. Archer
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
| | - M. Reck
- University Medical Center, Mannheim, Germany; Asklepios Klinikum Gauting, Gauting, Germany; Faculty Hospital Bulovka, Prague, Czech Republic; Wielkopolskie Centrum Chorob Pluc i Gruzlicy, Poznan, Poland; Cancer Research Center of Russia, Moscow, Russian Federation; MUHC - Royal Victoria Hospital, Montreal, PQ, Canada; Princess Margaret Hospital, Toronto, ON, Canada; St. Vincentius-Kliniken, Karlsruhe, Germany; F. Hoffmann-La Roche, Basel, Switzerland; Krankenhaus Grosshansdorf, Grosshansdorf, Germany
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Manegold C, Koschel G, Hruska D, Scott-von-Römer K, Mezger J, Pilz LR. Open, randomized, phase II study of single-agent gemcitabine and docetaxel as first- and second-line treatment in patients with advanced non-small-cell lung cancer. Clin Lung Cancer 2007; 8:245-51. [PMID: 17311688 DOI: 10.3816/clc.2007.n.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chemotherapy has been widely accepted as standard for palliation in advanced non-small-cell lung cancer. Gemcitabine and docetaxel are active as single agents. Our previous experience indicates that single-agent therapy, if given sequentially, could be an alternative to doublet combination chemotherapy and that sequence and schedule matter. PATIENTS AND METHODS Chemotherapy-naive patients with stage IIIB-IV non-small-cell lung cancer were randomized to receive first-line 3-weekly gemcitabine or docetaxel. At progression, patients received second-line therapy with the other agent. Treatment was considered feasible if 30% of the evaluable patients had > or = 2 cycles of first-line and 2 cycles of second-line therapy and patient survival was > or = 7 months from the start of treatment. For efficacy, time to progression, overall survival, response, and quality of life were analyzed. RESULTS Three hundred thirty patients received gemcitabine followed by docetaxel or docetaxel followed by gemcitabine. Treatment was feasible for 60 patients (38%) with gemcitabine followed by docetaxel and for 80 patients (49%) with docetaxel followed by gemcitabine; treatment favored docetaxel followed by gemcitabine (P = 0.03539). Median survival for gemcitabine followed by docetaxel and docetaxel followed by gemcitabine was 6.3 months and 8.6 months, and 1-year survival rate was 28% and 31%, respectively. Objective response rates were < or = 10% for both treatment strategies. Quality of life was significantly better in gemcitabine followed by docetaxel (P = 0.005). CONCLUSION Single-agent gemcitabine and docetaxel are feasible as defined for both sequences but treatment favors docetaxel followed by gemcitabine. Thus, it is reasonable to state that single-agent therapy given sequentially might be a candidate for palliation and therefore should be investigated in comparison with combination therapy.
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Affiliation(s)
- Christian Manegold
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany (Baden-Württemberg)
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Manegold C, Thatcher N, Kortsik C, Koschel G, Mezger J, Schott Von Römer K, Pilz LR. Sequencing of single-agent (SA) docetaxel (T) and gemcitabine (G) therapy for patients (pts) with advanced non-small cell lung cancer (NSCLC): Results of three consecutive randomized trials. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7035] [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
7035 Background: Standard doublet chemotherapy (DCT) is often clinically inappropriate. Since T and G show efficacy and favourable toxicity as SAs in 1st- and 2nd-line setting, sequencing of T and G may be an equally effective alternative to DCT for palliation. Three studies (S1-S3) were conducted: two to identify an optimal SA-sequence (S1/S2), and one to compare sequential SA to a platin-free doublet (S3). Methods: Common eligibility criteria included histologically confirmed stage IIIB or IV, performance status (PS) 0–2, and no prior chemotherapy. S1/S2 examined treatment feasibility (TF) of G or T with introduction of the opposite agent in case of progression. TF was defined as pt ability to receive ≥2 cycles (cyc) of 1st-line and if progressive ≥2 cyc of 2nd-line therapy and to survive ≥7 months (mos). In S1, G 1000 mg/m2 and T 35 mg/m2 was given on days (d) 1, 8, 15 (q4w) and in S2, G 1250 mg/m2 (d 1, 8) and T 100 mg/m2 (d 1; q3w). In S3, pts received G 1000 mg/m2 (d 1, 8) and T 75 mg/m2 (d 1; q3w) either concomitantly (G+T; 6 cyc) or sequentially (G→T; 3 cyc each). Primary endpoint of S3 was clinically relevant haematotoxicity (CRHT) defined as thrombocytopenia with platelet transfusions, anaemia with RBC-transfusions or febrile neutropenia with i.v. antibiotics (IVAB). Results: 819 pts were included (1998–2004): 85% of pts had stage IV disease and PS≤1. In S1 and S2 for (G→T)/(T→G) respectively: TF was 28/20% and 38/49% (p=.04); median survival (MS) was 9.0/5.0 mos (p=.03) and 6.3/8.6 mos; and median time to progression (TTP) was 4.3/2.2 mos and 2.4/3.3 mos. In S3, CRHT occurred less frequently with SA therapy (p<.001), transfusions and IVAB treatment days were less common. QoL also favoured SA therapy. For (G+T)/(G→T), MS was 7.3/7.4 mos, response rate was 33/22% (p=.05) and TTP was 6.3/4.9 mos (p=.04). Conclusions: Sequencing modern SA was effective and well tolerated. Weekly T and G regimens seem less feasible than 3-weekly but compared to the nonplatinum doublet CRHT and IVAB are reduced with better QoL and cost-effectiveness. [Table: see text]
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Affiliation(s)
- C. Manegold
- University Medical Center, Mannheim, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - N. Thatcher
- University Medical Center, Mannheim, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - C. Kortsik
- University Medical Center, Mannheim, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - G. Koschel
- University Medical Center, Mannheim, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - J. Mezger
- University Medical Center, Mannheim, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - K. Schott Von Römer
- University Medical Center, Mannheim, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - L. R. Pilz
- University Medical Center, Mannheim, Germany; Christie Hospital, Manchester, United Kingdom; Sankt Hildegardis Hospital, Mainz, Germany; General Hospital Harburg, Hamburg, Germany; St. Vincentius Hospital, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
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Huber RM, Reck M, Gosse H, von Pawel J, Mezger J, Saal JG, Kleinschmidt R, Steppert C, Steppling H. Efficacy of a toxicity-adjusted topotecan therapy in recurrent small cell lung cancer. Eur Respir J 2006; 27:1183-9. [PMID: 16481389 DOI: 10.1183/09031936.06.00015605] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The present prospective multicentre trial investigated whether topotecan, given at a starting dose of 1.25 mg.m(-2) with individual dose adjustment, can improve safety in patients with relapsed/refractory small cell lung cancer without loss of efficacy. Patients received topotecan intravenously on days 1-5, every 21 days, for up to six courses. In the absence of relevant haematotoxicities, topotecan was increased to 1.5 mg.m(-2) and reduced to 1.0 mg.m(-2) in case of severe haematotoxicities. Of 170 recruited patients, 73.2% had stage IV disease and 63.4% had platinum-containing pre-treatment. Patients received a total of 521 courses. In 72.6% of those courses, the dose remained at 1.25 mg.m(-2); in 9.1% it was reduced and in 18.3% it increased. Overall response rate was 14.1% including one complete response; 28.8% had stable disease. Median duration of response was 13.6 weeks and median survival was 23.4 weeks. Clinical benefit was obvious for sensitive as well as for refractory patients. Haematotoxicity of grade 3 or 4 was clearly lower compared with the standard dose of 1.5 mg.m(-2). In conclusion, topotecan at a dose of 1.25 mg.m(-2) appears to be as effective as the dose of 1.5 mg.m(-2), but with reduced toxicity. Since patients with recurrent small cell lung cancer have a poor prognosis, they benefit especially from good tolerability.
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Affiliation(s)
- R M Huber
- Ludwig Maximilians Universität, Klinikum der Universität, Innenstadt, Ziemssenstrasse 1, 80336 München, Germany,
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Lamberti C, Di Blasi K, Archut D, Fimmers R, Mathiak M, Bollmann M, Vogel J, Kindermann D, Mezger J, Schmidt-Wolf IG, Sauerbruch T. Population-based registration of unselected colorectal cancer patients: five-year survival in the region of Bonn/Rhine-Sieg, Germany. Z Gastroenterol 2005; 43:149-54. [PMID: 15700204 DOI: 10.1055/s-2004-813631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Epidemiological data of colorectal cancer are sparse and often incomplete. Therefore, we initiated a population-based examination of five-year survival of colorectal cancer patients. METHODS For complete registration, diagnosis and tumour stage of all patients in the region of Bonn/Rhine-Sieg were assessed independently according to reports of medical practitioners and pathologists. Each patient was followed by a standardised questionnaire during a period of five years. RESULTS Between June and November, 1994 348 patients were registered. Median age at diagnosis was 69 years for males (n = 160) and 72 years for females (n = 188). According to the UICC classification 18, 26, 23 and 26 % had stage I-IV tumours, respectively; the tumour stage remained unclear in 7 %. Adjuvant (radio)-chemotherapy was indicated in 89 patients, but only 49 % of these were treated. Five-year overall survival (OS) and relative overall survival were 41 and 54 %, respectively. Although disease-free survival (DFS) was significantly better for early stage colorectal cancer, OS did not differ significantly between stage I and stage III tumours. Young patients diagnosed before the age of 50 had a significantly lower DFS. These data were comparable with other European countries but were lower than data reported in the USA. DISCUSSION The high rate of patients with stage IV colorectal cancer and the low proportion of patients receiving adjuvant (radio)-chemotherapy according to international or national consensus recommendations were disappointing. Although data were comparable with other European countries more efforts are necessary to establish effective screening programs for asymptomatic patients and to increase the willingness for standardised adjuvant treatment.
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Affiliation(s)
- C Lamberti
- Medizinische Klinik und Poliklinik I, Universität Bonn, Germany.
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Manegold C, Thatcher N, Kortsik C, Koschel G, Spengler W, Mezger J, Müller A, Pilz L. O-102 Gemcitabine and docetaxel as concomitant or sequential first-linetherapy of advanced non-small cell lung cancer: Updated results of a randomized study. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Manegold C, Leichman G, Gravenor D, Woytowitz D, Mezger J, Haarmann C, Al-Adhami M, Schmalbach T, Whisnant J. PD-046 Phase II randomized trial adding a toll-like receptor 9 agonist (ProMuneTM) to first line chemotherapy shows improved response in advanced non-small cell lung cancer. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80379-4] [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: 11/30/2022]
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Leichman G, Gravenor D, Woytowitz D, Mezger J, Albert G, Schmalbach T, Al-Adhami M, Manegold C. CPG 7909, a TLR9 agonist, added to first line taxane/platinum for advanced non-small cell lung cancer, a randomized, controlled phase II study. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- G. Leichman
- Comprehensive Cancer Ctr, Palm Springs, CA; Family Cancer Ctr, Memphis, TN; Florida Cancer Specialists, Fort Myers, FL; St. Vincentius-Kliniken, Karlsruhe, Germany; Coley Pharm Group, Wellesley, MA; Univklin der Univ Heidelberg, Mannheim, Germany
| | - D. Gravenor
- Comprehensive Cancer Ctr, Palm Springs, CA; Family Cancer Ctr, Memphis, TN; Florida Cancer Specialists, Fort Myers, FL; St. Vincentius-Kliniken, Karlsruhe, Germany; Coley Pharm Group, Wellesley, MA; Univklin der Univ Heidelberg, Mannheim, Germany
| | - D. Woytowitz
- Comprehensive Cancer Ctr, Palm Springs, CA; Family Cancer Ctr, Memphis, TN; Florida Cancer Specialists, Fort Myers, FL; St. Vincentius-Kliniken, Karlsruhe, Germany; Coley Pharm Group, Wellesley, MA; Univklin der Univ Heidelberg, Mannheim, Germany
| | - J. Mezger
- Comprehensive Cancer Ctr, Palm Springs, CA; Family Cancer Ctr, Memphis, TN; Florida Cancer Specialists, Fort Myers, FL; St. Vincentius-Kliniken, Karlsruhe, Germany; Coley Pharm Group, Wellesley, MA; Univklin der Univ Heidelberg, Mannheim, Germany
| | - G. Albert
- Comprehensive Cancer Ctr, Palm Springs, CA; Family Cancer Ctr, Memphis, TN; Florida Cancer Specialists, Fort Myers, FL; St. Vincentius-Kliniken, Karlsruhe, Germany; Coley Pharm Group, Wellesley, MA; Univklin der Univ Heidelberg, Mannheim, Germany
| | - T. Schmalbach
- Comprehensive Cancer Ctr, Palm Springs, CA; Family Cancer Ctr, Memphis, TN; Florida Cancer Specialists, Fort Myers, FL; St. Vincentius-Kliniken, Karlsruhe, Germany; Coley Pharm Group, Wellesley, MA; Univklin der Univ Heidelberg, Mannheim, Germany
| | - M. Al-Adhami
- Comprehensive Cancer Ctr, Palm Springs, CA; Family Cancer Ctr, Memphis, TN; Florida Cancer Specialists, Fort Myers, FL; St. Vincentius-Kliniken, Karlsruhe, Germany; Coley Pharm Group, Wellesley, MA; Univklin der Univ Heidelberg, Mannheim, Germany
| | - C. Manegold
- Comprehensive Cancer Ctr, Palm Springs, CA; Family Cancer Ctr, Memphis, TN; Florida Cancer Specialists, Fort Myers, FL; St. Vincentius-Kliniken, Karlsruhe, Germany; Coley Pharm Group, Wellesley, MA; Univklin der Univ Heidelberg, Mannheim, Germany
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Manegold C, Thatcher N, Kortsik C, Koschel G, Spengler W, Mezger J, Müller A, Pilz LR. A phase II/III randomized study in advanced non-small cell lung cancer (NSCLC) with first line combination versus sequential gemcitabine (G) and docetaxel (D): Update on quality of life (QoL), toxicity, and costs. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. Manegold
- Universitätsklinikum Mannheim, Mannheim, Germany; Christie Hosp, Manchester, United Kingdom; KH Sankt Hildegardis, Mainz, Germany; AKH Hamburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; St. Vincentius-Kliniken, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Ctr (DKFZ), Heidelberg, Germany
| | - N. Thatcher
- Universitätsklinikum Mannheim, Mannheim, Germany; Christie Hosp, Manchester, United Kingdom; KH Sankt Hildegardis, Mainz, Germany; AKH Hamburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; St. Vincentius-Kliniken, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Ctr (DKFZ), Heidelberg, Germany
| | - C. Kortsik
- Universitätsklinikum Mannheim, Mannheim, Germany; Christie Hosp, Manchester, United Kingdom; KH Sankt Hildegardis, Mainz, Germany; AKH Hamburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; St. Vincentius-Kliniken, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Ctr (DKFZ), Heidelberg, Germany
| | - G. Koschel
- Universitätsklinikum Mannheim, Mannheim, Germany; Christie Hosp, Manchester, United Kingdom; KH Sankt Hildegardis, Mainz, Germany; AKH Hamburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; St. Vincentius-Kliniken, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Ctr (DKFZ), Heidelberg, Germany
| | - W. Spengler
- Universitätsklinikum Mannheim, Mannheim, Germany; Christie Hosp, Manchester, United Kingdom; KH Sankt Hildegardis, Mainz, Germany; AKH Hamburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; St. Vincentius-Kliniken, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Ctr (DKFZ), Heidelberg, Germany
| | - J. Mezger
- Universitätsklinikum Mannheim, Mannheim, Germany; Christie Hosp, Manchester, United Kingdom; KH Sankt Hildegardis, Mainz, Germany; AKH Hamburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; St. Vincentius-Kliniken, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Ctr (DKFZ), Heidelberg, Germany
| | - A. Müller
- Universitätsklinikum Mannheim, Mannheim, Germany; Christie Hosp, Manchester, United Kingdom; KH Sankt Hildegardis, Mainz, Germany; AKH Hamburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; St. Vincentius-Kliniken, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Ctr (DKFZ), Heidelberg, Germany
| | - L. R. Pilz
- Universitätsklinikum Mannheim, Mannheim, Germany; Christie Hosp, Manchester, United Kingdom; KH Sankt Hildegardis, Mainz, Germany; AKH Hamburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; St. Vincentius-Kliniken, Karlsruhe, Germany; Thoraxklinik, Heidelberg, Germany; German Cancer Research Ctr (DKFZ), Heidelberg, Germany
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Mueller A, Thatcher N, Kortsik C, Koschel G, Spengler W, Pilz L, Mezger J, Manegold C. A phase II/III randomized study in advanced non-small cell lung cancer (NSCLC) with first line combination versus sequential gemcitabine and docetaxel: Interim study results. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Mueller
- Thoraxklinik Heidelberg, Heidelberg, Germany; Christie Hospital NHS Trust, Manchester, United Kingdom; St. Hildegardiskrankenhaus Mainz, Mainz, Germany; AKH Hamburg - Harburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; St. Vincentius Kliniken, Karlruhe, Germany
| | - N. Thatcher
- Thoraxklinik Heidelberg, Heidelberg, Germany; Christie Hospital NHS Trust, Manchester, United Kingdom; St. Hildegardiskrankenhaus Mainz, Mainz, Germany; AKH Hamburg - Harburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; St. Vincentius Kliniken, Karlruhe, Germany
| | - C. Kortsik
- Thoraxklinik Heidelberg, Heidelberg, Germany; Christie Hospital NHS Trust, Manchester, United Kingdom; St. Hildegardiskrankenhaus Mainz, Mainz, Germany; AKH Hamburg - Harburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; St. Vincentius Kliniken, Karlruhe, Germany
| | - G. Koschel
- Thoraxklinik Heidelberg, Heidelberg, Germany; Christie Hospital NHS Trust, Manchester, United Kingdom; St. Hildegardiskrankenhaus Mainz, Mainz, Germany; AKH Hamburg - Harburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; St. Vincentius Kliniken, Karlruhe, Germany
| | - W. Spengler
- Thoraxklinik Heidelberg, Heidelberg, Germany; Christie Hospital NHS Trust, Manchester, United Kingdom; St. Hildegardiskrankenhaus Mainz, Mainz, Germany; AKH Hamburg - Harburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; St. Vincentius Kliniken, Karlruhe, Germany
| | - L. Pilz
- Thoraxklinik Heidelberg, Heidelberg, Germany; Christie Hospital NHS Trust, Manchester, United Kingdom; St. Hildegardiskrankenhaus Mainz, Mainz, Germany; AKH Hamburg - Harburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; St. Vincentius Kliniken, Karlruhe, Germany
| | - J. Mezger
- Thoraxklinik Heidelberg, Heidelberg, Germany; Christie Hospital NHS Trust, Manchester, United Kingdom; St. Hildegardiskrankenhaus Mainz, Mainz, Germany; AKH Hamburg - Harburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; St. Vincentius Kliniken, Karlruhe, Germany
| | - C. Manegold
- Thoraxklinik Heidelberg, Heidelberg, Germany; Christie Hospital NHS Trust, Manchester, United Kingdom; St. Hildegardiskrankenhaus Mainz, Mainz, Germany; AKH Hamburg - Harburg, Hamburg, Germany; KH Schillerhöhe, Gerlingen, Germany; German Cancer Research Centre (DKFZ), Heidelberg, Germany; St. Vincentius Kliniken, Karlruhe, Germany
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Gralla R, Lichinitser M, Van Der Vegt S, Sleeboom H, Mezger J, Peschel C, Tonini G, Labianca R, Macciocchi A, Aapro M. Palonosetron improves prevention of chemotherapy-induced nausea and vomiting following moderately emetogenic chemotherapy: results of a double-blind randomized phase III trial comparing single doses of palonosetron with ondansetron. Ann Oncol 2004; 14:1570-7. [PMID: 14504060 DOI: 10.1093/annonc/mdg417] [Citation(s) in RCA: 363] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although all first-generation 5-HT(3) receptor antagonists demonstrate efficacy in preventing acute chemotherapy-induced nausea and vomiting (CINV), effective prevention of delayed CINV has not yet been achieved. This study compared the efficacy and tolerability of palonosetron, a novel, second-generation 5-HT(3) receptor antagonist, with ondansetron. PATIENTS AND METHODS In this multicenter, randomized, double-blind, stratified, phase III study, 570 adult cancer patients were randomized to receive a single i.v. dose of palonosetron 0.25 mg, palonosetron 0.75 mg or ondansetron 32 mg, each administered 30 min before initiation of moderately emetogenic chemotherapy. The primary end point was the proportion of patients with no emetic episodes and no rescue medication [complete response (CR)] during the 24 h after chemotherapy administration (acute period). Secondary end points included efficacy in treatment of delayed CINV (</=5 days post-chemotherapy) and overall tolerability. RESULTS 563 patients were evaluable for efficacy. CR rates were significantly higher (P <0.01) for palonosetron 0.25 mg than ondansetron during the acute (0-24 h) (81.0% versus 68.6%, respectively), delayed (24-120 h) (74.1% versus 55.1%) and overall (0-120 h) (69.3% versus 50.3%) periods. CR rates achieved with palonosetron 0.75 mg were numerically higher but not statistically different from ondansetron during all three time intervals. Both treatments were well tolerated. CONCLUSIONS A single i.v. dose of palonosetron 0.25 mg was significantly superior to i.v. ondansetron 32 mg in the prevention of acute and delayed CINV.
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Affiliation(s)
- R Gralla
- New York Lung Cancer Alliance, New York, NY, USA
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Glasmacher A, Goldschmidt H, Mezger J, Haferlach T, Schmidt-Wolf IGH, Gieseler F. Oral idarubicin, dexamethasone and vincristine in the treatment of multiple myeloma: final analysis of a phase II trial. Haematologica 2004; 89:371-3. [PMID: 15020285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
This prospective phase II study evaluated a regimen with vincristine, oral idarubicin and dexamethasone (VID) in 74 patients with multiple myeloma. A partial response was achieved in 57% (16/28) of patients with previously untreated disease and in 35% (16/46) with refractory diseases. VID chemotherapy is an effective and tolerable oral alternative in an outpatient setting for these patients.
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Pilz L, Koschel G, Mezger J, Schott K, Spengler W, Manegold C. 774 Quality of life assessment and final results of a randomized Phase II study with single-agent gemcitabine and docetaxel given sequentially every 3 weeks show effective treatment in advanced NSCLC. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90799-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Ziske C, Mezger J, Jiménez C, Kleinschmidt R, Pels H, Schlegel U, Schmidt-Wolf IG. High-dose chemotherapy with autologous peripheral blood stem cell support for recurrent primary AFP-producing intracranial germinoma. Ger Med Sci 2003; 1:Doc03. [PMID: 19675701 PMCID: PMC2703232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2003] [Indexed: 11/13/2022]
Abstract
We report of a 34-year old man with second intracranial relapse of a suprasellar germinoma. Despite of extensive pretreatment with radiation and conventional chemotherapy relapse occurred and was treated with sequential high-dose chemotherapy followed by transfusion of autologous peripheral stem cells. The high-dose chemotherapy course was complicated by refractory derailment of pineal gland insufficiency. The patient achieved a complete remission after high dose chemotherapy which lasted for 13 months. Subsequently, he developed a third relapse and died.
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Affiliation(s)
- Carsten Ziske
- Medizinische Klinik und Poliklinik I, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Jörg Mezger
- Medizinische Abteilung II, St. Vincentiuskrankenhäuser, Karlsruhe, Germany
| | - Carlos Jiménez
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Rolf Kleinschmidt
- Medizinische Klinik und Poliklinik I, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Hendrik Pels
- Abteilung für Neurologie, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Uwe Schlegel
- Abteilung für Neurologie, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany
| | - Ingo G.H. Schmidt-Wolf
- Medizinische Klinik und Poliklinik I, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany,*To whom correspondence should be addressed: Ingo G.H. Schmidt-Wolf, Medizinische Klinik und Poliklinik I, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freud-Str. 25, 53105 Bonn, Germany, Tel.: +49-228-287-5489, Fax: +49-228-287-5849, E-mail:
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43
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Kruijtzer CMF, Schellens JHM, Mezger J, Scheulen ME, Keilholz U, Beijnen JH, Rosing H, Mathôt RAA, Marcus S, van Tinteren H, Baas P. Phase II and pharmacologic study of weekly oral paclitaxel plus cyclosporine in patients with advanced non-small-cell lung cancer. J Clin Oncol 2002; 20:4508-16. [PMID: 12454106 DOI: 10.1200/jco.2002.04.058] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A phase II study was performed to assess the efficacy and toxicity of oral cyclosporine (CsA) plus paclitaxel in advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Chemotherapy-naive or previously treated patients (one regimen) with measurable disease and World Health Organization performance status <or= 2 were eligible. Oral paclitaxel was given weekly in a dose of 90 mg/m(2) bid. CsA (10 mg/kg) was given 30 minutes before each dose of oral paclitaxel. RESULTS Twenty-six patients with a median age of 54 years (range, 32 to 77 years) were entered onto this study. Eighteen patients (69%) had received one prior chemotherapy regimen. The most frequently recorded toxicities were as follows: National Cancer Institute common toxicity criteria grade 3 neutropenia, eight patients (31%); grade 4, six patients (23%); grade 4 febrile neutropenia, three patients (12%); grade 2/3 neurotoxicity, three patients (12%); and grade 2 nail changes, four patients (15%). The overall response rate (ORR) of the 23 assessable patients was 26% (95% confidence interval [CI], 10% to 48%). In the intention-to-treat population, the ORR was 23% (95% CI, 9% to 44%). The median time to progression was 3.5 months (95% CI, 1.2 to 3.9 months), and median overall survival was 6.0 months (95% CI, 2.3 months to not available). Pharmacokinetics revealed that the mean area under the concentration-time curve (AUC) of oral paclitaxel was 5.0 +/- 2.3 micro mol/L/h in week 1 and 4.6 +/- 2.0 micro mol/L/h in week 2, with interpatient variabilities (coefficient of variation [%CV]) of 45% and 42%, respectively. The intrapatient variability (%CV) of the AUC was 14.5%. CONCLUSION Oral paclitaxel plus CsA is active and safe in advanced NSCLC, including in patients previously treated with chemotherapy.
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Affiliation(s)
- C M F Kruijtzer
- Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Rummel MJ, Chow KU, Karakas T, Jäger E, Mezger J, von Grünhagen U, Schalk KP, Burkhard O, Hansmann ML, Ritzel H, Bergmann L, Hoelzer D, Mitrou PS. Reduced-dose cladribine (2-CdA) plus mitoxantrone is effective in the treatment of mantle-cell and low-grade non-Hodgkin's lymphoma. Eur J Cancer 2002; 38:1739-46. [PMID: 12175690 DOI: 10.1016/s0959-8049(02)00143-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cladribine (2-chlorodeoxyadenosine) (2-CdA) has been shown to be effective in mantle-cell (MCL) and low-grade lymphomas (lgNHL). The aim of this multicentre study was to evaluate the rate and duration of remissions and to examine the toxicity of the combination of reduced-dose 2-CdA and mitoxantrone (CdM) in MCL and lgNHL as first-line therapy or for patients in their relapse. A total of 285 courses, median of five courses per patient, were administered to 62 evaluable patients (42 previously untreated, 20 relapsed) with 5 mg/m(2) 2-CdA per day given as an intermittent 2-h infusion over 3 consecutive days combined with 8 mg/m(2) mitoxantrone on days 1 and 2 for the untreated patients or 12 mg/m(2) mitoxantrone on day 1 for patients in their first relapse for a maximum of six cycles every four weeks. 32 follicular, 18 MCL, 9 lymphoplasmacytoid, 2 marginal zone and 1 unclassified low-grade B-cell lymphoma were involved in the study. 56 of the 62 patients responded to CdM resulting in an overall response rate of 90% (95% confidence interval (CI), 80-96%) with a complete remission (CR) rate of 44% (95% CI, 31-57%) and a median duration of remission of 25 months (range 6-42+). The overall survival rate at 48 months was 80%. For 42 previously untreated patients, the overall response rate was 88% (95% CI, 74-96%) with a CR rate of 38% (95% CI, 24-54%), whereas the response rate for the group of 20 previously treated patients was similar with a 95% overall response (95% CI, 75-100%) and a CR rate of 55% (95% CI, 32-77%). In MCL, CdM showed a high activity, achieving a response rate of 100% (95% CI, 81-100%) with a CR rate of 44% and a median duration of remission of 24 months (range 6-35+). Myelosuppression was the major toxicity with 23% grade 3 granulocytopenia and 50% grade 4. Thrombocytopenia was less commonly observed, with only 8% grades 3 and 4. These results demonstrate that the combination of reduced-dose 2-CdA and mitoxantrone is a highly active regimen in the treatment of low-grade lymphomas, and in particular of MCL.
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Affiliation(s)
- M J Rummel
- Department of Internal Medicine, Hematology/Oncology, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
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Mezger J. [Neoadjuvant and adjuvant chemotherapy of locally advanced stomach cancer]. Onkologie 2001; 24:374-5. [PMID: 11577750 DOI: 10.1159/000055110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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46
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Manegold C, Pilz L, Koschel G, Schott K, Hruska D, Mezger J. Single agent gemzar (G) and taxotere (T) given as 1st/2nd line therapy are active in advanced NSCLC: survival data from two randomized phase II studies. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80556-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Williams AB, Singh MP, Dos Santos K, Winfrey J, Mezger J. Report from the field: participation of HIV-positive women in clinical research. AIDS Public Policy J 2000; 12:46-52. [PMID: 10915256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- A B Williams
- Yale School of Nursing, in New Haven, Connecticut, USA
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Koschel R, Huber R, Gatzemeier U, Gosse H, von Pawel J, Hruska D, Mezger J, Saal J. Topotecan in second-line treatment of small cell lung cancer reduced toxicity with individualized therapy. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80136-1] [Citation(s) in RCA: 6] [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: 10/27/2022]
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Huber R, Gatzemeier U, Gosse H, von Pawel J, Hruska D, Mezger J, Saal J, Kleinschmidt R, Steppert C, Steppling H. Topotecan in Second-Line Therapy of SCLC: Impact on Survival? ACTA ACUST UNITED AC 2000. [DOI: 10.1159/000055042] [Citation(s) in RCA: 4] [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: 11/19/2022]
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Lamerz R, Stoetzer OJ, Mezger J, Brandt A, Darsow M, Wilmanns W. Value of human chorionic gonadotropin compared to CEA in discriminating benign from malignant effusions. Anticancer Res 1999; 19:2421-5. [PMID: 10470169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Human chorionic gonadotropin (HCG) is expressed in germ cell tumors and urothelial, breast, lung and colon cancers. The aim of the study was to investigate if the determination of HCG in comparison with CEA is able to discriminate between malignant and benign effusions. Effusion and partially serum samples of 61 patients with benign (g.i., heart/kidney isnuff.) and 116 patients with malignant diseases (g.i., gynec., lung, misc., CUP) were investigated. HCG was specifically determined by an IRMA using 2 monoclonal antibodies, CEA by a conventional double Ab RIA. Cytological staining was preformed using the Pappenheim-method on cytospin preparations. Significant differences (p < 0.001) were found for HCG between benign and malignant ascitic effusions with the best discrimination at 5 IU/l (ROC) and an overall sensitivity of 31.3% (spec. vs benign eff. 93.4%) increasing in subgroups from hematol. (5.8%) < misc. (31.3%) < gynec. (32.1%) < g.i. (36%) < lung (38.1%) to CUP (50%). CEA also showed significant differences between benign and malignant total and ascitic effusions, and weaker for the pleural subgroup (cutoff 9 ng/ml) with a total sensitivity of 44.6% (sp = 100%) increasing from misc. (30.8%) < lung (47.1%) < CUP (50%) < gynec. (60%) < g.i. (60.9%). Comparative cytology and TM determinations increased the positiverate of cytology (45.2%) to 58.3% for either cytology or HCG positive cases, or to 61.6% for either cytology or CEA positive cases. For the combined determination of cytologoy and HCG and CEA, the overall TM positive rate for 33 cytology-pos. cases was 78.8%, but in 40 cytology-negative cases 37.5% for TM positive cases. In conclusion HCG is useful in ascitic > pleural effusions with high specificity (90% at 5 IU/l) but low sensitivity of 31% increasing in g.i., lung and gynecologic cases, CEA a more general TM with higher sensitivity of 45% increasing in g.i., gynecologic and lung cases (sp. 100% at 9 ng/ml) both adding significantly to cytology-negative effusions.
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Affiliation(s)
- R Lamerz
- Medical Department II, Klinikum Grosshadern, University of Munich, Germany.
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