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van der Hoeven JJM, Monkhorst K, van de Wouw AJ, Roepman P. [Whole genome sequencing to find the primary tumour in cancer of unknown primary origin]. Ned Tijdschr Geneeskd 2023; 167:D7625. [PMID: 37823879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Cancer of unknown primary origin (CUP) remains a serious problem. The incidence in the Netherlands is stable, 1-2 percent of all new cancer cases. In general, patients undergo a long diagnostic trajectory and only a minority receive a tumour directed treatment. More than half of the patients die within two months after the diagnosis. A complete analysis of the DNA of a tumour specimen by means of whole genome sequencing may be helpful in finding the primary tumour. Dutch medical oncologists and pathologists set up a protocol for CUP patients, in which WGS may be implemented in the diagnostic procedure.
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Affiliation(s)
| | - Kim Monkhorst
- Antoni van Leeuwenhoek-Nederlands Kanker Instituut, afd. Pathologie, Amsterdam
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2
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Walraven JEW, van der Hel OL, van der Hoeven JJM, Lemmens VEPP, Verhoeven RHA, Desar IME. Factors influencing the quality and functioning of oncological multidisciplinary team meetings: results of a systematic review. BMC Health Serv Res 2022; 22:829. [PMID: 35761282 PMCID: PMC9238082 DOI: 10.1186/s12913-022-08112-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background Discussing patients with cancer in a multidisciplinary team meeting (MDTM) is customary in cancer care worldwide and requires a significant investment in terms of funding and time. Efficient collaboration and communication between healthcare providers in all the specialisms involved is therefore crucial. However, evidence-based criteria that can guarantee high-quality functioning on the part of MDTMs are lacking. In this systematic review, we examine the factors influencing the MDTMs’ efficiency, functioning and quality, and offer recommendations for improvement. Methods Relevant studies were identified by searching Medline, EMBASE, and PsycINFO databases (01–01-1990 to 09–11-2021), using different descriptions of ‘MDTM’ and ‘neoplasm’ as search terms. Inclusion criteria were: quality of MDTM, functioning of MDTM, framework and execution of MDTM, decision-making process, education, patient advocacy, patient involvement and evaluation tools. Full text assessment was performed by two individual authors and checked by a third author. Results Seventy-four articles met the inclusion criteria and five themes were identified: 1) MDTM characteristics and logistics, 2) team culture, 3) decision making, 4) education, and 5) evaluation and data collection. The quality of MDTMs improves when the meeting is scheduled, structured, prepared and attended by all core members, guided by a qualified chairperson and supported by an administrator. An appropriate amount of time per case needs to be established and streamlining of cases (i.e. discussing a predefined selection of cases rather than discussing every case) might be a way to achieve this. Patient centeredness contributes to correct diagnosis and decision making. While physicians are cautious about patients participating in their own MDTM, the majority of patients report feeling better informed without experiencing increased anxiety. Attendance at MDTMs results in closer working relationships between physicians and provides some medico-legal protection. To ensure well-functioning MDTMs in the future, junior physicians should play a prominent role in the decision-making process. Several evaluation tools have been developed to assess the functioning of MDTMs. Conclusions MDTMs would benefit from a more structured meeting, attendance of core members and especially the attending physician, streamlining of cases and structured evaluation. Patient centeredness, personal competences of MDTM participants and education are not given sufficient attention.
Supplementary information The online version contains supplementary material available at 10.1186/s12913-022-08112-0.
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3
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van Zeijl MCT, de Wreede LC, van den Eertwegh AJM, Wouters MWJM, Jochems A, Schouwenburg MG, Aarts MJB, van Akkooi ACJ, van den Berkmortel FWPJ, de Groot JWB, Hospers GAP, Kapiteijn E, Piersma D, van Rijn RS, Suijkerbuijk KPM, Ten Tije AJ, van der Veldt AAM, Vreugdenhil G, van der Hoeven JJM, Haanen JBAG. Survival outcomes of patients with advanced melanoma from 2013 to 2017: Results of a nationwide population-based registry. Eur J Cancer 2020; 144:242-251. [PMID: 33373869 DOI: 10.1016/j.ejca.2020.11.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/04/2020] [Revised: 10/15/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The treatment landscape has completely changed for advanced melanoma. We report survival outcomes and the differential impact of prognostic factors over time in daily clinical practice. METHODS From a Dutch nationwide population-based registry, patients with advanced melanoma diagnosed from 2013 to 2017 were analysed (n = 3616). Because the proportional hazards assumption was violated, a multivariable Cox model restricted to the first 6 months and a multivariable landmark Cox model from 6 to 48 months were used to assess overall survival (OS) of cases without missing values. The 2017 cohort was excluded from this analysis because of the short follow-up time. RESULTS Median OS of the 2013 and 2016 cohort was 11.7 months (95% confidence interval [CI]: 10.4-13.5) and 17.7 months (95% CI: 14.9-19.8), respectively. Compared with the 2013 cohort, the 2016 cohort had superior survival in the Cox model from 0 to 6 months (hazard ratio [HR] = 0.55 [95% CI: 0.43-0.72]) and in the Cox model from 6 to 48 months (HR = 0.68 [95% CI: 0.57-0.83]). Elevated lactate dehydrogenase levels, distant metastases in ≥3 organ sites, brain and liver metastasis and Eastern Cooperative Oncology Group performance score of ≥1 had stronger association with inferior survival from 0 to 6 months than from 6 to 48 months. BRAF-mutated melanoma had superior survival in the first 6 months (HR = 0.50 [95% CI: 0.42-0.59]). CONCLUSION(S) Prognosis for advanced melanoma in the Netherlands has improved from 2013 to 2016. Prognostic importance of most evaluated factors was higher in the first 6 months after diagnosis. BRAF-mutated melanoma was only associated with superior survival in the first 6 months.
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Affiliation(s)
- M C T van Zeijl
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, the Netherlands
| | - L C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, Leiden, 2333ZC, the Netherlands
| | - A J M van den Eertwegh
- Department of Medical Oncology, Amsterdam UMC, Location VU Medical Center (VUmc), Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, the Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands
| | - A Jochems
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands; Department of Medical Oncology, Haaglanden Medisch Centrum, Lijnbaan 32, Den Haag, 2512VA, the Netherlands
| | - M G Schouwenburg
- Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, Leiden, 2333AA, the Netherlands
| | - M J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, 6229 HX, the Netherlands
| | - A C J van Akkooi
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands
| | - F W P J van den Berkmortel
- Department of Medical Oncology, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162BG, the Netherlands
| | - J W B de Groot
- Department of Medical Oncology, Isala Clinics, Dokter van Heesweg 2, Zwolle, 8025AB, the Netherlands
| | - G A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713GZ, the Netherlands
| | - E Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, the Netherlands
| | - D Piersma
- Department of Internal Medicine, Medisch Spectrum Twente, Koningsplein 1, Enschede, 7512KZ, the Netherlands
| | - R S van Rijn
- Department of Internal Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, Leeuwarden, 8934AD, the Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Cancer Center, Heidelberglaan 100, Utrecht, 3584CX, the Netherlands
| | - A J Ten Tije
- Department of Internal Medicine, Amphia Hospital, Molengracht 21, Breda, 4818CK, the Netherlands
| | - A A M van der Veldt
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, Rotterdam, 3015CE, the Netherlands
| | - G Vreugdenhil
- Department of Internal Medicine, Maxima Medical Center, De Run 4600, Eindhoven, 5504DB, the Netherlands
| | - J J M van der Hoeven
- Department of Medical Oncology, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, the Netherlands
| | - J B A G Haanen
- Divisions of Medical Oncology and Molecular Oncology & Immunology, the Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066CX, the Netherlands.
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Schoffelen R, Lankheet AG, van Herpen CML, van der Hoeven JJM, Desar IME, Kramers C. Drug-drug interactions with aprepitant in antiemetic prophylaxis for chemotherapy. Neth J Med 2018; 76:109-114. [PMID: 29667586] [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: 06/08/2023]
Abstract
In the current guidelines to prevent hemotherapyinduced nausea and vomiting, multiple antiemetic drugs are administered simultaneously. In patients who receive highly emetogenic chemotherapy, aprepitant, an NK1-receptor antagonist, is combined with ondansetron and dexamethasone. Aprepitant can influence the pharmacokinetics of other drugs, as it is an inhibitor and inducer of CYP3A4. Some anticancer drugs and other co-medication frequently used in cancer patients are CYP3A4 or CYP29C substrates. We give an overview of the metabolism and current data on clinically relevant drug-drug interactions with aprepitant during chemotherapy. Physicians should be aware of the potential risk of drug-drug interactions with aprepitant, especially in regimens with curative intent. More research should be performed on drug-drug interactions with aprepitant and their clinical consequences to make evidence-based recommendations.
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Affiliation(s)
- R Schoffelen
- Department of Medical Oncology, Radboudumc, Nijmegen, the Netherlands
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5
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van der Hoeven JJM. [70-Gene signature as an aid to treatment decisions in early-stage breast cancer]. Ned Tijdschr Geneeskd 2017; 161:D1369. [PMID: 28401821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy. METHODS In this randomized, phase 3 study, we enrolled 6693 women with early-stage breast cancer and determined their genomic risk (using the 70-gene signature) and their clinical risk (using a modified version of Adjuvant! Online). Women at low clinical and genomic risk did not receive chemotherapy, whereas those at high clinical and genomic risk did receive such therapy. In patients with discordant risk results, either the genomic risk or the clinical risk was used to determine the use of chemotherapy. The primary goal was to assess whether, among patients with high-risk clinical features and a low-risk gene-expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval for the rate of 5-year survival without distant metastasis would be 92% (i.e., the noninferiority boundary) or higher. RESULTS A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. At 5 years, the rate of survival without distant metastasis in this group was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The absolute difference in this survival rate between these patients and those who received chemotherapy was 1.5 percentage points, with the rate being lower without chemotherapy. Similar rates of survival without distant metastasis were reported in the subgroup of patients who had estrogen-receptor-positive, human epidermal growth factor receptor 2-negative, and either node-negative or node-positive disease. CONCLUSIONS Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy.
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Komen MMC, Smorenburg CH, Nortier JWR, van der Ploeg T, van den Hurk CJG, van der Hoeven JJM. Results of scalp cooling during anthracycline containing chemotherapy depend on scalp skin temperature. Breast 2016; 30:105-110. [PMID: 27689316 DOI: 10.1016/j.breast.2016.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 08/16/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The success of scalp cooling in preventing or reducing chemotherapy induced alopecia (CIA) is highly variable between patients undergoing similar chemotherapy regimens. A decrease of the scalp skin temperature seems to be an important factor, but data on the optimum temperature reached by scalp cooling to prevent CIA are lacking. This study investigated the relation between scalp skin temperature and its efficacy to prevent CIA. MATERIALS AND METHODS In this explorative study, scalp skin temperature was measured during scalp cooling in 62 breast cancer patients undergoing up to six cycles of anthracycline containing chemotherapy. Scalp skin temperature was measured by using two thermocouples at both temporal sides of the head. The primary end-point was the need for a wig or other head covering. RESULTS Maximal cooling was reached after 45 min and was continued for 90 min after chemotherapy infusion. The scalp skin temperature after 45 min cooling varied from 10 °C to 31 °C, resulting in a mean scalp skin temperature of 19 °C (SEM: 0,4). Intrapersonal scalp skin temperatures during cooling were consistent for each chemotherapy cycle (ANOVA: P = 0,855). Thirteen out of 62 patients (21%) did not require a wig or other head covering. They appeared to have a significantly lower mean scalp skin temperature (18 °C; SEM: 0,7) compared to patients with alopecia (20 °C; SEM: 0,5) (P = 0,01). CONCLUSION The efficacy of scalp cooling during chemotherapy is temperature dependent. A precise cut-off point could not be detected, but the best results seem to be obtained when the scalp temperature decreases below 18 °C. TRIALREGISTER. NL NTR NUMBER 3082.
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Affiliation(s)
- M M C Komen
- Department of Internal Medicine and Medical Oncology, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, Alkmaar, 1815 JD, The Netherlands.
| | - C H Smorenburg
- Department of Medical Oncology, Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands.
| | - J W R Nortier
- Department of Medical Oncology, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands.
| | - T van der Ploeg
- Science Department, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, Alkmaar, 1815 JD, The Netherlands.
| | - C J G van den Hurk
- Comprehensive Cancer Organisation the Netherlands, PO Box 231, Eindhoven, 5600 AE, The Netherlands.
| | - J J M van der Hoeven
- Department of Medical Oncology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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7
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Charehbili A, Hamdy NAT, Smit VTHBM, Kessels L, van Bochove A, van Laarhoven HW, Putter H, Meershoek-Klein Kranenbarg E, van Leeuwen-Stok AE, van der Hoeven JJM, van de Velde CJH, Nortier JWR, Kroep JR. Vitamin D (25-0H D3) status and pathological response to neoadjuvant chemotherapy in stage II/III breast cancer: Data from the NEOZOTAC trial (BOOG 10-01). Breast 2015; 25:69-74. [PMID: 26614548 DOI: 10.1016/j.breast.2015.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Serum levels of 25-OH vitamin D3 (vitamin D) have been shown to be prognostic for disease-free survival in patients with breast cancer. We investigated the predictive value of these levels for pathological response after neoadjuvant chemotherapy in patients with breast cancer taking part in the NEOZOTAC phase-III trial. Additionally, the effect of chemotherapy on vitamin D levels was studied. MATERIALS AND METHODS Serum vitamin D was measured at baseline and before the last cycle of chemotherapy. The relationship between these measurements and clinical outcome, as defined by pathological complete response in breast and lymph nodes (pCR) was examined. RESULTS Baseline and end of treatment vitamin D data were available in 169 and 91 patients, respectively. Median baseline vitamin D values were 58.0 nmol/L. In patients treated with chemotherapy only, serum vitamin D levels decreased during neoadjuvant chemotherapy (median decrease of 16 nmol/L, P = 0.003). The prevalence of vitamin D levels < 50 nmol/L increased from 38.3% at baseline to 55.9% after chemotherapy. In the total population, baseline and end of therapy vitamin D levels were not related to pathological response. No associations were found between pCR and vitamin D level changes. CONCLUSION The significant decrease in vitamin D post-neoadjuvant chemotherapy suggests that vitamin D levels should be monitored and in case of decrease of vitamin D levels, correction may be beneficial for skeletal health and possibly breast cancer outcome.
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Affiliation(s)
- A Charehbili
- Leiden University Medical Center, Department of Medical Oncology, The Netherlands; Leiden University Medical Center, Department of Surgery, The Netherlands
| | - N A T Hamdy
- Leiden University Medical Center, Department of Endocrinology & Metabolic Diseases, The Netherlands
| | - V T H B M Smit
- Leiden University Medical Center, Department of Pathology, The Netherlands
| | - L Kessels
- Deventer Ziekenhuis, Department of Clinical Oncology, The Netherlands
| | - A van Bochove
- Zaans Medisch Centrum, Department of Clinical Oncology, The Netherlands
| | - H W van Laarhoven
- Radboud Universiteit Nijmegen/AMC Amsterdam, Department of Medical Oncology, The Netherlands
| | - H Putter
- Leiden University Medical Center, Department of Medical Statistics, The Netherlands
| | | | | | - J J M van der Hoeven
- Leiden University Medical Center, Department of Medical Oncology, The Netherlands
| | - C J H van de Velde
- Leiden University Medical Center, Department of Surgery, The Netherlands
| | - J W R Nortier
- Leiden University Medical Center, Department of Medical Oncology, The Netherlands
| | - J R Kroep
- Leiden University Medical Center, Department of Medical Oncology, The Netherlands.
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8
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Dijkgraaf EM, Santegoets SJAM, Reyners AKL, Goedemans R, Wouters MCA, Kenter GG, van Erkel AR, van Poelgeest MIE, Nijman HW, van der Hoeven JJM, Welters MJP, van der Burg SH, Kroep JR. A phase I trial combining carboplatin/doxorubicin with tocilizumab, an anti-IL-6R monoclonal antibody, and interferon-α2b in patients with recurrent epithelial ovarian cancer. Ann Oncol 2015. [PMID: 26216383 DOI: 10.1093/annonc/mdv309] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
MESH Headings
- Adenocarcinoma, Clear Cell/blood
- Adenocarcinoma, Clear Cell/drug therapy
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/blood
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/pathology
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/blood
- CA-125 Antigen/blood
- Carboplatin/administration & dosage
- Cystadenocarcinoma, Serous/blood
- Cystadenocarcinoma, Serous/drug therapy
- Cystadenocarcinoma, Serous/pathology
- Dose-Response Relationship, Drug
- Doxorubicin/administration & dosage
- Doxorubicin/analogs & derivatives
- Endometrial Neoplasms/blood
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/pathology
- Enzyme-Linked Immunosorbent Assay
- Female
- Follow-Up Studies
- Humans
- Interferon alpha-2
- Interferon-alpha/administration & dosage
- Interferon-gamma/blood
- Interleukin-6/blood
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Polyethylene Glycols/administration & dosage
- Prognosis
- Receptors, Interleukin-6/antagonists & inhibitors
- Recombinant Proteins/administration & dosage
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Affiliation(s)
- E M Dijkgraaf
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - S J A M Santegoets
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | | | - R Goedemans
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - M C A Wouters
- Department of Gynecologic Oncology, University Medical Center Groningen, Groningen
| | - G G Kenter
- Department of Gynecologic Oncology, Center for Gynecological Oncology Amsterdam, Amsterdam
| | | | - M I E van Poelgeest
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - M J P Welters
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - S H van der Burg
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
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9
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Dijkgraaf EM, Santegoets SJAM, Reyners AKL, Goedemans R, Wouters MCA, Kenter GG, van Erkel AR, van Poelgeest MIE, Nijman HW, van der Hoeven JJM, Welters MJP, van der Burg SH, Kroep JR. A phase I trial combining carboplatin/doxorubicin with tocilizumab, an anti-IL-6R monoclonal antibody, and interferon-α2b in patients with recurrent epithelial ovarian cancer. Ann Oncol 2015. [PMID: 26216383 DOI: 10.1093/annonc/mdv309.] [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] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The immune system is important in epithelial ovarian cancer (EOC). Interleukin-6 is associated with chemoresistance and an immune-suppressive tumor microenvironment. We investigated whether a combination of chemotherapeutics, blockade of interleukin 6 (IL-6) receptor (IL-6R; tocilizumab), and immune enhancer interferon-α (Peg-Intron) is feasible, safe, and able to enhance immunity in patients with recurrent EOC. PATIENTS AND METHODS In this dose-escalation study, patients received tocilizumab 1, 2, 4, or 8 mg/kg i.v., q4 weeks during the first three cycles of carboplatin (AUC5) plus doxorubicin [pegylated liposomal doxorubicin (PLD) 30 mg/m(2) or doxorubicin 50 mg/m(2) i.v., day 1, q4 weeks, for six cycles]. At the highest tocilizumab dose (8 mg/kg), Peg-Intron (1 µg/kg s.c.) was added. Peripheral blood mononuclear cells were collected for immunomonitoring at baseline, after three and six cycles. Dose-limiting toxicity (DLT), CA-125, and radiologic response were evaluated. RESULTS In the 23 patients enrolled, no DLT was established. The most frequent grade 3/4 adverse events (CTCAE v4.03) were neutropenia (23%), febrile neutropenia (19%), and ileus (19%). No treatment-related deaths occurred. Using CT evaluation, 11 of 21 assessable patients responded, 6 had stable disease and 3 progressive disease. Patients receiving highest dose tocilizumab showed a functional blockade of IL-6R with increased levels of serum IL-6 (P = 0.02) and soluble IL-6R (P = 0.008). Consequently, immune cells displayed decreased levels of pSTAT3, myeloid cells produced more IL-12 and IL-1β while T cells were more activated and secreted higher amounts of effector cytokines interferon-γ and tumor necrosis factor-α. An increase in sIL-6R was potentially associated with a survival benefit (P = 0.03). CONCLUSIONS Functional IL-6R blocking is feasible and safe in EOC patients treated with carboplatin/(pegylated liposomal)doxorubicin, using 8 mg/kg tocilizumab. This combination is recommended for phase II evaluation based on immune parameters. CLINICAL TRIAL REGISTER NCT01637532.
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Affiliation(s)
- E M Dijkgraaf
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - S J A M Santegoets
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | | | - R Goedemans
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - M C A Wouters
- Department of Gynecologic Oncology, University Medical Center Groningen, Groningen
| | - G G Kenter
- Department of Gynecologic Oncology, Center for Gynecological Oncology Amsterdam, Amsterdam
| | | | - M I E van Poelgeest
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - M J P Welters
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - S H van der Burg
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
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10
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Schneider TC, de Wit D, Links TP, van Erp NP, van der Hoeven JJM, Gelderblom H, van Wezel T, van Eijk R, Morreau H, Guchelaar HJ, Kapiteijn E. Beneficial Effects of the mTOR Inhibitor Everolimus in Patients with Advanced Medullary Thyroid Carcinoma: Subgroup Results of a Phase II Trial. Int J Endocrinol 2015; 2015:348124. [PMID: 26294908 PMCID: PMC4532868 DOI: 10.1155/2015/348124] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 06/17/2015] [Indexed: 11/17/2022] Open
Abstract
Objective. Until recently, advanced medullary thyroid cancer (MTC) had few treatment options except surgery. The mTOR inhibitor everolimus has shown encouraging results in neuroendocrine tumors. As part of a prospective phase II study, we analyzed the safety and efficacy of everolimus in advanced MTC. Methods. Seven patients with per RECIST 1.1 documented advanced MTC were included and received everolimus 10 mg daily. The primary objective was determining treatment efficacy. Secondary endpoints included progression-free survival (PFS), overall survival (OS), toxicity, and pharmacokinetics (PK). Results. Median follow-up duration was 28 weeks (17-147). Five patients (71%) showed SD, of which 4 (57%) showed SD >24 weeks. Median PFS and OS were 33 (95%CI: 8-56) and 30 (95%CI: 15-45) weeks, respectively. Toxicity was predominantly grade 1/2 and included mucositis (43%), fatigue (43%), and hypertriglyceridemia (43%). Four MTCs harbored the somatic RET mutation c.2753T>C, p.Met918Thr. The best clinical response was seen in a MEN2A patient. PK characteristics were consistent with phase I data. One patient exhibited extensive toxicity accompanying elevated everolimus plasma concentrations. Conclusions. This study suggests that everolimus exerts clinically relevant antitumor activity in patients with advanced MTC. Given the high level of clinical benefit and the relatively low toxicity profile, further investigation of everolimus in these patients is warranted.
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Affiliation(s)
- T. C. Schneider
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - D. de Wit
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - T. P. Links
- Department of Endocrinology, University Medical Center Groningen, 9700 RB Groningen, Netherlands
| | - N. P. van Erp
- Department of Clinical Pharmacy, Radboud University Nijmegen Medical Center, 6525 GA Nijmegen, Netherlands
| | - J. J. M. van der Hoeven
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - H. Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - T. van Wezel
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - R. van Eijk
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - H. Morreau
- Department of Pathology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - H. J. Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - E. Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
- *E. Kapiteijn:
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van der Hulle T, den Exter PL, Kooiman J, van der Hoeven JJM, Huisman MV, Klok FA. Meta-analysis of the efficacy and safety of new oral anticoagulants in patients with cancer-associated acute venous thromboembolism. J Thromb Haemost 2014; 12:1116-20. [PMID: 24819040 DOI: 10.1111/jth.12605] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/04/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Treatment of acute venous thromboembolism (VTE) in cancer patients is challenging, owing to a high risk of recurrent VTE and bleeding complications. The anticoagulants of choice are low molecular weight heparins (LMWHs), because of a proven higher efficacy than vitamin K antagonists (VKAs) and a similar bleeding profile. The recently introduced new oral anticoagulants (NOACs) have the potential to be alternative options for these patients, as these drugs share practical advantages with LMWH, are administered orally, and had similar efficacy to VKAs but a lower bleeding risk in phase 3 studies in the general VTE population. METHODS A systematic literature search was performed to identify phase 3 trials investigating NOACs for the treatment of VTE. The efficacy outcome was recurrent VTE, and the safety outcome was major and clinically relevant non-major bleeding. Pooled incidence rates and risk ratios (RRs) were calculated for cancer patients and non-cancer patients separately. RESULTS AND DISCUSSION Five studies were included, with 19 060 patients, of whom 973 (5.1%) had active cancer. The pooled incidence rates of recurrent VTE were 4.1% (95% confidence interval [CI] 2.6-6.0) in cancer patients treated with NOACs, and 6.1% (95% CI 4.1-8.5) in patients treated with VKAs (RR 0.66, 95% CI 0.38-1.2). The pooled incidence rates of major or non-major clinically relevant bleeding were 15% (95% CI 12-18) in cancer patients treated with NOACs, and 16% (95% CI 9.9-22) in patients treated with VKAs (RR 0.94, 95% CI 0.70-1.3). These results form a solid basis for the initiation of a head-to-head comparison of NOACs with LMWH in cancer patients.
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Affiliation(s)
- T van der Hulle
- Department of Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands
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12
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Dekker TJA, van de Velde CJH, van Bruggen D, Mesker WE, van der Hoeven JJM, Kroep JR, Tollenaar RAEM, Smit VTHBM. Quantitative assessment of lymph vascular space invasion (LVSI) provides important prognostic information in node-negative breast cancer. Ann Oncol 2013; 24:2994-8. [PMID: 24114856 DOI: 10.1093/annonc/mdt400] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Some studies investigating the prognostic value of lymph vascular space invasion (LVSI) have shown an association between LVSI and disease-free survival. Definitive criteria and optimal determination of this parameter remain unclear, however, especially regarding the clinical relevance of LVSI quantification. PATIENTS AND METHODS A subset of node-negative breast carcinomas from premenopausal patients from the European Organization for the Research and Treatment of Cancer trial 10854 (assessing efficacy of perioperative chemotherapy patients with T1-T3, N0-2, and M0 breast cancer (BC) was selected and scored for LVSI. In 358 evaluable breast carcinomas, the number of LVSI foci and tumor cells was determined in the largest tumor embolus within the lymph vessels. These two parameters were multiplied to calculate the LVSI tumor burden (LVSI TB). The optimal cutoff for this parameter was calculated in a test set (N = 120), tested in a validation set (N = 238), and compared with simple quantitation of the number of LVSI foci. RESULTS Tumors with a single LVSI focus are not associated with increased risk for relapse [hazard ratio (HR) 1.423, 95% confidence interval (CI) 0.762-2.656]. The LVSI TB had higher sensitivity and specificity compared with simple determination of the number of LVSI foci. LVSI TB was independently associated with disease-free survival in the validation set (HR 2.366, 95% CI 1.369-4.090, P = 0.002) in multivariate analysis and provided prognostic information in both the low- and high-risk node-negative BC groups (P < 0.001 and P = 0.007, respectively). CONCLUSION The determination of the number of LVSI foci multiplied by the number of tumor cells gives the most reliable quantitative assessment of this parameter, which can provide prognostic information in node-negative BC.
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Bruynzeel AME, Niessen HWM, Bronzwaer JGF, van der Hoeven JJM, Berkhof J, Bast A, van der Vijgh WJF, van Groeningen CJ. The effect of monohydroxyethylrutoside on doxorubicin-induced cardiotoxicity in patients treated for metastatic cancer in a phase II study. Br J Cancer 2007; 97:1084-9. [PMID: 17940501 PMCID: PMC2360436 DOI: 10.1038/sj.bjc.6603994] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to investigate the cardioprotective effect of the semisynthetic flavonoid 7-monohydroxyethylrutoside (monoHER) on doxorubicin (DOX)-induced cardiotoxicity in a phase II study in patients with metastatic cancer. Eight patients with metastatic cancer were treated with DOX preceded by a 10 min i.v. infusion of 1500 mg m−2 monoHER. Five patients were examined by endomyocardial biopsy after reaching a cumulative dose of 300 mg m−2. Histopathological changes in the cardiomyocytes (Billingham score) were compared with those described in literature for patients treated with DOX only. The mean biopsy score of the patients was higher (2.7) than the mean score (1.4) of historical data of patients who received similar cumulative doses of DOX. Although there is a considerable variability in few investigated patients, it was indicative that monoHER enhanced DOX-induced cardiotoxicity. However, the antitumour activity of DOX seemed better than expected: three of the four patients with metastatic soft-tissue sarcoma had a partial remission and the fourth patient stable disease. It is likely that the relatively high dose of monoHER is responsible for the lack of cardioprotection and for the high response rate in patients with soft-tissue sarcoma possibly by depleting the glutathione defense system in both heart and tumour.
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Affiliation(s)
- A M E Bruynzeel
- Department of Medical Oncology, 2 PK BR 010, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands.
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van Velthuysen MLF, Taal BG, van der Hoeven JJM, Peterse JL. Expression of oestrogen receptor and loss of E-cadherin are diagnostic for gastric metastasis of breast carcinoma. Histopathology 2005; 46:153-7. [PMID: 15693887 DOI: 10.1111/j.1365-2559.2005.02062.x] [Citation(s) in RCA: 30] [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: 01/08/2023]
Abstract
AIMS To investigate whether immunohistochemical staining for oestrogen receptor (ER)alpha, progesterone receptor (PgR) and E-cadherin might be useful to differentiate between metastatic breast carcinoma and primary gastric carcinoma. METHODS Gastric biopsies of 75 patients containing adenocarcinoma were stained for ERalpha, PgR and E-cadherin. Included were: Group A, 28 patients with primary gastric cancer; Group B, 28 patients with an adenocarcinoma containing gastric biopsy and a clinical diagnosis of metastatic breast carcinoma; Group C, all consecutive patients with a positive gastric biopsy in 2001 (n = 19) without clinical history of breast carcinoma and not followed by gastric resection (control group). RESULTS All ERalpha+ or PgR+ carcinomas (n = 20) were of patients with a previous or concurrent history of breast carcinoma: 19 in group B, one in group C. In addition, absence of E-cadherin staining was seen significantly more often in patients with metastatic breast carcinoma than in patients with primary gastric cancer (P < 0.001). CONCLUSION Positive immunohistochemical staining for ERalpha or PgR of an adenocarcinoma in a gastric biopsy is diagnostic for metastatic breast carcinoma. Moreover, when carcinoma in a gastric biopsy is negative for E-cadherin staining, metastatic breast carcinoma should be considered.
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Joshi U, van der Hoeven JJM, Comans EFI, Herder GJ, Teule GJJ, Hoekstra OS. In search of an unknown primary tumour presenting with extracervical metastases: the diagnostic performance of FDG-PET. Br J Radiol 2004; 77:1000-6. [PMID: 15569641 DOI: 10.1259/bjr/69059431] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [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: 11/05/2022] Open
Abstract
A retrospective study was carried out to determine the performance of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with unknown primary tumours presenting with metastases external to the neck. All patients referred to an academic PET centre (July, 1997 to December, 2000) presenting with an extracervical metastasis and no prior systemic therapy were eligible. The minimum follow-up period was 11 months. From 63 eligible cases, known metastases were FDG avid in all but one neuroendocrine process. PET scans were retrospectively classified as positive for a primary tumour (n=29), i.e. revealing at least one anatomical site suspected to be the primary tumour. This was confirmed in 16, either by histology (n=10) or radiological and clinical follow-up (n=6). There were four false positive cases. In nine patients, the primary tumour was never confirmed. Of the remaining 33 negative PET scans the primary tumour was clinically not found in 18. Follow-up and additional pathology investigations demonstrated the primary tumour in 15. A survey on clinical usefulness of PET (response rate 83%) suggested that PET positively contributed to diagnostic understanding in 29 of 52 evaluable cases. Applied late in the diagnostic trajectory, approximately four patients need to be scanned by PET in order to find one primary tumour. However, in addition to direct demonstration of unknown primaries, there appears to be a positive effect on the diagnostic work-up of these patients of a similar magnitude.
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Affiliation(s)
- U Joshi
- Department of Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, The Netherlands
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van Tilburg EW, Franssen EJF, van der Hoeven JJM, van der Meij M, Elshove D, Lammertsma AA, Windhorst AD. Radiosynthesis of[11C]docetaxel. J Labelled Comp Radiopharm 2004. [DOI: 10.1002/jlcr.861] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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van Oost FJ, van der Hoeven JJM, Hoekstra OS, Voogd AC, Coebergh JWW, van de Poll-Franse LV. Staging in patients with locoregionally recurrent breast cancer: current practice and prospects for positron emission tomography. Eur J Cancer 2004; 40:1545-53. [PMID: 15196539 DOI: 10.1016/j.ejca.2004.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 03/17/2004] [Accepted: 03/19/2004] [Indexed: 11/24/2022]
Abstract
The aim of this study was to describe the extent and yield of daily clinical practice when staging patients with a locoregional recurrence (LRR) of breast carcinoma and to explore the prospects for positron emission tomography (PET). The population-based Eindhoven Cancer Registry was used to select all breast cancer patients in the southeast of the Netherlands with a first episode of LRR between January 1, 1994 and June 30, 2000 (n = 175). Additional data concerning staging procedures and follow-up were collected from the medical records. Furthermore, we asked 77 physicians (response: 75%) about their opinions on staging procedures and actual treatment policy. At LRR presentation, 16% of patients were found to have distant metastases. An additional 24% were diagnosed with distant metastases within 18 months. The questionnaire revealed that 33% of clinicians thought that the sensitivity of conventional imaging techniques was too low. We tend to conclude that in daily clinical practice there is a need for more sensitive dissemination tests for patients with a LRR of breast cancer.
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Affiliation(s)
- F J van Oost
- Eindhoven Cancer Registry, Comprehensive Cancer Center South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands.
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