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Ocio EM, Efebera YA, Hájek R, Straub J, Maisnar V, Eveillard JR, Karlin L, Mateos MV, Oriol A, Ribrag V, Richardson PG, Norin S, Obermüller J, Bakker NA, Pour L. ANCHOR: melflufen plus dexamethasone and daratumumab or bortezomib in relapsed/refractory multiple myeloma: final results of a phase I/IIa study. Haematologica 2024; 109:867-876. [PMID: 37646657 PMCID: PMC10905089 DOI: 10.3324/haematol.2023.283490] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023] Open
Abstract
Melphalan flufenamide (melflufen), a first-in-class, alkylating peptide-drug conjugate, demonstrated clinical benefit in combination with dexamethasone in triple-class refractory multiple myeloma (MM). The phase I/IIa ANCHOR study evaluated melflufen (30 or 40 mg) and dexamethasone (40 mg with daratumumab; 20 mg followed by 40 mg with bortezomib; dose reduced if aged ≥75 years) in triplet combination with daratumumab (16 mg/kg; daratumumab arm) or bortezomib (1.3 mg/m2; bortezomib arm) in patients with relapsed/refractory MM refractory to an immunomodulatory agent and/or a proteasome inhibitor and who had received one to four prior lines of therapy. Primary objectives were to determine the optimal dose of melflufen in triplet combination (phase I) and overall response rate (phase IIa). In total, 33 patients were treated in the daratumumab arm and 23 patients received therapy in the bortezomib arm. No dose-limiting toxicities were reported at either melflufen dose level with either combination. With both triplet regimens, the most common grade ≥3 treatment-emergent adverse events were thrombocytopenia and neutropenia; thrombocytopenia was the most common treatment-emergent adverse event leading to treatment discontinuation. In the daratumumab arm, patients receiving melflufen 30 mg remained on treatment longer than those receiving the 40-mg dose. In the daratumumab arm, the overall response rate was 73% and median progression-free survival was 12.9 months. Notably, in the bortezomib arm, the overall response rate was 78% and median progression-free survival was 14.7 months. Considering the totality of the data, melflufen 30 mg was established as the recommended dose for use with dexamethasone and daratumumab or bortezomib for future studies in relapsed/refractory MM.
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Affiliation(s)
- Enrique M Ocio
- Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Santander.
| | - Yvonne A Efebera
- Department of Hematology/Oncology, Division of Blood and Marrow Transplant and Cellular Therapy, OhioHealth, Columbus, OH, USA and OhioHealth, Columbus, OH
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava, Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Jan Straub
- Všeobecná fakultní nemocnice, Prague, Czech Republic
| | - Vladimir Maisnar
- Fourth Department of Medicine - Hematology, Charles University Hospital, Hradec Králové, Czech Republic
| | | | - Lionel Karlin
- Department of Hematology, Centre Hospitalier Lyon-Sud, University Claude Bernard Lyon 1, Pierre-Bénite
| | | | - Albert Oriol
- Institut Català d'Oncologia and Josep Carreras Research Institute, Hospital Germans Trias i Pujol, Badalona
| | - Vincent Ribrag
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif
| | | | | | | | | | - Luděk Pour
- Fakultní nemocnice Brno, Brno, Czech Republic
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Stork M, Spicka I, Radocha J, Minarik J, Jelinek T, Jungova A, Pavlicek P, Pospisilova L, Sedlak F, Straub J, Pika T, Knechtova Z, Fidrichova A, Boichuk I, Sevcikova S, Maisnar V, Hajek R, Pour L. Daratumumab with lenalidomide and dexamethasone in relapsed or refractory multiple myeloma patients - real world evidence analysis. Ann Hematol 2023; 102:1501-1511. [PMID: 37088816 PMCID: PMC10182121 DOI: 10.1007/s00277-023-05188-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
We performed real world evidence (RWE) analysis of daratumumab, lenalidomide and dexamethasone (Dara-Rd) versus lenalidomide and dexamethasone (Rd) treatment in relapsed/refractory multiple myeloma patients (RRMM). In total, 240 RRMM patients were treated with Dara-Rd from 2016 to 2022 outside of clinical trials in all major Czech hematology centers. As a reference, 531 RRMM patients treated with Rd were evaluated. Patients' data were recorded in the Czech Registry of Monoclonal Gammopathies (RMG). Partial response (PR) or better response (ORR) was achieved in significantly more patients in Dara-Rd than in Rd group (91.2% vs. 69.9%; p < 0.001). The median progression free survival (PFS) was 26.9 months in the Dara-Rd and 12.8 months in the Rd group (p < 0.001). Median overall survival (OS) was not reached in the Dara-Rd compared to 27.2 months in the Rd group (p = 0.023). In patients with 1-3 previous treatment lines, there was significant PFS benefit of Dara-Rd compared to Rd (median PFS not reached vs. 13.2 months; p < 0.001). In patients with > 3 previous treatment lines, there was no significant PFS benefit of Dara-Rd treatment (7.8 months vs. 9.9 months; p = 0.874), similarly in patients refractory to PI + IMIDs (11.5 months vs. 9.2 months; p = 0.376). In RWE conditions, the median PFS in RRMM patients treated with Dara-Rd is shorter when compared to clinical trials. In heavily pretreated RRMM patients, efficacy of Dara-Rd treatment is limited; best possible outcomes of Dara-Rd are achieved in minimally pretreated patients.
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Affiliation(s)
- Martin Stork
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Ivan Spicka
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jakub Radocha
- 4th Department of Medicine - Hematology, Faculty of Medicine, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Alexandra Jungova
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Petr Pavlicek
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | | | - Frantisek Sedlak
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Hematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Tomas Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University Olomouc, Olomouc, Czech Republic
| | - Zdenka Knechtova
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Anna Fidrichova
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Ivanna Boichuk
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Sabina Sevcikova
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Vladimir Maisnar
- 4th Department of Medicine - Hematology, Faculty of Medicine, Charles University Hospital, Hradec Kralove, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic.
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Maisnar V, Pour L, Spicka I, Jelinek T, Minarik J, Jungova A, Stork M, Straub J, Radocha J, Pika T, Pospisilova L, Nair S, Kunovszki P, Hajek R. Patient Characteristics, Treatment Patterns, and Outcomes in Triple-Class Exposed Relapsed/Refractory Multiple Myeloma Patients, a Retrospective Observational Study Using Czech Registry Data. Clin Lymphoma Myeloma Leuk 2023; 23:145-153. [PMID: 36567210 DOI: 10.1016/j.clml.2022.11.001] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although novel therapies improved prognosis of multiple myeloma (MM) patients, clinical outcomes in the multi-refractory population are still poor. PATIENTS AND METHODS We reviewed data from the Czech Registry of Monoclonal Gammopathies, identified and characterized triple-class exposed (3CE) relapsed/refractory MM patients, treatment patterns after 3CE, assessed overall survival (OS), progression-free survival (PFS), time to next treatment (TTNT), explored cohorts with and without triple- and penta-refractoriness. RESULTS In 83 3CE patients who started subsequent therapies, the median OS was 14.2 months (95% CI, 8.5-19.9), PFS 6.2 months (95% CI, 3.9-8.5), and TTNT 7.2 months (95% CI, 4.6-9.8). Triple- and penta-class refractory patients had a significantly worse prognosis in all outcomes. Their life expectancy was shorter, the disease progression started earlier, and the TTNT was shorter, which increased likelihood of becoming refractory to more therapies. Time-to-event results from the first index date and all index dates analyses were very similar. CONCLUSION Similar to previous studies from the US and Europe, our results show a high disease burden. Introduction of novel therapies, such as CAR-T cells, new bispecific and trispecific monoclonal antibodies, and other drugs, is expected to bring significant benefits to these patients.
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Affiliation(s)
- Vladimir Maisnar
- Fourth Department of Internal Medicine - Hematology, University Hospital and Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Ivan Spicka
- Department of Hematology, First Faculty of Medicine, General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Jelinek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Jiri Minarik
- Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Alexandra Jungova
- Department of Hemato-Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Martin Stork
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Jan Straub
- Department of Hematology, First Faculty of Medicine, General University Hospital in Prague, Prague, Czech Republic
| | - Jakub Radocha
- Fourth Department of Internal Medicine - Hematology, University Hospital and Faculty of Medicine Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Tomas Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | | | | | | | - Roman Hajek
- Department of Hemato-Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
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Straub J, Weber C., Pusterla N, Freise F, Venner M. Comparison of refractometer and biuret reaction as measurement methods for serum total protein concentration in Warmblood foals. PFERDEHEILKUNDE 2023. [DOI: 10.21836/pem20230101] [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: 12/23/2022]
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Minarik J, Radocha J, Jungova A, Straub J, Jelinek T, Pika T, Pour L, Pavlicek P, Harvanova L, Pospisilova L, Krhovska P, Novakova D, Jindra P, Spicka I, Plonkova H, Stork M, Bacovsky J, Maisnar V, Hajek R. Ixazomib, Lenalidomide and Dexamethasone in Relapsed and Refractory Multiple Myeloma in Routine Clinical Practice: Extended Follow-Up Analysis and the Results of Subsequent Therapy. Cancers (Basel) 2022; 14:cancers14205165. [PMID: 36291949 PMCID: PMC9601107 DOI: 10.3390/cancers14205165] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/04/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary We report the final outomes of the addition of ixazomib to the combination of lenalidomide and dexamethasone in patients with relapsed and refractory multiple myeloma in the routine clinical practice. With prolonged follow-up, the overall response rate was similar in both cohorts, but the addition of ixazomib induced more deeper responses. Median progression free survival was significantly better in patients receiving ixazomib and translated into better overal survival. Inferior results were seen in patients who were pretreated with lenalidomide in previous regimens. We conclude that the treatment using IRD regimen in routine practice is easy, well tolerated, and with very good therapeutic outcomes, comparable to the outcomes of the clinical trial. Abstract Background: We confirmed the benefit of addition of ixazomib to lenalidomide and dexamethasone in patients with relapsed and refractory multiple myeloma (RRMM) in unselected real-world population. We report the final analysis for overall survival (OS), second progression free survival (PFS-2), and the subanalysis of the outcomes in lenalidomide (LEN) pretreated and LEN refractory patients. Methods: We assessed 344 patients with RRMM, treated with IRD (N = 127) or RD (N = 217). The data were acquired from the Czech Registry of Monoclonal Gammopathies (RMG). With prolonged follow-up (median 28.5 months), we determined the new primary endpoints OS, PFS and PFS-2. Secondary endpoints included the next therapeutic approach and the survival measures in LEN pretreated and LEN refractory patients. Results: The final overall response rate (ORR) was 73.0% in the IRD cohort and 66.8% in the RD cohort. The difference in patients reaching ≥VGPR remained significant (38.1% vs. 26.3%, p = 0.028). Median PFS maintained significant improvement in the IRD cohort (17.5 vs. 12.5 months, p = 0.013) with better outcomes in patients with 1–3 prior relapses (22.3 vs. 12.7 months p = 0.003). In the whole cohort, median OS was for IRD vs. RD patients 40.9 vs. 27.1 months (p = 0.001), with further improvement within relapse 1-3 (51.7 vs. 27.8 months, p ˂ 0.001). The median PFS of LEN pretreated (N = 22) vs. LEN naive (N = 105) patients treated by IRD was 8.7 vs. 23.1 months (p = 0.001), and median OS was 13.2 vs. 51.7 months (p = 0.030). Most patients in both arms progressed and received further myeloma-specific therapy (63.0% in the IRD group and 53.9% in the RD group). Majority of patients received pomalidomide-based therapy or bortezomib based therapy. Significantly more patients with previous IRD vs. RD received subsequent monoclonal antibodies (daratumumab—16.3% vs. 4.3%, p = 0.0054; isatuximab 5.0% vs. 0.0%, p = 0.026) and carfilzomib (12.5 vs. 1.7%, p = 0.004). The median PFS-2 (progression free survival from the start of IRD/RD therapy until the second disease progression or death) was significantly longer in the IRD cohort (29.8 vs. 21.6 months, p = 0.016). There were no additional safety concerns in the extended follow-up. Conclusions: The IRD regimen is well tolerated, easy to administer, and with very good therapeutic outcomes. The survival measures in unsorted real-world population are comparable to the outcomes of the clinical trial. As expected, patients with LEN reatment have poorer outcomes than those who are LEN-naive. The PFS benefit of IRD vs. RD translated into significantly better PFS-2 and OS, but the outcomes must be accounted for imbalances in pretreatment group characteristics (especially younger age and stem cell transplant pretreatment), and in subsequent therapies.
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Affiliation(s)
- Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
- Correspondence: ; Tel.: +420-588-44-5351
| | - Jakub Radocha
- 4th Department of Internal Medicine—Hematology, Faculty Hospital, Charles University in Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
| | - Alexandra Jungova
- Hematology and Oncology Department, Charles University Hospital Pilsen, 323 00 Pilsen, Czech Republic
| | - Jan Straub
- 1st Medical Department—Clinical Department of Haematology, First Faculty of Medicine and General Teaching Hospital Charles University, 110 00 Prague, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava, Faculty of Medicine University of Ostrava, 708 00 Ostrava, Czech Republic
| | - Tomas Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, 625 00 Brno, Czech Republic
| | - Petr Pavlicek
- Department of Internal Medicine and Hematology, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic
| | - Lubica Harvanova
- Department of Hematology and Transfusiology, University Hospital, Faculty of Medicine, Slovak Medical University and Comenius University, 831 01 Bratislava, Slovakia
| | - Lenka Pospisilova
- Institute of Biostatistics and Analyses, Ltd., 602 00 Brno, Czech Republic
| | - Petra Krhovska
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Denisa Novakova
- 4th Department of Internal Medicine—Hematology, Faculty Hospital, Charles University in Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
| | - Pavel Jindra
- Hematology and Oncology Department, Charles University Hospital Pilsen, 323 00 Pilsen, Czech Republic
| | - Ivan Spicka
- 1st Medical Department—Clinical Department of Haematology, First Faculty of Medicine and General Teaching Hospital Charles University, 110 00 Prague, Czech Republic
| | - Hana Plonkova
- Department of Hematooncology, University Hospital Ostrava, Faculty of Medicine University of Ostrava, 708 00 Ostrava, Czech Republic
| | - Martin Stork
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, 625 00 Brno, Czech Republic
| | - Jaroslav Bacovsky
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Vladimir Maisnar
- 4th Department of Internal Medicine—Hematology, Faculty Hospital, Charles University in Hradec Kralove, 500 03 Hradec Kralove, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava, Faculty of Medicine University of Ostrava, 708 00 Ostrava, Czech Republic
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Dohrmann J, Straub J, Wadephul R, Freise F, Pusterla N, Venner M. Evaluation of the detection of antibodies against Lawsonia intracellularis and changes in serum biochemistry in foals with and without equine proliferative enteropathy. PFERDEHEILKUNDE 2022. [DOI: 10.21836/pem20220405] [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: 11/27/2022]
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Straub J, Dohrmann J, Wadephul R, Singer A, Böse R, Barnum S, Pusterla N, Venner M. Kinetics of Lawsonia intracellularis antibodies in foals on a breeding farm with equine proliferative enteropathy. PFERDEHEILKUNDE 2022. [DOI: 10.21836/pem20220204] [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: 11/27/2022]
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Stork M, Sevcikova S, Minarik J, Krhovska P, Radocha J, Pospisilova L, Brozova L, Jarkovsky J, Spicka I, Straub J, Pavlicek P, Jungova A, Jelinek T, Sandecka V, Maisnar V, Hajek R, Pour L. Identification of patients at high risk of secondary extramedullary multiple myeloma development. Br J Haematol 2021; 196:954-962. [PMID: 34726261 PMCID: PMC9297924 DOI: 10.1111/bjh.17925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022]
Abstract
Multiple myeloma (MM) is characterized by malignant plasma cell infiltration of the bone marrow. In extramedullary multiple myeloma (EMD), a subclone of these cells migrates out of the bone marrow. Out of 4 985 MM patients diagnosed between 2005 and 2017 in the Czech Republic, we analyzed 234 secondary EMD patients to clarify risk factors of secondary EMD development. We found younger age [<65 years; odds ratio (OR) 4·38, 95% confidence interval (CI): 2·46–7·80, P < 0·0001], high lactate dehydrogenase (LDH) levels (>5 μkat/l; OR 2·07, 95% CI: 1·51–2·84, P < 0·0001), extensive osteolytic activity (OR 2·21, 95% CI: 1·54–3·15, P < 0·001), and immunoglobulin A (IgA; OR 1·53, 95% CI: 1·11–2·11, P = 0·009) or the non‐secretory type of MM (OR 2·83; 95% CI: 1·32–6·04, P = 0·007) at the time of MM diagnosis to be the main risk factors for secondary EMD development. Newly diagnosed MM (NDMM) patients with subsequent EMD had inferior median progression‐free (PFS) and overall (OS) survival when compared to NDMM patients without future EMD [mPFS: 13·8 months (95% CI: 11·4–16·3) vs 18·8 months (95% CI: 17·7–19·9), P = 0·006; mOS: 26·7 months (95% CI: 18·1–35·4) vs 58·7 months (95% CI: 54·8–62·6), P < 0·001]. We found that NDMM patients with specific risk factors associated with secondary EMD development have a more aggressive disease course before secondary EMD develops.
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Affiliation(s)
- Martin Stork
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Sabina Sevcikova
- Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Minarik
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petra Krhovska
- Department of Hemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine - Hematology, Faculty Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | | | - Lucie Brozova
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Ivan Spicka
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine and General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jan Straub
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Pavlicek
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alexandra Jungova
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Viera Sandecka
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vladimir Maisnar
- 4th Department of Internal Medicine - Hematology, Faculty Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
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Orlowski R, Delimpasi S, Straub J, Symeonidis A, Pour L, Hájek R, Touzeau C, Bhanderi V, Pavlíček P, Robak P, Berdeja JG, Matous JV, Karlin L, Zweegman S, Grosicki S, Pluta A, Kambhampati S, Suryanarayan K, Twumasi-Ankrah P, Dash A, Labotka R, Dimopoulos MA. P-210: Oral ixazomib (Ixa), IV daratumumab (Dara), and dexamethasone (dex; IDd) in relapsed/refractory multiple myeloma (RRMM) patients (pts) with 1–3 prior therapies: phase 2 study interim analysis (IA). Clinical Lymphoma Myeloma and Leukemia 2021. [DOI: 10.1016/s2152-2650(21)02337-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sandecká V, Pour L, Špička I, Minařík J, Radocha J, Jelínek T, Heindorfer A, Pavlíček P, Sýkora M, Jungová A, Kessler P, Wróbel M, Starostka D, Ullrychová J, Stejskal L, Štork M, Straub J, Pika T, Brožová L, Ševčíková S, Maisnar V, Hájek R. Bortezomib-based therapy for newly diagnosed multiple myeloma patients ineligible for autologous stem cell transplantation: Czech Registry Data. Eur J Haematol 2021; 107:466-474. [PMID: 34272773 DOI: 10.1111/ejh.13683] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study compared the use of bortezomib in different combination regimens in newly diagnosed multiple myeloma (NDMM) patients who were transplant ineligible. PATIENTS AND METHODS We analyzed data from the Registry of Monoclonal Gammopathies (RMG) of the Czech Myeloma Group (CMG) to provide real-world evidence of outcome for 794 newly diagnosed MM transplant ineligible patients. The most frequently used regimen was VCd (bortezomib-cyclophosphamide-dexamethasone) (47.5%) over VMP (bortezomib-melphalan-prednisone) (21.7%), BDd (bortezomib-doxorubicin-dexamethasone) (9.8%), and VTd (bortezomib-thalidomide-dexamethasone) (2.9%). RESULTS The overall response rate (ORR) was 69.2% (478/691), including 12.6% (≥ CR); 34.7% very good partial responses (VGPR); and 21.9% partial responses (PR). Among triplet regimens, VMP was the most effective regimen compared to VCd, BDd, and VTd. Median PFS was 22.3 vs. 18.5 vs. 13.7 vs. 13.8 mo, (P = .275), respectively, and median OS was 49 vs. 41.7 vs. 37.9 vs. 32.2 mo (P = .004), respectively. The most common grade 3-4 toxicities were anemia in 17.4% and infections in 18% of patients. CONCLUSION Our study confirmed that bortezomib-based treatment is effective and safe in NDMM transplant ineligible patients, especially VMP, which was identified as superior between bortezomib-based induction regimens not only in clinical trials, but also in real clinical practice.
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Affiliation(s)
- Viera Sandecká
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Ivan Špička
- 1st Department of Medicine, Department of Hematology, Charles University and General Hospital, Prague, Czech Republic
| | - Jiří Minařík
- Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine, Hematology, University Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Tomáš Jelínek
- Department of Hematooncology, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | | | - Petr Pavlíček
- Department of Internal Medicine and Hematology, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michal Sýkora
- Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Alexandra Jungová
- Hematology and Oncology Department, Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Czech Republic
| | - Marek Wróbel
- Department of Clinical Hematology, Hospital Novy Jicin, Czech Republic
| | - David Starostka
- Department of Clinical Hematology, Hospital Havirov, Czech Republic
| | - Jana Ullrychová
- Department of Clinical Hematology, Regional Health Corporation, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology, Silesian Hospital in Opava, Opava, Czech Republic
| | - Martin Štork
- Department of Internal Medicine, Hematology and Oncology, University Hospital, Brno, Czech Republic
| | - Jan Straub
- 1st Department of Medicine, Department of Hematology, Charles University and General Hospital, Prague, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Sabina Ševčíková
- Babak Myeloma Group, Department of Pathophysiology, Masaryk University, Brno, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Internal Medicine, Hematology, University Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Roman Hájek
- Department of Hematooncology, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
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Hájek R, Minařík J, Straub J, Pour L, Jungova A, Berdeja JG, Boccadoro M, Brozova L, Spencer A, van Rhee F, Vela-Ojeda J, Thompson MA, Abonour R, Chari A, Cook G, Costello CL, Davies FE, Hungria VT, Lee HC, Leleu X, Puig N, Rifkin RM, Terpos E, Usmani SZ, Weisel KC, Zonder JA, Bařinová M, Kuhn M, Šilar J, Čápková L, Galvez K, Lu J, Elliott J, Stull DM, Ren K, Maisnar V. Ixazomib-lenalidomide-dexamethasone in routine clinical practice: effectiveness in relapsed/refractory multiple myeloma. Future Oncol 2021; 17:2499-2512. [PMID: 33769076 DOI: 10.2217/fon-2020-1225] [Citation(s) in RCA: 10] [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] [Indexed: 02/01/2023] Open
Abstract
Aim: To evaluate the effectiveness and safety of ixazomib-lenalidomide-dexamethasone (IRd) in relapsed/refractory multiple myeloma in routine clinical practice. Patients & methods: Patient-level data from the global, observational INSIGHT MM and the Czech Registry of Monoclonal Gammopathies were integrated and analyzed. Results: At data cut-off, 263 patients from 13 countries were included. Median time from diagnosis to start of IRd was 35.8 months; median duration of follow-up was 14.8 months. Overall response rate was 73%, median progression-free survival, 21.2 months and time-to-next therapy, 33.0 months. Ixazomib/lenalidomide dose reductions were required in 17%/36% of patients; 32%/30% of patients discontinued ixazomib/lenalidomide due to adverse events. Conclusion: The effectiveness and safety of IRd in routine clinical practice are comparable to those reported in TOURMALINE-MM1. Clinical trial registration: NCT02761187 (ClinicalTrials.gov).
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Affiliation(s)
- Roman Hájek
- University Hospital Ostrava & Faculty of Medicine, University of Ostrava, Ostrava, 703 00, Czech Republic
| | - Jiří Minařík
- Palacky University & University Hospital Olomouc, Olomouc, 771 47, Czech Republic
| | - Jan Straub
- General Teaching Hospital, Prague, 128 08, Czech Republic
| | - Luděk Pour
- University Hospital, Brno, 625 00, Czech Republic
| | | | | | | | - Lucie Brozova
- Institute of Biostatistics & Analyses, Ltd, Brno, 602 00, Czech Republic
| | - Andrew Spencer
- Alfred Health-Monash University, Melbourne, 3004, Australia
| | - Frits van Rhee
- University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Jorge Vela-Ojeda
- UMAE Especialidades Centro Medico La Raza IMSS, Ciudad de México, 02990, Mexico
| | - Michael A Thompson
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI 53227, USA
| | - Rafat Abonour
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ajai Chari
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Caitlin L Costello
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92037, USA
| | - Faith E Davies
- Perlmutter Cancer Center, NYU Langone, New York, NY 10016, USA
| | - Vania Tm Hungria
- Clinica São Germano & Santa Casa Medical School, São Paulo, 04537-081, Brazil
| | - Hans C Lee
- M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Xavier Leleu
- Pôle Régional de Cancérologie, CHU de Poitiers, Poitiers, 86000, France
| | - Noemi Puig
- Department of Hematology, Hospital Universitario de Salamanca (HUSAL), IBSAL, IBMCC (USAL-CSIC), CIBERONC (CB16/12/00233), Salamanca, 37007, Spain
| | - Robert M Rifkin
- Rocky Mountain Cancer Centers US Oncology Research, Denver, CO 80218, USA
| | - Evangelos Terpos
- National & Kapodistrian University of Athens, School of Medicine, Athens, 115 27, Greece
| | | | - Katja C Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, 20251, Germany
| | - Jeffrey A Zonder
- Barbara Ann Karmanos Cancer Institute / Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Magda Bařinová
- Institute of Biostatistics & Analyses, Ltd, Brno, 602 00, Czech Republic
| | - Matyáš Kuhn
- Institute of Biostatistics & Analyses, Ltd, Brno, 602 00, Czech Republic
| | - Jiří Šilar
- Institute of Biostatistics & Analyses, Ltd, Brno, 602 00, Czech Republic
| | - Lenka Čápková
- Institute of Biostatistics & Analyses, Ltd, Brno, 602 00, Czech Republic
| | - Kenny Galvez
- Hospital Pablo Tobón Uribe, Medellin, 11001, Colombia
| | - Jin Lu
- Peking University People's Hospital, National Clinical Research Center for Hematologic Disease, Beijing, 100044, China
| | - Jennifer Elliott
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Dawn Marie Stull
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Kaili Ren
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Vladimír Maisnar
- Charles University Hospital & Faculty of Medicine, Hradec Králové, 121 08, Czech Republic
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12
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Minarik J, Pika T, Radocha J, Jungova A, Straub J, Jelinek T, Pour L, Pavlicek P, Mistrik M, Brozova L, Krhovska P, Machalkova K, Jindra P, Spicka I, Plonkova H, Stork M, Bacovsky J, Capkova L, Sykora M, Kessler P, Stejskal L, Heindorfer A, Ullrychova J, Skacel T, Maisnar V, Hajek R. Survival benefit of ixazomib, lenalidomide and dexamethasone (IRD) over lenalidomide and dexamethasone (Rd) in relapsed and refractory multiple myeloma patients in routine clinical practice. BMC Cancer 2021; 21:73. [PMID: 33451293 PMCID: PMC7810195 DOI: 10.1186/s12885-020-07732-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/14/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We have performed a head to head comparison of all-oral triplet combination of ixazomib, lenalidomide and dexamethasone (IRD) versus lenalidomide and dexamethasone (RD) in patients with relapsed and refractory multiple myeloma (RRMM) in the routine clinical practice. METHODS A total of 344 patients treated with IRD (N = 127) or RD (N = 217) were selected for analysis from the Czech Registry of Monoclonal Gammopathies (RMG). Descriptive statistics were used to assess patient's characteristics associated with the respective therapy. The primary endpoint was progression free survival (PFS), secondary end points included response rates and overall survival (OS). Survival endpoints were plotted using Kaplan-Meier methodology at 95% Greenwood confidence interval. Univariable and multivariable Cox proportional hazards models were used to evaluate the effect of treatment regimens and the significance of uneven variables. Statistical tests were performed at significance level 0.05. RESULTS In the whole cohort, median PFS for IRD was 17.5 and for RD was 11.5 months favoring the all-oral triplet, p = 0.005; in patients within relapse 1-3, the median PFS was 23.1 vs 11.6 months, p = 0.001. The hazard ratio for PFS was 0.67 (95% confidence interval [CI] 0.51-0.89, p = 0.006). The PFS advantage translated into improved OS for patients treated with IRD, median 36.6 months vs 26.0 months (p = 0.008). The overall response rate (ORR) was 73.0% in the IRD group vs 66.2% in the RD group with a complete response rate (CR) of 11.1% vs 8.8%, and very good partial response (VGPR) 22.2% vs 13.9%, IRD vs RD respectively. The IRD regimen was most beneficial in patients ≤75 years with ISS I, II, and in the first and second relapse. Patients with the presence of extramedullary disease did not benefit from IRD treatment (median PFS 6.5 months). Both regimens were well tolerated, and the incidence of total as well as grade 3/4 toxicities was comparable. CONCLUSIONS Our analysis confirms the results of the TOURMALINE-MM1 study and shows benefit of all-oral triplet IRD treatment versus RD doublet. It demonstrates that the addition of ixazomib to RD improves key survival endpoints in patients with RRMM in a routine clinical setting.
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Affiliation(s)
- Jiri Minarik
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic.
| | - Tomas Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine - Hematology, Faculty Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Alexandra Jungova
- Hematology and Oncology Department, Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Haematology, First Faculty of Medicine and General Teaching Hospital Charles University, Prague, Czech Republic
| | - Tomas Jelinek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Petr Pavlicek
- Department of Internal Medicine and Hematology, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Martin Mistrik
- Department of Hematology and Transfusiology, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Lucie Brozova
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Petra Krhovska
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Katerina Machalkova
- 4th Department of Internal Medicine - Hematology, Faculty Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Pavel Jindra
- Hematology and Oncology Department, Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - Ivan Spicka
- 1st Medical Department - Clinical Department of Haematology, First Faculty of Medicine and General Teaching Hospital Charles University, Prague, Czech Republic
| | - Hana Plonkova
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
| | - Martin Stork
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Jaroslav Bacovsky
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Lenka Capkova
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Michal Sykora
- Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Pelhrimov, Czech Republic
| | - Lukas Stejskal
- Department of Hematology, Silesian Hospital in Opava, Opava, Czech Republic
| | | | - Jana Ullrychova
- Department of Clinical Hematology, Regional Health Corporation, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Tomas Skacel
- 1st Department of Medicine, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic.,Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, USA
| | - Vladimir Maisnar
- 4th Department of Internal Medicine - Hematology, Faculty Hospital and Charles University in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Roman Hajek
- Department of Hematooncology, University Hospital Ostrava and Faculty of Medicine University of Ostrava, Ostrava, Czech Republic
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Le X, Kowalski D, Cho B, Conte P, Felip E, Garassino M, Viteri S, Chang GC, Richart J, Paz-Ares L, Juraeva D, Straub J, Stroh C, Paik P. OFP01.01 Liquid Biopsy to Detect MET Alterations in Patients with Advanced NSCLC: Biomarker Analysis from the VISION Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.033] [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: 10/22/2022]
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14
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Malejko K, Tumani V, Rau V, Neumann F, Plener PL, Fegert JM, Abler B, Straub J. Neural correlates of script-driven imagery in adolescents with interpersonal traumatic experiences: A pilot study. Psychiatry Res Neuroimaging 2020; 303:111131. [PMID: 32585577 DOI: 10.1016/j.pscychresns.2020.111131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/03/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023]
Abstract
In adults, trauma imagery has proven to be a useful tool to assess the neural mechanisms of psychological trauma processing. In adolescents, heterogeneous results could be found for other tasks, however, a trauma imagery paradigm has not been evaluated. For this purpose, we investigated a trauma imagery paradigm with control scripts to assess neural correlates of traumatic experiences in youth. 15 adolescents, who had experienced a traumatic interpersonal event in the past and have developed clinically relevant symptoms, underwent an fMRI scan while listening to their individual trauma- versus two control scripts (positive/negative). We analysed a parametric contrast of the imagery phases (trauma > negative > positive) which revealed activity in the thalamus, dorsal anterior cingulate cortex, cuneus, dorsomedial prefrontal cortex and amygdala. Additionally, amygdala-activity correlated positively with depression-symptom-severity. Our data provide evidence for the feasibility of fMRI during a trauma imagery task in adolescents to investigate networks previously related to hyperarousal in adults with PTSD. Further, we demonstrate the specificity of the activated networks for trauma imagery as compared to imagery of other emotional situations. The task might be particularly useful to evaluate neural correlates of treatment in adolescents when hyperarousal is a target symptom.
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Affiliation(s)
- K Malejko
- Ulm University, Department of Psychiatry and Psychotherapy III, Ulm, Germany.
| | - V Tumani
- Ulm University, Department of Psychiatry and Psychotherapy III, Ulm, Germany
| | - V Rau
- Ulm University, Department of Psychiatry and Psychotherapy III, Ulm, Germany
| | - F Neumann
- Ulm University, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany
| | - P L Plener
- Ulm University, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany; Medical University Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria
| | - J M Fegert
- Ulm University, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany
| | - B Abler
- Ulm University, Department of Psychiatry and Psychotherapy III, Ulm, Germany
| | - J Straub
- Ulm University, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany
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15
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Hájek R, Sandecka V, Špička I, Raab M, Goldschmidt H, Beck S, Minařík J, Pavlíček P, Radocha J, Heindorfer A, Jelínek T, Stejskal L, Brožová L, Ševčíková S, Straub J, Pika T, Pour L, Maisnar V, Seckinger A, Hose D. Identification of patients with smouldering multiple myeloma at ultra-high risk of progression using serum parameters: the Czech Myeloma Group model. Br J Haematol 2020; 190:189-197. [PMID: 32163180 DOI: 10.1111/bjh.16572] [Citation(s) in RCA: 6] [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: 12/04/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
Smouldering multiple myeloma (SMM) presents without MM defining symptoms. We aimed to identify patients with SMM with an 80% risk of progression within 2 years using only serum parameters. In total, 527 patients with SMM were included and divided into a training group (287 patients from the Czech Myeloma Group [CMG]) and an independent validation group (240 patients from Heidelberg). The median follow-up was 2·4 and 2·5 years, respectively. Progression to MM occurred in 51·9% of the CMG and 38·8% of the Heidelberg patients, respectively. The median risk of progression was 11·0% (CMG) and 9·7% (Heidelberg) per year, during the 5 years after diagnosis. A serum involved/uninvolved free light-chain ratio of >30, immunoparesis, and serum monoclonal (M) protein of ≥2·3 g/dl emerged as powerful predictors of 2-year progression rate with a hazard ratio (HR) of 2·49 (95% confidence interval [CI] 1·49-4·17), HR of 2·01 (95% CI 1·36-2·96) and HR of 2·00 (95% CI 1·44-2·79) (P < 0·001) in univariate Cox regression analysis, respectively. Based on this, the CMG model identified patients with SMM with a 2-year risk of progression of 78·7% (95% CI 53·1-95·7; HR 6·8; P < 0·001, CMG) and 81·3% (95% CI 47·1-98·8; HR 38·63; P < 0·001, Heidelberg). Serum parameters in the CMG model allow identification of patients with SMM with an 80% risk of progression to symptomatic MM within 2 years.
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Affiliation(s)
- Roman Hájek
- Department of Hemato-Oncology, University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic
| | - Viera Sandecka
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Ivan Špička
- 1st Department of Medicine, 1st Faculty of Medicine, Charles University and General Hospital in Prague, Praha, Czech Republic
| | - Marc Raab
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, Heidelberg, Germany
| | - Hartmut Goldschmidt
- Internal Medicine V and National Center for Tumor Diseases (NCT), University Clinic Heidelberg, Heidelberg, Germany
| | - Susanne Beck
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
| | - Jiří Minařík
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Petr Pavlíček
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic
| | - Jakub Radocha
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Adriana Heindorfer
- Department of Clinical Hematology, Hospital Liberec, Liberec, Czech Republic
| | - Tomáš Jelínek
- Department of Hemato-Oncology, University Hospital, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology and Transfusion, Hospital Opava, Opava, Czech Republic
| | - Lucie Brožová
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Sabina Ševčíková
- Department of Clinical Hematology, University Hospital Brno, Brno, Czech Republic.,Babak Myeloma Group, Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Straub
- 1st Department of Medicine, 1st Faculty of Medicine, Charles University and General Hospital in Prague, Praha, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, University Hospital, Olomouc, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Anja Seckinger
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
| | - Dirk Hose
- Labor für Myelomforschung, University Clinic Heidelberg, Heidelberg, Germany
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Park K, Zhou J, Kim DW, Ahmad A, Soo R, Bruns R, Straub J, Johne A, Scheele J, Yang JH, Wu YL. Tepotinib plus gefitinib in patients with MET-amplified EGFR-mutant NSCLC: Long-term outcomes of the INSIGHT study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.003] [Citation(s) in RCA: 2] [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: 11/13/2022] Open
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17
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Park K, Felip E, Veillon R, Cortot A, Mazieres J, Sakai H, Reinmuth N, Viteri S, Chen YM, Han JY, Jang TW, Morise M, Sakamoto T, Tokito T, Cho B, Bruns R, Scheele J, Straub J, Le X, Paik P. Tepotinib in NSCLC patients harboring METex14 skipping: Cohort A of phase II VISION study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz420.001] [Citation(s) in RCA: 4] [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: 11/15/2022] Open
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18
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Yang JH, Ellers-Lenz B, Straub J, Johne A, Wu YL. INSIGHT 2: Tepotinib plus osimertinib in patients with EGFR-mutant NSCLC having acquired resistance to EGFR TKIs due to MET-amplification: A phase II trial in progress study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Meredith-Duliba T, Bunt S, Didehbani N, Miller S, Straub J, Wang H, Cullum C. B-51 Impact of Resilience on Symptoms and Mood during Recovery in Adolescents and Young Adults Following Sports-Related Concussion. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
It is unclear how resilience, the ability to “bounce back” from a stressful experience, is associated with recovery following a sport-related concussion (SRC). The aim of this project is to assess how resilience is related to symptoms following SRC.
Method
Participants (N = 353) aged 12-25 were evaluated within 30 days of injury at clinics in the ConTex Concussion Registry. The Sport Concussion Assessment Tool-5 symptom evaluation, Brief Resilience Scale (BRS), General Anxiety Disorder-7 Item (GAD-7), and Patient Health Questionnaire-8 Item (PHQ-8) were administered at initial visit and at three-months. BRS scores were used to place subjects into low (n = 40), average (n = 214), and high (n = 99) resilience groups, with a 2 (time) by 3 (group) repeated measures ANOVA to compare symptom scales.
Results
At initial visit subjects with low resilience reported higher GAD-7 [F (2,308) = 3.95, p = .02; 95% C.I. 5.19, 7.64] and PHQ-8 [F (2,311) = 4.40, p = .01; 95% C.I. 4.76, 7.47] scores compared to average and high resilience samples and demonstrated significant interaction effects with time. Subjects with low resilience also endorsed more initial SCAT5 symptoms [F (2,350) = 3.69, p = .026, 95% C.I. 10.99, 14.18] but showed no interaction with time.
Conclusion
Findings suggest that resilience may influence mood (anxiety & depression) initially and during SRC recovery. Consideration of resilience as a pre-injury factor may be important in SRC research.
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Paik P, Cortot A, Felip E, Sakai H, Mazieres J, Horn L, Griesinger F, Bruns R, Scheele J, Straub J, Veillon R. A phase II trial of tepotinib in patients with non-small cell lung cancer (NSCLC) harboring MET alterations: The VISION study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.080] [Citation(s) in RCA: 2] [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: 11/13/2022] Open
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Paik P, Sakai H, Bruns R, Scheele J, Straub J, Felip E. OA06 Tepotinib in Non-Small Cell Lung Cancer with MET Exon 14-Skipping Mutations or MET Amplification: a Phase 2 Trial in Progress. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Paik P, Sakai H, Bruns R, Scheele J, Straub J, Felip E. Tepotinib in non-small cell lung cancer (NSCLC) with MET-exon 14 skipping mutations (METex14+) and MET amplification (METamp); A phase II trial in progress. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy425.056] [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: 11/12/2022] Open
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Ryoo BY, Ren Z, Kim TY, Pan H, Rau KM, Choi H, Park JW, Kim J, Yen CJ, Kim BH, Zhou D, Straub J, Zhao C, Qin S. Phase II trial of tepotinib vs sorafenib for treatment-naïve advanced hepatocellular carcinoma (HCC) in Asian patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy432.038] [Citation(s) in RCA: 1] [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: 11/13/2022] Open
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Sakai H, Felip E, Cortot A, Veillon R, Griesinger F, Patel J, Horn L, Mazieres J, De Castro Carpeno J, Morise M, Sakamoto T, Bruns R, Scheele J, Straub J, Paik P. Tepotinib in patients with advanced non-small lung cancer (NSCLC) and MET exon 14-skipping mutations: Phase II data. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy425.004] [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: 11/15/2022] Open
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Decaens T, Barone C, Assenat E, Wermke M, Fasolo A, Merle P, Blanc JF, Grando V, Bruns R, Straub J, Zhao C, Faivre S. Efficacy and safety of the Met inhibitor tepotinib in patients (pts) with advanced Met+ hepatocellular carcinoma (HCC) previously treated with sorafenib. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy432.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Decaens T, Barone C, Assenat E, Wermke M, Fasolo A, Merle P, Blanc J, Grando V, Bruns R, Straub J, Zhao C, Faivre S. Phase II efficacy and safety data for the MET inhibitor tepotinib in patients (pts) with sorafenib-treated advanced hepatocellular carcinoma (HCC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.081] [Citation(s) in RCA: 5] [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: 11/13/2022] Open
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Laeufle R, Arnold D, Kopetz S, Straub J, Bruns R, Massimini G, Debenedetto R, Linke R, Elez Fernandez E, Tabernero J. Patient selection for targeting integrin with abituzumab in patients with metastatic colorectal cancer (mCRC): A retrospective analysis of the randomized phase I/II Poseidon study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.035] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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Ryoo BY, Ren Z, Kim TY, Pan H, Rau KM, Choi H, Park JW, Kim J, Yen CJ, Kim BH, Zhou D, Straub J, Zhao C, Qin S. Phase II trial of tepotinib vs sorafenib in Asian patients (pts) with advanced hepatocellular carcinoma (HCC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.005] [Citation(s) in RCA: 5] [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: 11/14/2022] Open
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Radocha J, Maisnar V, Pour L, Špička I, Minařík J, Szeligová L, Pavlíček P, Jungová A, Krejčí M, Pika T, Straub J, Brožová L, Stejskal L, Heindorfer A, Jindra P, Kessler P, Mikula P, Sýkora M, Wróbel M, Jarkovský J, Hájek R. Validation of multiple myeloma risk stratification indices in routine clinical practice: Analysis of data from the Czech Myeloma Group Registry of Monoclonal Gammopathies. Cancer Med 2018; 7:4132-4145. [PMID: 29931775 PMCID: PMC6089168 DOI: 10.1002/cam4.1620] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022] Open
Abstract
This study used data from the Czech Myeloma Group Registry of Monoclonal Gammopathies to validate the International Myeloma Working Group (IMWG) and revised International Staging System (R-ISS) indices for risk stratification in patients with multiple myeloma (MM) in clinical practice. Patients were included if they had symptomatic MM, complete data allowing R-ISS and IMWG staging (including cytogenetic information regarding t(4;14), t(14;16), and del(17p)), and key parameters for treatment evaluation. Median overall survival (OS) in included patients (n = 550) was 47.7 (95% CI: 39.5-55.9) and 46.2 (95% CI: 38.9-53.5) months from diagnosis and initiation of first-line therapy, respectively. Patients categorized as higher vs lower risk had reduced survival; median OS from diagnosis was 35.4 (95% CI: 30.5-40.3) vs 58.3 (95% CI: 53.8-62.9) months in high-risk vs other patients (IMWG; P = .001) and 34.1 (95% CI: 30.2-38.0) vs 47.2 (95% CI: 43.4-51.0) months in Stage III vs Stage II patients (R-ISS; P < .001). In conclusion, IMWG and R-ISS risk stratification indices are applicable to patients with MM in a real-world setting.
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Affiliation(s)
- Jakub Radocha
- 4th Department of Medicine - Haematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Medicine - Haematology, Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Ivan Špička
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Jiři Minařík
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czech Republic
| | - Lenka Szeligová
- Department of Haemato-Oncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
| | - Petr Pavlíček
- Department of Internal Medicine and Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alexandra Jungová
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Tomáš Pika
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University, Olomouc, Czech Republic
| | - Jan Straub
- 1st Medical Department - Clinical Department of Haematology of the First Faculty of Medicine, General Teaching Hospital Charles University, Prague, Czech Republic
| | - Lucie Brožová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology, Hospital Opava, Opava, Czech Republic
| | | | - Pavel Jindra
- Hematology and Oncology Department, Charles University Hospital, Pilsen, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion Medicine, Hospital Pelhrimov, Pelhrimov, Czech Republic
| | - Peter Mikula
- Department of Clinical Haematology, Hospital in Havirov, Havirov, Czech Republic
| | - Michal Sýkora
- Department of Clinical Hematology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Marek Wróbel
- Department of Hematology, Hospital Novy Jicin, Novy Jicin, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Hájek
- Department of Haemato-Oncology, Faculty of Medicine, University Hospital Ostrava, University of Ostrava, Ostrava, Czech Republic
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Abstract
ZusammenfassungDisruptive Mood Dysregulation Disorder (DMDD), übersetzbar als disruptive Störung der Stimmungsregulation, findet sich als neues eigenständiges Krankheitsbild im DSM-5. Im Gegensatz zu anderen disruptiven Störungsbildern wurde DMDD in den Bereich der depressiven Störungen gelegt. Der vorliegende Beitrag soll sich mit den diagnostischen Kriterien, der Prävalenz sowie den Behandlungsoptionen dieses neuen Störungsbildes, basierend auf einer selektiven Literaturübersicht auseinandersetzen. Aus Deutschland liegen keine Studien vor, die aufbauend auf den neuen diagnostischen Kriterien erstellt wurden; eine Prävalenzschätzung ist daher schwierig. Aus den USA wurden Prävalenzraten von ca. 1% aus nicht klinischen Stichproben berichtet. Die spezifischen therapeutischen Optionen zur Behandlung dieses neu geschaffenen Störungsbildes sind in ihrer Evidenz kaum überprüft. Essenziell scheinen die Trennung des Störungsbildes von bipolaren Störungen und die Beachtung von DMDD als möglicher Vorläufer einer depressiven Entwicklung.
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Adam Z, Ozábalová E, Němec P, Bedáňová H, Kuman M, Krejčí J, Špinarová L, Žampachová V, Čermáková Z, Pour L, Krejčí M, Sanecká V, Štork M, Pika T, Straub J, Adamová D, Stavařová Y, Král Z, Mayer J. [Heart transplantation and follow-up treatment with AL-amyloidosis in 5 patients]. Vnitr Lek 2018; 64:441-449. [PMID: 29791180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The prognosis for patients with cardiac impairment due to AL-amyloid deposition and severe cardiac insufficiency is poor, with a survival median in the order of months. The classical treatment of AL-amyloidosis in combination with cardiac insufficiency is very poorly tolerated and the treatment of such patients is associated with considerably higher mortality than among other patients with AL-amyloidosis. If, however, patients with an isolated or another dominating cardiac impairment, without severe damage to other organs and tissues, have a heart transplant performed, their cardiovascular condition will significantly improve as a result, along with their ability to tolerate any kind of treatment for AL-amyloidosis including that using high-dose chemotherapy with a transplant of autologous hematopoietic stem cells. The achievement of complete remission of AL-amyloidosis is a precondition for long-term survival, since when not achieved, amyloid deposition also arises in the transplanted heart. At the Centre for Cardiovascular and Transplantation Surgery, Brno, the first heart transplant due to its impairment by AL-amyloidosis was performed in 2010. By the year 2017 the number of patients with AL-amyloidosis, who had first undergone a heart transplant with subsequent treatment for AL-amyloidosis, increased to 5. The median age at which a heart transplant was performed is 60 (48-65) years. Four patients were men, one was a woman. The median monitoring equals 65 (88-15) months. Complete remission of AL-amyloidosis was achieved in all the patients. There were 5 lines of treatment needed for the first patient to attain it, of that twice high-dose melphalan with autologous stem cell transplantation, for the second patient a second-line treatment, high-dose melphalan and bortezomib-based therapy. No specific therapy was needed for the third patient, as immunosuppressive therapy following the heart transplant containing prednison led to complete remission of AL-amyloidosis. In the fourth case, sustainable complete remission was reached by high-dose melphalan and in the fifth case by one line of bortezomib-based therapy. The aforementioned data illustrate that a heart transplant is the first step which makes the patients with a severe heart failure, not tolerating any efficient therapy of AL-amyloidosis, capable of undergoing intense treatment of AL-amyloidosis. Sometimes one high-dose chemotherapy is sufficient, while at other times multiple treatment lines are needed to reach complete remission of AL-amyloidosis.Key words: AL-amyloidosis - autologous hematopoietic stem cells transplantation - bortezomib - cardiomyopathy - lenalidomide - thalidomide - heart transplantation.
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Lambert L, Ourednicek P, Meckova Z, Gavelli G, Straub J, Spicka I. Whole-body low-dose computed tomography in multiple myeloma staging: Superior diagnostic performance in the detection of bone lesions, vertebral compression fractures, rib fractures and extraskeletal findings compared to radiography with similar radiation exposure. Oncol Lett 2017; 13:2490-2494. [PMID: 28454425 DOI: 10.3892/ol.2017.5723] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/17/2016] [Indexed: 11/06/2022] Open
Abstract
The primary objective of the present prospective study was to compare the diagnostic performance of conventional radiography (CR) and whole-body low-dose computed tomography (WBLDCT) with a comparable radiation dose reconstructed using hybrid iterative reconstruction technique, in terms of the detection of bone lesions, skeletal fractures, vertebral compressions and extraskeletal findings. The secondary objective was to evaluate lesion attenuation in relation to its size. A total of 74 patients underwent same-day skeletal survey by CR and WBLDCT. In CR and WBLDCT, two readers assessed the number of osteolytic lesions at each region and stage according to the International Myeloma Working Group (IMWG) criteria. A single reader additionally assessed extraskeletal findings and their significance, the number of vertebral compressions and bone fractures. The radiation exposure was 2.7±0.9 mSv for WBLDCT and 2.5±0.9 mSv for CR (P=0.054). CR detected bone involvement in 127 out of 486 regions (26%; P<0.0001), confirmed by WBLDCT. CR underestimated the disease stage in 16% and overestimated it in 8% of the patients (P=0.0077). WBLDCT detected more rib fractures compared with CR (188 vs. 47; P<0.0001), vertebral compressions (93 vs. 67; P=0.010) and extraskeletal findings (194 vs. 52; P<0.0001). There was no correlation observed between lesion size (≥5 mm) and its attenuation (r=-0.006; P=0.93). The inter-observer agreement for the presence of osteolytic lesions was κ=0.76 for WBLDCT, and κ=0.55 for CR. The present study concluded that WBLDCT with hybrid iterative reconstruction technique demonstrates superiority to CR with an identical radiation dose in the detection of bone lesions, skeletal fractures, vertebral compressions and extraskeletal findings, which results in up- or downstaging in 24% patients according to the IMWG criteria. The attenuation of osteolytic lesions can be measured with the avoidance of the partial volume effect.
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Affiliation(s)
- Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Petr Ourednicek
- Department of Imaging Methods, St. Anne's University Hospital in Brno, 656 91 Brno, Czech Republic
| | - Zuzana Meckova
- Institute of Nuclear Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Giampaolo Gavelli
- Radiology Unit, IRCCS-Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), I-47014 Meldola, Italy
| | - Jan Straub
- Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
| | - Ivan Spicka
- Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital in Prague, 128 08 Prague, Czech Republic
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Abstract
Urinary tract infections (UTI) are the most common bacterial infections in children. The symptoms are not very specific and range from abdominal pain, poor feeding to nocturnal urinary incontinence. The technique of collecting urine plays an important role for securing the diagnosis. The best way to obtain urine in non-toilet-trained children is catheterization or suprapubic bladder aspiration. In toilet-trained children midstream urine is an acceptable alternative after cleaning the foreskin or labia. In the case of an infection a prompt empirical antibiotic therapy is necessary to reduce the risk of parenchymal scarring of the kidneys. There are different approaches to diagnose vesicoureteral reflux in different countries. The commonly used standard approach in Germany is voiding cystourethrography. In the case of reflux dimercaptosuccinic acid (DMSA) scintigraphy should be performed additionally to exclude renal scarring (bottom-up approach).
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Affiliation(s)
- E Lellig
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - M Apfelbeck
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - J Straub
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - A Karl
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - S Tritschler
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - C G Stief
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - M Riccabona
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Straub J, Metzger CD, Plener PL, Koelch MG, Groen G, Abler B. Successful group psychotherapy of depression in adolescents alters fronto-limbic resting-state connectivity. J Affect Disord 2017; 209:135-139. [PMID: 27912160 DOI: 10.1016/j.jad.2016.11.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/31/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current resting state imaging findings support suggestions that the neural signature of depression and therefore also its therapy should be conceptualized as a network disorder rather than a dysfunction of specific brain regions. In this study, we compared neural connectivity of adolescent patients with depression (PAT) and matched healthy controls (HC) and analysed pre-to-post changes of seed-based network connectivities in PAT after participation in a cognitive behavioral group psychotherapy (CBT). METHODS 38 adolescents (30 female; 19 patients; 13-18 years) underwent an eyes-closed resting-state scan. PAT were scanned before (pre) and after (post) five sessions of CBT. Resting-state functional connectivity was analysed in a seed-based approach for right-sided amygdala and subgenual anterior cingulate cortex (sgACC). Symptom severity was assessed using the Beck Depression Inventory Revision (BDI-II). RESULTS Prior to group CBT, between groups amygdala and sgACC connectivity with regions of the default mode network was stronger in the patients group relative to controls. Within the PAT group, a similar pattern significantly decreased after successful CBT. Conversely, seed-based connectivity with affective regions and regions processing cognition and salient stimuli was stronger in HC relative to PAT before CBT. Within the PAT group, a similar pattern changed with CBT. Changes in connectivity correlated with the significant pre-to-post symptom improvement, and pre-treatment amygdala connectivity predicted treatment response in depressed adolescents. LIMITATIONS Sample size and missing long-term follow-up limit the interpretability. CONCLUSIONS Successful group psychotherapy of depression in adolescents involved connectivity changes in resting state networks to that of healthy controls.
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Affiliation(s)
- J Straub
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Germany
| | - C D Metzger
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - M G Koelch
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Germany; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical School Brandenburg, Germany
| | - G Groen
- Department of Psychiatry and Psychotherapy III, University Hospital Ulm, Germany
| | - B Abler
- Department of Psychiatry and Psychotherapy III, University Hospital Ulm, Germany.
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Adam Z, Straub J, Krejčí M, Pour L, Brančíková D, Ostřížková L, Sandecká V, Štork M. [Osteoprotective therapy with bisphosphonates or denosumab in patients with multiple myeloma: benefit and risks]. Vnitr Lek 2017; 63:311-321. [PMID: 28726429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bisphosphonates have been used during the complete treatment of multiple myeloma for more than twenty years. They slow osteolysis and thereby contribute to the improvement of quality of life. Their long-term use, however, is related to 2 serious, usually later appearing complications: osteonecrosis of the jaw, occurring in 6-9 % of patients, and rarer atypical bone fractures. Both these complications are very difficult to heal, and all the more emphasis is therefore laid on prevention. This first of all includes discussion about the risk with the patient, followed by a dental checkup before the commencement of therapy and then repeated during its course, as well as reduced use of these drugs for a necessary period of time. However osteonecrosis of the jaw does not only develop as a consequence of bisphosphonate therapy. The complication is also caused by some new drugs (denosumab and others) used in cancer therapies. The text includes an overview of the drugs currently used in cancer treatment, which also increase the risk of appearance of osteonecrosis of the jaw. For patients with multiple myeloma, who achieve the complete or very good partial remission after chemotherapy, it is recommended to administer these drugs for more than 1 year after achieving the positive treatment response, but not longer than for 2 years. Only regarding those who do not reach the good treatment response, bisphosphonates are administered over the long term, as long as osteolytic activity of the disease lasts.Key words: atypical bone fractures - bisphosphonates - drug induced osteonecrosis of the jaw - multiple myeloma.
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Affiliation(s)
- J. Straub
- University Institute of Medical Chemistry and Stomatological Clinic, Debrecen, Hungary
| | - P. Adler
- University Institute of Medical Chemistry and Stomatological Clinic, Debrecen, Hungary
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Straub J, Apfelbeck M, Karl A, Khoder W, Lellig K, Tritschler S, Stief C, Riccabona M. [Vesico-ureteral reflux: Diagnosis and treatment recommendations]. Urologe A 2016; 55:27-34. [PMID: 26676728 DOI: 10.1007/s00120-015-0003-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vesico-ureteral reflux (VUR) is one of the most common urologic diseases in childhood. About every third child that presents with a urinary tract infection (UTI) has urinary reflux to the ureter or kidney. Demonstration of a backflow of urine into the ureters or kidneys proves vesicoureteral reflux. In unclear cases, a positioned instillation of contrast agent (PIC) cystogram might be performed and is able to prove vesico-ureteral reflux. OBJECTIVES Since low-grade VUR has a high probability of maturation and self-limitation, infants with VUR should be given prophylactic antibiotics during their first year of life, reevaluating the status of VUR after 12 months. The aim of any treatment is to prevent renal damage. THERAPY The individual risk of renal scarring is decisive for the choice of adequate therapy. This risk is mainly dependent on reflux grade, age, and gender of the child as well as parental therapy adherence. In principle, therapeutic options include conservative as well as endoscopic or open surgical antireflux therapies. CONCLUSION Decisions on treatment should be made individually with parents taking into account all the findings available.
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Affiliation(s)
- J Straub
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - M Apfelbeck
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - A Karl
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - W Khoder
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - K Lellig
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - S Tritschler
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - C Stief
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - M Riccabona
- Urologische Klinik und Poliklinik der Ludwig-Maximilians-Universität München, LMU, Klinikum Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Dimopoulos MA, Moreau P, Palumbo A, Joshua D, Pour L, Hájek R, Facon T, Ludwig H, Oriol A, Goldschmidt H, Rosiñol L, Straub J, Suvorov A, Araujo C, Rimashevskaya E, Pika T, Gaidano G, Weisel K, Goranova-Marinova V, Schwarer A, Minuk L, Masszi T, Karamanesht I, Offidani M, Hungria V, Spencer A, Orlowski RZ, Gillenwater HH, Mohamed N, Feng S, Chng WJ. Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): a randomised, phase 3, open-label, multicentre study. Lancet Oncol 2016; 17:27-38. [DOI: 10.1016/s1470-2045(15)00464-7] [Citation(s) in RCA: 524] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 01/11/2023]
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Lellig E, Straub J, Riccabona M. [Imaging in pediatric urology]. Urologe A 2015; 54:956-62. [PMID: 26113301 DOI: 10.1007/s00120-015-3853-9] [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: 11/28/2022]
Abstract
BACKGROUND For many years, sonography and the intravenous pyelogram (IVP) were the most important examination methods for the evaluation of the urinary tract in children. Both methods have their pros and cons: sonography provides ideal visualization of normal kidneys and the evaluation of the pelvicalyceal system. For detection or exclusion of renal scarring, however, this method is not well suited. It provides no information regarding kidney function. METHODS With an IVP, it is possible to evaluate urinary excretion and, thus, indirectly assess kidney function. As this examination method involves radiation exposure and the necessity of a contrast agent, it should be avoided in the examination of children. The CT is an excellent examination method that can diagnose nearly all urological diseases in children or answer urological questions; however, a CT scan applies the highest radiation dose of all discussed methods. For this reason, examination via MRI is of increasing importance in uroradiology. Initially only the T2 sequences for the visualization of the urinary tract in children were applied. CONCLUSION The current technical developments as well as the use of the contrast agent gadolinium and the antidiuretic agent furosemide allow an all-in-one evaluation of the kidneys and urinary tract.
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Affiliation(s)
- E Lellig
- Urologische Klinik und Poliklinik, Campus Großhadern, LMU München, Marchioninistraße 15, 81377, München, Deutschland,
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Dimopoulos MA, Moreau P, Palumbo A, Joshua DE, Pour L, Hajek R, Facon T, Ludwig H, Oriol A, Goldschmidt H, Rosinol L, Straub J, Suvorov A, Araujo C, Pika T, Gaidano G, Weisel K, Goranova-Marinova V, Gillenwater HH, Chng WJ. Carfilzomib and dexamethasone (Kd) vs bortezomib and dexamethasone (Vd) in patients (pts) with relapsed multiple myeloma (RMM): Results from the phase III study ENDEAVOR. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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)
| | | | | | | | - Ludek Pour
- University Hospital Brno, Brno, Czech Republic
| | - Roman Hajek
- University Hospital Brno and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Albert Oriol
- Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Jan Straub
- Vseobecna Fakultni Nemocnice v Praze, Prague, Czech Republic
| | | | - Carla Araujo
- Centre Hospitalier de la Cote Basque, Bayonne, France
| | - Tomas Pika
- University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Katja Weisel
- Universitatsklinikum Tubingen, Tubingen, Germany
| | | | | | - Wee Joo Chng
- National University Cancer Institute, National University Health System, Singapore, Singapore
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Vansteenkiste J, Barlesi F, Waller CF, Bennouna J, Gridelli C, Goekkurt E, Verhoeven D, Szczesna A, Feurer M, Milanowski J, Germonpre P, Lena H, Atanackovic D, Krzakowski M, Hicking C, Straub J, Picard M, Schuette W, O'Byrne K. Cilengitide combined with cetuximab and platinum-based chemotherapy as first-line treatment in advanced non-small-cell lung cancer (NSCLC) patients: results of an open-label, randomized, controlled phase II study (CERTO). Ann Oncol 2015; 26:1734-40. [PMID: 25939894 DOI: 10.1093/annonc/mdv219] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 01/16/2015] [Accepted: 04/28/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This multicentre, open-label, randomized, controlled phase II study evaluated cilengitide in combination with cetuximab and platinum-based chemotherapy, compared with cetuximab and chemotherapy alone, as first-line treatment of patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients were randomized 1:1:1 to receive cetuximab plus platinum-based chemotherapy alone (control), or combined with cilengitide 2000 mg 1×/week i.v. (CIL-once) or 2×/week i.v. (CIL-twice). A protocol amendment limited enrolment to patients with epidermal growth factor receptor (EGFR) histoscore ≥200 and closed the CIL-twice arm for practical feasibility issues. Primary end point was progression-free survival (PFS; independent read); secondary end points included overall survival (OS), safety, and biomarker analyses. A comparison between the CIL-once and control arms is reported, both for the total cohorts, as well as for patients with EGFR histoscore ≥200. RESULTS There were 85 patients in the CIL-once group and 84 in the control group. The PFS (independent read) was 6.2 versus 5.0 months for CIL-once versus control [hazard ratio (HR) 0.72; P = 0.085]; for patients with EGFR histoscore ≥200, PFS was 6.8 versus 5.6 months, respectively (HR 0.57; P = 0.0446). Median OS was 13.6 for CIL-once versus 9.7 months for control (HR 0.81; P = 0.265). In patients with EGFR ≥200, OS was 13.2 versus 11.8 months, respectively (HR 0.95; P = 0.855). No major differences in adverse events between CIL-once and control were reported; nausea (59% versus 56%, respectively) and neutropenia (54% versus 46%, respectively) were the most frequent. There was no increased incidence of thromboembolic events or haemorrhage in cilengitide-treated patients. αvβ3 and αvβ5 expression was neither a predictive nor a prognostic indicator. CONCLUSIONS The addition of cilengitide to cetuximab/chemotherapy indicated potential clinical activity, with a trend for PFS difference in the independent-read analysis. However, the observed inconsistencies across end points suggest additional investigations are required to substantiate a potential role of other integrin inhibitors in NSCLC treatment. CLINICAL TRIAL REGISTRATION ID NUMBER NCT00842712.
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Affiliation(s)
- J Vansteenkiste
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - F Barlesi
- Multidisciplinary Oncology and Therapeutic Innovations, Aix Marseille University-Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - C F Waller
- Haematology, Oncology and Stem Cell Transplantation, University Hospital of Freiburg, Freiburg, Germany
| | - J Bennouna
- Département d'Oncologie Médicale, Centre Rene Gauducheau, Saint-Herblain Cedex, France
| | - C Gridelli
- Division of Medical Oncology, Azienda Ospedaliera 'S.G. Moscati', Avellino, Italy
| | - E Goekkurt
- Department of Oncology, Hematology, Stem Cell Transplantation and Hemostaseology, University Hospital Aachen, Aachen, Germany
| | - D Verhoeven
- Iridium Cancer Network, Medical Oncology, AZ Klina, Antwerp, Belgium
| | - A Szczesna
- Mazowieckie Centrum Leczenia Chorób Pluc i Gruźlicy, Otwock, Poland
| | - M Feurer
- Lungenpraxis Munich, Munich, Germany
| | - J Milanowski
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - P Germonpre
- Pulmonary Medicine, AZ Maria Middelares, Ghent, Belgium
| | - H Lena
- Pneumology, CHU Rennes, Rennes, France
| | - D Atanackovic
- Oncology/Hematology/Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Krzakowski
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Lung and Thoracic Tumours, Warsaw, Poland
| | | | | | | | - W Schuette
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle, Germany
| | - K O'Byrne
- Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
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Radocha J, Pour L, Pika T, Maisnar V, Špička I, Gregora E, Krejčí M, Minařík J, Machálková K, Straub J, Pavlíček P, Hájek R, Žák P. Multicentered patient-based evidence of the role of free light chain ratio normalization in multiple myeloma disease relapse. Eur J Haematol 2015; 96:119-27. [PMID: 25816709 DOI: 10.1111/ejh.12556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The normalization of free light chain ratio (FLCr) has been introduced as a marker of stringent complete remission (CR) of multiple myeloma (MM). There is currently a lack of literature assessing the role of FLCr on MM disease progression and remission status. PATIENTS AND METHODS A multicentered retrospective review of 125 patients with MM in CR and various FLCr values was completed. Parameters of interest included patient demographics, FLCr values, complete remission (CR)/relapse status, and time to progression (TTP). The FLCr values were recorded to provide time-dependent findings on the role of FLCr on progression-free survival and overall survival (OS). RESULTS The mean follow-up time of 125 patients from five hospitals in the Czech Republic was 31 months. A total of 47.2% of patients relapsed (54 of 125) during the follow-up period. The median TTP of patients with normal FLCr (n = 66) was 54.4 and 40.2 months for patients with abnormal FLCr (n = 59) (P = 0.217). None of the patients reached median overall survival regardless of FLCr values (P = 0.821). In the subgroup of newly diagnosed patients after upfront autologous stem cell transplantation (ASCT), there were 55.6% of patients (35 of 63) with normal FLCr and 44.4% (28 of 64) with abnormal FLCr. A total of 34.9% of patients (22 of 63) relapsed in this subgroup. Within the abnormal FLCr patients, a median TTP was 56.3 months, but no median TTP was reached among the normal FLCr patients (P = 0.746). Median OS in patients with normal (nFLCr) and abnormal FLCr (aFLCr) was not reached (P = 0.787). CONCLUSION We did not observe any benefit from FLCr normalization in CR in myeloma patients in terms of progression-free survival or overall survival.
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Affiliation(s)
- Jakub Radocha
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Luděk Pour
- Department of Internal Medicine-Hematooncology, University Hospital Brno, Brno, Czech Republic
| | - Tomáš Pika
- Department of Internal Medicine III, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Vladimír Maisnar
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Ivan Špička
- First Department of Medicine-Department of Hematology, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Evžen Gregora
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marta Krejčí
- Department of Internal Medicine-Hematooncology, University Hospital Brno, Brno, Czech Republic
| | - Jiří Minařík
- Department of Internal Medicine III, Palacky University and University Hospital Olomouc, Olomouc, Czech Republic
| | - Kateřina Machálková
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
| | - Jan Straub
- First Department of Medicine-Department of Hematology, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - Petr Pavlíček
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Roman Hájek
- Department of Clinical Hematology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Žák
- 4th Department of Medicine - Hematology, Charles University Hospital and Faculty of Medicine Hradec, Králové, Czech Republic
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Minarik J, Pavlicek P, Pour L, Pika T, Maisnar V, Spicka I, Jarkovsky J, Krejci M, Bacovsky J, Radocha J, Straub J, Kessler P, Wrobel M, Walterova L, Sykora M, Obernauerova J, Brozova L, Gregora E, Adamova D, Gumulec J, Adam Z, Scudla V, Hajek R. Subcutaneous bortezomib in multiple myeloma patients induces similar therapeutic response rates as intravenous application but it does not reduce the incidence of peripheral neuropathy. PLoS One 2015; 10:e0123866. [PMID: 25875484 PMCID: PMC4396992 DOI: 10.1371/journal.pone.0123866] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/23/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Subcutaneous (SC) application of bortezomib has been recently introduced as a new application route in multiple myeloma (MM) patients. We performed an analysis to compare the outcomes of bortezomib-based therapy in multiple myeloma (MM) patients treated using either intravenous (IV) or subcutaneous (SC) route of administration. PATIENTS AND METHODS During January 2012 through December 2013, we performed a retrospective analysis of 446 patients with MM treated with bortezomib-based regimens (either once weekly - 63% or twice weekly - 27%) in both, the first line setting, and in relapse, with separate analysis of patients undergoing autologous stem cell transplantation. We assessed the response rates and toxicity profiles in both, IV and SC route of bortezomib administration. RESULTS The response rates in both IV and SC arm were similar with overall response rate 71.7% vs 70.7%, complete remissions in 13.9% vs 8.6%, very good partial remissions in 30.8% vs 34.5% and partial remissions in 27% vs 27.6%. The most frequent grade ≥ 3 toxicities were anemia, thrombocytopenia and neutropenia, with no significant differences between IV and SC group. There were no significant differences in the rate of peripheral neuropathy (PN). PN of any grade was present in 48% in the IV arm and in 41% in the SC arm. PN grade ≥ 2 was present in 20% vs 18% and PN grade ≥ 3 was present in 6% vs 4%. CONCLUSIONS We conclude that subcutaneous application of bortezomib has similar therapeutic outcomes and toxicity profile as intravenous route of application. In our cohort there was no difference in the incidence of PN, suggesting that PN is dose dependent and might be reduced by lower intensity schemes rather than by the route of administration.
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Affiliation(s)
- Jiri Minarik
- Department of Hemato-oncology, University Hospital Olomouc and Medical Faculty of Palacky University Olomouc, Olomouc, Czech Republic
- * E-mail:
| | - Petr Pavlicek
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic
| | - Ludek Pour
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Tomas Pika
- Department of Hemato-oncology, University Hospital Olomouc and Medical Faculty of Palacky University Olomouc, Olomouc, Czech Republic
| | - Vladimir Maisnar
- Department of Clinical Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Ivan Spicka
- Department of Internal Medicine, University Hospital, Praha, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marta Krejci
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Jaroslav Bacovsky
- Department of Hemato-oncology, University Hospital Olomouc and Medical Faculty of Palacky University Olomouc, Olomouc, Czech Republic
| | - Jakub Radocha
- Department of Clinical Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Jan Straub
- Department of Internal Medicine, University Hospital, Praha, Czech Republic
| | - Petr Kessler
- Department of Hematology and Transfusion, General Hospital, Pelhrimov, Czech Republic
| | - Marek Wrobel
- Department of Oncology, Hospital Novy Jicin, Novy Jicin, Czech Republic
| | - Lenka Walterova
- Department of Clinical Hematology, General Hospital Liberec, Liberec, Czech Republic
| | - Michal Sykora
- Department of Clinical Hematology, General Hospital, Ceske Budejovice, Czech Republic
| | - Jarmila Obernauerova
- Department of Hematology and Transfusion, Claudian Hospital, Mlada Boleslav, Czech Republic
| | - Lucie Brozova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Evzen Gregora
- Department of Clinical Hematology, University Hospital Kralovske Vinohrady, Praha, Czech Republic
| | - Dagmar Adamova
- Department of Hematology and Transfusiology, Silesian Hospital, Opava, Czech Republic
| | - Jaromir Gumulec
- Department of Haematooncology, University Hospital Ostrava and the Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Zdenek Adam
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Vlastimil Scudla
- Department of Hemato-oncology, University Hospital Olomouc and Medical Faculty of Palacky University Olomouc, Olomouc, Czech Republic
| | - Roman Hajek
- Department of Haematooncology, University Hospital Ostrava and the Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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Élez E, Kocáková I, Höhler T, Martens UM, Bokemeyer C, Van Cutsem E, Melichar B, Smakal M, Csőszi T, Topuzov E, Orlova R, Tjulandin S, Rivera F, Straub J, Bruns R, Quaratino S, Tabernero J. Abituzumab combined with cetuximab plus irinotecan versus cetuximab plus irinotecan alone for patients with KRAS wild-type metastatic colorectal cancer: the randomised phase I/II POSEIDON trial. Ann Oncol 2015; 26:132-140. [PMID: 25319061 DOI: 10.1093/annonc/mdu474] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [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] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Integrins are involved in tumour progression and metastasis, and differentially expressed on colorectal cancer (CRC) cells. Abituzumab (EMD 525797), a humanised monoclonal antibody targeting integrin αν heterodimers, has demonstrated preclinical activity. This trial was designed to assess the tolerability of different doses of abituzumab in combination with cetuximab and irinotecan (phase I) and explore the efficacy and tolerability of the combination versus that of cetuximab and irinotecan in patients with metastatic CRC (mCRC) (phase II part). METHODS Eligible patients had KRAS (exon 2) wild-type mCRC and had received prior oxaliplatin-containing therapy. The trial comprised an initial safety run-in using abituzumab doses up to 1000 mg combined with a standard of care (SoC: cetuximab plus irinotecan) and a phase II part in which patients were randomised 1 : 1 : 1 to receive abituzumab 500 mg (arm A) or 1000 mg (arm B) every 2 weeks combined with SoC, or SoC alone (arm C). The primary end point was investigator-assessed progression-free survival (PFS). Secondary end points included overall survival (OS), response rate (RR) and tolerability. Associations between tumour integrin expression and outcomes were also assessed. RESULTS Phase I showed that abituzumab doses up to 1000 mg were well tolerated in combination with SoC. Seventy-three (arm A), 71 (arm B) and 72 (arm C) patients were randomised to the phase II part. Baseline characteristics were balanced. PFS was similar in the three arms: arm A versus SoC, hazard ratio (HR) 1.13 [95% confidence interval (CI) 0.78-1.64]; arm B versus SoC, HR 1.11 (95% CI 0.77-1.61). RRs were also similar. A trend toward improved OS was observed: arm A versus SoC, HR 0.83 (95% CI 0.54-1.28); arm B versus SoC, HR 0.80 (95% CI 0.52-1.25). Grade ≥3 treatment-emergent adverse events were observed in 72%, 78% and 67% of patients. High tumour integrin αvβ6 expression was associated with longer OS in arms A [HR 0.55 (0.30-1.00)] and B [HR 0.41 (0.21-0.81)] than in arm C. CONCLUSION The primary PFS end point was not met, although predefined exploratory biomarker analyses identified subgroups of patients in whom abituzumab may have benefit. The tolerability of abituzumab combined with cetuximab and irinotecan was acceptable. Further study is warranted. CLINICALTRIALS.GOV IDENTIFIER: NCT01008475.
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Affiliation(s)
- E Élez
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - I Kocáková
- Department of Comprehensive Cancer Care, Masarykuv Onkologicky Ustav, Brno, Czech Republic
| | - T Höhler
- Medical Clinic I, Prosper-Hospital, Recklinghausen
| | - U M Martens
- Department of Hematology/Oncology, Cancer Center Heilbronn-Franken, Heilbronn
| | - C Bokemeyer
- Department of Oncology/Hematology, University Hospital Hamburg, Hamburg, Germany
| | - E Van Cutsem
- Department of Digestive Oncology, University Hospital Gasthuisberg Leuven and KULeuven, Leuven, Belgium
| | - B Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc
| | - M Smakal
- Department of Oncology, Horovice, Czech Republic
| | - T Csőszi
- Department of Oncology, Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelointezet, Szolnok, Hungary
| | - E Topuzov
- GOU VPO St-Petersburg SMA, n/a Mechnikov Federal Agency of Healthcare, St Petersburg
| | - R Orlova
- City Clinical Oncology Dispensary, St Petersburg
| | - S Tjulandin
- S.I. Russian Cancer Research Center, Moscow, Russia
| | - F Rivera
- University Hospital Marques de Valdecilla, Santander, Spain
| | | | - R Bruns
- Merck KGaA, Darmstadt, Germany
| | | | - J Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Fikrle M, Palecek T, Masek M, Kuchynka P, Straub J, Spicka I, Rysava R, Linhart A. The diagnostic performance of cardiac magnetic resonance in detection of myocardial involvement in AL amyloidosis. Clin Physiol Funct Imaging 2014; 36:218-24. [PMID: 25393773 DOI: 10.1111/cpf.12216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The non-invasive assessment of amyloid heart disease may be challenging. Cardiac magnetic resonance (CMR) represents a method of choice for assessment of left ventricular (LV) morphology and function, and it also provides a unique possibility to evaluate the presence of amyloid deposition by the late gadolinium enhancement (LGE) technique. However, so far, published studies have not been consistent in terms of described LGE patterns associated with amyloid cardiomyopathy. AIMS To compare echocardiographic and CMR assessment of LV morphology and function and to evaluate the presence and pattern of LGE in a population of patients with AL amyloid cardiomyopathy. METHODS Twenty-two consecutive patients with newly diagnosed AL amyloid cardiomyopathy and without contraindications to CMR were comprehensively examined by echocardiography and CMR. RESULTS Echocardiography and CMR did not differ in the evaluation of interventricular septal thickness, LV end-diastolic diameter and ejection fraction. Significant differences were found between echocardiographic and CMR estimates of LV end-diastolic volume (P<0·01) and LV mass (P<0·001). Various global LGE patterns (transmural homogenous or heterogeneous, subendocardial) were present in 17 patients (77%), patchy LGE was observed in one case (4·5%) and suboptimal nulling of the myocardium was reported in two subjects (9%). CONCLUSIONS Echocardiography significantly overestimates LV mass and underestimates LV volumes in patients with AL amyloid cardiomyopathy as compared to CMR. As it is present in more than three quarters of individuals with AL amyloid cardiomyopathy, any type of global LGE pattern may be considered as pathogenomic for amyloid heart disease.
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Affiliation(s)
- Michal Fikrle
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Palecek
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Martin Masek
- Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Kuchynka
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Jan Straub
- 1st Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Ivan Spicka
- 1st Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Romana Rysava
- Department of Nephrology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Vansteenkiste J, Barlesi F, Waller C, Bennouna J, Gridelli C, Goekkurt E, Verhoeven D, Szczesna A, Feurer M, Milanowski J, Germonpre P, Lena H, Atanackovic D, Krzakowski M, Hicking C, Straub J, Picard M, Schuette W, Byrne KO. Cilengitide (Cil) Combined with Cetuximab and Platinum-Based Chemotherapy As First-Line Treatment in Advanced Non-Small Cell Lung Cancer (Nsclc) Patients (Pts): Phase Ii Randomised Certo Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.14] [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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47
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Miller K, Hussain M, Le Moulec S, Rybicka I, Bruns R, Straub J. Abituzumab (Di17E6, Emd 525797) Treatment for Chemotherapy-Naive Patients with Asymptomatic or Mildly Symptomatic Metastatic Castration-Resistant Prostate Cancer (Mcrpc): Primary Outcomes of the Placebo-Controlled Phase 2 Study Perseus (Nct01360840). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.20] [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: 11/12/2022] Open
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48
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MacKerell AD, Bashford D, Bellott M, Dunbrack RL, Evanseck JD, Field MJ, Fischer S, Gao J, Guo H, Ha S, Joseph-McCarthy D, Kuchnir L, Kuczera K, Lau FT, Mattos C, Michnick S, Ngo T, Nguyen DT, Prodhom B, Reiher WE, Roux B, Schlenkrich M, Smith JC, Stote R, Straub J, Watanabe M, Wiórkiewicz-Kuczera J, Yin D, Karplus M. All-atom empirical potential for molecular modeling and dynamics studies of proteins. J Phys Chem B 2014; 102:3586-616. [PMID: 24889800 DOI: 10.1021/jp973084f] [Citation(s) in RCA: 11569] [Impact Index Per Article: 1156.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
New protein parameters are reported for the all-atom empirical energy function in the CHARMM program. The parameter evaluation was based on a self-consistent approach designed to achieve a balance between the internal (bonding) and interaction (nonbonding) terms of the force field and among the solvent-solvent, solvent-solute, and solute-solute interactions. Optimization of the internal parameters used experimental gas-phase geometries, vibrational spectra, and torsional energy surfaces supplemented with ab initio results. The peptide backbone bonding parameters were optimized with respect to data for N-methylacetamide and the alanine dipeptide. The interaction parameters, particularly the atomic charges, were determined by fitting ab initio interaction energies and geometries of complexes between water and model compounds that represented the backbone and the various side chains. In addition, dipole moments, experimental heats and free energies of vaporization, solvation and sublimation, molecular volumes, and crystal pressures and structures were used in the optimization. The resulting protein parameters were tested by applying them to noncyclic tripeptide crystals, cyclic peptide crystals, and the proteins crambin, bovine pancreatic trypsin inhibitor, and carbonmonoxy myoglobin in vacuo and in crystals. A detailed analysis of the relationship between the alanine dipeptide potential energy surface and calculated protein φ, χ angles was made and used in optimizing the peptide group torsional parameters. The results demonstrate that use of ab initio structural and energetic data by themselves are not sufficient to obtain an adequate backbone representation for peptides and proteins in solution and in crystals. Extensive comparisons between molecular dynamics simulations and experimental data for polypeptides and proteins were performed for both structural and dynamic properties. Energy minimization and dynamics simulations for crystals demonstrate that the latter are needed to obtain meaningful comparisons with experimental crystal structures. The presented parameters, in combination with the previously published CHARMM all-atom parameters for nucleic acids and lipids, provide a consistent set for condensed-phase simulations of a wide variety of molecules of biological interest.
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Affiliation(s)
- A D MacKerell
- Department of Chemistry & Chemical Biology, Harvard University, Cambridge, Massachusetts 02138, Department of Pharmaceutical Sciences, University of Maryland, School of Pharmacy, Baltimore, Maryland 21201, and Laboratoire de Chimie Biophysique, ISIS, Institut Le Bel, Université Louis Pasteur, 67000 Strasbourg, France
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49
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Elez E, Kocáková I, Höhler T, Martens U, Bokemeyer C, Van Cutsem E, Melichar B, Smakal M, Cso˝szi T, Vyushkov D, Topuzov E, Orlova R, Tjulandin S, Rivera F, Straub J, Bruns R, Quaratino S, Tabernero J. Abituzumab Combined with Cetuximab Plus Irinotecan Versus Cetuximab Plus Irinotecan Alone, as Second-Line Treatment for Patients with KRAS Wild-Type Metastatic Colorectal Cancer: The Poseidon Phase I/Randomized Phase II Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu193.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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50
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Minarik J, Sandecka V, Maisnar V, Gregora E, Spicka I, Starostka D, Plonkova H, Jarkovsky J, Walterova L, Wrobel M, Adamova D, Pika T, Melicharova H, Pour L, Radocha J, Pavlicek P, Straub J, Gumulec J, Bacovsky J, Adam Z, Scudla V, Hajek R. 10 years of experience with thalidomide in multiple myeloma patients: Report of the Czech Myeloma Group. Leuk Res 2013; 37:1063-9. [DOI: 10.1016/j.leukres.2013.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 06/14/2013] [Accepted: 06/15/2013] [Indexed: 11/25/2022]
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