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Heinrich K, Karthaus M, Fruehauf S, Graeven U, Mueller L, König AO, von Weikersthal LF, Caca K, Kretzschmar A, Goekkurt E, Haas S, Alig AHS, Kurreck A, Stahler A, Held S, Sommerhäuser G, Heinemann V, Stintzing S, Trarbach T, Modest DP. Impact of sex on the efficacy and safety of panitumumab plus fluorouracil and folinic acid versus fluorouracil and folinic acid alone as maintenance therapy in RAS WT metastatic colorectal cancer (mCRC). Subgroup analysis of the PanaMa-study (AIO-KRK-0212). ESMO Open 2023; 8:101568. [PMID: 37441876 PMCID: PMC10507735 DOI: 10.1016/j.esmoop.2023.101568] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Clinical trials in metastatic colorectal cancer (mCRC) are usually conducted irrespective of sex. Sex-associated differences relating to safety and efficacy in the treatment of mCRC, however, are gaining interest. METHODS PanaMa investigated the efficacy of panitumumab (Pmab) plus fluorouracil and folinic acid (FU/FA) versus FU/FA alone after induction therapy with six cycles of FU/FA and oxaliplatin plus Pmab in patients with RAS wild-type mCRC. In this post hoc analysis, the study population was stratified for sex. Evaluated efficacy endpoints during maintenance treatment were progression-free survival (PFS, primary endpoint of the trial), overall survival (OS) and objective response rate during maintenance therapy. Safety endpoints were rates of any grade and grade 3/4 adverse events during maintenance therapy. RESULTS In total, 165 male and 83 female patients were randomized and treated. Male and female patients showed numerically better objective response rates with Pmab, without reaching statistical significance. Male patients derived a significant benefit from the addition of Pmab to maintenance treatment with regard to PFS [hazard ratio (HR) 0.63; 95% confidence interval (CI) 0.45-0.88; P = 0.006] that was not observed in female patients (HR 0.85; 95% CI 0.53-1.35; P = 0.491). The better PFS for male patients treated with Pmab did not translate into improved OS (HR 0.85; 95% CI 0.55-1.30; P = 0.452). Female patients showed numerically improved OS when treated with Pmab. There was no difference in the total of grade ≥3 adverse events during maintenance regarding sex (P = 0.791). Female patients, however, had a higher rate of any grade nausea, diarrhea and stomatitis. CONCLUSIONS In the PanaMa trial, the addition of Pmab to maintenance treatment of RAS wild-type mCRC with FU/FA improved the outcome in terms of the primary endpoint (PFS) particularly in male patients. Female patients did not show the same benefit while experiencing higher rates of adverse events. Our results support the development of sex-specific protocols.
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Affiliation(s)
- K Heinrich
- Department of Medicine III, University Hospital, LMU Munich, Munich; German Cancer Consortium (DKTK), Partner Site Munich, Munich. https://twitter.com/heinrich_kat
| | - M Karthaus
- Department of Hematology and Oncology, Munich Hospital Neuperlach, Munich
| | | | - U Graeven
- Kliniken Maria Hilf GmbH, Moenchengladbach
| | | | - A O König
- Department of Gastroenterology, University Medicine Göttingen, Goettingen
| | | | - K Caca
- Department of Gastroenterology, Hematology and Oncology, Hospital Ludwigsburg, Ludwigsburg
| | | | - E Goekkurt
- Practice of Hematology and Oncology (HOPE), Hamburg; University Cancer Center Hamburg (UCCH), Hamburg
| | - S Haas
- Department of Hematology and Oncology, Friedrich-Ebert-Hospital, Neumünster
| | - A H S Alig
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - A Kurreck
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - A Stahler
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - S Held
- ClinAssess GmbH, Leverkusen
| | - G Sommerhäuser
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich; German Cancer Consortium (DKTK), Partner Site Munich, Munich; Comprehensive Cancer Center, University Hospital (LMU), Munich
| | - S Stintzing
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg
| | - T Trarbach
- Reha-Zentrum am Meer, Bad Zwischenahn; Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - D P Modest
- Department of Hematology, Oncology and Cancer Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; German Cancer Consortium (DKTK), German Cancer Research Centre (DKFZ), Heidelberg.
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Pape UF, Kasper S, Meiler J, Sinn M, Vogel A, Mueller L, Burkhard O, Caca K, Heeg S, Rodriguez Laval V, Kuhl A, Arsenic R, Jansen H, Mehrling T, Hilgier K, Wagner I, Utku N. Post-hoc analyses of a subgroup of patients with advanced biliary tract cancer (BTC) who crossed over to treatment with etoposide toniribate (EDO-S7.1) in a randomized phase II study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.051] [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: 11/14/2022] Open
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Kreutzer T, Walter B, Schmidt A, Meier B, Wannhoff A, Schmidbaur S, Meining A, Caca K. Untersuchung des Appendizitis-Risiko nach endoskopischer Vollwandresektion von Adenomen im Bereich der Appendix mit dem FTRD-System. Z Gastroenterol 2018. [DOI: 10.1055/s-0038-1669128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T Kreutzer
- Klinikum Ludwigsburg, Medizinische Klinik I, Ludwigsburg, Deutschland
| | - B Walter
- Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm, Deutschland
| | - A Schmidt
- Universitätsklinikum Freiburg, Klinik für Innere Medizin II, Freiburg, Deutschland
| | - B Meier
- Klinikum Ludwigsburg, Medizinische Klinik I, Ludwigsburg, Deutschland
| | - A Wannhoff
- Klinikum Ludwigsburg, Medizinische Klinik I, Ludwigsburg, Deutschland
| | - S Schmidbaur
- Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm, Deutschland
| | - A Meining
- Universitätsklinikum Ulm, Klinik für Innere Medizin I, Ulm, Deutschland
| | - K Caca
- Klinikum Ludwigsburg, Medizinische Klinik I, Ludwigsburg, Deutschland
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Schmoll H, Haustermans K, Price T, Nordlinger B, Hofheinz R, Daisne J, Janssens J, Brenner B, Schmidt P, Reinel H, Hollerbach S, Caca K, Fauth F, Hannig C, Zalcberg J, Tebbutt N, Mauer M, Marreaud S, Lutz M, Van Cutsem E. PETACC-6: Preop chemoradiation and postop chemotherapy (capecitabine +/- oxaliplatin) in locally advanced rectal cancer: Overall survival after long term follow-up. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.018] [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: 11/12/2022] Open
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Haas M, Siveke JT, Schenk M, Lerch MM, Caca K, Freiberg-Richter J, Fischer von Weikersthal L, Kullmann F, Reinacher-Schick A, Fuchs M, Kanzler S, Kunzmann V, Ettrich TJ, Kruger S, Westphalen CB, Held S, Heinemann V, Boeck S. Efficacy of gemcitabine plus erlotinib in rash-positive patients with metastatic pancreatic cancer selected according to eligibility for FOLFIRINOX: A prospective phase II study of the 'Arbeitsgemeinschaft Internistische Onkologie'. Eur J Cancer 2018; 94:95-103. [PMID: 29549862 DOI: 10.1016/j.ejca.2018.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION In metastatic pancreatic ductal adenocarcinoma (mPDAC) treatment, erlotinib is known to be more effective in patients developing skin rash. Treatment with the FOLFIRINOX regimen is only performed in fit patients following defined inclusion criteria. The present study investigates the efficacy of gemcitabine plus erlotinib (gem/erlotinib) in rash-positive patients fit for FOLFIRINOX. PATIENTS AND METHODS For this prospective phase II study, 150 patients were recruited in 20 centres. All patients received gem/erlotinib for 4 weeks (run-in phase); the subsequent treatment was determined by the development of skin rash: patients with rash grades 1-4 continued with gem/erlotinib, rash-negative patients were switched to FOLFIRINOX. Primary study end-point was to achieve a 1-year survival rate in rash-positive patients ≥40%. RESULTS Ninety patients were deemed positive for skin rash by the end of the run-in phase, showing a 1-year survival rate of 40.0% (95% confidence interval [CI] 29.8-50.9). Median overall survival (OS) was 10.1 months, progression-free survival (PFS) was 3.8 months and overall response rate (ORR) was 23.3%. Patients switched to FOLFIRINOX (n = 27) had a 1-year survival rate of 48.1% (95% CI 28.7-68.1), a median OS of 10.9 months, a median PFS of 6.6 months and an ORR of 33.3%. Rash-negative patients had a lower quality of life at baseline but seemed to experience an improved control of pain during FOLFIRINOX. CONCLUSIONS First-line treatment with gem/erlotinib was effective in fit, rash-positive mPDAC patients achieving a 1-year survival rate comparable to previous reports for FOLFIRINOX. The study was registered at clinicaltrials.gov (NCT0172948) and Eudra-CT (2011-005471-17).
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Affiliation(s)
- M Haas
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
| | - J T Siveke
- 2nd Medical Department, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Solid Tumor Translational Oncology (DKTK, Partner Site Essen), West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Schenk
- Department of Haematology and Oncology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - M M Lerch
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - K Caca
- Department of Internal Medicine I, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | | | - F Kullmann
- Department of Medicine I, Klinikum Weiden, Weiden, Germany
| | - A Reinacher-Schick
- Department of Haematology and Oncology, St. Josef-Hospital, Ruhr University, Bochum, Germany
| | - M Fuchs
- Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Klinikum Bogenhausen, Munich, Germany
| | - S Kanzler
- Department of Internal Medicine II, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - V Kunzmann
- Department of Medical Oncology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - T J Ettrich
- Department of Internal Medicine I, University of Ulm, Ulm, Germany
| | - S Kruger
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - C B Westphalen
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - S Boeck
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
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Abstract
A 46-year-old woman presented with acute abdominal pain in the right upper quadrant. Esophagogastroduodenoscopy revealed a duodenal stenosis within the horizontal part of the duodenum. Based on the findings of abdominal computed tomography (CT), endosonography, Doppler duplex sonography and angiography, the diagnosis of an aneurysm of a branch of the inferior pancreaticoduodenal artery was established. This arterial branch was part of a collateral circulation between the superior mesenteric artery and the proper hepatic artery caused by obturation of the celiac artery. The symptomatic duodenal stenosis was the result of a local hematoma due to prior rupture of an aneurysm. After successful coiling of the afferent vessels to the aneurysm follow-up examinations showed progredient resorption of the hematoma and the patient was free of complaints.
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Affiliation(s)
- M Bauder
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland.
| | - A Fiala
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Ludwigsburg, Ludwigsburg, Deutschland
| | - C Klinger
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
| | - W Kersjes
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum Ludwigsburg, Ludwigsburg, Deutschland
| | - K Caca
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
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Modest D, Kasper S, Stintzing S, Prasnikar N, Müller L, Caca K, Gökkurt E, von Weikersthal LF, Kopp HG, Trarbach T. Randomized phase II study of maintenance treatment with 5-FU/FA plus panitumumab vs 5-FU/FA alone after induction (mFOLFOX6 plus panitumumab) in patients with RAS WT metastatic colorectal cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schmoll H, Stein A, Hofheinz R, Price T, Nordlinger B, Daisne JF, Daisne JF, Janssens J, Brenner B, Schmidt P, Reinel H, Hollerbach S, Caca K, Fauth F, Zalcberg J, Marreaud S, Mauer M, Lutz M, Van Cutsem E, Haustermans K. Preoperative chemoradiotherapy and postoperative chemotherapy with capecitabine and oxaliplatin vs. capecitabine alone in locally advanced rectal cancer: final analyses. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Meier B, Schmidt A, Caca K. [Endoscopic full-thickness resection]. Internist (Berl) 2016; 57:755-62. [PMID: 27286839 DOI: 10.1007/s00108-016-0087-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Conventional endoscopic resection techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) are powerful tools for the treatment of gastrointestinal (GI) neoplasms. However, those techniques are limited to the superficial layers of the GI wall (mucosa and submucosa). Lesions without lifting sign (usually arising from deeper layers) or lesions in difficult anatomic positions (appendix, diverticulum) are difficult - if not impossible - to resect using conventional techniques, due to the increased risk of complications. For larger lesions (>2 cm), ESD appears to be superior to the conventional techniques because of the en bloc resection, but the procedure is technically challenging, time consuming, and associated with complications even in experienced hands. Since the development of the over-the-scope clips (OTSC), complications like bleeding or perforation can be endoscopically better managed. In recent years, different endoscopic full-thickness resection techniques came to the focus of interventional endoscopy. Since September 2014, the full-thickness resection device (FTRD) has the CE marking in Europe for full-thickness resection in the lower GI tract. Technically the device is based on the OTSC system and combines OTSC application and snare polypectomy in one step. This study shows all full-thickness resection techniques currently available, but clearly focuses on the experience with the FTRD in the lower GI tract.
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Affiliation(s)
- B Meier
- Medizinische Klinik I, Gastroenterologie und Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
| | - A Schmidt
- Medizinische Klinik I, Gastroenterologie und Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
| | - K Caca
- Medizinische Klinik I, Gastroenterologie und Onkologie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland.
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Landerer J, Damm M, Caca K, Zimmermann K, Merk T. Fallbericht: Vom metastasierten Tumor zur isolierten Tuberkulose. Pneumologie 2016. [DOI: 10.1055/s-0036-1572219] [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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Damm M, Landerer J, Platzer L, Merk T, Caca K. Remission mit Rituximab – erfolgreiche Therapie einer Polyangiitis mit Granulomatose bei einem Jugendlichen. Pneumologie 2016. [DOI: 10.1055/s-0036-1572072] [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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Damm M, El-Tawel H, Beller K, Landerer J, Caca K, Merk T. Lymphangiomatose mit Mediastinaltumor, Knochen- und Milzzysten bei einem 38-jährigen Patienten mit Kolonkarzinom – ein Fallbericht. Pneumologie 2016. [DOI: 10.1055/s-0036-1572070] [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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Mueller J, Schmidt A, Herrmann G, Caca K. [Rituximab therapy for relapsing IgG4-autoimmune pancreatitis and cholangitis - a case report]. Z Gastroenterol 2015; 53:40-2. [PMID: 25594706 DOI: 10.1055/s-0034-1385717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a patient with autoimmune pancreatitis and cholangitis. During a period of 3 years and despite therapy with steroids and immunmodulatory drugs such as azathioprine and mycophenolate mofetil he suffered from multiple relapse episodes including bile duct stenoses requiring endoscopic interventions. After initiation of therapy with the monoclonal CD20 antibody Rituximab, steroids could be stopped completely and the patient remains in remission. Rituximab should be considered in therapy of relapsing autoimmune pancreatitis and cholangitis.
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Affiliation(s)
- J Mueller
- Innere Medizin, Klinikum Ludwigsburg
| | - A Schmidt
- Innere Medizin, Klinikum Ludwigsburg
| | | | - K Caca
- Innere Medizin, Klinikum Ludwigsburg
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Schmoll H, Haustermans K, Price T, Nordlinger B, Hofheinz R, Daisne J, Janssens J, Brenner B, Schmidt P, Reinel H, Hollerbach S, Caca K, Fauth F, Hannig C, Zalcberg J, Tebbutt N, Mauer M, Messina C, Lutz M, Van Cutsem E. Preoperative Chemoradiotherapy and Postoperative Chemotherapy with Capecitabine +/- Oxaliplatin in Locally Advanced Rectal Cancer: Interim Analysis for Disease-Free Survival of Petacc 6. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schmoll HJ, Haustermans K, Price T, Nordlinger B, Hofheinz R, Daisne JF, Janssens J, Brenner B, Schmidt P, Reinel H, Hollerbach S, Caca K, Fauth F, Hannig C, Zalcberg J, Tebbutt N, Mauer M, Messina C, Lutz M, Van Cutsem E. PG 6.2 Preoperative chemoradiotherapy and postoperative chemotherapy with capecitabine and oxaliplatin vs. capecitabine alone in locally advanced rectal cancer: disease free survival results at interim analysis. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70023-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schmidt A, Meier B, Caca K. [49-year-old man with acute dysphagia]. Dtsch Med Wochenschr 2013; 138:1769-70. [PMID: 24002876 DOI: 10.1055/s-0033-1343322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- A Schmidt
- Klinik für Innere Medizin, Gastroenterologie, Hämato- Onkologie, Diabetologie und Infektiologie, Klinikum Ludwigsburg
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Sörensen AS, Kalmar G, Schmidt A, Caca K. Endoskopische Blutstillung mit absorbierbaren modifizierten Polymeren (AMP®; EndoClot™) - erste Erfahrungen im oberen Gastrointestinaltrakt. Z Gastroenterol 2013. [DOI: 10.1055/s-0033-1352910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Schmoll HJ, Haustermans K, Price T, Nordlinger B, Hofheinz R, Daisne JF, Janssens J, Brenner B, Schmidt P, Reinel H, Hollerbach S, Caca K, Fauth F, Hannig C, Zalcberg J, Tebbutt N, Mauer M, Messina C, Lutz M, Van Cutsem E. Preoperative Chemoradiotherapy and Postoperative Chemotherapy with Capecitabine and Oxaliplatin vs. Capecitabine Alone in Locally Advanced Rectal Cancer: Response to the Local Treatment After Chemoradiation and Surgery as Secondary Endpoint. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt201.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Meier B, Schmidt A, Kalmar G, Caca K, Wagner D. Manifestation of an abdominal immune reconstitution inflammatory syndrome associated with a nontuberculous mycobacterial infection - a case report. Z Gastroenterol 2013; 51:440-3. [PMID: 23681897 DOI: 10.1055/s-0033-1335012] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is an inflammatory reaction in HIV-infected patients after initiation of antiretroviral therapy. It results from restored immunity to specific infectious or non-infectious antigens. We describe the case of a 47-year-old female patient who presented with an unspecific painful pressure in the abdomen and weight loss that was diagnosed as intra-abdominal (unmasking) IRIS due to nontuberculous mycobacterial infection (Mycobacterium avium complex). Antiretroviral therapy had been initiated six months earlier when pneumocystis pneumonia led to the diagnosis of HIV infection with a viral load of 123 000 copies/ml and a CD 4 cell count of 6/µl. Although IRIS is a known complication after initiation of antiretroviral therapy in HIV-infected patients this case with a rare site of manifestation and symptoms that are common in all day gastroenterological clinic highlights a differential diagnosis that requires a high index of suspicion and the need for the careful use of diagnostic tools.
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Affiliation(s)
- B Meier
- Gastroenterologie, Klinikum Ludwigsburg, 71640 Ludwigsburg.
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Atmaca A, Al-Batran SE, Werner D, Pauligk C, Güner T, Koepke A, Bernhard H, Wenzel T, Banat AG, Brueck P, Caca K, Prasnikar N, Kullmann F, Günther Derigs H, Koenigsmann M, Dingeldein G, Neuhaus T, Jäger E. A randomised multicentre phase II study with cisplatin/docetaxel vs oxaliplatin/docetaxel as first-line therapy in patients with advanced or metastatic non-small cell lung cancer. Br J Cancer 2013; 108:265-70. [PMID: 23329236 PMCID: PMC3566804 DOI: 10.1038/bjc.2012.555] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: This study was designed to compare cisplatin/docetaxel with oxaliplatin/docetaxel in patients with advanced and metastatic non-small lung cancer as a first-line treatment. Methods: Patients were randomly assigned to receive either cisplatin 75 mg m−2 and docetaxel 75 mg m−2 every 3 weeks or oxaliplatin 85 mg m−2 and docetaxel 50 mg m−2 every 2 weeks. The primary end point was response rate, and secondary end points were toxicity, time to progression and overall survival. Results: A total of 88 patients (median age: 65 (39–86) years; stage IV: 93%) were randomly assigned. Response rate (complete and partial response) was 47% (95% CI: 33–61%) in the cisplatin/docetaxel arm and 28% (95% CI: 17–43%) in the oxaliplatin/docetaxel arm (P=0.118). There was no significant difference in time to progression (6.3 vs 4.9 months, P=0.111) and median overall survival (11.6 vs 7.0 months, P=0.102) with cisplatin/docetaxel vs oxaliplatin/docetaxel, although slight trends favouring cisplatin were seen. Oxaliplatin/docetaxel was associated with significantly less (any grade) renal toxicity (56% vs 11%), any grade fatigue (81% vs 59%), complete alopecia (76% vs 27%), any grade leukopenia (84% vs 61%) and grade 3/4 leukopenia (44% vs 14%) and neutropenia (56% vs 27%). Conclusion: Oxaliplatin/docetaxel has activity in metastatic non-small cell lung cancer, but it seems to be inferior to cisplatin/docetaxel.
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Affiliation(s)
- A Atmaca
- Department of Hematology and Oncology, Institute of Clinical Research (IKF) at Krankenhaus Nordwest, UCT-University Cancer Center, 60488 Frankfurt am Main, Germany.
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von Renteln D, Gutmann TE, Schmidt A, Vassiliou MC, Rudolph HU, Caca K. Standard diagnostic laparoscopy is superior to NOTES approaches: results of a blinded, randomized controlled porcine study. Endoscopy 2012; 44:596-604. [PMID: 22402984 DOI: 10.1055/s-0031-1291790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIM The use of transluminal endoscopic access via the stomach or colon for flexible diagnostic peritoneoscopy has been proposed, although the diagnostic value of the technique has not yet been fully clarified. In this animal trial, the two main natural orifice transluminal endoscopic surgery (NOTES) approaches - transgastric (TG) and transcolonic (TC) - were compared with standard transabdominal access using both rigid (TAR) and flexible instruments (TAF) for diagnostic laparoscopy. METHODS A total of 48 peritoneoscopies were performed using two randomly assigned approaches in 24 anesthetized pigs. The ability of the examinations to detect 576 electrocautery markings simulating intraperitoneal metastases, to achieve complete organ visualization, and to simulate organ biopsies was analyzed. RESULTS Sensitivities for the detection of lesions were 78.5 %, 59.7 %, 48.6 %, and 38.9 % for TAR, TAF, TC, and TG, respectively; standard laparoscopy was superior to all other approaches (P < 0.01). Among the NOTES approaches, TC was superior for examining the upper abdomen (P = 0.03). Complete organ visualization was better with the transabdominal approach (visual analogue scale TAR 7.15, TAF 6.71) than with the NOTES access routes (TC 5.07, TG 4.35); standard rigid laparoscopy was superior to both NOTES approaches (P < 0.01). Organ biopsy simulation was possible in 87 %, 85 %, 72 %, and 65 % of cases with TAR, TAF, TC, and TG, respectively. Standard rigid laparoscopy was again superior to both NOTES approaches (TAR vs. TC, P = 0.03; TAR vs. TG, P < 0.01). CONCLUSIONS In this experimental trial, rigid standard laparoscopy provided better organ visualization, better lesion detection, and better biopsy capability than the transgastric and transcolonic NOTES approaches. In its current form, NOTES appears to be unsuitable for diagnostic laparoscopy.
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Affiliation(s)
- D von Renteln
- Department of Interdisciplinary Endoscopy, Hamburg-Eppendorf University Hospital, Hamburg, Germany
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Schmittel A, Sebastian M, Fischer von Weikersthal L, Martus P, Gauler T, Kaufmann C, Hortig P, Fischer J, Link H, Binder D, Fischer B, Caca K, Eberhardt W, Keilholz U. A German multicenter, randomized phase III trial comparing irinotecan–carboplatin with etoposide–carboplatin as first-line therapy for extensive-disease small-cell lung cancer. Ann Oncol 2011; 22:1798-804. [DOI: 10.1093/annonc/mdq652] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [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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Atmaca A, Al-Batran S, Güner T, Pauligk C, Koepke A, Bernhard H, Wenzel T, Banat AG, Brueck P, Caca K, Prasnikar N, Kullmann F, Jäger E. Randomized multicenter phase II study with docetaxel in combination with either cisplatin or oxaliplatin as first-line treatment in patients with advanced or metastatic non-small cell lung cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e18024] [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: 11/20/2022] Open
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Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Böhle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Höcht S, Hofheinz RD, Höfler H, Höhler T, Hölscher AH, Horneber M, Hübner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Körber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Mönig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Röcken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schütte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline "Diagnosis and treatment of esophagogastric cancer"]. Z Gastroenterol 2011; 49:461-531. [PMID: 21476183 DOI: 10.1055/s-0031-1273201] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- M Moehler
- Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101 Mainz.
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Eickhoff A, Vetter S, von Renteln D, Caca K, Kähler G, Eickhoff JC, Jakobs R, Riemann JF. Effectivity of current sterility methods for transgastric NOTES procedures: results of a randomized porcine study. Endoscopy 2010; 42:748-52. [PMID: 20669093 DOI: 10.1055/s-0030-1255597] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Natural-orifice transluminal endoscopic surgery (NOTES) is an emerging transluminal technique in which interventions are carried out by entering the abdominal cavity via a natural orifice such as the stomach. Infection is a potential risk of the procedure, and the potential pathogens are different from those encountered with skin incisions. Currently, available data regarding prophylactic anti-infective treatment are limited. We compared the effectiveness of topical antimicrobial lavage of mouth and stomach and proton pump inhibitor therapy with gastric cleansing with sterile saline solution in preventing NOTES-related contamination and infection. METHODS A randomized survival swine study was performed. Eight pigs underwent preparation with intravenously administered proton pump inhibitors, mouth and gastric lavage (chlorhexidine), and gastric irrigation (diluted neomycin), plus single-shot intravenous antibiotics. Control group (n = 8) underwent gastric cleansing with sterile saline solution. Peritoneal biopsy, multiple smears, and dilutions for cultures were taken and incubated. The swine were sacrificed after 14 days. Bacterial load was expressed in colony-forming units (CFU). RESULTS One pig died due to gallbladder perforation after 3 days, 2/15 swine presented minor clinical signs of infection in the 14-day follow-up (all 3 pigs were in the control group). Mean C-reactive protein levels were 5.7 +/- 2.4 g/dL (therapy group) and 12.2 +/- 3.8 g/dL (control) ( P = 0.17). Bacterial growth was seen in 1/8 swine (therapy group) and 6/8 swine (control group) ( P = 0.002). Bacterial load was 282 CFU/mL (therapy) vs. 3.2 x 10 (5) CFU/mL (control) ( P = 0.023) in the follow-up. CONCLUSION The use of intravenous antibiotics in addition to topical antimicrobial lavage of mouth and stomach and treatment with proton pump inhibitors decreased the peritoneal bacterial load to almost zero and this was associated with a significantly lower peritoneal infection rate compared with saline-only lavage.
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Affiliation(s)
- A Eickhoff
- Medical Department C, Klinikum Ludwigshafen gGmbH, Ludwigshafen, Germany.
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Abstract
BACKGROUND AND STUDY AIM Endoscopic mucosal resection (EMR) is a minimally invasive method for en bloc removal of superficial gastrointestinal lesions. The aim of this study was to evaluate the feasibility of a novel grasp-and-snare EMR technique. METHODS In 10 domestic pigs, gastric lesions of approximately 3 cm were marked using electrocautery. EMR was performed using a double-channel endoscope. A novel tissue anchor was used through one channel, and a monofilament snare through the other. After submucosal injection, a circumferential mucosal incision was created. The tissue-anchoring device was then advanced through the open snare and anchored into the submucosal layer. The tissue-anchoring device was partly retracted into the endoscope and the snare was positioned into the circular incision. The snare was subsequently closed and the specimen resected by applying high-frequency electrocautery. RESULTS Mean time to perform EMR was 32.4 minutes (range 22-41 minutes, SD 6.3). EMR yielded specimens that ranged in area from 2.7 cm (minor axis) by 2.8 cm (major axis) to 4.0 cm by 4.2 cm (mean area 9.36 cm(2); range 5.94-13.19 cm(2); SD +/- 2.50). Complete en bloc resection including all electrocautery markings was achieved in 9/10 cases. In one case, resection was achieved in two steps. One gastric wall perforation occurred. No other adverse events were observed. CONCLUSIONS Grasp-and-snare EMR is feasible in an animal model. The technique can be performed efficiently compared with standard methods. To avoid perforation, caution is needed to ensure that tissue anchor needles are placed within and not deeper than the submucosal layer prior to tissue retraction.
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Affiliation(s)
- D von Renteln
- Department of Gastroenterology, Hepatology, and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
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Schmidt A, Caca K. [Therapy of upper gastrointestinal hemorrhage]. Dtsch Med Wochenschr 2010; 135:399-408; quiz 409-12. [PMID: 20180166 DOI: 10.1055/s-0030-1249177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Schmidt
- Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Diabetologie und Infektiologie, Klinikum Ludwigsburg
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von Renteln D, Schmidt A, Vassiliou MC, Rudolph HU, Gieselmann M, Caca K. Endoscopic closure of large colonic perforations using an over-the-scope clip: a randomized controlled porcine study. Endoscopy 2009; 41:481-6. [PMID: 19533550 DOI: 10.1055/s-0029-1214759] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Perforation of the colon is considered to be one of the most serious complications of flexible endoscopy. The over-the-scope clip system (OTSC) has previously been shown to close small colonic perforations effectively. The aim of this randomized controlled porcine study was to compare acute closure strengths between the novel 11-mm over-the-scope-clip and surgical closure for large colonic perforations. MATERIAL AND METHODS In 24 anesthetized domestic pigs, an 18-mm sigmoid perforation was created endoscopically using a needle knife and dilating balloon. The animals were randomly assigned to undergo either open surgical repair (n = 12) or endoscopic closure using the OTSC system (n = 12). Pressurized leak tests were performed during necropsy. RESULTS Mean time to perform the incision in the sigmoid colon and obtain peritoneal access was 5.5 minutes (range 3-12; SD +/- 2.5). Mean time for endoscopic closure was 6.8 minutes (range 3-14; SD +/- 3). At necropsy, all OTSC and surgical closures demonstrated complete sealing of colotomy sites. In one case peritoneum and in a second case adjacent small intestine were found incorporated into the OTSC closure. No other complications occurred. Pressurized leak tests revealed a mean burst pressure of 62.8 mmHg (range 18-112; SD 35.7) for OTSC closures and 67.4 mmHg (range 30-90; SD 19) for sutured closure. No significant differences in burst pressures were noted between the OTSC closures and surgical repair. CONCLUSION Closure of acute perforations using the OTSC system is comparable to surgical closure in a nonsurvival porcine model.
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Affiliation(s)
- D von Renteln
- Department of Gastroenterology, Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany
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von Renteln D, Schiefke I, Fuchs KH, Raczynski S, Philipper M, Breithaupt W, Caca K, Neuhaus H. Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease using multiple Plicator implants: 12-month multicenter study results. Surg Endosc 2009; 23:1866-75. [PMID: 19440792 DOI: 10.1007/s00464-009-0490-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 02/23/2009] [Accepted: 03/25/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND The full-thickness Plicator (Ethicon Endosurgery, Sommerville, NJ, USA) was developed for endoscopic treatment of gastroesophageal reflux disease (GERD). The goal is to restructure the antireflux barrier by delivering transmural pledgeted sutures through the gastric cardia. To date, studies using this device have involved the placement of a single suture to create the plication. The purpose of this study was to evaluate the 12-month safety and efficacy of this procedure using multiple implants to restructure the gastroesophageal (GE) junction. METHODS A multicenter, prospective, open-label trial was conducted at four tertiary centers. Eligibility criteria included symptomatic GERD [GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire, off of medication], and pathologic reflux (abnormal 24-h pH) requiring daily proton pump inhibitor therapy. Patients with Barrett's epithelium, esophageal dysmotility, hiatal hernia > 3 cm, and esophagitis (grade III or greater) were excluded. All patients underwent endoscopic full-thickness plication with linear placement of at least two transmural pledgeted sutures in the anterior gastric cardia. RESULTS Forty-one patients were treated. Twelve months post treatment, 74% of patients demonstrated improvement in GERD-HRQL scores by > or = 50%, with mean decrease of 17.6 points compared with baseline (7.8 vs. 25.4, p < 0.001). Using an intention-to-treat model, 63% of patients had symptomatic improvements of > or = 50%, with mean GERD-HRQL decrease of 15.0 (11.0 vs. 26.0, p < 0.001). The need for daily proton pump inhibitor (PPI) therapy was eliminated in 69% of patients at 12 months on a per-protocol basis, and 59% on an intention-to-treat basis. Adverse events included postprocedure abdominal pain (44%), shoulder pain (24%), and chest pain (17%). No long-term adverse events occurred. CONCLUSIONS Endoscopic full-thickness plication using multiple Plicator implants can be used safely and effectively to improve GERD symptoms and reduce medication use.
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Affiliation(s)
- D von Renteln
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Teaching Hospital of the Heidelberg University, Ludwigsburg, Germany.
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Ebert MP, Auernhammer C, Caca K, Eckel F, Fischbach W, Geissler M, Göke B, Greten T, Kubicka S, Lutz MP, Möhler M, Opitz O, Pavel M, Porschen R, Reinacher-Schick A, Schmiegel W, Seufferlein T, Wiedenmann B, Schmid RM. [Gastrointestinal oncology - therapy update 2008 / 2009]. Z Gastroenterol 2009; 47:296-306. [PMID: 19267319 DOI: 10.1055/s-2008-1027989] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As a consequence of recent studies the treatment of gastrointestinal cancers has become challenging and is undergoing constant changes on the basis of the results of new trials. The steering committee of the working group on gastrointestinal cancers of the Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten has decided to summarise and present recent updates of the current treatment guidelines and recommendations for the most relevant gastrointestinal malignancies. In this review we have included recent findings from large trials on esophageal, gastric, pancreatic, cholangiocellular and liver cancers, as well as colorectal cancers, neuroendocrine tumours and lymphomas. This includes an update on the combination with novel targeted agents and the introduction of potential predictive biomarkers in the selection of the appropriate treatment strategy.
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Affiliation(s)
- M P Ebert
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, 81675 München.
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von Renteln D, Eickhoff A, Kaehler G, Riecken B, Caca K. Endoscopic closure of the natural orifice transluminal endoscopic surgery (NOTES) access site to the peritoneal cavity by means of transmural resorbable sutures: an animal survival study. Endoscopy 2009; 41:154-9. [PMID: 19214896 DOI: 10.1055/s-0028-1119465] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic closure of the transgastric access site is still a critical area of active research and development into natural orifice transluminal surgery (NOTES). To date, no endoscopic technique has utilized resorbable transmural sutures for closure of the NOTES gastrostomy. MATERIAL AND METHODS Endoscopic gastrostomy closure by means of resorbable sutures was performed in ten female domestic pigs in an animal survival study. Peritoneal cavity access was gained through the anterior gastric wall using the percutaneous endoscopic gastrostomy (PEG) technique and an 18-mm balloon dilator. NOTES exploration of the gallbladder and tubal ligation were performed prior to endoscopic gastrostomy closure. Necropsy was performed 3 weeks post procedure. RESULTS Mean suturing time was 26 minutes (range 14 - 35 minutes). In total 90 % (9/10) of gastrostomy closures were performed by means of two transmural resorbable sutures. One gastrostomy was closed using a single resorbable suture. One case of gallbladder perforation occurred during peritoneoscopy and the pig was sacrificed due to subsequent peritonitis 2 days after the procedure. All other pigs (9/10) were found to be healthy 3 weeks after the NOTES procedure and were sacrificed as planned per protocol. Of all the 17 sutures that were applied in the remaining nine pigs, 16 (94 %) had been absorbed, releasing the pledgets intraluminally. During laparotomy no signs of injury to adjacent organs were found in any of these nine animals. In 8/10 pigs (80 %) the gastrostomy site did not burst with pressures exceeding 100 mmHg. Two suturing sites did burst at pressures of 57 and 62 mmHg, respectively. CONCLUSIONS Endoscopic transmural suturing enables rapid and easy placement of leak-proof resorbable sutures and is suitable for closure of the NOTES transgastric access.
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Affiliation(s)
- D von Renteln
- Department of Gastroenterology, Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany.
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von Renteln D, Kaehler G, Eickhoff A, Riecken B, Caca K. Gastric full-thickness suturing following NOTES procedures for closure of the access site to the peritoneal cavity. Endoscopy 2008; 40 Suppl 2:E99-100. [PMID: 19085715 DOI: 10.1055/s-2007-995574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D von Renteln
- Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Affiliation(s)
- D von Renteln
- Department of Gastroenterology, Hepatology, and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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von Renteln D, Riecken B, Muehleisen H, Caca K. Transjugular intrahepatic portosystemic shunt and endoscopic submucosal dissection for treatment of early gastric cancer in a cirrhotic patient. Endoscopy 2008; 40 Suppl 2:E32-3. [PMID: 18283618 DOI: 10.1055/s-2007-966800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D von Renteln
- Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany
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von Renteln D, Riecken B, Walz B, Muehleisen H, Caca K. Endoscopic GIST resection using FlushKnife ESD and subsequent perforation closure by means of endoscopic full-thickness suturing. Endoscopy 2008; 40 Suppl 2:E224-5. [PMID: 18819068 DOI: 10.1055/s-2008-1077458] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D von Renteln
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
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Wiedmann M, Zeh J, Schoppmeyer K, Moebius C, Niederhagen M, Wittekind C, Mossner J, Caca K. Bendamustine--a new approach to the treatment of advanced hepatocellular carcinoma? J Chemother 2008; 20:112-8. [PMID: 18343753 DOI: 10.1179/joc.2008.20.1.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIMS Therapeutic options for advanced hepatocellular carcinoma (HCC) are limited. Bendamustine, a bifunctional cytostatic agent with mainly alkylating effect may be an alternative. METHODS Five HCC cell lines were incubated in vitro with five different concentrations of bendamustine. In addition, cell lines Huh-7 and HepG2 were tested in a chimeric mouse model. RESULTS In vitro treatment with bendamustine resulted in an IC( 50 )<6 microg/mL in two, <12 microg/mL in one, and 12-23 microg/mL in two cell lines. In vivo, bendamustine reduced significantly tumor volume in chimeric mice. CONCLUSION Bendamustine demonstrated significant tumor growth inhibition both in vitro and in vivo at concentrations that can be reached in the plasma. The potential role of bendamustine therapy for HCC and its tolerability in impaired liver function is currently subject of a phase II study.
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Affiliation(s)
- M Wiedmann
- Department of Internal Medicine II, University of Leipzig, Germany.
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Schmidt A, Schwella N, Helmchen U, von Renteln D, Caca K. 42-jähriger Patient mit bilateralem Visusverlust und hypertensiver Entgleisung. Internist (Berl) 2008; 49:989-90, 992-4. [PMID: 18427761 DOI: 10.1007/s00108-008-2123-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Schmidt
- Medizinische Klinik I, Klinikum Ludwigsburg, Posilipo Strasse 1-4, 71640, Ludwigsburg, Germany.
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von Renteln D, Brey U, Riecken B, Caca K. Endoscopic full-thickness plication (Plicator) with two serially placed implants improves esophagitis and reduces PPI use and esophageal acid exposure. Endoscopy 2008; 40:173-8. [PMID: 18322871 DOI: 10.1055/s-2007-995515] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Recently, several endoluminal procedures for the treatment of gastroesophageal reflux disease (GERD) have been introduced. Most of these techniques have been abandoned because they lack long-term efficacy or have serious side effects. In a recently published prospective randomized, sham-controlled trial, the Plicator was shown to be effective at controlling reflux symptoms and esophageal acid exposure. In all previous studies, only a single implant was used. The aim of the present pilot study was to determine the safety and efficacy of two serially placed Plicator implants. PATIENTS AND METHODS Thirty-seven patients requiring maintenance therapy with proton pump inhibitors (PPIs) were enrolled in this single-center pilot study. All patients received two Plicator implants. Exclusion criteria were hiatus hernia larger than 3 cm, grade IV esophagitis, Barrett's esophagus, and esophageal motility disorders. The primary study end point was at least 50 % improvement in the GERD Health-Related Quality of Life (HRQL) score. Secondary end points included GERD medication use, esophageal acid exposure, esophagitis grade, and heartburn/regurgitation scores. RESULTS Thirty-seven patients underwent endoscopic full-thickness plication using two serially placed Plicator implants. At 6 months after treatment, the proportion of patients achieving at least 50 % improvement in GERD-HRQL score was 68 %. Complete cessation of PPI treatment was achieved in 59 % of patients. In pH studies conducted at 6 months (n = 29), median percentage of time for which pH was below 4 decreased by 36 %, with 28 % of patients experiencing pH normalization. There were no serious adverse events requiring intervention. CONCLUSIONS Endoscopic full-thickness plication using two serially placed Plicator implants was both safe and effective in reducing esophagitis, GERD symptoms, medication use, and esophageal acid exposure.
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Affiliation(s)
- D von Renteln
- Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Wiedmann M, Haefner M, Niederhagen M, Schoppmeyer K, Wittekind C, Moebius C, Mossner J, Caca K. Treatment of pancreatic cancer with two novel histone deacetylase inhibitors NVP-LAQ824 and NVP-LBH589. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4624 Background: Pancreatic cancer is the fifth to sixth leading cause of cancer death in Europe and up to 90% of patients will present with locally advanced or metastatic disease. Unfortunately, little progress has been obtained from chemotherapy regimens in the past decade. Treatment with histone deacetylase inhibitors, like NVP-LAQ824 and NVP-LBH589, either alone or in combination with conventional chemotherapy may be a novel alternative. Methods: Cell-growth inhibition by NVP-LAQ824 and NVP-LBH589 was studied in vitro in 8 human pancreatic cancer cell lines by MTT assay. In addition, the anti-tumoral effect of NVP-LBH589 was studied in a chimeric mouse model. Anti-tumoral drug mechanism was assessed by immunoblotting for p21WAF-1, acH4, p42/p44, Phospho-p42/p44, AKT, Phospho- AKT, cell cycle analysis, TUNEL assay, and immunohistochemistry for MIB-1. Results: In vitro treatment with both compounds significantly suppressed the growth of all cancer cell lines (mean IC50 (6d) 0.06 and 0.03 μM, respectively) and was associated with hyperacetylation of nucleosomal histones H4, increased expression of p21WAF-1, and cell cycle arrest at G2/M-checkpoint. After 21 d, NVP-LBH589 alone reduced tumor mass in vivo by 70% and in combination with gemcitabine by 81% in comparison to placebo for cell line L3.6 pl. Further analysis of the tumor specimens revealed slightly increased apoptosis (TUNEL) and no significant reduction of cell proliferation (MIB-1). Protein levels of p42/p44, and AKT remained stable, whereas levels of Phospho-p42/p44 and Phospho-AKT increased. Conclusions: Our findings suggest that NVP-LBH589 > NVP-LAQ824 are active against human pancreatic cancer in vitro. In addition, NVP-LBH589 demonstrated significant in vivo activity and potentiated the efficacy of gemcitabine, although the precise mechanism of drug action is not yet completely understood. Therefore, further preclinical and clinical evaluation of this new drug for the treatment of pancreatic cancer is recommended. No significant financial relationships to disclose.
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Affiliation(s)
- M. Wiedmann
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - M. Haefner
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - M. Niederhagen
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K. Schoppmeyer
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - C. Wittekind
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - C. Moebius
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - J. Mossner
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K. Caca
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
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Renteln DV, Caca K. Endoskopische transmurale Gastroplicatio in der Refluxtherapie: Eine wirksame Therapie? Endosk heute 2007. [DOI: 10.1055/s-2007-981173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Placement of self-expanding metal stents (SEMS) for palliation of malignant stenoses at the gastroesophageal junction is often associated with stent migration and reflux symptoms. SEMS with an antireflux mechanism have been developed to overcome the latter problem. The aim of this study was to evaluate the safety and efficacy of antireflux Z-stents. Patients with advanced squamous cell or adenocarcinoma of the distal esophagus or cardia suffering from dysphagia received an antireflux Z-stent. Technical success, complications of the procedure, clinical symptoms before and after stent placement, reinterventions and survival were recorded. Follow-up was accomplished by patient interviews and a standardized questionnaire for primary care physicians. Eighteen consecutive patients received an antireflux Z-stent. Seventeen of 18 stents were placed technically successful in a single endoscopic procedure. Mean dysphagia score improved from 2.2 to 0.6. Four patients (22%) had permanent reflux symptoms, an additional nine (50%) were taking proton pump inhibitors on a regular basis. In 10 patients, a re-intervention was necessary mainly due to dislocation of the stent. To ensure adequate nutrition three and two patients received a percutaneous gastrostomy and a jejunostomy, respectively. Median survival from stent insertion was 54 days (range, 3-201). Although placement of an antireflux Z-stent is technically feasible, its application is hampered by frequent stent migration and insufficient prevention of gastroesophageal reflux. Further technical improvements of stents or alternative methods like brachytherapy are required for satisfactory palliation of malignant gastroesophageal stenosis.
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Affiliation(s)
- K Schoppmeyer
- Department of Internal Medicine II, University of Leipzig, Leipzig, Germany
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von Renteln D, Riecken B, Ulmer M, Caca K. Biliary stenting and successful intentional stent retrieval after 6 months in a benign stricture following hepaticojejunostomy. Endoscopy 2007; 39 Suppl 1:E335-6. [PMID: 18273784 DOI: 10.1055/s-2007-966833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D von Renteln
- Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Renteln DV, Caca K. Endoskopische Antirefluxtherapien - was bleibt? - Transmurale Doppelnaht scheint am effektivsten. Klinikarzt 2007. [DOI: 10.1055/s-2007-970169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Caca K. [GERD: endoscopic antireflux therapies]. Praxis (Bern 1994) 2006; 95:1185-7. [PMID: 16909687 DOI: 10.1024/0369-8394.95.31.1185] [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] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A couple of minimally-invasive, endoscopic antireflux procedures have been developed during the last years. Beside endoscopic suturing these included injection/implantation technique of biopolymers and application of radiofrequency. Radiofrequency (Stretta) has proved only a very modest effect, while implantation techniques have been abandoned due to lack of long-term efficacy (Gatekeeper) or serious side effects (Enteryx). While first generation endoluminal suturing techniques (EndoCinch, ESD) demonstrated a proof of principle their lack of durability, due to suture loss, led to the development of a potentially durable transmural plication technique (Plicator). In a prospective-randomized, sham-controlled trial the Plicator procedure proved superiority concerning reflux symptoms, medication use and esophageal acid exposure (24-h-pH-metry). While long-term data have to be awaited to draw final conclusions, technical improvements will drive innovation in this field.
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Affiliation(s)
- K Caca
- Medizinische Klinik I, Klinikum Ludwigsburg.
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Feisthammel J, Schoppmeyer K, Wiedmann M, Mossner J, Schulze M, Caca K. Irinotecan with 5-FU/FA in advanced biliary tract adenocarcinomas—A two-center phase II trial (GBFiri). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14088 Background: The majority of patients with biliary tract cancer present with advanced, unresectable tumors. Irinotecan and 5-Fluorouracil/folinic acid (FOLFIRI) have synergistic activity in gastrointestinal cancers. The aim of this study was to determine the tolerability and activity of systemic chemotherapy with FOLFIRI in patients with intrahepatic cholangiocarcinoma (CCC) or gallbladder cancer (GBC). Methods: This was a prospective, multicenter, non-randomised, open-label, phase II trial. Eligibility criteria: Inoperable adenocarcinoma of the biliary tract, measurable disease, age 18–80 years, ECOG PS 0–2. Patients received irinotecan 80 mg/m2 as a 30 min infusion, followed by folinic acid 500 mg/m2 over 2 h and 5-FU 2000 mg/m2 over 24h weekly × 6 followed by a 2 week rest. Treatment was continued until progression or limiting toxicity. Response to therapy was assessed after every other cycle according to RECIST criteria. Primary end point was response rate, secondary end points were overall survival, progression free survival and toxicity. Results: 30 pts (CCC 17, GBC 13) were enrolled. A total of 387 doses (Median 12.9; 1 to 36) were administered with an overall relative dose intensity of 98%. 30 patients are evaluable for safety. WHO grade 3/4 drug related adverse events occured in 7 patients (23%): Leukopenias in 2, anemia in 1, and diarrhea in 4 patients. 14 patients completed 2 cycles and were evaluable for response. Response rates: CR 0/30, PR 3/30 (10%) and SD 3/30 (10%). 8 patients presented with disease progression at restaging. Median overall survival: CCC 166 days, GBC 327 days. Progression-free-survival: CCC 84 days, GBC 159 days. Conclusions: FOLFIRI is a well tolerated regimen in patients with biliary cancer that can be safely administered on an outpatient basis. FOLFIRI has no substantial activity in CCC and moderate activity in GBC. Further studies are required to define a standard palliative chemotherapy for treatment of biliary cancer. No significant financial relationships to disclose.
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Affiliation(s)
- J. Feisthammel
- University of Leipzig, Leipzig, Germany; Klinikum Zittau, Zittau, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K. Schoppmeyer
- University of Leipzig, Leipzig, Germany; Klinikum Zittau, Zittau, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - M. Wiedmann
- University of Leipzig, Leipzig, Germany; Klinikum Zittau, Zittau, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - J. Mossner
- University of Leipzig, Leipzig, Germany; Klinikum Zittau, Zittau, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - M. Schulze
- University of Leipzig, Leipzig, Germany; Klinikum Zittau, Zittau, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K. Caca
- University of Leipzig, Leipzig, Germany; Klinikum Zittau, Zittau, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
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Schoppmeyer K, Wiedmann MW, Liebmann A, Miethe S, Mossner J, Caca K, Witzigmann H, Hildebrandt G. Radiochemotherapy followed by gemcitabine and capecitabine in extrahepatic bile duct cancer (EBDC): A phase I/II-trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14087 Background: The 5-year survival rate of patients with resected EBDC is less than 30%. Phase II trials demonstrated that advanced EBDC responds to both chemotherapy with gemcitabine and capecitabine and to radiotherapy. Our objective was to define a feasible and effective postoperative therapy in patients with EBDC. Methods: Patients were eligible after surgery for EBDC. Surgery included resection of lymph node positive cancer, incomplete resections and diagnostic laparotomy in unresectable tumors. Patients received a fractionated radiotherapy with 49.6 Gy accompanied by gemcitabine 100 mg/m2 weekly × 5. After a two week rest patients were treated with gemcitabine (1000 mg/m2 IV D1+8 q3w) and capecitabine (1500 mg/m2 PO D1–14 q3w) on a 3-week cycle. Treatment continued for 6 cycles in nonmeasurable disease or until disease progression or intolerable toxicity. Primary endpoint was toxicity; secondary endpoints were response rate in measurable disease and overall survival. Results: 18 Patients (resectable/unresectable disease 7/11) were enrolled. Radiotherapy was completed in all patients and a total of 66 cycles of chemotherapy were applied. Anemia, fatigue, and nausea were the most common mild adverse events in 16, 14, and 16 patients, respectively. Grade 3 and 4 toxicity was rare after resection but frequent in unresectable disease and consisted of fatigue, nausea, duodenal ulcer, cachexia and cholangitis in 1, 2, 2, 4, and 4 patients, respectively. We observed a 50% disease stabilization rate in patients with measurable disease. Median overall survival was 7.9 months in patients with unresectable tumors. Median overall survival in patients after resection has not been reached after a median follow-up of 19.5 months. Conclusions: Radiochemotherapy with gemcitabine followed by gemcitabine and capecitabine is an active regimen with manageable toxicity after resection of EBDC but has significant toxicity in unresectable disease. No significant financial relationships to disclose.
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Affiliation(s)
- K. Schoppmeyer
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - M. W. Wiedmann
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - A. Liebmann
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - S. Miethe
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - J. Mossner
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K. Caca
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - H. Witzigmann
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - G. Hildebrandt
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
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47
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Wiedmann M, Bluethner T, Niederhagen M, Schoppmeyer K, Moessner J, Caca K. Two novel histone deacetylase inhibitors NVP-LAQ824 and NVP-LBH589 are active against biliary tract cancer and potentiate the efficacy of gemcitabine. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4149 Background: Chromatin remodelling agents such as histone deacetylase inhibitors have been shown to modulate gene expression in tumor cells and inhibit tumor growth and angiogenesis. NVP-LAQ824 and NVP-LBH589 are two novel chemical entities belonging to a cinnamic hydroxamic acid class of compounds. Little is known about their efficacy for the treatment of biliary tract cancer. Methods: Cell-growth inhibition by NVP-LAQ824 and NVP-LBH589 was studied in vitro in 7 human biliary tract cancer cell lines by MTT assay. In addition, the anti-tumoral effect of NVP-LBH589 was studied in a chimeric mouse model. Anti-tumoral drug mechanism was assessed by immunoblotting for p21WAF-1, acH3Lys9 and acH4, cell cycle analysis, PARP assay, TUNEL assay, and immunhistochemistry for MIB-1. Results: In vitro treatment with both compounds significantly suppressed the growth of all cancer cell lines (mean IC50 (3d) 0.08 and 0.04 μM, respectively) and was associated with hyperacetylation of nucleosomal histones H3 and H4, increased expression of p21WAF-1, cell cycle arrest at G2/M-checkpoint, and induction of apoptosis (PARP cleavage). After 28 d, NVP-LBH589 reduced tumor mass by 66% (bile duct cancer) and 87% (gallbladder cancer) in vivo in comparison to placebo and potentiated the efficacy of gemcitabine. Further analysis of the tumor specimens revealed increased apoptosis (TUNEL) and reduced cell proliferation (MIB-1). Conclusions: Our findings suggest that NVP-LBH589 > NVP-LAQ824 are active against human biliary tract cancer in vitro. In addition, NVP-LBH589 demonstrated significant in vivo activity and potentiated the efficacy of gemcitabine. Therefore, further clinical evaluation of this new drug for the treatment of biliary tract cancer is recommended. No significant financial relationships to disclose.
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Affiliation(s)
- M. Wiedmann
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - T. Bluethner
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - M. Niederhagen
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K. Schoppmeyer
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - J. Moessner
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - K. Caca
- University of Leipzig, Leipzig, Germany; Klinikum Ludwigsburg, Ludwigsburg, Germany
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Schoppmeyer K, Lange T, Wittekind C, Niederwieser D, Caca K. TIPS for Venoocclusive Disease Following Stem Cell Transplantation. Z Gastroenterol 2006; 44:483-6. [PMID: 16773513 DOI: 10.1055/s-2005-858957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hepatic veno-occlusive disease (VOD) is a complication of allogeneic blood stem cell transplantation (SCT). Duplex ultrasound has been proposed to predict the outcome of VOD. We report here the case of a 39-year-old female patient with VOD following allogeneic SCT for AML. Repeated Doppler ultrasound examinations did not indicate a high-risk profile. However, the patient's condition deteriorated and was refractory to medical therapy. Transjugular intrahepatic portosystemic shunting (TIPS) was performed 19 days after transplantation and VOD resolved subsequently. VOD often has an unpredictable course. Transjugular intrahepatic portosystemic shunts may prove beneficial for patients with refractory disease.
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Affiliation(s)
- K Schoppmeyer
- Abteilung für Gastroenterologie und Hepatologie, Medizinische Klinik und Poliklinik II, Universität Leipzig, Germany
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49
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Feisthammel J, Troltzsch M, Witzigmann H, Mossner J, Caca K. An unusual cause and treatment for ascites after liver transplantation. Gut 2006; 55:763, 884. [PMID: 16698752 PMCID: PMC1856248 DOI: 10.1136/gut.2005.080382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- J Feisthammel
- Department of Medicine II, University of Leipzig, Leipzig, Germany
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50
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Wiedmann M, Schoppmeyer K, Witzigmann H, Hauss J, Mössner J, Caca K. [Current diagnostics and therapy for carcinomas of the biliary tree and gallbladder]. Z Gastroenterol 2005; 43:473-5. [PMID: 15871071 DOI: 10.1055/s-2005-858186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- M Wiedmann
- Medizinische Klinik II, Universität Leipzig
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