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Graham JS, Boyd K, Coxon FY, Wall LR, Eatock MM, Maughan TS, Highley M, Soulis E, Harden S, Bützberger-Zimmerli P, Evans TRJ. A phase II study of capecitabine and oxaliplatin combination chemotherapy in patients with inoperable adenocarcinoma of the gall bladder or biliary tract. BMC Res Notes 2016; 9:161. [PMID: 26969121 PMCID: PMC4788848 DOI: 10.1186/s13104-015-1778-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 11/30/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Advanced biliary tract carcinomas are associated with a poor prognosis, and palliative chemotherapy has only modest benefit. This multi-centre phase II study was conducted to determine the efficacy of capecitabine in combination with oxaliplatin in patients with inoperable gall bladder or biliary tract cancer. METHODS This was a Phase II, non-randomised, two-stage Simon design, multi-centre study. Ethics approval was sought and obtained by the North West MREC, and then locally by the West Glasgow Hospitals Research Ethics Committee. Eligible patients with inoperable locally advanced or metastatic adenocarcinoma of the gall bladder or biliary tract and with adequate performance status, haematologic, renal, and hepatic function were treated with capecitabine (1000 mg/m(2) po, twice daily, days 1-14) and oxaliplatin (130 mg/m(2) i.v., day 1) every 3 weeks for up to six cycles. The primary objective of the study was to determine the objective tumour response rates (complete and partial). The secondary objectives included assessment of toxicity, progression-free survival, and overall survival. RESULTS Forty-three patients were recruited between July 2003 and December 2005. The regimen was well tolerated with no grade 3/4 neutropenia or thrombocytopenia. Grade 3/4 sensory neuropathy was observed in six patients. Two-thirds of patients received their chemotherapy without any dose delays. Overall response rate was 23.8% (95% CI 12.05-39.5%). Stable disease was observed in a further 13 patients (31%) and progressive disease observed in 12 (28.6%) of patients. The median progression-free survival was 4.6 months (95% CI 2.8-6.4 months; Fig. 1) and the median overall survival 7.9 months (95% CI 5.3-10.4 months; Fig. 2). Fig. 1 Progression-free survival Fig. 2 Overall survival CONCLUSION Capecitabine combined with oxaliplatin has a lower disease control and shorter overall survival than the combination of cisplatin with gemcitabine which has subsequently become the standard of care in this disease. However, capecitabine in combination with oxaliplatin does have modest activity in this disease, and can be considered as an alternative treatment option for patients in whom cisplatin and/or gemcitabine are contra-indicated.
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Affiliation(s)
- J. S. Graham
- />Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN UK
| | - K. Boyd
- />Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN UK
| | - F. Y. Coxon
- />Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, NE7 7DN UK
| | - L. R. Wall
- />Edinburgh Cancer Centre, Western General Hospital, Edinburgh, EH4 2XU UK
| | - M. M. Eatock
- />Belfast Cancer Centre, Belfast City Hospital, Belfast, BT9 7AB UK
| | - T. S. Maughan
- />Velindre Hospital, Whitchurch, Cardiff, CF14 2TL UK
| | - M. Highley
- />Ninewells Hospital, Dundee, DD1 9SY UK
| | - E. Soulis
- />Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN UK
| | - S. Harden
- />Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN UK
| | | | - T. R. J. Evans
- />Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 OYN UK
- />Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1BD UK
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Eatock MM, Tebbutt NC, Bampton CL, Strickland AH, Valladares-Ayerbes M, Swieboda-Sadlej A, Van Cutsem E, Nanayakkara N, Sun YN, Zhong ZD, Bass MB, Adewoye AH, Bodoky G. Phase II randomized, double-blind, placebo-controlled study of AMG 386 (trebananib) in combination with cisplatin and capecitabine in patients with metastatic gastro-oesophageal cancer. Ann Oncol 2012; 24:710-8. [PMID: 23108953 DOI: 10.1093/annonc/mds502] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We evaluated AMG 386, an investigational peptibody that neutralizes the interaction between angiopoietins-1 and -2 and the Tie2 receptor, combined with cisplatin/capecitabine (CX) as first-line treatment for metastatic gastro-oesophageal cancer. PATIENTS AND METHODS Patients with metastatic gastric, gastro-oesophageal junction, or distal oesophageal adenocarcinoma were randomized 1:1:1 to CX (cisplatin 80 mg/m(2) IV Q3W; capecitabine 1000 mg/m(2) P.O. BID for 14 days Q3W) plus intravenous AMG 386 10 mg/kg QW (Arm A) or 3 mg/kg QW (Arm B), or placebo QW (Arm C). The primary end point was estimated progression-free survival (PFS). RESULTS A total of 171 patients were enrolled. Median estimated PFS in Arms A, B, and C was 4.2, 4.9, and 5.2 months, respectively (hazard ratio for Arms A+B combined versus Arm C, 0.98; 95% CI 0.67-1.43; P = 0.92). Objective response rates were 27% (Arm A), 43% (Arm B), and 35% (Arm C). Incidence of grade ≥3 adverse events was 80% in Arm A, 84% in Arm B, and 75% in Arm C. There was no evidence of pharmacokinetic interactions. CONCLUSIONS In this study, PFS and ORR were estimated to be similar with AMG 386 plus CX and placebo plus CX treatment. Compared with placebo, toxicity of AMG 386 plus CX was greater but manageable. PREVIOUS PRESENTATION The results of this study have not been previously published or submitted for publication elsewhere. The results were presented in part at the Gastrointestinal Cancers Symposium, San Francisco, CA, January 20-22, 2011. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT00583674.
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Affiliation(s)
- M M Eatock
- Department of Oncology, Belfast City Hospital, Belfast BT9 7AB, Northern Ireland.
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Eatock MM, Szanto J, Tebbutt NC, Bampton CL, Strickland AH, Valladares Ayerbes M, Nanayakkara N, Sun Y, Adewoye AH, Bodoky G. Randomized, double-blind, placebo-controlled phase II study of AMG 386 in combination with cisplatin and capecitabine (CX) in patients (pts) with metastatic gastroesophageal adenocarcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.66] [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
66 Background: AMG 386, a first-in-class investigational peptide-Fc fusion protein (peptibody), blocks angiogenesis via inhibiting the interaction between angiopoietins-1 and -2 and the Tie2 receptor. We evaluated the efficacy and tolerability of AMG 386 or placebo plus CX in the first-line treatment of metastatic gastroesophageal adenocarcinoma. Methods: Pts with confirmed metastatic adenocarcinoma of the stomach, gastroesophageal junction or distal esophagus were randomized 1:1:1 to receive CX (cisplatin, 80 mg/m2 IV Q3W; capecitabine, 1,000 mg/m2 orally BID for 14 days Q3W) plus AMG 386 10 mg/kg (Arm A), 3 mg/kg (Arm B), or placebo (Arm C) IV QW. The primary endpoint was progression-free survival (PFS). Secondary endpoints included objective response rate (ORR; in pts with measurable disease), adverse events (AEs), and pharmacokinetics (PK). Results: 171 pts were randomized (Arm A/B/C, n = 56/59/56). Efficacy results are summarized in the table. The incidence of grade ≥ 3 AEs in Arms A/B/C was 80/84/75%. Serious AEs occurred in 73/60/47% and serious AEs grade ≥ 3 in 66/60/43% of pts. AEs in Arms A/B/C included abdominal pain (30/40/17%; grade ≥ 3, 18/3/4%), peripheral edema (13/29/6%; grade ≥ 3, 0/2/0%), venous thromboembolic events (20/22/19%; grade ≥ 3, 20/19/17%), and pulmonary embolism (9/3/15%; grade ≥ 3, 9/2/13%). Median AMG 386 Cmax and Cmin values at steady state after CX coadministration were dose-proportional. Coadministration with CX did not markedly affect AMG 386 exposure. Conclusions: In this study, AMG 386 plus CX did not significantly improve PFS or ORR over placebo plus CX in this patient population. The toxicity of the combination of AMG 386 plus CX, compared with placebo, was greater but manageable. No unexpected AEs occurred. [Table: see text] [Table: see text]
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Affiliation(s)
- M. M. Eatock
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - J. Szanto
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - N. C. Tebbutt
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - C. L. Bampton
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - A. H. Strickland
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - M. Valladares Ayerbes
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - N. Nanayakkara
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - Y. Sun
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - A. H. Adewoye
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
| | - G. Bodoky
- Belfast City Hospital, Belfast, PA, United Kingdom; University of Debrecen Medical and Health Science Centre, Debrecen, Hungary; Austin Health, Heidelberg, Australia; Adelaide Cancer Centre, Kurralta Park, Australia; Monash Medical Centre, East Bentleigh, Australia; Oncology Service, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain; Quintiles, San Diego, CA; Amgen Inc., Thousand Oaks, CA; Amgen, Thousand Oaks, CA; Fovarosi Onkormanyzat Egyesitett Szent Imre es Szent Laszlo Korhaz
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Manikyam Y, Hanna GG, Harte RJ, Henry PG, Houston RF, Eatock MM. Impact of socioeconomic status on treatment outcome in patients with advanced esophagogastric cancer in Northern Ireland. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20531] [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
e20531 Background: The survival advantage for combination chemotherapy in advanced gastroesophageal adenocarcinoma is well documented. Epirubicin and cisplatin in combination with either 5FU (ECF) or capecitabine (ECX) result in response rates of 35–46% and a median survival of around 9 months in RCT. We report the impact of socioeconomic status on the outcome of ECF and ECX treatment in advanced gastroesophageal cancer patients in Northern Ireland between 2000 and 2007. Methods: All patients with advanced esophageal (O), gastric (G), or esophagogastric junction (OGJ) adenocarcinoma, receiving palliative chemotherapy from January 2000 to August 2007, were identified from our institutional database. Baseline demographics, clinical characteristics, treatment details, and clinical outcomes were recorded. Patients receiving chemotherapy in a clinical trial were excluded. Survival was estimated using the Kaplan-Meier method. Deprivation was assessed using the patient's home address deprivation index (DPI) (Northern Ireland Multiple Deprivation Measure 2005; May 2005. Northern Ireland Statistics and Research Agency. www.nisra.gov.uk ). Results: 274 eligible patients (m=200, f=74, O=114, OGJ=19, G=141) were identified. Median age was 62 years (range 22–83). 172 (62.8%) had ECOG performance status 0 or 1. 231 patients (84.3%) had metastatic disease, 43 (15.7%) had locally advanced disease. 216 (78.8%) patients received ECF and 58 (21.2%) patients received ECX. Overall median survival was 7.3 months. Treatment response and performance status were strong predictors of survival, however disease extent did not influence survival. Median survival was significantly longer in those with DPIs in the upper two quintiles than the lower 3 quintiles (9.5 months vs. 6.8 months, p=0.032). Conclusions: Outcomes achieved with palliative ECF/ECX treatment are similar to the reference clinical trials. Socioeconomic deprivation is significantly associated with reduced survival in this group of patients and is unrelated to disease extent at presentation; however it may be related to nutritional status and comorbidity and requires further investigation. No significant financial relationships to disclose.
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Affiliation(s)
- Y. Manikyam
- Northern Ireland Cancer Centre, Belfast, United Kingdom; CCRCB, Queen's University of Belfast, Belfast, United Kingdom
| | - G. G. Hanna
- Northern Ireland Cancer Centre, Belfast, United Kingdom; CCRCB, Queen's University of Belfast, Belfast, United Kingdom
| | - R. J. Harte
- Northern Ireland Cancer Centre, Belfast, United Kingdom; CCRCB, Queen's University of Belfast, Belfast, United Kingdom
| | - P. G. Henry
- Northern Ireland Cancer Centre, Belfast, United Kingdom; CCRCB, Queen's University of Belfast, Belfast, United Kingdom
| | - R. F. Houston
- Northern Ireland Cancer Centre, Belfast, United Kingdom; CCRCB, Queen's University of Belfast, Belfast, United Kingdom
| | - M. M. Eatock
- Northern Ireland Cancer Centre, Belfast, United Kingdom; CCRCB, Queen's University of Belfast, Belfast, United Kingdom
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