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Locatelli F, Strålin KB, Schmid I, Sevilla J, Smith OP, van den Heuvel-Eibrink MM, Zecca M, Zwaan CM, Gaudy A, Patturajan M, Poon J, Simcock M, Niemeyer CM. Efficacy and safety of azacitidine in pediatric patients with newly diagnosed advanced myelodysplastic syndromes before hematopoietic stem cell transplantation in the AZA-JMML-001 trial. Pediatr Blood Cancer 2024; 71:e30931. [PMID: 38433307 DOI: 10.1002/pbc.30931] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/19/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
Here we report efficacy, pharmacokinetics, and safety data obtained in treatment-naive, pediatric patients with newly diagnosed advanced MDS receiving azacitidine in the AZA-JMML-001 study. The primary endpoint was response rate (proportion of patients with complete response [CR], partial response [PR], or marrow CR, sustained for ≥4 weeks). Of the 10 patients enrolled, one had an unconfirmed marrow CR and none had confirmed responses after three cycles; the study was therefore closed after stage 1. Azacitidine was well tolerated. The lack of efficacy of azacitidine in pediatric patients with newly diagnosed advanced MDS highlights the need for effective new treatments in these patients.
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Affiliation(s)
- Franco Locatelli
- IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Irene Schmid
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - Julián Sevilla
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Owen P Smith
- NCCS, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Child Health, University of Utrecht-Wilhelmina Childrens Hospital, Utrecht, The Netherlands
| | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Christian M Zwaan
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | | | | - Charlotte M Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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2
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O'Brien MM, Alonzo TA, Cooper TM, Levine JE, Brown PA, Slone T, August KJ, Benettaib B, Biserna N, Poon J, Patturajan M, Chen N, Simcock M, Zimmerman L, Kolb EA. Results of a phase 2, multicenter, single-arm, open-label study of lenalidomide in pediatric patients with relapsed or refractory acute myeloid leukemia. Pediatr Blood Cancer 2021; 68:e28946. [PMID: 33694257 DOI: 10.1002/pbc.28946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Outcomes after relapse remain poor in pediatric patients with acute myeloid leukemia (AML), and new therapeutic approaches are needed. Lenalidomide has demonstrated activity in adults with lower risk myelodysplastic syndromes and older adults with relapsed or refractory (R/R) AML. METHODS In this phase 2 study (NCT02538965), pediatric patients with R/R AML who received two or more prior therapies were treated with lenalidomide (starting dose 2 mg/kg/day on days 1-21 of each 28-day cycle) for a maximum of 12 cycles. The primary endpoint was rate of complete response (CR) and CR with incomplete blood count recovery (CRi) within the first four cycles. RESULTS Seventeen patients enrolled and received one or more dose of lenalidomide. Median age was 12 years (range 5-18 years), median white blood cell count was 3.7 × 109 /L, and median peripheral blood blast count was 1.0 × 109 /L. One patient (5.9%) with a complex karyotype including del(5q) achieved CRi after two cycles of lenalidomide. This responder proceeded to a second hematopoietic stem cell transplantation and has remained without evidence of disease for 3 years. All patients experienced one or more of grades 3-4 treatment-emergent adverse event (TEAE). The most common grades 3-4 TEAEs were thrombocytopenia (58.8%), febrile neutropenia (47.1%), anemia (41.2%), and hypokalemia (41.2%). CONCLUSIONS In this population of pediatric patients with R/R AML, safety data were consistent with the known safety profile of lenalidomide. As only one patient responded, further evaluation of lenalidomide at the dose and schedule studied is not warranted in pediatric AML, with the possible exception of patients with del(5q).
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Affiliation(s)
- Maureen M O'Brien
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Todd A Alonzo
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Todd M Cooper
- Seattle Children's Cancer and Blood Disorders Center, University of Washington, Seattle, Washington, USA
| | - John E Levine
- Bone Marrow and Stem Cell Transplantation Program, Mount Sinai School of Medicine, New York, New York, USA
| | | | - Tamra Slone
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Keith J August
- Children's Mercy Hospital Kansas City, Kansas City, Missouri, USA
| | | | - Noha Biserna
- Formerly Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | | | | | - Mathew Simcock
- Celgene Ltd., a Bristol-Myers Squibb Company, Uxbridge, UK
| | | | - E Anders Kolb
- Nemours Center for Cancer and Blood Disorders, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
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3
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Fangusaro J, Cefalo MG, Garré ML, Marshall LV, Massimino M, Benettaib B, Biserna N, Poon J, Quan J, Conlin E, Lewandowski J, Simcock M, Jeste N, Hargrave DR, Doz F, Warren KE. Phase 2 Study of Pomalidomide (CC-4047) Monotherapy for Children and Young Adults With Recurrent or Progressive Primary Brain Tumors. Front Oncol 2021; 11:660892. [PMID: 34168987 PMCID: PMC8218626 DOI: 10.3389/fonc.2021.660892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Treatment of recurrent primary pediatric brain tumors remains a major challenge, with most children succumbing to their disease. We conducted a prospective phase 2 study investigating the safety and efficacy of pomalidomide (POM) in children and young adults with recurrent and progressive primary brain tumors. Methods Patients with recurrent and progressive high-grade glioma (HGG), diffuse intrinsic pontine glioma (DIPG), ependymoma, or medulloblastoma received POM 2.6 mg/m2/day (the recommended phase 2 dose [RP2D]) on days 1-21 of a 28-day cycle. A Simon's Optimal 2-stage design was used to determine efficacy. Primary endpoints included objective response (OR) and long-term stable disease (LTSD) rates. Secondary endpoints included duration of response, progression-free survival (PFS), overall survival (OS), and safety. Results 46 patients were evaluable for response (HGG, n = 19; DIPG, ependymoma, and medulloblastoma, n = 9 each). Two patients with HGG achieved OR or LTSD (10.5% [95% CI, 1.3%-33.1%]; 1 partial response and 1 LTSD) and 1 patient with ependymoma had LTSD (11.1% [95% CI, 0.3%-48.2%]). There were no ORs or LTSD in the DIPG or medulloblastoma cohorts. The median PFS for patients with HGG, DIPG, ependymoma, and medulloblastoma was 7.86, 11.29, 8.43, and 8.43 weeks, respectively. Median OS was 5.06, 3.78, 12.02, and 11.60 months, respectively. Neutropenia was the most common grade 3/4 adverse event. Conclusions Treatment with POM monotherapy did not meet the primary measure of success in any cohort. Future studies are needed to evaluate if POM would show efficacy in tumors with specific molecular signatures or in combination with other anticancer agents. Clinical Trial Registration ClinicalTrials.gov, identifier NCT03257631; EudraCT, identifier 2016-002903-25.
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Affiliation(s)
- Jason Fangusaro
- Department of Pediatrics, Children's Healthcare of Atlanta and Aflac Cancer Center at Emory University Medical School, Atlanta, GA, United States
| | - Maria Giuseppina Cefalo
- Department of Hematology/Oncology and Stem Cell Transplantation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Lynley V Marshall
- Children and Young People's Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Noha Biserna
- Bristol Myers Squibb, Princeton, NJ, United States
| | | | - Jackie Quan
- Bristol Myers Squibb, Princeton, NJ, United States
| | - Erin Conlin
- Bristol Myers Squibb, Princeton, NJ, United States
| | | | | | - Neelum Jeste
- Bristol Myers Squibb, Princeton, NJ, United States
| | - Darren R Hargrave
- Pediatric Oncology Unit, UCL Great Ormond Street Hospital for Children, London, United Kingdom
| | - François Doz
- Department of Pediatric Oncology, Institut Curie and University of Paris, Paris, France
| | - Katherine E Warren
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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4
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Amoroso L, Castel V, Bisogno G, Casanova M, Marquez-Vega C, Chisholm JC, Doz F, Moreno L, Ruggiero A, Gerber NU, Fagioli F, Hingorani P, Melcón SG, Slepetis R, Chen N, le Bruchec Y, Simcock M, Vassal G. Phase II results from a phase I/II study to assess the safety and efficacy of weekly nab-paclitaxel in paediatric patients with recurrent or refractory solid tumours: A collaboration with the European Innovative Therapies for Children with Cancer Network. Eur J Cancer 2020; 135:89-97. [PMID: 32554315 DOI: 10.1016/j.ejca.2020.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The phase I component of a phase I/II study defined the recommended phase II dose and established the tolerability of nab-paclitaxel monotherapy in paediatric patients with recurrent or refractory solid tumours. The activity and safety of nab-paclitaxel monotherapy was further investigated in this phase II study. PATIENTS AND METHODS Paediatric patients with recurrent or refractory Ewing sarcoma, neuroblastoma or rhabdomyosarcoma received 240 mg/m2 of nab-paclitaxel on days 1, 8 and 15 of each 28-day cycle. The primary end-point was the overall response rate (ORR; complete response [CR] + partial response [PR]). Secondary end-points included duration of response, disease control rate (DCR; CR + PR + stable disease [SD]), progression-free survival, 1-year overall survival, safety and pharmacokinetics. RESULTS Forty-two patients were enrolled, 14 each with Ewing sarcoma, neuroblastoma and rhabdomyosarcoma. The ORRs were 0%, 0% and 7.1% (1 confirmed PR), respectively. The DCRs were 30.8% (4 SD), 7.1% (1 SD) and 7.1% (1 confirmed PR and 0 SD) in the Ewing sarcoma, neuroblastoma and rhabdomyosarcoma groups, respectively. The median progression-free survival was 13.0, 7.4 and 5.1 weeks, respectively, and the 1-year overall survival rates were 48%, 25% and 15%, respectively. The most common grade III/4IVadverse events were haematologic (neutropenia [50%] and anaemia [48%]), and grade III/IV peripheral neuropathy occurred in 2 patients (14%) in the rhabdomyosarcoma group. Pharmacokinetics analyses revealed that paclitaxel tissue distribution was both rapid and extensive. CONCLUSIONS In this phase II study, limited activity was observed; however, the safety of nab-paclitaxel in paediatric patients was confirmed. TRIAL REGISTRATION NCT01962103 and EudraCT 2013-000144-26.
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Affiliation(s)
| | - Victoria Castel
- Pediatric Hematology/Oncology Unit, University Hospital La Fe, Valencia, Spain
| | - Gianni Bisogno
- Hematology/Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | | | - François Doz
- Institut Curie and Paris Descartes University, Paris, France
| | - Lucas Moreno
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | | | | | - Franca Fagioli
- Pediatric Oncology Department, Regina Margherita Children's Hospital, AOU Città della Salute e Della Scienza di Torino, Turin, Italy; Department of Public Health and Paediatric Sciences, University of Torino, Turin, Italy
| | - Pooja Hingorani
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Yvan le Bruchec
- Celgene International, A Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Mathew Simcock
- Celgene International, A Bristol-Myers Squibb Company, Boudry, Switzerland
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Niemeyer CM, Flotho C, Lipka DB, Starý J, Rössig C, Baruchel A, Klingebiel T, Micalizzi C, Michel G, Nysom K, Rives S, Schmugge Liner M, Zecca M, Baumann I, Benettaib B, Poon J, Simcock M, Patturajan M, Van Den Heuvel-Eibrink MM, Locatelli F. Upfront azacitidine (AZA) in juvenile myelomonocytic leukemia (JMML): Interim analysis of the prospective AZA-JMML-001 study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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
10031 Background: Hematopoietic stem cell transplantation (HSCT) is the only curative therapy for JMML patients (pts). Novel therapies controlling the disorder prior to HSCT are urgently needed. A phase 2, multicenter, open-label study was conducted to evaluate safety and anti-leukemia activity of AZA monotherapy prior to HSCT in pts with newly diagnosed (ND) JMML. Methods: AZA (75 mg/m2 IV) was administered once daily on days 1–7 of each 28-day cycle (C). Primary endpoint was number of pts with clinical complete remission or clinical partial remission (cPR) at C3 day (D) 28 (C3D28). Results: 18 JMML pts (13 PTPN11-, 3 NRAS-, 1 KRAS-, 1 NF1-mutated) were enrolled from 09/2015 to 11/2017. Median (range) white blood cell and platelet (Plt) counts were 19.7 (4.3–59.0) × 109/L and 28 (7–85) × 109/L, respectively. DNA methylation class (MC) was high, intermediate (int), or low in 11, 5, and 2 pts, respectively. 16 pts completed C3 and 5 pts C6. 2 pts discontinued treatment (Tx) pre-C3D28 due to disease progression (PD). 6 pts (33%) had ≥ 1 grade (Gr) 3–4 manageable adverse event (AE) related to AZA. Most common Gr 3–4 AEs related to AZA were neutropenia (2) and anemia (2). 11 pts (61%) were in cPR at C3D28; 7 had PD at C3D28 or prior. All 7 pts of the int/low MC and 4/11 in high MC achieved cPR. 17 pts received HSCT at median of 58 days (37–518) from last AZA dose; 14 were leukemia-free at a median follow-up of 15.7 months (0.1–31.7) after HSCT. 2 pts (high MC) given HSCT relapsed after allograft. 16/18 pts were alive at a median follow-up of 19.8 months (2.6–37.3) from diagnosis. 1 pt discontinuing Tx prior to C3 died from PD; 1 non-responder died from transplant-related causes. Plt response in pts with cPR prompted retrospective comparison of Plt counts at time of HSCT with a historical registry control cohort. Pts with NF1-mutated JMML with higher Plt counts versus other genetic subtypes were excluded. While 7/16 (44%) study pts had Plt counts ≥ 100 × 109/L at HSCT, only 10/58 (17%) historical cohort pts reached this cutoff ( P < 0.01). Conclusions: This study shows that AZA monotherapy was well tolerated in pts with ND JMML. Although the long-term advantage of AZA Tx remains to be fully assessed, responses show it was effective in JMML and provided clinical benefit to pts in this study. Clinical trial information: NCT02447666.
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Affiliation(s)
- Charlotte M. Niemeyer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christian Flotho
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel B. Lipka
- Division of Cancer Epigenomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Starý
- Fakultní nemocnice v Motole, Prague, Czech Republic
| | - Claudia Rössig
- University Children's Hospital Muenster, Muenster, Germany
| | - Andre Baruchel
- CHU Paris–Hôpital Universitaire Robert Debré (APHP), Paris, France
| | | | | | | | | | - Susana Rives
- Hospital Sant Joan de Deu de Barcelona, Institut de Recerca Hospital Sant Joan de Deu, Barcelona, Spain
| | | | - Marco Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | | | | | | | - Franco Locatelli
- IRCCS Ospedale Pediatrico Bambino Gesù, Rome; Sapienza, University of Rome, Rome, Italy
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6
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Fangusaro JR, Locatelli F, Garré ML, Marshall LV, Massimino M, Benettaib B, Biserna N, Poon J, Quan J, Conlin E, Lewandowski J, Simcock M, Jeste N, Hargrave DR, Doz FP, Warren KE. A phase II clinical study of pomalidomide (CC-4047) monotherapy for children and young adults with recurrent or progressive primary brain tumors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10035 Background: Central nervous system (CNS) tumors are the most common cause of pediatric cancer mortality and novel therapies are needed for refractory disease. Pomalidomide (pom) is an oral immunomodulatory agent with CNS penetration, anti-angiogenic, anti-inflammatory and cytotoxic activity. Methods: This Phase 2 study evaluated both safety and efficacy of pom in pediatric patients with recurrent/progressive CNS tumors. Using a Simon’s two-stage design, patients were stratified to high-grade glioma [HGG], ependymoma, medulloblastoma or diffuse intrinsic pontine glioma [DIPG] cohorts. Patients received pom 2.6 mg/m2 for 21 days of a 28-day cycle. The primary endpoint was objective response rate (complete response [CR], partial response [PR]) or prolonged stable disease [SD] (defined as ≥ 6 cycles, or ≥ 3 for DIPG). Stage 1 required ≥ 2/9 subjects, within each cohort, to have a response or prolonged SD to move into Stage 2, and ≥ 5/20 responders or patients with prolonged SD at the end of Stage 2 for pom to be deemed effective. Results: Of 52 treated patients (median age 11.5 y/o; range 4-18), 47 were evaluable for primary endpoint. Median treatment duration was 2 cycles (range 1-16). Only the HGG cohort met protocol-defined criteria to advance to Stage 2, with one PR and one prolonged SD in Stage 1. Forty-six of 47 evaluable patients discontinued pom, due to adverse event (n = 1; pneumonia), withdrawal by parent/guardian (n = 2), death (n = 4; 3 progressive disease, 1 sepsis), or progressive disease (n = 39). Nineteen of 52 treated patients experienced ≥ 1 grade 3–4 treatment-emergent adverse event (TEAE) related to pom, neutropenia (n = 15) being the most commonly reported. Twenty-six patients died on study. All deaths were attributed to either disease progression or complications from disease. Conclusions: Single agent pomalidomide failed to meet a clinically meaningful level of efficacy in children with recurrent/progressive HGG, DIPG, medulloblastoma or ependymoma. However, it should be noted that a sustained response was observed in a child with HGG, replicating the outcome observed in one child with HGG in the Phase 1 (PBTC-043) trial. Clinical trial information: NCT03257631.
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Affiliation(s)
- Jason R. Fangusaro
- Childrens' Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | - Franco Locatelli
- IRCCS Ospedale Bambino Gesù Children’s Hospital, Rome, Italy, University of Pavia, Pavia, Italy
| | | | - Lynley V. Marshall
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
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7
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Moreno L, Casanova M, Chisholm JC, Berlanga P, Chastagner PB, Baruchel S, Amoroso L, Gallego Melcón S, Gerber NU, Bisogno G, Fagioli F, Geoerger B, Glade Bender JL, Aerts I, Bergeron C, Hingorani P, Elias I, Simcock M, Ferrara S, Le Bruchec Y, Slepetis R, Chen N, Vassal G. Phase I results of a phase I/II study of weekly nab-paclitaxel in paediatric patients with recurrent/refractory solid tumours: A collaboration with innovative therapies for children with cancer. Eur J Cancer 2018; 100:27-34. [PMID: 29936064 DOI: 10.1016/j.ejca.2018.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/29/2018] [Accepted: 05/01/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND nab-Paclitaxel has demonstrated efficacy in adults with solid tumours and preclinical activity in paediatric solid tumour models. Results from phase I of a phase I/II study in paediatric patients with recurrent/refractory solid tumours treated with nab-paclitaxel are reported. PATIENTS AND METHODS Patients with recurrent/refractory extracranial solid tumours received nab-paclitaxel on days 1, 8 and 15 every 4 weeks at 120, 150, 180, 210, 240, or 270 mg/m2 (rolling-6 dose-escalation) to establish the maximum tolerated dose (MTD) and recommended phase II dose (RP2D). RESULTS Sixty-four patients were treated. Dose-limiting toxicities were grade 3 dizziness at 120 mg/m2 and grade 4 neutropenia >7 days at 270 mg/m2. The most frequent grade 3/4 adverse events were haematologic, including neutropenia (36%), leukopenia (36%) and lymphopenia (25%). Although the MTD was not reached, 270 mg/m2 was declared non-tolerable due to grade 3/4 toxicities during cycles 1-2 (neutropenia, n = 5/7; skin toxicity, n = 2/7; peripheral neuropathy, n = 1/7). Of 58 efficacy-evaluable patients, complete response occurred in one patient (2%; Ewing sarcoma) and partial responses in four patients (7%; rhabdomyosarcoma, Ewing sarcoma, renal tumour with pulmonary metastases [high-grade, malignant] and sarcoma not otherwise specified); all responses occurred at ≥210 mg/m2. Thirteen patients (22%) had stable disease (5 lasting ≥16 weeks) per RECIST. CONCLUSIONS nab-Paclitaxel 240 mg/m2 qw3/4 (nearly double the adult recommended monotherapy dose for this schedule in metastatic breast cancer) was selected as the RP2D based on the tolerability profile, pharmacokinetics and antitumour activity. Phase II is currently enrolling patients with recurrent/refractory neuroblastoma, rhabdomyosarcoma and Ewing sarcoma. CLINICALTRIALS.GOV: NCT01962103. EUDRACT 2013-000144-26.
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Affiliation(s)
- Lucas Moreno
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | | | | | - Pablo Berlanga
- Unidad de Oncologia Pediatrica, Hospital Universitario I Politècnic La Fe, Valencia, Spain
| | | | | | | | | | | | - Gianni Bisogno
- Department of Pediatrics, Hematology/Oncology Division, Padova, Italy
| | - Franca Fagioli
- Pediatric Onco-Hematology Division, Regina Margherita, Torino, Italy
| | - Birgit Geoerger
- Gustave Roussy, Department of Pediatric and Adolescent Oncology, Villejuif, France
| | | | - Isabelle Aerts
- Institut Curie, PSL Research University, Oncology Center SIREDO (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Paris, France
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8
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Moreno L, Casanova M, Chisholm JC, Berlanga P, Chastagner PB, Baruchel S, Manzitti C, Gallego Mélcon S, Gerber NU, Bisogno G, Fagioli F, Geoerger B, Glade Bender J, Aerts I, Bergeron C, Hingorani P, Elias I, Simcock M, Slepetis R, Vassal G. Phase 1/2 study of weekly nab-paclitaxel (nab-P) in pediatric patients (pts) with recurrent/refractory solid tumors (STs): Dose-finding and pharmacokinetics (PK). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lucas Moreno
- Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | - Pablo Berlanga
- Unidad de Oncologia Pediatrica, Hospital Universitario la Fe, Valencia, Spain
| | | | | | | | | | | | - Gianni Bisogno
- Department of Pediatrics, Hematology/Oncology Division, Padova, Italy
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9
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Dimopoulos MA, Weisel KC, Cavo M, Corradini P, Delforge M, Morgan GJ, Hansson M, Palumbo A, Ocio EM, Simcock M, Miller N, Slaughter A, Leupin N, Nikolova ZG, Moreau P. The STRATUS trial (MM-010): A single-arm phase 3b study of pomalidomide plus low-dose dexamethasone (POM + LoDEX) in refractory or relapsed and refractory multiple myeloma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps8625] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Katja C. Weisel
- Department of Hematology and Oncology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Michele Cavo
- Seràgnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Paolo Corradini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Gareth J Morgan
- Centre for Myeloma Research, Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | | | | | | | - Philippe Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
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10
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Schoenewolf NL, Belloni B, Simcock M, Tonolla S, Vogt P, Scherrer E, Holzmann D, Dummer R. Clinical implications of distinct metastasizing preferences of different melanoma subtypes. Eur J Dermatol 2014; 24:236-41. [PMID: 24721680 DOI: 10.1684/ejd.2014.2292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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: 11/17/2022]
Abstract
BACKGROUND The incidence and mortality of malignant melanoma have been rising during the past decades, the latter being due to the high invasion capacity and the metastatic potential of melanoma cells to distant organs. OBJECTIVE We investigated the distribution pattern of melanoma metastases taking into account different clinicopathological subtypes of melanoma. METHODS We studied 310 stage IV (AJCC 2009) melanoma patients retrospectively with regard to potential correlations between frequency and occurrence of metastasis and the genetic background and pathological/clinical melanoma subtypes. For all patients, the time to distant metastasis (TTDM) and the distribution patterns of metastases were analyzed and correlated to the median survival time. RESULTS Superficially Spreading (SSM) and Nodular melanomas (NMM) spread to the brain more frequently than Acrolentiginous (ALM) and Mucosal (MM) melanomas (p = 0.0012). The preference to affect the skeleton was significantly higher for ALM and MM in comparison to SSM and NMM (p = 0.0049). Lentigo maligna (LMM) tumors showed a significantly lower metastatic spread to distant lymph nodes (p = 0.0159). BRAF mutant versus wildtype tumors showed no significant differences concerning localization of metastasis but patients with BRAF mutant tumors were significantly younger at primary diagnosis and had a significantly shorter stage IV survival (p = 0.0106). CONCLUSION This study shows a clear distinction of melanoma subtypes with regard to metastasizing preferences. Further knowledge about melanoma subtype specific characteristics, including molecular markers predictive of homing preferences, may help to understand and manage this heterogeneous disease in terms of prognosis and follow-up procedures.
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Affiliation(s)
- Nicola L Schoenewolf
- Department of Dermatology, University Hospital of Zurich, Gloriastr. 31, 8091 Zurich, Switzerland
| | - Benedetta Belloni
- Department of Dermatology, University Hospital of Zurich, Gloriastr. 31, 8091 Zurich, Switzerland
| | - Mathew Simcock
- SAKK Coordinating Center, Effingerstr. 40, 3008 Bern, Switzerland
| | - Sabina Tonolla
- Department of Dermatology, University Hospital of Zurich, Gloriastr. 31, 8091 Zurich, Switzerland
| | - Pascale Vogt
- Department of Dermatology, University Hospital of Zurich, Gloriastr. 31, 8091 Zurich, Switzerland
| | - Ellen Scherrer
- Department of Dermatology, University Hospital of Zurich, Gloriastr. 31, 8091 Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology, University Hospital of Zurich, Frauenklinikstr. 24, 8091 Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital of Zurich, Gloriastr. 31, 8091 Zurich, Switzerland
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Ghadjar P, Bojaxhiu B, Simcock M, Terribilini D, Isaak B, Gut P, Wolfensberger P, Brömme JO, Geretschläger A, Behrensmeier F, Pica A, Aebersold DM. High Dose-Rate Versus Low Dose-Rate Brachytherapy for Lip Cancer. Int J Radiat Oncol Biol Phys 2012; 83:1205-12. [DOI: 10.1016/j.ijrobp.2011.09.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 09/07/2011] [Accepted: 09/19/2011] [Indexed: 10/15/2022]
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Schoenewolf NL, Dummer R, Mihic-Probst D, Moch H, Simcock M, Ochsenbein A, Gillessen S, Schraml P, von Moos R. Detecting BRAF Mutations in Formalin-Fixed Melanoma: Experiences with Two State-of-the-Art Techniques. Case Rep Oncol 2012; 5:280-9. [PMID: 22740817 PMCID: PMC3383294 DOI: 10.1159/000339300] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Melanoma is characterized by a high frequency of BRAF mutations. It is unknown if the BRAF mutation status has any predictive value for therapeutic approaches such as angiogenesis inhibition. Patients and Methods We used 2 methods to analyze the BRAF mutation status in 52 of 62 melanoma patients. Method 1 (mutation-specific real-time PCR) specifically detects the most frequent BRAF mutations, V600E and V600K. Method 2 (denaturing gel gradient electrophoresis and direct sequencing) identifies any mutations affecting exons 11 and 15. Results Eighteen BRAF mutations and 15 wild-type mutations were identified with both methods. One tumor had a double mutation (GAA) in codon 600. Results of 3 samples were discrepant. Additional mutations (V600M, K601E) were detected using method 2. Sixteen DNA samples were analyzable with either method 1 or method 2. There was a significant association between BRAF V600E mutation and survival. Conclusion Standardized tissue fixation protocols are needed to optimize BRAF mutation analysis in melanoma. For melanoma treatment decisions, the availability of a fast and reliable BRAF V600E screening method may be sufficient. If other BRAF mutations in exons 11 and 15 are found to be of predictive value, a combination of the 2 methods would be useful.
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Schraml P, von Teichman A, Mihic-Probst D, Simcock M, Ochsenbein A, Dummer R, Michielin O, Seifert B, Schläppi M, Moch H, von Moos R. Predictive value of the MGMT promoter methylation status in metastatic melanoma patients receiving first-line temozolomide plus bevacizumab in the trial SAKK 50/07. Oncol Rep 2012; 28:654-8. [PMID: 22614944 DOI: 10.3892/or.2012.1826] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 04/30/2012] [Indexed: 11/06/2022] Open
Abstract
The O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status is a predictive parameter for the response of malignant gliomas to alkylating agents such as temozolomide. First clinical trials with temozolomide plus bevacizumab therapy in metastatic melanoma patients are ongoing, although the predictive value of the MGMT promoter methylation status in this setting remains unclear. We assessed MGMT promoter methylation in formalin-fixed, primary tumor tissue of metastatic melanoma patients treated with first-line temozolomide and bevacizumab from the trial SAKK 50/07 by methylation-specific polymerase chain reaction. In addition, the MGMT expression levels were also analyzed by MGMT immunohistochemistry. Eleven of 42 primary melanomas (26%) revealed a methylated MGMT promoter. Promoter methylation was significantly associated with response rates CR + PR versus SD + PD according to RECIST (response evaluation criteria in solid tumors) (p<0.05) with a trend to prolonged median progression-free survival (8.1 versus 3.4 months, p>0.05). Immunohistochemically different protein expression patterns with heterogeneous and homogeneous nuclear MGMT expression were identified. Negative MGMT expression levels were associated with overall disease stabilization CR+PR+SD versus PD (p=0.05). There was only a poor correlation between MGMT methylation and lack of MGMT expression. A significant proportion of melanomas have a methylated MGMT promoter. The MGMT promoter methylation status may be a promising predictive marker for temozolomide therapy in metastatic melanoma patients. Larger sample sizes may help to validate significant differences in survival type endpoints.
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Affiliation(s)
- Peter Schraml
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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14
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Ghadjar P, Simcock M, Studer G, Allal AS, Ozsahin M, Bernier J, Töpfer M, Zimmermann F, Betz M, Glanzmann C, Aebersold DM. Concomitant Cisplatin and Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: 10-Year Follow-Up of a Randomized Phase III Trial (SAKK 10/94). Int J Radiat Oncol Biol Phys 2012; 82:524-31. [DOI: 10.1016/j.ijrobp.2010.11.067] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 11/05/2010] [Accepted: 11/12/2010] [Indexed: 11/17/2022]
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15
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Zaman K, Thürlimann B, Huober J, Schönenberger A, Pagani O, Lüthi J, Simcock M, Giobbie-Hurder A, Berthod G, Genton C, Brauchli P, Aebi S. Bone mineral density in breast cancer patients treated with adjuvant letrozole, tamoxifen, or sequences of letrozole and tamoxifen in the BIG 1-98 study (SAKK 21/07). Ann Oncol 2011; 23:1474-81. [PMID: 22003243 DOI: 10.1093/annonc/mdr448] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The risk of osteoporosis and fracture influences the selection of adjuvant endocrine therapy. We analyzed bone mineral density (BMD) in Swiss patients of the Breast International Group (BIG) 1-98 trial [treatment arms: A, tamoxifen (T) for 5 years; B, letrozole (L) for 5 years; C, 2 years of T followed by 3 years of L; D, 2 years of L followed by 3 years of T]. PATIENTS AND METHODS Dual-energy X-ray absorptiometry (DXA) results were retrospectively collected. Patients without DXA served as control group. Repeated measures models using covariance structures allowing for different times between DXA were used to estimate changes in BMD. Prospectively defined covariates were considered as fixed effects in the multivariable models. RESULTS Two hundred and sixty-one of 546 patients had one or more DXA with 577 lumbar and 550 hip measurements. Weight, height, prior hormone replacement therapy, and hysterectomy were positively correlated with BMD; the correlation was negative for letrozole arms (B/C/D versus A), known osteoporosis, time on trial, age, chemotherapy, and smoking. Treatment did not influence the occurrence of osteoporosis (T score < -2.5 standard deviation). CONCLUSIONS All aromatase inhibitor regimens reduced BMD. The sequential schedules were as detrimental for bone density as L monotherapy.
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Affiliation(s)
- K Zaman
- Breast Center, CePO, University Hospital, Lausanne.
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16
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von Moos R, Seifert B, Simcock M, Goldinger SM, Gillessen S, Ochsenbein A, Michielin O, Cathomas R, Schläppi M, Moch H, Schraml PH, Mjhic-Probst D, Mamot C, Schönewolf N, Dummer R. First-line temozolomide combined with bevacizumab in metastatic melanoma: a multicentre phase II trial (SAKK 50/07). Ann Oncol 2011; 23:531-6. [PMID: 21527587 DOI: 10.1093/annonc/mdr126] [Citation(s) in RCA: 56] [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: 11/13/2022] Open
Abstract
BACKGROUND Oral temozolomide has shown similar efficacy to dacarbazine in phase III trials with median progression-free survival (PFS) of 2.1 months. Bevacizumab has an inhibitory effect on the proliferation of melanoma and sprouting endothelial cells. We evaluated the addition of bevacizumab to temozolomide to improve efficacy in stage IV melanoma. PATIENTS AND METHODS Previously untreated metastatic melanoma patients with Eastern Cooperative Oncology Group performance status of two or more were treated with temozolomide 150 mg/m(2) days 1-7 orally and bevacizumab 10 mg/kg body weight i.v. day 1 every 2 weeks until disease progression or unacceptable toxicity. The primary end point was disease stabilisation rate [complete response (CR), partial response (PR) or stable disease (SD)] at week 12 (DSR12); secondary end points were best overall response, PFS, overall survival (OS) and adverse events. RESULTS Sixty-two patients (median age 59 years) enrolled at nine Swiss centres. DSR12 was 52% (PR: 10 patients and SD: 22 patients). Confirmed overall response rate was 16.1% (CR: 1 patient and PR: 9 patients). Median PFS and OS were 4.2 and 9.6 months. OS (12.0 versus 9.2 months; P = 0.014) was higher in BRAF V600E wild-type patients. CONCLUSIONS The primary end point was surpassed showing promising activity of this bevacizumab/temozolomide combination with a favourable toxicity profile. Response and OS were significantly higher in BRAF wild-type patients.
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Affiliation(s)
- R von Moos
- Department of Medicine Oncology, Kantonal Hospital Graubuenden, Chur, Switzerland.
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Madlung A, Simcock M, Ghadjar P. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer 2011; 117:3532; author reply 3532-3. [DOI: 10.1002/cncr.25949] [Citation(s) in RCA: 2] [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: 11/06/2022]
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18
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Passweg JR, Giagounidis AA, Simcock M, Aul C, Dobbelstein C, Stadler M, Ossenkoppele G, Hofmann WK, Schilling K, Tichelli A, Ganser A. Immunosuppressive Therapy for Patients With Myelodysplastic Syndrome: A Prospective Randomized Multicenter Phase III Trial Comparing Antithymocyte Globulin Plus Cyclosporine With Best Supportive Care—SAKK 33/99. J Clin Oncol 2011; 29:303-9. [PMID: 21149672 DOI: 10.1200/jco.2010.31.2686] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose Immunosuppressive treatment is reported to improve cytopenia in some patients with myelodysplastic syndrome (MDS). Combined antithymocyte globulin (ATG) and cyclosporine (CSA) is most effective in patients with immune-mediated marrow failure. Patients and Methods This trial was designed to assess the impact of immunosuppression on hematopoiesis, transfusion requirements, transformation, and survival in patients with MDS randomly assigned to 15 mg/kg of horse ATG for 5 days and oral CSA for 180 days (ATG+CSA) or best supportive care (BSC), stratified by treatment center and International Prognostic Scoring System (IPSS) risk score. Primary end point was best hematologic response at 6 months. Eligible patients had an Eastern Cooperative Oncology Group performance status of ≤ 2 and transfusion dependency of less than 2 years in duration. Results Between 2000 and 2006, 45 patients received ATG+CSA (median age, 62 years; range, 23 to 75 years; 56% men) and 43 patients received BSC (median age, 65 years; range, 24 to 76 years; 81% men). IPSS score was low, intermediate-1, intermediate-2, high, and not evaluable in eight, 24, seven, one, and five patients on ATG+CSA, respectively, and eight, 25, five, zero, and five patients on BSC, respectively. Refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess of blasts (RAEB) -I, RAEB-II, and hypoplastic disease were present in 21, six, nine, zero, and nine patients on ATG+CSA, respectively, and 18, eight, 11, two, and four patients on BSC, respectively. By month 6, 13 of 45 patients on ATG+CSA had a hematologic response compared with four of 43 patients on BSC (P = .0156). Two-year transformation-free survival (TFS) rates were 46% (95% CI, 28% to 62%) and 55% (95% CI, 34% to 70%) for ATG+CSA and BSC patients, respectively (P = .730), whereas overall survival (OS) estimates were 49% (95% CI, 31% to 66%) and 63% (95% CI, 42% to 78%), respectively (P = .828). Conclusion This open-label randomized phase III trial demonstrates that ATG+CSA treatment seems to be associated with hematologic response in a subset of patients without apparent impact on TFS and OS.
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Affiliation(s)
- Jakob R. Passweg
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Aristoteles A.N. Giagounidis
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Mathew Simcock
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Carlo Aul
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Christiane Dobbelstein
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Michael Stadler
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Gert Ossenkoppele
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Wolf-Karsten Hofmann
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Kristina Schilling
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - André Tichelli
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
| | - Arnold Ganser
- From the Hôpitaux Universitaires de Geneve, Geneva; Swiss Group for Clinical Cancer Research, Bern; Basel University Hospital, Basel, Switzerland; Medizinische Klinik II, St Johannes Hospital, Duisburg; Hannover Medical School, Hannover; University Hospital Mannheim, Mannheim; Friedrich-Schiller-Universität Jena, Jena, Germany; and Vrije Universiteit University Medical Center, Amsterdam, the Netherlands
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Dummer R, Michielin O, Seifert B, Ochsenbein AF, Cathomas R, Schlaeppi MR, Simcock M, Gillessen S, Goldinger SM, von Moos R. First-line temozolomide (TEM) combined with bevacizumab (BEV) in metastatic melanoma (MM): A multicenter phase II trial (SAKK 50/07). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Fuerstenberger G, Boneberg E, Simcock M, Dummer R, Goldinger SM, Michielin O, Seifert B, Ochsenbein AF, Schlaeppi MR, von Moos R. Predictive and prognostic potential of angiogenic serum factors and circulating endothelial cells in metastatic melanoma patients receiving temozolamide plus bevacizumab (SAKK 50/07). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8585] [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: 11/20/2022] Open
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21
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Ochsenbein AF, Schraml P, Mihic D, Simcock M, Dummer R, Michielin O, Seifert B, Schlaeppi MR, Moch H, von Moos R. MGMT promoter methylation status in metastatic melanoma patients receiving first-line temozolomide plus bevacizumab (SAKK 50/07). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8558] [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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22
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von Moos R, Roth A, Ruhstaller T, Widmer L, Uhlmann C, Cathomas R, Köberle D, Simcock M, Lanz D, Popescu R. Oxaliplatin, irinotecan and capecitabine (OCX) for first-line treatment of advanced/metastatic colorectal cancer: a phase I trial (SAKK 41/03). ACTA ACUST UNITED AC 2010; 33:295-9. [PMID: 20523092 DOI: 10.1159/000313598] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A phase I multicentre trial was conducted to define the recommended dose of capecitabine in combination with oxaliplatin and irinotecan (OCX) in metastatic colorectal cancer. PATIENTS AND METHODS Patients with performance status (PS) < 2 and adequate haematological, renal and liver function received oxaliplatin 70 mg/m(2) on days 1 and 15, irinotecan 100 mg/m(2) on days 8 and 22 and one of five dose levels (DL 1-5, between 800 and 1,600 mg/ m(2)) of capecitabine on days 1-29 every 5 weeks. RESULTS 23 patients received a median of 3 cycles. 3 dose-limiting toxicities occurred (DL 1: grade 3 (G3) elevated alkaline phosphatase; DL 5: 1 patient G4 hyperglycaemia/G3 diarrhoea and 1 sudden death). The most common severe adverse event was G3 diarrhoea (13%). Severe haematotoxicity was rare. Therapy was stopped mainly due to metastasectomy or tumour progression (7 patients each). 8 patients reached a partial response. Median time to progression and overall survival (OS) were 8.0 and 21.9 months, respectively. CONCLUSIONS The recommended capecitabine dose in this schedule is 1,400 mg/m(2) daily. The OCX regimen is well tolerated. The response rate was surprisingly low with progression-free survival (PFS) and OS within the range of a triple combination. Further studies in combination with targeted agents are warranted.
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Ghadjar P, Simcock M, Schreiber-Facklam H, Zimmer Y, Gräter R, Evers C, Arnold A, Wilkens L, Aebersold DM. Incidence of small lymph node metastases with evidence of extracapsular extension: clinical implications in patients with head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2010; 78:1366-72. [PMID: 20231070 DOI: 10.1016/j.ijrobp.2009.09.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 08/24/2009] [Accepted: 09/26/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE Small lymph nodes (LN) show evidence of extracapsular extension (ECE) in a significant number of patients. This study was performed to determine the impact of ECE in LN ≤7 mm as compared with ECE in larger LN. METHODS AND MATERIALS All tumor-positive LN of 74 head and neck squamous cell carcinoma (HNSCC) patients with at least one ECE positive LN were analyzed retrospectively for the LN diameter and the extent of ECE. Clinical endpoints were regional relapse-free survival, distant metastasis-free survival, and overall survival. The median follow-up for the surviving patients was 2.1 years (range, 0.3-9.2 years). RESULTS Forty-four of 74 patients (60%) had at least one ECE positive LN ≤10 mm. These small ECE positive LN had a median diameter of 7 mm, which was used as a cutoff. Thirty patients (41%) had at least one ECE positive LN ≤7 mm. In both univariate and multivariate Cox regression analyses, the incidence of at least one ECE positive LN ≤7 mm was a statistically significant prognostic factor for decreased regional relapse-free survival (adjusted hazard ratio [HR]: 2.7, p = 0.03, 95% confidence interval [CI]: 1.1-6.4), distant metastasis-free survival (HR: 2.6, p = 0.04, 95% CI: 1.0-6.6), and overall survival (HR: 2.5, p = 0.03, 95% CI: 1.1-5.8). CONCLUSIONS The incidence of small ECE positive LN metastases is a significant prognostic factor in HNSCC patients. Small ECE positive LN may represent more invasive tumor biology and could be used as prognostic markers.
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Affiliation(s)
- Pirus Ghadjar
- Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
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Koeberle D, Montemurro M, Samaras P, Majno P, Simcock M, Limacher A, Lerch S, Kovàcs K, Inauen R, Hess V, Saletti P, Borner M, Roth A, Bodoky G. Continuous Sunitinib treatment in patients with advanced hepatocellular carcinoma: a Swiss Group for Clinical Cancer Research (SAKK) and Swiss Association for the Study of the Liver (SASL) multicenter phase II trial (SAKK 77/06). Oncologist 2010; 15:285-92. [PMID: 20203173 DOI: 10.1634/theoncologist.2009-0316] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sunitinib (SU) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenic activity. The objective of this trial was to demonstrate antitumor activity of continuous SU treatment in patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS Key eligibility criteria included unresectable or metastatic HCC, no prior systemic anticancer treatment, measurable disease, and Child-Pugh class A or mild Child-Pugh class B liver dysfunction. Patients received 37.5 mg SU daily until progression or unacceptable toxicity. The primary endpoint was progression-free survival at 12 weeks (PFS12). RESULTS Forty-five patients were enrolled. The median age was 63 years; 89% had Child-Pugh class A disease and 47% had distant metastases. PFS12 was rated successful in 15 patients (33%; 95% confidence interval, 20%-47%). Over the whole trial period, one complete response and a 40% rate of stable disease as the best response were achieved. The median PFS duration, disease stabilization duration, time to progression, and overall survival time were 1.5, 2.9, 1.5, and 9.3 months, respectively. Grade 3 and 4 adverse events were infrequent. None of the 33 deaths were considered drug related. CONCLUSION Continuous SU treatment with 37.5 mg daily is feasible and has moderate activity in patients with advanced HCC and mild to moderately impaired liver dysfunction. Under this trial design (>13 PFS12 successes), the therapy is considered promising. This is the first trial describing the clinical effects of continuous dosing of SU in HCC patients on a schedule that is used in an ongoing, randomized, phase III trial in comparison with the current treatment standard, sorafenib (ClinicalTrials.gov identifier, NCT00699374).
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Affiliation(s)
- Dieter Koeberle
- Department of Internal Medicine, Division Oncology/Hematology, Kantonsspital St. Gallen, CH-9007 St. Gallen, Switzerland.
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Ghadjar P, Schreiber-Facklam H, Gräter R, Evers C, Simcock M, Geretschläger A, Blumstein NM, Zbären P, Zimmer Y, Wilkens L, Aebersold DM. Quantitative Analysis of Extracapsular Extension of Metastatic Lymph Nodes and its Significance in Radiotherapy Planning in Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2010; 76:1127-32. [DOI: 10.1016/j.ijrobp.2009.03.065] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 03/08/2009] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
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Zaman K, Thürlimann B, Huober J, Schönenberger A, Pagani O, Lüthi J, Simcock M, Giobbie-Hurder A, Genton C, Aebi S. Modelling Bone Mineral Density in Swiss Breast Cancer Patients Treated with Letrozole, Tamoxifen and Sequences of Letrozole and Tamoxifen in the BIG 1-98 Study (SAKK 21/07). Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-5037] [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: 11/16/2022]
Abstract
Abstract
Background: Bone health is a concern when treating early stage breast cancer patients with adjuvant aromatase inhibitors. Early detection of patients (pts) at risk of osteoporosis and fractures may be helpful for starting preventive therapies and selecting the most appropriate endocrine therapy schedule. We present statistical models describing the evolution of lumbar and hip bone mineral density (BMD) in pts treated with tamoxifen (T), letrozole (L) and sequences of T and L.Methods: Available dual-energy x-ray absorptiometry exams (DXA) of pts treated in trial BIG 1-98 were retrospectively collected from Swiss centers. Treatment arms: A) T for 5 years, B) L for 5 years, C) 2 years of T followed by 3 years of L and, D) 2 years of L followed by 3 years of T. Pts without DXA were used as a control for detecting selection biases. Patients randomized to arm A were subsequently allowed an unplanned switch from T to L. Allowing for variations between DXA machines and centres, two repeated measures models, using a covariance structure that allow for different times between DXA, were used to estimate changes in hip and lumbar BMD (g/cm2) from trial randomization. Prospectively defined covariates, considered as fixed effects in the multivariable models in an intention to treat analysis, at the time of trial randomization were: age, height, weight, hysterectomy, race, known osteoporosis, tobacco use, prior bone fracture, prior hormone replacement therapy (HRT), bisphosphonate use and previous neo-/adjuvant chemotherapy (ChT). Similarly, the T-scores for lumbar and hip BMD measurements were modeled using a per-protocol approach (allowing for treatment switch in arm A), specifically studying the effect of each therapy upon T-score percentage.Results: A total of 247 out of 546 pts had between 1 and 5 DXA; a total of 576 DXA were collected. Number of DXA measurements per arm were; arm A 133, B 137, C 141 and D 135. The median follow-up time was 5.8 years. Significant factors positively correlated with lumbar and hip BMD in the multivariate analysis were weight, previous HRT use, neo-/adjuvant ChT, hysterectomy and height. Significant negatively correlated factors in the models were osteoporosis, treatment arm (B/C/D vs. A), time since endocrine therapy start, age and smoking (current vs. never).Modeling the T-score percentage, differences from T to L were -4.199% (p = 0.036) and -4.907% (p = 0.025) for the hip and lumbar measurements respectively, before any treatment switch occurred.Conclusions: Our statistical models describe the lumbar and hip BMD evolution for pts treated with L and/or T. The results of both localisations confirm that, contrary to expectation, the sequential schedules do not seem less detrimental for the BMD than L monotherapy. The estimated difference in BMD T-score percent is at least 4% from T to L.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5037.
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Affiliation(s)
- K. Zaman
- 1CEPO, Centre Hospitalier Universitaire Vaudois, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - B. Thürlimann
- 2Breast Center, Kantonsspital, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - J. Huober
- 2Breast Center, Kantonsspital, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - A. Schönenberger
- 3Kantonsspital, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - O. Pagani
- 4Oncology Institute of Southern Switzerland, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - J. Lüthi
- 5Oncology, Hospital, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - M. Simcock
- 6SAKK Coordinating Center, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - A. Giobbie-Hurder
- 7IBCSG Statistical Center, Dana-Farber Cancer Inst., MA,
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - C. Genton
- 6SAKK Coordinating Center, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - S. Aebi
- 8Medical Oncology, University Hospital, Switzerland
- 9On Behalf of the Swiss Group for Clinical Cancer Research (SAKK), Switzerland
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Ghadjar P, Simcock M, Schreiber-Facklam H, Zimmer Y, Gräter R, Evers C, Arnold A, Wilkens L, Aebersold D. Incidence of Small Lymph Node Metastases with Evidence of Extracapsular Extension: Clinical Implications in Patients with Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.411] [Citation(s) in RCA: 2] [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: 11/24/2022]
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Hitz F, Martinelli G, Zucca E, von Moos R, Mingrone W, Simcock M, Peterson J, Cogliatti SB, Bertoni F, Zimmermann DR, Ghielmini M. A multicentre phase II trial of gemcitabine for the treatment of patients with newly diagnosed, relapsed or chemotherapy resistant mantle cell lymphoma: SAKK 36/03. Hematol Oncol 2009; 27:154-9. [PMID: 19274614 DOI: 10.1002/hon.891] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mantle cell lymphoma (MCL) has a poor prognosis with often short and incomplete remissions. We aimed to test the efficacy and tolerability of gemcitabine in treating MCL. Gemcitabine was given in doses of 1000 mg/m(2) as a 30 min infusion on days 1 and 8 of each 3 week cycle for a maximum of nine cycles. Eighteen patients with a median age of 70 years were recruited. MCL was newly diagnosed in half of patients and relapsed in the remainder. Fifteen patients had Ann Arbor stage IV. The best-recorded responses were 1 CR (complete remission), 4 PRs (partial responses), 8 SDs (stable diseases) and 4 PDs (diseases progression). The response rate (RR) (CR + PR) was 5 (28%; 95% confidence interval: 7.1, 48.5). The patient achieving a CR had stage IV disease. Most haematological adverse events occurred during the first chemotherapy cycle. Three patients developed non-haematological serious adverse events: dyspnea, glomerular microangiopathy with haemolytic uremic syndrome (HUS) and hyperglycaemia. The median time-to-progression and treatment response duration (TRD) was 8.0 (95% confidence interval: 5.5, 9.3) and 10.6 (95% confidence interval: 5.5, 10.9) months, respectively. We conclude that Gemcitabine is well tolerated, moderately active and can induce disease stabilization in patients with MCL.
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Affiliation(s)
- F Hitz
- Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
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Koeberle D, Montemurro M, Samaras P, Simcock M, Limacher A, Hess V, Inauen R, Borner M, Roth A, Bodoky G. 6515 Continuous sunitinib treatment in patients with unresectable hepatocellular carcinoma (HCC): A multicenter phase II trial (SAKK 77/06 and SASL 23). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ghadjar P, Blank-Liss W, Simcock M, Hegyi I, Beer KT, Moch H, Aebersold DM, Zimmer Y. MET Y1253D-activating point mutation and development of distant metastasis in advanced head and neck cancers. Clin Exp Metastasis 2009; 26:809-15. [PMID: 19639388 DOI: 10.1007/s10585-009-9280-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 06/26/2009] [Indexed: 11/29/2022]
Abstract
We investigated if the MET-activating point mutation Y1253D influences clinical outcomes in patients with advanced squamous cell carcinoma of the head and neck (HNSCC). The study population consisted of 152 HNSCC patients treated by hyperfractionated radiotherapy alone or concomitant with chemotherapy between September 1994 and July 2000. Tumors were screened for the presence of the MET-activating point mutation Y1253D. Seventy-eight patients (51%) received radiotherapy alone, 74 patients (49%) underwent radiotherapy concomitant with chemotherapy. Median patient age was 54 years and median follow-up was 5.5 years. Distant metastasis-free survival, local relapse-free survival and overall survival were compared with MET Y1253D status. During follow-up, 29 (19%) patients developed distant metastasis. MET Y1253D was detected in tumors of 21 out of 152 patients (14%). Distant metastasis-free survival (P = 0.008) was associated with MET Y1253D. In a multivariate Cox regression model, adjusted for T-category, only presence of MET Y1253D was associated with decreased distant metastasis-free survival: hazard ratio = 2.5 (95% confidence interval: 1.1, 5.8). The observed association between MET Y1253D-activating point mutation and decreased distant metastasis-free survival in advanced HNSCC suggests that MET may be a potential target for specific treatment interventions.
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Affiliation(s)
- Pirus Ghadjar
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Koeberle D, Montemurro M, Samaras P, Majno P, Simcock M, Kovacs K, Inauen R, Hess V, Saletti P, Bodoky G. Continuous sunitinib treatment in patients with unresectable hepatocellular carcinoma (HCC): A multicenter phase II trial (SAKK 77/06 and SASL 23). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4591] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4591 Background: Sunitinib (SU) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenetic activity. Evidence for clinical activity in HCC was reported in 2 phase II trials [Zhu et al and Faivre et al, ASCO 2007] using either a 37.5 or a 50 mg daily dose in a 4 weeks on, 2 weeks off regimen. The objective of this trial was to demonstrate antitumor activity of continuous SU treatment in patients (pts) with HCC. Methods: Key eligibility criteria included unresectable or metastatic HCC, no prior systemic anticancer treatment, measurable disease and Child-Pugh A or B liver dysfunction. Pts received 37.5 mg SU daily until progression or unacceptable toxicity. The primary endpoint was progression free survival at 12 weeks (PFS12) defined as ‘success’ if the patient was alive and without tumor progression assessed by 12 weeks (± 7 days) after registration. A PFS12 of ≤ 20% was considered uninteresting and promising if ≥ 40%. Using the Simon-two minimax stage design with 90% power and 5% significance the sample size was 45 pts. Secondary endpoints included safety assessments, measurement of serum cobalamin levels and tumor density. Results: From September 2007 to August 2008 45 pts, mostly male (87%), were enrolled in 10 centers. Median age was 63 years, 89% had Child-Pugh A and 47% had distant metastases. Median largest lesion diameter was 84 mm (range: 18 - 280) and 18% had prior TACE. Reasons for stopping therapy were: PD 60%, symptomatic deterioration 16%, toxicity 11%, death 2% (due to tumor), and other reasons 4%; 7% remain on therapy. PFS12 was rated as success in 15 pts (33%) (95% CI: 20%, 49%) and failure in 27 (60%); 3 were not evaluable (due to refusal). Over the whole trial period 1 CR and 40% SD as best response were achieved. Median PFS, duration of disease stabilization, TTP and OS were 2.8, 3.2, 2.8 and 9.3 months, respectively. Grade 3 and 4 adverse events were infrequent and all deaths due to the tumor. Conclusions: Continuous SU treatment with 37.5 mg/d daily is feasible and demonstrates moderate activity in pts with advanced HCC and mild to moderately impaired liver dysfunction. Under this trial design the therapy is considered promising (> 13 PFS12 successes). No significant financial relationships to disclose.
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Affiliation(s)
- D. Koeberle
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - M. Montemurro
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Samaras
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Majno
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - M. Simcock
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - K. Kovacs
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - R. Inauen
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - V. Hess
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - P. Saletti
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - G. Bodoky
- Kantonsspital St. Gallen, St. Gallen, Switzerland; Centre Hospitalier Universitaire Vaudois Lausanne, Lausanne, Switzerland; University Hospital Zurich, Zurich, Switzerland; University Hospital of Geneva, Geneva, Switzerland; Statistics Unit, SAKK Coordination Center, Berne, Switzerland; St. László Teaching Hospital, Budapest, Hungary; University Hospital Basel, Basel, Switzerland; Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
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Taverna CJ, Bassi S, Hitz F, Mingrone W, Pabst T, Cevreska L, del Giglio A, Vorobiof DA, Simcock M, Ghielmini M. First results of long-term rituximab maintenance treatment in follicular lymphoma: Safety analysis of the randomized phase III trial SAKK 35/03. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
8534 Background: Rituximab maintenance has been shown to be effective in patients with follicular lymphoma. The optimal duration of maintenance remains unknown. Methods: We prospectively registered 270 patients with untreated, chemotherapy resistant or relapsed follicular lymphoma. All patients received rituximab induction consisting of 4 weekly doses (375 mg/m2). Responding patients (PR and CR) were randomized to a short maintenance consisting of four doses of rituximab (375 mg/m2) every two months (arm A) or prolonged maintenance consisting of rituximab every two months for a maximum of five years or until progression or unacceptable toxicity (arm B). Primary endpoint was event-free survival. Here we present the safety analysis. Results: From October 2004 to November 2007 165 patients were randomized, 82 in arm A and 83 in arm B. The median follow up is 22.7 months. A total of 442 hematological and non-hematological adverse events were observed, 27 of grade 3 and 6 of grade 4. Five subsequent cancers and 9 grade 3 and 4 infections were reported. Grade 3 and 4 neutropenia occurred in 5 patients, decreased levels of IgG were observed in 19 patients. Four grade 3 infections occurred after 2 years of maintenance. In arm B, maintenance was stopped due to unacceptable toxicity (fever) in 1 patient after 18 months and due to subsequent breast cancer in 1 patient after 20 months. One patient died 4 months after randomization because of ileus and consecutive peritonitis; considered to be unrelated to therapy. Twenty-nine patients are on maintenance for two or more years of which 6 patients are on for three or more years. In this analysis, median duration of the prolonged maintenance is 23.7 months. Conclusions: Rituximab maintenance beyond two years is feasible. We do not have evidence for increased toxicity after 2 years of maintenance. However, close follow up of patients under prolonged rituximab maintenance is necessary. The trial has been closed for accrual but there are still patients on treatment. [Table: see text]
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Affiliation(s)
- C. J. Taverna
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - S. Bassi
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - F. Hitz
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - W. Mingrone
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - T. Pabst
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - L. Cevreska
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - A. del Giglio
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - D. A. Vorobiof
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - M. Simcock
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
| | - M. Ghielmini
- Kantonsspital Munsterlingen, Munsterlingen, Switzerland; Istituto Europeo di Oncologia, Milan, Italy; Kantonsspital St. Gallen, St. Gallen, Switzerland; Kantonsspital Aarau/Olten, Olten, Switzerland; Inselspital Bern, Bern, Switzerland; Department of Hematology, Skopje, Macedonia, The Former Yugoslav Republic of; Hematology and Oncology, ABC Fondation, Sao Paulo, Brazil; Sandton Oncology Center, Johannesburg, South Africa; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Oncology
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Zaman K, Thürlimann B, Huober J, Schönenberger A, Pagani O, Lüthi J, Simcock M, Giobbie-Hurder A, Genton C, Aebi S. Modeling bone mineral density (BMD) evolution in postmenopausal patients treated by letrozole (L), tamoxifen (T), and sequences of T and L (SAKK 21/07). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.545] [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
545 Background: Osteoporosis and fractures are long term complications of aromatase inhibitor use in the adjuvant therapy of breast cancer. Early detection of patients (pts) at risk of treatment-induced osteoporosis may allow preventive therapy and selection of the most appropriate endocrine therapy. We developed a statistical model describing the evolution of BMD in pts treated with T, L and sequences of T and L. Methods: Available dual-energy x-ray absorptiometry exams (DXA) of pts treated in trial BIG 1–98 were retrospectively collected from Swiss centers. Treatment arms: A) T for 5 years; B) L for 5 years; C) 2 years of T followed by 3 years of L; and D) 2 years of L followed by 3 years of T. Pts without DXA were used as a control for detecting selection bias. A repeated measures model using the first-order autoregressive covariance structure to allow for different times between DXA was used to model BMD (g/cm2) since trial randomisation. Prospectively defined covariates were considered as fixed effects in a multivariable model using an intention to treat analysis. Covariates at trial randomization were: age, height, weight, race, known osteoporosis, tobacco use, prior bone fracture, prior hormone replacement therapy (HRT), bisphosphonate use and previous neo-/adjuvant chemotherapy (ChT). Results: A total of 247 out of 546 pts had between 1 and 5 DXA; a total of 576 DXA were collected. Arm A contained 67 pts, B 63 pts, C 55 pts and D 62 pts. Median follow-up was 5.8 years. Factors correlated with BMD in the multivariate analysis were weight (0.003/kg, p < 0.0001), height (0.003/cm, p = 0.0083), osteoporosis (-0.130, p < 0.0001), tobacco (current / previously vs. never: -0.057, p = 0.0011 / -0.042, p = 0.0798), previous HRT (0.030, p = 0.0244), ChT (0.032, p = 0.0174), time since endocrine therapy start (-0.009/year, p = 0.0164) and treatment arm (B / C / D vs. A: -0.068, p = 0.0002 / -0.091, p < 0.0001 / -0.064, p = 0.003). Conclusions: Our statistical model describes the BMD evolution for pts treated with L and/or T. All treatment regimens affect BMD. Contrary to expectation, the switch schedule T followed by L does not seem to result in better bone protection compared to L monotherapy. [Table: see text]
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Affiliation(s)
- K. Zaman
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - B. Thürlimann
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - J. Huober
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - A. Schönenberger
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - O. Pagani
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - J. Lüthi
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - M. Simcock
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - A. Giobbie-Hurder
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - C. Genton
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
| | - S. Aebi
- CEPO, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Breast Center, Kantonspital, St. Gallen, Switzerland; Kantonsspital, Aarau, Switzerland; Oncology Institute of Southern Switzerland, Viganello, Lugano, Switzerland; Oncology Hospital, Thun, Switzerland; SAKK Coordinating Center, Bern, Switzerland; IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA; Medical Oncology, University Hospital, Bern, Switzerland
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Fux CA, Rauch A, Simcock M, Bucher HC, Hirschel B, Opravil M, Vernazza P, Cavassini M, Bernasconi E, Elzi L, Furrer H. Tenofovir use is Associated with an Increase in Serum Alkaline Phosphatase in the Swiss HIV Cohort Study. Antivir Ther 2008. [DOI: 10.1177/135965350801300803] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Tenofovir (TDF) use has been associated with proximal renal tubulopathy, reduced calculated glomerular filtration rates (cGFR) and losses in bone mineral density. Bone resorption could result in a compensatory osteoblast activation indicated by an increase in serum alkaline phosphatase (sAP). A few small studies have reported a positive correlation between renal phosphate losses, increased bone turnover and sAP. Methods We analysed sAP dynamics in patients initiating ( n=657), reinitiating ( n=361) and discontinuing ( n=73) combined antiretroviral therapy with and without TDF and assessed correlations with clinical and epidemiological parameters. Results TDF use was associated with a significant increase of sAP from a median of 74 U/l (interquartile range 60–98) to a plateau of 99 U/l (82–123) after 6 months ( P<0.0001), with a prompt return to baseline upon TDF discontinuation. No change occurred in TDF-sparing regimes. Univariable and multivariable linear regression analyses revealed a positive correlation between sAP and TDF use ( P≤0.003), but no correlation with baseline cGFR, TDF-related cGFR reduction, changes in serum alanine aminotransferase (sALT) or active hepatitis C. Conclusions We document a highly significant association between TDF use and increased sAP in a large observational cohort. The lack of correlation between TDF use and sALT suggests that the increase in sAP is because of the bone isoenzyme and indicates stimulated bone turnover. This finding, together with published data on TDF-related renal phosphate losses, this finding raises concerns that TDF use could result in osteomalacia with a loss in bone mineral density at least in a subset of patients. This potentially severe long-term toxicity should be addressed in future studies.
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Affiliation(s)
- Christoph A Fux
- Division of Infectious Diseases, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Andri Rauch
- Division of Infectious Diseases, University Hospital Berne and University of Berne, Berne, Switzerland
| | - Mathew Simcock
- Basel Institute for Clinical Epidemiology, Basel, Switzerland
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology, Basel, Switzerland
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | - Luigia Elzi
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Hansjakob Furrer
- Division of Infectious Diseases, University Hospital Berne and University of Berne, Berne, Switzerland
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Zenhausern R, Simcock M, Gratwohl A, Hess U, Bargetzi M, Tobler A. Rituximab in patients with hairy cell leukemia relapsing after treatment with 2-chlorodeoxyadenosine (SAKK 31/98). Haematologica 2008; 93:1426-8. [DOI: 10.3324/haematol.11564] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Fux CA, Rauch A, Simcock M, Bucher HC, Hirschel B, Opravil M, Vernazza P, Cavassini M, Bernasconi E, Elzi L, Furrer H. Tenofovir use is associated with an increase in serum alkaline phosphatase in the Swiss HIV Cohort Study. Antivir Ther 2008; 13:1077-1082. [PMID: 19195333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Tenofovir (TDF) use has been associated with proximal renal tubulopathy, reduced calculated glomerular filtration rates (cGFR) and losses in bone mineral density. Bone resorption could result in a compensatory osteoblast activation indicated by an increase in serum alkaline phosphatase (sAP). A few small studies have reported a positive correlation between renal phosphate losses, increased bone turnover and sAP. METHODS We analysed sAP dynamics in patients initiating (n = 657), reinitiating (n = 361) and discontinuing (n = 73) combined antiretroviral therapy with and without TDF and assessed correlations with clinical and epidemiological parameters. RESULTS TDF use was associated with a significant increase of sAP from a median of 74 U/I (interquartile range 60-98) to a plateau of 99 U/I (82-123) after 6 months (P < 0.0001), with a prompt return to baseline upon TDF discontinuation. No change occurred in TDF-sparing regimes. Univariable and multivariable linear regression analyses revealed a positive correlation between sAP and TDF use (P < or = 0.003), but no correlation with baseline cGFR, TDF-related cGFR reduction, changes in serum alanine aminotransferase (sALT) or active hepatitis C. CONCLUSIONS We document a highly significant association between TDF use and increased sAP in a large observational cohort. The lack of correlation between TDF use and sALT suggests that the increase in sAP is because of the bone isoenzyme and indicates stimulated bone turnover. This finding, together with published data on TDF-related renal phosphate losses, this finding raises concerns that TDF use could result in osteomalacia with a loss in bone mineral density at least in a subset of patients. This potentially severe long-term toxicity should be addressed in future studies.
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Affiliation(s)
- Christoph A Fux
- Division of Infectious Diseases, University Hospital Berne and University of Berne, Berne, Switzerland.
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Fux CA, Simcock M, Wolbers M, Bucher HC, Hirschel B, Opravil M, Vernazza P, Cavassini M, Bernasconi E, Elzi L, Furrer H, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Fux C, Gorgievski M, Günthard H, Hirschel B, Hösli I, Kahlert C, Kaiser L, Karrer U, Keiser O, Kind C, Klimkait T, Ledergerber B, Martinez B, Müller N, Nadal D, Opravil M, Paccaud F, Pantaleo G, Perrin L, Piffaretti JC, Rauch A, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Tenofovir Use is associated with a Reduction in Calculated Glomerular Filtration Rates in the Swiss HIV Cohort Study. Antivir Ther 2007. [DOI: 10.1177/135965350701200812] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background A growing number of case reports have described tenofovir (TDF)-related proximal renal tubulopathy and impaired calculated glomerular filtration rates (cGFR). We assessed TDF-associated changes in cGFR in a large observational HIV cohort. Methods We compared treatment-naive patients or patients with treatment interruptions ≥12 months starting either a TDF-based combination antiretroviral therapy (cART) ( n=363) or a TDF-sparing regime ( n=715). The predefined primary endpoint was the time to a 10 ml/min reduction in cGFR, based on the Cockcroft-Gault equation, confirmed by a follow-up measurement at least 1 month later. In sensitivity analyses, secondary endpoints including calculations based on the modified diet in renal disease (MDRD) formula were considered. Endpoints were modelled using pre-specified covariates in a multiple Cox proportional hazards model. Results Two-year event-free probabilities were 0.65 (95% confidence interval [CI] 0.58–0.72) and 0.80 (95% CI 0.76–0.83) for patients starting TDF-containing or TDF-sparing cART, respectively. In the multiple Cox model, diabetes mellitus (hazard ratio [HR]=2.34 [95% CI 1.24–4.42]), higher baseline cGFR (HR=1.03 [95% CI 1.02–1.04] by 10 ml/min), TDF use (HR=1.84 [95% CI 1.35–2.51]) and boosted protease inhibitor use (HR=1.71 [95% CI 1.30–2.24]) significantly increased the risk for reaching the primary endpoint. Sensitivity analyses showed high consistency. Conclusion There is consistent evidence for a significant reduction in cGFR associated with TDF use in HIV-infected patients. Our findings call for a strict monitoring of renal function in long-term TDF users with tests that distinguish between glomerular dysfunction and proximal renal tubulopathy, a known adverse effect of TDF.
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Affiliation(s)
- Christoph A Fux
- Division of Infectious Diseases, University Hospital Berne, Berne, Switzerland
| | - Mathew Simcock
- Basel Institute for Clinical Epidemiology, Basel, Switzerland
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Marcel Wolbers
- Basel Institute for Clinical Epidemiology, Basel, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology, Basel, Switzerland
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | | | | | | | | | | | - Luigia Elzi
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Hansjakob Furrer
- Division of Infectious Diseases, University Hospital Berne, Berne, Switzerland
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - Ph Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
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Simcock M, Blasko M, Karrer U, Bertisch B, Pless M, Blumer L, Vora S, Robinson JO, Bernasconi E, Terziroli B, Moirandat-Rytz S, Furrer H, Hirschel B, Vernazza P, Sendi P, Rickenbach M, Bucher HC, Battegay M, Koller MT, Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Gorgievski M, Günthard H, Hirsch H, Hirschel B, Hösli IH, Kahlert C, Kaiser L, Karrer U, Kind C, Klimkait T, Ledergerber B, Martinetti G, Martinez B, uUller NM, Nadal D, Opravil M, Paccaud F, Pantaleo G, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. Treatment and Prognosis of AIDS-Related Lymphoma in the Era of Highly Active Antiretroviral Therapy: Findings from the Swiss HIV Cohort Study. Antivir Ther 2007. [DOI: 10.1177/135965350701200609] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To assess the characteristics of combination antiretroviral therapy (cART) administered concomitantly with chemotherapy and to establish prognostic determinants of patients with AIDS-related non-Hodgkin's lymphoma. Methods The study included 91 patients with AIDS-related non-Hodgkin's lymphoma from the Swiss HIV Cohort Study enrolled between January 1997 and October 2003, excluding lymphomas of the brain. We extracted AIDS-related non-Hodgkin's lymphoma- and HIV-specific variables at the time of lymphoma diagnosis as well as treatment changes over time from charts and from the Swiss HIV Cohort Study database. Cox regression analyses were performed to study predictors of overall and progression-free survival. Results During a median follow up of 1.6 years, 57 patients died or progressed. Thirty-five patients stopped chemotherapy prematurely (before the sixth cycle) usually due to disease progression; these patients had a shorter median survival than those who completed six or more cycles (14 versus 28 months). Interruptions of cART decreased from 35% before chemotherapy to 5% during chemotherapy. Factors associated with overall survival were CD4+ T-cell count (<100 cells/μl) (hazard ratio [HR] 2.95 [95% confidence interval (CI) 1.53–5.67], hepatitis C seropositivity (HR 2.39 [95% CI 1.01–5.67]), the international prognostic index score (HR 1.98–3.62 across categories) and Burkitt histological subtypes (HR 2.56 [95% CI 1.13–5.78]). Conclusions Interruptions of cART were usually not induced by chemotherapy. The effect of cART interruptions on AIDS-related non-Hodgkin's lymphoma prognosis remains unclear, however, hepatitis C seropositivity emerged as a predictor of death beyond the well-known international prognostic index score and CD4+ T-cell count.
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Affiliation(s)
- Mathew Simcock
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Monika Blasko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Urs Karrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Barbara Bertisch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland
| | - Miklos Pless
- Division of Oncology, University Hospital Basel, Switzerland
| | - Liisa Blumer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Samir Vora
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | | | | | | | | | - Hansjakob Furrer
- Division of Infectious Diseases, University Hospital Bern, Switzerland
| | - Bernard Hirschel
- Division of Infectious Diseases, University Hospital Geneva, Switzerland
| | | | - Pedram Sendi
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Martin Rickenbach
- Data Centre of the Swiss HIV Cohort Study, University Hospital Lausanne, Switzerland
| | - Heiner C Bucher
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Michael T Koller
- Basel Institute for Clinical Epidemiology, University Hospital Basel, Switzerland
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - Ph Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011-Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
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Laifer G, Widmer AF, Simcock M, Bassetti S, Trampuz A, Frei R, Tamm M, Battegay M, Fluckiger U. TB in a low-incidence country: differences between new immigrants, foreign-born residents and native residents. Am J Med 2007; 120:350-6. [PMID: 17398230 DOI: 10.1016/j.amjmed.2006.10.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 09/06/2006] [Accepted: 10/31/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND New immigrants and foreign-born residents add to the burden of pulmonary tuberculosis (TB) in low-incidence countries. The highest TB rates have been found among recent immigrants. Active screening programs are likely to change the clinical presentation of TB, but the extent of the difference between immigrant and resident populations has not been studied prospectively. METHODS Adult new immigrants were screened upon entry to 1 of 5 immigration centers in Switzerland. Immigrants with abnormal chest radiographs were enrolled and compared in a cohort study to consecutive admitted foreign-born residents from moderate-to-high incidence countries and native residents presenting with suspected TB. RESULTS Of 42,601 new immigrants screened, 112 had chest radiographs suspicious for TB. They were compared with foreign-born residents (n=118) and native residents (n=155) with suspected TB (n=385 patients included). Active TB was confirmed in 40.5% of all patients (immigrants 38.4%, foreign-born residents 50%, native residents 34.8%). Clinical signs and symptoms of TB and laboratory markers of inflammation were significantly less common in immigrants than in the other groups with normal results in >70%. The proportion of positive results on rapid testing to detect M. tuberculosis (MTB) in 3 respiratory specimens was significantly lower in immigrants (34.9% for acid-fast staining; 55.8% for polymerase chain reaction) compared with foreign-born residents (76.2% and 89.1%, respectively) and native residents (83.3% and 90.9%, respectively). Isoniazid resistance and multi-drug resistance were more prevalent in immigrants. CONCLUSION New immigrants with TB detected in a screening program are often asymptomatic and have a low yield of rapid diagnostic tests but are at higher risk for resistant MTB strains. Postmigration follow-up of pulmonary infiltrates is essential in order to control TB among immigrants, even in the absence of clinical and laboratory signs of infection.
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Affiliation(s)
- Gerd Laifer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland.
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Sendi P, Günthard HF, Simcock M, Ledergerber B, Schüpbach J, Battegay M. Cost-effectiveness of genotypic antiretroviral resistance testing in HIV-infected patients with treatment failure. PLoS One 2007; 2:e173. [PMID: 17245449 PMCID: PMC1769464 DOI: 10.1371/journal.pone.0000173] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2006] [Accepted: 12/22/2006] [Indexed: 11/19/2022] Open
Abstract
Background Genotypic antiretroviral resistance testing (GRT) in HIV infection with drug resistant virus is recommended to optimize antiretroviral therapy, in particular in patients with virological failure. We estimated the clinical effect, cost and cost-effectiveness of using GRT as compared to expert opinion in patients with antiretroviral treatment failure. Methods We developed a mathematical model of HIV disease to describe disease progression in HIV-infected patients with treatment failure and compared the incremental impact of GRT versus expert opinion to guide antiretroviral therapy. The analysis was conducted from the health care (discount rate 4%) and societal (discount rate 2%) perspective. Outcome measures included life-expectancy, quality-adjusted life-expectancy, health care costs, productivity costs and cost-effectiveness in US Dollars per quality-adjusted life-year (QALY) gained. Clinical and economic data were extracted from the large Swiss HIV Cohort Study and clinical trials. Results Patients whose treatment was optimized with GRT versus expert opinion had an increase in discounted life-expectancy and quality-adjusted life-expectancy of three and two weeks, respectively. Health care costs with and without GRT were $US 421,000 and $US 419,000, leading to an incremental cost-effectiveness ratio of $US 35,000 per QALY gained. In the analysis from the societal perspective, GRT versus expert opinion led to an increase in discounted life-expectancy and quality-adjusted life-expectancy of three and four weeks, respectively. Health care costs with and without GRT were $US 551,000 and $US 549,000, respectively. When productivity changes were included in the analysis, GRT was cost-saving. Conclusions GRT for treatment optimization in HIV-infected patients with treatment failure is a cost-effective use of scarce health care resources and beneficial to the society at large.
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Affiliation(s)
- Pedram Sendi
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
- Basel Institute for Clinical Epidemiology, Basel University Hospital, Basel, Switzerland
- * To whom correspondence should be addressed. E-mail: (PS); (MB)
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, Zurich University Hospital, Zurich, Switzerland
| | - Mathew Simcock
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
- Basel Institute for Clinical Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, Zurich University Hospital, Zurich, Switzerland
| | - Jörg Schüpbach
- Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
- * To whom correspondence should be addressed. E-mail: (PS); (MB)
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Fux CA, Simcock M, Wolbers M, Bucher HC, Hirschel B, Opravil M, Vernazza P, Cavassini M, Bernasconi E, Elzi L, Furrer H. Tenofovir use is associated with a reduction in calculated glomerular filtration rates in the Swiss HIV Cohort Study. Antivir Ther 2007; 12:1165-1173. [PMID: 18240857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND A growing number of case reports have described tenofovir (TDF)-related proximal renal tubulopathy and impaired calculated glomerular filtration rates (cGFR). We assessed TDF-associated changes in cGFR in a large observational HIV cohort. METHODS We compared treatment-naive patients or patients with treatment interruptions > or = 12 months starting either a TDF-based combination antiretroviral therapy (cART) (n = 363) or a TDF-sparing regime (n = 715). The predefined primary endpoint was the time to a 10 ml/min reduction in cGFR, based on the Cockcroft-Gault equation, confirmed by a follow-up measurement at least 1 month later. In sensitivity analyses, secondary endpoints including calculations based on the modified diet in renal disease (MDRD) formula were considered. Endpoints were modelled using pre-specified covariates in a multiple Cox proportional hazards model. RESULTS Two-year event-free probabilities were 0.65 (95% confidence interval [CI] 0.58-0.72) and 0.80 (95% CI 0.76-0.83) for patients starting TDF-containing or TDF-sparing cART, respectively. In the multiple Cox model, diabetes mellitus (hazard ratio [HR] = 2.34 [95% CI 1.24-4.42]), higher baseline cGFR (HR = 1.03 [95% CI 1.02-1.04] by 10 ml/min), TDF use (HR = 1.84 [95% CI 1.35-2.51]) and boosted protease inhibitor use (HR = 1.71 [95% CI 1.30-2.24]) significantly increased the risk for reaching the primary endpoint. Sensitivity analyses showed high consistency. CONCLUSION There is consistent evidence for a significant reduction in cGFR associated with TDF use in HIV-infected patients. Our findings call for a strict monitoring of renal function in long-term TDF users with tests that distinguish between glomerular dysfunction and proximal renal tubulopathy, a known adverse effect of TDF.
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Affiliation(s)
- Christoph A Fux
- Division of Infectious Diseases, University Hospital Berne, Berne, Switzerland.
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Simcock M, Blasko M, Karrer U, Bertisch B, Pless M, Blumer L, Vora S, Robinson JO, Bernasconi E, Terziroli B, Moirandat-Rytz S, Furrer H, Hirschel B, Vernazza P, Sendi P, Rickenbach M, Bucher HC, Battegay M, Koller MT. Treatment and prognosis of AIDS-related lymphoma in the era of highly active antiretroviral therapy: findings from the Swiss HIV Cohort Study. Antivir Ther 2007; 12:931-939. [PMID: 17926647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess the characteristics of combination antiretroviral therapy (cART) administered concomitantly with chemotherapy and to establish prognostic determinants of patients with AIDS-related non-Hodgkin's lymphoma. METHODS The study included 91 patients with AIDS-related non-Hodgkin's lymphoma from the Swiss HIV Cohort Study enrolled between January 1997 and October 2003, excluding lymphomas of the brain. We extracted AIDS-related non-Hodgkin's lymphoma- and HIV-specific variables at the time of lymphoma diagnosis as well as treatment changes over time from charts and from the Swiss HIV Cohort Study database. Cox regression analyses were performed to study predictors of overall and progression-free survival. RESULTS During a median follow up of 1.6 years, 57 patients died or progressed. Thirty-five patients stopped chemotherapy prematurely (before the sixth cycle) usually due to disease progression; these patients had a shorter median survival than those who completed six or more cycles (14 versus 28 months). Interruptions of cART decreased from 35% before chemotherapy to 5% during chemotherapy. Factors associated with overall survival were CD4+ T-cell count (<100 cells/microl) (hazard ratio [HR] 2.95 [95% confidence interval (CI) 1.53-5.67], hepatitis C seropositivity (HR 2.39 [95% CI 1.01-5.67]), the international prognostic index score (HR 1.98-3.62 across categories) and Burkitt histological subtypes (HR 2.56 [95% CI 1.13-5.78]). CONCLUSIONS Interruptions of cART were usually not induced by chemotherapy. The effect of cART interruptions on AIDS-related non-Hodgkin's lymphoma prognosis remains unclear, however, hepatitis C seropositivity emerged-as a predictor of death beyond the well-known international prognostic index score and CD4+ T-cell count.
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Affiliation(s)
- Mathew Simcock
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
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Battegay M, Bernasconi E, Böni J, Bucher H, Bürgisser P, Cattacin S, Cavassini M, Dubs R, Egger M, Elzi L, Erb P, Fischer M, Flepp M, Fontana A, Francioli P, Furrer H, Gorgievski M, Günthard H, Hirschel B, Hösli I, Kahlert C, Kaiser L, Karrer U, Keiser O, Kind C, Klimkait T, Ledergerber B, Martinez B, Müller N, Nadal D, Opravil M, Paccaud F, Pantaleo G, Perrin L, Bijker JC, Rickenbach M, Rudin C, Schmid P, Schultze D, Schüpbach J, Speck R, Taffé P, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S, Elzi L, Spoerl D, Voggensperger J, Nicca D, Simcock M, Bucher HC, Spirig R, Battegay M. A Smoking Cessation Programme in HIV-Infected Individuals: A Pilot Study. Antivir Ther 2006. [DOI: 10.1177/135965350601100611] [Citation(s) in RCA: 19] [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] [Indexed: 12/21/2022]
Abstract
Background Antiretroviral therapy (ART) is a risk factor for cardiovascular disease (CVD) and smoking the most important modifiable cardiovascular risk factor. Methods We prospectively evaluated a smoking cessation programme (SCP) in HIV-infected individuals (intervention: counselling and nicotine replacement therapy). Primary endpoint was the smoking cessation rate at 12 months; secondary endpoints were CVD morbidity and mortality. Controls were a not randomized control group of smokers not participating in the SCP. Results Four-hundred and seventeen of 680 (61%) patients were smokers, and 34 of these participated in the SCP. Of these 34 individuals, 82% were male, the median age was 43 years, prior AIDS was recorded in 29%, and depressive disorder was recorded in 18%. Twenty-five (74%) patients were receiving ART. Additional risk factors were dyslipidaemia (68%), a prior cardiovascular event (24%), hypertension (15%), and a family history of CVD in 2/34 (6%) individuals. According to the Framingham equation, the 10-year risk of CVD was higher in SCP participants than in controls (11.2% versus 8.5%, P=0.06). At termination of the SCP, 17/34 (50%) individuals had stopped smoking compared with 57/383 (15%) controls. Self-reported smoking abstinence for ≥12 months was 13/34 (38%) in the intervention group and 27/383 (7%) in the control group (odds ration 6.2, 95% confidence interval 2.8–14.3). During the follow-up, two SCP participants and 4 controls experienced a myocardial infarction. One patient in the control group died of CVD. Conclusions SCP in HIV-infected individuals is feasible and should be encouraged. The long-term impact of smoking cessation on CVD morbidity and mortality should be evaluated in comparative trials.
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Affiliation(s)
| | - M Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - E Bernasconi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - J Böni
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Bucher
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Bürgisser
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - S Cattacin
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Cavassini
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - R Dubs
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Egger
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - L Elzi
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Erb
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Fischer
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - M Flepp
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - A Fontana
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
| | - H Furrer
- Chairman of the Clinical and Laboratory Committee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | - P Schmid
- Chairman of the Scientific Board
| | | | | | - R Speck
- Chairman of the Scientific Board
| | - P Taffé
- Chairman of the Scientific Board
| | - P Tarr
- Chairman of the Scientific Board
| | | | - A Trkola
- Chairman of the Scientific Board
| | | | - R Weber
- Chairman of the Scientific Board
| | - S Yerly
- Chairman of the Scientific Board
| | - Luigia Elzi
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
| | - David Spoerl
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
| | - Jacqueline Voggensperger
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
- Outpatient Department of Internal Medicine, University Hospital Basel
| | - Dunja Nicca
- Outpatient Department of Internal Medicine, University Hospital Basel
- Institute of Nursing Sciences, University of Basel
| | - Mathew Simcock
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
- Basel Institute for Clinical Epidemiology, University Hospital Basel
| | - Heiner C Bucher
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel
- Basel Institute for Clinical Epidemiology, University Hospital Basel
| | | | - Manuel Battegay
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011- Lausanne
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Simcock M, Sendi P, Ledergerber B, Keller T, Schüpbach J, Battegay M, Günthard HF, Backmann S, Battegay M, Bernasconi E, Bucher H, Bürgisser P, Egger M, Erb P, Fierz W, Fischer M, Flepp M, Francioli P, Furrer HJ, Gorgievski M, Günthard H, Grob P, Hirschel B, Kaiser L, Kind C, Klimkait T, Ledergerber B, Lauper U, Nadal D, Opravil M, Paccaud F, Pantaleo G, Perrin L, Piffaretti JC, Rickenbach M, Rudin C, Schüpbach J, Speck R, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S. A Longitudinal Analysis of Healthcare Costs after Treatment Optimization following Genotypic Antiretroviral Resistance Testing: Does Resistance Testing pay off? Antivir Ther 2006. [DOI: 10.1177/135965350601100305] [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: 11/17/2022]
Abstract
Objective To assess the impact of antiretroviral therapy optimized by genotypic antiretroviral resistance testing (GRT) on healthcare costs over a 2-year period in patients after antiretroviral treatment failure. Study design Non-randomized, prospective, tertiary care, clinic-based study. Patients One-hundred and forty-two HIV patients enrolled in the ‘ZIEL’ study and the Swiss HIV Cohort Study who experienced virological treatment failure. Methods For all patients GRT was used to optimize the antiretroviral treatment regimen. All healthcare costs during 2 years following GRT were assessed using micro-costing. Costs were separated into ART medication costs and healthcare costs other than ART medication (that is, non-ART medication costs, in-patient costs and ambulatory [out-patient] costs). These cost estimates were then split into four consecutive 6-month periods (period 1–4) and the accumulated cost for each period was calculated. Univariate and multivariate regression modelling techniques for repeated measurements were applied to assess the changes of healthcare costs over time and factors associated with healthcare costs following GRT. Results Overall healthcare costs after GRT decreased over time and were significantly higher in period 1 (32%; 95% confidence interval [CI]: 18–47) compared with period 4. ART medication costs significantly increased by 1,017 (95% CI: 22–2,014) Swiss francs (CHF) from period 1–4, whereas healthcare costs other than ART medication costs decreased substantially by a factor of 3.1 (95% CI: 2.6–3.7) from period 1 to period 4. Factors mostly influencing healthcare costs following GRT were AIDS status, costs being 15% (95% CI: 6–24) higher in patients with AIDS compared with patients without AIDS, and baseline viral load, costs being 12% (95% CI: 6–17) higher in patients with each log increase in plasma RNA. Conclusions Optimized antiretroviral treatment regimens following GRT lead to a reduction of healthcare costs in patients with treatment failure over 2 years. Patients in a worse health state (that is, a positive AIDS status and high baseline viral load) will experience higher overall costs.
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Affiliation(s)
- Mathew Simcock
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital, Basel, Switzerland
| | - Pedram Sendi
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
- Basel Institute for Clinical Epidemiology, University Hospital, Basel, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, Zurich University Hospital, Zurich, Switzerland
| | - Tamara Keller
- Division of Infectious Diseases and Hospital Epidemiology, Zurich University Hospital, Zurich, Switzerland
| | - Jörg Schüpbach
- Swiss National Center for Retroviruses, University of Zurich, Zurich, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, Zurich University Hospital, Zurich, Switzerland
| | - S Backmann
- Chairman of the Clinical and Laboratory Committee
| | - M Battegay
- Chairman of the Clinical and Laboratory Committee
| | - E Bernasconi
- Chairman of the Clinical and Laboratory Committee
| | - H Bucher
- Chairman of the Clinical and Laboratory Committee
| | - Ph Bürgisser
- Chairman of the Clinical and Laboratory Committee
| | - M Egger
- Chairman of the Clinical and Laboratory Committee
| | - P Erb
- Chairman of the Clinical and Laboratory Committee
| | - W Fierz
- Chairman of the Clinical and Laboratory Committee
| | - M Fischer
- Chairman of the Clinical and Laboratory Committee
| | - M Flepp
- Chairman of the Clinical and Laboratory Committee
| | - P Francioli
- President of the SHCS, Centre Hospitalier Universitaire Vaudois, CH-1011, Lausanne
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - C Rudin
- Chairman of the Mother & Child Substudy
| | | | - R Speck
- Chairman of the Scientific Borad
| | | | - A Trkola
- Chairman of the Scientific Borad
| | | | - R Weber
- Chairman of the Scientific Borad
| | - S Yerly
- Chairman of the Scientific Borad
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Simcock M, Sendi P, Ledergerber B, Keller T, Schüpbach J, Battegay M, Günthard HF. A longitudinal analysis of healthcare costs after treatment optimization following genotypic antiretroviral resistance testing: does resistance testing pay off? Antivir Ther 2006; 11:305-14. [PMID: 16759046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To assess the impact of antiretroviral therapy optimized by genotypic antiretroviral resistance testing (GRT) on healthcare costs over a 2-year period in patients after antiretroviral treatment failure. STUDY DESIGN Non-randomized, prospective, tertiary care, clinic-based study. PATIENTS One-hundred and forty-two HIV patients enrolled in the 'ZIEL' study and the Swiss HIV Cohort Study who experienced virological treatment failure. METHODS For all patients GRT was used to optimize the antiretroviral treatment regimen. All healthcare costs during 2 years following GRT were assessed using microcosting. Costs were separated into ART medication costs and healthcare costs other than ART medication (that is, non-ART medication costs, in-patient costs and ambulatory [out-patient] costs). These cost estimates were then split into four consecutive 6-month periods (period 1-4) and the accumulated cost for each period was calculated. Univariate and multivariate regression modelling techniques for repeated measurements were applied to assess the changes of healthcare costs over time and factors associated with healthcare costs following GRT. RESULTS Overall healthcare costs after GRT decreased over time and were significantly higher in period 1 (32%; 95% confidence interval [Cl]: 18-47) compared with period 4. ART medication costs significantly increased by 1,017 (95% Cl: 22-2,014) Swiss francs (CHF) from period 1-4, whereas healthcare costs other than ART medication costs decreased substantially by a factor of 3.1 (95% Cl: 2.6-3.7) from period 1 to period 4. Factors mostly influencing healthcare costs following GRT were AIDS status, costs being 15% (95% Cl: 6-24) higher in patients with AIDS compared with patients without AIDS, and baseline viral load, costs being 12% (95% Cl: 6-17) higher in patients with each log increase in plasma RNA. CONCLUSIONS Optimized antiretroviral treatment regimens following GRT lead to a reduction of healthcare costs in patients with treatment failure over 2 years. Patients in a worse health state (that is, a positive AIDS status and high baseline viral load) will experience higher overall costs.
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Affiliation(s)
- Mathew Simcock
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
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Elzi L, Spoerl D, Voggensperger J, Nicca D, Simcock M, Bucher HC, Spirig R, Battegay M. A smoking cessation programme in HIV-infected individuals: a pilot study. Antivir Ther 2006; 11:787-95. [PMID: 17310823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Antiretroviral therapy (ART) is a risk factor for cardiovascular disease (CVD) and smoking the most important modifiable cardiovascular risk factor. METHODS We prospectively evaluated a smoking cessation programme (SCP) in HIV-infected individuals (intervention: counselling and nicotine replacement therapy). Primary endpoint was the smoking cessation rate at 12 months; secondary endpoints were CVD morbidity and mortality. Controls were a not randomized control group of smokers not participating in the SCP. RESULTS Four-hundred and seventeen of 680 (61%) patients were smokers, and 34 of these participated in the SCP. Of these 34 individuals, 82% were male, the median age was 43 years, prior AIDS was recorded in 29%, and depressive disorder was recorded in 18/%. Twenty-five (74%) patients were receiving ART. Additional risk factors were dyslipidaemia (68%), a prior cardiovascular event (24%), hypertension (1 5%), and a family history of CVD in 2/34 (6%) individuals. According to the Framingham equation, the 10-year risk of CVD was higher in SCP participants than in controls (11.2% versus 8.5%, P=0.06). At termination of the SCP, 17/34 (50%) individuals had stopped smoking compared with 57/383 (15%) controls. Self-reported smoking abstinence for a12 months was 13/34 (38%) in the intervention group and 27/383 (7%) in the control group (odds ration 6.2, 95% confidence interval 2.8-14.3). During the follow-up, two SCP participants and 4 controls experienced a myocardial infarction. One patient in the control group died of CVD. CONCLUSIONS SCP in HIV-infected individuals is feasible and should be encouraged. The long-term impact of smoking cessation on CVD morbidity and mortality should be evaluated in comparative trials.
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Affiliation(s)
- Luigia Elzi
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel
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Weisser M, Rausch C, Droll A, Simcock M, Sendi P, Steffen I, Buitrago C, Sonnet S, Gratwohl A, Passweg J, Fluckiger U. Galactomannan does not precede major signs on a pulmonary computerized tomographic scan suggestive of invasive aspergillosis in patients with hematological malignancies. Clin Infect Dis 2005; 41:1143-9. [PMID: 16163633 DOI: 10.1086/444462] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Accepted: 06/02/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Detection of serum galactomannan (GM) antigen and presence of the halo sign on a pulmonary computerized tomographic (CT) scan have a high specificity but a low sensitivity to diagnose invasive aspergillosis (IA) in patients at risk for this disease. To our knowledge, the relationship between the time at which pulmonary infiltrates are detected by CT and the time at which GM antigens are detected by enzyme immunoassay (EIA) has not been studied. METHODS In a prospective study, tests for detection of GM were performed twice weekly for patients with hematological malignancies who had undergone hematopoetic stem cell transplantation (HSCT) or had received induction and/or consolidation chemotherapy. A pulmonary CT scan was performed once weekly. Infiltrates were defined as either major or minor signs. IA was classified as proven, probable, or possible, in accordance with the definition stated by the European Organization for Research and Treatment of Cancer-Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group. RESULTS We analyzed 161 episodes of infection in 107 patients (65 allogeneic HSCT recipients, 30 autologous HSCT recipients, and 66 induction and/or consolidation chemotherapy recipients). A total of 109 episodes with no IA, 32 episodes with possible IA, and 20 episodes with probable or proven IA were identified. Minor pulmonary signs were detected by CT in 70 episodes (43%), and major pulmonary signs were detected by CT in 11 episodes (7%). Univariate and multivariate analyses revealed no significant association between detection of GM by EIA and detection of abnormal pulmonary signs by CT. A significant association was found between GM levels and receipt of piperacillin-tazobactam. GM test results were not positive before major signs were seen on CT images. Only 7 (10%) of 70 patients with minor pulmonary signs had positive GM test results before detection of the greatest pathologic change by CT. CONCLUSIONS We show that detection of GM by EIA does not precede detection of major lesions by pulmonary CT. In the clinical setting, the decision to administer mold-active treatment should based on detection of new pulmonary infiltrates on CT performed early during infection, rather than on results of EIA for detection of GM.
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Affiliation(s)
- M Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel, Switzerland
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