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Westermann A, Ottevanger P, Reyners A, Kroep JR, Van Oijen MGH, Lalisang R, Witteveen PO. PAZEC: a Dutch Gynaecological Oncology Group open-label, multicenter, phase II study of pazopanib in metastatic and locally advanced hormone-resistant endometrial cancer. Int J Gynecol Cancer 2024:ijgc-2023-004781. [PMID: 38184318 DOI: 10.1136/ijgc-2023-004781] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE There is a continued need for improvement of second-line systemic treatment for metastatic and/or recurrent endometrial cancer. METHODS In this phase II, open-label study, eligible patients had histologically or cytologically confirmed endometrial cancer, documented progressive disease, and a WHO performance status of ≤2. All participants received treatment with pazopanib 800 mg once daily until progression, unacceptable toxicity, or patient refusal. The primary endpoint was progression-free survival at 3 months, with secondary outcomes of overall response rate, progression-free survival, overall survival, and toxicity. The study was powered to demonstrate 50% progression-free survival at 3 months with α=0.05 and β=80%. RESULTS Between January 2011 and February 2016, 60 eligible patients were included (intention-to-treat population). Median age was 68 (range, 53-85) years. Previous treatment included pelvic radiotherapy (58%), chemotherapy (90%), and hormonal therapy (43%). Three-month progression-free survival was 63.3% in the intention-to-treat population, with median progression-free survival and overall survival of 3.4 and 7.5 months, respectively. Overall response rate was 8.3%, and median follow-up 7.6 months. The most common grade 3 or higher adverse events were gastrointestinal toxicity in 21% of participants, including two patients with a gut perforation, one fatal gastrointestinal hemorrhage, one enterocutaneous fistula, and one fatal enterovaginal fistula. Extensive peritoneal disease existed in 80% of the patients with severe gastrointestinal toxicity. A definite correlation with previous radiotherapy could not be established. CONCLUSIONS Pazopanib met its primary endpoint of 3 months' progression-free survival in advanced endometrial cancer (63.3%), but response rates were modest. There may be a correlation for rare but severe gastrointestinal toxicity with previous treatments and/or disease site that has yet to be elucidated.
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Affiliation(s)
- Anneke Westermann
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Petronella Ottevanger
- Dutch Gynaecological Oncology Group (DGOG) and Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - An Reyners
- University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Judith R Kroep
- DGOG and Department of Medical Oncology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | | | - Roy Lalisang
- Internal Medicine/Medical Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Embaby A, Kutzera J, Geenen JJ, Pluim D, Hofland I, Sanders J, Lopez-Yurda M, Beijnen JH, Huitema ADR, Witteveen PO, Steeghs N, van Haaften G, van Vugt MATM, de Ridder J, Opdam FL. WEE1 inhibitor adavosertib in combination with carboplatin in advanced TP53 mutated ovarian cancer: A biomarker-enriched phase II study. Gynecol Oncol 2023; 174:239-246. [PMID: 37236033 DOI: 10.1016/j.ygyno.2023.05.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE In the first part of this phase II study (NCT01164995), the combination of carboplatin and adavosertib (AZD1775) was shown to be safe and effective in patients with TP53 mutated platinum-resistant ovarian cancer (PROC). Here, we present the results of an additional safety and efficacy cohort and explore predictive biomarkers for resistance and response to this combination treatment. METHODS This is a phase II, open-label, non-randomized study. Patients with TP53 mutated PROC received carboplatin AUC 5 mg/ ml·min intravenously and adavosertib 225 mg BID orally for 2.5 days in a 21-day cycle. The primary objective is to determine the efficacy and safety of carboplatin and adavosertib. Secondary objectives include progression-free survival (PFS), changes in circulating tumor cells (CTC) and exploration of genomic alterations. RESULTS Thirty-two patients with a median age of 63 years (39-77 years) were enrolled and received treatment. Twenty-nine patients were evaluable for efficacy. Bone marrow toxicity, nausea and vomiting were the most common adverse events. Twelve patients showed partial response (PR) as best response, resulting in an objective ORR of 41% in the evaluable patients (95% CI: 23%-61%). The median PFS was 5.6 months (95% CI: 3.8-10.3). In patients with tumors harboring CCNE1 amplification, treatment efficacy was slightly but not significantly better. CONCLUSIONS Adavosertib 225 mg BID for 2.5 days and carboplatin AUC 5 could be safely combined and showed anti-tumor efficacy in patients with PROC. However, bone marrow toxicity remains a point of concern, since this is the most common reason for dose reductions and dose delays.
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Affiliation(s)
- Alaa Embaby
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - Joachim Kutzera
- Department of Genetics, Utrecht University, Utrecht, the Netherlands
| | - Jill J Geenen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Dick Pluim
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ingrid Hofland
- Core Facility Molecular Pathology & Biobanking, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Joyce Sanders
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marta Lopez-Yurda
- Biometrics Department, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jos H Beijnen
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Pharmacy, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alwin D R Huitema
- Department of Clinical Pharmacology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Pharmacy, The Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gijs van Haaften
- Department of Genetics, Utrecht University, Utrecht, the Netherlands
| | - Marcel A T M van Vugt
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeroen de Ridder
- Center for Molecular Medicine and Oncode Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans L Opdam
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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Koldenhof JJ, van der Baan FH, Verberne EG, Kamphuis AM, Verheijden RJ, Tonk EH, van Lindert AS, van der Stap J, Teunissen SC, Witteveen PO, Suijkerbuijk KP. Patient-Reported Outcomes During Checkpoint Inhibition: Insight into Symptom Burden in Daily Clinical Practice. J Pain Symptom Manage 2022; 63:997-1005. [PMID: 35196557 DOI: 10.1016/j.jpainsymman.2022.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022]
Abstract
CONTEXT While praised for inducing durable anti-tumour responses, immune checkpoint inhibitors (ICI) also cause immune-related adverse events (irAEs) that can vary in severity and affect health-related quality of life (HRQL). OBJECTIVES This study was performed to provide insight into the course of symptoms and the influence of irAEs on HRQL measured with the treatment-specific Utrecht Symptom Diary Immunotherapy (USD-I). METHODS In this observational cohort study, melanoma or non-small lung cancer (NSCLC) patients treated with PD(L)1-inhibitors between February 2016 and December 2018 were included. Data on symptoms, wellbeing and influence of side effects on HRQL were obtained using the patient-scored, treatment-specific USD-I, which was completed as part of routine care. Patients scored symptom intensity on a 0-10 numeric rating scale (NRS); NRS≥3 considered clinically relevant. RESULTS A total of 162 melanoma (55%) or NSCLC (45%) patients completed 1493 USDs (median seven per patient). Most common patient-reported clinically relevant symptoms were: inactivity, fatigue, pain, cough and sleeping problems. Symptom prevalence decreased during treatment. Patients generally reported a low influence of side effects on HRQL. A higher number of clinically relevant symptoms at a certain time point correlated with poorer wellbeing. CONCLUSIONS These data illustrate that ICI-treatment is generally well tolerated. However, especially the number of clinically relevant symptoms can impact patients wellbeing. Systematic use of an ICI-tailored PROM could create a window to discuss symptoms in a structured way which may promote personalized care during treatment.
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Affiliation(s)
- Josephine J Koldenhof
- Department of Medical Oncology (J.J.K., E.G.V., A.M.K, R.J.V., E.H.T., P.O.W., K.P.S.), University Medical Center Utrecht, University Utrecht, The Netherlands.
| | - Frederieke H van der Baan
- Center of Expertise in Palliative Care (F.H.B., S.C.T.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Elisabeth G Verberne
- Department of Medical Oncology (J.J.K., E.G.V., A.M.K, R.J.V., E.H.T., P.O.W., K.P.S.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Annemarleen M Kamphuis
- Department of Medical Oncology (J.J.K., E.G.V., A.M.K, R.J.V., E.H.T., P.O.W., K.P.S.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Rik J Verheijden
- Department of Medical Oncology (J.J.K., E.G.V., A.M.K, R.J.V., E.H.T., P.O.W., K.P.S.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Erwin H Tonk
- Department of Medical Oncology (J.J.K., E.G.V., A.M.K, R.J.V., E.H.T., P.O.W., K.P.S.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Anne S van Lindert
- Department of Pulmonary Diseases (A.S.L, J.S.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Janneke van der Stap
- Department of Pulmonary Diseases (A.S.L, J.S.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Saskia C Teunissen
- Center of Expertise in Palliative Care (F.H.B., S.C.T.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology (J.J.K., E.G.V., A.M.K, R.J.V., E.H.T., P.O.W., K.P.S.), University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Karjin P Suijkerbuijk
- Department of Medical Oncology (J.J.K., E.G.V., A.M.K, R.J.V., E.H.T., P.O.W., K.P.S.), University Medical Center Utrecht, University Utrecht, The Netherlands
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Bruijnen CP, Koldenhof JJ, Verheijden RJ, van den Bos F, Emmelot-Vonk MH, Witteveen PO, Suijkerbuijk KPM. Frailty and checkpoint inhibitor toxicity in older patients with melanoma. Cancer 2022; 128:2746-2752. [PMID: 35439334 PMCID: PMC9325486 DOI: 10.1002/cncr.34230] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 12/19/2022]
Abstract
Background Immune checkpoint inhibitors (ICIs) can cause immune‐related adverse events (irAEs) that range from mild to life‐threatening. Age itself does not seem to be a predictor for the occurrence of irAEs. It is unknown whether frailty plays a role in the occurrence of irAEs. Therefore, the authors assessed whether irAEs and their sequelae occur more often in frail patients than in fit patients according to the Geriatric 8 (G8) assessment. Methods Patients with melanoma aged 70 years and older who were about to start ICI therapy and were screened with the G8 assessment were enrolled in this prospective, observational study. Patients were classified by the G8 as either fit or frail. The primary outcome was the occurrence of grade ≥3 irAEs. Results In total, 92 patients were included for statistical analyses, 26 (29%) of whom were classified as frail. Grade ≥3 irAEs occurred in 20% of patients. There was no significant difference in the occurrence of grade ≥3 irAEs between fit and frail patients (17% vs 27%; P = .26). Frail patients were admitted to the hospital because of irAEs significantly more often than fit patients (29% vs 54%; P = .02) and showed a trend toward increased length of hospitalization (5 vs 8 days; P = .06) and more frequent use of immunosuppressants or ICI discontinuation for irAEs (36% vs 58%; P = .06). Conclusions Although frailty appears to be unrelated to the occurrence of severe irAEs, it is an indicator of irAE‐related adverse sequelae, such as hospital admission. Screening for frailty can be of added value in the shared decision‐making process for older patients who qualify for ICI treatment. Frailty screening with the Geriatric 8 (G8) was used as a guide for making individualized treatment decisions. Frailty according to the G8 was associated with sequelae of immune‐related adverse events, such as hospitalizations and visits to the emergency department.
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Affiliation(s)
- Cheryl P Bruijnen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - José J Koldenhof
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rik J Verheijden
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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Melis EJ, Zwart-van Rijkom JE, Egberts TC, van den Bemt BJ, Witteveen PO, Gardarsdottir H. The association between patient satisfaction with information and adherence to oral anticancer agents. J Oncol Pharm Pract 2022; 29:637-645. [PMID: 35130094 DOI: 10.1177/10781552221077258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Adherence to anticancer agents is a critical factor in achieving adequate clinical response, and became a major challenge for patients and caregivers since the increased substitution of parenteral cytostatic by oral drugs. One of the factors that influences adherence is how well informed patients are about their therapy. This study assesses the association between patient satisfaction with information about oral anticancer agents and adherence. MATERIALS AND METHODS This study was conducted among patients (≥18 years) who began oral anticancer therapy. Patients satisfaction with information and adherence were assessed using validated questionnaires. Adherence was also assessed using refill data. Logistic regression was applied to assess the association between overall patient satisfaction with information and both self-reported adherence and adherence based on an MPR value of above 80%. RESULTS In total, 124 patients were included in the study. The median (IQR) satisfaction with information was 15.0(4) on a scale of 0-17. Eighty-two percent of participants reported adherence, while the refill data demonstrated that 64.5% of patients had an adherence rate of 80% or higher. Overall satisfaction with information was not significantly associated with self-reported adherence (OR adj 0.98 [95% CI 0.85-1.15]) or refill-based adherence (OR adj 1.11 [95% CI 0.99-1.24]). CONCLUSION The findings indicate no significant relationship between patient satisfaction with information and adherence. The population was highly satisfied with information about the oral anticancer agents, which indicates a high level of satisfaction with usual care. However, the refill data reveals that 35.5% of patients were not adherent.
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Affiliation(s)
- Eward J Melis
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Toine Cg Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmaco-epidemiology and Clinical Pharmacology, 534214Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Bart Jf van den Bemt
- Department of Pharmacy, 6033Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Pharmaco-epidemiology and Clinical Pharmacology, 534214Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Bruijnen CP, de Groot LGR, Vondeling AM, de Bree R, van den Bos F, Witteveen PO, Emmelot-Vonk MH. Functional decline after surgery in older patients with head and neck cancer. Oral Oncol 2021; 123:105584. [PMID: 34742007 DOI: 10.1016/j.oraloncology.2021.105584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION In addition to classical endpoints such as survival and complication rates, other outcomes such as quality of life and functional status are increasingly recognized as important endpoints, especially for elderly patients. However, little is known about the long-term effect of surgery with regard to these other outcomes. Our aim is to investigate the functional status and self-reported health status of patients ≥ 70 years one year after surgery for head and neck cancer. METHODS We present one-year follow-up data of patients ≥ 70 year who underwent surgery for HNC. During an interview by telephone, functional status was evaluated by using the Katz-15 Index of Independence questionnaire including six items covering basic Activities of Daily Living (ADL) and nine items covering Instrumental Activities of Daily Living (IADL). Measurements were compared with those obtained preoperatively. RESULTS In total, 126 patients were included and eventually we collected follow-up data of 68 patients. There was a statistically significant decrease in functional status on the total Katz-15 and on the IADL questionnaire scores one year after surgery (mean 1.34 versus 2.42,p-value 0.00 and mean 1.21 versus 1.94,p-value 0.00). There was no significant change concerning ADL dependence (p-value 0.18) and cognitive status (p-value 0.11). The self-reported health status improved postoperatively, although not statistically significantly so (mean 67.36 versus 71.25,p-value 0.12). CONCLUSION Approximately-one year after surgery for HNC, there is a significant decline in functional status indicating a higher level of dependency.
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Affiliation(s)
- Cheryl P Bruijnen
- The department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Lotte G R de Groot
- The department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ariel M Vondeling
- The department of Geriatrics, Diakonessenhuis, Utrecht, the Netherlands
| | - Remco de Bree
- The department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frederiek van den Bos
- The department of Geriatrics, Leids University Medical Center, Leiden, the Netherlands
| | - Petronella O Witteveen
- The department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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van Weelden WJ, Lalisang RI, Bulten J, Lindemann K, van Beekhuizen HJ, Trum H, Boll D, Werner HM, van Lonkhuijzen LR, Yigit R, Forsse D, Witteveen PO, Galaal K, van Ginkel A, Bignotti E, Weinberger V, Sweegers S, Kroep JR, Cabrera S, Snijders MP, Inda MA, Eriksson AGZ, Krakstad C, Romano A, van de Stolpe A, Pijnenborg JM, Pijnenborg JMA. Impact of hormonal biomarkers on response to hormonal therapy in advanced and recurrent endometrial cancer. Am J Obstet Gynecol 2021; 225:407.e1-407.e16. [PMID: 34019887 DOI: 10.1016/j.ajog.2021.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/02/2021] [Accepted: 05/08/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Approximately 20% of women with endometrial cancer have advanced-stage disease or suffer from a recurrence. For these women, prognosis is poor, and palliative treatment options include hormonal therapy and chemotherapy. Lack of predictive biomarkers and suboptimal use of existing markers for response to hormonal therapy have resulted in overall limited efficacy. OBJECTIVE This study aimed to improve the efficacy of hormonal therapy by relating immunohistochemical expression of estrogen and progesterone receptors and estrogen receptor pathway activity scores to response to hormonal therapy. STUDY DESIGN Patients with advanced or recurrent endometrial cancer and available biopsies taken before the start of hormonal therapy were identified in 16 centers within the European Network for Individualized Treatment in Endometrial Cancer and the Dutch Gynecologic Oncology Group. Tumor tissue was analyzed for estrogen and progesterone receptor expressions and estrogen receptor pathway activity using a quantitative polymerase chain reaction-based messenger RNA model to measure the activity of estrogen receptor-related target genes in tumor RNA. The primary endpoint was response rate defined as complete and partial response using the Response Evaluation Criteria in Solid Tumors. The secondary endpoints were clinical benefit rate and progression-free survival. RESULTS Pretreatment biopsies with sufficient endometrial cancer tissue and complete response evaluation were available in 81 of 105 eligible cases. Here, 22 of 81 patients (27.2%) with a response had estrogen and progesterone receptor expressions of >50%, resulting in a response rate of 32.3% (95% confidence interval, 20.9-43.7) for an estrogen receptor expression of >50% and 50.0% (95% confidence interval, 35.2-64.8) for a progesterone receptor expression of >50%. Clinical benefit rate was 56.9% for an estrogen receptor expression of >50% (95% confidence interval, 44.9-68.9) and 75.0% (95% confidence interval, 62.2-87.8) for a progesterone receptor expression of >50%. The application of the estrogen receptor pathway test to cases with a progesterone receptor expression of >50% resulted in a response rate of 57.6% (95% confidence interval, 42.1-73.1). After 2 years of follow-up, 34.3% of cases (95% confidence interval, 20-48) with a progesterone receptor expression of >50% and 35.8% of cases (95% confidence interval, 20-52) with an estrogen receptor pathway activity score of >15 had not progressed. CONCLUSION The prediction of response to hormonal treatment in endometrial cancer improves substantially with a 50% cutoff level for progesterone receptor immunohistochemical expression and by applying a sequential test algorithm using progesterone receptor immunohistochemical expression and estrogen receptor pathway activity scores. However, results need to be validated in the prospective Prediction of Response to Hormonal Therapy in Advanced and Recurrent Endometrial Cancer (PROMOTE) study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud Institute of Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
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Roze JF, van Meurs HS, Monroe GR, Veldhuis WB, van Lonkhuijzen LRCW, Bennink RJ, Groeneweg JW, Witteveen PO, Jonges GN, Zweemer RP, Braat AJAT. [ 18F]FDG and [ 18F]FES positron emission tomography for disease monitoring and assessment of anti-hormonal treatment eligibility in granulosa cell tumors of the ovary. Oncotarget 2021; 12:665-673. [PMID: 33868587 PMCID: PMC8021033 DOI: 10.18632/oncotarget.27925] [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: 01/30/2021] [Accepted: 03/15/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose: Adult granulosa cell tumors (AGCTs) of the ovary represent a rare malignancy in which timing and choice of treatment is a clinical challenge. This study investigates the value of FDG-PET/CT and FES-PET/CT in monitoring recurrent AGCTs and assessing eligibility for anti-hormonal treatment. Materials and Methods: We evaluated 22 PET/CTs from recurrent AGCT patients to determine tumor FDG (n = 16) and FES (n = 6) uptake by qualitative and quantitative analysis. We included all consecutive patients from two tertiary hospitals between 2003-2020. Expression of ERα and ERβ and mitoses per 2 mm2 were determined by immunohistochemistry and compared to FES and FDG uptake, respectively. Results: Qualitative assessment showed low-to-moderate FDG uptake in most patients (14/16), and intense uptake in 2/16. One patient with intense tumor FDG uptake had a high mitotic rate (18 per 2 mm2) Two out of six patients showed FES uptake on PET/CT at qualitative analysis. Lesion-based quantitative assessment showed a mean SUVmax of 2.4 (± 0.9) on FDG-PET/CT and mean SUVmax of 1.7 (± 0.5) on FES-PET/CT. Within patients, expression of ERα and ERβ varied and did not seem to correspond with FES uptake. In one FES positive patient, tumor locations with FES uptake remained stable or decreased in size during anti-hormonal treatment, while all FES negative locations progressed. Conclusions: This study shows that in AGCTs, FDG uptake is limited and therefore FDG-PET/CT is not advised. FES-PET/CT may be useful to non-invasively capture the estrogen receptor expression of separate tumor lesions and thus assess the potential eligibility for hormone treatment in AGCT patients.
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Affiliation(s)
- Joline F Roze
- Department of Gynecological Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hannah S van Meurs
- Department of Gynecological Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Glen R Monroe
- Department of Gynecological Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Luc R C W van Lonkhuijzen
- Department of Gynecological Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Roel J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jolijn W Groeneweg
- Department of Gynecological Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geertruida N Jonges
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald P Zweemer
- Department of Gynecological Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arthur J A T Braat
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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van den Berg M, van der Meij E, Bos AME, Boshuizen MCS, Determann D, van Eekeren RRJP, Lok CAR, Schaake EE, Witteveen PO, Wondergem MJ, Braat DDM, Beerendonk CCM, Hermens RPMG. Development and testing of a tailored online fertility preservation decision aid for female cancer patients. Cancer Med 2021; 10:1576-1588. [PMID: 33580749 PMCID: PMC7940215 DOI: 10.1002/cam4.3711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background Decision making regarding future fertility can be very difficult for female cancer patients. To support patients in decision making, fertility preservation decision aids (DAs) are being developed. However, to make a well‐informed decision, patients need personalized information tailored to their cancer type and treatment. Tailored cancer‐specific DAs are not available yet. Methods Our DA was systematically developed by a multidisciplinary steering group (n = 21) in an iterative process of draft development, three rounds of alpha testing, and revisions. The drafts were based on current guidelines, literature, and patients' and professionals' needs. Results In total, 24 cancer‐specific DAs were developed. In alpha testing, cancer survivors and professionals considered the DA very helpful in decision making, and scored an 8.5 (scale 1–10). In particular, the cancer‐specific information and the tool for recognizing personal values were of great value. Revisions were made to increase readability, personalization, usability, and be more careful in giving any false hope. Conclusions A fertility preservation DA containing cancer‐specific information is important in the daily care of female cancer patients and should be broadly available. Our final Dutch version is highly appraised, valid, and usable in decision making. After evaluating its effectiveness with newly diagnosed patients, the DA can be translated and adjusted according to (inter)national guidelines.
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Affiliation(s)
- Michelle van den Berg
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elleke van der Meij
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annelies M E Bos
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Christianne A R Lok
- Centre for Gynecological Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Eva E Schaake
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle J Wondergem
- Department of Hematology, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Didi D M Braat
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina C M Beerendonk
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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10
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Rietveld MJA, van der Velden J, Westermann AM, van Driel WJ, Sonke GS, Witteveen PO, Ploos van Amstel FK, Massuger LFAG, Ottevanger PB. Intraperitoneal treatment for advanced ovarian cancer, the Dutch experience. What did we learn? Neth J Med 2020; 78:349-356. [PMID: 33380532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Combined administration of intravenous (iv) and intraperitoneal (ip) (iv/ip) chemotherapy is an effective adjuvant treatment option after primary debulking surgery (PDS) for advanced ovarian cancer (OC). Increased toxicityand patient burden limit its use in daily practice. OBJECTIVE To assess toxicity and survival outcomes of iv/ip chemotherapy in daily practice in the Netherlands. METHODS This retrospective cohort study included 81 women who underwent at least an optimal PDS for FIGO stage III OC followed by iv/ip chemotherapy according to the Armstrong regimen, in four hospitals in the Netherlands between January 2007 and May 2016. We collected information on surgical procedure, abdominal port implantation, toxicity, and recurrence-free and overall survival. RESULTS All participants underwent PDS, of whom 60 (74%) had their ip catheter implanted during PDS. Most frequently reported all grade toxicity was haematological n = 44 (54%). Forty-four patients (54%) completed all six cycles of iv/ip chemotherapy. The most frequent causes of discontinuation of iv/ip administration were renal dysfunction (12/37 = 32%) and catheter problems (7/37 = 19%). Median recurrence-free survival and overall survival were 24 months (range 0 - 108) and 80 months (range 4-115), respectively. Surgical outcome, completion of more than three courses of treatment and intra-abdominal localisation of recurrent disease were associated with better survival outcomes. CONCLUSION In daily practice, 54% of patients with advanced OC could complete all scheduled cycles of iv/ ip chemotherapy with acceptable morbidity and toxicity, leading to outcomes comparable with the results of published trials on iv/ip chemotherapy.
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Affiliation(s)
- M J A Rietveld
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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11
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Bruijnen CP, Heijmer A, van Harten-Krouwel DG, van den Bos F, de Bree R, Witteveen PO, Emmelot-Vonk MH. Validation of the G8 screening tool in older patients with cancer considered for surgical treatment. J Geriatr Oncol 2020; 12:793-798. [PMID: 33172806 DOI: 10.1016/j.jgo.2020.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/06/2020] [Accepted: 10/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The Geriatric 8 (G8) has proven to be one of the most sensitive frailty-screening tools for older patients with cancer undergoing systemic treatment. In this study we validated whether the G8 is also suitable for identifying impairments in their comprehensive geriatric assessment (CGA) in older patients with cancer undergoing surgery. Thereby, we investigated the differences in postoperative outcomes between the fit and frail patients classified by the G8. METHODS Patients ≥70 years with a surgery indication because of a (suspected) malignant disease were prospectively enrolled. In all patients, a CGA was performed. The G8 results were assessed in parallel. The diagnostic value of the G8 was determined by comparing the result with the CGA as a reference test. Deficits in CGA was defined as ≥ two impairments of the CGA. Postoperative complications were retrospectively obtained from the medical record and compared between the fit and frail patients. RESULTS In total, 143 patients were enrolled. The sensitivity, specificity, and negative predictive value of the G8 were 82% (95% CI 70-91), 63% (95% CI 52-73), and 85% (95% CI 75-91). In the patients with an impaired G8, a significantly prolonged hospital stay, higher rate of delirium, and higher 1-year mortality rate were seen. CONCLUSION The G8 is a simple and useful screening tool for identifying deficits in CGA in older patients with cancer requiring surgery. Second, we concluded that patients with an impaired G8 are more at risk for a complicated recovery from surgery.
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Affiliation(s)
- Cheryl P Bruijnen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Anne Heijmer
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Frederiek van den Bos
- Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Lugtenberg RT, Boers-Doets CB, Witteveen PO, van Herpen CML, Wymenga ANM, de Groot JWB, Hoeben A, Del Grande C, van Doorn B, Koldenhof JJ, Driessen CML, Gelderblom H. Prospective practice survey of management of cetuximab-related skin reactions. Support Care Cancer 2020; 29:3497-3506. [PMID: 33150521 PMCID: PMC8163687 DOI: 10.1007/s00520-020-05862-7] [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: 09/08/2020] [Accepted: 10/26/2020] [Indexed: 01/09/2023]
Abstract
Purpose Evidence-based guidelines on how to prevent or treat cetuximab-related skin reactions are lacking and multiple care and management strategies are used. The main purpose of the present study is to gain information about the different skincare products being used against skin reactions in metastatic colorectal cancer (mCRC) and recurrent/metastatic (R/M) or locally advanced (LA) squamous cell cancer of the head and neck (SCCHN) patients treated with cetuximab. Methods An open-label, prospective observational study conducted in the Netherlands. The occurrence of skin reactions and the care and management options taken were documented for 16 weeks, starting from the first administration of cetuximab. Results A total of 103 patients were included in 7 hospitals. 38 patients (37%) developed a grade ≥ 2 skin reaction. Eighty-six patients could be analysed for the primary endpoint (73.3% males, mean age 62.4 years, n = 44 LA SCCHN, n = 16 R/M SCCHN, n = 26 mCRC). The most frequently used skin products at some point during the observation period were moisturizing products (70%), systemic antibiotics (64%), topical antibiotics (58%), lipid-regenerating (28%) and other topical products (28%). The overall use of products gradually increased from baseline to week 6–10, reducing by week 16. Hospital protocols were the primary reason (> 50%) for choice of the skincare products and medications. Conclusion A variety of skin care products and antibiotics were commonly used. Only few patients developed severe cutaneous reactions. For patients, the occurrence of skin reactions did not influence their willingness to continue cetuximab therapy.
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Affiliation(s)
- R T Lugtenberg
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - C B Boers-Doets
- Department of Medical Strategy, CancerMed, Wormer, The Netherlands.,Department of Adverse Event Research & Valorisation, Impaqtt Foundation, Wormer, The Netherlands
| | - P O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C M L van Herpen
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - A N M Wymenga
- Department of Medical Oncolog, Medical Spectrum Twente, Enschede, The Netherlands
| | - J W B de Groot
- Department of Medical Oncology, Isala Oncology Center, Zwolle, The Netherlands
| | - A Hoeben
- Department of Medical Oncology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - C Del Grande
- Merck B.V., Netherlands, an affiliate of Merck KgaA, Darmstadt Germany, Schiphol-Rijk, The Netherlands
| | - B van Doorn
- Merck B.V., Netherlands, an affiliate of Merck KgaA, Darmstadt Germany, Schiphol-Rijk, The Netherlands
| | - J J Koldenhof
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C M L Driessen
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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13
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van den Brekel L, van der Baan FH, Zweers D, Koldenhof JJ, Vos JBH, de Graeff A, Witteveen PO, Teunissen SCCM. Predicting Anxiety in Hospitalized Cancer Patients. J Pain Symptom Manage 2020; 60:522-530.e1. [PMID: 32305577 DOI: 10.1016/j.jpainsymman.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Anxiety in patients with cancer is highly prevalent; yet it remains underestimated and inadequately assessed. Little is known about predictors for anxiety in hospitalized patients with cancer. Insight in predictors should improve recognition and enable a targeted approach. OBJECTIVES To determine the prevalence of anxiety and predictors for anxiety in hospitalized patients with cancer at different stages of disease. METHODS A cross-sectional analysis of patients with cancer admitted to the Utrecht University Medical Center in 2015-2018 was conducted. The Utrecht Symptom Diary, an adapted Dutch version of the Edmonton Symptom Assessment System, was used to assess symptom burden on a numeric rating scale (0 = no symptom and 10 = worst possible symptom). Scores ≥4 were considered clinically relevant. All patients completed the Utrecht Symptom Diary as part of routine care. The first questionnaire after admission was selected. Using multivariable linear regression, the predictive value of potential predictors on anxiety was analyzed. RESULTS In total, 2144 patients were included, of which 22% reported clinically relevant anxiety. The prevalence of anxiety was highest (36%) in patients receiving symptom-directed palliation only. In the total group, female gender, younger age, depressed mood, sleeping problems, dyspnea, and cancer of the head and neck were predictive of anxiety. Throughout all stages of disease, depressed mood was consistently the strongest predictor. CONCLUSION We found a high prevalence of anxiety in hospitalized patients with cancer. It is recommended to explore anxiety in hospitalized patients with cancer, in particular when they experience depressed mood. Structural use of a symptom diary during hospitalization facilitates the recognition of anxiety and concurrent symptoms.
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Affiliation(s)
- Lieke van den Brekel
- Department of General Practice, Center of Expertise Palliative Care-Utrecht, Julius Center for Healthcare Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands.
| | - Frederieke H van der Baan
- Department of General Practice, Center of Expertise Palliative Care-Utrecht, Julius Center for Healthcare Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands
| | - Danielle Zweers
- Department of General Practice, Center of Expertise Palliative Care-Utrecht, Julius Center for Healthcare Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands; Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - José J Koldenhof
- Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J Bernard H Vos
- Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Department of General Practice, Center of Expertise Palliative Care-Utrecht, Julius Center for Healthcare Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands; Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
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14
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van der Baan FH, Koldenhof JJ, de Nijs EJ, Echteld MA, Zweers D, Hesselmann GM, Vervoort SC, Vos JB, de Graaf E, Witteveen PO, Suijkerbuijk KP, de Graeff A, Teunissen SC. Validation of the Dutch version of the Edmonton Symptom Assessment System. Cancer Med 2020; 9:6111-6121. [PMID: 32643871 PMCID: PMC7476846 DOI: 10.1002/cam4.3253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/31/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Utrecht Symptom Diary (USD) is a Dutch and adapted version of the Edmonton Symptom Assessment System, a patient-reported outcome measurement (PROM) tool to asses and monitor symptoms in cancer patients. This study analyses the validity and responsiveness of the USD and the cutoff points to determine the clinical significance of a symptom score. METHODS Observational longitudinal cohort study including adult in- and outpatients treated in an academic hospital in the Netherlands who completed at least one USD as part of routine care (2012-2019). The distress thermometer and problem checklist (DT&PC) was used as a reference PROM. Content, construct and criterion validity, responsiveness, and cutoff points are shown with prevalences, area under receiver operating characteristic (ROC) curve, Chi-squared test, Wilcoxon signed-rank test, and positive and negative predictive values, respectively. RESULTS A total of 3913 patients completed 22 400 USDs. Content validity was confirmed for all added USD items with prevalences of ≥22%. All USD items also present on the DT&PC demonstrated a good criterion validity (ROC >0.8). Construct validity was confirmed for the USD as a whole and for the items dry mouth, dysphagia and well-being (P < .0001). USD scores differed significantly for patients when improving or deteriorating on the DT&PC which confirmed responsiveness. Optimal cutoff points (3 or 4) differed per symptom. CONCLUSION The USD is a valid 12-item PROM for the most prevalent symptoms in cancer patients, which has content, criterion, and construct validity, and detects clinically important changes over time, in both curative and palliative phase.
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Affiliation(s)
- Frederieke H van der Baan
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Josephine J Koldenhof
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Ellen J de Nijs
- Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael A Echteld
- Avans University of Applied Sciences, Breda/Tilburg, The Netherlands
| | - Danielle Zweers
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Ginette M Hesselmann
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Sigrid C Vervoort
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Jan B Vos
- Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Karijn P Suijkerbuijk
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, The Netherlands
| | - Saskia C Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, The Netherlands
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15
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Maggen C, Lok CA, Cardonick E, van Gerwen M, Ottevanger PB, Boere IA, Koskas M, Halaska MJ, Fruscio R, Gziri MM, Witteveen PO, Van Calsteren K, Amant F. Gastric cancer during pregnancy: A report on 13 cases and review of the literature with focus on chemotherapy during pregnancy. Acta Obstet Gynecol Scand 2019; 99:79-88. [PMID: 31529466 PMCID: PMC6972614 DOI: 10.1111/aogs.13731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 12/14/2022]
Abstract
Introduction Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer. Material and methods Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed. Results In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6‐30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported. Conclusions The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account.
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Affiliation(s)
- Charlotte Maggen
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Christianne A Lok
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elyce Cardonick
- Department of Obstetrics and Gynecology, Cooper, University Health Care, Camden, NJ, USA
| | - Mathilde van Gerwen
- Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Ingrid A Boere
- Department of Medical Oncology, Erasmus MC Cancer, Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martin Koskas
- Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France
| | - Michael J Halaska
- Faculty Hospital Kralovske, Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Mina M Gziri
- Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium
| | - Petronella O Witteveen
- Department of Medical Oncology, Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics, University Hospitals Leuven, Leuven and Department of Development and regeneration, KU Leuven, Leuven, Belgium
| | - Frédéric Amant
- Department of Oncology, KU Leuven, Leuven, Belgium.,Center for Gynecological Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands.,Center for Gynecological Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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16
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Zweers D, de Graeff A, Duijn J, de Graaf E, Witteveen PO, Teunissen SCCM. Patients’ Needs Regarding Anxiety Management in Palliative Cancer Care: A Qualitative Study in a Hospice Setting. Am J Hosp Palliat Care 2019; 36:947-954. [DOI: 10.1177/1049909119846844] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction: Anxiety is a common symptom in the palliative phase, and symptom management depends on the competencies of individual professionals. This study aims to get insight into the needs of anxious hospice patients with advanced cancer regarding support. Method: Semi-structured interviews were performed in admitted hospice patients with cancer. Patients admitted from May 2017 till May 2018 were eligible whether or not they were anxious. Interviews were analyzed and coded within predefined topics. Results: Fourteen patients were included: 10 females, median age 71, and median World Health Organization performance score 3. Most patients were highly educated. Thirteen patients were interviewed within 6 months before death. Information, open communication, sense of control, safety, adequate symptom management, and respect for patients’ coping strategy were the 6 main expressed needs. Conclusion: Assessing patients’ needs regarding anxiety provided important angles where health-care professionals can make a difference in order to support anxious patients in their final stage of life to realize tailored palliative care. Future research should focus on the development of a systematic approach for health-care professionals to manage anxiety in daily care of terminal patients.
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Affiliation(s)
- Danielle Zweers
- Department General Practice, Center of Expertise Palliative Care, Utrecht, the Netherlands
- Department Medical Oncology, Cancer Center University Medical Center, Utrecht, the Netherlands
| | - Alexander de Graeff
- Department Medical Oncology, Cancer Center University Medical Center, Utrecht, the Netherlands
| | - Jette Duijn
- GGD Hollands Noorden, Alkmaar, The Netherlands
| | - Everlien de Graaf
- Department General Practice, Center of Expertise Palliative Care, Utrecht, the Netherlands
| | - Petronella O. Witteveen
- Department Medical Oncology, Cancer Center University Medical Center, Utrecht, the Netherlands
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17
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Halaska MJ, Uzan C, Han SN, Fruscio R, Dahl Steffensen K, Van Calster B, Stankusova H, Delle Marchette M, Mephon A, Rouzier R, Witteveen PO, Vergani P, Van Calsteren K, Rob L, Amant F. Characteristics of patients with cervical cancer during pregnancy: a multicenter matched cohort study. An initiative from the International Network on Cancer, Infertility and Pregnancy. Int J Gynecol Cancer 2019; 29:ijgc-2018-000103. [PMID: 30898935 DOI: 10.1136/ijgc-2018-000103] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Treatment of cervical cancer during pregnancy is often complex and challenging. This study aimed to analyze current patterns of practice in the management of pregnant patients diagnosed with cervical cancer. METHODS This was a matched cohort study comprising patients managed for cervical cancer during pregnancy from six European centers. Patient information was retrieved from the dataset of the International Network for Cancer, Infertility and Pregnancy from 1990 to 2012. Each center matched its patients with two non-pregnant controls for age (±5 years) and International Federation of Gynecology and Obstetrics (FIGO) 2009 stage. Information on age, histological type, grade, lymphovascular space invasion, stage, tumor size, method of diagnosis, site of recurrence, delivery, date of recurrence, and date of death was recorded. Progression-free survival was compared using multivariable Cox proportional hazards regression. RESULTS A total of 132 pregnant patients and 256 controls were analyzed. The pregnant patients (median age 34 years, range 21-43) were diagnosed at a median gestational age of 18.4 weeks of pregnancy (range 7-39). Stage distribution during pregnancy was 14.4% for stage IA, 47.0% for IB1, 18.9% for IB2, and 19.7% for II-IV. For treatment during pregnancy, 17.4% of the patients underwent surgery, 16.7% received neoadjuvant chemotherapy, 26.5% delayed their treatment, 12.9% had a premature delivery, and 26.5% had their pregnancy terminated. Median follow-up was 84 months (67 months for pregnant and 95 months for non-pregnant patients). The unadjusted hazard ratio of pregnancy for progression-free survival was 1.18 (95% confidence interval 0.74 to 1.88). CONCLUSION Surgery and chemotherapy is increasingly used in the management of pregnant patients with cervical cancer and prognosis is similar to that of non-pregnant patients.
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Affiliation(s)
- Michael J Halaska
- Department of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Catherine Uzan
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
- Department of Gynecology and Breast surgery, Pitié Salpêtrière Hospital, Institut Universitaire de Cancérologie, Sorbonne University, INSERM U938, Paris, France
| | - Sileny N Han
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | | | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hana Stankusova
- Department of Medical Oncology, Faculty Hospital Motol, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Martina Delle Marchette
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | | | | | - Petronella O Witteveen
- Department of Medical Oncology, Cancer Center University Medical Center, Utrecht, The Netherlands
| | - Patrizia Vergani
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Kristina Van Calsteren
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Lukas Rob
- Department of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady, 3rd Medical Faculty, Charles University, Prague, Czech Republic
| | - Frederic Amant
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, KU Leuven, Leuven, Belgium
- Centre for Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Gootjes EC, Bakkerus L, Ten Tije AJ, Witteveen PO, Buffart TE, Bridgewater JA, Primrose JN, Verhoef C, Verheul HMW. The value of tumour debulking for patients with extensive multi-organ metastatic colorectal cancer. Eur J Cancer 2018; 103:160-164. [PMID: 30243064 DOI: 10.1016/j.ejca.2018.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/23/2018] [Accepted: 07/08/2018] [Indexed: 02/07/2023]
Abstract
Local treatment of metastases by surgical resection or other ablative therapies is technically feasible in an increasing number of patients with multi-organ metastatic cancer. This results in a growing debate on whether patients with extensive disease, that is traditionally deemed unresectable, may benefit from local treatment of metastases when added to standard palliative systemic therapy. For selected patients with oligometastatic colorectal cancer, local treatment of metastases has become the standard of care based on retrospective reports showing long-term survival rates. In addition to systemic therapy, preliminary evidence suggests that patients with extensive metastatic colorectal cancer may also benefit from local treatment. Here, we present the future perspectives based on the available literature on local treatment approaches in colorectal cancer.
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Affiliation(s)
- Elske C Gootjes
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Lotte Bakkerus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Albert J Ten Tije
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands; Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | | | - Tineke E Buffart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | | | - John N Primrose
- University Surgery and Cancer Sciences Division, University of Southampton, Southampton General Hospital, Southampton UK
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Henk M W Verheul
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
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Koldenhof JJ, Lankheet NAG, Steeghs N, Teunissen SCCM, Witteveen PO. Patient-reported outcome measures in a pharmacokinetic study with sunitinib, a prospective cohort study. Support Care Cancer 2018; 26:2641-2650. [PMID: 29464389 PMCID: PMC6018583 DOI: 10.1007/s00520-018-4075-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/29/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE During treatment with tyrosine kinase inhibitors, such as sunitinib, patients experience treatment and/or disease-related symptoms. Although application of patient-reported outcome measures (PROMs) enhances early recognition of symptoms, early clinical trials are focused on symptom severity objectified by the Common Terminology Criteria for Adverse Events (CTCAE) in order to evaluate drug safety and to determine a personalized and/or safe dosage range. To gain insight into patient-reported symptoms in addition to healthcare professional-reported adverse events (AEs), a substudy was conducted in an ongoing pharmacokinetic-guided sunitinib dosing study. METHODS In patients for whom sunitinib was considered standard therapy or patients with advanced/metastatic tumors for whom no standard therapy was available, patient-reported symptoms and well-being besides healthcare professional-reported AEs were assessed. RESULTS Twenty-nine patients were included for analysis. Over 50% of them experienced a decreased well-being, caused by symptoms of mild and moderate intensity. Compared to healthcare professionals, all measured symptoms, with the exception of fatigue and vomiting, were reported statistically significantly more often by patients. CONCLUSIONS Application of PROMs in early clinical trials on personalized or individualized oral targeted anticancer agents is feasible and enhances early recognition of symptom burden due to multiple CTCAE grade 1-2 AEs, just as pro-active symptom management and effect evaluation of interventions performed. Application of PROMs in these trials might be clinically relevant in obtaining dose-limiting toxicities.
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Affiliation(s)
- J J Koldenhof
- Department of Medical Oncology, HP B02.225, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands.
| | - N A G Lankheet
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - N Steeghs
- Department of Medical Oncology and Clinical Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - S C C M Teunissen
- Department of Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - P O Witteveen
- Department of Medical Oncology, HP B02.225, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
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20
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Koldenhof JJ, Langenberg MHG, Witteveen PO, Teunissen SCCM. Patient-reported symptoms and stepwise symptom management in patients on epidermal growth factor inhibitors: A retrospective, descriptive cohort study. Eur J Cancer Care (Engl) 2018; 27:e12800. [PMID: 29314360 DOI: 10.1111/ecc.12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 12/18/2022]
Abstract
Adverse events (AEs) of epidermal growth factor inhibitors (EGFRi) influence well-being with a risk to dose modifications (DMs). Hereby, clinical benefit of treatment might be affected. This retrospective cohort study was set up to gain insight into the suitability and added value of a patient-reported outcome measurement tool (PROM), together with a stepwise intervention management plan for EGFRi-related AEs in daily practice. The primary objective was to gain insight into total treatment duration and DMs, and the secondary objective to gain insight into patient-reported symptoms and well-being as well as healthcare professional-reported AEs. Sixty-eight patients on cetuximab and 19 on panitumumab treatment were included for analysis; 69% had squamous cell carcinoma of head and neck (SCCHN) and 26% metastatic colorectal carcinoma. DMs due to AEs occurred in 39% of the patients and dose discontinuations in 22%. Especially anorexia, dysphagia, oral pain and skin changes led to a decreased well-being. In patients on EGFRi, application of PROMs together with a stepwise symptom management plan enhances early recognition of symptom burden, pro-active symptom management and effect evaluation of interventions performed whereby well-being recovers. Since only SCCHN patients discontinued treatment due to AEs, patient-centred care focused on radiotherapy-related AEs, creates opportunities for amelioration.
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Affiliation(s)
- J J Koldenhof
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - M H G Langenberg
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P O Witteveen
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S C C M Teunissen
- Department of Primary Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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21
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Hoogendam JP, Vlek CA, Witteveen PO, Verheijen R, Zweemer RP. Surgical lymph node assessment in mucinous ovarian carcinoma staging: a systematic review and meta-analysis. BJOG 2017; 124:370-378. [PMID: 27444115 DOI: 10.1111/1471-0528.14226] [Citation(s) in RCA: 14] [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] [Accepted: 06/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The proportion of women with mucinous ovarian carcinoma in whom nodal metastases are identified during staging remains unclear. OBJECTIVES To review the literature on surgical lymph node assessment during staging of women diagnosed with mucinous ovarian carcinoma. SEARCH STRATEGY A systematic search using synonyms of 'mucinous ovarian carcinoma' and 'lymph node assessment' was conducted in PubMed, Scopus, Embase and the Cochrane Library. SELECTION CRITERIA When they covered ten or more mucinous ovarian carcinoma cases, staging surgery and minimally one of the following outcomes: prevalence of metastases, stage shift or survival data. DATA COLLECTION AND ANALYSIS Studies were quality evaluated with the Cochrane risk-of-bias assessment tool for non-randomised studies of interventions. Outcomes were pooled using an inverse variance weighted random effects model. MAIN RESULTS Sixteen studies were included. In 278 women with mucinous ovarian cancer suspected to be stage I-II, a pooled proportion of 0.8% (95% CI <0.1-2.9%) had lymph node metastases and were upstaged. In those suspected of stage I (n = 184), this proportion was 0.7% (95% CI <0.1-3.8%). No difference (P = 0.287) was found in metastases between sampling at 0.0% (95% CI 0.0-3.3%) and complete pelvic and/or para-aortic lymph node dissection at 1.2% (95% CI <0.1-4.2%). One study directly compared the survival of patients staged with and without lymph node dissection and reported no significant difference. CONCLUSIONS Surgical lymph node assessment in women suspected of stage I-II mucinous ovarian carcinoma rarely identifies nodal metastases and consequently has no significant impact on staging. TWEETABLE ABSTRACT Surgical lymph node assessment in women with stage I-II mucinous ovarian cancer rarely has staging consequences.
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Affiliation(s)
- J P Hoogendam
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - C A Vlek
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - P O Witteveen
- Department of Medical Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - Rhm Verheijen
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - R P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
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22
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Infante JR, Cassier PA, Gerecitano JF, Witteveen PO, Chugh R, Ribrag V, Chakraborty A, Matano A, Dobson JR, Crystal AS, Parasuraman S, Shapiro GI. A Phase I Study of the Cyclin-Dependent Kinase 4/6 Inhibitor Ribociclib (LEE011) in Patients with Advanced Solid Tumors and Lymphomas. Clin Cancer Res 2016; 22:5696-5705. [PMID: 27542767 DOI: 10.1158/1078-0432.ccr-16-1248] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/15/2016] [Accepted: 07/22/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Ribociclib (an oral, highly specific cyclin-dependent kinase 4/6 inhibitor) inhibits tumor growth in preclinical models with intact retinoblastoma protein (Rb+). This first-in-human study investigated the MTD, recommended dose for expansion (RDE), safety, preliminary activity, pharmacokinetics, and pharmacodynamics of ribociclib in patients with Rb+ advanced solid tumors or lymphomas. EXPERIMENTAL DESIGN Patients received escalating doses of ribociclib (3-weeks-on/1-week-off or continuous). Dose escalation was guided by a Bayesian Logistic Regression Model with overdose control principle. RESULTS Among 132 patients, 125 received ribociclib 3-weeks-on/1-week-off and 7 were dosed continuously. Nine dose-limiting toxicities were observed among 70 MTD/RDE evaluable patients during cycle 1, most commonly neutropenia (n = 3) and thrombocytopenia (n = 2). The MTD and RDE were established as 900 and 600 mg/day 3-weeks-on/1-week-off, respectively. Common treatment-related adverse events were (all-grade; grade 3/4) neutropenia (46%; 27%), leukopenia (43%; 17%), fatigue (45%; 2%), and nausea (42%; 2%). Asymptomatic Fridericia's corrected QT prolongation was specific to doses ≥600 mg/day (9% of patients at 600 mg/day; 33% at doses >600 mg/day). Plasma exposure increases were slightly higher than dose proportional; mean half-life at the RDE was 32.6 hours. Reduced Ki67 was observed in paired skin and tumor biopsies, consistent with ribociclib-mediated antiproliferative activity. There were 3 partial responses and 43 patients achieved a best response of stable disease; 8 patients were progression-free for >6 months. CONCLUSIONS Ribociclib demonstrated an acceptable safety profile, dose-dependent plasma exposure, and preliminary signs of clinical activity. Phase I-III studies of ribociclib are under way in various indications. Clin Cancer Res; 22(23); 5696-705. ©2016 AACR.
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Affiliation(s)
- Jeffrey R Infante
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, Tennessee.
| | | | | | | | | | | | | | | | - Jason R Dobson
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Adam S Crystal
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Sudha Parasuraman
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
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23
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Milojkovic Kerklaan B, Slater S, Flynn M, Greystoke A, Witteveen PO, Megui-Roelvink M, de Vos F, Dean E, Reyderman L, Ottesen L, Ranson M, Lolkema MPJ, Plummer R, Kristeleit R, Evans TRJ, Schellens JHM. A phase I, dose escalation, pharmacodynamic, pharmacokinetic, and food-effect study of α2 integrin inhibitor E7820 in patients with advanced solid tumors. Invest New Drugs 2016; 34:329-37. [PMID: 27039386 DOI: 10.1007/s10637-016-0344-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 01/13/2023]
Abstract
UNLABELLED Introduction E7820 is an orally administered sulfonamide that inhibits alfa-2-integrin mRNA expression. Pre-clinically E7820 showed tumor anti-angiogenic effects in various tumor cell lines and xenograft mouse models. Human daily dosing of 100 mg QD had previously been shown to be safe and tolerable. Methods The study consisted of two parts: Part A (food effect) and Part B (determination of maximum tolerated dose (MTD) for bi-daily (BID) dosing). E7820 dosing started at 50 mg BID with planned escalation to 60, 80 and 100 mg BID every 28 days. Results Fifteen patients were enrolled in Part A and 26 in Part B. The most frequent adverse events of all grades were constipation, diarrhea, nausea, and fatigue while anemia, neutropenia, and fatigue were most frequent grade ≥3 toxicities. At dose-level 60 mg BID, two patients experienced dose-limiting toxicities (grade 3 neutropenic sepsis and grade 4 neutropenia). Therefore the recommended dose (RD) was 50 mg BID. Food had no effect on E7820 exposure. E7820 exposure following twice daily administration was dose-proportional. Expression of platelet integrin-α2 measured as a response biomarker in Part B, generally decreased by a median 7.7 % from baseline following treatment with 50 mg BID E7820. Reduction was most pronounced within 1-week post treatment. The median duration of treatment was median 54, range 20-111 days. The best overall response in any treatment group was stable disease (SD): 23.1 % in Part A (100 mg QD); at the RD 66.7 % (12 of 18 patients) and 40 % in the 60 mg BID group in Part B. CONCLUSIONS Food had no effect on E7820 exposure. A dose of 50 mg BID was considered the MTD. Treatment with E7820 is safe and tolerable with 2/3 of patients (66.7 %) at MTD having SD as their best response.
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Affiliation(s)
- B Milojkovic Kerklaan
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - S Slater
- The Beatson West of Scotland Cancer Centre, University Glasgow, Glasgow, UK
| | - M Flynn
- University College London Hospital, London, United Kingdom
| | - A Greystoke
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | - P O Witteveen
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Megui-Roelvink
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - F de Vos
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Dean
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | | | | | - M Ranson
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | - M P J Lolkema
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
- Erasmus Medical Center Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Plummer
- Sir Bobby Robson Cancer Trials Research Centre Newcastle, Newcastle, UK
| | - R Kristeleit
- University College London Hospital, London, United Kingdom
| | - T R J Evans
- The Beatson West of Scotland Cancer Centre, University Glasgow, Glasgow, UK
| | - J H M Schellens
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
- Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
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24
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Munster P, Aggarwal R, Hong D, Schellens JHM, van der Noll R, Specht J, Witteveen PO, Werner TL, Dees EC, Bergsland E, Agarwal N, Kleha JF, Durante M, Adams L, Smith DA, Lampkin TA, Morris SR, Kurzrock R. First-in-Human Phase I Study of GSK2126458, an Oral Pan-Class I Phosphatidylinositol-3-Kinase Inhibitor, in Patients with Advanced Solid Tumor Malignancies. Clin Cancer Res 2015; 22:1932-9. [PMID: 26603258 DOI: 10.1158/1078-0432.ccr-15-1665] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/12/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE GSK2126458 (GSK458) is a potent inhibitor of PI3K (α, β, γ, and δ), with preclinical studies demonstrating broad antitumor activity. We performed a first-in-human phase I study in patients with advanced solid tumors. MATERIALS AND METHODS Patients received oral GSK458 once or twice daily in a dose-escalation design to define the maximum tolerated dose (MTD). Expansion cohorts evaluated pharmacodynamics, pharmacokinetics, and clinical activity in histologically and molecularly defined cohorts. RESULTS One hundred and seventy patients received doses ranging from 0.1 to 3 mg once or twice daily. Dose-limiting toxicities (grade 3 diarrhea,n= 4; fatigue and rash,n= 1) occurred in 5 patients (n= 3 at 3 mg/day). The MTD was 2.5 mg/day (MTD with twice daily dosing undefined). The most common grade ≥3 treatment-related adverse events included diarrhea (8%) and skin rash (5%). Pharmacokinetic analyses demonstrated increased duration of drug exposure above target level with twice daily dosing. Fasting insulin and glucose levels increased with dose and exposure of GSK458. Durable objective responses (ORs) were observed across multiple tumor types (sarcoma, kidney, breast, endometrial, oropharyngeal, and bladder cancer). Responses were not associated withPIK3CAmutations (OR rate: 5% wild-type vs. 6% mutant). CONCLUSIONS Although the MTD of GSK458 was 2.5 mg once daily, twice-daily dosing may increase duration of target inhibition. Fasting insulin and glucose levels served as pharmacodynamic markers of drug exposure. Select patients achieved durable responses; however,PIK3CAmutations were neither necessary nor predictive of response. Combination treatment strategies and novel biomarkers may be needed to optimally target PI3K.
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Affiliation(s)
| | | | - David Hong
- MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Theresa L Werner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - E Claire Dees
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | | | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | | | - Laurel Adams
- GlaxoSmithKline, Research Triangle Park, North Carolina
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25
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Koldenhof JJ, Witteveen PO, de Vos R, Walraven M, Tillier CN, Verheul HMW, Teunissen SCCM. Symptoms from treatment with sunitinib or sorafenib: a multicenter explorative cohort study to explore the influence of patient-reported outcomes on therapy decisions. Support Care Cancer 2014; 22:2371-80. [PMID: 24687539 DOI: 10.1007/s00520-014-2223-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 03/20/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Optimal long-lasting treatment with sunitinib and sorafenib is limited by dose modifications (DMs) due to adverse events (AEs). These AEs may be underrecognized and their influence on health-related quality of life (HRQL) underestimated. Improved insight into the relationship between AEs and therapy decisions is needed. To improve decision making around managing symptoms and reduce DMs, this study was set up to explore the influence of patient-reported symptoms on therapy decisions. METHODS In this multicenter cohort study, patient characteristics, reasons for and different forms of used dose modifications, and AEs were prospectively obtained from cancer patients on sunitinib/sorafenib treatment. Used instruments to get insight into AEs were the patient-scored Utrecht Symptom Diary (USD) and the professional-scored Common Terminology Criteria for AEs version 3.0. RESULTS Median total treatment duration in 42 patients was 16 weeks. Median time till dose modification was 10 weeks. DMs occurred mostly due to multiple mild AEs. By using the USD, a higher prevalence of most AEs was found compared to the literature. Sixty percent of the patients experienced a decreased HRQL due to multiple AEs. CONCLUSIONS Because severe AEs due to sunitinib/sorafenib treatment seldom occur, it is more important to focus on treating and preventing multiple mild AEs with higher impact on HRQL, when trying to avoid dose modifications. Using patient self-reported measurement methods helps to early recognize symptoms and to differentiate among symptom intensities. This systematic approach might help to achieve the optimal dosing, which might improve PFS and OS.
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Affiliation(s)
- J J Koldenhof
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands,
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26
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Hoogstraat M, de Pagter MS, Cirkel GA, van Roosmalen MJ, Harkins TT, Duran K, Kreeftmeijer J, Renkens I, Witteveen PO, Lee CC, Nijman IJ, Guy T, van ’t Slot R, Jonges TN, Lolkema MP, Koudijs MJ, Zweemer RP, Voest EE, Cuppen E, Kloosterman WP. Genomic and transcriptomic plasticity in treatment-naive ovarian cancer. Genome Res 2014; 24:200-11. [PMID: 24221193 PMCID: PMC3912411 DOI: 10.1101/gr.161026.113] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 10/17/2013] [Indexed: 12/23/2022]
Abstract
Intra-tumor heterogeneity is a hallmark of many cancers and may lead to therapy resistance or interfere with personalized treatment strategies. Here, we combined topographic mapping of somatic breakpoints and transcriptional profiling to probe intra-tumor heterogeneity of treatment-naïve stage IIIC/IV epithelial ovarian cancer. We observed that most substantial differences in genomic rearrangement landscapes occurred between metastases in the omentum and peritoneum versus tumor sites in the ovaries. Several cancer genes such as NF1, CDKN2A, and FANCD2 were affected by lesion-specific breakpoints. Furthermore, the intra-tumor variability involved different mutational hallmarks including lesion-specific kataegis (local mutation shower coinciding with genomic breakpoints), rearrangement classes, and coding mutations. In one extreme case, we identified two independent TP53 mutations in ovary tumors and omentum/peritoneum metastases, respectively. Examination of gene expression dynamics revealed up-regulation of key cancer pathways including WNT, integrin, chemokine, and Hedgehog signaling in only subsets of tumor samples from the same patient. Finally, we took advantage of the multilevel tumor analysis to understand the effects of genomic breakpoints on qualitative and quantitative gene expression changes. We show that intra-tumor gene expression differences are caused by site-specific genomic alterations, including formation of in-frame fusion genes. These data highlight the plasticity of ovarian cancer genomes, which may contribute to their strong capacity to adapt to changing environmental conditions and give rise to the high rate of recurrent disease following standard treatment regimes.
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Affiliation(s)
- Marlous Hoogstraat
- Department of Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Netherlands Center for Personalized Cancer Treatment, 3584 CG Utrecht, The Netherlands
| | - Mirjam S. de Pagter
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Geert A. Cirkel
- Department of Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Netherlands Center for Personalized Cancer Treatment, 3584 CG Utrecht, The Netherlands
| | - Markus J. van Roosmalen
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | | | - Karen Duran
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Jennifer Kreeftmeijer
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Ivo Renkens
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Petronella O. Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - Isaac J. Nijman
- Netherlands Center for Personalized Cancer Treatment, 3584 CG Utrecht, The Netherlands
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Tanisha Guy
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Ruben van ’t Slot
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Trudy N. Jonges
- Department of Pathology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Martijn P. Lolkema
- Department of Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Netherlands Center for Personalized Cancer Treatment, 3584 CG Utrecht, The Netherlands
| | - Marco J. Koudijs
- Department of Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Netherlands Center for Personalized Cancer Treatment, 3584 CG Utrecht, The Netherlands
| | - Ronald P. Zweemer
- Department of Reproductive Medicine and Gynaecology, Division Woman and Baby, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Emile E. Voest
- Department of Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Netherlands Center for Personalized Cancer Treatment, 3584 CG Utrecht, The Netherlands
| | - Edwin Cuppen
- Netherlands Center for Personalized Cancer Treatment, 3584 CG Utrecht, The Netherlands
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
- Hubrecht Institute, KNAW and University Medical Center Utrecht, 3584 CT Utrecht, The Netherlands
| | - Wigard P. Kloosterman
- Department of Medical Genetics, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
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Amant F, von Minckwitz G, Han SN, Bontenbal M, Ring AE, Giermek J, Wildiers H, Fehm T, Linn SC, Schlehe B, Neven P, Westenend PJ, Müller V, Van Calsteren K, Rack B, Nekljudova V, Harbeck N, Untch M, Witteveen PO, Schwedler K, Thomssen C, Van Calster B, Loibl S. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol 2013; 31:2532-9. [PMID: 23610117 DOI: 10.1200/jco.2012.45.6335] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [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
PURPOSE We aimed to determine the prognosis of patients with breast cancer diagnosed during pregnancy (BCP). PATIENTS AND METHODS In this cohort study, a multicentric registry of patients with BCP (from Cancer in Pregnancy, Leuven, Belgium, and GBG 29/BIG 02-03) compiled pro- and retrospectively between 2003 and 2011 was compared with patients who did not have associated pregnancies, using an age limit of 45 years. Patients with a diagnosis postpartum were excluded. The main analysis was performed using Cox proportional hazards regression of disease-free survival (DFS) and overall survival (OS) on exposure (pregnant or not), adjusting for age, stage, grade, hormone receptor status, human epidermal growth factor 2 status, histology, type of chemotherapy, use of trastuzumab, radiotherapy, and hormone therapy. RESULTS The registry contained 447 women with BCP, mainly originating from Germany and Belgium, of whom 311 (69.6%) were eligible for analysis. The nonpregnant group consisted of 865 women. Median age was 33 years for the pregnant and 41 years for the nonpregnant patients. Median follow-up was 61 months. The hazard ratio of pregnancy was 1.34 (95% CI, 0.93 to 1.91; P = .14) for DFS and 1.19 (95% CI, 0.73 to 1.93; P = .51) for OS. Cox regression estimated that the 5-year DFS rate for pregnant patients would have increased from 65% to 71% if these patients had not been pregnant. Likewise, the 5-year OS rate would have increased from 78% to 81%. CONCLUSION The results show similar OS for patients diagnosed with BCP compared with nonpregnant patients. This information is important when patients are counseled and supports the option to start treatment with continuation of pregnancy.
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Affiliation(s)
- Frédéric Amant
- Multidisciplinary Breast Cancer Center, University Hospitals Leuven and Department of Oncology, Katholieke Universiteit Leuven, UZ Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
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Stuurman FE, Voest EE, Awada A, Witteveen PO, Bergeland T, Hals PA, Rasch W, Schellens JHM, Hendlisz A. Phase I study of oral CP-4126, a gemcitabine derivative, in patients with advanced solid tumors. Invest New Drugs 2013; 31:959-66. [PMID: 23345000 DOI: 10.1007/s10637-013-9925-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/06/2013] [Indexed: 02/04/2023]
Abstract
CP-4126 is a gemcitabine (2',2'-difluorodeoxycytidine; dFdC) 5' elaidic acid ester. The purpose of this dose-escalating study was to assess safety, pharmacokinetics (PK) and preliminary antitumor activity of the oral formulation and to determine the recommended dose (RD) for phase II studies. The study had a two-step design: a non-randomized dose-escalating step I with oral CP-4126 alone, followed by a randomized, cross-over step II that compared oral CP-4126 with dFdC i.v.. CP-4126 was given on days 1,8,15 in a 4-week schedule with increasing doses until the RD was established. 26 patients with different solid tumours were enrolled in step I at seven dose levels (100-3,000 mg/day). The most frequent drug-related AEs were fatigue and dysgeusia, the majority being grade 1-2. One patient experienced a dose limiting toxicity after one dose of CP-4126 at 1,300 mg/day (ASAT grade 3). PK of CP-4126 could not be determined. The metabolites dFdC and dFdU obeyed dose-dependent pharmacokinetics. Exposures to dFdC were about ten-fold lower compared to exposures after comparable doses of dFdC i.v.. Nine patients reached stable disease as best response, whereby in one patient with vaginal carcinoma a 25 % reduction of tumor volume was reached. This study demonstrates that CP-4126 can be safely administered orally to patients up to 3,000 mg/day in a d1,8,15 q4w schedule with a tolerable safety profile. CP-4126 acts as a prodrug for dFdC when given orally, but because of the poor absorption and the rapid pre-systemic metabolism the study was terminated early and no RD could be determined.
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Affiliation(s)
- F E Stuurman
- Division of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
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29
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Koolen SLW, Witteveen PO, Jansen RS, Langenberg MHG, Kronemeijer RH, Nol A, Garcia-Ribas I, Callies S, Benhadji KA, Slapak CA, Beijnen JH, Voest EE, Schellens JHM. Phase I study of Oral gemcitabine prodrug (LY2334737) alone and in combination with erlotinib in patients with advanced solid tumors. Clin Cancer Res 2011; 17:6071-82. [PMID: 21753156 DOI: 10.1158/1078-0432.ccr-11-0353] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE LY2334737 is an orally available prodrug of gemcitabine. The objective of this study was to determine the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of daily administration of LY2334737 with or without erlotinib. EXPERIMENTAL DESIGN Patients with advanced or metastatic cancer were treated with escalating doses of LY2334737 monotherapy or in combination with continuous daily administration of 100 mg erlotinib. LY2334737 was given once daily for 14 days of a 21-day cycle. The study was extended with a bioequivalence trial to investigate a novel LY2334737 drug formulation. RESULTS A total of 65 patients were treated in this study. The MTD was 40 mg LY2334737. Fatigue was the most frequent DLT for LY2334737 monotherapy (4 patients) followed by elevated transaminase levels (2 patients), both observed at the 40- to 50-mg dose levels. Among the 10 patients in the combination arm, 2 had DLTs at the 40-mg dose level. These were fatigue and elevated liver enzyme levels. The most common adverse events were fatigue (n = 38), nausea (n = 27), vomiting (n = 24), diarrhea (n = 23), anorexia (n = 20), pyrexia (n = 18), and elevated transaminase levels (n = 14). The pharmacokinetics showed dose proportional increase in LY2334737 and gemcitabine exposure. The metabolite 2',2'-difluorodeoxyuridine accumulated with an accumulation index of 4.3 (coefficient of variation: 20%). In one patient, complete response in prostate-specific antigen was observed for 4 cycles, and stable disease was achieved in 22 patients overall. Pharmacokinetic analysis showed that the 2 investigated LY2334737 drug formulations were bioequivalent. CONCLUSIONS LY2334737 displays linear pharmacokinetics and the MTD is 40 mg with or without daily administration of 100 mg erlotinib. Signs of antitumor activity warrant further development.
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Affiliation(s)
- Stijn L W Koolen
- Division of Clinical Pharmacology, The Netherlands Cancer Institute, The Netherlands.
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Walraven M, Witteveen PO, Lolkema MPJ, van Hillegersberg R, Voest EE, Verheul HMW. Antiangiogenic tyrosine kinase inhibition related gastrointestinal perforations: a case report and literature review. Angiogenesis 2011; 14:135-41. [PMID: 21188500 PMCID: PMC3102838 DOI: 10.1007/s10456-010-9197-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 12/14/2010] [Indexed: 12/11/2022]
Abstract
Anti-VEGF (vascular endothelial growth factor) therapy with the monoclonal antibody bevacizumab can cause gastrointestinal (GI) perforations. In recent years it became apparent that GI perforations also occur during treatment with antiangiogenic tyrosine kinase inhibitors (TKIs). It is of clinical importance to consider (vague) abdominal complaints during antiangiogenic treatment as a sign of a GI perforation. To illustrate this serious complication, we report four cases of antiangiogenic treatment related GI perforations. In three cases this was due to antiangiogenic TKI treatment. Reported risk factors of GI perforations due to bevacizumab include the presence of a primary tumor in situ and recent history of endoscopy or abdominal radiotherapy. Pathology assessments of surgical removal of the perforated intestinal part reveal that perforations are predominantly seen at the tumor or anastomotic site, in case of carcinomatosis or diverticulitis or when GI obstruction or an intra-abdominal abscess is present. Whether the same risk factors may be involved in antiangiogenic TKI related GI perforations is unknown. The underlying mechanisms responsible for GI perforation during antiangiogenic treatment is unknown, but disturbance of host cell homeostasis of immune cells as well as platelet-endothelial cell interactions may play an important role. In conclusion, while clinical awareness that antiangiogenic treatment can cause GI perforations is critical for current medical practice, it is also very important to get more insight in its underlying mechanisms so that this life-threatening complication may be prevented in the near future.
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Affiliation(s)
- Maudy Walraven
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martijn P. J. Lolkema
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R. van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emile E. Voest
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H. M. W. Verheul
- Department of Medical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Langenberg MHG, Witteveen PO, Roodhart J, Lolkema MP, Verheul HMW, Mergui-Roelvink M, Brendel E, Krätzschmar J, Loembé B, Nol-Boekel A, Christensen O, Schellens JHM, Voest EE. Phase I evaluation of telatinib, a VEGF receptor tyrosine kinase inhibitor, in combination with bevacizumab in subjects with advanced solid tumors. Ann Oncol 2011; 22:2508-2515. [PMID: 21378200 DOI: 10.1093/annonc/mdq767] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blocking both receptor and ligand of the vascular endothelial growth factor (receptor) VEGF(R) pathway might be feasible and increase antitumor activity. This phase I study investigated telatinib, an oral tyrosine kinase inhibitor targeting VEGFR-2, combined with bevacizumab, in adults with solid tumors. PATIENTS AND METHODS Twenty-six patients were treated in successive cohorts with telatinib (twice-daily continuously, 450-900 mg) or bevacizumab (bi-weekly, starting dose 5 mg/kg). Safety, pharmacokinetics, endothelial (progenitor) cell (E(P)C)/growth factor kinetics and efficacy were assessed. RESULTS Most frequent adverse events were pain, nausea, voice changes and fatigue. Five dose-limiting toxicities (DLTs) occurred: hypertension (cohort I and II), bowel perforation, lipase increase and atrial flutter (cohort III). Cumulative toxicity resulted in a bevacizumab dose reduction to 1 mg/kg (cohort III). Due to three DLTs (n = 14), this cohort represented the best-tolerated dose level. Bevacizumab effectively neutralized plasma VEGF even at 1 mg/kg. Twelve patients had stable disease (clinical benefit 46%). EPC and SDF-1α levels increased during monotherapy telatinib. CONCLUSIONS Telatinib (450 mg b.i.d.) combined with bevacizumab (1 mg/kg bi-weekly) shows antitumor activity, but accumulating constitutional toxicity impedes long-term treatment of patients. Therefore, this combination will not be pursued in a phase II setting.
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Affiliation(s)
- M H G Langenberg
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht
| | - P O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht
| | - J Roodhart
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht
| | - M P Lolkema
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht
| | - H M W Verheul
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht
| | - M Mergui-Roelvink
- Department of Medical Oncology, The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | - E Brendel
- Department of Pharmacokinetic Analysis, Bayer HealthCare AG, Wuppertal, Germany
| | - J Krätzschmar
- Department of Pharmacokinetic Analysis, Bayer HealthCare AG, Wuppertal, Germany
| | - B Loembé
- Bayer Schering Pharma, Mijdrecht, The Netherlands
| | - A Nol-Boekel
- Department of Medical Oncology, The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands
| | | | - J H M Schellens
- Department of Medical Oncology, The Netherlands Cancer Institute Amsterdam, Amsterdam, The Netherlands; Department of Pharmaceutical Sciences, Division Drug Toxicology, Utrecht University, Utrecht, The Netherlands
| | - E E Voest
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht.
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Boss DS, Witteveen PO, van der Sar J, Lolkema MP, Voest EE, Stockman PK, Ataman O, Wilson D, Das S, Schellens JH. Clinical evaluation of AZD1152, an i.v. inhibitor of Aurora B kinase, in patients with solid malignant tumors. Ann Oncol 2010; 22:431-7. [PMID: 20924078 DOI: 10.1093/annonc/mdq344] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To determine, for each of two dosing schedules, the dose-limiting toxicity (DLT) and maximum-tolerated dose (MTD) of AZD1152, an Aurora B kinase inhibitor, and to evaluate its safety, biologic activity and pharmacokinetics (PK). PATIENTS AND METHODS Patients with advanced solid malignancies were treated with escalating doses (100-650 mg) of AZD1152, administered as a 2-h infusion every 7 days (A) or 14 days (B). Adverse events (AEs), PK variables and tumor response were assessed. RESULTS Fifty-nine patients were treated; 19 in schedule A and 40 in schedule B. The MTDs were 200 and 450 mg, respectively. Neutropenia (with/without fever) was the most frequent AE and DLT in each schedule. Common Terminology Criteria of Adverse Events version 3.0 grade ≥3 neutropenia and leukopenia occurred in 58% and 11% of patients, respectively, in schedule A and 43% and 20%, respectively, in schedule B. No objective tumor responses were observed at any dose or schedule, although stable disease, as defined by RECIST, was achieved in 15 patients (25%) overall. Systemic exposure to AZD1152-hQPA (active drug) was observed by 1 h into the infusion and exhibited linear PK. CONCLUSIONS AZD1152 was generally well tolerated with neutropenia being the most frequently reported AE and DLT. Exposure to AZD1152-hQPA, the active drug of AZD1152, was linear.
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Affiliation(s)
- D S Boss
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam
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Langenberg MHG, Nijkamp MW, Roodhart JML, Snoeren N, Tang T, Shaked Y, van Hillegersberg R, Witteveen PO, Vermaat JSP, Kranenburg O, Kerbel RS, Medema RH, Borel Rinkes IHM, Voest EE. Liver surgery induces an immediate mobilization of progenitor cells in liver cancer patients: A potential role for G-CSF. Cancer Biol Ther 2010; 9:743-8. [PMID: 20215863 DOI: 10.4161/cbt.9.9.11551] [Citation(s) in RCA: 16] [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: 12/15/2022] Open
Abstract
BACKGROUND In preclinical models recruitment of bone-marrow derived (endothelial) progenitor cells (BD(E)PCs) contributes to tumor growth and metastasis formation. Here we investigated whether these (E)PCs and mobilizing cytokines are released after partial hepatectomy or radiofrequency ablation (RFA) for liver tumors. In addition, we tested whether G-CSF could play a role in EPC mobilization in mice and in human volunteers. RESULTS Patients undergoing partial hepatectomy or RFA showed an instantaneous release of EPCs following laparotomy and mobilization of the liver. Elevated EPC levels were maintained during the entire procedure, but dropped to near-baseline levels 4 h after completion of the procedure. Plasma G-CSF levels showed a 5-10-fold increase after the procedure and low-dose G-CSF administration to mice or healthy volunteers was sufficient to induce an immediate release of EPCs. Surgery also caused an increase in the plasma levels of VEGF, but not SDF-1alpha. METHODS Before, during and after liver surgery plasma and mononuclear cells were collected from 12 patients undergoing partial hepatectomy or RFA. To explore the role of G-CSF C57Bl/6 mice and 20 human volunteers received G-CSF (0.3, 3 or 300microg). In all individuals, (E)PC numbers were determined by flow cytometry at predefined timepoints shortly after therapy. Plasma levels of G-CSF, VEGF and SDF-1alpha were measured by ELISA. CONCLUSION Compliant with previous published data concerning VDA and chemotherapy treatment, liver surgery induces an instantaneous release of EPCs, conceivably in response to elevated G-CSF levels. This suggests the value of exploring therapeutic avenues to prevent this process.
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Langenberg MHG, Witteveen PO, Roodhart JM, Verheul HMW, Mergui-Roelvink M, van der Sar J, Brendel E, Laferriere N, Schellens JHM, Voest EE. Phase I evaluation of telatinib, a vascular endothelial growth factor receptor tyrosine kinase inhibitor, in combination with irinotecan and capecitabine in patients with advanced solid tumors. Clin Cancer Res 2010; 16:2187-97. [PMID: 20233884 DOI: 10.1158/1078-0432.ccr-09-2436] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We studied the safety and tolerability of telatinib, an orally available, small-molecule tyrosine kinase inhibitor of the vascular endothelial growth factor receptor (VEGFR-2/VEGFR-3), platelet-derived growth factor receptor beta, and c-Kit in combination with capecitabine and irinotecan. EXPERIMENTAL DESIGN Telatinib twice daily continuously, irinotecan once every 3 weeks, and capecitabine oral twice daily on day 1 to 14 were administered in cycles of 21 days in escalating doses in successive cohorts. Toxicity was evaluated to conform to the Common Terminology Criteria for Adverse Events version 3.0. Pharmacokinetic and (circulating) endothelial (progenitor) cell measurements were done. Tumor efficacy was evaluated using the Response Evaluation Criteria in Solid Tumors. RESULTS Twenty-three patients were included in this phase I trial. Most frequently (>25%) reported adverse events of any grade were vomiting, nausea, fatigue, diarrhea, alopecia, and hand-foot syndrome. A silent myocardial infarction and two cases of decreased left ventricular ejection fraction were reported; both were reversible. Cardiac monitoring of the subsequent patients did not reveal other abnormalities. The study was terminated when the recommended single agent phase II doses of telatinib (900 mg twice daily) and capecitabine/irinotecan was reached. Pharmacokinetic profiles showed no clinically relevant changes upon coadministration of the three drugs. (Circulating) endothelial (progenitor) cell levels stabilized during treatment. Five of 23 patients had partial remission and 9 of 23 patients showed stable disease. CONCLUSIONS Continuous administration of 900 mg telatinib twice daily can be safely combined with irinotecan (180 mg/m(2)) and capecitabine (1,000 mg/m(2) twice daily, day 1-14) and is the recommended schedule for further phase II studies. Tumor shrinkage and disease stabilization was observed. Cardiac toxicity needs further investigation in following studies.
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Affiliation(s)
- Marlies H G Langenberg
- Department of Medical Oncology, University Medical Center Utrecht and Science Faculty, Department Pharmaceutical Sciences, Division Drug Toxicology, Utrecht University, Utrecht, the Netherlands
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Kuenen B, Witteveen PO, Ruijter R, Giaccone G, Dontabhaktuni A, Fox F, Katz T, Youssoufian H, Zhu J, Rowinsky EK, Voest EE. A phase I pharmacologic study of necitumumab (IMC-11F8), a fully human IgG1 monoclonal antibody directed against EGFR in patients with advanced solid malignancies. Clin Cancer Res 2010; 16:1915-23. [PMID: 20197484 DOI: 10.1158/1078-0432.ccr-09-2425] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to determine a maximum tolerated dose (MTD) and recommended dose for disease-directed studies of necitumumab (IMC-11F8), a fully human IgG(1) monoclonal antibody directed at the epidermal growth factor receptor, and to characterize the safety profile, pharmacokinetics, preliminary antitumor activity, and immunogenicity of necitumumab. EXPERIMENTAL DESIGN Patients with advanced solid malignancies were treated with 100 to 1,000 mg (flat dosing) necitumumab followed by a 2-week pharmacokinetics sampling period, before beginning 6-week cycles of therapy. RESULTS Sixty patients received necitumumab weekly (29 patients) or every other week (31 patients). Two patients receiving 1,000 mg every 2 weeks experienced dose-limiting toxicities (DLT; grade 3 headache), accompanied by grade 3 nausea and vomiting in one patient. Occurring hours after the initial dose, these DLTs established 800 mg as the MTD. Mild dose-related skin toxicity was the most common drug-related toxicity (80%). One patient in each arm experienced grade 3 acneform rash, which responded to oral antibiotics and topical therapy. Toxicity was similar on both schedules. Necitumumab exhibited saturable elimination and nonlinear pharmacokinetics. At 800 mg (both arms), its half-life was approximately 7 days. All patients treated with >or=600 mg necitumumab achieved target trough concentrations (>or=40 microg/mL). Antibodies against necitumumab were not detected. Partial response and stable disease were experienced by 2 and 16 patients, respectively. CONCLUSION Well tolerated, necitumumab is associated with preliminary evidence of antitumor activity, and achieves biologically relevant concentrations throughout the dosing period. The recommended dose of necitumumab for further clinical development is 800 mg (flat dose) weekly or every 2 weeks based on the clinical setting.
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Affiliation(s)
- Bart Kuenen
- Department of Oncology, Free University Hospital of Amsterdam, Amsterdam, the Netherlands
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van Cruijsen H, Voest EE, Punt CJ, Hoekman K, Witteveen PO, Meijerink MR, Puchalski TA, Robertson J, Saunders O, Jürgensmeier JM, van Herpen CM, Giaccone G. Phase I evaluation of cediranib, a selective VEGFR signalling inhibitor, in combination with gefitinib in patients with advanced tumours. Eur J Cancer 2010; 46:901-11. [DOI: 10.1016/j.ejca.2009.12.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 12/07/2009] [Accepted: 12/14/2009] [Indexed: 10/20/2022]
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Vernooij F, Witteveen PO, Verweij E, van der Graaf Y, Heintz APM. The impact of hospital type on the efficacy of chemotherapy treatment in ovarian cancer patients. Gynecol Oncol 2009; 115:343-8. [PMID: 19800674 DOI: 10.1016/j.ygyno.2009.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 08/16/2009] [Accepted: 08/22/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The hospital type affects the surgical outcomes of ovarian cancer patients. In the present study, we wanted to investigate the effect of hospital type on chemotherapy efficacy. METHODS Data were collected from 1077 ovarian cancer patients treated from 1996 to 2003 in a random sample of 18 Dutch hospitals. Hospitals were categorized by the number of medical oncologists working in a hospital and additionally by chemotherapy volume (< or =100, 101-200, or >200 patients yearly) and ovarian cancer patient-volume (< or =6, 7-12, >12 yearly). The outcomes were the proportions of patients achieving complete remission, recurrence rates, and disease-free and overall survival. Data were analyzed using multivariable logistic regression (complete remission and recurrence) and Cox regression (survival). RESULTS Data of 761 of the 777 patients who received chemotherapy could be analyzed. Hospital type did not affect the complete remission rates, recurrence rates, or the disease-free survival. Overall survival was better in hospitals with 2 or more medical oncologists and in hospitals with a high ovarian cancer patient-volume (hazard ratios both 0.8 (95% confidence interval=0.7-1.0)). CONCLUSIONS Thus, hospital type did not influence the outcomes of first-line chemotherapy in ovarian cancer patients. However, overall survival was better in hospitals with 2 or more medical oncologists and in hospitals with a high ovarian cancer patient-volume, suggesting differences in second-line chemotherapy.
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Affiliation(s)
- Flora Vernooij
- Department of Gynecological Surgery and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Witteveen PO, van der Velden J, Vergote I, Guerra C, Scarabeli C, Coens C, Demonty G, Reed N. Phase II study on paclitaxel in patients with recurrent, metastatic or locally advanced vulvar cancer not amenable to surgery or radiotherapy: a study of the EORTC-GCG (European Organisation for Research and Treatment of Cancer--Gynaecological Cancer Group). Ann Oncol 2009; 20:1511-1516. [PMID: 19487487 DOI: 10.1093/annonc/mdp043] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [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 No standard treatment options are available for patients with advanced, recurrent or metastatic vulvar carcinoma not amenable for locoregional treatment. PATIENTS AND METHODS In this phase II study, patients with advanced vulvar cancer received paclitaxel (Taxol) every 3 weeks for up to 10 cycles. Primary objective was response rate. Secondary objectives were response duration and toxicity. Response evaluation was assessed by World Health Organisation criteria, toxicity according to Common Toxicity Criteria. RESULTS Thirty-one women from 10 institutions were included, with a median age of 64 (range 47-84), of which 29 were assessable for response. On study patients received a median of four cycles (range 1-10). SAFETY Grade 3 and 4 neutropenia was seen in eight patients (8/29 = 27.6%), which in one patient resulted in neutropenic fever and treatment-related death. Further treatment-related grade 3/4 toxicity includes fatigue in three patients (10.3%) and neuropathy in one patient (3.4%). EFFICACY Overall response was 13.8% (n = 4; two complete responses + two partial responses). With a median follow-up of 24 months, median PFS was 2.6 months (95%confidence interval 2.04-4.21). CONCLUSION Paclitaxel shows moderate activity for local control in advanced vulvar cancer.
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Affiliation(s)
- P O Witteveen
- Department of Medical Oncology, University Medical Center Utrecht.
| | - J van der Velden
- Department of Gynaecological Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - I Vergote
- Department of Gynaecological Oncology, University Hospital Leuven, Belgium
| | - C Guerra
- Department of Gynaecological Oncology, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - C Scarabeli
- Department of Gynecological Oncology, Azienda Ospedaliera di Pavia, Italy
| | - C Coens
- EORTC Headquarters, Brussels, Belgium
| | - G Demonty
- EORTC Headquarters, Brussels, Belgium
| | - N Reed
- Department of Clinical Oncology, Gartnavel General Hospital, Glasgow, UK
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Vernooij F, Heintz APM, Witteveen PO, van der Heiden-van der Loo M, Coebergh JW, van der Graaf Y. Specialized care and survival of ovarian cancer patients in The Netherlands: nationwide cohort study. J Natl Cancer Inst 2008; 100:399-406. [PMID: 18334710 DOI: 10.1093/jnci/djn033] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is much debate on the necessity of regionalization of ovarian cancer care. We investigated the association between hospital type and survival of patients with ovarian cancer in The Netherlands. METHODS A retrospective, population-based cohort study was performed on all Dutch patients diagnosed with ovarian cancer from January 1, 1996, through December 31, 2003. We used data from the Netherlands Cancer Registry that were linked to mortality data from the Statistics Netherlands database to obtain the date and cause of death. Five-year relative survival ratios, defined as the ratio of the observed survival in the patient population to the expected survival of women in the general population with the same age, were determined for the total population and for groups stratified by tumor stage and/or hospital type. The association between hospital type and disease-specific survival was analyzed by use of multivariable Cox regression analyses. RESULTS We analyzed data from 8621 women with epithelial ovarian cancer, of whom 3482 (40%) were treated in general hospitals, 3510 (41%) were treated in semispecialized hospitals, and 1557 (18%) were treated in specialized hospitals. Five-year relative overall survival ratios of patients treated in general, semispecialized, and specialized hospitals were 38.0% (95% confidence interval [CI] = 36.0% to 39.9%), 39.4% (95% CI = 37.5% to 41.4%), and 40.3% (95% CI = 37.4% to 43.1%), respectively; median survival of patients aged 50-75 years was 36 months (interquartile range [IQR] = 13 to >54 months), 37 months (IQR = 14 to >54 months), and 38 months (IQR = 15 to >55 months), respectively. Age and cancer stage were associated with the relationship between hospital type and ovarian cancer-specific survival but histologic tumor type, grade, year of diagnosis, and socioeconomic status were not. Among patients with early-stage ovarian cancer, treatment in semispecialized and specialized hospitals was associated with lower risks of ovarian cancer-specific mortality than treatment in general hospitals. Among patients with stage I-IIA disease who were aged 50-75 years, risk of ovarian cancer-specific mortality was 30% and 42% lower after treatment in semispecialized and specialized hospitals, respectively, than in general hospitals (for semispecialized hospitals, hazard ratio [HR] = 0.70, 95% CI = 0.53 to 0.93; for specialized hospitals, HR = 0.58, 95% CI = 0.38 to 0.87). Among patients with advanced ovarian cancer, hospital type was not associated with survival. CONCLUSION Hospital type was statistically significantly associated with survival among Dutch ovarian cancer patients with early-stage ovarian cancer: Patients who were treated in specialized and semispecialized hospitals survived longer than patients treated in general hospitals.
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Affiliation(s)
- Flora Vernooij
- Department of Gynecologic Surgery and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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van der Bilt JDW, Soeters ME, Duyverman AMMJ, Nijkamp MW, Witteveen PO, van Diest PJ, Kranenburg O, Borel Rinkes IHM. Perinecrotic hypoxia contributes to ischemia/reperfusion-accelerated outgrowth of colorectal micrometastases. Am J Pathol 2007; 170:1379-88. [PMID: 17392176 PMCID: PMC1829470 DOI: 10.2353/ajpath.2007.061028] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Ischemia/reperfusion (I/R) is often inevitable during hepatic surgery and may stimulate the outgrowth of colorectal micrometastases. Postischemic microcirculatory disturbances contribute to I/R damage and may induce prolonged tissue hypoxia and consequent stabilization of hypoxia-inducible factor (HIF)-1alpha. The aim of this study was to evaluate the contribution of postischemic microcirculatory disturbances, hypoxia, and HIF-1alpha to I/R-accelerated tumor growth. Partial hepatic I/R attributable to temporary clamping of the left liver lobe induced microcirculatory failure for up to 5 days. This was accompanied by profound and prolonged perinecrotic tissue hypoxia, stabilization of HIF-1alpha, and massive perinecrotic outgrowth of pre-established micrometastases. Restoration of the microcirculation by treatment with Atrasentan and L-arginine minimized hypoxia and HIF-1alpha stabilization and reduced the accelerated outgrowth of micrometastases by 50%. Destabilization of HIF-1alpha by the HSP90 inhibitor 17-DMAG caused an increase in tissue necrosis but reduced I/R-stimulated tumor growth by more than 70%. In conclusion, prevention of postischemic microcirculatory disturbances and perinecrotic hypoxia reduces the accelerated outgrowth of colorectal liver metastases after I/R. This may, at least in part, be attributed to the prevention of HIF-1alpha stabilization. Prevention of tissue hypoxia or inhibition of HIF-1alpha may represent attractive approaches to limiting recurrent tumor growth after hepatic surgery.
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Tjin-A-ton MLR, van Montfrans C, Koldenhof JJ, Sigurdsson V, Voest EE, Witteveen PO. [Skin eruptions as an adverse reaction to epidermal growth-factor receptor inhibitors]. Ned Tijdschr Geneeskd 2007; 151:945-52. [PMID: 17520845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Inhibition of the epidermal growth-factor receptor (EGFR) is a new strategy in the treatment of solid malignancies. Two men, aged 65 and 59 years, with a metastasized renal carcinoma and a 51-year-old man with a metastasized melanoma developed an acneiform eruption during EGFR inhibition. The second and third patient also developed paronychia. Treatment in all patients consisted of antiseptics and topical antibiotics; the first and third patient also received an oral antibiotic. Withdrawal of the EGFR inhibitor because of progression of the disease led to complete recovery of the cutaneous lesions in the first and the third patient; both died after several months. In the second patient, the side effects reached an acceptable level during continued EGFR therapy. EGFR inhibition is usually accompanied by cutaneous side effects. An acneiform eruption is seen in up to 90% of all treated patients. Other side effects include dry skin, and nail and hair changes. The pathogenesis of these side effects is related to inhibition of EGFR signalling pathways in the skin, but is not yet fully understood. The treatment of EGFR inhibitor-mediated cutaneous toxicity is based mainly on clinical experience.
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Affiliation(s)
- M L R Tjin-A-ton
- Universitair Medisch Centrum Utrecht, divisie Interne Geneeskunde en Dermatologie, Heidelberglaan 100, 3584 CX Utrecht
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Kuppens IELM, Witteveen PO, Schot M, Schuessler VM, Daehling A, Beijnen JH, Voest EE, Schellens JHM. Phase I dose-finding and pharmacokinetic trial of orally administered indibulin (D-24851) to patients with solid tumors. Invest New Drugs 2006; 25:227-35. [PMID: 17146730 DOI: 10.1007/s10637-006-9027-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 11/07/2006] [Indexed: 10/23/2022]
Abstract
Indibulin is a synthetic small molecule which antitumor activity is based upon destabilization of microtubules. The primary study objectives were to determine the impact of fasted and fed condition on pharmacokinetic parameters, as well as the maximum tolerated dose of the oral drinking solution of indibulin administered once daily for 14 days every 3 weeks in patients with solid tumors. In the pilot food effect part, patients received a single dose of 20 mg indibulin on day-8 and -4, fasted or fed, in a randomized crossover design. In the dose-escalation part, patients received a single dose of indibulin on day-4. Three dose levels were evaluated: 20, 40 and 80 mg. After a washout period, patients received indibulin once daily for 14 days every 3 weeks (multiple dose part). Blood samples were collected in the pilot food effect- and in the dose escalation study. A total of 14 patients entered, of which 6 completed the food effect study. The ratio of indibulin (fed/fasted) in the food effect study for AUC(0-72) was estimated as 1.24 (P=0.082, 95%CI 0.96-1.41) and C(max) ratio was 0.89 (P=0.54, 95%CI 0.55-1.44). Interpatient variability was high. Higher peak plasma concentrations were reached under fasting conditions which was undesired regarding tolerability. Therefore the dose escalation study was continued under fed conditions. Dose limiting toxicities, nausea and vomiting, appeared to be related to the increased volume of the solvent lactic acid. This study is continued, evaluating indibulin administered as capsules on the recommended dose level of 60 mg daily for 14 days.
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Affiliation(s)
- I E L M Kuppens
- Department of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX Amsterdam, The Netherlands.
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Schröder W, Campone M, Abadie S, Witteveen PO, Viens P, Du Bois A. A phase IB, open label, safety and pharmacokinetic (PK) study of escalating doses of PTK787/ZK 222584 (PTK/ZK) in combination with paclitaxel and carboplatin in patients (Pts) with stage IC to IV epithelial ovarian cancer (EOC). Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952829] [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: 10/20/2022] Open
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Sijmons EA, van Lankveld MAL, Witteveen PO, Peeters PHM, Koot VCM, van Leeuwen JS. Compliance to clinical guidelines for early-stage epithelial ovarian cancer in relation to patient outcome. Eur J Obstet Gynecol Reprod Biol 2006; 131:203-8. [PMID: 16707204 DOI: 10.1016/j.ejogrb.2006.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2005] [Revised: 02/02/2006] [Accepted: 03/28/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To assess compliance to current surgical staging and adjuvant treatment guidelines for patients with early-stage epithelial ovarian carcinoma and its impact on overall survival. METHODS Patients diagnosed between 1991 and 1997 with early-stage ovarian cancer were recruited from the Regional Cancer Registry of the central region in the Netherlands. Demographic data, tumour characteristics, surgical findings and therapeutic data were abstracted from medical records. Patients were classified into optimal and non-optimal surgical staging. Overall survival was estimated using Kaplan-Meier method. To adjust for age hazard ratios for overall survival were estimated with a Cox Proportional Hazards model. RESULTS One hundred and twenty-five patients were included in the study, 41 of them (32.8%) were optimally staged. Guidelines for adjuvant radio- or chemotherapy were adequately followed in all 62 grade I patients and in 44 out of 59 grade II and III patients (74.6%). During 734.6 person-years of follow up 31 patients died. Five-year overall survival figures were 97.6% in the optimally staged group and 68.5% in the non-optimally staged group. Patients who were non-optimally staged, had a significant higher risk to die than those who were optimally staged (HR: 7.4; 95% CI: 1.7-32.2). In patients with a grade II and III tumours, complete surgical staging still had a significant influence on survival (HR: 3.8; 95% CI 1.7-8.3). In women with grade II or III tumours, adjuvant radio- or chemotherapy administered in accordance to the guidelines did not improve overall survival regardless whether they were optimally staged or not. CONCLUSION Incomplete staging in early-stage ovarian cancer leads to gross mis-classification in grade II and III tumours and to a lesser extent in grade I tumours. This leads to undertreatment in both surgical and adjuvant therapy. Subsequently unnecessary deaths may occur. More effort must be put in identifying obstacles interfering with compliance of guidelines.
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Affiliation(s)
- Edith A Sijmons
- University Medical Center Utrecht, Department of Gynaecology, Box 85500, 3508 GA Utrecht, The Netherlands
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van Lankveld MAL, Peeters PHM, van Eijkeren MA, Koot VCM, Witteveen PO, Mali WPTM. The value of abdominal CT scans in decision-making during chemotherapy in ovarian cancer. Med Oncol 2004; 21:41-8. [PMID: 15034212 DOI: 10.1385/mo:21:1:41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Accepted: 09/23/2003] [Indexed: 11/11/2022]
Abstract
OBJECTIVE During chemotherapy of ovarian cancer many CT scans are performed to assess tumor response during treatment. The aim of this study was to determine the value of abdominal CT scan in the decision to continue chemotherapy or not, after the standard six cycles. METHODS All ovarian cancer patients diagnosed between 1991 and 1997 were retrospectively included in the study. Clinical parameters, surgical results, diagnostic test results, and therapeutic strategies were collected from medical records. With logistic modeling those parameters were chosen that predicted best the chance of receiving additional chemotherapy. The chance of receiving further chemotherapy after six cycles based on these parameters was computed and compared to the chance based on CT scan results in addition to these parameters. Arbitrarily we defined a change of over 20% as meaningful. RESULTS Eighteen of 50 included patients (36%) received over six cycles of chemotherapy; 29 patients (10%) were at low risk for receiving over six cycles, because they had an optimal debulking surgery and low levels of CA-125 at cycle six. The chance of receiving continued chemotherapy after taking into account positive tumor signs on CT-scan was 22%. This figure further increased to 33% if tumor presence was based on judgment of two CT scans. High-risk patients were patients with suboptimal debulking surgery or patients with an optimal debulking, but high CA-125 levels at cycle six (n = 21). Based on these parameters their chance of receiving additional chemotherapy was 71%, and after taking into account results of one or two CT-scans, the risks increased to 74% and 81%, respectively. CONCLUSION CT scans are of no value in deciding the number of chemotherapy cycles in the initial treatment for ovarian cancer. They cost a lot of money, can add a lot of confusion, and offer no benefit over results of debulking surgery and CA-125 levels.
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Affiliation(s)
- M A L van Lankveld
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht Box 85500, 3508 GA Utrecht, The Netherlands
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Radema SA, Witteveen PO, Gebbink MB, Voest EE. [The clinical perspective of angiogenesis inhibitors]. Ned Tijdschr Geneeskd 2003; 147:1675-80. [PMID: 14513538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
An important development in the treatment of cancer is the recognition that the tumour's microenvironment, notably its vasculature, may be an attractive target for therapy. In the eighties of the last century, the concept of angiogenesis (the formation of new blood vessels from existing vasculature) was developed. Angiogenesis is the driving force behind tumour growth and metastasis. Recent angiogenesis research has elucidated the role of growth factors (vascular endothelial growth factor (VEGF), epidermal growth factor), metalloproteinases and endogenous proteins such as angiostatin and endostatin. This new knowledge has led to the rapid development of several angiogenesis inhibiting strategies. Although these new strategies showed very promising results in preclinical animal studies, early clinical studies with individual angiogenesis inhibitors have shown no antitumour effect so far. However, in recent studies blocking VEGF in addition to conventional chemotherapy has led to an increase in disease-free survival time and in response rate to chemotherapy. Angiogenesis research has contributed to the knowledge of the biology of cancer, the design of modified clinical studies and the development of surrogate markers that can be used as pharmacodynamic end points in future studies.
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Affiliation(s)
- S A Radema
- Universitair Medisch Centrum Utrecht, afd. Medische Oncologie, Postbus 85.500, 3508 GA Utrecht
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Abstract
In this review we discuss the most important issues concerning the treatment of advanced cervical cancer. Advances in the treatment of cervical cancer are made slowly, but recently the data from five important randomised studies gave rise to an important change in the standard treatment of this disease. For the new standard in advanced cervical cancer, it is clear that chemotherapy should be added to the radiation regimen for an optimal treatment. However, firm conclusions to which drugs or regimens cannot be drawn at this moment.
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Affiliation(s)
- P O Witteveen
- Department of Internal Medicine, Section of Oncology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
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Van Eijkeren MA, Sijmons EA, Witteveen PO, Verhaar MJ, Sie-Go DM, Heintz AP. Treatment of metastatic invasive moles in two husband-side sisters-in-law. Case reports and review of literature. EUR J GYNAECOL ONCOL 2002; 22:406-8. [PMID: 11874069] [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: 02/24/2023]
Abstract
PURPOSE OF INVESTIGATION The treatment of "high risk" persistent trophoblastic disease (PTD) consists of poly-chemotherapy. This policy probably will lead to overtreatment of some patients. Also, familiar molar pregnancies through the paternal line are unknown in the literature up till now. METHODS We describe two cases of "high risk" PTD in two husband-side sisters-in-law, in which poly-chemotherapy was stopped after histology became available and showed invasive metastatic mole. CONCLUSION It should be stressed that treatment decisions should be made based on the concept of "high" or "low" risk PTD, but if histology becomes available, chemotherapy might be less aggressive in cases of invasive mole. If invasive mole could be familiar through the paternal line remains unclear with the current knowledge of genetics in trophoblastic disease.
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Affiliation(s)
- M A Van Eijkeren
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands
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Roovers JP, Sijmons EA, van Leeuwen JH, Mol BW, Witteveen PO, Slee PH, Heintz AP. Is platinum-based chemotherapy with paclitaxel effective in optimally debulked patients with advanced ovarian cancer? Eur J Obstet Gynecol Reprod Biol 2001; 97:80-4. [PMID: 11435015 DOI: 10.1016/s0301-2115(00)00502-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Suboptimally debulked patients with advanced ovarian cancer who are treated with a combination of cisplatin plus paclitaxel (TP therapy) have a better survival as compared to patients treated with a combination of cisplatin plus cyclophosphamide (CP therapy), but this advantage has not been demonstrated in optimally debulked patients. We performed a retrospective study to compare the effectiveness of TP therapy and CP therapy in optimally debulked patients. STUDY DESIGN From 1991 to 1996, 87 consecutive patients with advanced ovarian cancer treated in the University Hospital Utrecht and the St. Antonius Hospital were included in the study. Overall survival (OS) of patients treated with TP or CP were compared. Multivariable Cox-regression analysis was used to calculate a hazard rate ratio (HRR) for OS. RESULTS In the study period, 51 patients were treated with CP, and 36 patients were treated with TP. In the 18 patients with a tumorrest >2cm, there was a clear, but not statistically significant benefit from TP. In 69 patients with a tumorrest <or=2cm, life expectancy was not increased in patients treated with TP as compared to patients treated with CP (HRR 0.9 (95% CI 0.4-1.9)). CONCLUSION We could not show that ovarian cancer patients with residual disease of <or=2cm who were treated with TP had better survival as compared to patients who were treated with CP. Taking into account the high costs of treatment with TP, a randomized trial comparing the effects of TP therapy and CP therapy in optimally debulked patients is warranted.
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Affiliation(s)
- J P Roovers
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands.
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Hartkamp A, van Boxtel AJ, Zonnenberg BA, Witteveen PO. Totally implantable venous access devices: evaluation of complications and a prospective comparative study of two different port systems. Neth J Med 2000; 57:215-23. [PMID: 11099790 DOI: 10.1016/s0300-2977(00)00083-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Totally implantable venous access devices (TIVADs) are valuable instruments in case prolonged intravenous therapy is required, but implantation and use of these devices are associated with complications. The purpose of this study was to evaluate perioperative and long-term complications associated with TIVADs. In addition, we compared two different types of TIVADs with respect to implantation, care protocol and patients' comfort. METHODS In a retrospective study perioperative and long-term complications in a general oncology population were analysed. In a prospective randomized study comparison of two types of TIVADs was carried out. RESULTS Perioperative complications occurred in 27 (21.4%) of 126 implanted TIVADs: catheter malposition (16.7%) in 21 patients, pneumothorax (0.8%) in one and haemorrhage (4.0%) in five. Long-term complications appeared in 31 (25.2%) out of 123 TIVADs: thrombosis in 9 (7.3%), especially associated with malposition of the tip of the catheter; infection in 10 (8.1%); extravasation in 2 (1.6%); migration of the catheter tip in 6 (4.8%); pain at reservoir in 3 (2.4%) and inaccessibility of the port in 1 (0.8%). No significant differences were found with respect to implantation, care accessibility and patients' comfort between the two TIVADs. CONCLUSIONS The use of TIVADs is associated with some risk of serious perioperative and long-term complications. In case of thrombotic complications these systems can be saved with appropriate treatment. Correct positioning of the catheter tip is essential to prevent thrombotic complications. In case of TIVAD-related infectious complications, the possibility of saving the TIVAD depends on the causative microorganism and type of infection. Furthermore, to increase patients' satisfaction with TIVADs they should be well informed about the surgical procedure and possible disadvantages of these devices.
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Affiliation(s)
- A Hartkamp
- Department of Internal Medicine, University Medical Centre (UMC) Utrecht, F02.126 Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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