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Roila F, Ruggeri B, Ballatori E, Patoia L, Palazzo S, Colucci G, Di Costanzo F, Cascinu S, Labianca R, Sobrero A, Cortesi E, Bressi C, Ferraldeschi R, Mazzoli M, Evangelista M, Di Fonzo C, Cigolari S, Angelini V, Cioffi A, Guardasole V, Zarra E, Tonato M, Betti M, Marrocolo F, Bon-ciarelli V, Cetto G, Silingardi V, Cognetti F, Beretta G, Pessi A, Mosconi S, Milesi L, Bertetto O, Malacarne P, Marzola M, Margutti G, Modenesi C, Manente P, Comandone A, Oliva C, Berniolo P, Cutin SC, Luporini G, Colucci G, Recaldin E, Nicodemo M, Picece V, Turaz-za M, Ferrazzi E, Solina G, Rosati G, Rossi A, Manzione L, Sozzi P, Fornarini G, Lavarello A, Catalano G, Giordani P, Alessandroni P, Troccoli G, Ramus GV, Tonda L, Sirgiovanni M, Iannello GP, Tinessa V, Ruggiero A, Palazzo S, Barni S, Mandalà M, Cremonesi M, Porcile G, Destefanis M, Testore F, Carteni G, Daniele B, Volta C, Ferraù F, Zaniboni A, Marchetti P, Citone G, Cefaro GA, Iacono C, Musi M, Mozzicafreddo A, Imperiale FN, Filippelli G, Sciacca V, D'Aprile M, Isa L, Recchia F, Spada S, Cascinu S, Carroccio R, Mustacchi G, Ceccherini R, Chetrì M, Rizzo P, Botturi M, Marchei P, Bretti S, Montalbetti L, Reguzzoni G, Massidda B, Ionta M, Cruciani G, Prosperi A, Mantovani G, Sidoti V, Peta A, Greco E, Cicero G, Sobrero A, Marsilio P, Vigevani E, Rimondi G, Gebbia V, Nuzzo A, Biondi E, Caroti C, D'Amico M, Tuveri G, Pieri G, Enrici RM, Tonini G, Santini D, Iannone T, Pizza C, Belli M, Del Prete S, Pizza C, Trevisonne R, Serlenga M, Laricchiuta R, Lacava V, Bumma C, Roselli M, Verderame F, Mascia V, Perrone D, Prantera T, Venuta S, Nastasi G, Bortolussi V, Lembo A. Adjuvant Systemic Therapies in Patients with Colorectal Cancer: An Audit on Clinical Practice in Italy. Tumori 2019; 91:472-6. [PMID: 16457144 DOI: 10.1177/030089160509100605] [Citation(s) in RCA: 5] [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] [Indexed: 11/16/2022]
Abstract
Aims and Background Rarely are conclusions from clinical trials summarized in international consensus conferences and promptly transferred to patient care. The adjuvant therapy for colorectal cancer used in daily clinical practice in Italy is described and compared with the recommendations of the 1990 NIH Consensus Conference. Patients and Methods We audited prescriptions of adjuvant systemic therapies for Italian colorectal cancer patients in 82 centers during a fixed one-week period. Results Among 434 patients receiving adjuvant chemotherapy there were 139 (42.5%) colon cancer patients with N- and 169 (51.7%) with N+ regional nodal involvement. Treatment at academic centers, a young age, T4 and a low total number of lymph nodes removed at surgery were the factors potentially justifying the decision for adjuvant chemotherapy in stage II colon cancer patients. The most common chemotherapy used was a bolus of 5-fluorouracil/folinic acid for 6 months (75.8%). Adjuvant radiotherapy was not administered to 37 (38.5%) of 96 patients with stage II and III rectal cancer. Conclusions The study shows that a substantial proportion of patients on adjuvant treatment at a certain time point in a large enough sample of Italian centers are stage II (potential over-treatment) and that an under-treatment of stage II and III rectal cancer patients (lack of radiotherapy) occurs too often in daily clinical practice in this country.
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Affiliation(s)
| | - Fausto Roila
- Divisione Oncologia Medica, Ospedale Policlinico, Perugia
| | | | - Enzo Ballatori
- Unità di Statistica Medica, Dip. Medicina Interna e Sanità Pubblica, Università, L'Aquila
| | - Lucio Patoia
- Dip. Medicina Interna e Scienze Oncologiche, Università, Perugia
| | | | - Giuseppe Colucci
- Oncologia Medica e Sperimentale, Istituto Nazionale Tumori, Bari
| | | | | | | | | | - E. Cortesi
- D.H. Oncologico Policlinico Umberto I, Roma
| | - C. Bressi
- D.H. Oncologico Policlinico Umberto I, Roma
| | | | - M. Mazzoli
- D.H. Oncologico Policlinico Umberto I, Roma
| | | | | | - S. Cigolari
- III Medicina Interna, Università Federico II, Napoli
| | - V. Angelini
- III Medicina Interna, Università Federico II, Napoli
| | - A. Cioffi
- III Medicina Interna, Università Federico II, Napoli
| | - V. Guardasole
- III Medicina Interna, Università Federico II, Napoli
| | - E. Zarra
- III Medicina Interna, Università Federico II, Napoli
| | - M. Tonato
- Divisione Oncologia Medica, Policlinico, Perugia
| | - M. Betti
- Divisione Oncologia Medica, Policlinico, Perugia
| | - F. Marrocolo
- Divisione Oncologia Medica, Policlinico, Perugia
| | | | - G. Cetto
- Divisione Clinicizzata Oncologia Medica, Ospedale Maggiore, Verona
| | | | - F. Cognetti
- Divisione Oncologia Medica, Istituto Nazionale dei Tumori, Roma
| | - G. Beretta
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - A. Pessi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - S. Mosconi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - L. Milesi
- Divisione Oncologia Medica, Ospedali Riuniti, Bergamo
| | - O. Bertetto
- Divisione Oncologia Medica, Ospedale S. Giovanni Molinette, Torino
| | - P. Malacarne
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - M. Marzola
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - G. Margutti
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - C. Modenesi
- Divisione Oncologia Clinica, Ospedale S. Anna, Ferrara
| | - P. Manente
- Divisione Oncologia Medica, Ospedale Civile, Castelfranco Veneto
| | - A. Comandone
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | - C. Oliva
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | - P. Berniolo
- Divisione Oncologia Medica, Ospedale Gradenigo, Torino
| | | | - G. Luporini
- Divisione Oncologia Medica, Ospedale S. Carlo Borromeo, Milano
| | - G. Colucci
- Divisione Oncologia Medica e Sperimentale, Istituto Nazionale Tumori, Bari
| | - E. Recaldin
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - M. Nicodemo
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - V. Picece
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - M. Turaz-za
- Divisione Oncologia Medica, Ospedale S. Cuore, Negrar, Verona
| | - E. Ferrazzi
- Divisione Oncologia Medica, Ospedale Civile, Rovigo
| | - G. Solina
- Divisione Chirurgia Oncologica, Ospedale Cervello, Palermo
| | - G. Rosati
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - A. Rossi
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - L. Manzione
- Divisione Oncologia Medica, Ospedale Civile, Potenza
| | - P. Sozzi
- Divisione Oncologia Medica, Ospedale degli Infermi, Biella
| | - G. Fornarini
- Divisione Oncologia Medica, Ospedale degli Infermi, Biella
| | - A. Lavarello
- Divisione Oncologia Medica, Ospedale Civile, Sestri Levante
| | - G. Catalano
- Divisione Oncologia Medica, Ospedale S. Salvatore, Pesaro
| | - P. Giordani
- Divisione Oncologia Medica, Ospedale S. Salvatore, Pesaro
| | | | - G. Troccoli
- Divisione Oncologia Medica, Policlinico Universitario, Bari
| | - G. Vietti Ramus
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | - L. Tonda
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | - M.P. Sirgiovanni
- UO di Oncologia, Ospedale S. Giovanni Bosco, ASL Torino 4, Torino
| | | | - V. Tinessa
- Divisione Oncologia Medica, Ospedale Civile, Benevento
| | - A Ruggiero
- Divisione Oncologia Medica, Ospedale Civile, Benevento
| | - S. Palazzo
- Divisione Oncologia Medica, Ospedale Mariano Santo, Cosenza
| | - S. Barni
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - M. Mandalà
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - M. Cremonesi
- UO di Oncologia Medica, Azienda Ospedaliera, Treviglio
| | - G. Porcile
- Divisione Oncologia Medica, Ospedale Civile, Alba
| | | | - F. Testore
- Divisione Oncologia Medica, Ospedale Civile, Asti
| | - G. Carteni
- Divisione Oncologia Medica, Ospedale Cardarelli, Napoli
| | - B. Daniele
- Divisione Oncologia Medica, Istituto Nazionale Tumori, Napoli
| | - C. Volta
- Divisione Oncologia Medica, Ospedale Maggiore della Carità, Novara
| | - F. Ferraù
- Divisione Oncologia Medica, Ospedale Civile, Taormina
| | - A. Zaniboni
- Divisione Oncologia Medica, C. Cura Poliambulanza, Brescia
| | - P. Marchetti
- Divisione Oncologia Medica, Ospedale S. Salvatore, L'Aquila
| | - G. Citone
- Divisione Oncologia Medica, Ospedale S. Salvatore, L'Aquila
| | | | - C. Iacono
- Divisione Oncologia Medica, Ospedale Civile, Ragusa
| | - M. Musi
- Divisione Oncologia Medica, Ospedale Generale, Aosta
| | | | | | | | - V. Sciacca
- Divisione Oncologia Medica, Ospedale S. Maria Goretti, Latina
| | - M. D'Aprile
- Divisione Oncologia Medica, Ospedale S. Maria Goretti, Latina
| | - L. Isa
- Divisione Oncologia Medica, Ospedale Civile, Gorgonzola
| | - F. Recchia
- Divisione Oncologia Medica, Ospedale Civile, Avezzano
| | - S. Spada
- D.H. Oncologico, Ospedale Umberto I, Siracusa
| | - S. Cascinu
- Divisione Oncologia Medica, Ospedale Civile, Parma
| | - R. Carroccio
- Unità Operativa Complessa di Oncologia Medica, Ospedale Umberto I, Enna
| | | | | | - M. Chetrì
- D.H. Oncologico, Ospedale di Summa, Brindisi
| | - P. Rizzo
- D.H. Oncologico, Ospedale di Summa, Brindisi
| | - M. Botturi
- UO Radioterapia, Ospedale Niguarda, Milano
| | - P. Marchei
- Divisione Oncologia Medica, Università La Sapienza, Roma
| | - S. Bretti
- Divisione Oncologia Medica, Ospedale Civile, Ivrea
| | | | - G. Reguzzoni
- D. H. Oncologico, Ospedale Civile, Busto Arsizio
| | - B. Massidda
- Oncologia Medica, Policlinico Universitario, Monserrato, Cagliari
| | - M.T. Ionta
- Oncologia Medica, Policlinico Universitario, Monserrato, Cagliari
| | - G. Cruciani
- Divisione Oncologia Medica, Ospedale Civile, Lugo
| | | | - G. Mantovani
- Divisione Oncologia Medica, Università, Cagliari
| | - V. Sidoti
- Divisione Oncologia Medica, Ospedale Civile, Pinerolo
| | - A. Peta
- Divisione Ematologia Oncologica, Ospedale Pugliese, Catanzaro
| | - E. Greco
- Divisione Oncologia Medica, Ospedale Civile, Lamezia Terme
| | - G. Cicero
- Divisione Oncologia Medica, Ospedale Civile, Castrovillari
| | - A. Sobrero
- Divisione Oncologia Medica, Policlinico Universitario, Udine
| | - P. Marsilio
- Divisione Oncologia Medica, Ospedale Civile, Udine
| | - E. Vigevani
- Divisione Oncologia Medica, Ospedale Civile, Tolmezzo
| | - G. Rimondi
- Divisione Oncologia Medica, Ospedale Civile, Tolmezzo
| | - V. Gebbia
- Divisione Oncologia Medica, Policlinico Universitario, Palermo
| | - A. Nuzzo
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano
| | - E. Biondi
- UO di Oncologia Medica, Ospedale Renzetti, Lanciano
| | - C. Caroti
- Divisione Oncologia Medica, Ospedale Galliera, Genova
| | - M. D'Amico
- Divisione Oncologia Medica, Ospedale Galliera, Genova
| | - G. Tuveri
- Divisione Oncologia Medica, Ospedale della Pietà, Trieste
| | - G. Pieri
- Divisione Oncologia Medica, Ospedale della Pietà, Trieste
| | | | - G. Tonini
- Oncologia Medica, Università Campus Biomedico, Roma
| | - D. Santini
- Oncologia Medica, Università Campus Biomedico, Roma
| | - T. Iannone
- Unità di Radioterapia Oncologica, Ospedale civile, Belluno
| | - C. Pizza
- Divisione Oncologia Medica, Ospedale S. Maria della Pietà, Nola
| | | | - S. Del Prete
- Divisione Oncologia Medica, Ospedale Civile, Frattamaggiore
| | - C. Pizza
- Divisione Oncologia Medica, Ospedale S. Maria della Pietà, Nola
| | - R. Trevisonne
- Divisione Oncologia Medica e Radioterapia, Ospedale Civile, Ascoli Piceno
| | - M. Serlenga
- Oncologia Radioterapica, Ospedale Civile, Barletta
| | | | - V. Lacava
- D.H. Oncologia, Università La Sapienza, Roma
| | - C. Bumma
- Divisione Oncologia Medica, Ospedale S. Giovanni Vecchio, Torino
| | - M. Roselli
- Oncologia Medica, Università di Roma “Tor Vergata”, Roma
| | | | - V. Mascia
- Divisione Oncologia Medica, Policlinico Universitario, Cagliari
| | - D. Perrone
- Divisione Oncologia Medica, Ospedale Civile, Saluzzo, Cuneo
| | - T. Prantera
- Divisione Oncologia Medica, Ospedale S. Giovanni di Dio, Crotone
| | - S. Venuta
- Divisione Oncologia Medica, Policlinico Universitario, Catanzaro
| | - G. Nastasi
- Divisione Medicina Oncologica, Ospedale Civile, Alzano Lombardo
| | | | - A. Lembo
- Servizio Oncologia Medica, Casa di Cura M. Polo, Roma
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Samaniego F, Hollebecque A, Foss F, Lister J, Mita M, Wagner-Johnston N, Dyer M, You B, Prica A, Hernandez-Llizaliturri F, Ferraldeschi R, Chan D, Zhang J, Mehta A. PRELIMINARY RESULTS OF ASTX660, A NOVEL NON-PEPTIDOMIMETIC cIAP1/2 AND XIAP ANTAGONIST, IN RELAPSED/REFRACTORY PERIPHERAL T-CELL LYMPHOMA AND CUTANEOUS T CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.211_2631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- F. Samaniego
- Lymphoma & Myeloma; UT MD Anderson Cancer Center; Houston United States
| | - A. Hollebecque
- Early Drug Development (DITEP) Gastro-Intestinal Oncology; Institute Gustave Roussy; Villejuif France
| | - F. Foss
- Internal Medicine; Hematology, Yale Cancer Center; New Haven United States
| | - J. Lister
- Division of Hematology and Cellular Therapy; Allegheny Health Network Cancer Institute; Pittsburgh United States
| | - M. Mita
- Experimental Therapeutics; Samuel Oschin Comprehensive Cancer Institute Cedars-Sinai Medical Center; Los Angeles United States
| | | | - M. Dyer
- Ernest and Helen Scott Haematological Research Institute; University of Leicester; Leicester United Kingdom
| | - B. You
- Medical Oncology; Centre Hospitalier Lyon Sud; Pierre Benite France
| | - A. Prica
- Hematology; Princess Margaret Cancer Centre Mount Sinai Hospital; Toronto Ontario Canada
| | | | - R. Ferraldeschi
- Clinical Development; Astex Pharmaceuticals, Inc.; Pleasanton United States
| | - D. Chan
- Clinical Development; Astex Pharmaceuticals, Inc.; Pleasanton United States
| | - J. Zhang
- Clinical Development; Astex Pharmaceuticals, Inc.; Pleasanton United States
| | - A. Mehta
- Hematology and Oncology; University of Alabama at Birmingham; Birmingham United States
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3
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Rescigno P, Lorente D, Bianchini D, Kolinsky M, Zafeiriou Z, Ferraldeschi R, Mateo J, Recine F, Jayaram A, Nava Rodrigues D, Riisnaes R, Miranda S, Figueiredo I, Crespo M, Mehra N, Perez-Lopez R, Tunariu N, Reid A, Attard G, De Bono J. 2558 Impact of PTEN protein loss on response to docetaxel and overall survival (OS) in metastatic castration resistant prostate cancer (mCRPC) patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31377-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ferraldeschi R, Welti J, Luo J, Attard G, de Bono JS. Targeting the androgen receptor pathway in castration-resistant prostate cancer: progresses and prospects. Oncogene 2015; 34:1745-57. [PMID: 24837363 PMCID: PMC4333106 DOI: 10.1038/onc.2014.115] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 12/11/2022]
Abstract
Androgen receptor (AR) signaling is a critical pathway for prostate cancer cells, and androgen-deprivation therapy (ADT) remains the principal treatment for patients with locally advanced and metastatic disease. However, over time, most tumors become resistant to ADT. The view of castration-resistant prostate cancer (CRPC) has changed dramatically in the last several years. Progress in understanding the disease biology and mechanisms of castration resistance led to significant advancements and to paradigm shift in the treatment. Accumulating evidence showed that prostate cancers develop adaptive mechanisms for maintaining AR signaling to allow for survival and further evolution. The aim of this review is to summarize molecular mechanisms of castration resistance and provide an update in the development of novel agents and strategies to more effectively target the AR signaling pathway.
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Affiliation(s)
- R Ferraldeschi
- Prostate Cancer Targeted Therapy Group, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - J Welti
- Prostate Cancer Targeted Therapy Group, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - J Luo
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Attard
- Prostate Cancer Targeted Therapy Group, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - JS de Bono
- Prostate Cancer Targeted Therapy Group, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
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5
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Crespo M, van Dalum G, Ferraldeschi R, Zafeiriou Z, Sideris S, Lorente D, Bianchini D, Rodrigues DN, Riisnaes R, Miranda S, Figueiredo I, Flohr P, Nowakowska K, de Bono JS, Terstappen LWMM, Attard G. Androgen receptor expression in circulating tumour cells from castration-resistant prostate cancer patients treated with novel endocrine agents. Br J Cancer 2015; 112:1166-74. [PMID: 25719830 PMCID: PMC4385957 DOI: 10.1038/bjc.2015.63] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [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: 10/18/2014] [Revised: 01/19/2015] [Accepted: 01/27/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Abiraterone and enzalutamide are novel endocrine treatments that abrogate androgen receptor (AR) signalling in castration-resistant prostate cancer (CRPC). Here, we developed a circulating tumour cells (CTCs)-based assay to evaluate AR expression in real-time in CRPC and investigated nuclear AR expression in CTCs in patients treated with enzalutamide and abiraterone. METHODS CTCs were captured and characterised using the CellSearch system. An automated algorithm to identify CTCs and quantify AR expression was employed. The primary aim was to evaluate the association between CTC AR expression and prior treatment with abiraterone or enzalutamide. RESULTS AR expression in CTCs was evaluated in 94 samples from 48 metastatic CRPC patients. We observed large intra-patient heterogeneity of AR expression in CTCs. Prior exposure to abiraterone or enzalutamide was not associated with a change in CTCs AR expression (median intensity and distribution of AR-positive classes). In support of this, we also confirmed maintained nuclear AR expression in tissue samples collected after progression on abiraterone. AR staining also identified additional AR-positive CD45-negative circulating cells that were CK-negative/weak and therefore missed using standard protocols. The number of these events correlated with traditional CTCs and was associated with worse outcome on univariate analysis. CONCLUSIONS We developed a non-invasive method to monitor AR nuclear expression in CTCs. Our studies confirm nuclear AR expression in CRPC patients progressing on novel endocrine treatments. Owing to the significant heterogeneity of AR expression in CTCs, studies in larger cohorts of patients are required to identify associations with outcome.
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Affiliation(s)
- M Crespo
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - G van Dalum
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, 7522ND, Enschede, The Netherlands
| | - R Ferraldeschi
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - Z Zafeiriou
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - S Sideris
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - D Lorente
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - D Bianchini
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - D N Rodrigues
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - R Riisnaes
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - S Miranda
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - I Figueiredo
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - P Flohr
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - K Nowakowska
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
| | - J S de Bono
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
| | - L W M M Terstappen
- Department of Medical Cell BioPhysics, MIRA Institute, University of Twente, 7522ND, Enschede, The Netherlands
| | - G Attard
- Section of Medicine, The Institute of Cancer Research, Sutton, Surrey, SM2 5NG, UK
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, SM2 5NG, UK
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6
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Lorente D, Mateo J, Templeton AJ, Zafeiriou Z, Bianchini D, Ferraldeschi R, Bahl A, Shen L, Su Z, Sartor O, de Bono JS. Baseline neutrophil-lymphocyte ratio (NLR) is associated with survival and response to treatment with second-line chemotherapy for advanced prostate cancer independent of baseline steroid use. Ann Oncol 2014; 26:750-755. [PMID: 25538172 DOI: 10.1093/annonc/mdu587] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR), proposed as an indicator of cancer-related inflammation, has known prognostic value in prostate cancer. We examine its association with survival (OS) and response in patients treated with second-line chemotherapy. METHODS We analysed patients with metastatic castration-resistant prostate cancer (mCRPC) treated in the TROPIC trial, evaluating cabazitaxel versus mitoxantrone. Cox regression models were used to investigate the association of baseline NLR (BLNLR) with OS and the significance of a change in NLR count with treatment. Logistic regression models were used to determine the association of BLNLR counts with prostate specific antigen (PSA) and RECIST responses. The optimal NLR cut-off was established based on the concordance index of different values. RESULTS Data from 755, 654 and 405 patients was available for OS, PSA and RECIST response analysis respectively. Median OS was 14.0 months [95% confidence interval (CI) 13.2-14.8]. Median NLR was 2.9 (IQR: 1.9-5.1). BLNLR was associated with survival (HR 1.5, 95% CI 1.1-2.1, P = 0.011) in multivariable analysis (MVA) independently of variables included in the Halabi nomogram, treatment arm and corticosteroid use. The optimal cut-off for a dichotomous NLR was selected at 3.0 based on its higher c-index related to survival. BLNLR ≥3.0 was associated with lower PSA response (40.1% versus 59.9%; P < 0.001) and RECIST response (7.7% versus 15.6%, P = 0.022) in MVA. Conversion from high (≥3) to low (<3) NLR was associated with improved survival (HR 0.66; 95% CI 0.51-0.85; P = 0.001) and higher PSA response rates (66.4% versus 33.6%; P = 0.000). Use of corticosteroids at baseline did not modify the association between NLR and survival. CONCLUSIONS NLR is a valid prognostic biomarker in CRPC and is associated with survival, PSA and RECIST responses in patients treated with second-line chemotherapy. Changes in NLR counts with treatment may indicate benefit. NLR prognostic value is independent of prior use of corticosteroids. CLINICALTRIALSGOV NCT00417079.
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Affiliation(s)
- D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - J Mateo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - A J Templeton
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Z Zafeiriou
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK
| | - A Bahl
- Department of Clinical Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - L Shen
- Oncology, Sanofi Oncology, Cambridge
| | - Z Su
- Oncology, Sanofi Oncology, Cambridge
| | - O Sartor
- Department of Medicine: Section of Hematology & Medical Oncology and Department of Urology, Tulane University, New Orleans, USA
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton (Surrey), UK.
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7
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Lorente D, Omlin A, Ferraldeschi R, Pezaro C, Perez R, Mateo J, Altavilla A, Zafeirou Z, Tunariu N, Parker C, Dearnaley D, Gillessen S, de Bono J, Attard G. Tumour responses following a steroid switch from prednisone to dexamethasone in castration-resistant prostate cancer patients progressing on abiraterone. Br J Cancer 2014; 111:2248-53. [PMID: 25314055 PMCID: PMC4264443 DOI: 10.1038/bjc.2014.531] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/02/2014] [Accepted: 09/10/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Abiraterone is a CYP17A1 inhibitor that improves survival in castration-resistant prostate cancer (CRPC). Abiraterone is licensed in combination with prednisone 5 mg twice daily to prevent a syndrome of secondary mineralocorticoid excess. We hypothesised that a 'steroid switch' from prednisone to dexamethasone would induce secondary responses in patients progressing on abiraterone and prednisone 5 mg b.i.d. METHODS We performed a 'steroid switch' in patients with CRPC at PSA progression on abiraterone and prednisolone. Patients were monitored for secondary declines in PSA, radiological tumour regression and toxicity. RESULTS A retrospective analysis of 30 CRPC patients who underwent a steroid switch from prednisolone to dexamethasone while on abiraterone was performed. A total of six patients (20%) had a ⩾50% PSA decline that was confirmed by a second PSA level at least 3 weeks later. In all, 11 patients (39.2%) had a confirmed ⩾30% PSA decline. Median time to PSA progression on abiraterone and dexamethasone was 11.7 weeks (95% CI: 8.6-14.8 weeks) in the whole cohort and 27.6 weeks (95% CI: 14.5-40.7 weeks) in patients who achieved a confirmed 50% PSA decline. Nine patients had RECIST evaluable disease: two of these patients had RECIST partial response, six patients had stable disease and one patient had progressive disease at the first imaging assessment. Treatment was well tolerated, with no grade 3 and grade 4 adverse events. One patient had to be reverted to prednisolone because of grade 2 hypotension. CONCLUSIONS Durable PSA responses occur in up to 40% of patients following a 'steroid switch' for PSA progression on abiraterone and prednisone. Studies are ongoing to elucidate the mechanisms underlying this response.
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Affiliation(s)
- D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
- Kantonsspital St. Gallen, Department of Oncology and Haematology, Rorschacherstrasse 95, CH-9007 St. Gallen, Switzerland
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - C Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - R Perez
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - J Mateo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - A Altavilla
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - Z Zafeirou
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - N Tunariu
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - C Parker
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - D Dearnaley
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - S Gillessen
- Kantonsspital St. Gallen, Department of Oncology and Haematology, Rorschacherstrasse 95, CH-9007 St. Gallen, Switzerland
| | - J de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton SM2 5PT, Surrey, UK
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Mateo J, Hall E, Sandhu S, Omlin A, Miranda S, Carreira S, Goodall J, Gillman A, Mossop H, Ralph C, Zafeiriou Z, Perez Lopez R, Tunariu N, Ferraldeschi R, Nava Rodrigues D, Kunju L, Robinson D, Attard G, Chinnaiyan A, de Bono J. Antitumour Activity of the Parp Inhibitor Olaparib in Unselected Sporadic Castration-Resistant Prostate Cancer (Crpc) in the Toparp Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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9
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Lopez RP, Lorente D, Mateo J, Blackledge M, Sideris S, Zafeiriou Z, Smith A, Ferraldeschi R, Rescigno P, Rata M, Naumann U, Collins D, Attard G, Leach M, Koh D, de Bono J, Tunariu N. Prognostic Relevance of Imaging Bone Metastases By Whole Body Diffusion-Weighted Magnetic Resonance Imaging (Wbdwi) in Metastatic Castration-Resistant Prostate Cancer (Mcrpc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Ferraldeschi R, Slovin S, Hussain S, Saad F, Garcia J, Kabbinavar F, Uppal N, Vogelzang N, Poiesz B, Gelmann E, Picus J, Mahadevan D, Sundar S, Nikapota A, Pacey S, Oganesian A, Manlapaz-Espiritu L, Hao Y, Keer H, de Bono J. A Phase 1/2 Study of At13387, a Heat Shock Protein 90 (Hsp90) Inhibitor in Combination with Abiraterone Acetate (Aa) and Prednisone (P) in Patients (Pts) with Castration-Resistant Prostate Cancer (Mcrpc) No Longer Responding to Aa. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Zafeiriou Z, Ferraldeschi R, Omlin A, Pezaro C, Mukherji D, Lorente D, Altavilla A, Sideris S, Rescigno P, Mateo J, Bianchini D, Smith A, Lopez RP, Mehra N, Ravi P, Grist E, Tunariu N, Attard G, de Bono J. Sequencing of Docetaxel (D) and Abiraterone Acetate (Aa) for Metastatic Castration-Resistant Prostate Cancer (Mcrpc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Pezaro C, Omlin A, Lorente D, Rodrigues DN, Ferraldeschi R, Bianchini D, Mukherji D, Riisnaes R, Altavilla A, Crespo M, Tunariu N, de Bono J, Attard G. Visceral disease in castration-resistant prostate cancer. Eur Urol 2014; 65:270-273. [PMID: 24295792 PMCID: PMC4881819 DOI: 10.1016/j.eururo.2013.10.055] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/31/2013] [Indexed: 11/29/2022]
Abstract
Metastatic involvement of the viscera in men with advanced castration-resistant prostate cancer (CRPC) has been poorly characterised to date. In 359 CRPC patients treated between June 2003 and December 2011, the frequency of radiologically detected visceral metastases before death was 32%. Of the 92 patients with computed tomography performed within 3 mo of death, 49% had visceral metastases. Visceral metastases most commonly involved the liver (20%) and lung (13%). Median survival from diagnosis of visceral disease was 7.1 mo (95% confidence interval, 5.9-8.3). Survival was affected by the degree of bone involvement at detection of visceral disease, varying from 6.1 mo in men with more than six bone metastases to 18.2 mo in men with no bone metastases (p=0.001). Heterogeneity was noted in clinical phenotypes and prostate-specific antigen trends at development of visceral metastases. Visceral metastases are now more commonly detected in men with CRPC, likely due to the introduction of novel survival-prolonging treatments.
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Affiliation(s)
- C Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Nava Rodrigues
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Mukherji
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - R Riisnaes
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Altavilla
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - M Crespo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - N Tunariu
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - J de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
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13
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Omlin A, Pezaro CJ, Zaidi S, Lorente D, Mukherji D, Bianchini D, Ferraldeschi R, Sandhu S, Dearnaley D, Parker C, Van As N, de Bono JS, Attard G. Reply: 'Comment on Anti-tumour activity of abiraterone and diethylstilboestrol when administered sequentially to men with castration-resistant prostate cancer'. Br J Cancer 2014; 110:267-8. [PMID: 24300975 PMCID: PMC3887311 DOI: 10.1038/bjc.2013.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - C J Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - S Zaidi
- Academic Urology Unit, Sutton, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - D Mukherji
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - S Sandhu
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - D Dearnaley
- Academic Urology Unit, Sutton, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - C Parker
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - N Van As
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, Chelsea, London, UK
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Section of Medicine, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey SM2 5PT, UK
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14
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Bianchini D, Omlin A, Pezaro C, Lorente D, Ferraldeschi R, Mukherji D, Crespo M, Figueiredo I, Miranda S, Riisnaes R, Zivi A, Buchbinder A, Rathkopf DE, Attard G, Scher HI, de Bono J, Danila DC. First-in-human Phase I study of EZN-4176, a locked nucleic acid antisense oligonucleotide to exon 4 of the androgen receptor mRNA in patients with castration-resistant prostate cancer. Br J Cancer 2013; 109:2579-86. [PMID: 24169353 PMCID: PMC3833213 DOI: 10.1038/bjc.2013.619] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [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: 07/25/2013] [Revised: 09/12/2013] [Accepted: 09/15/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prostate cancer remains dependent of androgen receptor (AR) signalling, even after emergence of castration resistance. EZN-4176 is a third-generation antisense oligonucleotide that binds to the hinge region (exon 4) of AR mRNA resulting in full-length AR mRNA degradation and decreased AR protein expression. This Phase I study aimed to evaluate EZN-4176 in men with castration-resistant prostate cancer (CRPC). METHODS Patients with progressing CRPC were eligible; prior abiraterone and enzalutamide treatment were allowed. EZN-4176 was administered as a weekly (QW) 1-h intravenous infusion. The starting dose was 0.5 mg kg(-1) with a 4-week dose-limiting toxicity (DLT) period and a 3+3 modified Fibonacci dose escalation design. After determination of the DLT for weekly administration, an every 2 weeks schedule was initiated. RESULTS A total of 22 patients were treated with EZN-4176. At 10 mg kg(-1) QW, two DLTs were observed due to grade 3-4 ALT or AST elevation. No confirmed biochemical or soft tissue responses were observed. Of eight patients with <5 circulating tumour cells at baseline, a conversion to <5 was observed in three (38%) patients. The most common EZN-4176-related toxicities (all grades) were fatigue (59%), reversible abnormalities in liver function tests ALT (41%) and AST (41%) and infusion-related reactions including chills (36%) and pyrexia (14%). CONCLUSION Activity of EZN-4176 at the doses and schedules explored was minimal. The highest dose of 10 mg kg(-1) QW was associated with significant but reversible transaminase elevation.
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Affiliation(s)
- D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - C Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - D Mukherji
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - M Crespo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - I Figueiredo
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - S Miranda
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - R Riisnaes
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - A Zivi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - A Buchbinder
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - D E Rathkopf
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - H I Scher
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
| | - J de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
- ENZON Pharmaceuticals Inc.; Bridgewater, NJ, USA
| | - D C Danila
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
- Memorial Sloan-Kettering Cancer Center (MSKCC) and Weill Cornell Medical College, Center for Prostate and Urologic Cancers, New York, NY, USA
- ENZON Pharmaceuticals Inc.; Bridgewater, NJ, USA
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Bianchini D, Lorente D, Rodriguez-Vida A, Omlin A, Pezaro C, Ferraldeschi R, Zivi A, Attard G, Chowdhury S, de Bono JS. Antitumour activity of enzalutamide (MDV3100) in patients with metastatic castration-resistant prostate cancer (CRPC) pre-treated with docetaxel and abiraterone. Eur J Cancer 2013; 50:78-84. [PMID: 24074764 DOI: 10.1016/j.ejca.2013.08.020] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [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: 05/08/2013] [Revised: 07/23/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The new generation anti-androgen enzalutamide and the potent CYP17 inhibitor abiraterone have both demonstrated survival benefits in patients with metastatic castration-resistant prostate cancer (CRPC) progressing after docetaxel. Preliminary data on the antitumour activity of abiraterone after enzalutamide have suggested limited activity. The antitumour activity and safety of enzalutamide after abiraterone in metastatic CRPC patients is still unknown. PATIENTS AND METHODS We retrospectively identified patients treated with docetaxel and abiraterone prior to enzalutamide to investigate the activity and safety of enzalutamide in a more advanced setting. Prostate specific antigen (PSA), radiological and clinical assessments were analysed. RESULTS 39 patients with metastatic CRPC were identified for this analysis (median age 70years, range: 54-85years). Overall 16 patients (41%) had a confirmed PSA decline of at least 30%. Confirmed PSA declines of ⩾50% and ⩾90% were achieved in 5/39 (12.8%) and 1/39 (2.5%) respectively. Of the 15 patients who responded to abiraterone, two (13.3%) also had a confirmed ⩾50% PSA decline on subsequent enzalutamide. Among the 22 abiraterone-refractory patients, two (9%) achieved a confirmed ⩾50% PSA decline on enzalutamide. CONCLUSION Our preliminary case series data suggest limited activity of enzalutamide in the post-docetaxel and post-abiraterone patient population.
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Affiliation(s)
- D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Rodriguez-Vida
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - C Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - A Zivi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - S Chowdhury
- Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
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Omlin A, J Pezaro C, Zaidi S, Lorente D, Mukherji D, Bianchini D, Ferraldeschi R, Sandhu S, Dearnaley D, Parker C, Van As N, de Bono JS, Attard G. Antitumour activity of abiraterone and diethylstilboestrol when administered sequentially to men with castration-resistant prostate cancer. Br J Cancer 2013; 109:1079-84. [PMID: 23928659 PMCID: PMC3778298 DOI: 10.1038/bjc.2013.446] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 05/13/2013] [Revised: 07/05/2013] [Accepted: 07/10/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Abiraterone is a standard treatment for men with castration-resistant prostate cancer (CRPC). We evaluated the antitumour activity of abiraterone following the synthetic oestrogen diethylstilboestrol (DES). METHODS Castration-resistant prostate cancer patients treated with abiraterone were identified. Demographics, response variables and survival data were recorded. RESULTS Two-hundred and seventy-four patients received abiraterone, 114 (41.6%) after DES. Pre-chemotherapy abiraterone resulted in ≥50% PSA declines in 35/41 (85.4%) DES-naïve and 20/27 (74.1%) DES-treated patients. Post-docetaxel abiraterone resulted in ≥50% PSA declines in 40/113 (35.4%) DES-naïve and 23/81 (28.4%) DES-treated patients. Time to PSA progression was similar regardless of prior DES. CONCLUSION Abiraterone has important antitumour activity in men with CRPC even after DES exposure.
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Affiliation(s)
- A Omlin
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - C J Pezaro
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - S Zaidi
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - D Lorente
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Mukherji
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Bianchini
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - R Ferraldeschi
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - S Sandhu
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - D Dearnaley
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - C Parker
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, UK
| | - N Van As
- Academic Urology Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, Chelsea, UK
| | - J S de Bono
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
| | - G Attard
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK
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Nelli F, Naso G, De Pasquale Ceratti A, Saltarelli R, Dauria G, Lugini A, Ferraldeschi R, Picone V, Moscetti L, Cortesi E. Weekly Vinorelbine and Docetaxel as Second-Line Chemotherapy for Pretreated Non-Small Cell Lung Cancer Patients: a Phase I-II Trial. J Chemother 2013; 16:392-9. [PMID: 15332716 DOI: 10.1179/joc.2004.16.4.392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 10/31/2022]
Abstract
Docetaxel was proven to be effective as second-line therapy for patients with advanced NSCLC after failure of platinum-based front-line chemotherapy. We designed this phase I/II study to define the Maximum Tolerated Dose of weekly docetaxel combined with weekly vinorelbine, and subsequently evaluate tolerability and activity of this schedule in NSCLC patients who were progressive after treatment with either cisplatin and gemcitabine or carboplatin and paclitaxel regimens. To be eligible for the study, patients were required to have a WHO performance status < or =2, failure after at least two cycles of first platinum-based chemotherapy, and no prior treatment with docetaxel and vinorelbine. A total of 27 patients were enrolled in this phase I/II study. A weekly docetaxel dose of 25 mg/m2 was recommended in combination with fixed vinorelbine dose of 20 mg/m2, and 24 patients were treated at this dose level. Severe neutropenia (62%) and febrile neutropenia (29%) were the most frequent toxicities, with 83% of patients requiring dose modification or delay. In the phase II study, 5 (21%) patients obtained a partial response, 8 (33%) patients had stable disease, whereas 10 (42%) patients progressed. After a median follow-up of 18.7 months, median survival was 8 months, with 30% surviving at 1 year. Regardless of the use of weekly docetaxel schedule, this regimen was highly myelosuppressive, and did not seem to improve response rate and survival compared to single-agent docetaxel. No further developments of this schedule are warranted.
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Affiliation(s)
- F Nelli
- Department of Experimental Medicine and Pathology, Medical Oncology, University of Rome La Sapienza, Rome, Italy
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Affiliation(s)
- R. Ferraldeschi
- Division of Cancer Therapeutics, Signal Transduction & Molecular Pharmacology and Clinical Pharmacology & Trials Team, Institute of Cancer Research, Sutton, SM25NG, United Kingdom;
| | - C. Pezaro
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, SM25PT, United Kingdom; ,
| | - V. Karavasilis
- Medical Oncology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece;
| | - J. de Bono
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, SM25PT, United Kingdom; ,
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Arnedos M, Ferraldeschi R, A'Hern R, Hadfield K, Roberts S, Drury S, Howell A, Evans DG, Wardley AM, Smith IE, Newman WG, Dowsett M. Polymorphisms of the aromatase gene (CYP19A1) and benefit of aromatase inhibitors (AIs) in metastatic breast cancer (mBC) patients. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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22
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Masi G, Loupakis F, Fornaro L, Baldi G, Cupini S, Di Donato S, Ferraldeschi R, Sonaglio C, Granetto C, Falcone A. Outcome of initially unresectable metastatic colorectal cancer (MCRC) patients (pts) treated with first-line FOLFOXIRI followed by R0 surgical resection of metastases (mts). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Masi G, Bursi S, Loupakis F, Barbara C, Brunetti I, Ferraldeschi R, Evangelista W, Chiara S, Granetto C, Falcone A. 3022 POSTER Long-term outcome of unresectable metastatic colorectal cancer (MCRC) patients (pts) treated with first-line FOLFOXIRI followed by R0 surgical resection of metastases. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bogdanovic G, Priftakis P, Giraud G, Kuzniar M, Ferraldeschi R, Kokhaei P, Mellstedt H, Remberger M, Ljungman P, Winiarski J, Dalianis T. Association between a high BK virus load in urine samples of patients with graft-versus-host disease and development of hemorrhagic cystitis after hematopoietic stem cell transplantation. J Clin Microbiol 2005; 42:5394-6. [PMID: 15528753 PMCID: PMC525183 DOI: 10.1128/jcm.42.11.5394-5396.2004] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [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: 02/04/2023] Open
Abstract
BK virus (BKV) load in urine alone or in combination with acute graft-versus-host disease (GVHD) was correlated to development of hemorrhagic cystitis (HC). BKV load in combination with acute GVHD discriminated the best, while BKV and viral load alone, but not GVHD, still showed predictive ability for HC.
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Affiliation(s)
- G Bogdanovic
- Department of Oncology-Pathology, Karolinska Institute, Hudding University Hospital, Stockholm, Sweden
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