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Dietz J, Spengler U, Müllhaupt B, Schulze Zur Wiesch J, Piecha F, Mauss S, Seegers B, Hinrichsen H, Antoni C, Wietzke-Braun P, Peiffer KH, Berger A, Matschenz K, Buggisch P, Backhus J, Zizer E, Boettler T, Neumann-Haefelin C, Semela D, Stauber R, Berg T, Berg C, Zeuzem S, Vermehren J, Sarrazin C, Giostra E, Berning M, Hampe J, De Gottardi A, Rauch A, Semmo N, Discher T, Trauth J, Fischer J, Gress M, Günther R, Heinzow H, Schmidt J, Herrmann A, Stallmach A, Hilgard G, Deterding K, Lange C, Ciesek S, Wedemeyer H, Hoffmann D, Klinker H, Schulze P, Kocheise F, Müller-Schilling M, Kodal A, Kremer A, Ganslmayer M, Siebler J, Lammert F, Rissland J, Löbermann M, Götze T, Canbay A, Lohse A, von Felden J, Jordan S, Maieron A, Moradpour D, Chave JP, Moreno C, Müller T, Muche M, Epple HJ, Port K, von Hahn T, Cornberg M, Manns M, Reinhardt L, Ellenrieder V, Rockstroh J, Schattenberg J, Sprinzl M, Galle P, Roeb E, Steckstor M, Schmiegel W, Brockmeyer N, Seufferlein T, Stremmel W, Strey B, Thimme R, Teufel A, Vogelmann R, Ebert M, Tomasiewicz K, Trautwein C, Tacke F, Koenen T, Weber T, Zachoval R, Mayerle J, Raziorrouh B, Angeli W, Beckebaum S, Doberauer C, Durmashkina E, Hackelsberger A, Erhardt A, Garrido-Lüneburg A, Gattringer H, Genné D, Gschwantler M, Gundling F, Hametner S, Schöfl R, Hartmann C, Heyer T, Hirschi C, Jussios A, Kanzler S, Kordecki N, Kraus M, Kullig U, Wollschläger S, Magenta L, Beretta-Piccoli BT, Menges M, Mohr L, Muehlenberg K, Niederau C, Paulweber B, Petrides A, Pinkernell M, Piso R, Rambach W, Reiser M, Riecken B, Rieke A, Roth J, Schelling M, Schlee P, Schneider A, Scholz D, Schott E, Schuchmann M, Schulten-Baumer U, Seelhoff A, Stich A, Stickel F, Ungemach J, Walter E, Weber A, Winzer T, Abels W, Adler M, Audebert F, Baermann C, Bästlein E, Barth R, Barthel K, Becker W, Behrends J, Benninger J, Berger F, Berzow D, Beyer T, Bierbaum M, Blaukat O, Bodtländer A, Böhm G, Börner N, Bohr U, Bokemeyer B, Bruch H, Bucholz D, Burkhard O, Busch N, Chirca C, Delker R, Diedrich J, Frank M, Diehl M, Dienethal A, Dietel P, Dikopoulos N, Dreck M, Dreher F, Drude L, Ende K, Ehrle U, Baumgartl K, Emke F, Glosemeyer R, Felten G, Hüppe D, Fischer J, Fischer U, Frederking D, Frick B, Friese G, Gantke B, Geyer P, Schwind H, Glas M, Glaunsinger T, Goebel F, Göbel U, Görlitz B, Graf R, Gruber H, Härter G, Herder M, Heuchel T, Heuer S, Höffl KH, Hörster H, Sonne JU, Hofmann W, Holst F, Hunstiger M, Hurst A, Jägel-Guedes E, John C, Jung M, Kallinowski B, Kapzan B, Kerzel W, Khaykin P, Klarhof M, Klüppelberg U, Klugewitz K, Knapp B, Knevels U, Kochsiek T, Körfer A, Köster A, Kuhn M, Langekamp A, Künzig B, Link R, Littman M, Löhr H, Lutz T, Knecht G, Lutz U, Mainz D, Mahle I, Maurer P, Mayer C, Meister V, Möller H, Heyne R, Moritzen D, Mroß M, Mundlos M, Naumann U, Nehls O, Ningel K, Oelmann A, Olejnik H, Gadow K, Pascher E, Petersen J, Philipp A, Pichler M, Polzien F, Raddant R, Riedel M, Rietzler S, Rössle M, Rufle W, Rump A, Schewe C, Hoffmann C, Schleehauf D, Schmidt K, Schmidt W, Schmidt-Heinevetter G, Schmidtler-von Fabris J, Schnaitmann E, Schneider L, Schober A, Niehaus-Hahn S, Schwenzer J, Seidel T, Seitel G, Sick C, Simon K, Stähler D, Stenschke F, Steffens H, Stein K, Steinmüller M, Sternfeld T, Strey B, Svensson K, Tacke W, Teuber G, Teubner K, Thieringer J, Tomesch A, Trappe U, Ullrich J, Urban G, Usadel S, von Lucadou A, Weinberger F, Werheid-Dobers M, Werner P, Winter T, Zehnter E, Zipf A. Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections. Clin Gastroenterol Hepatol 2021; 19:195-198.e2. [PMID: 31706062 DOI: 10.1016/j.cgh.2019.10.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/19/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.8 However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.
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Affiliation(s)
- Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, and German Center for Infection Research (DZIF), Partner Site, Cologne-Bonn, Germany
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Felix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Barbara Seegers
- Gastroenterologisch-Hepatologisches Zentrum Kiel, Kiel, Germany
| | | | - Christoph Antoni
- Department of Internal Medicine II, University Hospital Mannheim, Mannheim, Germany
| | | | - Kai-Henrik Peiffer
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Annemarie Berger
- Institute for Medical Virology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Peter Buggisch
- Institute for Interdisciplinary Medicine IFI, Hamburg, Germany
| | - Johanna Backhus
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Eugen Zizer
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Tobias Boettler
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Semela
- Division of Gastroenterology and Hepatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Rudolf Stauber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Berg
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany; Medizinische Klinik 2, St Josefs-Hospital, Wiesbaden, Germany.
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Kurreck A, Geissler M, Martens UM, Riera-Knorrenschild J, Greeve J, Florschütz A, Wessendorf S, Ettrich T, Kanzler S, Nörenberg D, Seidensticker M, Held S, Buechner-Steudel P, Atzpodien J, Heinemann V, Stintzing S, Seufferlein T, Tannapfel A, Reinacher-Schick AC, Modest DP. Dynamics in treatment response and disease progression of metastatic colorectal cancer (mCRC) patients with focus on BRAF status and primary tumor location: analysis of untreated RAS-wild-type mCRC patients receiving FOLFOXIRI either with or without panitumumab in the VOLFI trial (AIO KRK0109). J Cancer Res Clin Oncol 2020; 146:2681-2691. [PMID: 32449003 PMCID: PMC7467910 DOI: 10.1007/s00432-020-03257-z] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE In mCRC, disease dynamics may play a critical role in the understanding of long-term outcome. We evaluated depth of response (DpR), time to DpR, and post-DpR survival as relevant endpoints. METHODS We analyzed DpR by central review of computer tomography images (change from baseline to smallest tumor diameter), early tumor shrinkage (≥ 20% reduction in tumor diameter at first reassessment), time to DpR (study randomization to DpR-image), post-DpR progression-free survival (pPFS = DpR-image to tumor progression or death), and post-DpR overall survival (pOS = DpR-image to death) with special focus on BRAF status in 66 patients and primary tumor site in 86 patients treated within the VOLFI-trial, respectively. RESULTS BRAF wild-type (BRAF-WT) compared to BRAF mutant (BRAF-MT) patients had greater DpR (- 57.6% vs. - 40.8%, p = 0.013) with a comparable time to DpR [4.0 (95% CI 3.1-4.4) vs. 3.9 (95% CI 2.5-5.5) months; p = 0.8852]. pPFS was 6.5 (95% CI 4.9-8.0) versus 2.6 (95% CI 1.2-4.0) months in favor of BRAF-WT patients (HR 0.24 (95% CI 0.11-0.53); p < 0.001). This transferred into a significant difference in pOS [33.6 (95% CI 26.0-41.3) vs. 5.4 (95% CI 5.0-5.9) months; HR 0.27 (95% CI 0.13-0.55); p < 0.001]. Similar observations were made for patients stratified for primary tumor site. CONCLUSIONS BRAF-MT patients derive a less profound treatment response compared to BRAF-WT patients. The difference in outcome according to BRAF status is evident after achievement of DpR with BRAF-MT patients hardly deriving any further disease control beyond DpR. Our observations hint towards an aggressive tumor evolution in BRAF-MT tumors, which may already be molecularly detectable at the time of DpR.
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Affiliation(s)
- A Kurreck
- Department of Hematology, Oncology, and Tumor Immunology (CVK/CCM), Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - U M Martens
- Klinik für Innere Medizin III, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | | | - J Greeve
- St. Vincenz-Krankenhaus Paderborn, Paderborn, Germany
| | | | | | - T Ettrich
- Universitätsklinikum Ulm, Ulm, Germany
| | - S Kanzler
- Leopoldina Krankenhaus, Schweinfurt, Germany
| | - D Nörenberg
- Medical Faculty Mannheim, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - M Seidensticker
- Klinik Und Poliklinik für Radiologie, LMU Klinikum, München, Germany
| | - S Held
- ClinAssess, Leverkusen, Germany
| | | | - J Atzpodien
- Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| | - V Heinemann
- Department of Medicine III and Comprehensive Cancer Center, University Hospital Munich (LMU), Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center, Heidelberg, Germany
| | - S Stintzing
- Department of Hematology, Oncology, and Tumor Immunology (CVK/CCM), Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - A Tannapfel
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - A C Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - D P Modest
- Department of Hematology, Oncology, and Tumor Immunology (CVK/CCM), Charité University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Geissler M, Klingler T, Modest D, Knorrenschild JR, Ettrich T, Kanzler S, Heinemann V, Held S, Martens U. Quality of life during 1st-line FOLFOXIRI+/- panitumumab in RAS wild-type metastatic colorectal cancer: Results from the randomized VOLFI trial (AIO KRK-0109). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.057] [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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Geissler M, Tannapfel A, Reinacher-Schick A, Martens U, Ricke J, Riera-Knorrenschield J, Kanzler S, Held S, Heinemann V, Seufferlein T, Modest D. Final results of the randomized phase II VOLFI trial (AIO- KRK0109): mFOLFOXIRI + Panitumumab versus FOLFOXIRI as first-line treatment in patients with RAS wild-type metastatic colorectal cancer (mCRC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz156.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Haas M, Waldschmidt D, Stahl M, Reinacher-Schick A, Freiberg-Richter J, Kaiser F, Kanzler S, Frickhofen N, Seufferlein T, Dechow T, Mahlberg R, Malfertheiner P, Illerhaus G, Kubicka S, Held S, Westphalen C, Kruger S, Boeck S, Heinemann V. Gemcitabine plus afatinib versus gemcitabine alone in metastatic pancreatic cancer: An explorative randomized AIO phase II trial (ACCEPT). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Geissler M, Klingler T, Riera Knorrenschild J, Tannapfel A, Greeve J, Seufferlein T, Kanzler S, Held S, Heinemann V, Reinacher-Schick A, Martens U. 1st-line mFOLFOXIRI + panitumumab vs FOLFOXIRI treatment of RAS wt mCRC: A randomized phase II VOLFI trial of the AIO (KRK-0109). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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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Geissler M, Klingler T, Riera-Knorrenschield J, Tannapfel A, Seufferlein T, Held S, Florschütz A, Kanzler S, Heinemann V, Reinacher-Schick A, Martens U. mFOLFOXIRI + Panitumumab versus FOLFOXIRI as first-line treatment in patients with RAS wild- type metastatic colorectal cancer m(CRC): a randomized phase II VOLFI trial of the AIO (AIO- KRK0109). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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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Schmoll H, Garlipp B, Junghanß C, Vogel A, Kaiser U, Florschütz A, Kanzler S, Hannig C, Meinert F, Cygon F, Stein A. FOLFOX/bevacizumab +/- irinotecan in advanced colorectal cancer (CHARTA): Long term outcome. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy149.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haas M, Siveke JT, Schenk M, Lerch MM, Caca K, Freiberg-Richter J, Fischer von Weikersthal L, Kullmann F, Reinacher-Schick A, Fuchs M, Kanzler S, Kunzmann V, Ettrich TJ, Kruger S, Westphalen CB, Held S, Heinemann V, Boeck S. Efficacy of gemcitabine plus erlotinib in rash-positive patients with metastatic pancreatic cancer selected according to eligibility for FOLFIRINOX: A prospective phase II study of the 'Arbeitsgemeinschaft Internistische Onkologie'. Eur J Cancer 2018; 94:95-103. [PMID: 29549862 DOI: 10.1016/j.ejca.2018.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/13/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION In metastatic pancreatic ductal adenocarcinoma (mPDAC) treatment, erlotinib is known to be more effective in patients developing skin rash. Treatment with the FOLFIRINOX regimen is only performed in fit patients following defined inclusion criteria. The present study investigates the efficacy of gemcitabine plus erlotinib (gem/erlotinib) in rash-positive patients fit for FOLFIRINOX. PATIENTS AND METHODS For this prospective phase II study, 150 patients were recruited in 20 centres. All patients received gem/erlotinib for 4 weeks (run-in phase); the subsequent treatment was determined by the development of skin rash: patients with rash grades 1-4 continued with gem/erlotinib, rash-negative patients were switched to FOLFIRINOX. Primary study end-point was to achieve a 1-year survival rate in rash-positive patients ≥40%. RESULTS Ninety patients were deemed positive for skin rash by the end of the run-in phase, showing a 1-year survival rate of 40.0% (95% confidence interval [CI] 29.8-50.9). Median overall survival (OS) was 10.1 months, progression-free survival (PFS) was 3.8 months and overall response rate (ORR) was 23.3%. Patients switched to FOLFIRINOX (n = 27) had a 1-year survival rate of 48.1% (95% CI 28.7-68.1), a median OS of 10.9 months, a median PFS of 6.6 months and an ORR of 33.3%. Rash-negative patients had a lower quality of life at baseline but seemed to experience an improved control of pain during FOLFIRINOX. CONCLUSIONS First-line treatment with gem/erlotinib was effective in fit, rash-positive mPDAC patients achieving a 1-year survival rate comparable to previous reports for FOLFIRINOX. The study was registered at clinicaltrials.gov (NCT0172948) and Eudra-CT (2011-005471-17).
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Affiliation(s)
- M Haas
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
| | - J T Siveke
- 2nd Medical Department, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Solid Tumor Translational Oncology (DKTK, Partner Site Essen), West German Cancer Center, University Hospital Essen, Essen, Germany
| | - M Schenk
- Department of Haematology and Oncology, Hospital Barmherzige Brüder, Regensburg, Germany
| | - M M Lerch
- Department of Medicine A, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt University, Greifswald, Germany
| | - K Caca
- Department of Internal Medicine I, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | | | - F Kullmann
- Department of Medicine I, Klinikum Weiden, Weiden, Germany
| | - A Reinacher-Schick
- Department of Haematology and Oncology, St. Josef-Hospital, Ruhr University, Bochum, Germany
| | - M Fuchs
- Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Klinikum Bogenhausen, Munich, Germany
| | - S Kanzler
- Department of Internal Medicine II, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - V Kunzmann
- Department of Medical Oncology, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - T J Ettrich
- Department of Internal Medicine I, University of Ulm, Ulm, Germany
| | - S Kruger
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - C B Westphalen
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - S Held
- ClinAssess GmbH, Leverkusen, Germany
| | - V Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - S Boeck
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
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Kanzler S, Rix A, Czigany Z, Tanaka H, Fukushima K, Kögel B, Pawlowsky K, Tolba RH. Recommendation for severity assessment following liver resection and liver transplantation in rats: Part I. Lab Anim 2018; 50:459-467. [PMID: 27909196 DOI: 10.1177/0023677216678018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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
Score sheets were first introduced 30 years ago to assess pain, distress and suffering in animals. To date, however, there is still no general agreement on their use in research practice, and only a few publications can be found on this topic. In the present work, we demonstrate the use of a special score sheet for severity assessment in the first three postoperative days in two showcased studies performed on Wistar and Lewis rats undergoing liver resection or orthotopic liver transplantation, respectively. Scoring of different criteria and the total score were evaluated within each intervention. Additionally, both procedures were compared regarding their degree of severity. Suitability of these score sheets was evaluated for assessing severity of the procedures and these showed a minor severity within each investigated study. A comparison of both studies showed slightly higher scores involving liver transplantation. In contradiction to the common classification of these procedures as a moderate severity grade the score sheets applied here indicates a minor severity grade within each investigated study. Also, limitations and possible improvements in the design of our score sheets for defined interventions are reconsidered.
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Affiliation(s)
- S Kanzler
- Institute for Pharmacology and Toxicology
| | - A Rix
- Institute for Experimental Molecular Imaging
| | - Z Czigany
- Department for General, Visceral, and Transplantation Surgery
| | - H Tanaka
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - K Fukushima
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - B Kögel
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - K Pawlowsky
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - R H Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University Hospital, Aachen, Germany
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Geissler M, Martens U, Knorrenschield R, Greeve J, Florschuetz A, Tannapfel A, Wessendorf S, Seufferlein T, Kanzler S, Heinemann V, Held S, Reinacher-Schick A. mFOLFOXIRI + panitumumab versus FOLFOXIRI as first-line treatment in patients with RAS wild-type metastatic colorectal cancer m(CRC): A randomized phase II VOLFI trial of the AIO (AIO-KRK0109). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Schmoll H, Garlipp B, Junghanß C, Leithauser M, Vogel A, Schaefers M, Kaiser U, Hoeffkes H, Florschütz A, Ruessel J, Kanzler S, Edelmann T, Forstbauer H, Göhler T, Hannig C, Hildebrandt B, Steighardt J, Meinert F, Cygon F, Stein A. FOLFOX / Bevacizumab (Beva) +/- Irinotecan in advanced colorectal cancer (CRC): A randomized phase II trial (AIO KRK 0209, CHARTA). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Martens U, Wessendorf S, Knorrenschild JR, Buechner-Steudel P, Florschuetz A, Atzpodien J, Greeve J, Kanzler S, Ettrich T, Lindig U, Egger M, Hebart H, Geissler M. 2049 AIO-KRK-0109: A randomized phase II trial of panitumumab plus FOLFOXIRI or FOLFOXIRI alone as 1st-line treatment in RAS-wild-type metastatic colorectal cancer (mCRC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30972-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Moehler M, Maderer A, Schimanski C, Kanzler S, Denzer U, Kolligs FT, Ebert MP, Distelrath A, Geissler M, Trojan J, Schütz M, Berie L, Sauvigny C, Lammert F, Lohse A, Dollinger MM, Lindig U, Duerr EM, Lubomierski N, Zimmermann S, Wachtlin D, Kaiser AK, Schadmand-Fischer S, Galle PR, Woerns M. Gemcitabine plus sorafenib versus gemcitabine alone in advanced biliary tract cancer: a double-blind placebo-controlled multicentre phase II AIO study with biomarker and serum programme. Eur J Cancer 2014; 50:3125-35. [PMID: 25446376 DOI: 10.1016/j.ejca.2014.09.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [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: 07/17/2014] [Revised: 09/13/2014] [Accepted: 09/22/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Since sorafenib has shown activity in different tumour types and gemcitabine regimens improved the outcome for biliary tract cancer (BTC) patients, we evaluated first-line gemcitabine plus sorafenib in a double-blind phase II study. PATIENTS AND METHODS 102 unresectable or metastatic BTC patients with histologically proven adenocarcinoma of gallbladder or intrahepatic bile ducts, Eastern Cooperative Oncology Group (ECOG) 0-2 were randomised to gemcitabine (1000 mg/m2 once weekly, first 7-weeks+1-week rest followed by once 3-weeks+1-week rest) plus sorafenib (400 mg twice daily) or placebo. Treatment continued until progression or unacceptable toxicity. Tumour samples were prospectively stained for sorafenib targets and potential biomarkers. Serum samples (first two cycles) were measured for vascular endothelial growth factors (VEGFs), vascular endothelial growth factor receptor 2 (VEGFR-2) and stromal cell-derived factor 1 (SDF1)α by enzyme-linked immunosorbent assay (ELISA). RESULTS Gemcitabine plus sorafenib was generally well tolerated. Four and three patients achieved partial responses in the sorafenib and placebo groups, respectively. There was no difference in the primary end-point, median progression-free survival (PFS) for gemcitabine plus sorafenib versus gemcitabine plus placebo (3.0 versus 4.9 months, P=0.859), and no difference for median overall survival (OS) (8.4 versus 11.2 months, P=0.775). Patients with liver metastasis after resection of primary BTC survived longer with sorafenib (P=0.019) compared to placebo. Patients who developed hand-foot syndrome (HFS) showed longer PFS and OS than patients without HFS. Two sorafenib targets, VEGFR-2 and c-kit, were not expressed in BTC samples. VEGFR-3 and Hif1α were associated with lymph node metastases and T stage. Absence of PDGFRβ expression correlated with longer PFS. CONCLUSION The addition of sorafenib to gemcitabine did not demonstrate improved efficacy in advanced BTC patients. Biomarker subgroup analysis suggested that some patients might benefit from combined treatment.
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Affiliation(s)
- M Moehler
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany.
| | - A Maderer
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - C Schimanski
- Department of Internal Medicine, Marienhospital Darmstadt, Darmstadt, Germany
| | - S Kanzler
- 2nd Department of Medicine, Leopoldina Hospital, Schweinfurt, Germany
| | - U Denzer
- 1st Department of Medicine, University Hospital Hamburg, Hamburg, Germany
| | - F T Kolligs
- Department of Medicine II, University Hospital Munich, Munich, Germany
| | - M P Ebert
- 2nd Department of Medicine, University Hospital Mannheim, Mannheim, Germany
| | - A Distelrath
- Tumor Department, Hospital Fulda, Fulda, Germany
| | - M Geissler
- Department of Internal Medicine, Hospital Esslingen, Esslingen, Germany
| | - J Trojan
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany
| | - M Schütz
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - L Berie
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - C Sauvigny
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - F Lammert
- Department of Internal Medicine II, University Hospital Homburg, Homburg, Germany
| | - A Lohse
- 1st Department of Medicine, University Hospital Hamburg, Hamburg, Germany
| | - M M Dollinger
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - U Lindig
- Department of Internal Medicine II, University Hospital Jena, Jena, Germany
| | - E M Duerr
- Department of Medicine II, University Hospital Munich, Munich, Germany
| | - N Lubomierski
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany
| | - S Zimmermann
- Department of Internal Medicine II, University Hospital Homburg, Homburg, Germany
| | - D Wachtlin
- Interdisciplinary Center for Clinical Trials of the University Medical Center Mainz, Germany
| | - A-K Kaiser
- Interdisciplinary Center for Clinical Trials of the University Medical Center Mainz, Germany
| | - S Schadmand-Fischer
- Department of Radiology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - P R Galle
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - M Woerns
- Department of Internal Medicine, Johannes Gutenberg-University of Mainz, Mainz, Germany
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Moehler MH, Schimanski CC, Kanzler S, Woerns MA, Denzer U, Kolligs FT, Ebert MP, Distelrath A, Geissler M, Zeuzem S, Lammert F, Lohse AW, Dollinger MM, Lindig U, Duerr EM, Lubomierski N, Zimmermann S, Kabisch M, Schadmann-Fischer S, Galle PR. A randomized, double-blind, multicenter phase II AIO trial with gemcitabine plus sorafenib versus gemcitabine plus placebo in patients with chemotherapy-naive advanced or metastatic biliary tract cancer: First safety and efficacy data. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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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von Wichert G, Hoehler T, Schimanski CC, Moehler MH, Hofheinz R, Kanzler S, Hinke A, Seufferlein T, Siebler J, Hochhaus A, Arnold D, Hallek M, Hacker UT. Phase I/II trial of capecitabine (Cap) and oxaliplatin (Ox) in combination with bevacizumab (Bev) and imatinib (Ima) in patients with metastatic colorectal cancer (CRC): AIO KRK 0205. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moehler M, Al-Batran SE, Andus T, Anthuber M, Arends J, Arnold D, Aust D, Baier P, Baretton G, Bernhardt J, Boeing H, Böhle E, Bokemeyer C, Bornschein J, Budach W, Burmester E, Caca K, Diemer WA, Dietrich CF, Ebert M, Eickhoff A, Ell C, Fahlke J, Feussner H, Fietkau R, Fischbach W, Fleig W, Flentje M, Gabbert HE, Galle PR, Geissler M, Gockel I, Graeven U, Grenacher L, Gross S, Hartmann JT, Heike M, Heinemann V, Herbst B, Herrmann T, Höcht S, Hofheinz RD, Höfler H, Höhler T, Hölscher AH, Horneber M, Hübner J, Izbicki JR, Jakobs R, Jenssen C, Kanzler S, Keller M, Kiesslich R, Klautke G, Körber J, Krause BJ, Kuhn C, Kullmann F, Lang H, Link H, Lordick F, Ludwig K, Lutz M, Mahlberg R, Malfertheiner P, Merkel S, Messmann H, Meyer HJ, Mönig S, Piso P, Pistorius S, Porschen R, Rabenstein T, Reichardt P, Ridwelski K, Röcken C, Roetzer I, Rohr P, Schepp W, Schlag PM, Schmid RM, Schmidberger H, Schmiegel WH, Schmoll HJ, Schuch G, Schuhmacher C, Schütte K, Schwenk W, Selgrad M, Sendler A, Seraphin J, Seufferlein T, Stahl M, Stein H, Stoll C, Stuschke M, Tannapfel A, Tholen R, Thuss-Patience P, Treml K, Vanhoefer U, Vieth M, Vogelsang H, Wagner D, Wedding U, Weimann A, Wilke H, Wittekind C. [German S3-guideline "Diagnosis and treatment of esophagogastric cancer"]. Z Gastroenterol 2011; 49:461-531. [PMID: 21476183 DOI: 10.1055/s-0031-1273201] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- M Moehler
- Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55101 Mainz.
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Moehler M, Voigt J, Kastor M, Heil M, Sengespeick C, Biesterfeld S, Dippold W, Kanzler S, Galle P. Endosonographie mit Feinnadelpunktion in der Primärdiagnostik unklarer Raumforderungen im oberen Gastrointestinaltrakt. Dtsch Med Wochenschr 2011; 136:303-8. [DOI: 10.1055/s-0031-1272527] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Moehler M, Mueller A, Trarbach T, Lordick F, Seufferlein T, Kubicka S, Geißler M, Schwarz S, Galle PR, Kanzler S. Cetuximab with irinotecan, folinic acid and 5-fluorouracil as first-line treatment in advanced gastroesophageal cancer: a prospective multi-center biomarker-oriented phase II study. Ann Oncol 2010; 22:1358-1366. [PMID: 21119032 DOI: 10.1093/annonc/mdq591] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cetuximab plus irinotecan/folinic acid/5-fluorouracil (5-FU) (IF) was evaluated as first-line treatment of patients with advanced gastric cancer and gastroesophageal junction tumors. Preplanned analyses of the influence of tumor biomarkers on treatment outcome were carried out. PATIENTS AND METHODS Patients received weekly cetuximab (400 mg/m(2) on day 1, subsequently 250 mg/m(2)) plus irinotecan (80 mg/m(2)) and a 24-hour continuous infusion of folinic acid (200 mg/m(2)) and 5-FU (1500 mg/m(2)) on days 1, 8, 15, 22, 29 and 36 of a 50-day cycle, until progressive disease (PD). RESULTS The most common grade 3/4 toxic effects in 49 patients were diarrhea (15%) and skin toxic effects (14%). In 48 assessable patients, the overall response rate was 46% and disease control rate was 79%. Median progression-free survival (PFS) and overall survival (OS) was 9.0 months [95% confidence interval (CI) 7.1-15.6] and 16.5 months (95% CI 11.7-30.1), respectively. Tumor response was more common than nonresponse in epidermal growth factor receptor-expressing tumors (P = 0.041). Tumor PTEN expression was associated with longer PFS (P = 0.035) and OS (P = 0.0127) than no PTEN expression. CONCLUSION Cetuximab plus IF was well tolerated and efficacy data were encouraging. This treatment combination and the role of selected biomarkers are under investigation in the ongoing phase III EXPAND trial.
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Affiliation(s)
- M Moehler
- First Department of Internal Medicine, University of Mainz, Mainz.
| | - A Mueller
- First Department of Internal Medicine, University of Mainz, Mainz
| | - T Trarbach
- Department of Medicine (Cancer Research), West German Cancer Centre, University Hospital of Essen, Essen
| | - F Lordick
- Third Department of Internal Medicine, University Hospital, Technical University of Munich, Munich
| | - T Seufferlein
- First Department of Internal Medicine, University Hospital of Halle, Halle
| | - S Kubicka
- Department of Gastroenterology and Hepatology, Center of Internal Medicine, Hannover Medical School, Hannover
| | - M Geißler
- Department of Internal Medicine, City Hospital of Esslingen, Esslingen
| | - S Schwarz
- First Department of Internal Medicine, University of Mainz, Mainz
| | - P R Galle
- First Department of Internal Medicine, University of Mainz, Mainz
| | - S Kanzler
- First Department of Internal Medicine, University of Mainz, Mainz; Second Department of Medicine, Schweinfurt Hospital, Schweinfurt, Germany
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Reinel H, Schäßburger K, Meyer D, Pfändner K, Kanzler S. 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) as postoperative adjuvant chemotherapy (CT) for node-positive rectal cancer after radiochemotherapy (R-CT) and surgery. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14125] [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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Trarbach T, Moehler M, Heinemann V, Köhne CH, Przyborek M, Schulz C, Sneller V, Gallant G, Kanzler S. Phase II trial of mapatumumab, a fully human agonistic monoclonal antibody that targets and activates the tumour necrosis factor apoptosis-inducing ligand receptor-1 (TRAIL-R1), in patients with refractory colorectal cancer. Br J Cancer 2010; 102:506-12. [PMID: 20068564 PMCID: PMC2822942 DOI: 10.1038/sj.bjc.6605507] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Recombinant tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) induces tumour-selective apoptosis in various pre-clinical models by binding its specific receptors expressed on cancer cells. Mapatumumab is a fully human monoclonal antibody that is agonistic to the TRAIL Receptor 1 (TRAIL-R1). Methods: This phase II multicentre study was designed to evaluate the efficacy and safety of mapatumumab in patients with colorectal cancer (CRC) who had failed to respond to, were intolerant to, or not candidates for fluoropyrimidine, oxaliplatin, and irinotecan-based regimens. All patients received two loading doses of mapatumumab (20 mg kg−1 every 14 days), followed by maintenance therapy with 10 mg kg−1 infused every 14 days. Results: A total of 38 patients, who had progressive disease after a median of three earlier chemotherapy lines, were enrolled. No response according to the Response Evaluation Criteria in Solid Tumors was observed. A total of 12 patients (32%) achieved stable disease for a median of 2.6 months. The median progression-free survival was 1.2 months. The most common adverse events reported, regardless of relationship, were fatigue, nausea, anorexia, and abdominal pain. Plasma mapatumumab concentrations were within the range of exposures predicted by the results of phase I studies of mapatumumab. Conclusion: No clinical activity of single-agent mapatumumab was observed in patients with advanced refractory CRC. However, on the basis of its favourable safety profile and pre-clinical evidence of potential synergy in combination with agents commonly used in the treatment of colorectal cancer, further evaluation of mapatumumab in combination with chemotherapy is warranted.
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Affiliation(s)
- T Trarbach
- Department of Medicine (Cancer Research), West German Cancer Centre, University Hospital Essen, Essen 45122, Germany.
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Mueller A, Schwarz S, Biesterfeld S, Kanzler S, Trarbach T, Seufferlein T, Kubicka S, Lordick F, Galle P, Moehler M. PP113 Cetuximab with irinotecan/folinic acid/5-FU as first-line treatment inadvanced gastric cancer: A prospective multi-center phase II study and its molecular markers of the Arbeitsgemeinschaft Internistische Onkologie. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)72191-3] [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: 10/20/2022] Open
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Möhler M, Mueller A, Trarbach T, Seufferlein T, Kubicka S, Lordick F, Geissler M, Daum S, Galle P, Kanzler S. 6579 Cetuximab with Irinotecan/Folinic Acid/5-FU as first-line treatment in advanced gastric cancer: a prospective multi-center phase II study and additional biomarkers of the Arbeitsgemeinschaft Internistische Onkologie. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71300-x] [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: 11/30/2022] Open
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Moehler M, Kanzler S, Geissler M, Raedle J, Ebert MP, Daum S, Flieger D, Seufferlein T, Galle PR, Hoehler T. A randomized multicenter phase II study comparing capecitabine with irinotecan or cisplatin in metastatic adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol 2009; 21:71-7. [PMID: 19605504 DOI: 10.1093/annonc/mdp269] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The combination of irinotecan with 5-fluorouracil demonstrates efficacy with tolerable safety in the first-line treatment of metastatic gastroesophageal cancer (mGC). This randomized phase II trial compared for the first time capecitabine with irinotecan or cisplatin in this setting. PATIENTS AND METHODS Patients were randomly assigned to receive 3-week cycles of capecitabine 1000 mg/m(2), twice daily for 14 days, with on day 1 either irinotecan 250 mg/m(2) (XI) or cisplatin 80 mg/m(2) (XP). The primary end point was overall response rate (ORR) and secondary end points included progression-free survival (PFS), overall survival (OS) and safety. RESULTS Of 118 patients recruited, 112 were eligible for safety analysis and 103 for efficacy analysis. In the XI and XP treatment arms, there were no marked differences in ORR, 37.7% versus 42.0%, and median PFS, 4.2 versus 4.8 months, although median OS was longer, 10.2 versus 7.9 months, respectively. Grade 3/4 toxicity was higher in the XP regimen for thrombocytes (18.2% versus 1.8%), nausea (23.6% versus12.3%) and vomiting (16.4% versus 1.8%) and in the XI arm for diarrhea (22.8% versus 7.3%). CONCLUSION The comparable activity and safety of the XI and XP regimens establish XI as a relevant platinum-free first-line treatment choice for patients with mGC.
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Affiliation(s)
- M Moehler
- Department of Medicine, University of Mainz, Mainz, Germany.
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Kanzler S, Trarbach T, Seufferlein T, Kubicka S, Lordick F, Geissler M, Daum S, Galle PR, Moehler M. Cetuximab with irinotecan/folinic acid/5-FU as first-line treatment in advanced gastric cancer: A nonrandomized multicenter AIO phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4534] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4534 Background: Cetuximab has demonstrated high efficacy in combination with irinotecan-based therapies in metastatic colorectal cancer and irinotecan/folinic acid/5-FU (IF) may be an effective alternative to cisplatin-based regimens in advanced gastric cancer. We therefore conducted a phase II AIO study to evaluate the tolerability and efficacy of cetuximab combined with IF as first-line treatment in patients with advanced gastric cancer. Methods: Patients (pts) were eligible with untreated adenocarcinoma of the stomach or oesophagogastric junction, with ECOG performance status (PS) < 2, measurable lesions and adequate organ functions. Pts received weekly cetuximab (first dose 400 mg/m2, subsequent doses 250 mg/m2) combined with chemotherapy consisting of irinotecan (80 mg/m2) plus 24 hours continuous infusion of sodium folinic acid (Na-FA: 200 mg/m2) and 5-FU (1500 mg/m2) on days 1, 8, 15, 22, 29 and 36 of a 50-day cycle. Treatment was continued until tumor progression and tumor assessments were performed every 2nd cycle. Results: Between Aug 2006 and Sep 2007, 49 pts were enrolled: 71% were males, median age was 63 years (range 33–77), median PS was 0 (65% pts), and 69% of pts and 31% of pts had gastric and oesophagogastric junction carcinomas, respectively. The median treatment time was 15.2 weeks (range 1.1–69.1). Grade 3/4 toxicities were diarrhoea (17% pts), skin reactions (13% pts), anorexia (9% pts), anaemia and fatigue (7%pts), allergic reactions, leucopoenia and neutropenia (4% pts each). Among 48 response-evaluable pts, the overall response rate (CR + PR) was 42% (CR 4%/PR 38%) and the tumour control rate was 73%. Median progression-free and overall survival times were 8.5 months (36.6 weeks; 95% CI 30.1; 48.1) and 16.6 months (71.1 weeks; 95% CI 50; 93.4), respectively. Conclusions: Cetuximab plus IF was well tolerated and encouraging survival data were observed. Cetuximab combined with chemotherapy in advanced or metastatic gastric cancer is under further investigation in an ongoing phase III trial. No significant financial relationships to disclose.
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Affiliation(s)
- S. Kanzler
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - T. Trarbach
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - T. Seufferlein
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - S. Kubicka
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - F. Lordick
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - M. Geissler
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - S. Daum
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - P. R. Galle
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
| | - M. Moehler
- University of Mainz, Mainz, Germany; University Eessen, Essen, Germany; University Halle, Halle, Germany; University of Hannover, Hannover, Germany; University Heidelberg, Heidelberg, Germany; Klinik Esslingen, Esslingen, Germany; Charité Berlin, Berlin, Germany
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Goetz M, Kiesslich R, Dienes HP, Drebber U, Murr E, Hoffman A, Kanzler S, Galle PR, Delaney P, Neurath MF. In vivo confocal laser endomicroscopy of the human liver: a novel method for assessing liver microarchitecture in real time. Endoscopy 2008; 40:554-62. [PMID: 18609449 DOI: 10.1055/s-2008-1077296] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND STUDY AIMS Confocal endomicroscopy is a unique novel tool for in vivo histology in humans. Due to limitations imposed by the form of the equipment and by sterilization workflows, its use has been limited to the gastrointestinal tract so far. We have developed a rigid miniaturized probe for confocal endomicroscopy of the human liver during laparoscopy. PATIENTS AND METHODS To assess the feasibility and potential clinical value of this new system (diameter 6.3 mm), 25 patients with liver disease were examined during routine minilaparoscopy under conscious sedation. RESULTS Subsurface serial images (from surface to 250 microm) were generated in real time after fluorescein injection, permitting visualization of hepatocytes, bile ducts, sinusoids, and collagen fibers in vivo. Typical appearances of liver diseases were identified. Confocal diagnosis of moderate-to-severe steatosis and pericellular fibrosis correlated well with histopathologic analysis of subsequent biopsies (83.3 % and 84.6 %, respectively). In addition, intra-abdominal structures such as gallbladder, omentum, and stomach were analyzed by endomicroscopy. CONCLUSIONS A miniaturized imaging system for confocal laparoscopy allowed in vivo microscopic analysis of healthy and diseased human liver for the first time during ongoing minilaparoscopy. Although such in vivo imaging does not yet compete with conventional histopathology, this novel confocal laparoscopy system may be of future relevance for immediate morphodynamic analysis in liver disease and the targeting of biopsies in vivo.
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Affiliation(s)
- M Goetz
- First Medical Clinic, University of Mainz, Mainz, Germany.
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Kanzler S, Teufel A, Galle PR. [Liver function test to predict hepatic failure after liver resection--expensive and without clinical relevance?]. Zentralbl Chir 2007; 132:267-73. [PMID: 17724626 DOI: 10.1055/s-2007-981197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Hepatic failure after liver resection is a complication that is dreaded by surgeons and has a poor outcome. Inadequate functional reserve of the remaining liver parenchyma leads to the inability to regenerate and finally to the progression of liver failure. In order to predict the functional reserve of the remaining liver parenchyma, many different liver function tests have been established. Basis for most liver function assessments are metabolic liver functions such as cytochrome p450 dependent pathways or the extraction and biliary excretion of dye. Nuclear imaging of the liver parenchyma does not only allow visualisation of the liver but also accumulation of information on hepatocyte volume that might be a better predictor for the hepatic reserve and the regenerative capacity compared to the liver volume alone. However, to date no single method has been proven to be able to predict safe limits of resectability. If an underlying liver disease is excluded the resectability is mostly limited by volumetric analysis and technical feasibility of liver resection. In patients with underlying liver disease cirrhosis should be excluded. In case of liver cirrhosis, only Child-Pugh-Turcott A patients with normal bilirubin levels and without portal hypertension should be considered for liver resection.
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Affiliation(s)
- S Kanzler
- I. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität, Mainz.
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Moehler M, Trarbach T, Seufferlein T, Kubicka S, Kanzler S, Lordick F, Geissler M, Daum S, Hoehler T, Galle P. 3518 POSTER Cetuximab with Irinotecan/FA/5-FU as first-line treatment in advanced gastric cancer: Preliminary results of a non-randomized multicenter AIO phase II study. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71021-2] [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: 10/22/2022] Open
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Reinacher-Schick A, Geißler M, Graeven U, Freier W, Hegewisch-Becker S, Arnold D, Kanzler S, Dietrich G, Schmoll HJ, Schmiegel W. Comparable safety and response rate with bevacizumab in combination with capecitabine/oxaliplatin (CapOx/Bev) vs. capecitabine/irinotecan (CapIri/Bev) in advanced CRC (mCRC): A randomized phase II study of the AIO GI study group. Z Gastroenterol 2007. [DOI: 10.1055/s-2007-988128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Herber S, Pitton M, Mönch C, Schneider J, Manzl N, Kummer I, Kanzler S, Schuchmann M, Junginger T, Düber C, Otto G. Transarterielle Chemoembolisation (TACE) des Hepatozellulären Karzinoms (HCC) bei Patienten mit Pfortaderthrombose - Erfahrungen. Zentralbl Chir 2007; 132:306-15. [PMID: 17724633 DOI: 10.1055/s-2007-981207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Comparative analysis of the course of disease in patients with initial diagnosis of portal vein thrombosis in HCC treated with sequential TACE. Evaluation of the efficacy and safety of the method in a selected patient cohort. PATIENTS AND METHODS The study included 22 patients with HCC that were palliatively treated at least 3 times with TACE. All patients presented a portal vein thrombosis in the initial CT investigation. The TACE-procedure was carried out in regular intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10-20 ml Lipiodol. Follow-up investigations were carried out with contrast enhanced Multislice-CT before and after TACE and control of the laboratory panel (i. e. blood count, liver enzymes and coagulation). RESULTS Mean survival was 15.7 months (95%-CI 11.6-19.8) with a mean follow-up after last TACE of 6.1 +/- 4.8 months. The mean number of TACE procedures was 5.5 +/- 2.7. During the investigation period 17 / 22 (77.3%) patients died. In 23.5% retrospective analysis revealed a liver decompensation as the cause of death and in 58.8% patients died from the tumor disease. The cumulative 1-, 2- and 3-year survival was 55.0, 21.0 and 0%. The mean tumor size was 7.2 +/- 3.4 cm. Unifocal tumors were found in 18.2% of the cases whereas multifocal tumors were found in 81.8%. In 59.1% of the patients tumor extended to both liver lobes. In case of tumor infiltration of the portal vein survival was significantly worse compared to patients with no evidence of a tumor thrombosis (p = 0.01; cumulative 1- and 2-year survival 46% and 8% vs. 77% and 46%). CONCLUSION The palliative treatment of the HCC with TACE shows an improvement of survival. There was no increase of death due to liver decompensation in our cohort. Patients with a tumor infiltration of the portal vein showed a significantly worsened survival. The presence of a portal vein thrombosis at the initial diagnosis of the HCC is not an absolute contraindication for TACE treatment but patients have to be elected carefully with critical regard to their liver function.
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Affiliation(s)
- S Herber
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Johannes-Gutenberg-Universität, Mainz.
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Junginger T, Kneist W, Dünschede F, von Langsdorff C, Seifert J, Kanzler S. Lebermetastasen kolorektaler Karzinome - wie oft kann man operieren? Zentralbl Chir 2007; 132:281-6. [PMID: 17724628 DOI: 10.1055/s-2007-981196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Recurrent liver metastases of colorectal carcinoma are frequent. The repeat hepatectomy is superior to other therapeutic options. In about 20% of patients with recurrent liver metastases a complete resection (R0) is possible. The morbidity of repeat hepatectomy is similar to that of first hepatectomy. The 5-year survival rate after repeat hepatectomy ranges between 30 and 40%. Often in the follow-up additional operations become necessary for extrahepatic recurrencies. For determination of the optimal therapy an interdisciplinary approach must be chosen.
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Affiliation(s)
- T Junginger
- Klinik und Poliklinik für Allgemein und Abdominalchirurgie, Johannes-Gutenberg-Universität, Mainz.
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Moehler MH, Geissler M, Raedle J, Ebert M, Scherubl H, Flieger D, Seufferlein T, Galle P, Kanzler S. Erythropoetin (epoetin beta) once weekly in anemic patients with advanced cancer of the stomach or gastroesophageal junction: Interim results of a randomized German AIO phase II trail. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15133 Background: Tumor-related or chemotherapy-induced anemia is common in gastrointestinal cancer patients and results in reduced quality of life and worse prognosis. Thus, the effectiveness of erythropoetin (epoetin beta) treatment (EB) to achieve and maintain a target haemoglobin (Hb) level of ≥ 11 g/dl was assessed within a randomised German AIO phase II study to assess efficacy of irinotecan/capecitabine versus cisplatin/capecitabine in advanced gastric or lower esophageal cancer. Methods: Patients (pts) with untreated locally advanced or metastatic adenocarcinoma of stomach or gastroesophageal junction (KPS ≥ 60%, > one measurable lesion, adequate organ functions) were randomized to receive 3-weekly cycles of either irinotecan 250 mg/m2 d1 (arm A) or cisplatin 80 mg/m2 d1 (arm B). Capecitabine was administered at 2000 mg/m2 for 14 days in both arms. In both arms, EB (30,000 I.E. once weekly) was given at Hb of < 11 g/dl and continued until Hb ≥ 12 g/dl. If after 4 treatment weeks, Hb increase was < 0.5 g/dl, EB was increased to 30,000 I.E. twice weekly. FACT-An questionnaires were completed at each cycle. Results: At time of abstract submission, 81 pts were randomized to A (37 pts) or B (44 pts). 23 pts received at least 3 EB injections (A: 10 pts, B: 13 pts). Median Hb prior to EB was 10.5 g/dl (A: 10.4 g/dl, B: 10.5 g/dl) and median Hb at end of EB was 11.6 g/dl (A: 11.5 g/dl, B: 11.75 g/dl). During EB, 80 % of A and 77 % of B achieved target Hb of ≥ 11 g/dl with a median rise in Hb of 2.0 g/dl (A: 1.4 g/dl, B: 2 g/dl). 5 pts in A and 7 pts in B responded with a ≥ 1 g/dl rise in Hb during first 4 weeks. FACT-An questionnaires showed no change from baseline to end of EB. Among evaluable pts with EB (20 pts) versus without EB (34 pts), response (CR + PR) and tumor control rates (CR + PR + SD) were 60% vs 35% and 85% vs 70%, respectively. Conclusions: EB is effective in raising Hb levels in advanced or metastatic gastric cancer. Patients receiving EB tend to show a better response to chemotherapy. No significant financial relationships to disclose.
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Affiliation(s)
- M. H. Moehler
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
| | - M. Geissler
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
| | - J. Raedle
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
| | - M. Ebert
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
| | - H. Scherubl
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
| | - D. Flieger
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
| | - T. Seufferlein
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
| | - P. Galle
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
| | - S. Kanzler
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charite Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital Ulm, Ulm, Germany
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Schmiegel WH, Reinacher-Schick A, Freier W, Dietrich G, Arnold D, Kanzler S, Geissler M, Graeven U, Hegewisch-Becker S, Schmoll H. Comparable safety and response rate with bevacizumab in combination with capecitabine/oxaliplatin (CapOx/Bev) versus capecitabine/irinotecan (CapIri/Bev) in advanced CRC (mCRC): A randomized phase II study of the AIO GI tumor study group. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4034 Background: Bevacizumab (Bev) combined with 5-FU/FA and both, irinotecan or oxaliplatin are standard regimens for mCRC. Recently, a phase III trial has demonstrated that infusional 5-FU can be substituted by capecitabine (cape) when combined with oxaliplatin and Bev whereas conflicting data are available for feasibility and efficacy of cape/irinotecan combinations. This randomized phase II trial was to compare safety and efficacy of Bev with either CapOx or CapIri in untreated mCRC. Methods: Eligibility criteria: untreated mCRC pts, ECOG PS <= 2, measurable lesion(s), adequate hematologic and organ function. Primary endpoint was % of pts progression-free after 6 months. Treatment plan: Bev 7.5 mg/kg day (d)1 with either oxaliplatin (130 mg/m2 d1)/cape (1,000 mg/m2 bid d1–14; CapOx/Bev, arm A) or irinotecan (200 mg/m2 d1)/cape (800 mg/m2 bid d 1–14; CapIri/Bev, arm B), all q d22. Arm B doses were 20% lower for both, cape and irinotecan, compared to previous trials reporting an unacceptable toxicity profile (Köhne, ASCO 2005). Treatment was continued until progression or unacceptable toxicity. Results: So far, toxicity data are available on 228 (118/110 pts arm A/B) of total 240 pts. Baseline characteristics (arm A/B): median age 64/65 yrs, male 67%/68%. A total of 684/719 cycles (median 6/6 cycles) have been administered. Most common CTC grade 3/4 toxicities (% of pts): Diarrhea 17.0/15.5, hand-foot-syndrome 5.9/2.7, peripheral neuropathy 15.3/0.0. Specific AE′s such as thrombosis, 3° hypertension and GI perforation occurred in 3.4/4.5%, 3.4/0.9% and 0.9/0.9% of pts, respectively. Among 185 evaluable pts (96/89), tumor control rates (CR+PR+SD) in arm A/B were 81.4%/82.8%, overall response rates (CR+PR) were 49.0%/52.7%. Conclusions: Both regimens, CapOx/Bev and CapIri/Bev, are well tolerated without differences in toxicity (except neuropathy). Interestingly, despite the protocol defined dose reduction of CapIri there is seemingly no difference in efficacy as measured by tumor control and response rate. Meanwhile, the trial has finished accrual and data including PFS rate will be presented at the meeting. [Table: see text]
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Affiliation(s)
- W. H. Schmiegel
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - A. Reinacher-Schick
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - W. Freier
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - G. Dietrich
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - D. Arnold
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - S. Kanzler
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - M. Geissler
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - U. Graeven
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - S. Hegewisch-Becker
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
| | - H. Schmoll
- Ruhr Universitaet, Bochum, Germany; Center of Oncology, Hildesheim, Germany; Bietigheim Hospital, Bietigheim, Germany; Martin-Luther-University, Halle, Germany; Johannes Gutenberg University, Mainz, Germany; Community Hospital, Esslingen, Germany; Maria Hilf Hospital, Moenchengladbach, Germany; Center of Oncology, Hamburg, Germany
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Elmadfa I, Al-Saghir S, Kanzler S, Frisch G, Majchrzak D, Wagner KH. Selected quality parameters of salmon and meat when fried with or without added fat. INT J VITAM NUTR RES 2007; 76:238-46. [PMID: 17243088 DOI: 10.1024/0300-9831.76.4.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/19/2022]
Abstract
AIM To determine whether pan-frying (pork, beef and salmon) without oil or with different fats (olive oil, corn oil or a partially hydrogenated plant oil) or steaming (only salmon) have effects on the total fat content, the fatty acid pattern, lipid peroxidation, tocopherols and in particular for salmon on vitamin D(3) and astaxanthin. MATERIAL AND METHODS Pork, beef patties and salmon were pan-fried (6 min each), beef fillet was pan-fried (5 min) with an additional braising period of 90 minutes and salmon was steamed for 12 minutes. Each pan-frying treatment was done with the above mentioned fats and without fat. Total fat was determined gravimetrically, the fatty acid pattern with GC, the tocopherols, astaxanthin and vitamin D(3) by using HPLC. RESULTS The effects on the fat quality and quantity in the final products were related to the pan-frying fat used, however, the power of the outcome was depending on the surface to volume ratio. The highest increase in total fat was observed for pork, followed by the beef patties and the braised beef. The same has been assessed for the fatty acid pattern. Tocopherols changed according to the oil used, in particular gamma-tocopherol significantly increased for each preparation after the use of corn oil. Only in pork an increase in lipid oxidation of the oil preparations has been observed. Vitamin D(3) in salmon significantly decreased after heat treatment, however a 150 g salmon portion would provide between 13.9 and 14.7 mug Vitamin D(3) which is around five times more than the average daily intake. CONCLUSION Pan-frying without fat can be recommended for the daily use, since the total fat intake is too high in developed countries and one main task of nutritional recommendations is to reduce the total fat intake. When pan-fried with fat, the choice of the fat is of high importance since it directly influences the quality and the flavour of the final product. In order to increase the fat quality from nutritional point of view only oils of plant or vegetable origin should be used in households. Pan-fried salmon is a good source of Vitamin D(3).
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Affiliation(s)
- I Elmadfa
- Institut für Ernährungswissenschaften der Universität Wien, Althanstrasse 14, 1090 Vienna, Austria
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Herber S, Otto G, Schneider J, Manzl N, Kummer I, Kanzler S, Schuchmann A, Thies J, Düber C, Pitton M. Transarterial chemoembolization (TACE) for inoperable intrahepatic cholangiocarcinoma. Cardiovasc Intervent Radiol 2007; 30:1156-65. [PMID: 17508242 DOI: 10.1007/s00270-007-9032-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 03/27/2007] [Accepted: 03/28/2007] [Indexed: 12/17/2022]
Abstract
The aim of this retrospective study was to determine the safety and efficacy of chemoembolization (TACE) as palliative treatment for patients with unresectable intrahepatic cholangiocarcinoma (CCA) and to compare the results with those in the literature. Fifteen patients with histology-proven CCA (5 men, 10 women) had received palliative treatment with TACE over a 6-year period. The treatment protocol comprised repeated TACE at a minimum of 8-week intervals. TACE was performed with a mixture of 10 ml Lipiodol and 10 mg mitomycin C injected into the tumor-supplying vessels. Follow-up investigations after 8-10 weeks comprised contrast-enhanced multislice spiral CT and laboratory control. Statistical evaluation included survival analysis using the Kaplan-Meier method. During the investigation period 58 TACEs (3.9 +/- 3.8; 1-15) were performed in 15 patients. Mean tumor size was 10.8 +/- 4.6 cm (range, 2.0-18.0 cm). Unifocal tumor disease was diagnosed in eight patients, and multifocal disease in seven. Mean survival was 21.1 months (95% CI, 9.4-32.5 months). At the end of the investigation period 3 patients are still alive, and 12 patients have died. The 1-, 2-, and 3-year survival rate was 51.3%, 27.5%, and 27.5% respectively. According to RECIST criteria interim best response to therapy was stable disease in 9 of 15 patients, a partial response in 1 of 15 patients, and tumor progression in 4 of 15 patients. No deaths and no acute liver failure occurred under TACE therapy. Major complications were observed in two patients, comprising anaphylactic shock owing to contrast medium administration in one and gastric ulceration due to lipiodol displacement in the second patient. These results demonstrate that TACE is a safe procedure with a moderate number of complications for patients suffering from inoperable CCA. According to recently published data on i.v. chemotherapy we suggest that TACE might be able to prolong survival in selected patients who would succumb under other palliative treatment modalities.
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Affiliation(s)
- S Herber
- Department of Diagnostic and Interventional Radiology, University of Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.
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Herber SC, Otto G, Woerns M, Moench C, Kanzler S, Junginger T, Schneider J, Schuchmann M, Kummer I, Manzl N, Düber C, Pitton MB. [Single center experience over a 5-year period with sequential transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC)]. ROFO-FORTSCHR RONTG 2007; 179:289-99. [PMID: 17325996 DOI: 10.1055/s-2006-927355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze the course of disease of patients treated with sequential TACE and to evaluate the dependent and independent prognostic factors for patient survival using the Cox Proportional Hazard Model. MATERIALS AND METHODS 94 patients palliatively treated with TACE. Patients were selected if they had been treated at least 3 times. The TACE procedure was carried out at 8-week intervals using a suspension consisting of a fixed dosage of Mitomycin C (10 mg) and 10 ml Lipiodol. Follow-up investigations included contrast-enhanced multislice CT before and after TACE and assessment of the laboratory test results (i. e., blood count, liver enzymes, and coagulation). RESULTS In 66.7 % of the patients, multifocal tumors were found. In 16.0 % of the patients, the tumor load represented more then 50 % of the liver volume. In 23.4 % of the cases, a portal vein thrombosis was found in the initial CT scan. The mean survival for the total cohort was 24.1 months (95 %-CI 20.1 - 28.2). During the investigation period, 72/94 of the patients died. The cumulative 1-year, 2-year, and 3-year survival rates are 71.6 %, 33.9 %, und 17.2 %, respectively. A median of 6.0 +/- 3.1 (range 14, n total = 612 TACE) was performed in each patient. A total of 62.5 % patients died because of tumor progression whereas 18.1 % died due to progressive liver failure. Patients in whom the tumor responded to the TACE treatment and who did not develop ascites or those with Okuda stage I or unifocal tumor growth showed a survival benefit whereas the presence of portal vein thrombosis was associated with a significantly poor outcome (p < 0.05). The Child-Pugh stage was not statistically significant for the disease course; the occurrence of new tumor lesions had no influence with regard to 1-year and 2-year survival but had a significant influence on long-term survival (p < 0.05). Independent prognostic factors are (multivariate analysis; p < 0.05): number of TACE performed, tumor type (i. e., unifocal vs. multifocal), response to TACE (response vs. progression), and Okuda stage. CONCLUSION Our results emphasize the value of TACE in the palliative treatment of HCC. Under sequential TACE therapy the course of disease in patients suffering from portal vein thrombosis was not significantly worse. Crucial prognostic factors for the course of the HCC are tumor type and extension, response to TACE, and liver function at the beginning of TACE.
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Affiliation(s)
- S C Herber
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Johannes-Gutenberg-Universität Mainz.
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Goetz M, Fottner C, Schirrmacher E, Delaney P, Gregor S, Schneider C, Strand D, Kanzler S, Memadathil B, Weyand E, Holtmann M, Schirrmacher R, Weber MM, Anlauf M, Klöppel G, Vieth M, Galle PR, Bartenstein P, Neurath MF, Kiesslich R. In-vivo confocal real-time mini-microscopy in animal models of human inflammatory and neoplastic diseases. Endoscopy 2007; 39:350-6. [PMID: 17427071 DOI: 10.1055/s-2007-966262] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Although various improvements in tissue imaging modalities have recently been achieved, in-vivo molecular and subsurface imaging in the field of gastroenterology remains a technical challenge. In this study we evaluated a newly developed, handheld, miniaturized confocal laser microscopy probe for real-time in-vivo molecular and subsurface imaging in rodent models of human disease. MATERIALS AND METHODS The minimicroscope uses a 488-nm, single line laser for fluorophore excitation. The optical slice thickness is 7 microm, the lateral resolution 0.7 microm. The range of the z-axis is 0-250 microm below the tissue surface. Imaging was performed using different fluorescent staining protocols; 5-carboxyfluorescein-labeled octreotate was synthesized for targeted molecular imaging. RESULTS Cellular and subcellular details of the gastrointestinal tract could be visualized in vivo at high resolution. Confocal real-time microscopy allowed in-vivo identification of tumor vessels and liver metastases, as well as diagnosis of focal hepatic inflammation, necrosis, and associated perfusion anomalies. Somatostatin-receptor targeting permitted in-vivo molecular staining of AR42-J-induced carcinoma and pancreatic islet cells. CONCLUSIONS Confocal mini-microscopy allows rapid in-vivo molecular and subsurface imaging of normal and pathological tissue in the gastrointestinal tract at high resolution. Because this technology is applicable to humans, it might impact on future in-vivo microsocpic and molecular diagnosis of diseases such as cancer and inflammation.
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Affiliation(s)
- M Goetz
- Medical Clinic I, University of Mainz, Mainz, Germany.
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Waldner M, Schimanski C, Klaas W, Bittinger F, Pitton M, Korenkov M, Kiesslich R, Neurath M, Galle P, Kanzler S. [Massive hemorrhage in a 28-year-old male patient with intestinal Behçet's disease]. Z Gastroenterol 2006; 44:1047-51. [PMID: 17063434 DOI: 10.1055/s-2006-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A 28-year-old man was admitted to the emergency room of our hospital after syncope and acute gastrointestinal bleeding. On the basis of numerous oral and genital ulcerations as well as uveitis anterior and erythema nodosum, the diagnosis of Behçet's disease had been confirmed previously. The bleeding focus could not be detected by endoscopy. During the next days recurrent massive hemorrhages occurred in spite of immunosuppressive therapy with steroids. Angiography revealed a circumscribed bleeding source in the colon transversum near the left colonic flexure, which was treated by superselective coil embolization. A massive hemorrhage reoccurred and required a surgical approach with a Hartmann procedure. Histology depicted bleeding into the submucosa and mucosa and an ulcer in this area as well as lymphatic infiltration of the mucosa. Immunosuppressive therapy was intensified with azathioprine and resulted in a dramatic improvement of the oral and genital ulcers. In addition, no further gastrointestinal hemorrhage occurred. Due to its higher prevalence in patients from eastern Asia, Behçet's disease poses an important differential diagnosis of intestinal hemorrhage in patients of this descent.
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Affiliation(s)
- M Waldner
- I. Medizinische Klinik, Johannes-Gutenberg-Universität, Mainz
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39
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Schimanski CC, Hörner V, Kanzler S, Galle PR, Moehler M. [Immunotherapy of colorectal cancer--overview and perspectives]. Z Gastroenterol 2006; 44:673-81. [PMID: 16902899 DOI: 10.1055/s-2006-926905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The specific immunotherapy of colorectal cancer initially revealed promising results. However, a significant clinical benefit for patients has still to be proven in phase III trails. In order to compare the different clinical approaches and early phase I - II studies, there is an urgent need for the establishment and acceptance of new standardized diagnostic tools for detecting and quantifying induced and clinical relevant immune responses in patients. Whether or not subgroups with a certain genetic background, such as specific HLA alleles, reveal a better benefit from tumour vaccinations needs to be further analysed. Currently, only two specific antibodies, targeting membraneous receptors or their ligands, such as EGF or VEGF, have been approved by diverse national drug authorities. The question as to whether these antibodies also induce an antibody-dependent cellular toxicity (ADCC) is currently being analysed.
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Moehler M, Kanzler S, Geissler M, Raedle J, Ebert M, Scherubl H, Flieger D, Seufferlein T, Galle PR, Hoehler T. Irinotecan/capecitabine versus cisplatin/capecitabine in advanced adenocarcinoma of the stomach or gastroesophageal junction: Interim analysis of a randomized German AIO phase II study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4032 Background: Irinotecan with 5-FU is highly effective in advanced gastric cancer. In addition, capecitabine seems to be as effective as 5-FU, with its advantage of oral administration. Thus, we compared efficacy and toxicity of irinotecan/capecitabine versus cisplatin/capecitabine in this prospective multicentric, open trail. Methods: Patients (pts) with previously untreated locally advanced or metastatic adenocarcinoma of stomach or gastroesophageal junction and Karnofsky Performance status (KPS) of ≥ 60%, at least one measurable lesion and adequate organ functions were eligible. Pts were randomized to 3-weekly cycles of irinotecan 250 mg/m2, day 1 (arm A) or to cisplatin 80 mg/m2, day 1 (arm B). Capecitabine was administered at a 1000 mg/m2 twice daily for 14 days followed by a 7-day rest in both arms. Primary endpoint was remission rate, treatment was continued until disease progression. Results: At time of abstract submission, 91 of 120 pts (planned sample size) were randomized to arm A (45 pts) or B (46 pts). Interim data were available on 76 patients included into intent to treat analysis (34 pts arm A, 42 pts arm B). Baseline characteristics (arm A vs. B) were median age: 60 vs. 64 years, gender (female/male) 23%/77% vs. 30%/70%, KPS (≥80%) 97% vs. 93%, tumor distribution of gastric origin and gastroesophageal junction 85%/15% vs. 63%/37%. Grade 3 toxicities in A/B (% of pts) were anemia 3/9, neutropenia 17/19, diarrhoea 17/5, nausea 14/21, vomiting 3/14, hand-foot syndrome 6/2, respectively. Grade 4 toxicity occured only for neutropenia with 3% vs.5% in A/B, respectively. In 59 evaluable pts (28/31 in A/B), overall remission rate (CR + PR) and tumor control rate (CR + PR + SD) were 39% vs. 42% and 64% vs. 74%, respectively. Despite being only very descriptive, median progression-free and overall survival (arm A vs B) were 5.2 vs. 5.0 and 8.9 vs. 9.4 months, respectively. Conclusions: In patients with locally advanced or metastatic gastric and gastroesophageal cancer, both regimen irinotecan/capecitabine or cisplatin/capecitabine are effective, well tolerated and can be administered safely on an out-patient basis. Currently, both treatment arms are comparable. Accrual continues. No significant financial relationships to disclose.
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Affiliation(s)
- M. Moehler
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - S. Kanzler
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - M. Geissler
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - J. Raedle
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - M. Ebert
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - H. Scherubl
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - D. Flieger
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - T. Seufferlein
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - P. R. Galle
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - T. Hoehler
- University of Mainz, Mainz, Germany; University of Freiburg, Freiburg, Germany; Saarland University, Homburg, Germany; University of Magdeburg, Magdeburg, Germany; Charité Campus Benjamin Franklin, Berlin, Germany; Klinikum Aschaffenburg, Aschaffenburg, Germany; University Hospital, Ulm, Germany; Prosper-Hospital Recklinghausen, Recklinghausen, Germany
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Kiesslich R, Moenk S, Reinhardt K, Kanzler S, Schilling D, Jakobs R, Denzer U, Neumann M, Vollmer J, Schütz M, Heinrichs W, Neurath MF, Galle PR. [Combined simulation training: a new concept and workshop is useful for crisis management in gastrointestinal endoscopy]. Z Gastroenterol 2005; 43:1031-9. [PMID: 16142611 DOI: 10.1055/s-2005-858542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Crisis management as well as realistic emergency situations can be trained in the new developed simulation workshop "Gastrointestinal Endoscopy and Crisis Resource Management" by combining a full-scale simulator and the Erlanger Endoscopy Trainer. The aim of the current study was to evaluate the efficiency of the newly developed simulation workshop. METHODS Endoscopists with more than 12 months experience can train their endoscopic skills and crisis resource management with the help of different simulators. In addition, two different scenarios (GI bleeding with significant blood loss and sedation overdoses) embedded in a realistic surrounding (emergency room) have to be managed by the participants. Vital parameters, endoscopic skills, as well as personal interactions were recorded and graded. RESULTS 100 participants took part in the newly developed workshop (between June and December 2003). The participants showed a significantly better endoscopic performance and a significantly better crisis management after the standardized training program. CONCLUSIONS Simulation training plays an essential role in aviation and minimizes the risk for human errors. In the current study it is clearly shown that simulation training is also useful in gastrointestinal endoscopy. The newly developed workshop may thus be of crucial importance to improve personal crisis management. Simulation also leads to an improvement of endoscopic and emergency skills. Accordingly, simulation training should be recommended or offered as an education option in gastrointestinal endoscopy.
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Affiliation(s)
- R Kiesslich
- I. Med. Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz.
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42
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Denzer U, Mollenhauer M, Kanzler S, Galle PR, Lohse AW. Prospective comparison of cardiopulmonary events during minilaparoscopy and colonoscopy under conscious sedation. Endoscopy 2005; 37:460-5. [PMID: 15844026 DOI: 10.1055/s-2005-861195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Cardiorespiratory parameters were examined throughout diagnostic minilaparoscopy procedures. The same parameters were analyzed during colonoscopy, and the data were compared. PATIENTS AND METHODS Sixty-five consecutive unselected patients undergoing minilaparoscopy (group 1: ASA I, n = 34; group 2: ASA II/III, n = 31) and 61 consecutive unselected patients undergoing colonoscopy (group 3: ASA I, n = 31; group 4: ASA II/III, n = 30) were included. Oxygen saturation (Sao (2)), heart rate (HR) and mean arterial pressure (RRm) were measured continuously, and 12-lead electrocardiography (ECG) recordings were made at specific times during each procedure. RESULTS Minor differences were observed, particularly after premedication, probably due to different dosage regimens and timing in the two examination techniques. After premedication, testing for differences from baseline values showed a minor decrease in Sao (2) and RRm in the minilaparoscopy groups in comparison with the colonoscopy groups (median Sao (2), group 1: 99.9 % +/- 0 vs. group 3 : 100 % -1, P = 0.0078; median RRm, group 1: 99.5 - 4 mm Hg vs. group 3 : 96 -16 mm Hg, P = 0.046, and median RRm, group 2 : 110 + 1 mm Hg vs. group 4 : 101 -13.5 mm Hg, P = 0.0007). HR increased in minilaparoscopy in comparison with colonoscopy (median HR: group 2 : 77 + 4 beats/min vs. group 4 : 75.5 +/- 0 beats/min; P = 0.01). Comparison of defined relevant pathological changes in Sao (2), RRm, HR, and ECG showed no significant differences. DISCUSSION These data indicate that diagnostic minilaparoscopy under conscious sedation is only associated with limited risk in patients with compensated cardiopulmonary diseases. This is probably due to the low insufflation pressure used.
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Affiliation(s)
- U Denzer
- First Dept. of Medicine, Johannes Gutenberg University, Mainz, Germany.
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43
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Mosler P, Mergener K, Denzer U, Kiesslich R, Galle PR, Kanzler S. Current practice in managing patients on anticoagulants and/or antiplatelet agents around the time of gastrointestinal endoscopy -- a nation-wide survey in Germany. Z Gastroenterol 2005; 42:1289-93. [PMID: 15558438 DOI: 10.1055/s-2004-813586] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Anticoagulants and antiplatelet agents are widely used in the prophylaxis and management of thromboembolic and cardiovascular diseases. Gastrointestinal bleeding is a well-known complication of these agents. Modification of anticoagulant and antiplatelet therapy is often required in patients undergoing surgical procedures and specific recommendations for the perioperative period have been issued. Fewer data exist with regard to the use of these agents around the time of endoscopic procedures. A survey of the American Society for Gastrointestinal Endoscopy (ASGE), performed several years ago, showed a wide variation between endoscopists in the management of anticoagulants and antiplatelet agents in the periendoscopic period. Subsequently, guidelines have been proposed by the ASGE as well as the German Society for Gastroenterology (DGVS). The aim of this study was to investigate the current practices among German endoscopists regarding the use of these medications in patients undergoing endoscopic procedures and to assess their adherence to published guidelines. Our data demonstrate that, in spite of the dissemination of guidelines, there is still a wide variation in the periendoscopic management of patients who are at increased risk for bleeding due to anticoagulants, especially in patients taking antiplatelet agents.
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Affiliation(s)
- P Mosler
- I. Medizinische Klinik und Poliklinik der Johannes-Gutenberg-Universität Mainz, Germany.
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44
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Denzer U, Hoffmann S, Helmreich-Becker I, Kauczor HU, Thelen M, Kanzler S, Galle PR, Lohse AW. Minilaparoscopy in the diagnosis of peritoneal tumor spread: prospective controlled comparison with computed tomography. Surg Endosc 2004; 18:1067-70. [PMID: 15156385 DOI: 10.1007/s00464-003-9139-0] [Citation(s) in RCA: 35] [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: 05/30/2003] [Accepted: 01/10/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early diagnosis of peritoneal spread in malignant disease prevents unnecessary laparotomies. Minimally invasive laparoscopy with the patient under conscious sedation is a new, easily feasible diagnostic technique. This study compares prospective and controlled diagnostic minilaparoscopy with computed tomography (CT) scan for the diagnosis of peritoneal metastases. METHODS In this study, 56 patients with malignant disease were prospectively investigated with diagnostic minilaparoscopy and CT scan. RESULTS The study criteria were fulfilled by 54 patients. Minilaparoscopy detected peritoneal carcinosis in 28 of 54 cases, whereas CT detected the disease in 14 of 54 cases. For 36 patients, the diagnosis could be verified by histologic examination of peritoneal biopsies or laparotomy. In this group, minilaparoscopy detected peritoneal carcinosis in 25 of 36 cases, whereas CT detected the disease in 12 of 36 cases. CONCLUSIONS Minilaparoscopy was more sensitive than CT in detecting peritoneal carcinosis (100% vs 47.8%; p < 0.01). Considering its low grade of invasiveness and superior sensitivity, minilaparoscopy should be regarded as the procedure of choice for the early detection of peritoneal carcinosis.
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Affiliation(s)
- U Denzer
- Department of Medicine, Johannes Gutenberg University, Langenbeckstrasse 1, D-55131, Mainz, Germany.
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Abstract
Autoimmune Hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and overlap syndromes of these three disease entities are regarded as autoimmune liver diseases. These conditions are important differential diagnoses of elevated liver function tests as about 10 % of liver transplantations in Europe and North America are for these indications. The diagnosis is often difficult but can be facilitated by sequential measurement of relevant autoantibodies, exclusion of other liver disease, ultrasound, ERCP and liver histology. In AIH immunosuppressive therapy has been shown to prevent or stop the development of cirrhosis and improve the prognosis of the patients decisively. In other autoimmune liver diseases this evidence is missing making individual therapeutic decisions necessary. Ursodesoxycholic acid (UDCA) seems to slow disease progression in particular in early stages of PBC.
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MESH Headings
- Adult
- Autoantibodies/analysis
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/therapy
- Azathioprine/administration & dosage
- Azathioprine/therapeutic use
- Biopsy
- Child
- Cholagogues and Choleretics/therapeutic use
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/diagnostic imaging
- Cholangitis, Sclerosing/immunology
- Cholangitis, Sclerosing/therapy
- Diagnosis, Differential
- Enzyme-Linked Immunosorbent Assay
- Female
- Hepatitis, Autoimmune/diagnosis
- Hepatitis, Autoimmune/drug therapy
- Hepatitis, Autoimmune/pathology
- Hepatitis, Autoimmune/therapy
- Humans
- Immunoassay
- Immunosuppression Therapy
- Immunosuppressive Agents/administration & dosage
- Immunosuppressive Agents/therapeutic use
- Liver/pathology
- Liver Cirrhosis, Biliary/diagnosis
- Liver Cirrhosis, Biliary/drug therapy
- Liver Cirrhosis, Biliary/immunology
- Liver Cirrhosis, Biliary/pathology
- Liver Diseases/diagnosis
- Liver Diseases/diagnostic imaging
- Liver Diseases/immunology
- Liver Diseases/pathology
- Liver Diseases/therapy
- Liver Function Tests
- Liver Transplantation
- Male
- Middle Aged
- Mycophenolic Acid/administration & dosage
- Mycophenolic Acid/analogs & derivatives
- Mycophenolic Acid/therapeutic use
- Prognosis
- Ultrasonography
- Ursodeoxycholic Acid/therapeutic use
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Affiliation(s)
- E M Bayer
- I. Medizinische Klinik und Poliklinik Johannes-Gutenberg-Universität Mainz, Germany
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46
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Kiesslich R, Kanzler S, Vieth M, Moehler M, Neidig J, Thanka Nadar BJ, Schilling D, Burg J, Nafe B, Neurath MF, Galle PR. Minimal change esophagitis: prospective comparison of endoscopic and histological markers between patients with non-erosive reflux disease and normal controls using magnifying endoscopy. Dig Dis 2004; 22:221-7. [PMID: 15383765 DOI: 10.1159/000080323] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION More than half the patients with gastroesophageal reflux disease (GERD) show no endoscopic abnormality or minimal change esophagitis (non-erosive reflux disease, NERD). We investigated the value of endoscopic and histological markers for the prediction of NERD before and after treatment with 20 mg esomeprazole. METHODS Between July and October 2002, consecutive patients presenting for upper endoscopy were stratified into GERD and non-reflux patients (control group) with the help of a questionnaire. The endoscopist was blind to the presence of reflux symptoms. Using magnifying endoscopes minimal change esophagitis was defined by the presence of vascular injection or vascular spots above the Z-line, villous mucosal surface and islands of squamous cell epithelium below the Z-line. Targeted and random biopsies were taken below and above the Z-line. Patients with endoscopically visible classical signs of esophagitis (Los Angeles A-D) or histologically proven Barrett's esophagus were not further investigated in the study (drop out). The esophageal specimens were histologically evaluated for erosions, infiltration with leukocytes, hyperplasia of basal cells and length of papillae. Patients with NERD were treated with 20 mg esomeprazole/day for 4 weeks and reevaluated by endoscopy as described before. RESULTS 39 patients with heartburn and 39 patients without reflux symptoms (controls) were finally included in the analysis (per protocol). Patients with NERD significantly (p = 0.005) more often showed endoscopic signs of minimal change esophagitis (27/39) than the control group (8/39). An increased length of papillae (14/39 versus 2/39; p = 0.005) and basal cell hyperplasia (17/39 versus 4/39; p = 0.009) were significantly more common in the heartburn group. After treatment with esomeprazole, no significant endoscopic or histological differences between the NERD and control group could be observed. CONCLUSIONS Minimal change esophagitis can be seen with high resolution magnifying endoscopy. By combining endoscopic and histological markers NERD can be predicted with a sensitivity of 62% and a specificity of 74%. Treatment with esomeprazole for 4 weeks reverses the slight alterations to normal.
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Affiliation(s)
- R Kiesslich
- 1st Medical Clinic, Johannes Gutenberg University Mainz, Germany.
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47
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Mosler P, Kiesslich R, Stein R, Galle PR, Thüroff JW, Kanzler S. Use of a duodenoscope in the management of a ureteral calculus in a patient with ureterosigmoidostomy (Mainz pouch II; rectosigmoid pouch). Endoscopy 2003; 35:1086-7. [PMID: 14648431 DOI: 10.1055/s-2003-44591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- P Mosler
- Dept. of Medicine I, Johannes Gutenberg University, Mainz, Germany.
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Kiesslich R, Mergener K, Naumann C, Hahn M, Jung M, Koehler HH, Nafe B, Kanzler S, Galle PR. Value of chromoendoscopy and magnification endoscopy in the evaluation of duodenal abnormalities: a prospective, randomized comparison. Endoscopy 2003; 35:559-63. [PMID: 12822089 DOI: 10.1055/s-2003-40240] [Citation(s) in RCA: 42] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic staining methods are increasingly being used to evaluate lesions in the esophagus and colon. The aim of this prospective study was to investigate chromoendoscopy and magnification endoscopy for the evaluation of mucosal lesions in the duodenum. PATIENTS AND METHODS Consecutive patients were randomly assigned to undergo conventional endoscopy without staining (group A) or intravital staining of the duodenal mucosa with indigo carmine and evaluation with a conventional video endoscope (group B) or a magnification endoscope (group C). Visible lesions were characterized before and after staining, and biopsies were taken for histological assessment. RESULTS A total of 118 patients was examined. Chromoendoscopy detected significantly more lesions in the duodenal bulb (98 vs. 28; P = 0.0042) in more patients (29 vs. 15; P = 0.0025) compared with conventional endoscopy (group A). After mucosal staining, there was no difference between video endoscopy and magnification endoscopy with regard to the number or extent of the lesions identified. Significantly more targeted biopsies were possible after intravital staining. The most commonly identified lesions on targeted biopsies included (staining/control groups): gastric metaplasia (14/3), hyperplastic Brunner's glands (6/3), inflammatory changes (7/6), villous atrophy (1/3), adenoma (1/0). CONCLUSIONS Intravital staining of the duodenum with indigo carmine may be useful for detecting mucosal abnormalities, delineating their extent, and allowing targeted biopsies. Magnification endoscopy, when used in addition to chromoendoscopy, does not appear to further increase the diagnostic yield for detecting duodenal abnormalities.
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Affiliation(s)
- R Kiesslich
- Dept. of Medicine I, Johannes Gutenberg University, Mainz, Germany.
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Baeres M, Herkel J, Czaja AJ, Wies I, Kanzler S, Cancado ELR, Porta G, Nishioka M, Simon T, Daehnrich C, Schlumberger W, Galle PR, Lohse AW. Establishment of standardised SLA/LP immunoassays: specificity for autoimmune hepatitis, worldwide occurrence, and clinical characteristics. Gut 2002; 51:259-64. [PMID: 12117891 PMCID: PMC1773315 DOI: 10.1136/gut.51.2.259] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.1] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antibodies to soluble liver antigen/liver pancreas (SLA/LP) are specific markers of autoimmune hepatitis. Their target antigen has recently been cloned. AIMS To establish standardised immunoassays using the recombinant antigen, and to assess the frequency and significance of seropositivity in patients from different countries. METHODS An enzyme linked immunoassay was developed using purified recombinant antigen and validated by testing sera from 200 healthy blood donors and 1026 patients with various liver and non-liver diseases. The assay was then applied to 454 sera from 419 patients with autoimmune hepatitis from different countries. All sera were also tested by inhibition immunoassay and western blot. RESULTS Antibodies were reliably detected by the recombinant immunoassay and occurred exclusively in patients with autoimmune liver disease. Twenty three of 149 patients from the USA (15%), 23/132 from Brazil (17%), 21/108 from Germany (19%), and 2/30 from Japan (7%) were seropositive. Clinical features at presentation were similar between seropositive and seronegative patients. However, relapse after corticosteroid withdrawal or during maintenance therapy occurred more commonly in seropositive patients. CONCLUSIONS Antibodies to SLA/LP can be reliably detected by these standardised immunoassays based on recombinant antigen. Antibodies to SLA/LP occur with similar frequencies in different geographical regions, races, and age groups, and are of exquisite diagnostic specificity. Whether SLA/LP positive patients represent a clinically distinct subgroup remains to be determined; relapse during treatment reduction appeared to be more common in the SLA/LP group.
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Affiliation(s)
- M Baeres
- I Department of Medicine, Johannes Gutenberg-University, Mainz, Germany
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50
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Kanzler S, Bozkurt S, Herkel J, Galle PR, Dienes HP, Lohse AW. Nachweis von SLA/LP-Autoantikörpern
bei Patienten mit primär biliärer Zirrhose als
Marker für eine sekundäre autoimmune Hepatitis
(Overlapsyndrom). Dtsch Med Wochenschr 2001; 126:450-6. [PMID: 11360449 DOI: 10.1055/s-2001-12906] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to evaluate whether the presence of SLA/LP-autoantibodies in PBC-patients gives evidence for a secondary AIH, also called AIH/PBC-overlap-syndrome. PATIENTS AND METHODS Out of 233 consecutive patients with PBC who had been followed between October 1980 and April 2000, we evaluated the data of anti-SLA/LP-positive patients and compared them to patients with an anti-SLA/LP-negative AIH/PBC overlap syndrome as well as to patients with a classical course of AIH and PBC. RESULTS In total we could identify nine PBC patients with anti-SLA/LP antibodies (six women/three men) or 3.9% of the study population, Anti-SLA/LP-positive PBC patients were slightly younger at diagnosis in comparison to anti-SLA/LP-negative PBC-patients (49.9 vs. 53.2 years). Transaminases and gamma-globulins were significantly higher in anti-SLA/LP-positive PBC-patients in comparison to anti-SLA/LP-negative PBC-patients (mean: 235 vs. 55 IU/l and 27.6 vs. 19.5 g/l). Anti-SLA/LP-positive patients significantly more frequently had an HLA-type that is characteristic for AIH (B8; DR3; DR4). Immunosuppressive therapy reduced inflammatory activity and cholestasis significantly. Relapses were frequent after reduction or discontinuation of immunosuppressive therapy. CONCLUSION The presence of SLA/LP autoantibodies in PBC patients has a high specificity for a secondary AIH (AIH/PBC overlap syndrome). These patients have a good response to immunosuppressive therapy. The autoantibody profile and immunogenetics may help in future to identify PBC patients that benefit most from immunosuppressive therapy.
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MESH Headings
- Adult
- Aged
- Autoantibodies/analysis
- Biopsy
- Blotting, Western
- Clinical Enzyme Tests
- Data Interpretation, Statistical
- Enzyme-Linked Immunosorbent Assay
- Female
- Fluorescent Antibody Technique
- Follow-Up Studies
- Hepatitis, Autoimmune/diagnosis
- Hepatitis, Autoimmune/drug therapy
- Hepatitis, Autoimmune/etiology
- Hepatitis, Autoimmune/immunology
- Hepatitis, Autoimmune/pathology
- Humans
- Immunosuppressive Agents/therapeutic use
- Liver/immunology
- Liver/pathology
- Liver Cirrhosis, Biliary/complications
- Liver Cirrhosis, Biliary/diagnosis
- Liver Cirrhosis, Biliary/drug therapy
- Liver Cirrhosis, Biliary/immunology
- Liver Cirrhosis, Biliary/pathology
- Male
- Middle Aged
- Time Factors
- Transaminases/blood
- gamma-Globulins/analysis
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Affiliation(s)
- S Kanzler
- I. Medizinische Klinik und Poliklinik, Johannes Gutenberg Universität, Mainz
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