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Carril-Ajuria L, Lavaud P, Dalban C, Negrier S, Gravis G, Motzer RJ, Chevreau C, Tannir NM, Oudard S, McDermott DF, Laguerre B, Hammers HJ, Barthelemy P, Plimack ER, Borchiellini D, Gross-Goupil M, Jiang R, Lee CW, de Silva H, Rini BI, Escudier B, Albigès L. Validation of the Lung Immune Prognostic Index (LIPI) as a prognostic biomarker in metastatic renal cell carcinoma. Eur J Cancer 2024; 204:114048. [PMID: 38653033 DOI: 10.1016/j.ejca.2024.114048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The Lung Immune Prognostic Index (LIPI) is associated with immune checkpoint inhibitors (ICI) outcomes across different solid tumors, particularly in non-small cell lung cancer. Data regarding the prognostic and/or predictive role of LIPI in metastatic renal cell carcinoma (mRCC) are still scarce. The aim of this study was to evaluate whether LIPI could be predictive of survival in mRCC patients. METHODS We used patient level data from three different prospective studies (NIVOREN trial: nivolumab; TORAVA trial: VEGF/VEGFR-targeted therapy (TT); CheckMate 214: nivolumab-ipilimumab vs sunitinib). LIPI was calculated based on a derived neutrophils/(leukocyte-neutrophil) ratio > 3 and lactate-dehydrogenase >upper limit of normal, classifying patients into three groups (LIPI good, 0 factors;LIPI intermediate (int), 1 factor;LIPI poor, 2 factors) and/or into two groups (LIPI good, 0 factors;LIPI int/poor, 1-2 factors) according to trial sample size. Primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS). RESULTS In the Nivolumab dataset (n = 619), LIPI was significantly associated with OS (LIPI-good 30.1 vs 13.8 months in the LIPI int/poor; HR= 0.47) and PFS (HR=0.74). In the VEGF/VEGFR-TT dataset (n = 159), only a correlation with PFS was observed. In the CheckMate214 dataset (n = 1084), LIPI was significantly associated with OS (nivolumab-ipilimumab OS LIPI good vs int/poor: HR=0.55, p < 0.0001; sunitinib: OS LIPI good vs int/poor: 0.38, p < 0.0001) in both treatment groups in univariate and multivariate analysis. CONCLUSIONS Pretreatment-LIPI correlated with worse survival outcomes in mRCC treated with either ICI or antiangiogenic therapy, confirming LIPI's prognostic role in mRCC irrespective of systemic treatment used.
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Affiliation(s)
| | | | - Cecile Dalban
- Department of Biostatistics, Centre Leon Bernard, Lyon, France
| | | | | | | | | | - Nizar M Tannir
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stéphane Oudard
- Hôpital Européen Georges Pompidou, Oncology department, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | | | | | | | | | | | | | - Marine Gross-Goupil
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
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Piringer G, Thaler J, Anchisi S, Geffriaud-Ricouard C, Gueldner M, Scholten F, Derigs HG, Bohanes P, Grünberger B, Schwarz L, von Moos R, Hofheinz RD. Quality of life, effectiveness, and safety of aflibercept plus FOLFIRI in older patients with metastatic colorectal cancer: An analysis of the prospective QoLiTrap study. J Geriatr Oncol 2023; 14:101638. [PMID: 37776611 DOI: 10.1016/j.jgo.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/23/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) mainly affects older patients. The pivotal VELOUR phase III trial of aflibercept plus FOLFIRI in metastatic CRC (mCRC) included only 5.9% of patients aged ≥75 years. Herein, we report a preplanned analysis from QoLiTrap, a large prospective observational study evaluating the impact of age on quality of life (QoL), effectiveness, and safety of aflibercept plus FOLFIRI in daily clinical practice in Europe. MATERIALS AND METHODS Enrolled patients had progressive mCRC, had failed a prior oxaliplatin-based regimen, and had received aflibercept (4 mg/kg) plus FOLFIRI every two weeks until disease progression, death, unacceptable toxicity, or physician/patient decision. Analyses were performed by age classes (<60, 60-64, 65-69, 70-74, and ≥ 75 years). The primary endpoint was the percentage of patients whose global health status (GHS) of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was maintained (i.e., no worsening from baseline by at least 5% over a 12-week treatment). Secondary endpoints included tumor objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS Overall, 1277 patients (<60 years, n = 327; 60-64 years, n = 231; 65-69 years, n = 227; 70-74 years, n = 259; and ≥ 75 years, n = 233) were treated, of whom 872 were evaluable for QoL. GHS was maintained in 36.5%, 41.6%, 38.9%, 41.8%, and 44.8% of patients aged <60, 60-64, 65-69, 70-74, and ≥ 75 years, respectively. Age did not influence PFS (median 7.8 months), OS (median 14.4 months), or ORR (20.8%). Number of cycles, dose delays for any cause, and dose reductions for adverse events (AEs) were comparable between age classes. Grade ≥ 3 AEs occurred in 47.7%, 51.9%, 51.5%, 55.2%, and 55.8% of patients aged <60, 60-64, 65-69, 70-74, and ≥ 75 years, respectively. The main grade ≥ 3 AEs were hypertension (11.2%) and diarrhea (9%) in patients aged ≥75 years. DISCUSSION The results suggest that aflibercept plus FOLFIRI maintains QoL and retains its activity, including a high objective tumor response, regardless of age and treatment line. In fit older patients, the safety profile seems manageable, with no new safety signals.
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Affiliation(s)
- Gudrun Piringer
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Grieskirchner Str. 42, 4600 Wels, Austria; Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Wels-Grieskirchen Hospital, Grieskirchner Str. 42, 4600 Wels, Austria
| | - Sandro Anchisi
- Department of Oncology, Valais Romand Hospital Center, Valais Hospital, Av. Grand-Champsec 86, 1951 Sion, Switzerland
| | | | - Max Gueldner
- Sanofi-Aventis Deutschland GmbH, Luetzowstraße 107, 10785 Berlin, Germany
| | - Felicitas Scholten
- Department of Internal Medicine 3, Hematology, Oncology, Palliative Medicine and Pneumology, Frankfurt Höchst Clinic, Gotenstrasse 6-8, 65929 Frankfurt am Main, Germany
| | - Hans-Günter Derigs
- Department of Internal Medicine 3, Hematology, Oncology, Palliative Medicine and Pneumology, Frankfurt Höchst Clinic, Gotenstrasse 6-8, 65929 Frankfurt am Main, Germany
| | - Pierre Bohanes
- Department of Oncology and Internal Medicine, Center for Chemotherapy, 1004 Lausanne, Switzerland
| | - Birgit Grünberger
- Department of Internal Medicine, Hematology and Oncology, Hospital Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
| | - Leonora Schwarz
- Department of Biometry, Alcedis, Winchesterstr 3, 35394 Giessen, Germany
| | - Roger von Moos
- Department of Oncology, Cantonal Hospital Graubuenden, Loestrasse 170, 7000 Chur, Switzerland
| | - Ralf-Dieter Hofheinz
- Department of Oncology, University Hospital Mannheim, Theodor-Kutzer-Ufer 1, 68167 Mannheim, Germany.
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Breda-Yepes M, Rodríguez-Hernández LA, Gómez-Figueroa E, Mondragón-Soto MG, Arellano-Flores G, Hernández-Hernández A, Rodríguez-Rubio HA, Martínez P, Reyes-Moreno I, Álvaro-Heredia JA, Gutiérrez Aceves GA, Villanueva-Castro E, Sangrador-Deitos MV, Alonso-Vanegas M, Guerrero-Juárez V, González-Aguilar A. Relative cerebral blood volume as response predictor in the treatment of recurrent glioblastoma with anti-angiogenic therapy. Clin Neurol Neurosurg 2023; 233:107904. [PMID: 37499302 DOI: 10.1016/j.clineuro.2023.107904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/08/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Glioblastoma is one of the most common brain tumors in adult populations, usually carrying a poor prognosis. While several studies have researched the impact of anti-angiogenic therapies, especially anti-VEFG treatments in glioblastoma, few have attempted to assess its progress using imaging studies. PURPOSE We attempted to analyze whether relative cerebral blood volume (rCBV) from dynamic susceptibility-weighted contrast-enhanced MRI (DSC-MRI) could predict response in patients with glioblastoma undergoing Bevacizumab (BVZ) treatment. METHODS We performed a retrospective study evaluating patients with recurrent glioblastoma receiving anti-angiogenic therapy with BVZ between 2012 and 2017 in our institution. Patients were scheduled for routine MRIs at baseline and first-month follow-up visits. Studies were processed for DSC-MRI, cT1, and FLAIR images, from which relative cerebral blood volume measurements were obtained. We assessed patient response using the Response Assessment in Neuro-Oncology (RANO) working group criteria and overall survival. RESULTS 40 patients were included in the study and were classified as Bevacizumab responders and non-responders. The average rCBV before treatment was 4.5 for both groups, and average rCBV was 2.5 for responders and 5.4 for non-responders. ROC curve set a cutoff point of 3.7 for rCBV predictive of response to BVZ. Cox Multivariate analysis only showed rCBV as a predictive factor of OS. CONCLUSION A statistically significant difference was found in rCBV between patients who responded and those who did not respond to BVZ treatment. rCBV may be a low-cost and effective marker to assess response to Bevacizumab treatment in GBM.
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Affiliation(s)
- Michele Breda-Yepes
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico
| | | | | | | | | | | | | | - Pablo Martínez
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico
| | | | - Juan A Álvaro-Heredia
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico
| | | | | | | | - Mario Alonso-Vanegas
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Mexico
| | | | - Alberto González-Aguilar
- The American British Cowdray (ABC) Medical Center, Mexico City, Mexico; Department of Neuro-Oncology, National Institute of Neurology and Neurosurgery, Mexico; Emergency Department, National Institute of Neurology and Neurosurgery, Mexico.
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Ahdi HS, Wichelmann TA, Pandravada S, Ehrenpreis ED. Medication-induced osteonecrosis of the jaw: a review of cases from the Food and Drug Administration Adverse Event Reporting System (FAERS). BMC Pharmacol Toxicol 2023; 24:15. [PMID: 36879299 PMCID: PMC9987072 DOI: 10.1186/s40360-023-00657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Osteonecrosis of the jaw (ONJ) is a rare but serious adverse drug reaction (ADR) commonly associated with bisphosphonate and denosumab therapy. Prior research utilized an online, public FDA Adverse Event Reporting System (FAERS) Database to explore this ADR. This data identified and described several novel medications associated with ONJ. Our study aims to build upon the prior findings, reporting trends of medication induced ONJ over time and identifying newly described medications. METHODS We searched the FAERS database for all reported cases of medication related osteonecrosis of the jaw (MRONJ) from 2010 to 2021. Cases lacking patient age or gender were excluded. Only adults (18 +) and reports from Healthcare Professions were included. Duplicate cases were removed. The top 20 medications were identified and described for April 2010-December 2014 and April 2015-January 2021. RESULTS Nineteen thousand six hundred sixty-eight cases of ONJ were reported to the FAERS database from 2010-2021. 8,908 cases met inclusion criteria. 3,132 cases were from 2010-2014 and 5,776 cases from 2015-2021. Within the cases from 2010-2014, 64.7% were female and 35.3% were male, and the average age was 66.1 ± 11.1 years. Between 2015-2021, 64.3% were female and 35.7% were male, and the average age was 69.2 ± 11.5 years. Review of the 2010-2014 data identified several medications and drug classes associated with ONJ not previously described. They include lenalidomide, corticosteroids (prednisolone and dexamethasone), docetaxel and paclitaxel, letrozole, methotrexate, imatinib, and teriparatide. Novel drugs and classes described between 2015-2021 include palbociclib, pomalidomide, radium 223, nivolumab, and cabozantinib. DISCUSSION While stricter inclusion criteria and removal of duplicate cases led to fewer overall identified cases of MRONJ when compared to prior research, our data represents a more reliable analysis of MRONJ reports to the FAERS database. Denosumab was the most frequently reported medication associated with ONJ. While unable to imply incidence rates from our data due to the nature of the FAERS database, our findings provide further description of the various medications associated with ONJ and elucidate patient demographics associated with the ADR. Additionally, our study identifies cases of several newly described drugs and drug classes that have not been previously described in literature.
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Affiliation(s)
- Hardeep S Ahdi
- Department of Internal Medicine, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA.
| | - Thomas Adam Wichelmann
- Department of Internal Medicine, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - Sasirekha Pandravada
- Department of Internal Medicine, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
| | - Eli D Ehrenpreis
- Department of Internal Medicine, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
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Azam M, Hudgi A, Uy PP, Makhija J, Yap JEL. Safety of endoscopy in patients undergoing treatments with antiangiogenic agents: A 5-year retrospective review. World J Gastrointest Endosc 2022; 14:416-423. [PMID: 36051996 PMCID: PMC9329849 DOI: 10.4253/wjge.v14.i7.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/08/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antiangiogenic agents (AAs) are increasingly used to treat malignant tumors and have been associated with gastrointestinal (GI) bleeding and perforation. Elective surgeries and endoscopy are recommended to be delayed for 31 d until after AAs treatment. Data regarding the safety of endoscopy while on antiangiogenic agents is extremely limited. No guidelines are in place to address the concern about withholding these anti-angiogenic drugs.
AIM To evaluate the risks of endoscopy in patients on antiangiogenic agents from 2015 to 2020 at our institution.
METHODS This is a single centered retrospective study approved by the institutional review board statement of the institution. Patients that underwent endoscopy within 28 d of antiangiogenic agents’ treatment were included in the study. Primary outcome of interest was death, and secondary outcomes included perforation and GI bleeding. Data were analyzed utilizing descriptive statistics. Fifty-nine patients were included in the final analysis and a total of eighty-five procedures were performed that were characterized as low risk and high risk.
RESULTS Among the 59 patients a total of 85 endoscopic procedures were performed with 24 (28.2%) categorized as high-risk and 61 (71.8%) procedures as low-risk. Of the total number of patients, (50%) were on bevacizumab and the rest were on imatinib (11.7%), lenvatinib (6.7%) and, ramucirumab (5%). The average duration between administration of AAs and the performance of endoscopic procedures was 9.9 d. No procedure-related adverse events were noted among our study population. We did observe two deaths with one patient, on lenvatinib for metastatic hepatocellular carcinoma, who had persistent bleeding despite esophageal variceal banding and died 4 d later from hemorrhagic shock. Another patient was diagnosed with acute myeloid leukemia died 24 d after an esophagogastroduodenoscopy with biopsy after transition to comfort care.
CONCLUSION As per this single center retrospective study, the rate of endoscopic procedure-related adverse events and death within 28 d of AA administration appears to be low.
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Affiliation(s)
- Mohammad Azam
- Department of Internal Medicine, Medical College of Georgia/Augusta University, Augusta, GA 30912, United States
| | - Amit Hudgi
- Department of Internal Medicine, Medical College of Georgia/Augusta University, Augusta, GA 30912, United States
| | - Pearl Princess Uy
- Division of Gastroenterology, Medical College of Georgia/Augusta University, Augusta, GA 30912, United States
| | - Jinal Makhija
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, United States
| | - John Erikson L Yap
- Division of Gastroenterology, Medical College of Georgia/Augusta University, Augusta, GA 30912, United States
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Giralt-Peret L, Rodríguez-Urzay A, Pérez-Fernández S, Martínez-Alday N, Fonollosa-Calduch A. Real-life results in treating neovascular age-related macular degeneration with anti-VEGF therapy. Analysis of 122 patients from a single centre. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:191-197. [PMID: 35523465 DOI: 10.1016/j.oftale.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The prognosis of age-related macular degeneration (AMD) has improved significantly since the advent of antiangiogenic treatments. However, several «real life» studies have shown lower number of injections and a markedly worse visual prognosis than pivotal clinical trials. OBJECTIVE To assess the effectiveness and safety of the treatment of neovascular AMD and analyse clinical factors related to the functional and structural prognosis in routine clinical practice. MATERIAL AND METHODS Retrospective, observational, single-centre study that included 143 eyes of 122 patients diagnosed with neovascular AMD between the years 2015 and 2016, who received treatment with antiangiogenic drugs and were followed up for two or more years. RESULTS Visual acuity improved in 45% of patients after two years of treatment. The mean decrease in central macular thickness was 85 μm (p < 0.001) and the mean number of injections was 13. Retinal pigment epithelium rupture was present in 3.5%. Ranibizumab was the drug most used as a first option, although 79 patients (55.2%) required a change in treatment, most being switched to aflibercept. A greater number of visits (p < 0.001) and a lower number of injections (p < 0.01) were predictors of worse structural outcome. The number of visits was associated with better visual acuity (p < 0.001). CONCLUSIONS The treatment has demonstrated its efficacy by improving visual acuity and central macular thickness. However, the number of injections performed has generally been higher than in other real-life studies.
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Affiliation(s)
- L Giralt-Peret
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain; Facultad de Medicina de la Universidad del País Vasco (UPV/EHU), Leioa, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain.
| | - A Rodríguez-Urzay
- Facultad de Medicina de la Universidad del País Vasco (UPV/EHU), Leioa, Vizcaya, Spain
| | - S Pérez-Fernández
- Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
| | - N Martínez-Alday
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain; Facultad de Medicina de la Universidad del País Vasco (UPV/EHU), Leioa, Vizcaya, Spain
| | - A Fonollosa-Calduch
- Servicio de Oftalmología, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain; Facultad de Medicina de la Universidad del País Vasco (UPV/EHU), Leioa, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Vizcaya, Spain
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Abstract
OPINION STATEMENT Clinical trial enrollment should be actively encouraged in all patients diagnosed with advanced, surgically unresectable chondrosarcoma (CS) due to the lack of consensus treatment recommendations. In the absence of an appropriate clinical trial, treatments are determined based on histologic subtype of CS with consideration given to targetable mutations (i.e., IDH1). Conventional CS is inherently resistant to cytotoxic chemotherapy and patients may benefit from antiangiogenic therapy including off-label use of pazopanib. Individuals harboring an IDH1 mutation may derive clinical benefit from ivosidenib, an IDH1 inhibitor. Upon progression and with functional status permitting, alternative options include mTOR inhibitors (sirolimus, temsirolimus) or other tyrosine kinase inhibitors (dasatinib), though no clear sequencing data exists. For dedifferentiated CS, conventional chemotherapies with osteosarcoma-like regimens are upfront options although prospective data is limited with minimal overall benefit. Alternative treatment options include immunotherapy with pembrolizumab or ivosidenib in IDH1-mutant, dedifferentiated CS, but questionable efficacy was observed in small sample sizes with either approach. In mesenchymal CS, treatment with Ewing sarcoma-like chemotherapy regimens may be considered, although data supporting its use is even more limited given its rarity.
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Affiliation(s)
- Adam Rock
- Harbor-UCLA Medical Center, 1000 W. Carson St, Torrance, CA, 90502, USA
| | - Sana Ali
- Harbor-UCLA Medical Center, 1000 W. Carson St, Torrance, CA, 90502, USA
| | - Warren A Chow
- University of California Irvine, 101 The City Drive South, Orange, CA, 92868, USA. .,UCI Health, 101 The City Drive South, Building 63, Room 412, ZOT 4061, Orange, CA, 92868, USA.
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Oguntade AS, Al-Amodi F, Alrumayh A, Alobaida M, Bwalya M. Anti-angiogenesis in cancer therapeutics: the magic bullet. J Egypt Natl Canc Inst 2021; 33:15. [PMID: 34212275 DOI: 10.1186/s43046-021-00072-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Angiogenesis is the formation of new vascular networks from preexisting ones through the migration and proliferation of differentiated endothelial cells. Available evidence suggests that while antiangiogenic therapy could inhibit tumour growth, the response to these agents is not sustained. The aim of this paper was to review the evidence for anti-angiogenic therapy in cancer therapeutics and the mechanisms and management of tumour resistance to antiangiogenic agents. We also explored the latest advances and challenges in this field. MEDLINE and EMBASE databases were searched for publications on antiangiogenic therapy in cancer therapeutics from 1990 to 2020. Vascular endothelial growth factor (VEGF) is the master effector of the angiogenic response in cancers. Anti-angiogenic agents targeting the VEGF and HIF-α pathways include monoclonal antibodies to VEGF (e.g. bevacizumab), small-molecule tyrosine kinase inhibitors (TKIs) e.g. sorafenib, decoy receptor or VEGF trap e.g. aflibercept and VEGFR2 inhibitors (e.g. ramucirumab). These classes of drugs are vascular targeting which in many ways are advantageous over tumour cell targeting drugs. Their use leads to a reduction in the tumour blood supply and growth of the tumour blood vessels. Tumour resistance and cardiovascular toxicity are important challenges which limit the efficacy and long-term use of anti-angiogenic agents in cancer therapeutics. Tumour resistance can be overcome by dual anti-angiogenic therapy or combination with conventional chemotherapy and immunotherapy. Emerging nanoparticle-based therapy which can silence the expression of HIF-α gene expression by antisense oligonucleotides or miRNAs has been developed. Effective delivery platforms are required for such therapy. SHORT CONCLUSION Clinical surveillance is important for the early detection of tumour resistance and treatment failure using reliable biomarkers. It is hoped that the recent interest in mesenchymal cell-based and exosome-based nanoparticle delivery platforms will improve the cellular delivery of newer anti-angiogenics in cancer therapeutics.
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Affiliation(s)
- Ayodipupo S Oguntade
- Nuffield Department of Population Health, University of Oxford, Oxford, UK. .,Institute of Cardiovascular Science, University College London, London, UK.
| | - Faez Al-Amodi
- Institute of Cardiovascular Science, University College London, London, UK
| | - Abdullah Alrumayh
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Muath Alobaida
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Mwango Bwalya
- Institute of Cardiovascular Science, University College London, London, UK
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Swamy K. Vascular-immuno-phenotypic (VIP) model for locally advanced and oligo-metastatic cancer: A hypothesis. Med Hypotheses 2021; 152:110618. [PMID: 34102599 DOI: 10.1016/j.mehy.2021.110618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/11/2021] [Accepted: 05/25/2021] [Indexed: 01/18/2023]
Abstract
Primary Hypothesis: In cancer therapy, normalization of the vasculature, and not disruption, to facilitate the reversal of the immuno-phenotypic changes, is the sine-qua-non for cancer elimination. The triad of normalization of the vasculature, leading to the improved immunological tumour microenvironment and increased susceptibility of resistant phenotypic cancer cells (VIP model), forms the basis of this hypothesis. This article hypothesizes the absolute need for vascular normalization for the eradication of cancer. Locally advanced and oligometastatic cancers have the potential to be cured with aggressive therapy. The focus on vascular normalization its clinical relevance in this situation is essential. Most traditional approaches have focused on the elimination of cancer by targeting and disrupting vasculature. Initially, antiangiogenic drugs showed significant promise in animal experiments. However, this vascular disruption approach has not paid the expected long-term dividends in the clinical setup. However, antiangiogenics are playing a significant role when used concurrently with chemotherapy/immunotherapy. Antiangiogenics have dual temporal actions - an initial normalization effect with improved oxygenation followed by pruning of blood vessels, resulting in exaggerated hypoxia along with a rebound progression. The literature is replete with phenomena of initial vascular normalization with a paradigm shift in the immuno-phenotypic milieu of cancer as part of vascular targeting approaches. The hypothesis in this article stresses the need to have strategies to extend this normalization window or to have pre-clinical trials to optimize the dose scheduling of antiangiogenics cyclically along with chemo/targeted/immune therapy and other combination therapies. We can implement this hypothesis by a combinatorial harmonization of present-day cancer therapies in the setting of tumor vasculature integrity. In addition, based on the proposed hypothesis, the current normalization effect of antiangiogenics and newer therapy development should focus primarily on normalization of the vasculature as well as targeting hypoxia-Inducible-factor-1 alpha (HIF-1 α) in the presence of differential genetic modulation of vascular endothelial cell resistance enhancement along with cancer cell sensitization. Also, the article enumerates six supporting hypotheses supplementing the primary hypothesis.
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Carril-Ajuria L, Colomba E, Cerbone L, Romero-Ferreiro C, Crouzet L, Laguerre B, Thibault C, Vicier C, de Velasco G, Fléchon A, Saldana C, Benusiglio PR, Bressac-de Paillerets B, Guillaud-Bataille M, Gaignard P, Scoazec JY, Richard S, Caron O, Escudier B, Albiges L. Response to systemic therapy in fumarate hydratase-deficient renal cell carcinoma. Eur J Cancer 2021; 151:106-114. [PMID: 33975058 DOI: 10.1016/j.ejca.2021.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Fumarate hydratase-deficient (FHdef) renal cell carcinoma (RCC) is a rare entity associated with the hereditary leiomyomatosis and RCC syndrome with no standard therapy approved. The aim of this retrospective study was to evaluate the efficacy of different systemic treatments in this population. METHODS We performed a multicentre retrospective analysis of Fhdef RCC patients to determine the response to systemic treatments. The endpoints were objective response rate (ORR), time-to-treatment failure (TTF), and overall survival (OS). The two latter were estimated using the Kaplan-Meier method. RESULTS Twenty-four Fhdef RCC patients were identified, and 21 under systemic therapy were included in the analysis: ten received cabozantinib, 14 received sunitinib, nine received "other antiangiogenics" (sorafenib, pazopanib, and axitinib), three received erlotinib-bevacizumab (E-B), three received mTOR inhibitors, and 11 received immune checkpoint blockers (ICBs). ORR for treatments were 50% for cabozantinib, 43% for sunitinib, 63% for "other antiangiogenics," and 30% for E-B, whereas ORR was 0% for mTOR inhibitors and 18% for ICBs. The median TTF (mTTF) was significantly higher with antiangiogenics (11.6 months) than with mTOR inhibitors (4.4 months) or ICBs (2.7 months). In the first-line setting, antiangiogenics presented a higher ORR compared with nivolumab-ipilimumab (64% versus 25%) and a significantly superior mTTF (11.0 months vs 2.5 months; p = 0.0027). The median OS from the start of the first systemic treatment was 44.0 months (95% confidence interval: 13.0-95.0). CONCLUSIONS We report the first European retrospective study of Fhdef RCC patients treated with systemic therapy with a remarkably long median OS of 44.0 months. Our results suggest that antiangiogenics may be superior to ICB/mTOR inhibitors in this population.
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Affiliation(s)
- Lucia Carril-Ajuria
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Department of Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - Emeline Colomba
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Luigi Cerbone
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Laurence Crouzet
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Constance Thibault
- Department of Medical Oncology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Cécile Vicier
- Department of Medical Oncology, Institute Paoli-Calmettes, Marseille, France
| | - Guillermo de Velasco
- Department of Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | - Carolina Saldana
- Department of Medical Oncology, Hôpital Henri Mondor Créteil AP-HP, France
| | - Patrick R Benusiglio
- UF d'Oncogénétique, Département de Génétique et Institut Universitaire de Cancérologie, GH Pitié-Salpêtrière, AP-HP Sorbonne Université F-75013 Paris, France
| | | | - Marine Guillaud-Bataille
- UF d'Oncogénétique, Département de Génétique et Institut Universitaire de Cancérologie, GH Pitié-Salpêtrière, AP-HP Sorbonne Université F-75013 Paris, France; Service de Génétique, Molecular Genetic Department, GRCC, 94805 Villejuif, France
| | - Pauline Gaignard
- Biochemistry Department, Hôpital Bicêtre, APHP Université Paris-Saclay, Le Kremlin Bicêtre F-94275, France
| | - Jean-Yves Scoazec
- Department of Pathology, University Paris-Saclay, Gustave Roussy Cancer Center, Villejuif, France
| | - Stéphane Richard
- Réseau National de Référence pour Cancers Rares de l'Adulte PREDIR labellisé par l'INCa, Hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France; Génétique Oncologique EPHE, PSL Research University, Paris, France; UMR9019 CNRS Genome Integrity and Cancers, Institute Gustave Roussy, Villejuif, France
| | - Olivier Caron
- Laboratory Integrative Tumor Immunology and Genetic Oncology, Institute Gustave Roussy, Villejuif, France
| | - Bernard Escudier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Réseau National de Référence pour Cancers Rares de l'Adulte PREDIR labellisé par l'INCa, Hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Réseau National de Référence pour Cancers Rares de l'Adulte PREDIR labellisé par l'INCa, Hôpital Bicêtre, AP-HP, Le Kremlin Bicêtre, France.
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Li XS, Li XF, Jin LF, Zhao Y, Shen WZ. [Treatment of ALK negative metastatic inflammatory myofibroblastic tumor by combination of pembrolizumab and anlotinib: a case report]. Zhonghua Zhong Liu Za Zhi 2021; 43:240-242. [PMID: 33601493 DOI: 10.3760/cma.j.cn112152-20191216-00810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- X S Li
- Department of Oncology and Hematology, the Second Hospital of Jilin University, Changchun 130041, China
| | - X F Li
- Department of Oncology and Hematology, the Second Hospital of Jilin University, Changchun 130041, China
| | - L F Jin
- Department of Oncology and Hematology, the Second Hospital of Jilin University, Changchun 130041, China
| | - Y Zhao
- Department of Oncology and Hematology, the Second Hospital of Jilin University, Changchun 130041, China
| | - W Z Shen
- Department of Oncology and Hematology, the Second Hospital of Jilin University, Changchun 130041, China
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12
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Minot-This MS, Edeline J. [New approval: Atezolizumab and bevacizumab for first line of unresecable hepatocellular carcinoma]. Bull Cancer 2021; 108:139-40. [PMID: 33546873 DOI: 10.1016/j.bulcan.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022]
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Perez-Fidalgo JA, Grau F, Fariñas L, Oaknin A. Systemic treatment of newly diagnosed advanced epithelial ovarian cancer: From chemotherapy to precision medicine. Crit Rev Oncol Hematol 2020; 158:103209. [PMID: 33388455 DOI: 10.1016/j.critrevonc.2020.103209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/05/2020] [Accepted: 12/20/2020] [Indexed: 11/17/2022] Open
Abstract
Despite optimal first-line treatment based on debulking surgery and platinum-paclitaxel chemotherapy, most of the patients with advanced ovarian cancer (AOC) will eventually relapse. Over the last decades, different strategies have been assessed to improve AOC patients' outcomes in the front-line treatment. However, first line treatment landscape of AOC had not undergone major changes until the last three years. In the present review, we will navigate through the different therapeutic approaches developed in first-line AOC which range from variations in dose/administration via of conventional carboplatin-based chemotherapy to the incorporation of anti-angiogenic agents and PARP inhibitors.
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Affiliation(s)
- J Alejandro Perez-Fidalgo
- Department of Oncology and Hematology, Hospital Clinico Universitario Valencia, INCLIVA, CIBERONC, Spain.
| | - Francisco Grau
- Department of Oncology, Hospital Vall d'Hebron, VHIO, Barcelona, Spain
| | - Lorena Fariñas
- Department of Oncology, Hospital Vall d'Hebron, VHIO, Barcelona, Spain
| | - Ana Oaknin
- Department of Oncology, Hospital Vall d'Hebron, VHIO, Barcelona, Spain
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Al Abdullateef A, Alhareky MS. Awareness among patient at risk of developing Medication Related Osteonecrosis of the Jaw (MRONJ) - A primary prevention strategy. Saudi Pharm J 2020; 28:771-8. [PMID: 32550810 DOI: 10.1016/j.jsps.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022] Open
Abstract
The quality of life, in itself, in cancer patients or in osteoporotic individuals, without even considering the side effects of the medication in the first place, has a considerable negative impact on the clinical outcome. The Medication Related Osteonecrosis of the Jaw (MRONJ), in the maxillofacial region, although rare, needs to be addressed with the prime importance. One of the key components of any given preventive treatment strategy is to, create awareness about the medication related unwanted effects, among health care professionals and patients. Objective This study is aimed to explore and assess the awareness level among dental patients about MRONJ, the risk factors, and the high-risk category (who are prone to develop MRONJ). Material and methods This is a prospective interviewer administered research electronic data capture (REDCap) survey. The sample included 68 patients, who are currently taking or will be taking Bisphosphonate (BP), and/or Denosumab, and anti-Angiogenic agent. Data have been analyzed using IBM SPSS software, Results Sixty-eight patients (18 males and 50 females), participated in this study. Only 23 subjects (33.82%) were aware about the MRONJ. Females were more aware about the complications than males. The awareness among the subjects with education at college level appears to be higher than the subjects having education less than high school level. Even though, a dental check- up, is mandatory, prior to starting these medications, to see if any dental treatment is required, only slightly more than half of the patients (54.72%) had a dental checkup. Conclusion This is a novel study in the Middle- East, used to assess awareness about the MRONJ including three type of related medications. Low awareness of MRONJ is alarming. The results of the study will help to initiate the process of providing the education materials, about the side effects and importance of oral hygiene maintenance, giving priority to improve the quality of life in such patients. Awareness of patients regarding the complications must be an important part of health care practice guidelines.
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Vera R, Mata E, González E, Juez I, Alonso V, Iranzo P, Martínez NP, López C, Cabrera JM, Safont MJ, Ruiz-Casado A, Salgado M, González B, Escudero P, Rivera F, Pericay C. Is aflibercept an optimal treatment for wt RAS mCRC patients after progression to first line containing anti-EGFR? Int J Colorectal Dis 2020; 35:739-46. [PMID: 32062727 DOI: 10.1007/s00384-020-03509-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the efficacy and safety data of aflibercept + FOLFIRI in wt RAS mCRC patients after progression to standard chemotherapy + anti-EGFR treatment. METHODS Retrospective, observational study in real life conducted in wt RAS mCRC patients treated with FOLFIRI-aflibercept after progression to standard first line chemotherapy + anti-EGFR treatment. RESULTS A total of 120 patients from 12 Spanish hospitals were enrolled. Median age is 60 years (62.5%/37.5%male/female). Primary tumor site is 24.1%/75.9% right/left-side colon, and 40.8% of patients had a prior resection. All patients had wild-type RAS tumors including 5% of patients with BRAF mutations and received anti-EGFR treatment. At the time aflibercept was initiated, ECOG PS is 0/1 in 96% of patients. Median number of FOLFIRI-aflibercept cycles is 12. Efficacy results: Overall response rate is 33%; progression-free survival (PFS) is 6.9 months (95%CI: 6.1-7.8). Primary tumor resection was the only significant variable related to PFS in the multivariate analysis. Median overall survival (OS) is 14.5 months (95%CI: 9.7-19.3). ECOG and number of metastatic sites were related to OS in multivariate analysis. About 54.1% of patients received a third-line therapy including TAS-102 (23%), regorafenib (18.5%), and capecitabine (9.2%). TOXICITY Grade 3-4 toxicities were observed in 37.5% of the patients (hematologic 16.6%, hypertension 7.5%, asthenia 5.9%, and perforation 2.5%). Aflibercept dose was reduced in 18.3% of patients. CONCLUSIONS The results show that patients with wt RAS mCRC who received an anti-EGFR as part of the first-line treatment achieved similar RR, PFS, OS, and toxicities to those reported in VELOUR trial. These results suggest that FOLFIRI-aflibercept after first-line treatment with anti-EGFR is an appropriated option for RAS wt mCRC.
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Gutiérrez Zurimendi G, Llarena Ibarguren R, Lecumberri Castaños D, Fernández Pereda R, Urresola Olabarrieta A, García De Casasola-Rodríguez G, Zabala Egurrola JA, Arruza-Echevarría A. [Pancreatic metastasis of primary kidney cancer: A presentation of a serie of clinical cases and revision of the literature.]. ARCH ESP UROL 2020; 73:147-154. [PMID: 32124846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Kidney cancer is around 2-3% of malignant tumours in adults. It has an important tendency to metastasize, being the most affected organs lungs, liver,brain, bone and adrenal glands. The pancreas is a rare site of kidney metastasis, with an incidence of 1-2.8%. The aim of this paper is to analyze the clinical diagnosis, treatment and prognosis of the pancreatic metastasis secondary to kidney cancer. METHOD We present a retrospective descriptive analysis of 6 cases of pancreatic metastasis of primary kidney cancer diagnosed at Cruces University Hospital since 2011.We describe the cases individually also making a global analysis of the pathology and literature review. RESULTS Two of the patients had pancreatic and extrapancreatic metastatic lesions, being treated systemic treatment without adjacent surgery. They showed an overall worse prognosis. The rest of the patients had only pancreatic disease,rational for surgical removal of all masses without need of further adjuvant treatment. The results after surgery were encouraging, with longer overall survival, progression free survival and better quality of life. CONCLUSIONS Pancreatic metastases of kidney cancer are very rare and they can appear several years after nephrectomy. Patients with history of kidney cancer should be followed for long term after surgery. When metastases are limited to the pancreas, radical surgery has longer overall survival, progression free survival and better quality of life outcomes.
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17
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Neuzillet C, de Mestier L, Rousseau B, Mir O, Hebbar M, Kocher HM, Ruszniewski P, Tournigand C. Unravelling the pharmacologic opportunities and future directions for targeted therapies in gastro-intestinal cancers part 2: Neuroendocrine tumours, hepatocellular carcinoma, and gastro-intestinal stromal tumours. Pharmacol Ther 2017; 181:49-75. [PMID: 28723416 DOI: 10.1016/j.pharmthera.2017.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Until the 1990s, cytotoxic chemotherapy has been the cornerstone of medical therapy for gastrointestinal (GI) cancers. Better understanding of the cancer cell molecular biology has led to the therapeutic revolution of targeted therapies, i.e. monoclonal antibodies or small molecule inhibitors directed against proteins that are specifically overexpressed or mutated in cancer cells. These agents, being more specific to cancer cells, were expected to be less toxic than conventional cytotoxic agents. However, their effects have sometimes been disappointing, due to intrinsic or acquired resistance mechanisms, or to an activity restricted to some tumour settings, illustrating the importance of patient selection and early identification of predictive biomarkers of response to these therapies. Targeted agents have provided clinical benefit in many GI cancer types. Particularly, some GI tumours are considered chemoresistant and targeted therapies have offered a new therapeutic base for their management. Hence, somatostatin receptor-directed strategies, sorafenib, and imatinib have revolutioned the management of neuroendocrine tumours (NET), hepatocellular carcinoma (HCC), and gastrointestinal stromal tumours (GIST), respectively, and are now used as first-line treatment in many patients affected by these tumours. However, these agents face problems of resistances and identification of predictive biomarkers from imaging and/or biology. We propose a comprehensive two-part review providing a panoramic approach of the successes and failures of targeted agents in GI cancers to unravel the pharmacologic opportunities and future directions for these agents in GI oncology. In this second part, we will focus on NET, HCC, and GIST, whose treatment relies primarily on targeted therapies.
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Affiliation(s)
- Cindy Neuzillet
- INSERM UMR1149, Beaujon University Hospital (Assistance Publique-Hôpitaux de Paris, AP-HP), Paris 7 Diderot University, 100 Boulevard du Général Leclerc, 92110 Clichy, France; Department of Medical Oncology, Henri Mondor University Hospital (AP-HP), Paris Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; Tumour Biology Laboratory, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom; Barts and The London HPB Centre, The Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom.
| | - Louis de Mestier
- INSERM UMR1149, Beaujon University Hospital (Assistance Publique-Hôpitaux de Paris, AP-HP), Paris 7 Diderot University, 100 Boulevard du Général Leclerc, 92110 Clichy, France; Department of Gastroenterology and Pancreatology, Beaujon University Hospital (AP-HP), Paris 7 Diderot University, 100 Boulevard du Général Leclerc, 92110 Clichy, France
| | - Benoît Rousseau
- Department of Medical Oncology, Henri Mondor University Hospital (AP-HP), Paris Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; Institut Mondor de Recherche Biomédicale, INSERM UMR955 Team 18, Paris Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Olivier Mir
- Department of Cancer Medicine - Sarcoma Group, Department of Early Drug Development (DITEP) - Phase 1 Unit, Gustave Roussy Cancer Campus, University of Paris Sud, 114, Rue Edouard Vaillant, 94800 Villejuif, France
| | - Mohamed Hebbar
- Department of Medical Oncology, Lille University Hospital, 1, Rue Polonovski, 59037 Lille, France
| | - Hemant M Kocher
- Tumour Biology Laboratory, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom; Barts and The London HPB Centre, The Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom
| | - Philippe Ruszniewski
- INSERM UMR1149, Beaujon University Hospital (Assistance Publique-Hôpitaux de Paris, AP-HP), Paris 7 Diderot University, 100 Boulevard du Général Leclerc, 92110 Clichy, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor University Hospital (AP-HP), Paris Est Créteil University (UPEC), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Lebellec L, Chauffert B, Blay JY, Le Cesne A, Chevreau C, Bompas E, Bertucci F, Cupissol D, Fabbro M, Saada-Bouzid E, Duffaud F, Feuvret L, Bonneville-Levard A, Bay JO, Vauleon E, Vinceneux A, Noel G, Penel N, Mir O. Advanced chordoma treated by first-line molecular targeted therapies: Outcomes and prognostic factors. A retrospective study of the French Sarcoma Group (GSF/GETO) and the Association des Neuro-Oncologues d'Expression Française (ANOCEF). Eur J Cancer 2017; 79:119-28. [PMID: 28478340 DOI: 10.1016/j.ejca.2017.03.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND To assess the role of first-line Molecular Targeted Therapies (MTTs) in Advanced chordoma (AC) patients. METHODS Retrospective study of 80 patients treated between January 2004 and December 2015 at 15 major French Sarcoma or Neurooncology Centres. RESULTS The sex ratio M/F was 46/34. The median age was 59 (6-86) years. The primary sites were the sacrum (50, 62.5%), mobile spine (12, 15.0%), and skull base (18, 22.5%). Metastases were present in 28 patients (36.0%). The first line of MTTs consisted of imatinib (62, 77.5%), sorafenib (11, 13.7%), erlotinib (5, 6.3%), sunitinib (1, 1.2%) and temsirolimus (1, 1.2%). The reported responses were: partial response (5, 6.3%), stable disease (58, 72.5%), or progressive disease (10, 12.5%). Symptomatic improvement was seen in 28/66 assessable patients (42.4%) and was associated with an objective response occurrence (p = 0.005), imatinib (p = 0.020) or erlotinib use (p = 0.028). The median progression-free survival (PFS) was 9.4°months (95% CI, [6.8-16.1]). Two independent factors of poor prognosis for PFS were identified: a skull-based primary location (HR = 2.5, p = 0.019), and the interval between diagnosis and MTT of <52months (HR = 2.8, p < 0.001). The median overall survival (OS) was 4.4°years (95% CI, [3.8-5.6]). Four independent factors of poor prognosis for OS were identified: the presence of liver metastases (HR = 13.2, p < 0.001), pain requiring opioids (HR = 2.9, p = 0.012), skull-based primary location (HR = 19.7, p < 0.001), and prior radiotherapy (photon alone) (HR = 2.5, p = 0.024). The PFS and OS did not significantly differ between the MTT. CONCLUSIONS The prognostic factors identified require validation in an independent database but are potently useful to guide treatment decisions and design further clinical trials.
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Gallego-Pinazo R, Monje-Fernández L, García-Marín N, Andreu-Fenoll M, Dolz-Marco R. Implications of the anatomical classification of the neovascular form of age-related macular degeneration. Arch Soc Esp Oftalmol 2017; 92:71-77. [PMID: 27378456 DOI: 10.1016/j.oftal.2016.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 05/09/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To present the clinical relevance of the anatomical classification of the neovascular form of Age-Related Macular Degeneration (AMD). METHODS Critical analysis of the current situation in the management of patients with neovascular AMD, by reviewing the available scientific evidence with regards to the classification of the types of neovascular lesion by angiography and optical coherence tomography (OCT). RESULTS The classification of the neovascular lesion type secondary to AMD by OCT in type 1 lesions (under the pigment epithelium), type 2 (subretinal), and type 3 (retinal angiomatous proliferation), provides an added value in allowing to establish a long-term visual prognosis, an estimate of the number of treatments that a certain case may require, and a stratification of the risk for secondary geographic atrophy. CONCLUSIONS Incorporating OCT to the initial qualitative analysis of cases with neovascular AMD offers an added value superior to that provided by the angiography, with the relevant clinical implications.
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Affiliation(s)
- R Gallego-Pinazo
- Unidad de Mácula, Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España; Red Temática de Investigación Cooperativa OFTARED, Instituto de Salud Carlos III, Madrid, España.
| | - L Monje-Fernández
- Servicio de Oftalmología, Complejo Universitario Hospitalario de León, León, España
| | - N García-Marín
- Unidad de Mácula, Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España; Red Temática de Investigación Cooperativa OFTARED, Instituto de Salud Carlos III, Madrid, España
| | - M Andreu-Fenoll
- Unidad de Mácula, Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España; Red Temática de Investigación Cooperativa OFTARED, Instituto de Salud Carlos III, Madrid, España
| | - R Dolz-Marco
- Unidad de Mácula, Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España; Red Temática de Investigación Cooperativa OFTARED, Instituto de Salud Carlos III, Madrid, España
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Quintela-Fandino M. Normoxic or hypoxic adaptation in response to antiangiogenic therapy: Clinical implications. Mol Cell Oncol 2016; 3:e1217368. [PMID: 27857979 DOI: 10.1080/23723556.2016.1217368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/08/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
In a recent article in Cell Reports, we described a novel mechanism for acquired resistance against new small-molecule antiangiogenic tyrosine-kinase inhibitors (TKIs). Vascular normalization-inducing TKIs block glycolysis and trigger a nutritional stress response in the tumor compartment that induces a (targetable) switch to mitochondrial metabolism. We discuss the implications for clinical/translational studies and suggest areas for future research.
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Affiliation(s)
- M Quintela-Fandino
- Breast Cancer Clinical Research Unit, CNIO - Spanish National Cancer Research Center , Madrid, Spain
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21
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Marret G, Neuzillet C, Rousseau B, Tournigand C. [Medical management of cholangiocarcinomas in 2015]. Bull Cancer 2016; 103:389-99. [PMID: 26922666 DOI: 10.1016/j.bulcan.2016.01.019] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 12/21/2022]
Abstract
Cholangiocarcinoma is a rare malignancy carrying a poor prognosis. Most patients are diagnosed with advanced-stage disease and are then ineligible for surgical resection, which is the only potentially curative therapeutic modality. The aim of this article is to provide an up-to-date review of medical management of patients with cholangiocarcinoma. The benefit of adjuvant therapy in patients undergoing curative-intent surgery is under evaluation. Combination chemotherapy with gemcitabine and platinum is the standard first-line treatment for patients with advanced cholangiocarcinoma. Targeted agents are not currently recommended due to limited data on use in this setting. The role of second-line chemotherapy is not established in advanced cholangiocarcinoma. Identification of predictive and prognostic markers to select patients who could benefit from second-line therapy is a major issue. A better understanding of the biological and molecular mechanisms underlying the carcinogenesis and the phenotypic heterogeneity of cholangiocarcinoma may path the way of new therapeutic strategies.
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Affiliation(s)
- Grégoire Marret
- Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Est Créteil (UPEC), hôpital Henri-Mondor, service d'oncologie médicale, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Cindy Neuzillet
- Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Est Créteil (UPEC), hôpital Henri-Mondor, service d'oncologie médicale, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France.
| | - Benoît Rousseau
- Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Est Créteil (UPEC), hôpital Henri-Mondor, service d'oncologie médicale, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
| | - Christophe Tournigand
- Assistance publique-Hôpitaux de Paris (AP-HP), université Paris Est Créteil (UPEC), hôpital Henri-Mondor, service d'oncologie médicale, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil, France
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Hernández-Agudo E, Mondejar T, Soto-Montenegro ML, Megías D, Mouron S, Sanchez J, Hidalgo M, Lopez-Casas PP, Mulero F, Desco M, Quintela-Fandino M. Monitoring vascular normalization induced by antiangiogenic treatment with (18)F-fluoromisonidazole-PET. Mol Oncol 2015; 10:704-18. [PMID: 26778791 PMCID: PMC5423153 DOI: 10.1016/j.molonc.2015.12.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 10/13/2015] [Revised: 11/24/2015] [Accepted: 12/10/2015] [Indexed: 01/07/2023] Open
Abstract
Background: Rationalization of antiangiogenics requires biomarkers. Vascular re‐normalization is one widely accepted mechanism of action for this drug class. The interstitium of tumors with abnormal vasculature is hypoxic. We sought to track vascular normalization with 18F‐misonidazole ([18F]‐FMISO, a probe that detects hypoxia) PET, in response to window‐of‐opportunity (WoO) treatment with the antiangiogenic dovitinib. Methods: Two patient‐derived pancreas xenografts (PDXs; Panc215 and Panc286) and the spontaneous breast cancer model MMTV‐PyMT were used. Animals were treated during 1 week of WoO treatment with vehicle or dovitinib, preceded and followed by [18F]‐FMISO‐PET, [18F]‐FDG‐PET, and histologic assessment (dextran extravasation, hypoxia and microvessel staining, and necrosis, cleaved caspase‐3 and Ki67 measurements). After WoO treatment, gemcitabine (pancreas)/adriamycin (breast) or vehicle was added and animals were treated until the humane endpoint. Tumor growth inhibition (TGI) and survival were the parameters studied. Results: [18F]‐FMISO SUV did not change after dovitinib‐WoO treatment compared to vehicle‐WoO (0.54 vs. 0.6) treatment in Panc215, but it decreased significantly in Panc286 (0.58 vs. 1.18; P < 0.05). In parallel, 10‐KDa perivascular dextran extravasation was not reduced with dovitinib or vehicle‐WoO treatment in Panc215, but it was reduced in Panc286. Whereas the addition of dovitinib to gemcitabine was indifferent in Panc215, it increased TGI in Panc286 (TGI switched from −59% to +49%). [18F]‐FMISO SUV changes were accompanied by an almost 100% increase in interstitial gemcitabine delivery (665–1260 ng/mL). The results were validated in the PyMT model. Conclusions: [18F]‐FMISO accurately monitored vascular re‐normalization and improved interstitial chemotherapy delivery. We describe a new technique to monitor the efficacy of antiangiogenics. This drug class currently lacks biomarkers. Antiangiogenics exert their positive effect by inducing stromal normalization. 18F‐fluoromisonidazole PET is able to monitor stromal normalization. Tumors showing stromal normalization by PET experience benefit from antiangiogenics.
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Affiliation(s)
- Elena Hernández-Agudo
- Breast Cancer Clinical Research Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain
| | - Tamara Mondejar
- Breast Cancer Clinical Research Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain
| | - Maria Luisa Soto-Montenegro
- Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañon, Doctor Esquerdo, 46, Madrid, 28007, Spain; CIBER de Salud Mental, Monforte de Lemos 3-5, Pabellón 11, Madrid, 28029, Spain
| | - Diego Megías
- Confocal Microscopy Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain
| | - Silvana Mouron
- Breast Cancer Clinical Research Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain
| | - Jesus Sanchez
- Breast Cancer Clinical Research Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain
| | - Manuel Hidalgo
- Gastrointestinal Cancer Clinical Research Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain
| | - Pedro Pablo Lopez-Casas
- Gastrointestinal Cancer Clinical Research Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain
| | - Francisca Mulero
- Molecular Imaging Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain
| | - Manuel Desco
- Unidad de Medicina y Cirugía Experimental, Instituto de Investigación Sanitaria Gregorio Marañon, Doctor Esquerdo, 46, Madrid, 28007, Spain; CIBER de Salud Mental, Monforte de Lemos 3-5, Pabellón 11, Madrid, 28029, Spain; Aerospace Engineering and Bioengineering Department, Universidad Carlos III, Avenida de la Universidad, 30. Leganés, Madrid, 28911, Spain
| | - Miguel Quintela-Fandino
- Breast Cancer Clinical Research Unit, CNIO - Spanish National Cancer Research Center, Melchor Fernandez Almagro, 3, Madrid, 28029, Spain.
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Abstract
Inhibition of vascular endothelial growth factor (VEGF) signaling, an initiator of tumor angiogenesis, inhibits tumor growth and invasion. Bevacizumab, a monoclonal antibody to VEGF, in common use as an adjunct to standard chemotherapy like irinotecan in advanced colorectal cancer, also affects the normal (nontumor) vasculature. Dysphonia or voice changes have been anecdotally reported in patients that have been exposed to antiangiogenics. In this case report, we present an occurrence of severe dysphonia in a 60-year-old male with metastatic colorectal cancer after reintroduction of irinotecan and bevacizumab. To our knowledge, this is the first case of dysphonia associated with bevacizumab rechallenge.
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Affiliation(s)
- Corey A Carter
- Walter Reed National Military Medical Center, Bethesda, Md., USA
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Garcia-Donas J, Rodriguez-Moreno JF, Romero-Laorden N, Rodriguez-Antona C. Renal carcinoma pharmacogenomics and predictors of response: Steps toward treatment individualization. Urol Oncol 2015; 33:179-86. [PMID: 24495452 DOI: 10.1016/j.urolonc.2013.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 09/10/2013] [Accepted: 09/13/2013] [Indexed: 02/07/2023]
Abstract
Molecular knowledge has deeply affected the treatment and outcome of kidney cancer in recent years, and several therapeutic options have become available. However, there are no validated biomarkers to select the best drug for each patient. Already published studies and ongoing investigations could change this scenario in the near future. Regarding antiangiogenic drugs, several works on single nucleotide polymorphisms have achieved promising results, with some SNPs predicting resistance to sunitinib and pazopanib being validated. If more evidence is gained, it could prompt prospective studies exploring a molecularly driven selection of treatment. Another relevant line of investigation for antiangiogenic drugs is the cytokines and antiangiogenic factors. Different studies have found that cytokines and antiangiogenic factors are able to predict the outcome of patients treated with sunitinib, pazopanib, or sorafenib. Issues regarding the thresholds of normality and the best time for assessment are pending, but the communicated results are encouraging. Less evidence is available for mammalian target of rapamycin inhibitors but recent data support a key role of the phosphoinositide 3-kinase/Akt pathway in clear cell renal cell carcinoma and points toward poor response to angiogenic drugs when the pathway is activated. Whether modern phosphoinositide 3-kinase inhibitors could be the best option for these patients is a question that should be addressed. Additionally, a new class of immunomodulators, like anti-programmed death 1 drugs, has demonstrated to achieve long-lasting stabilizations even in some patients with no radiological response or early progression. This is a singular situation where the identification of reliable predictors of efficacy will be key in the development of these drugs in renal cell carcinoma. Finally, germline mutations of the c-Met gene have been proposed as the first predictor of response to targeted therapies in papillary renal cell carcinoma. As a conclusion, translational research will be a cornerstone to move a next step forward in kidney cancer.
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Lee SM, Hackshaw A. A potential new enriching trial design for selecting non-small-cell lung cancer patients with no predictive biomarker for trials based on both histology and early tumor response: further analysis of a thalidomide trial. Cancer Med 2013; 2:360-6. [PMID: 23930213 PMCID: PMC3699848 DOI: 10.1002/cam4.74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/01/2013] [Accepted: 03/03/2013] [Indexed: 12/19/2022] Open
Abstract
There are few predictive biomarkers for antiangiogenic trials in lung cancer. We examine a potential treatment strategy in which a patient group is enriched using both histology and an early assessment of response during standard chemotherapy, and where a new agent is given for the remainder of chemotherapy and as maintenance. We performed a retrospective analysis of 722 stage IIIB/IV non-small-cell lung cancer patients from a double-blind placebo-controlled trial of thalidomide or placebo 100–200 mg/day, combined with gemcitabine/carboplatin (for up to four cycles), then given as single agent maintenance therapy. There was a significant statistical interaction between treatment and histology, with a possible benefit among squamous cell cancer (SCC) patients. We examined 150 SCC patients who were “nonprogressors” (stable disease or complete/partial response) after completing the second chemotherapy cycle. Endpoints were progression-free survival (PFS) and overall survival (OS). Among the 150 patients nonprogressors after cycle 2 (thalidomide, n = 72; placebo, n = 78; baseline characteristics were similar), the hazard ratios (HRs) were: OS = 0.76 (95% CI: 0.54–1.07) and PFS = 0.69 (95% CI: 0.50–0.97). In 57 patients who had a complete/partial response, the HRs were: OS = 0.63 (95% CI: 0.34–1.15) and PFS = 0.50 (95% CI: 0.28–0.88). SCC patients who were nonprogressors after 2 cycles of standard chemotherapy showed evidence of a benefit from thalidomide when taken for the remainder of chemotherapy and as maintenance. This strategy based on histology and, importantly, early assessment of tumor response, as a means of patient enrichment, could be examined in other lung cancer studies. Such an approach might be suitable for trials where there are no predictive biomarkers.
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Affiliation(s)
- Siow Ming Lee
- Department of Oncology, University College London (UCL) Hospitals and UCL Cancer Institute, 250 Euston Road, London, NW1 2PG, United Kingdom.
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Colombres GA, Gramajo AL, Arrambide MP, Juarez SM, Arevalo JF, Bar J, Juarez CP, Luna JD. Delayed corneal epithelial healing after intravitreal bevacizumab: a clinical and experimental study. J Ophthalmic Vis Res 2011; 6:18-25. [PMID: 22454702 PMCID: PMC3306063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 10/27/2010] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To report corneal epithelial defects (CEDs) and delayed epithelial healing after intravitreal bevacizumab (IVB) injection and to describe delayed corneal epithelial healing with topical administration of bevacizumab in an experimental rabbit model. METHODS A retrospective chart review was performed on 850 eyes of 850 patients with neovascular eye disease and diabetic macular edema who had received 1.25 to 2.5 mg IVB. In the experimental arm of the study, photorefractive keratectomy was used to create a 3 mm CED in the right eyes of 18 New Zealand rabbits which were then randomized to three equal groups. All rabbits received topical antibiotics, additionally those in group A received topical bevacizumab and animals in group B were treated with topical corticosteroids. The rate of epithelial healing was assessed at different time points using slitlamp photography. RESULTS In the clinical study, seven eyes of seven subjects developed CEDs the day after IVB injection. All of these eyes had preexisting corneal edema. The healing period ranged from 3 to 38 days (average 11 days) despite appropriate medical management. In the experimental study, topical bevacizumab and corticosteroids both significantly hindered corneal epithelial healing at 12 and 24 hours. CONCLUSION Bevacizumab was demonstrated to cause CEDs in clinical settings. Moreover, corneal epithelial healing was delayed by topical application of bevacizumab, in the experimental model. These short-term results suggest that corneal edema may be considered as a risk factor for epithelial defects after IVB.
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Affiliation(s)
| | - Ana L Gramajo
- Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina
| | | | - Silvina M Juarez
- Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina
| | | | - Jorge Bar
- Departamento de Oftalmología, Hospital Nacional de Clínicas, Buenos Aires, Argentina
| | - Claudio P Juarez
- Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina
| | - Jose D Luna
- Centro Privado de Ojos Romagosa-Fundación VER, Córdoba, Argentina,Correspondence to: José D Luna, MD. Departamento de Oftalmología, Centro Privado de Ojos Romagosa-Fundacion VER, Deán Funes 432, (5000) Córdoba, Argentina; Tel: +54 351 4211334, Fax: +54 351 4234848; e-mail:
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