Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Dec 18, 2016
Oxaliplatin and paclitaxel are commonly used chemotherapies associated with acute and chronic neu... more Oxaliplatin and paclitaxel are commonly used chemotherapies associated with acute and chronic neuropathies. There is a need to better understand the similarities and differences of these clinical syndromes. Neuropathy data were pooled from patients receiving adjuvant oxaliplatin and weekly paclitaxel or every 3 weeks of paclitaxel. Patients completed daily questionnaires after each chemotherapy dose and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire for patients with chemotherapy-induced peripheral neuropathy before each chemotherapy cycle and for 12 months post-treatment. Acute neuropathy symptoms from both drugs peaked around day 3. Acute symptoms experienced in cycle 1 predicted occurrence in subsequent cycles. Paclitaxel-induced acute symptoms were similar in intensity in each cycle and largely resolved between cycles. Oxaliplatin-induced acute symptoms were about half as severe in the first cycle as in later cycles and did not resol...
Journal of cancer research and clinical oncology, 2018
The old approach of one therapeutic for all patients with mCRC is evolving with a need to target ... more The old approach of one therapeutic for all patients with mCRC is evolving with a need to target specific molecular aberrations or cell-signalling pathways. Molecular screening approaches and new biomarkers are required to fully characterize tumours, identify patients most likely to benefit, and predict treatment response. MODUL is a signal-seeking trial with a design that is highly adaptable, permitting modification of different treatment cohorts and inclusion of further additional cohorts based on novel evidence on new compounds/combinations that emerge during the study. MODUL is ongoing and its adaptable nature permits timely and efficient recruitment of patients into the most appropriate cohort. Recruitment will take place over approximately 5 years in Europe, Asia, Africa, and South America. The design of MODUL with ongoing parallel/sequential treatment cohorts means that the overall size and duration of the trial can be modified/prolonged based on accumulation of new data. The...
ABSTRACT Das colorectale Carcinom ist mit 678.000 Neuerkrankungen und 394.000 Sterbefällen pro Ja... more ABSTRACT Das colorectale Carcinom ist mit 678.000 Neuerkrankungen und 394.000 Sterbefällen pro Jahr die vierthäufigste Krebserkrankung weltweit. In Westeuropa, Nordamerika und Australien ist die Inzidenz am höchsten, in Nordafrika am niedrigsten (Boyle 1998). Die Heilungsrate beträgt über alle Stadien etwa 50% in Deutschland (Schmoll 1997). Die individuelle Prognose der betroffenen Patienten wird von einer Reihe Faktoren beeinflußt, die bereits bei der Erstdiagnose nachweisbar sind. Dazu gehören unter anderem Alter, Geschlecht, Allgemeinzustand, Tumorlokalisation, Dauer der tumorinduzierten Symptome und Qualität der chirurgischen Intervention. Weitere Faktoren sind Gefäß- und Lymphbahninfiltration, Tumorzellploidie, Differenzierungsgrad und präoperativer CEA-Serumspiegel. Der zur Zeit etablierteste und somit am häufigsten für Therapieentscheidungen verwendete Marker ist der Lymphknotenstatus im Tumorresektat. Der Lymphknotenstatus ist die Grundlage aller Stagingsysteme und gilt derzeit als der beste einzelne prognostische Marker bei dieser Erkrankung. Heute basieren alle Therapieempfehlungen auf dem Stagingsystem der UICC auf Basis der TNM-Klassifikation. Eine Differenzierung zwischen einzelnen Risikogruppen kann mit diesem Instrument allerdings nur sehr grob getroffen werden. Analysiert man retrospektiv große Studien zur adjuvanten Therapie, findet man immer Patientengruppen, die keine adjuvante Behandlung benötigt hätten, während andere Subgruppen nicht ausreichend behandelt waren. Die Entwicklung neuer prognostischer Marker und ihre Einführung in die klinische Routine ist deshalb sehr wichtig, um weitere Diskriminationsinstrumente zur Verfügung zu haben.
Cisplatin is one of the most active and widely used anticancer drugs; however, its clinical effic... more Cisplatin is one of the most active and widely used anticancer drugs; however, its clinical efficiacy is often limited by the development of resistance. Since several studies indicated that ras oncogenes may modulate the cellular response to cisplatin or radiation, we investigated the gene-specific repair of the N-ras gene in the human K 562 cell line after exposure to cisplatin using a novel nonradioactive polymerase chain reaction inhibition assay. This assay is based on the fact that DNA lesions can block the Taq polymerase and thereby result in a decreased amplification of a damaged segment compared to the amplification of the same segment in a non-damaged template. The overall genomic repair rate was measured by atomic absorption spectroscopy. Immediately after cisplatin exposure no amplification segment was observed. However, a complete restoration of the N-ras gene (2.4 kb) was seen after 8 h posttreatment incubation. In contrast, only 60% of the overall genome was repaired at this time. Our results clearly indicate that cisplatin-induced DNA lesions are more efficiently removed from transcribed regions within the DNA, suggesting that the efficiency of DNA repair in a given gene may be correlated to its transcriptional activity. Since ras oncogenes control several cellular signal transduction pathways, known to be involved in DNA damage response, preferential repair of the N-ras gene could therefore be an important step to prevent inactivation of cellular defense mechanisms after exposure to genotoxic agents.
Background The purpose of this study was to define survival rates in patients with isolated advan... more Background The purpose of this study was to define survival rates in patients with isolated advanced abdominal nodal metastases secondary to colorectal cancer (CRC), treated with curative-intent trimodality therapy. Materials and Methods Sixty-five patients received trimodality therapy, defined as chemotherapy delivered with external beam radiotherapy (EBRT) followed by lymphadenectomy and intraoperative radiotherapy (IORT). Infusional 5-fluorouracil was the most common radiosensitizer used (63%, 41 patients). The median dose of EBRT was 50 Gy, and the median dose of IORT was 12.5 Gy. We evaluated time to distant metastasis, toxicities, local failure within the EBRT field, recurrence within the IORT field, and survival. Results Fifty-two percent of patients were male; patients’ median age was 50.5 years. All patients had an Eastern Cooperative Oncology Group score ≤1. Twenty-nine patients had right-sided colon cancer, 22 had left-sided colon cancer, and 14 had rectal primaries. The ...
In the phase III CORRECT trial, regorafenib significantly improved survival in treatment-refracto... more In the phase III CORRECT trial, regorafenib significantly improved survival in treatment-refractory metastatic colorectal cancer (mCRC). The CONSIGN study was designed to further characterize regorafenib safety and allow patients access to regorafenib before market authorization. This prospective, single-arm study enrolled patients in 25 countries at 186 sites. Patients with treatment-refractory mCRC and an Eastern Cooperative Oncology Group performance status (ECOG PS) ≤1 received regorafenib 160 mg once daily for the first 3 weeks of each 4-week cycle. The primary endpoint was safety. Progression-free survival (PFS) per investigator assessment was the only efficacy evaluation. In total, 2,872 patients were assigned to treatment and 2,864 were treated. Median age was 62 years, ECOG PS 0/1 was 47%/53%, and 74% had received at least three prior regimens for metastatic disease. Median treatment duration was three cycles. Treatment-emergent adverse events (TEAEs) led to dose reduction ...
European journal of cancer (Oxford, England : 1990), Jan 27, 2018
Patients with left-sided colon tumours have better survival and respond differently to biologics ... more Patients with left-sided colon tumours have better survival and respond differently to biologics compared with patients with right-sided tumours. Left-sided colon tumours and rectal cancers are often grouped together. Herein, we examined the clinicopathological differences and outcomes between left-sided colon and rectal cancers. Data from 2879 metastatic colorectal cancer patients enrolled on six first-line clinical trials during 2004-2010 were pooled. Patients were included if the primary tumour origin was clearly defined. Progression-free survival (PFS) and overall survival (OS) were compared in the two groups after adjusting for patient and tumour characteristics, metastatic sites and the first-line regimen. In total, 1374 patients with metastatic left-sided colon cancer and 1505 patients with metastatic rectal cancers were evaluated. Left-sided colon cancer patients were more likely to be female (40.1% versus 32.6%; P < 0.0001) and older (31.0% ≥ 70 years versus 25.8%; P = 0...
European journal of cancer (Oxford, England : 1990), Jan 21, 2018
Patient characteristics and stratification factors are key features influencing trial outcomes. H... more Patient characteristics and stratification factors are key features influencing trial outcomes. However, there is substantial heterogeneity in reporting of patient characteristics and use of stratification factors in phase 3 trials investigating systemic treatment of metastatic colorectal cancer (mCRC). We aimed to develop a minimum set of essential baseline characteristics and stratification factors to include in such trials. We performed a modified, two-round Delphi survey among international experts with wide experience in the conduct and methodology of phase 3 trials of systemic treatment of mCRC. Thirty mCRC experts from 15 different countries completed both consensus rounds. A total of 14 patient characteristics were included in the recommended set: age, performance status, primary tumour location, primary tumour resection, prior chemotherapy, number of metastatic sites, liver-only disease, liver involvement, surgical resection of metastases, synchronous versus metachronous me...
In the RAISE trial, ramucirumab+leucovorin/fluorouracil/irinotecan (FOLFIRI) improved the median ... more In the RAISE trial, ramucirumab+leucovorin/fluorouracil/irinotecan (FOLFIRI) improved the median overall survival (mOS) of patients with previously treated metastatic colorectal cancer versus patients treated with placebo+FOLFIRI but had a higher incidence of neutropaenia, leading to more chemotherapy dose modifications and discontinuations. Thus, we conducted an exploratory post-hoc analysis of RAISE and a retrospective, observational analysis of electronic medical record (EMR) data to determine and verify the association of neutropaenia, baseline absolute neutrophil count (ANC) and survival. The RAISE analysis used the study safety population (n=1057). IMS Health Oncology Database (IMS EMR) was the source for the real-world data set (n=617). RAISE patients with treatment-emergent neutropaenia had improved mOS compared with those without (ramucirumab arm: 16.1 vs 10.7 months, HR=0.57, p<0.0001; placebo arm: 12.7 vs 10.7 months, HR=0.76, p=0.0065). RAISE patients with low ANC ver...
The efficacy of immunotherapy varies widely among different gastrointestinal cancers. Response to... more The efficacy of immunotherapy varies widely among different gastrointestinal cancers. Response to immune checkpoint inhibitors is shown to correlate with tumor mutation load (TML), mismatch repair deficiency (dMMR) status, and programmed cell death-ligand 1 (PD-L1) expression. Herein, we quantify TML, dMMR, and PD-L1 expression and determine their interrelationship in gastrointestinal cancers. Here, a total of 4125 tumors from 14 different gastrointestinal cancer sites were studied using validated assays. Next-generation sequencing (NGS) was performed on genomic DNA isolated from formalin-fixed paraffin-embedded (FFPE) tumor specimens using the NextSeq platform. TML was calculated using only somatic nonsynonymous missense mutations sequenced with a 592-gene panel. Microsatellite instability (MSI) was assessed using direct analysis of altered known MSI loci in the target regions of the sequenced genes. PD-L1 expression was analyzed by immunohistochemistry (IHC). Interestingly, right-...
Background BRAF V600E mutations are present in 8%–10% of patients with metastatic colorectal canc... more Background BRAF V600E mutations are present in 8%–10% of patients with metastatic colorectal cancer (mCRC) and portend poor prognosis. This study investigated the impact of metastasectomy for patients with BRAF V600E mCRC. Subjects, Materials, and Methods Using prospective clinical and molecular data, patients with BRAF V600E mCRC were analyzed for clinical characteristics and survival. Statistical analyses utilized the Kaplan-Meier method, log-rank test, and Cox proportional hazard models. Results Fifty-two patients were identified between July 1, 2008, and January 4, 2016. Patient characteristics included median age 65 years, 61% female, Eastern Cooperative Oncology Group performance status ≤1, 71% with right-sided tumors, and 28% with liver-limited metastasis. In the first-line setting, 7% (4/52) received fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI)/bevacizumab (BEV) and 81% were treated with doublet chemotherapy consisting of fluoropyrimidine, oxaliplatin, a...
Patients with relapsed aggressive non-Hodgkin lymphoma (NHL) are often treated with platinum-base... more Patients with relapsed aggressive non-Hodgkin lymphoma (NHL) are often treated with platinum-based chemoimmunotherapy regimens in preparation for autologous stem cell transplant. We sought to reduce toxicity and maintain efficacy by using oxaliplatin with rituximab, cytarabine and dexamethasone (ROAD) in a phase II clinical trial in patients who had relapsed after one prior regimen. ROAD was delivered q21 days and consisted of rituximab 375 mg/m2 IV weekly x 4 doses (cycle 1 only); dexamethasone 40 mg PO/IV d2 - 5; oxaliplatin 130 mg/m2 IV d2; cytarabine 2000 mg/m2 IV x two doses on days 2 - 3; and pegfilgrastim 6 mg SC on d4. Forty-five eligible patients were accrued between 2006- 2008. Patient characteristics were a median age of 69 years; 96% had received prior rituximab; 53% were within one year of diagnosis. The median number of cycles received was 2 (range, 1-6). Forty-four % received ROAD as an outpatient. The overall response rate was 71% with 27% (12/45) CR and 44% (20/45) ...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 9, 2017
Purpose Molecular diagnostic testing has become an integral part of the evaluation of patients wi... more Purpose Molecular diagnostic testing has become an integral part of the evaluation of patients with metastatic colorectal cancer (CRC). Expanded mutational testing, such as next-generation sequencing (NGS), often identifies mutations with unclear clinical or prognostic implications. One such example is BRAF mutations that occur outside of codon 600 ((non-V600) BRAF mutations). Methods We conducted this multicenter, retrospective cohort study to characterize the clinical, pathologic, and survival implications of (non-V600) BRAF mutations in metastatic CRC. We pooled patients in whom (non-V600) BRAF mutations were identified from NGS databases at three large molecular genetics reference laboratories. Results A total of 9,643 patients with metastatic CRC underwent NGS testing. We identified 208 patients with (non-V600) BRAF mutations, which occurred in 2.2% of all patients tested and accounted for 22% of all BRAF mutations identified. Cancers with (non-V600) BRAF mutations, compared wi...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 17, 2017
Purpose Factors contributing to early mortality after initiation of treatment of metastatic color... more Purpose Factors contributing to early mortality after initiation of treatment of metastatic colorectal cancer are poorly understood. Materials and Methods Data from 22,654 patients enrolled in 28 randomized phase III trials contained in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were pooled. Multivariable logistic regression models for 30-, 60-, and 90-day mortality were constructed, including clinically and statistically significant patient and disease factors and interaction terms. A calculator (nomogram) for 90-day mortality was developed and validated internally using bootstrapping methods and externally using a 10% random holdout sample from each trial. The impact of early progression on the likelihood of survival to 90 days was examined with time-dependent Cox proportional hazards models. Results Mortality rates were 1.4% at 30 days, 3.4% at 60 days, and 5.5% at 90 days. Among baseline factors, advanced age, lower body mass index, poorer performance statu...
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, Dec 18, 2016
Oxaliplatin and paclitaxel are commonly used chemotherapies associated with acute and chronic neu... more Oxaliplatin and paclitaxel are commonly used chemotherapies associated with acute and chronic neuropathies. There is a need to better understand the similarities and differences of these clinical syndromes. Neuropathy data were pooled from patients receiving adjuvant oxaliplatin and weekly paclitaxel or every 3 weeks of paclitaxel. Patients completed daily questionnaires after each chemotherapy dose and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire for patients with chemotherapy-induced peripheral neuropathy before each chemotherapy cycle and for 12 months post-treatment. Acute neuropathy symptoms from both drugs peaked around day 3. Acute symptoms experienced in cycle 1 predicted occurrence in subsequent cycles. Paclitaxel-induced acute symptoms were similar in intensity in each cycle and largely resolved between cycles. Oxaliplatin-induced acute symptoms were about half as severe in the first cycle as in later cycles and did not resol...
Journal of cancer research and clinical oncology, 2018
The old approach of one therapeutic for all patients with mCRC is evolving with a need to target ... more The old approach of one therapeutic for all patients with mCRC is evolving with a need to target specific molecular aberrations or cell-signalling pathways. Molecular screening approaches and new biomarkers are required to fully characterize tumours, identify patients most likely to benefit, and predict treatment response. MODUL is a signal-seeking trial with a design that is highly adaptable, permitting modification of different treatment cohorts and inclusion of further additional cohorts based on novel evidence on new compounds/combinations that emerge during the study. MODUL is ongoing and its adaptable nature permits timely and efficient recruitment of patients into the most appropriate cohort. Recruitment will take place over approximately 5 years in Europe, Asia, Africa, and South America. The design of MODUL with ongoing parallel/sequential treatment cohorts means that the overall size and duration of the trial can be modified/prolonged based on accumulation of new data. The...
ABSTRACT Das colorectale Carcinom ist mit 678.000 Neuerkrankungen und 394.000 Sterbefällen pro Ja... more ABSTRACT Das colorectale Carcinom ist mit 678.000 Neuerkrankungen und 394.000 Sterbefällen pro Jahr die vierthäufigste Krebserkrankung weltweit. In Westeuropa, Nordamerika und Australien ist die Inzidenz am höchsten, in Nordafrika am niedrigsten (Boyle 1998). Die Heilungsrate beträgt über alle Stadien etwa 50% in Deutschland (Schmoll 1997). Die individuelle Prognose der betroffenen Patienten wird von einer Reihe Faktoren beeinflußt, die bereits bei der Erstdiagnose nachweisbar sind. Dazu gehören unter anderem Alter, Geschlecht, Allgemeinzustand, Tumorlokalisation, Dauer der tumorinduzierten Symptome und Qualität der chirurgischen Intervention. Weitere Faktoren sind Gefäß- und Lymphbahninfiltration, Tumorzellploidie, Differenzierungsgrad und präoperativer CEA-Serumspiegel. Der zur Zeit etablierteste und somit am häufigsten für Therapieentscheidungen verwendete Marker ist der Lymphknotenstatus im Tumorresektat. Der Lymphknotenstatus ist die Grundlage aller Stagingsysteme und gilt derzeit als der beste einzelne prognostische Marker bei dieser Erkrankung. Heute basieren alle Therapieempfehlungen auf dem Stagingsystem der UICC auf Basis der TNM-Klassifikation. Eine Differenzierung zwischen einzelnen Risikogruppen kann mit diesem Instrument allerdings nur sehr grob getroffen werden. Analysiert man retrospektiv große Studien zur adjuvanten Therapie, findet man immer Patientengruppen, die keine adjuvante Behandlung benötigt hätten, während andere Subgruppen nicht ausreichend behandelt waren. Die Entwicklung neuer prognostischer Marker und ihre Einführung in die klinische Routine ist deshalb sehr wichtig, um weitere Diskriminationsinstrumente zur Verfügung zu haben.
Cisplatin is one of the most active and widely used anticancer drugs; however, its clinical effic... more Cisplatin is one of the most active and widely used anticancer drugs; however, its clinical efficiacy is often limited by the development of resistance. Since several studies indicated that ras oncogenes may modulate the cellular response to cisplatin or radiation, we investigated the gene-specific repair of the N-ras gene in the human K 562 cell line after exposure to cisplatin using a novel nonradioactive polymerase chain reaction inhibition assay. This assay is based on the fact that DNA lesions can block the Taq polymerase and thereby result in a decreased amplification of a damaged segment compared to the amplification of the same segment in a non-damaged template. The overall genomic repair rate was measured by atomic absorption spectroscopy. Immediately after cisplatin exposure no amplification segment was observed. However, a complete restoration of the N-ras gene (2.4 kb) was seen after 8 h posttreatment incubation. In contrast, only 60% of the overall genome was repaired at this time. Our results clearly indicate that cisplatin-induced DNA lesions are more efficiently removed from transcribed regions within the DNA, suggesting that the efficiency of DNA repair in a given gene may be correlated to its transcriptional activity. Since ras oncogenes control several cellular signal transduction pathways, known to be involved in DNA damage response, preferential repair of the N-ras gene could therefore be an important step to prevent inactivation of cellular defense mechanisms after exposure to genotoxic agents.
Background The purpose of this study was to define survival rates in patients with isolated advan... more Background The purpose of this study was to define survival rates in patients with isolated advanced abdominal nodal metastases secondary to colorectal cancer (CRC), treated with curative-intent trimodality therapy. Materials and Methods Sixty-five patients received trimodality therapy, defined as chemotherapy delivered with external beam radiotherapy (EBRT) followed by lymphadenectomy and intraoperative radiotherapy (IORT). Infusional 5-fluorouracil was the most common radiosensitizer used (63%, 41 patients). The median dose of EBRT was 50 Gy, and the median dose of IORT was 12.5 Gy. We evaluated time to distant metastasis, toxicities, local failure within the EBRT field, recurrence within the IORT field, and survival. Results Fifty-two percent of patients were male; patients’ median age was 50.5 years. All patients had an Eastern Cooperative Oncology Group score ≤1. Twenty-nine patients had right-sided colon cancer, 22 had left-sided colon cancer, and 14 had rectal primaries. The ...
In the phase III CORRECT trial, regorafenib significantly improved survival in treatment-refracto... more In the phase III CORRECT trial, regorafenib significantly improved survival in treatment-refractory metastatic colorectal cancer (mCRC). The CONSIGN study was designed to further characterize regorafenib safety and allow patients access to regorafenib before market authorization. This prospective, single-arm study enrolled patients in 25 countries at 186 sites. Patients with treatment-refractory mCRC and an Eastern Cooperative Oncology Group performance status (ECOG PS) ≤1 received regorafenib 160 mg once daily for the first 3 weeks of each 4-week cycle. The primary endpoint was safety. Progression-free survival (PFS) per investigator assessment was the only efficacy evaluation. In total, 2,872 patients were assigned to treatment and 2,864 were treated. Median age was 62 years, ECOG PS 0/1 was 47%/53%, and 74% had received at least three prior regimens for metastatic disease. Median treatment duration was three cycles. Treatment-emergent adverse events (TEAEs) led to dose reduction ...
European journal of cancer (Oxford, England : 1990), Jan 27, 2018
Patients with left-sided colon tumours have better survival and respond differently to biologics ... more Patients with left-sided colon tumours have better survival and respond differently to biologics compared with patients with right-sided tumours. Left-sided colon tumours and rectal cancers are often grouped together. Herein, we examined the clinicopathological differences and outcomes between left-sided colon and rectal cancers. Data from 2879 metastatic colorectal cancer patients enrolled on six first-line clinical trials during 2004-2010 were pooled. Patients were included if the primary tumour origin was clearly defined. Progression-free survival (PFS) and overall survival (OS) were compared in the two groups after adjusting for patient and tumour characteristics, metastatic sites and the first-line regimen. In total, 1374 patients with metastatic left-sided colon cancer and 1505 patients with metastatic rectal cancers were evaluated. Left-sided colon cancer patients were more likely to be female (40.1% versus 32.6%; P < 0.0001) and older (31.0% ≥ 70 years versus 25.8%; P = 0...
European journal of cancer (Oxford, England : 1990), Jan 21, 2018
Patient characteristics and stratification factors are key features influencing trial outcomes. H... more Patient characteristics and stratification factors are key features influencing trial outcomes. However, there is substantial heterogeneity in reporting of patient characteristics and use of stratification factors in phase 3 trials investigating systemic treatment of metastatic colorectal cancer (mCRC). We aimed to develop a minimum set of essential baseline characteristics and stratification factors to include in such trials. We performed a modified, two-round Delphi survey among international experts with wide experience in the conduct and methodology of phase 3 trials of systemic treatment of mCRC. Thirty mCRC experts from 15 different countries completed both consensus rounds. A total of 14 patient characteristics were included in the recommended set: age, performance status, primary tumour location, primary tumour resection, prior chemotherapy, number of metastatic sites, liver-only disease, liver involvement, surgical resection of metastases, synchronous versus metachronous me...
In the RAISE trial, ramucirumab+leucovorin/fluorouracil/irinotecan (FOLFIRI) improved the median ... more In the RAISE trial, ramucirumab+leucovorin/fluorouracil/irinotecan (FOLFIRI) improved the median overall survival (mOS) of patients with previously treated metastatic colorectal cancer versus patients treated with placebo+FOLFIRI but had a higher incidence of neutropaenia, leading to more chemotherapy dose modifications and discontinuations. Thus, we conducted an exploratory post-hoc analysis of RAISE and a retrospective, observational analysis of electronic medical record (EMR) data to determine and verify the association of neutropaenia, baseline absolute neutrophil count (ANC) and survival. The RAISE analysis used the study safety population (n=1057). IMS Health Oncology Database (IMS EMR) was the source for the real-world data set (n=617). RAISE patients with treatment-emergent neutropaenia had improved mOS compared with those without (ramucirumab arm: 16.1 vs 10.7 months, HR=0.57, p<0.0001; placebo arm: 12.7 vs 10.7 months, HR=0.76, p=0.0065). RAISE patients with low ANC ver...
The efficacy of immunotherapy varies widely among different gastrointestinal cancers. Response to... more The efficacy of immunotherapy varies widely among different gastrointestinal cancers. Response to immune checkpoint inhibitors is shown to correlate with tumor mutation load (TML), mismatch repair deficiency (dMMR) status, and programmed cell death-ligand 1 (PD-L1) expression. Herein, we quantify TML, dMMR, and PD-L1 expression and determine their interrelationship in gastrointestinal cancers. Here, a total of 4125 tumors from 14 different gastrointestinal cancer sites were studied using validated assays. Next-generation sequencing (NGS) was performed on genomic DNA isolated from formalin-fixed paraffin-embedded (FFPE) tumor specimens using the NextSeq platform. TML was calculated using only somatic nonsynonymous missense mutations sequenced with a 592-gene panel. Microsatellite instability (MSI) was assessed using direct analysis of altered known MSI loci in the target regions of the sequenced genes. PD-L1 expression was analyzed by immunohistochemistry (IHC). Interestingly, right-...
Background BRAF V600E mutations are present in 8%–10% of patients with metastatic colorectal canc... more Background BRAF V600E mutations are present in 8%–10% of patients with metastatic colorectal cancer (mCRC) and portend poor prognosis. This study investigated the impact of metastasectomy for patients with BRAF V600E mCRC. Subjects, Materials, and Methods Using prospective clinical and molecular data, patients with BRAF V600E mCRC were analyzed for clinical characteristics and survival. Statistical analyses utilized the Kaplan-Meier method, log-rank test, and Cox proportional hazard models. Results Fifty-two patients were identified between July 1, 2008, and January 4, 2016. Patient characteristics included median age 65 years, 61% female, Eastern Cooperative Oncology Group performance status ≤1, 71% with right-sided tumors, and 28% with liver-limited metastasis. In the first-line setting, 7% (4/52) received fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI)/bevacizumab (BEV) and 81% were treated with doublet chemotherapy consisting of fluoropyrimidine, oxaliplatin, a...
Patients with relapsed aggressive non-Hodgkin lymphoma (NHL) are often treated with platinum-base... more Patients with relapsed aggressive non-Hodgkin lymphoma (NHL) are often treated with platinum-based chemoimmunotherapy regimens in preparation for autologous stem cell transplant. We sought to reduce toxicity and maintain efficacy by using oxaliplatin with rituximab, cytarabine and dexamethasone (ROAD) in a phase II clinical trial in patients who had relapsed after one prior regimen. ROAD was delivered q21 days and consisted of rituximab 375 mg/m2 IV weekly x 4 doses (cycle 1 only); dexamethasone 40 mg PO/IV d2 - 5; oxaliplatin 130 mg/m2 IV d2; cytarabine 2000 mg/m2 IV x two doses on days 2 - 3; and pegfilgrastim 6 mg SC on d4. Forty-five eligible patients were accrued between 2006- 2008. Patient characteristics were a median age of 69 years; 96% had received prior rituximab; 53% were within one year of diagnosis. The median number of cycles received was 2 (range, 1-6). Forty-four % received ROAD as an outpatient. The overall response rate was 71% with 27% (12/45) CR and 44% (20/45) ...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 9, 2017
Purpose Molecular diagnostic testing has become an integral part of the evaluation of patients wi... more Purpose Molecular diagnostic testing has become an integral part of the evaluation of patients with metastatic colorectal cancer (CRC). Expanded mutational testing, such as next-generation sequencing (NGS), often identifies mutations with unclear clinical or prognostic implications. One such example is BRAF mutations that occur outside of codon 600 ((non-V600) BRAF mutations). Methods We conducted this multicenter, retrospective cohort study to characterize the clinical, pathologic, and survival implications of (non-V600) BRAF mutations in metastatic CRC. We pooled patients in whom (non-V600) BRAF mutations were identified from NGS databases at three large molecular genetics reference laboratories. Results A total of 9,643 patients with metastatic CRC underwent NGS testing. We identified 208 patients with (non-V600) BRAF mutations, which occurred in 2.2% of all patients tested and accounted for 22% of all BRAF mutations identified. Cancers with (non-V600) BRAF mutations, compared wi...
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 17, 2017
Purpose Factors contributing to early mortality after initiation of treatment of metastatic color... more Purpose Factors contributing to early mortality after initiation of treatment of metastatic colorectal cancer are poorly understood. Materials and Methods Data from 22,654 patients enrolled in 28 randomized phase III trials contained in the ARCAD (Aide et Recherche en Cancérologie Digestive) database were pooled. Multivariable logistic regression models for 30-, 60-, and 90-day mortality were constructed, including clinically and statistically significant patient and disease factors and interaction terms. A calculator (nomogram) for 90-day mortality was developed and validated internally using bootstrapping methods and externally using a 10% random holdout sample from each trial. The impact of early progression on the likelihood of survival to 90 days was examined with time-dependent Cox proportional hazards models. Results Mortality rates were 1.4% at 30 days, 3.4% at 60 days, and 5.5% at 90 days. Among baseline factors, advanced age, lower body mass index, poorer performance statu...
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Papers by Axel Grothey