A phase III study evaluating oral glutamine and transforming growth factor-beta 2 on chemotherapy-induced toxicity in patients with digestive neoplasm

International audienceBACKGROUND:Patients with gastrointestinal (GI) cancer are exposed to cachexia, which is highly correlated with chemotherapy-induced side effects. Research suggests that specific immunonutrients could prevent such toxicities.AIMS:The primary objective of this phase III study was to evaluate the efficacy of glutamine and transforming growth factor-β2 (TGF-β2) in the prevention of grade 3-4 non-hematological toxicities induced by chemotherapy in patients with GI cancer.PATIENTS AND METHODS:We designed a double-blind, randomized, controlled and multicenter trial stratified according to center, type of chemotherapy, presence of cachexia, and age. Patients were randomized to receive either Clinutren Protect(®) (CP) or a control isocaloric diet (without TGF-β2 or glutamine).RESULTS:Between November 2007 and October 2011, 210 patients were enrolled in the study, of which 201 were included in the intention-to-treat analysis. Grade 3-4 non-hematological toxicities were not significantly different between the CP and control groups when evaluated by univariate and multivariate analyses. Likewise, no difference was observed regarding grade 3-4 hematological toxicities or reasons for treatment interruption.CONCLUSION:This randomized study does not support the hypothesis that oral glutamine and TGF-β2 supplementation is effective to reduce grade 3 or 4 non-hematological toxicities induced by chemotherapy in patients with GI neoplasm

Bevacizumab Maintenance Versus No Maintenance During Chemotherapy-Free Intervals in Metastatic Colorectal Cancer: A Randomized Phase III Trial (PRODIGE 9)

International audiencePurpose Conflicting results are reported for maintenance treatment with bevacizumab during chemotherapy-free intervals (CFI) in metastatic colorectal cancer after induction chemotherapy. Patients and Methods In this open-label, phase III, randomized controlled trial, we compared the tumor control duration (TCD) observed with bevacizumab maintenance and with no treatment (observation) during CFI subsequent to induction chemotherapy with 12 cycles of fluorouracil, leucovorin, and irinotecan plus bevacizumab. After disease progression, the induction regimen was repeated for eight cycles, followed by a new CFI. Results From March 2010 to July 2013, 491 patients were randomly assigned. Disease progression or death occurred during induction chemotherapy in 85 patients (17%); 261 patients (53%) had at least one reinduction, 107 (22%) had two reinductions, and 56 (11%) had three or more reinductions. The median TCD was 15 months in both groups; the median progression-free survival (PFS) from randomization was 9.2 and 8.9 months in the maintenance group and observation groups, respectively. The TCD observed in both groups was higher compared with the TCD hypotheses of the trial. The median overall survival (OS) was 21.7 and 22.0 months in the maintenance and observation groups, respectively. In the per-protocol population, defined as patients with at least one reinduction after the first progression, the median duration of the first CFI was 4.3 months in both arms; the median TCD was 17.8 and 23.3 months ( P = .339), the median PFS was 9.9 and 9.5 months, and the median OS was 27.6 and 28.5 months in the maintenance and observation groups, respectively. Multivariable analysis revealed that female gender, WHO performance status ≥ 2, and unresected primary tumors were associated with a shorter TCD. Conclusion Bevacizumab maintenance monotherapy did not improve TCD, CFI duration, PFS, or OS

Geriatric factors analyses from FFCD 2001-02 phase III study of first-line chemotherapy for elderly metastatic colorectal cancer patients

IF 6.163International audienceAIM:Several predictors of metastatic colorectal cancer (mCRC) outcomes have been described. Specific geriatric characteristics could be of interest to determine prognosis.METHOD:Elderly patients (75+) with previously untreated mCRC were randomly assigned to receive infusional 5-fluorouracil-based chemotherapy, either alone (FU) or in combination with irinotecan (IRI). Geriatric evaluations were included as an optional procedure. The predictive value of geriatric parameters was determined for the objective response rate (ORR), progression-free survival (PFS) and overall survival (OS).RESULTS:From June 2003 to May 2010, the FFCD 2001-02 randomised trial enrolled 282 patients. A baseline geriatric evaluation was done in 123 patients; 62 allocated to the FU arm and 61 to the IRI arm. The baseline Charlson index was ≤1 in 75%, Mini-Mental State Examination was ≤27/30 in 31%, Geriatric Depression Scale was >2 in 10% and Instrumental Activities of Daily Living (IADL) was impaired in 34% of the patients. Multivariate analyses revealed that no geriatric parameter was predictive for ORR or PFS. Normal IADL was independently associated with better OS. The benefit of doublet chemotherapy on PFS differed in subgroups of patients ≤80 years, with unresected primary tumour, leucocytes >11,000 mm3 and carcinoembryonic antigen >2N. There was a trend towards better OS in patients with normal IADL.CONCLUSION:The autonomy score was an independent predictor for OS. A trend toward a better efficacy of doublet chemotherapy in some subgroups of patients was reported and should be further explored

Preliminary safety data of the PRODIGE 81-FFCD 2101-TRIPLET-HCC trial assessing the triple combination atezolizumab-bevacizumab-ipilimumab in patients (pts) treated in systemic therapy for hepatocellular carcinoma (HCC).

Meeting abstract du 2024 ASCO Annual Meeting, Chicago, Ill., 31mai au 4 juin 2024International audienceBackground: TRIPLET-HCC is a French, multicentre, randomized 1:1, open-label phase II-III trial designed to evaluate efficacy and safety of the triple combination (Arm-A) by the addition of ipilimumab (1 mg/kg for the first 4 cycles) to atezolizumab/bevacizumab (Q3W), versus the double atezolizumab/bevacizumab combination (Arm-B) for HCC eligible to systemic therapy in first line setting. The primary objective of phase II is the objective response rate in Arm-A, and overall survival in Arm-A versus Arm-B in phase III. In phase II, the first 15 pts randomized in Arm-A were assessed for a safety-run in aim to detect a potential signal of overtoxicity after the first four cycles of triple therapy (induction phase), thus allowing or forbidding the continuation of the trial. Methods: The trial started on March 2023 the 9 th . Adverse events (AE) and their imputability to treatment were reported in the eCRF by investigators. An independent data safety monitoring board (DSMB) was gathered 4 weeks after the last injection of ipilimumab of the 5 th and the 15 th patient randomized in Arm-A of phase II. The second DSMB meeting took place on November 2023 after extraction of data in November 2023 the 9 th . These data are presented in the present abstract. Results: At the DSMB meeting date, 15 patients in Arm-A were analyzed for safety while 13 patients had been randomized in Arm-B and had reached at least 4 cycles of treatment. In Arm-A, 12 pts completed the first 4 cycles of triple therapy, 1 pt received 3 cycles (sepsis), 1 pt only 2 (prednisone > 10 mg/day for grade-1 myocarditis which recovered), and 1 pt only 1 (sepsis and death). In Arm-B, 11 pts received the first 4 cycles of double therapy, 2 pts only 3 (anemia, lithiasic cholangitis). Three deaths occurred: 2 in Arm-A (1 possible related to immune-related (iR) hepatitis (not biopsy-proven) associated with sepsis, and 1 sudden death of unknow etiology), and one in Arm-B (tumor progression). Three pts in Arm-A (2 radiologic progressions, 1 death) and 1 pt in Arm-B (1 tumor progression with death) were withdrawn of the trial. Regarding grade-3/4 treatment-related adverse events (TRAE), 3 were reported in Arm-A (1 ASAT increase, 1 arterial hypertension, 1 colitis), and 2 in Arm-B (1 tumor bleeding, 1 arterial hypertension). Conclusions: The preliminary safety data from the TRIPLET-HCC trial suggest that the triple combination therapy is associated with a manageable safety profile, showing no unexpected signs of over toxicity. The DSMB's decision to continue the trial underscores the potential of this innovative therapeutic approach in improving outcomes for HCC patients. These findings support further investigation into the efficacy and long-term safety of the triple combination therapy in a broader patient population. Clinical trial information: NCT05665348

Circulating Tumor Cells and Circulating Tumor DNA Detection in Potentially Resectable Metastatic Colorectal Cancer: A Prospective Ancillary Study to the Unicancer Prodige-14 Trial

International audienceThe management of patients with colorectal cancer (CRC) and potentially resectable liver metastases (LM) requires quick assessment of mutational status and of response to pre-operative systemic therapy. In a prospective phase II trial (NCT01442935), we investigated the clinical validity of circulating tumor cell (CTC) and circulating tumor DNA (ctDNA) detection. CRC patients with potentially resectable LM were treated with first-line triplet or doublet chemotherapy combined with targeted therapy. CTC (Cellsearch®) and Kirsten RAt Sarcoma (KRAS) ctDNA (droplet digital polymerase chain reaction (PCR)) levels were assessed at inclusion, after 4 weeks of therapy and before LM surgery. 153 patients were enrolled. The proportion of patients with high CTC counts (≥3 CTC/7.5mL) decreased during therapy: 19% (25/132) at baseline, 3% (3/108) at week 4 and 0/57 before surgery. ctDNA detection sensitivity at baseline was 91% (N=42/46) and also decreased during treatment. Interestingly, persistently detectable KRAS ctDNA (p=0.01) at 4 weeks was associated with a lower R0/R1 LM resection rate. Among patients who had a R0/R1 LM resection, those with detectable ctDNA levels before liver surgery had a shorter overall survival (p<0.001). In CRC patients with limited metastatic spread, ctDNA could be used as liquid biopsy tool. Therefore, ctDNA detection could help to select patients eligible for LM resection

Preliminary safety data of the PRODIGE 81-FFCD 2101-TRIPLET-HCC trial assessing the triple combination atezolizumab-bevacizumab-ipilimumab in patients (pts) treated in systemic therapy for hepatocellular carcinoma (HCC).

Meeting abstract du 2024 ASCO Annual Meeting, Chicago, Ill., 31mai au 4 juin 2024International audienceBackground: TRIPLET-HCC is a French, multicentre, randomized 1:1, open-label phase II-III trial designed to evaluate efficacy and safety of the triple combination (Arm-A) by the addition of ipilimumab (1 mg/kg for the first 4 cycles) to atezolizumab/bevacizumab (Q3W), versus the double atezolizumab/bevacizumab combination (Arm-B) for HCC eligible to systemic therapy in first line setting. The primary objective of phase II is the objective response rate in Arm-A, and overall survival in Arm-A versus Arm-B in phase III. In phase II, the first 15 pts randomized in Arm-A were assessed for a safety-run in aim to detect a potential signal of overtoxicity after the first four cycles of triple therapy (induction phase), thus allowing or forbidding the continuation of the trial. Methods: The trial started on March 2023 the 9 th . Adverse events (AE) and their imputability to treatment were reported in the eCRF by investigators. An independent data safety monitoring board (DSMB) was gathered 4 weeks after the last injection of ipilimumab of the 5 th and the 15 th patient randomized in Arm-A of phase II. The second DSMB meeting took place on November 2023 after extraction of data in November 2023 the 9 th . These data are presented in the present abstract. Results: At the DSMB meeting date, 15 patients in Arm-A were analyzed for safety while 13 patients had been randomized in Arm-B and had reached at least 4 cycles of treatment. In Arm-A, 12 pts completed the first 4 cycles of triple therapy, 1 pt received 3 cycles (sepsis), 1 pt only 2 (prednisone &gt; 10 mg/day for grade-1 myocarditis which recovered), and 1 pt only 1 (sepsis and death). In Arm-B, 11 pts received the first 4 cycles of double therapy, 2 pts only 3 (anemia, lithiasic cholangitis). Three deaths occurred: 2 in Arm-A (1 possible related to immune-related (iR) hepatitis (not biopsy-proven) associated with sepsis, and 1 sudden death of unknow etiology), and one in Arm-B (tumor progression). Three pts in Arm-A (2 radiologic progressions, 1 death) and 1 pt in Arm-B (1 tumor progression with death) were withdrawn of the trial. Regarding grade-3/4 treatment-related adverse events (TRAE), 3 were reported in Arm-A (1 ASAT increase, 1 arterial hypertension, 1 colitis), and 2 in Arm-B (1 tumor bleeding, 1 arterial hypertension). Conclusions: The preliminary safety data from the TRIPLET-HCC trial suggest that the triple combination therapy is associated with a manageable safety profile, showing no unexpected signs of over toxicity. The DSMB's decision to continue the trial underscores the potential of this innovative therapeutic approach in improving outcomes for HCC patients. These findings support further investigation into the efficacy and long-term safety of the triple combination therapy in a broader patient population. Clinical trial information: NCT05665348