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Hilbe, Wolfgang; Abacioglu, Ufuk; Aebersold, Daniel M.; Bachouchi, Mounir; Brodowicz, Thomas; Gaafar, Rabab; Holzer, Gerold; Mohn-Staudner, Andrea; Kalev, Dimitar; Kalinka-Warzocha, Ewa; Kovac, Viljem; Siano, Marco; Yumuk, Fulden; Tamasi, Lilla
Popper, Helmut H.; Gruber-Moesenbacher, Ulrike; Müllauer, Leonhard; Hutarew, Georg; Vesely, Michael; Pirker, Robert; Hilbe, Wolfgang; Ploner, Ferdinand; Setinek, Ulrike; Hulla, Wolfgang; Maier, Hans; Sterlacci, William; Kirchbacher, Klaus; Kolb, Rainer; Hochmair, Maximilian; Webersinke, Gerald; Stacher, Elvira; Grabher, Patricia; Hernler, Tamara
2013 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-013-0087-7
The introduction of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) for non-small cell lung cancer (NSCLC) with activating mutations of the EGFR has opened a new area of lung cancer treatment strategies and led to an enthusiastic search for additional mutations. Since then, numerous driver mutations such as EML4-ALK and ROS1 have been detected and specific treatment options have already been developed. However, molecular tests have to follow specific rules if applied in daily practice. The Austrian Working Group on Pulmonary Pathology and Oncology (AWGPPO) is presenting an updated version of their previous recommendation published in 2011. Several practical questions raised during the last 2 years will be addressed, such as reflex testing, selection of tissues, order of molecular tests, and the issue of resistance mechanisms.
Pilz, Lothar R; Manegold, Christian
2013 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-013-0082-z
The identification of potential molecular targets in lung cancer has stimulated the today’s search for antitumor agents to be tested in clinical trials with an appropriate endpoint. Three main categories of classical endpoints are applied: survival time endpoints, symptom endpoints, and endpoints relying on patients’ reporting, with the gold standard overall survival (OS). Efforts have been taken to substitute OS by surrogates. As a surrogate for OS, progression-free survival (PFS) should have the inherent considerable advantage, that it can detect subpopulations with longer PFS intervals early. OS and PFS was linked directly by splitting OS into PFS and the rest as survival time past progression (SPP). Variation in SPP is a quantitative factor in validating PFS as a surrogate of OS. If accompanied by some independent measures like quality of life (QoL) or treatment toxicity, PFS should be able to cover the clinical benefit achieved by treatment. In an adaptive trial design, the impact of SPP can be modeled by adjustments of the covariate structure by factors as QoL. OS as the gold standard is easy to measure and is precise but results are available late. PFS in contrast is complex to measure but will become attractive, because its results are available earlier and are not influenced by subsequent therapies. Therefore, PFS, as an endpoint with some extra measures, has become an acceptable alternative to OS in lung cancer trials recently. Extra measures under discussion to enrich PFS are QoL and information of SPP, or adaptive designs.
Greinix, Hildegard T.; Mitterbauer, Margit; Rabitsch, Werner; Worel, Nina; Just, Ulrike; Knobler, Robert; Kalhs, Peter
2013 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-013-0080-1
Allogeneic hematopoietic cell transplantation (HCT) is a well-established curative treatment option for selected patients with hematologic and oncologic diseases. Acute graft-versus-host disease (GvHD) has remained a serious complication of HCT and is associated with high morbidity and mortality especially in patients not responding to first-line therapy with corticosteroids. So far, no standard for salvage therapy of acute corticosteroid-refractory GvHD has been established worldwide. Use of extracorporeal photopheresis results in high response rates, has a steroid-sparing effect and is associated with improved patients’ survival.
Fridrik, Michael A.; Egle, Alexander
2013 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-013-0081-0
Maintenance treatment is used in patients if a curative therapy is not available and is currently explored where curation rates need to be improved in aggressive lymphoma. A discussion of valid endpoints is specifically important in the case of indolent lymphoma. The most valid endpoint for maintenance treatment is clearly overall survival, but adequate trial designs may be difficult to achieve and times to relevant results may be excessive. Therefore other endpoints such as quality-adjusted life year or the time to resistance to maintenance treatment or to resistance to repeated reinduction therapies are explored. Several drugs are used for maintenance treatment. The best data exist for interferon alfa and Rituximab. Interferon alfa is able to prolong survival in indolent lymphoma, but it has too many side effects. Rituximab had proven efficacy in second remission in follicular lymphoma and may be useful even in first remission. It has also proven effective in mantle-cell, marginal, and small lymphocytic lymphoma. Maintenance strategies for chronic lymphocytic leukemia have only been explored in phase II designs so far. However, a number of trials currently explore the use of Rituximab or Lenalidomide in a randomized fashion for chronic lymphocytic leukemia maintenance. At all entities included in the overview, several maintenance treatment trials are under way and patients are to be entered in these trials.
Valent, Peter; Aberer, Elisabeth; Beham-Schmid, Christine; Fellinger, Christina; Fuchs, Wolfgang; Gleixner, Karoline V.; Greul, Rosemarie; Hadzijusufovic, Emir; Hoermann, Gregor; Sperr, Wolfgang R.; Wimazal, Friedrich; Wöhrl, Stefan; Zahel, Brigitte; Pehamberger, Hubert
2013 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-013-0083-y
Mastocytosis is a group of rare diseases characterized by abnormal expansion and accumulation of tissue mast cells in various organ systems. The disease can be divided into cutaneous and systemic variants. Although considered a rare pathologic condition, more and more patients are currently diagnosed as suffering from mastocytosis. The increasing incidence is best explained by enhanced awareness and improved diagnostics in the Western world. This has in turn created a need to establish optimal facilities for the diagnosis, management, and therapy of patients with mastocytosis. In 2002, the European Competence Network on Mastocytosis (ECNM) was established, with the aim to provide all available information to doctors and patients, and to improve management and therapy of mastocytosis in Europe. Within the ECNM, Centers of Excellence and Reference Centers have been defined and inaugurated. In addition, several countries established a local network of competence within the ECNM. In 2011, the Austrian Competence Network on Mastocytosis (AUCNM) was inaugurated. The AUCNM serves as an integral part and essential partner of the ECNM. In the current article, the structure, aims, achievements, and ongoing projects of the AUCNM are presented.
Drach, Johannes; Huk, Ihor; Lamm, Wolfgang
2013 memo - Magazine of European Medical Oncology
doi: 10.1007/s12254-013-0078-8
We present a case of a 23-year-old female patient with relapsed classical Hodgkin lymphoma in reduced general condition. She was refractory after multiple lines of prior chemotherapy including autologous stem cell transplantation. By applying a targeted therapy concept using brentuximab vedotin (SGN-35), the patient experienced a rapid clinical improvement with loss of B symptoms immediately after the first treatment cycle. Elevated serum levels for C-reactive protein (CRP) and lactate dehydrogenase (LDH) returned to normal, and a significant improvement of hemoglobin levels were observed. Moreover, after administration of 16 cycles, the patient remains in complete remission, lasting now for > 15 months. Tolerability of treatment was excellent without evidence of infections or peripheral neuropathy. This case illustrates the clinical potential of brentuximab vedotin in patients with end-stage Hodgkin lymphoma who would otherwise have only limited treatment options.
Skrabs, Cathrin; Sillaber, Christian; Schiefer, Ana-Iris; Simonitsch-Klupp, Ingrid; Staudinger, Thomas; Putman, Monique; Rabitsch, Werner; Jaeger, Ulrich
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