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@article{2364606,
author = {Peyrl, Andreas and Chocholous, Monika and Sabel, Magnus and Lassaletta, Alvaro and Štěrba, Jaroslav and Leblond, Pierre and Nysom, Karsten and Torsvik, Ingrid and Chi, Susan N and Perwein, Thomas and Jones, Neil and Holm, Stefan and Nyman, Per and Moerse, Helena and Oeberg, Anders and WeilerandWichtl, Liesa and Leiss, Ulrike and Haberler, Christine and Schmook, Maresa T and Mayr, Lisa and Dieckmann, Karin and Kool, Marcel and Gojo, Johannes and Azizi, Amedeo A and Andre, Nicolas and Kieran, Mark and Slavc, Irene},
article_location = {UNITED STATES},
article_number = {12},
doi = {http://dx.doi.org/10.1001/jamaoncol.2023.4437},
keywords = {CENTRAL-NERVOUS-SYSTEMHIGH-DOSE CHEMOTHERAPYSTEM-CELL RESCUEQUALITY-OF-LIFEPHASE-IIPEDIATRIC MALIGNANCIESMOLECULAR SUBGROUPSTUMOR-GROWTHCHILDRENTHERAPY},
language = {eng},
issn = {2374-2437},
journal = {JAMA ONCOLOGY},
title = {Sustained Survival Benefit in Recurrent Medulloblastoma by a Metronomic Antiangiogenic Regimen A Nonrandomized Controlled Trial},
url = {https://jamanetwork.com/journals/jamaoncology/fullarticle/2811045},
volume = {9},
year = {2023}
}
TY - JOUR
ID - 2364606
AU - Peyrl, Andreas - Chocholous, Monika - Sabel, Magnus - Lassaletta, Alvaro - Štěrba, Jaroslav - Leblond, Pierre - Nysom, Karsten - Torsvik, Ingrid - Chi, Susan N - Perwein, Thomas - Jones, Neil - Holm, Stefan - Nyman, Per - Moerse, Helena - Oeberg, Anders - Weiler-Wichtl, Liesa - Leiss, Ulrike - Haberler, Christine - Schmook, Maresa T - Mayr, Lisa - Dieckmann, Karin - Kool, Marcel - Gojo, Johannes - Azizi, Amedeo A - Andre, Nicolas - Kieran, Mark - Slavc, Irene
PY - 2023
TI - Sustained Survival Benefit in Recurrent Medulloblastoma by a Metronomic Antiangiogenic Regimen A Nonrandomized Controlled Trial
JF - JAMA ONCOLOGY
VL - 9
IS - 12
SP - 1688-1695
EP - 1688-1695
PB - AMER MEDICAL ASSOC
SN - 23742437
KW - CENTRAL-NERVOUS-SYSTEMHIGH-DOSE CHEMOTHERAPYSTEM-CELL RESCUEQUALITY-OF-LIFEPHASE-IIPEDIATRIC MALIGNANCIESMOLECULAR SUBGROUPSTUMOR-GROWTHCHILDRENTHERAPY
UR - https://jamanetwork.com/journals/jamaoncology/fullarticle/2811045
N2 - Importance Medulloblastoma recurrence in patients who have previously received irradiation has a dismal prognosis and lacks a standard salvage regimen.Objective To evaluate the response rate of pediatric patients with medulloblastoma recurrence using an antiangiogenic metronomic combinatorial approach (Medulloblastoma European Multitarget Metronomic Anti-Angiogenic Trial [MEMMAT]).Design, Setting, and Participants This phase 2, investigator-initiated, multicenter nonrandomized controlled trial assessed 40 patients with relapsed or refractory medulloblastoma without a ventriculoperitoneal shunt who were younger than 20 years at original diagnosis. Patients were enrolled between April 1, 2014, and March 31, 2021.Interventions Treatment consisted of daily oral thalidomide, fenofibrate, celecoxib, and alternating 21-day cycles of low-dose (metronomic) oral etoposide and cyclophosphamide, supplemented by intravenous bevacizumab and intraventricular therapy consisting of alternating etoposide and cytarabine.Main Outcomes and Measures The primary end point was response after 6 months of antiangiogenic metronomic therapy. Secondary end points included progression-free survival (PFS), overall survival (OS), and quality of life. Adverse events were monitored to assess safety.Results Of the 40 patients (median [range] age at treatment start, 10 [4-17] years; 25 [62.5%] male) prospectively enrolled, 23 (57.5%) achieved disease control after 6 months of treatment, with a response detected in 18 patients (45.0%). Median OS was 25.5 months (range, 10.9-40.0 months), and median PFS was 8.5 months (range, 1.7-15.4 months). Mean (SD) PFS at both 3 and 5 years was 24.6% (7.9%), while mean (SD) OS at 3 and 5 years was 43.6% (8.5%) and 22.6% (8.8%), respectively. No significant differences in PFS or OS were evident based on molecular subgroup analysis or the number of prior recurrences. In patients demonstrating a response, mean (SD) overall 5-year PFS was 49.7% (14.3%), and for patients who remained progression free for the first 12 months of treatment, mean (SD) 5-year PFS was 66.7% (16.1%). Treatment was generally well tolerated. Grade 3 to 4 treatment-related adverse events included myelosuppression, infections, seizures, and headaches. One heavily pretreated patient with a third recurrence died of secondary acute myeloid leukemia.Conclusions and Relevance This feasible and well-tolerated MEMMAT combination regimen demonstrated promising activity in patients with previously irradiated recurrent medulloblastoma. Given these results, this predominantly oral, well-tolerated, and outpatient treatment warrants further evaluation.
ER -
PEYRL, Andreas, Monika CHOCHOLOUS, Magnus SABEL, Alvaro LASSALETTA, Jaroslav ŠTĚRBA, Pierre LEBLOND, Karsten NYSOM, Ingrid TORSVIK, Susan N CHI, Thomas PERWEIN, Neil JONES, Stefan HOLM, Per NYMAN, Helena MOERSE, Anders OEBERG, Liesa WEILER-WICHTL, Ulrike LEISS, Christine HABERLER, Maresa T SCHMOOK, Lisa MAYR, Karin DIECKMANN, Marcel KOOL, Johannes GOJO, Amedeo A AZIZI, Nicolas ANDRE, Mark KIERAN and Irene SLAVC. Sustained Survival Benefit in Recurrent Medulloblastoma by a Metronomic Antiangiogenic Regimen A Nonrandomized Controlled Trial. \textit{JAMA ONCOLOGY}. UNITED STATES: AMER MEDICAL ASSOC, 2023, vol.~9, No~12, p.~1688-1695. ISSN~2374-2437. Available from: https://dx.doi.org/10.1001/jamaoncol.2023.4437.
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