156 results on '"Halfdan Sorbye"'
Search Results
2. Early radiologic signal of responsiveness to immune checkpoint blockade in microsatellite-stable/mismatch repair-proficient metastatic colorectal cancer
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Sebastian Meltzer, Anne Negård, Kine M. Bakke, Hanne M. Hamre, Christian Kersten, Eva Hofsli, Marianne G. Guren, Halfdan Sorbye, Kjersti Flatmark, and Anne Hansen Ree
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Cancer Research ,Oncology - Abstract
Background Immune checkpoint blockade (ICB) results in radiologic tumour response dynamics that differ from chemotherapy efficacy measures and require an early signal of clinical utility. Methods Previously untreated, unresectable microsatellite-stable (MSS)/mismatch repair-proficient (pMMR) colorectal cancer (CRC) patients were randomly assigned to the oxaliplatin-based Nordic FLOX regimen (control arm) or repeat sequential two FLOX cycles and two ICB cycles (experimental arm). The radiologic response was assessed every 8 weeks. In this post hoc analysis, we explored early target lesion (TL) dynamics as indicator of ICB responsiveness. Progression-free survival (PFS) was the primary endpoint. Results Using a landmark analysis approach, we categorised experimental-arm patients into ≥10% (N = 19) or N = 16) TL reduction at the first post-baseline response assessment. Median PFS for the groups was 16.0 (95% confidence interval (CI), 12.3–19.7) and 3.9 months (95% CI, 2.3–5.5), respectively, superior and inferior (both P N = 31). Conclusions Radiologic TL reduction of ≥10% at the first post-baseline response assessment identified patients with ICB-responsive metastatic MSS/pMMR-CRC. This pragmatic measure may be used to monitor patients in investigational ICB schedules, enabling early treatment adaptation for unresponsive cases. Trial registration ClinicalTrials.gov number, NCT03388190 (02/01/2018).
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- 2022
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3. Impact of <scp>KRAS</scp> and <scp>BRAF</scp> mutations on treatment efficacy and survival in high‐grade gastroenteropancreatic neuroendocrine neoplasms
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Hege Elvebakken, Geir Olav Hjortland, Herish Garresori, Per Arne Andresen, Emiel A. M. Janssen, Olav Karsten Vintermyr, Inger M. B. Lothe, and Halfdan Sorbye
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Cellular and Molecular Neuroscience ,Endocrinology ,Endocrine and Autonomic Systems ,Endocrinology, Diabetes and Metabolism - Published
- 2023
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4. Survival According to Primary Tumor Location, Stage, and Treatment Patterns in Locoregional Gastroenteropancreatic High-grade Neuroendocrine Carcinomas
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Arvind Dasari, Chan Shen, Anjali Devabhaktuni, Ruda Nighot, and Halfdan Sorbye
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Pancreatic Neoplasms ,Neuroendocrine Tumors ,Cancer Research ,Databases, Factual ,Esophageal Neoplasms ,Oncology ,Humans ,Prognosis ,digestive system diseases ,Carcinoma, Neuroendocrine - Abstract
Background Although the gastrointestinal tract (including the pancreas, gastroenteropancreatic (GEP) is the most common site for extrapulmonary neuroendocrine carcinoma (NEC), the current treatment patterns of locoregional GEP NEC and in particular, the role of surgical resection is unclear. Methods Data from the National Cancer Database between 2004 and 2016 were used for this study. Results Of 2314 GEP NEC cases (stages I–III), 52.5% were stage III. Colon was the most common site (30%); 30.9% of all cases were small cell morphology. Age, morphology, stage, and primary site were associated with significant differences in treatment patterns. Management of NEC mimicked that of adenocarcinomas arising at the respective sites: colon NEC most likely to be treated with surgery and chemotherapy; anal and esophageal NEC was primarily likely to receive chemotherapy and radiation, and rectal NEC mostly likely to receive trimodality therapy. However, 25%-40% of patients did not undergo surgical resection even at sites typically managed with curative resection, and there was a trend toward lesser resection over time. The prognostic impact of surgical resection was significant across all stages and correlated with variations in survival across primary sites. Even in patients undergoing chemoradiation, surgery was the only prognostic variable that significantly affected survival in stages I–II patients (HR 0.63) and showed a strong trend in stage III (HR 0.77) patients. Conclusions Treatment patterns in GEP NEC vary considerably according to stage and primary tumor site. Surgery significantly improved survival in stages I–II patients and showed a strong trend in stage III patients regardless of primary tumor location and other perioperative therapies.
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- 2022
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5. The molecular characteristics of high-grade gastroenteropancreatic neuroendocrine neoplasms
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Hege Elvebakken, Sönke Detlefsen, Oleksii Nikolaienko, Aurel Perren, Stian Knappskog, Inger Marie Bowitz Lothe, Anna Sundlöv, Johanna Svensson, Anne Couvelard, Wei Deng, Harrish Garresori, Andreas Venizelos, Halfdan Sorbye, Merete Krogh, Christian Kersten, Geir Olav Hjortland, and Eva Hofsli
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Proto-Oncogene Proteins B-raf ,Cancer Research ,molecular markers ,ARID1A ,Endocrinology, Diabetes and Metabolism ,610 Medicine & health ,Biology ,medicine.disease_cause ,Gastroenteropancreatic ,Endocrinology ,Stomach Neoplasms ,SETD2 ,High-grade ,Intestinal Neoplasms ,Carcinoma ,medicine ,Humans ,MEN1 ,high-grade ,Lung cancer ,Gene ,ATRX ,genetic alterations ,neuroendocrine neoplasms ,Research ,neuroendocrine carcinoma ,Molecular markers ,medicine.disease ,digestive system diseases ,Carcinoma, Neuroendocrine ,Pancreatic Neoplasms ,Neuroendocrine Tumors ,Oncology ,Neuroendocrine neoplasms ,Neuroendocrine carcinoma ,gastroenteropancreatic ,Cancer research ,570 Life sciences ,biology ,KRAS ,Retinoblastoma-Binding Protein 2 ,Genetic alterations - Abstract
High-grade (HG) gastroenteropancreatic (GEP) neuroendocrine neoplasms (NEN) are rare but have a very poor prognosis and represent a severely understudied class of tumours. Molecular data for HG GEP-NEN are limited, and treatment strategies for the carcinoma subgroup (HG GEP-NEC) are extrapolated from small-cell lung cancer (SCLC). After pathological re-evaluation, we analysed DNA from tumours and matched blood samples from 181 HG GEP-NEN patients; 152 neuroendocrine carcinomas (NEC) and 29 neuroendocrine tumours (NET G3). Based on the sequencing of 360 cancer-related genes, we assessed mutations and copy number alterations (CNA). For NEC, frequently mutated genes were TP53 (64%), APC (28%), KRAS (22%) and BRAF (20%). RB1 was only mutated in 14%, but CNAs affecting RB1 were seen in 34%. Other frequent copy number losses were ARID1A (35%), ESR1 (25%) and ATM (31%). Frequent amplifications/gains were found in MYC (51%) and KDM5A (45%). While these molecular features had limited similarities with SCLC, we found potentially targetable alterations in 66% of the NEC samples. Mutations and CNA varied according to primary tumour site with BRAF mutations mainly seen in colon (49%), and FBXW7 mutations mainly seen in rectal cancers (25%). Eight out of 152 (5.3%) NEC were microsatellite instable (MSI). NET G3 had frequent mutations in MEN1 (21%), ATRX (17%), DAXX, SETD2 and TP53 (each 14%). We show molecular differences in HG GEP-NEN, related to morphological differentiation and site of origin. Limited similarities to SCLC and a high fraction of targetable alterations indicate a high potential for better-personalized treatments.
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- 2022
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6. Author response for 'European Neuroendocrine Tumor Society ( <scp>ENETS</scp> ) 2023 Guidance Paper for Digestive Neuroendocrine Carcinoma'
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null Halfdan Sorbye, null Enrique Grande, null Marianne Pavel, null Margot Tesselaar, null Nicola Fazio, null Nicholas Simon Reed, null Ulrich Knigge, null Emanuel Christ, null Valentina Ambrosini, null Anne Couvelard, and null Eva Tiensuu Janson
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- 2023
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7. Mutation Spectrum in Liquid Versus Solid Biopsies From Patients With Advanced Gastroenteropancreatic Neuroendocrine Carcinoma
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Stian Knappskog, Tobias Grob, Andreas Venizelos, Ursula Amstutz, Geir O. Hjortland, Inger M. Lothe, Christian Kersten, Eva Hofsli, Anna Sundlöv, Hege Elvebakken, Herish Garresori, Anne Couvelard, Johanna Svensson, Halfdan Sorbye, and Aurel Perren
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Cancer Research ,Oncology ,570 Life sciences ,biology ,610 Medicine & health - Abstract
PURPOSE Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are rare and have a poor prognosis. Most GEP-NEC are diagnosed with metastatic disease, with only minor biopsies available for molecular diagnostics. We assessed the applicability of liquid biopsies for molecular profiling of GEP-NEC. MATERIALS AND METHODS We performed massive parallel sequencing of 76 cancer-related genes in circulating tumor DNA from 50 patients with advanced GEP-NEC and compared findings to previous analyses of solid tumor biopsies from the same patients. Plasma samples were collected before therapy, and the median time span between blood and tissue sampling was 25 days. RESULTS We detected 178 somatic mutations in the liquid biopsies, 127 (71%) were also detected in the solid biopsies, whereas 51 (29%) were unique to the liquid biopsies. In the same 76 genes, we previously detected 199 somatic mutations (single nucleotide variants) in solid biopsies, of which 127 (64%) were also now detected in liquid biopsies. In exploratory subgroup assessments, concordance was higher in patients with liver metastases ( P = 1.5 × 10–5) and increasing with level of liver involvement ( P = 1.2 × 10–4). The concordance was similar between GEP-NEC with different primary sites, except being lower in esophageal cases ( P = .001). Concordance was not associated with tumor mutation burden. Tumor tissue mutations also detected in liquid biopsies was lower for MSI (40%) versus MSS tumors (70%; P = 7.8 × 10–4). We identified potentially targetable mutations in plasma of 26 (52%) of patients with GEP-NEC; nine patients (18%) had potentially targetable mutation detected only in liquid biopsies. CONCLUSION Liquid biopsy analyses may be an applicable alternative to solid biopsies in GEP-NEC. Liquid biopsies may add additional mutations compared with tumor biopsies alone and could be useful for biomarker assessment in clinical trials for these patients.
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- 2023
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8. Abstract 3279: Systemic immune response invoked by short-course oxaliplatin-based chemotherapy (FLOX) for efficacy of sequential immune checkpoint blockade (ICB; nivolumab) in microsatellite-stable (MSS) metastatic colorectal cancer (mCRC)
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Sebastian Meltzer, Kjersti Flatmark, Anniken J. Fuglestad, Hanne M. Hamre, Christian Kersten, Eva Hofsli, Marianne G. Guren, Halfdan Sorbye, Anne Negård, and Anne Hansen Ree
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Cancer Research ,Oncology - Abstract
Purpose: Most mCRC patients harbor MSS disease without inherent immunogenicity. The METIMMOX study (NCT03388190) explored an unconventional concept, that patients with previously untreated, unresectable abdominal metastases from MSS-CRC may achieve therapeutic efficacy from short-course oxaliplatin-based chemotherapy (FLOX) and sequential ICB (nivolumab). Among study patients who were assigned this highly experimental treatment, 15% obtained long-lasting complete response and more than a half met an early occurring radiologic signal of ICB responsiveness predicting significantly extended progression-free survival (PFS) compared to study control arm patients given standard FLOX chemotherapy [PMID: 36229579]. The aim of the present study was to verify if systemic tumor-defeating immunity had been invoked by the short-course FLOX treatment in the responding patients. The fms-related tyrosine kinase-3 ligand (Flt3L) is a circulating factor that reflects the direct cytotoxic effects of chemotherapy and also activates dendritic cells that present the shed tumor antigens to tumor-targeting T-cells. Procedures: Study patients were randomly assigned to the control arm of FLOX (oxaliplatin 85 mg/m2 on day 1 and bolus 5-fluorouracil 500 mg/m2 and folinic acid 100 mg on days 1 and 2) Q2W or the experimental arm of repeat sequential cycles of 2 FLOX Q2W and 2 nivolumab (240 mg) Q2W. Radiologic response assessment was done every 8 weeks with PFS as the primary endpoint. Patients were categorized into those with target lesion (TL) reduction of ≥10% or Results: For all subjects, median Flt3L was 103.8 pg/ml (range 24.6-306.1) at baseline and 162.4 pg/ml (range 53.3-503.8) at 4 weeks. For the experimental arm patients (n = 34), the higher 4-week Flt3L level, the deeper overall radiologic response (rho = -0.39, p = 0.022, Spearman correlation). The 4-week Flt3L level was higher in patients who obtained ≥10% TL reduction (n = 18; median 233.5 pg/ml, range 94.9-466.7) than in those who did not meet this 8-week predictive signal of extended PFS (n = 16; median 161.9 pg/ml, range 53.3-374.8; p = 0.022, Mann-Whitney U test). Selecting a 160 pg/ml cut-off, patients with 4-week Flt3L values above (n = 21) obtained longer PFS (median of 13.6 months, 95% CI 7.6-19.7) than those with serum values below (n = 13; median PFS of 5.9 months, 95% CI 2.4-9.3; p = 0.046, log-rank test). Conclusions: High circulating Flt3L after initial short-course FLOX chemotherapy, as a proxy of invoked tumor-defeating immunity, was associated with an early radiologic signal of ICB responsiveness and improved PFS in patients with MSS-mCRC. Citation Format: Sebastian Meltzer, Kjersti Flatmark, Anniken J. Fuglestad, Hanne M. Hamre, Christian Kersten, Eva Hofsli, Marianne G. Guren, Halfdan Sorbye, Anne Negård, Anne Hansen Ree. Systemic immune response invoked by short-course oxaliplatin-based chemotherapy (FLOX) for efficacy of sequential immune checkpoint blockade (ICB; nivolumab) in microsatellite-stable (MSS) metastatic colorectal cancer (mCRC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3279.
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- 2023
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9. Clinicopathological factors associated with tumour‐specific mutation detection in plasma of patients with <scp> RAS </scp> ‐mutated or <scp> BRAF </scp> ‐mutated metastatic colorectal cancer
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Olav Dajani, Elin H. Kure, Per Pfeiffer, Bengt Glimelius, K. L.G. Spindler, Halfdan Sorbye, Ole Christian Lingjærde, Niels Pallisgaard, Tormod Kyrre Guren, Julian Hamfjord, and Kjell Magne Tveit
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Neuroblastoma RAS viral oncogene homolog ,Oncology ,Cancer Research ,medicine.medical_specialty ,biology ,Colorectal cancer ,business.industry ,Hazard ratio ,Context (language use) ,Odds ratio ,medicine.disease ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Carcinoembryonic antigen ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,biology.protein ,KRAS ,business ,Allele frequency - Abstract
Detection of tumour-specific circulating cell-free DNA in plasma (ctDNA) fails in a significant number of cases depending on the clinical context. The primary aim was to investigate clinicopathological factors associated with detection of ctDNA in patients with RAS-/BRAF-mutated metastatic colorectal cancer (mCRC) prior to first-line therapy. A secondary aim was to evaluate the prognostic impact of ctDNA compared to other biomarkers. Patients were included from the NORDIC-VII study (N = 253). ctDNA was sampled prior to treatment and analysed for hotspot tissue mutations (KRAS, NRAS and BRAF) using droplet digital PCR. Multivariable regression models were constructed to predict the probability of mutation detection and survival. Increasing radiological size of target lesions by increments of 1 cm (odds ratio (OR) = 1.18; 95% confidence interval (CI) 1.09-1.27; P < 0.001), intact primary tumour (OR = 3.17; 95% CI 1.22-8.22; P = 0.018) and more than one metastatic site (OR = 3.08; 95% CI 1.32-7.19; P = 0.009) were associated with mutation detection in plasma. Metastatic involvement of the lung was associated with non-detection (OR = 0.26; 95% CI 0.12-0.58; P = 0.001). Pre-analytical and analytical factors modulated detection. High allele frequencies of ctDNA indicated poor prognosis independently of CEA and CA19-9 (hazard ratio (HR) = 2.38; 95% CI 1.74-3.26; P < 0.001; N = 206). Clinicopathological characteristics should be carefully considered when evaluating ctDNA results from mCRC patients, especially when confronted with a plasma negative result. ctDNA may prove to be a clinically useful marker in the evaluation of mCRC treatment.
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- 2021
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10. Volumetric parameters from [ <scp> 18 F </scp> ] <scp>FDG PET</scp> / <scp>CT</scp> predicts survival in patients with high‐grade gastroenteropancreatic neuroendocrine neoplasms
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Henning Langen Stokmo, Mahmoud Aly, Inger Marie Bowitz Lothe, Austin J. Borja, Siavash Mehdizadeh Seraj, Rina Ghorpade, Xuan Miao, Geir Olav Hjortland, Eirik Malinen, Halfdan Sorbye, Thomas J. Werner, Abass Alavi, and Mona‐Elisabeth Revheim
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Cellular and Molecular Neuroscience ,Endocrinology ,Endocrine and Autonomic Systems ,Endocrinology, Diabetes and Metabolism - Published
- 2022
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11. Volumetric parameters from [
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Henning, Langen Stokmo, Mahmoud, Aly, Inger Marie, Bowitz Lothe, Austin J, Borja, Siavash, Mehdizadeh Seraj, Rina, Ghorpade, Xuan, Miao, Geir Olav, Hjortland, Eirik, Malinen, Halfdan, Sorbye, Thomas J, Werner, Abass, Alavi, and Mona-Elisabeth, Revheim
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Neuroendocrine Tumors ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Humans ,Middle Aged ,Prognosis ,Tumor Burden - Abstract
A positive fluorine-18 labelled 2-deoxy-2-fluoroglucose ([
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- 2022
12. PRRT in high-grade gastroenteropancreatic neuroendocrine neoplasms (WHO G3)
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Halfdan Sorbye, Simona Grozinsky-Glasberg, and Grace Kong
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0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Poor prognosis ,Peptide receptor ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Disease ,Neuroendocrine tumors ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Stomach Neoplasms ,Positron Emission Tomography Computed Tomography ,Internal medicine ,Intestinal Neoplasms ,medicine ,Humans ,Receptors, Somatostatin ,Radioisotopes ,Chemotherapy ,Somatostatin receptor ,business.industry ,medicine.disease ,Pancreatic Neoplasms ,Neuroendocrine Tumors ,Ki-67 Antigen ,030104 developmental biology ,030220 oncology & carcinogenesis ,Radionuclide therapy ,business ,Progressive disease - Abstract
Peptide receptor radionuclide therapy (PRRT) is an established treatment for grade 1 and 2 gastroenteropancreatic neuroendocrine tumors with an increased uptake on somatostatin receptor imaging (SRI). Patients with metastatic high-grade (WHO G3) gastroenteropancreatic neuroendocrine neoplasms (NET G3 and NEC) represent a heterogeneous subgroup with poor prognosis and standard platinum-etoposide chemotherapy have limited therapeutic benefit. However, there is promising emerging evidence supporting the effectiveness of PRRT in SRI-positive G3 disease. A review search for studies reporting on PRRT in gastroenteropancreatic neuroendocrine neoplasms G3 was performed: four studies with more than ten cases were found. PRRT was mainly given as second- or third-line treatment in patients with progressive disease. Most patients had a pancreatic primary, 50% had well-differentiated tumors, and most had a Ki-67 55%). PRRT should be considered for patients with increased uptake on SRI, both in gastroenteropancreatic NET G3 cases and as well as in NEC cases with a Ki-67 21–55%. PRRT for NEC with a Ki-67 >55% is less defined, but could be considered in highly selected cases after response to initial chemotherapy where all residual disease have high uptake on SRI. Dual tracer using 18F-FDG PET/CT and SRI provides important information for patient selection for PRRT in this heterogeneous complex high-grade disease.
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- 2020
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13. Author response for 'Plasma protein biomarkers for the detection of pancreatic neuroendocrine tumours and differentiation from small intestinal neuroendocrine tumours'
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null Espen Thiis‐Evensen, null Magnus Kjellman, null Ulrich Knigge, null Henning Gronbaek, null Camilla Schalin‐Jäntti, null Staffan Welin, null Halfdan Sorbye, null Maria del Pilar Schneider, null Roger Belusa, null E. Thiis‐Evensen, null M. Kjellman, null U. Knigge, null S. Welin, null H. Gronbaek, null H. Sorbye, null M. T. Joergensen, null A. K. Elf, null R. Belusa, null C. Schalin‐Jäntti, null M. T. Jørgensen, null H. Waldum, null J. A. Søreide, null S. Metso, null T. Ebeling, null F. Lindberg, null K. Landerholm, null G. Wallin, null F. Salem, null G. Purkalne, null I. Kudaba, null R. Janciauskiene, null T. Suuroja, null Edita Baltruškevičienė, and null The Nordic NET Biomarker Group
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- 2022
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14. Author response for 'ENETS consensus guidance for synoptic reporting of molecular imaging studies'
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Frederico Costa, Damian Wild, E. P. Krenning, B. Wiedenmann, Halfdan Sorbye, Rodney J. Hicks, Clarisse Dromain, Anders Sundin, Vikas Prasad, Lisa Bodei, A. Frilling, James R. Howe, Eric Raymond, Anna Koumarianou, W.W. de Herder, Christophe Deroose, Staffan Welin, James C. Yao, and D. O'Toole
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medicine.medical_specialty ,business.industry ,medicine ,Medical physics ,Molecular imaging ,business - Published
- 2021
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15. Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach
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Arne Oshaug, Halfdan Sorbye, Geir Hoff, Eline Aas, Paal Joranger, and Arild Nesbakken
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Male ,medicine.medical_specialty ,Survival ,Colorectal cancer ,Cost-Benefit Analysis ,Economics, Econometrics and Finance (miscellaneous) ,Markov models ,Psychological intervention ,Norwegian ,Decision Support Techniques ,Surgeries ,03 medical and health sciences ,0302 clinical medicine ,Willingness to pay ,Health care ,Chemotherapy ,Humans ,Medicine ,030212 general & internal medicine ,Intensive care medicine ,Aged ,Health economics ,Norway ,business.industry ,030503 health policy & services ,Health Policy ,Health Care Costs ,medicine.disease ,Analyse innovations ,Markov Chains ,language.human_language ,Costs ,language ,Female ,Observational study ,Quality-Adjusted Life Years ,Colorectal Neoplasms ,0305 other medical science ,business - Abstract
New and emerging advances in colorectal cancer (CRC) treatment combined with limited healthcare resources highlight the need for detailed decision-analytic models to evaluate costs, survival and quality-adjusted life years. The objectives of this article were to estimate the expected lifetime treatment cost of CRC for an average 70-year-old patient and to test the applicability and flexibility of a model in predicting survival and costs of changing treatment scenarios. The analyses were based on a validated semi-Markov model using data from a Norwegian observational study (2049 CRC patients) to estimate transition probabilities and the proportion resected. In addition, inputs from the Norwegian Patient Registry, guidelines, literature, and expert opinions were used to estimate resource use. We found that the expected lifetime treatment cost for a 70-year-old CRC patient was €47,300 (CRC stage I €26,630, II €38,130, III €56,800, and IV €69,890). Altered use of palliative chemotherapy would increase the costs by up to 29%. A 5% point reduction in recurrence rate for stages I-III would reduce the costs by 5.3% and increase overall survival by 8.2 months. Given the Norwegian willingness to pay threshold per QALY gained, society's willingness to pay for interventions that could result in such a reduction was on average €28,540 per CRC patient. The life years gained by CRC treatment were 6.05 years. The overall CRC treatment costs appear to be low compared to the health gain, and the use of palliative chemotherapy can have a major impact on cost. The model was found to be flexible and applicable for estimating the cost and survival of several CRC treatment scenarios. We acknowledge the Department of Health, Nutrition and Management (HEL), The Faculty of Health Sciences, and Oslo and Akershus University College of Applied Sciences for funding Paal Joranger’s doctorate.
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- 2019
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16. Clinicopathological factors associated with tumour-specific mutation detection in plasma of patients with RAS-mutated or BRAF-mutated metastatic colorectal cancer
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Julian, Hamfjord, Tormod Kyrre, Guren, Bengt, Glimelius, Halfdan, Sorbye, Per, Pfeiffer, Olav, Dajani, Ole Christian, Lingjaerde, Kjell Magne, Tveit, Niels, Pallisgaard, Karen-Lise Garm, Spindler, and Elin H, Kure
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Male ,Proto-Oncogene Proteins B-raf ,Lung Neoplasms ,Membrane Proteins ,Prognosis ,Survival Analysis ,Circulating Tumor DNA ,GTP Phosphohydrolases ,Proto-Oncogene Proteins p21(ras) ,Logistic Models ,Gene Frequency ,Mutation ,Biomarkers, Tumor ,Humans ,Female ,Colorectal Neoplasms - Abstract
Detection of tumour-specific circulating cell-free DNA in plasma (ctDNA) fails in a significant number of cases depending on the clinical context. The primary aim was to investigate clinicopathological factors associated with detection of ctDNA in patients with RAS-/BRAF-mutated metastatic colorectal cancer (mCRC) prior to first-line therapy. A secondary aim was to evaluate the prognostic impact of ctDNA compared to other biomarkers. Patients were included from the NORDIC-VII study (N = 253). ctDNA was sampled prior to treatment and analysed for hotspot tissue mutations (KRAS, NRAS, and BRAF) using droplet digital PCR. Multivariable regression models were constructed to predict the probability of mutation detection and survival. Increasing radiological size of target lesions by increments of 1 cm (odds ratio [OR] = 1.18; 95% confidence interval [CI] 1.09-1.27; P .001), intact primary tumour (OR = 3.17; 95% CI 1.22-8.22; P = .018) and more than one metastatic site (OR = 3.08; 95% CI 1.32-7.19; P = .009) were associated with mutation detection in plasma. Metastatic involvement of the lung was associated with non-detection (OR = 0.26; 95% CI 0.12-0.58; P = .001). Preanalytical and analytical factors modulated detection. High allele frequencies of ctDNA indicated poor prognosis independently of CEA and CA19-9 (hazard ratio [HR] = 2.38; 95% CI 1.74-3.26; P .001; N = 206). Clinicopathological characteristics should be carefully considered when evaluating ctDNA results from mCRC patients, especially when confronted with a plasma negative result. ctDNA may prove to be a clinically useful marker in the evaluation of mCRC treatment.
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- 2021
17. Surgery of the primary tumour in 201 patients with high‐grade gastroenteropancreatic neuroendocrine and mixed neuroendocrine‐non‐neuroendocrine neoplasms
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Eva Tiensuu Janson, Morten Ladekarl, Kirstine Nielsen, Renate Galleberg, Geir Olav Hjortland, Seppo W. Langer, Carsten Palnæs Hansen, Ulrich Knigge, Andreas Kjaer, Birgitte Federspiel, Halfdan Sorbye, Hans-Christian Pommergaard, Anna Sundlöv, Lene Weber Vestermark, Elizaveta Mitkina Tabaksblat, Herish Garresori, and Pauline Knigge
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Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Rectum ,030209 endocrinology & metabolism ,surgery ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Endocrinology ,Stomach Neoplasms ,Intestinal Neoplasms ,Humans ,Medicine ,Stage (cooking) ,Aged ,Aged, 80 and over ,Performance status ,Endocrine and Autonomic Systems ,business.industry ,Proportional hazards model ,Stomach ,Gallbladder ,neuroendocrine carcinoma ,Middle Aged ,Anal canal ,Prognosis ,Confidence interval ,Surgery ,Pancreatic Neoplasms ,Survival Rate ,Neuroendocrine Tumors ,Treatment Outcome ,medicine.anatomical_structure ,gastroenteropancreatic neuroendocrine tumours ,Female ,business ,030217 neurology & neurosurgery - Abstract
The benefit of surgery in high-grade gastroenteropancreatic neuroendocrine neoplasms (GEP NEN) and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) is uncertain. The present study aimed to investigate outcomes after tumour surgery in patients with high-grade (Ki-67 > 20%) GEP NEN or MiNEN stage I-III or stage IV. We analysed data from patients treated in the period 2007-2015 at eight Nordic university hospitals. Overall survival (OS) and progression-free survival (PFS)/disease-free survival (DFS) were analysed by Kaplan-Meier estimates. Prognostic factors were evaluated using Cox regression. We included 201 surgically resected patients, 143 stage I-III and 58 stage IV, with 68% having neuroendocrine carcinoma, 23% MiNEN, 5% neuroendocrine tumour G3 and 4% uncertain NEN G3. Primary tumours were located in colon/rectum (52%), oesophagus/cardia (19%), pancreas (10%), stomach (7%), jejunum/ileum (5%), duodenum (4%), gallbladder (2%) and anal canal (1%). For patients with stage I-III, median DFS was 12 months (95% confidence interval [CI] = 5.5-18.5) and median OS was 32 months (95% CI = 24.0-40.0). For patients with stage I-III and an R0 resection, median DFS was 21 months (95% CI = 4.9-37.1) and median OS was 39 months (95% CI = 25.0-53.0). For patients with stage IV, median PFS/DFS was 4 months (95% CI = 1.9-6.1) and median OS was 11 months (95% CI = 4.8-17.2). For patients with stage IV and an R0 resection, median DFS was 6 months (95% CI = 0-16.4) and median OS was 32 months (95% CI = 25.5-38.5). Performance status > 1 and colorectal primary were associated with poor prognosis. There was no difference in survival between patients with high-grade GEP NEN and MiNEN. Surgery of the primary tumour in patients with loco-regional high-grade GEP NEN or MiNEN led to good long-term results and should be considered if an R0 resection is considered achievable. Highly selected patients with stage IV disease may also benefit from surgery.
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- 2021
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18. Abstract 522: Immunogenic chemotherapy and immune checkpoint inhibition (ICI) in microsatellite-stable (MSS) metastatic colorectal cancer (mCRC): Biomarkers indicative of durable treatment response
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Christian Kersten, Hanne Hamre, Christin Johansen, Halfdan Sorbye, Kathrine Røe Redalen, Anne Negård, Eva Hofsli, Marianne Grønlie Guren, Kine Mari Bakke, Anne Hansen Ree, Kjersti Flatmark, and Sebastian Meltzer
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Oncology ,Cancer Research ,medicine.medical_specialty ,Chemotherapy ,business.industry ,Colorectal cancer ,medicine.medical_treatment ,Cancer ,Disease ,medicine.disease ,Immune checkpoint ,Oxaliplatin ,Regimen ,Internal medicine ,medicine ,Nivolumab ,business ,medicine.drug - Abstract
Purpose: Cancer immune therapy has revolutionized patient outcome for the small mCRC subgroup with highly immunogenic disease. The majority of mCRC cases, however, are MSS with inherently low susceptibility to immune therapy. In our ongoing METIMMOX study (NCT03388190), MSS-mCRC patients are randomized to oxaliplatin-based immunogenic chemotherapy followed by ICI (experimental study arm) or the oxaliplatin-based standard-of-care (control arm). A subgroup of experimental arm patients has obtained durable major partial or complete responses. Such remarkable outcomes call for biomarkers that may help identifying MSS-mCRC patients who will benefit from such sequential therapy. Experimental procedures: Study enrollment began August 2018. Patients with unresectable, previously untreated MSS-mCRC have been randomized to the Nordic FLOX regimen (standard-of-care) or repeat sequential 2 FLOX cycles and 2 cycles of nivolumab (240 mg Q2W). At analysis October 2020, 48 patients were evaluable for progression-free survival (PFS). Serum collected at baseline and after the first 2 FLOX and 2 nivolumab cycles were analyzed for 42 immune factors with the Luminex multiplex immunoassay. The Significance Analysis for Microarrays method was applied to select the most significant proteins. Diffusion-weighted magnetic resonance imaging (DW-MRI) of the liver was performed at baseline and after the first 2 FLOX cycles. Using a b-value of 1000 s/mm2, the intensity ratio of a representative metastatic lesion relative to normal parenchymal tissue in the liver was calculated at each recording. Results: At this early time of analysis, with median follow-up of 8.6 (range, 1-21) months, median PFS for the entire groups of control and experimental arm patients was identical (6.4 and 6.6 months, respectively). We selected 13 experimental arm patients with long (median 13.6 months) or short (median 5.6 months) PFS for the serum protein analysis and 9 patients with liver DW-MRI. High serum CD40L levels (> median 47.6 ng/ml) at baseline or CD23 levels (> median 15.7 ng/ml) after the first 2 FLOX and 2 nivolumab cycles were both associated with improved PFS (p < 0.001 and p < 0.007; log-rank test). The baseline DW-MRI intensity of the peripheral hyperintense rim of the metastatic lesion (2.0- to 2.8-fold higher than the corresponding parenchymal value) diminished towards the parenchymal intensity (1.2- to 1.6-fold higher) after the first 2 FLOX cycles in patients with longer PFS than the median for all study patients. The rim intensity did not change in patients with short PFS. Conclusions: Three potential response markers in serum or at DW-MRI (one at baseline, one following the induction immunogenic chemotherapy, and one following the subsequent ICI) were identified for MSS-mCRC at this early time of the METIMMOX study conduct. Citation Format: Anne Hansen Ree, Sebastian Meltzer, Kine M. Bakke, Hanne M. Hamre, Christian Kersten, Eva Hofsli, Marianne Grønlie Guren, Halfdan Sorbye, Christin Johansen, Anne Negård, Kathrine Røe Redalen, Kjersti Flatmark. Immunogenic chemotherapy and immune checkpoint inhibition (ICI) in microsatellite-stable (MSS) metastatic colorectal cancer (mCRC): Biomarkers indicative of durable treatment response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 522.
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- 2021
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19. 1100MO Molecular characteristics of high-grade gastroenteropancreatic neuroendocrine neoplasms
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Johanna Svensson, Inger Marie Bowitz Lothe, Stian Knappskog, Christian Kersten, Halfdan Sorbye, Anna Sundlöv, Andreas Venizelos, Geir Olav Hjortland, Merete Krogh, Sönke Detlefsen, Hege Elvebakken, Aurel Perren, and H. Garresori
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Oncology ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Hematology ,business - Published
- 2021
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20. SO-13 KRAS-G12C mutations in a Nordic cohort of 1441 metastatic colorectal cancer patients
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Bengt Glimelius, Ari Ristimäki, Annamarja Lamminmäki, T. Kuopio, Eetu Heervä, Annika Ålgars, Raija Ristamäki, Per Pfeiffer, Helena Isoniemi, Jari Sundström, T. Salminen, T. Muhonen, Raija Kallio, P. Halonen, Soili Kytölä, E. Osterlund, Pia Österlund, Leena-Maija Soveri, Halfdan Sorbye, L. Nunes, M. Keinänen, and K. Pulkkanen
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Oncology ,0303 health sciences ,medicine.medical_specialty ,Colorectal cancer ,business.industry ,Hematology ,medicine.disease_cause ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Cohort ,medicine ,KRAS ,business ,030304 developmental biology - Published
- 2021
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21. Patient reported symptoms, coping and quality of life during somatostatin analogue treatment for metastatic small- intestinal neuroendocrine tumours
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Espen Thiis-Evensen, Simen Myhre, Liv Sylvi Meyer, Halfdan Sorbye, and Kjersti Elisabeth Mordal
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Vitamin ,Adult ,Male ,Quality of life ,medicine.medical_specialty ,Coping (psychology) ,Population ,Small-intestinal neuroendocrine tumour ,lcsh:Computer applications to medicine. Medical informatics ,Somatostatin analogue ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Surveys and Questionnaires ,Adaptation, Psychological ,Intestinal Neoplasms ,medicine ,Vitamin D and neurology ,Humans ,030212 general & internal medicine ,Patient Reported Outcome Measures ,Prospective Studies ,education ,Prospective cohort study ,Aged ,Abdominal discomfort ,education.field_of_study ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,General Medicine ,Middle Aged ,Patient reported symptoms ,Somatostatin Analogue ,Neuroendocrine Tumors ,chemistry ,030220 oncology & carcinogenesis ,lcsh:R858-859.7 ,Female ,medicine.symptom ,Coping ,business ,Flatulence ,Somatostatin - Abstract
Background Patients with metastatic small-intestinal neuroendocrine tumours (NET) have been shown to have a reduced quality of life compared to the general population and many have disabling symptoms during somatostatin analogue (SSA) treatment. The aim of this prospective study was to document the patient-reported symptoms, coping and quality of life during SSA treatment and to measure patients’ fat-soluble vitamin levels. Methods Patients with metastatic small-intestinal NET on treatment with long-acting SSA were included. Data on patient characteristics, blood samples, questionnaires (EORTC-QLQ-C30 and GI.NET-21) and structured patient interviews were collected at inclusion and after 1 year. Results Eighty-eight patients were included, 77 (88%) attended 1 year follow-up. Approximately 50% of patients reported symptoms, the most common symptoms at baseline and after 1 year follow-up were diarrhoea, flatulence, fatigue, abdominal discomfort and sore injection lumps. Diarrhoea and fatigue were reported as their main complaint, 23% had > 5 daily episodes of diarrhoea and 59% reported fatigue. However, patients reported a high perceived quality of life, high daily activity, coped with their symptoms and managed their daily life well. Deficiency of vitamin D (27%) and A (13%) were observed. Conclusions Patients with metastatic small-intestinal NET on SSA treatment reported a high frequency of symptoms. Minor improvements were seen after 1-year of follow-up, illustrating that many symptoms might be difficult to improve, or may not be recognised by the health service. Patients, however, generally reported a high quality of life. Care for NET patients on SSA treatment should include a regular systematic symptom registration and vitamin measurements.
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- 2020
22. Pivotal phase III COMPOSE trial will compare 177Lu-edotreotide with best standard of care for well-differentiated aggressive grade 2 and grade 3 gastroenteropancreatic neuroendocrine tumors
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Thorvardur Ragnar Halfdanarson, Diane Lauren Reidy, Namrata Vijayvergia, Daniel M. Halperin, Grace Goldstein, Grace Kong, Michael Michael, Simone Leyden, Simona Grozinsky-Glasberg, Halfdan Sorbye, Kjell E. Oberg, Cristina Sierras, and Philip Harris
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Cancer Research ,Oncology - Abstract
TPS514 Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs), which represent approximately 70% of NETs, frequently develop metastatic disease with limited treatment options. Current standard therapies for well-differentiated high grade 2 and grade 3 GEP-NETs include cytoreductive procedures, somatostatin analogues, molecular targeted therapies (everolimus or sunitinib), chemotherapy and peptide receptor radionuclide therapy (PRRT), with no specified sequence of use. PRRT may stabilize disease and induce objective tumor responses. This treatment uses radiolabeled somatostatin analogues to selectively target somatostatin receptor expressing (SSTR+) tumor cells. 177Lu-edotreotide is an innovative radiolabeled somatostatin analogue with a favorable safety profile and promising efficacy. Retrospective data in metastatic GEP-NETs treated with two or more 177Lu-edotreotide cycles demonstrated a progression free survival (PFS) of at least 30 months. The currently recruiting Phase III COMPETE trial compares the efficacy and safety of 177Lu-edotreotide, versus everolimus, in grade 1 and grade 2 GEP-NETs. Methods: COMPOSE (NCT04919226) is a prospective, randomized, controlled, open-label, multi-center Phase III study, in patients with well-differentiated high grade 2 and grade 3 (Ki-67 index 15−55%), SSTR+, GEP-NETs. This trial is to evaluate the efficacy, safety and patient-reported outcomes of first- or second-line treatment with 177Lu-edotreotide PRRT compared to best standard of care. It aims to randomize 202 patients 1:1 to a defined number of cycles of 177Lu-edotreotide or an active comparator (either chemotherapy [CAPTEM or FOLFOX] or everolimus, according to investigator´s choice). The primary endpoint is PFS, assessed every 12 weeks until disease progression (RECIST v1.1), or death, whichever occurs earlier. Secondary outcomes include overall survival, assessed up to 2 years after disease progression. Study recruitment for COMPOSE commenced in September 2021. It is expected that COMPOSE will inform optimal treatment options for patients with well-differentiated high grade 2 and grade 3 SSTR+ GEP-NETs, including for first-line therapy. Clinical trial information: NCT04919226.
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- 2022
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23. The Problem of High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms
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Aurel Perren, Eric Baudin, and Halfdan Sorbye
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0301 basic medicine ,business.industry ,Endocrinology, Diabetes and Metabolism ,Poorly differentiated ,Clinical course ,Neuroendocrine tumors ,medicine.disease ,Primary tumor ,Well differentiated ,Neuroendocrine Carcinomas ,stomatognathic diseases ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Endocrinology ,030220 oncology & carcinogenesis ,medicine ,Cancer research ,Stage (cooking) ,business ,Clinical treatment - Abstract
High-grade gastroenteropancreatic neuroendocrine neoplasms are well-differentiated neuroendocrine tumors or poorly differentiated small/large cell neuroendocrine carcinoma. Distinguishing these entities relies on different genetic backgrounds and resulting different biology. The new classification creates several problems. Almost all clinical treatment data on neuroendocrine neoplasms do not stratify between well and poorly differentiated, providing insufficient help in treatment selection. Treatment of gastroenteropancreatic neuroendocrine neoplasms should separate between well-differentiated neuroendocrine tumors and neuroendocrine carcinoma, and depends on primary tumor site, stage, proliferation rate, and clinical course. This article addresses how to diagnose and treat gastroenteropancreatic neuroendocrine neoplasms, focusing on well-differentiated neuroendocrine tumors versus neuroendocrine carcinomas.
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- 2018
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24. Abstracts
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Staffan Welin, Becker Kj, U. Knigge, T. Ström, Magnus Kjellman, Viktor Johanson, Henning Grønbæk, Metso Si, Roger Belusa, Halfdan Sorbye, Espen Thiis-Evensen, and Maiken Thyregod Joergensen
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endocrine system ,medicine.medical_specialty ,biology ,Endocrine and Autonomic Systems ,business.industry ,Endocrinology, Diabetes and Metabolism ,Chromogranin A ,030209 endocrinology & metabolism ,Kallikrein ,Blood proteins ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Endocrinology ,Small Intestinal Neuroendocrine Tumor ,Internal medicine ,biology.protein ,Medicine ,Biomarker (medicine) ,business ,Somatostatin analog - Abstract
Plasma Protein Kallikrein-14 Strongly Predicts Pronounced Chromogranin A (CgA) Response in Small Intestinal Neuroendocrine Tumor (NET) Patients after Somatostatin Analog (SSA) Treatment : The Nordic EXPLAIN Biomarker Study
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- 2018
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25. 1108P Folfirinox in the treatment of advanced gastroenteropancreatic neuroendocrine carsinomas
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Geir Olav Hjortland, M.E. Revheim, E. Mitkina Tabaksblat, H.L. Stokmo, B.P. Butt, Morten Ladekarl, and Halfdan Sorbye
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Oncology ,medicine.medical_specialty ,FOLFIRINOX ,business.industry ,Internal medicine ,medicine ,Hematology ,business - Published
- 2021
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26. SO-15 Quality of life and physical functioning in older patients with metastatic colorectal cancer receiving palliative chemotherapy: The randomized NORDIC9-study
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Pia Österlund, Gabor Liposits, Bengt Glimelius, Hella Skuladottir, Laurids Østergaard Poulsen, Sören Möller, Åke Berglund, Halfdan Sorbye, Camilla Qvortrup, Per Pfeiffer, Eva Hofsli, Carl-Henrik Shah, Henrik Eshøj, Stine Braendegaard Winther, and Jesper Ryg
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medicine.medical_specialty ,Colorectal cancer ,business.industry ,Combination chemotherapy ,Hematology ,medicine.disease ,3. Good health ,Oxaliplatin ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Geriatric oncology ,Quality of life ,Randomized controlled trial ,Interquartile range ,law ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Clinical endpoint ,030212 general & internal medicine ,business ,medicine.drug - Abstract
Quality of life data from randomized trials are lacking in older patients with metastatic colorectal cancer (mCRC). In the randomized NORDIC9-study, reduced-dose S1+oxaliplatin (SOx) showed superior efficacy compared to full-dose S1 monotherapy. We hypothesized that treatment with SOx does not result in inferior quality of life. Patients with mCRC aged ≥70 years and that were not a candidate for standard combination chemotherapy were included and randomly assigned to receive either S1 or SOx. The EORTC QLQ-C30 questionnaire was completed at baseline, after 9, and 18 weeks. The primary endpoint was global Quality of Life (QoL) at 9 weeks. For statistical analysis, a non-inferiority design was chosen applying linear mixed effects models for repeated measurements. The results were interpreted according to statistical significance and anchor-based, clinically relevant between-group minimally important differences (MID). A total of 160 patients aged (median (Interquartile range (IQR))) 78 years (76-81) were included. The QLQ-C30 questionnaire was completed by 150, 100, and 60 patients at baseline, at 9, and 18 weeks, respectively. The difference at 9 weeks in global QoL was 6.85 (95%CI-1.94; 15.65) and 7.37 (0.70; 14.05) in the physical functioning domain in favor of SOx exceeding the threshold for MID. At 18 weeks, the between-group MID in physical functioning was preserved. Dose-reduced combination chemotherapy may be recommended in vulnerable older patients with mCRC, rather than full-dose monotherapy.
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- 2021
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27. Comparative study of lung and extrapulmonary poorly differentiated neuroendocrine carcinomas: A SEER database analysis of 162,983 cases
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Halfdan Sorbye, James C. Yao, Kathan Mehta, Lauren Averett Byers, and Arvind Dasari
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0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Prognostic variable ,business.industry ,Incidence (epidemiology) ,Large cell ,Cancer ,medicine.disease ,Cell morphology ,Gastroenterology ,Primary tumor ,digestive system diseases ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Internal medicine ,Epidemiology ,medicine ,business ,Survival rate - Abstract
BACKGROUND Extrapulmonary neuroendocrine carcinomas (NECs) are poorly studied and are managed similar to lung NECs, which may not account for differences between the 2 groups of tumors as well as the heterogeneity within extrapulmonary NEC. METHODS Data from the Surveillance, Epidemiology, and End Results program between 1973 and 2012 were used to estimate the relative percentages of lung NECs and subgroups of extrapulmonary NECs, epidemiological patterns at these sites, and the median and 5-year overall survival rates. RESULTS Of 162,983 NEC cases, 14,732 were extrapulmonary; of these, 5509 were gastrointestinal (37.44%), 4151 were of unknown primary (28.2%), and 5072 were of other sites (34.4%). Lung NEC had the highest percentage of small cell morphology (95.2%) and gastrointestinal NEC had the least (38.7%), with the rest being other morphologies. Significant differences were noted with regard to median age (range, 48-74 years), percentage of cases of distant stage disease (24%-77%), and incidence according to sex and race. The median survival of patients with lung NEC was 7.6 months, that for patients with gastrointestinal NEC was 7.5 months (range, 25.1 months for NEC at the small intestine to 5.7 months for NEC at the pancreas), and that for patients with unknown NEC was 2.5 months. The 5-year survival rate for patients with local stage disease ranged from 58% to 60% for NECs of the female genital tract and small intestine to 25% for esophageal NECs. The primary tumor site remained statistically significant for survival even after adjusting for known prognostic variables (P
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- 2017
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28. Cetuximab in treatment of metastatic colorectal cancer: final survival analyses and extended RAS data from the NORDIC-VII study
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Maria Thomsen, Per Pfeiffer, Fridbjorn Sigurdsson, Inger Marie Bowitz Lothe, Bengt Glimelius, Pia Österlund, Kjell Magne Tveit, Eva Skovlund, Elin H. Kure, Halfdan Sorbye, Tormod Kyrre Guren, Thoralf Christoffersen, and Astrid M. Dalsgaard
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Male ,0301 basic medicine ,Oncology ,Cancer Research ,Organoplatinum Compounds ,Colorectal cancer ,DNA Mutational Analysis ,Leucovorin ,Cetuximab ,Kaplan-Meier Estimate ,chemotherapy ,GTP Phosphohydrolases ,0302 clinical medicine ,cetuximab ,Antineoplastic Combined Chemotherapy Protocols ,5-fluorouracil ,Neoplasm Metastasis ,Middle Aged ,Survival Rate ,Fluorouracil ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,population characteristics ,Female ,medicine.drug ,Adult ,Proto-Oncogene Proteins B-raf ,medicine.medical_specialty ,colorectal cancer ,Disease-Free Survival ,BRAF ,Proto-Oncogene Proteins p21(ras) ,Young Adult ,03 medical and health sciences ,Folinic acid ,Breast cancer ,Internal medicine ,FLOX ,Journal Article ,medicine ,Humans ,neoplasms ,Survival rate ,Aged ,Proportional Hazards Models ,Cancer och onkologi ,Rectal Neoplasms ,business.industry ,oxaliplatin ,Membrane Proteins ,medicine.disease ,digestive system diseases ,Oxaliplatin ,030104 developmental biology ,Cancer and Oncology ,Clinical Study ,business ,RAS - Abstract
BACKGROUND: The NORDIC-VII study is a randomised phase III trial of cetuximab plus continuous or intermittent fluorouracil, folinic acid, and oxaliplatin (Nordic FLOX) vs FLOX alone in first-line treatment of metastatic colorectal cancer. The present report presents an updated and final survival analysis with BRAF and extended RAS mutational status, 5 years after the primary analysis.METHODS: A total of 566 patients were included in the intention-to-treat (ITT) population of the NORDIC-VII study. Updated survival status was obtained from 176 patients who were alive in the primary survival analyses. Samples from 223 tumours previously found to be KRAS (exon 2) and BRAF (V600E) wild-type, were re-analysed for KRAS (exons 3 and 4) and NRAS (exons 2-4) mutations.RESULTS: Including the extended RAS analyses, RAS and BRAF mutational status was available from 457 patients (81% of the ITT population). RAS was mutated in 46% and BRAF in 12% of the tumours. RAS and BRAF, if mutated, were negative prognostic factors. The updated analyses confirmed the finding of the primary report that cetuximab did not provide any additional benefit when added to FLOX in patients with RAS/BRAF wild-type tumours, neither on progression-free nor overall survival. However, the outcomes in a subset of patients, which, after the first eight treatment cycles, received cetuximab alone, suggested a beneficial effect of cetuximab monotherapy.CONCLUSIONS: Adding cetuximab to Nordic FLOX did not provide any clinical benefit, but the data suggested an effect of cetuximab monotherapy in patients with RAS/BRAF wild-type tumours in the NORDIC-VII cohort. The data were compatible with a negative interaction between cetuximab and the Nordic FLOX chemotherapy backbone.
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- 2017
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29. 485P Link between PODXL and the EGFR axis in metastatic colorectal cancer and in vitro: Implications for improved treatment stratification
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Christina Siesing, Kristine Aasebø, Fredrik Pontén, Karin Jirström, Halfdan Sorbye, Emelie Karnevi, Björn Nodin, A. Petersson, Jakob Eberhard, Per Pfeiffer, C. Qvortrup, Anders Larsson, and Bengt Glimelius
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Oncology ,medicine.medical_specialty ,business.industry ,Colorectal cancer ,Internal medicine ,Medicine ,Stratification (water) ,Hematology ,business ,medicine.disease - Published
- 2020
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30. CDX2: A Prognostic Marker in Metastatic Colorectal Cancer Defining a Better
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Kristine, Aasebø, Anca, Dragomir, Magnus, Sundström, Artur, Mezheyeuski, Per-Henrik, Edqvist, Geir Egil, Eide, Fredrik, Ponten, Per, Pfeiffer, Bengt, Glimelius, and Halfdan, Sorbye
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caudal type homeobox transcription factor ,Oncology ,stage 4 colorectal cancer ,CDX2 ,embryonic structures ,colorectal cancer ,prognosis ,metastatic disease ,population based ,digestive system diseases ,Original Research - Abstract
Background: Survival of metastatic colorectal cancer (mCRC) patients has improved, but mainly for trial patients. New predictive and prognostic biomarkers validated in the general mCRC population are needed. Caudal-type homeobox 2 (CDX2) is an intestine-specific transcription factor with potential prognostic and predictive effect, but the importance in mCRC has not been fully investigated. Methods: Immunohistochemistry analysis of CDX2 was performed in a Scandinavian population-based cohort of mCRC (n = 796). Frequency, clinical and tumor characteristics, response rate, progression-free survival, and overall survival (OS) were estimated. Results: Loss of CDX2 expression was found in 87 (19%) of 452 stained cases, in 53% if BRAF mutated (BRAFmut) and in 9% if KRAS mutated (KRASmut). CDX2 loss was associated with microsatellite instability, BRAFmut, and poor differentiation and inversely associated with KRASmut. Patients with CDX2 loss received less first-line (53 vs. 64%, p = 0.050) and second-line (23 vs. 39%, p = 0.006) chemotherapy and secondary surgery (1 vs. 9%, p = 0.019). Median progression-free survival and OS for patients given first-line combination chemotherapy was 4 and 10 months if CDX2 loss vs. 9 and 24 months if CDX2 expressed (p = 0.001, p < 0.001). Immediate progression on first-line combination chemotherapy was seen in 35% of patients with CDX2 loss vs. 10% if CDX2 expressed (p = 0.003). Median OS in patients with BRAFmut or KRASmut and CDX2 expressed in tumor (both 21 months) was comparable to wild-type patients (27 months). However, if CDX2 loss, median OS was only 8 and 11 months in BRAFmut and KRASmut cases, respectively, and 10 months in double wild-type patients. In multivariate analysis, CDX2 loss (hazard ratio: 1.50, p = 0.027) and BRAFmut (hazard ratio: 1.62, p = 0.012) were independent poor prognostic markers for OS. Conclusion: In a population-based cohort of mCRC patients, CDX2 loss is an independent poor prognostic marker. Expression of CDX2 defines a new subgroup of BRAFmut cases with a much better prognosis. Loss of CDX2 defines a small group of KRASmut cases with a worse prognosis. Patients with CDX2 loss receive less palliative chemotherapy with less benefit and rarely reach secondary surgery.
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- 2019
31. A role for radionuclide therapy for high-grade NETs
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Halfdan Sorbye
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medicine.medical_specialty ,business.industry ,Radionuclide therapy ,Medicine ,Radiology ,business - Published
- 2019
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32. Prospective Study of Chromogranin A as a Predictor of Progression in Patients with Pancreatic, Small-Intestinal, and Unknown Primary Neuroendocrine Tumors
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Gitte Dam, Dyveke Ebbesen, Halfdan Sorbye, Henning Grønbæk, Eva Tiensuu Janson, Anders Sundin, Ulrich Knigge, Claus Jensen, Björn Paulsson, and Espen Thiis Evensen
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Adult ,Male ,endocrine system ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Neuroendocrine tumors ,Gastroenterology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Endocrinology ,Internal medicine ,Post-hoc analysis ,Intestinal Neoplasms ,medicine ,Biomarkers, Tumor ,Humans ,Prospective Studies ,Gastroenteropancreatic neuroendocrine tumors ,Prospective cohort study ,Rank correlation ,Aged ,Aged, 80 and over ,biology ,Endocrine and Autonomic Systems ,business.industry ,Chromogranin A ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Neuroendocrine Tumors ,Cross-Sectional Studies ,Tumor progression ,biology.protein ,Disease Progression ,Biomarker (medicine) ,Neoplasms, Unknown Primary ,Female ,business ,Biomarkers - Abstract
Background: Retrospective studies are conflicting but most of them report that an increase in plasma chromogranin A (CgA) predicts tumor progression in neuroendocrine tumor (NET) patients. Prospectively, we investigated if a change in plasma CgA is associated with tumor burden changes in NET patients with disseminated disease. Methods: We included 239 patients treated at 5 NET centers from December 2010 to December 2013. CgA was measured within 6 weeks of a CT or MRI in a patient undergoing at least 2 scan examinations performed over a period of 1–24 months. In a post hoc analysis, CgA measured 3–6 months prior to the CT/MRI was analyzed. Changes in tumor size were evaluated by RECIST1.1. A 25% change in CgA was chosen to discriminate between increased, decreased, or unchanged levels. Results: In 671 events (2 CT/MRI scans and 2 corresponding CgA measurements), we found a weak positive correlation between the RECIST 1.1 responses and change in plasma CgA from baseline (Spearman’s rank correlation coefficient: 0.15; p < 0.05). Of 304 events in the post hoc analysis, 58 showed progression, 228 showed stable disease, and 18 showed regression, with a median change in CgA of 19% (IQR: 57 to –20%), –12% (23 to –38%), and –73% (–55 to –83%), respectively. The correlation coefficient for all sites was 0.17 (p = 0.003), and it was 0.16 (p = 0.07), 0.18 (p = 0.04), and 0.20 (p = 0.21) for small-intestinal (n = 137), pancreatic (n = 123), and unknown primary NET (n = 40), respectively. In the 58 patients showing tumor progression, the sensitivity and specificity of an increased CgA concentration were 36 and 82%, respectively, with positive and negative predictive values of 32 and 85%. Conclusions: In this prospective study of gastroenteropancreatic NET patients, we observed only a weak association between a change in plasma CgA and changes in tumor burden. CgA as a single biomarker was thus inadequate to predict tumor progression.
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- 2019
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33. Ekspertpanel for ny vurdering ved alvorlig sykdom
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Halfdan Sorbye
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Text mining ,business.industry ,medicine ,MEDLINE ,General Medicine ,Medical emergency ,medicine.disease ,business - Published
- 2019
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34. Metastatic colorectal carcinomas with high SATB2 expression are associated with better prognosis and response to chemotherapy: a population-based Scandinavian study
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Fredrik Pontén, Magnus Sundström, Per Pfeiffer, Per-Henrik Edqvist, Bengt Glimelius, Anca Dragomir, Ulf Thunberg, Camilla Qvortrup, Halfdan Sorbye, and Artur Mezheyeuski
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Response to therapy ,Colorectal cancer ,medicine.medical_treatment ,Antineoplastic Agents ,Population based ,Scandinavian and Nordic Countries ,030218 nuclear medicine & medical imaging ,Unmet needs ,Cohort Studies ,Proto-Oncogene Proteins p21(ras) ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Neoplasm Metastasis ,Aged ,Aged, 80 and over ,Chemotherapy ,business.industry ,Clinical Laboratory Medicine ,Immunochemistry ,Hematology ,General Medicine ,Matrix Attachment Region Binding Proteins ,Middle Aged ,medicine.disease ,Prognosis ,digestive system diseases ,Klinisk laboratoriemedicin ,030220 oncology & carcinogenesis ,Mutation ,Female ,raf Kinases ,business ,Colorectal Neoplasms ,Cohort study ,Transcription Factors - Abstract
Background: Survival and response to therapy in patients with metastatic colorectal cancer (mCRC) are very heterogeneous. There is an unmet need for better markers of prognosis and treatment benefit for mCRC patients. The homeobox 2 gene SATB2 has a highly specific expression in colorectal tissue and is associated with better prognosis in non-metastatic CRC. Material and methods: A population-based cohort of 798 mCRC patients was analysed. From primary tumour material, protein expression was assessed by immunohistochemistry. BRAF and KRAS mutation status was also determined. Associations with clinicopathological data, overall and progression-free survival and response to first-line chemotherapy were analysed. Results: Tumour tissue and clinical data were available from 467 patients. SATB2 was strongly expressed in 58% of cases, significantly more in left-sided, low-grade and wild-type BRAF tumours. Patients with high SATB2 tumours had longer overall survival compared with low SATB2 tumours (median 13 vs 8 months respectively, p
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- 2019
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35. Repeat sequential oxaliplatin-based chemotherapy (FLOX) and nivolumab versus FLOX alone as first-line treatment of microsatellite-stable (MSS) metastatic colorectal cancer (mCRC): Initial results from the randomized METIMMOX study
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Christian Kersten, Christin Johansen, Anne Negård, Kjersti Flatmark, Anne Hansen Ree, Eva Hofsli, Hanne Hamre, Sebastian Meltzer, Marianne Grønlie Guren, and Halfdan Sorbye
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Oncology ,Cancer Research ,medicine.medical_specialty ,Chemotherapy ,business.industry ,Colorectal cancer ,medicine.medical_treatment ,Disease ,medicine.disease ,Immune checkpoint ,Blockade ,Oxaliplatin ,Internal medicine ,FLOX ,Medicine ,Nivolumab ,business ,medicine.drug - Abstract
3556 Background: Immune checkpoint blockade (ICB) has revolutionized patient outcome for the small mCRC subgroup with highly immunogenic disease. The majority of mCRC cases, however, are MSS without innate ICB susceptibility. In our ongoing METIMMOX study, we hypothesize that MSS mCRC can be transformed into an immunogenic condition by short-course oxaliplatin-based therapy (FLOX), enabling patients with unresectable, previously untreated metastases to obtain durable disease control when adding ICB therapy. Here we present the protocol-planned interim analysis. Methods: Eligibility criteria include infradiaphragmatic metastasis and C-reactive protein < 60 mg/L. At analysis 15 January 2021, 54 patients stratified according to primary tumor sidedness and mutational status and evaluable for the primary end point (progression-free survival; PFS) had been randomly assigned to a standard-of-care schedule of 8 FLOX cycles Q2W (control arm) or repeat sequential 2 FLOX cycles and 2 nivolumab cycles (240 mg Q2W) to a total of 8 cycles (experimental arm), for both arms before treatment break until disease progression and reintroduction of a new treatment sequence. Radiologic response assessment is every 8 weeks. Safety, tolerability, objective response rate, and duration of response are among secondary end points. Results: At median follow-up of 6.4 (range, 0.5-20) months, patients were well balanced between the treatment arms with regard to the predefined strata and single-organ or multiple-organ metastases. Median PFS for the entire groups of control and experimental arm patients was 5.6 (range, 0.5-15; n = 26) and 6.6 (range, 0.5-20; n = 28) months, respectively. The number of FLOX-related CTCAE grade 3 or higher adverse events, including 2 deaths after initial FLOX administration, was comparable in the two arms. Twelve immune-related grade 3-4 adverse events (no new safety signals) were recorded. In the experimental arm, 4 (16%) patients, all RAS/BRAF-mutant cases, had experienced complete response and 9 (32%) patients had ongoing objective response at 8 months. The control arm cases had 0 with complete response and 6 (23%) with ongoing objective response at 8 months, 1 of whom had proceeded to curative-intent liver surgery. Conclusions: MSS mCRC patients may hold the opportunity of ICB responsiveness evoked by short-course oxaliplatin-based chemotherapy. The search for predictive biomarkers of ICB responsiveness is ongoing in the specifically designed METIMMOX correlative study program. Clinical trial information: NCT03388190.
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- 2021
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36. Experience with S-1 in older Caucasian patients with metastatic colorectal cancer (mCRC): Findings from an observational chart review
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Helle Anita Jensen, Kanita Zubcevic, Camilla Qvortrup, Lene Weber Vestermark, Stine Braendegaard Winther, Halfdan Sorbye, Merete Krogh, and Per Pfeiffer
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Diarrhea ,Male ,0301 basic medicine ,Oncology ,medicine.medical_specialty ,Organoplatinum Compounds ,Colorectal cancer ,Irinotecan ,Capecitabine ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Adverse effect ,Fatigue ,Aged ,Tegafur ,Aged, 80 and over ,Performance status ,business.industry ,Hematology ,General Medicine ,medicine.disease ,digestive system diseases ,Oxaliplatin ,Surgery ,Clinical trial ,Drug Combinations ,Oxonic Acid ,Treatment Outcome ,030104 developmental biology ,030220 oncology & carcinogenesis ,Camptothecin ,Female ,Observational study ,Colorectal Neoplasms ,business ,medicine.drug - Abstract
Background: An aging population will increase the number of older patients with metastatic colorectal cancer (mCRC). However, there is limited knowledge about treatment in older patients as they are under-represented in clinical trials. The oral fluoropyrimidine S-1 is associated with a lower rate of adverse events than capecitabine and may therefore be a suitable drug for elderly. However, data on the use of S-1 in Caucasian mCRC patients are lacking/scarce. Material and methods: In the present study we evaluated safety and the efficacy of S-1 alone or in combination with oxaliplatin (SOx) or irinotecan (IRIS) in older mCRC patients. Patients who received at least one cycle of S-1 (first-line therapy), SOx (mainly first-line therapy) or IRIS (second-line therapy) were included. Results: From June 2012 to December 2014, 71 older patients received ≥1 cycle of either S-1 (n = 9), SOx (n = 44) or IRIS (n = 18) for mCRC. Median age was 76 years and most patients had a WHO performance status of 0 (32%) or 1 (56%). All patients were evaluable for response and safety. In the SOx group, 18 (41%) and 20 patients (45%) had partial response (PR) and stable disease (SD), respectively (disease control rate 86%). Median progression-free survival (PFS) was 8.5 months and median overall survival (OS) was 18.5 months. In the S-1 group (median age 82 years), PR was 22%, median PFS 6.4 months and median OS 15.8 months. In the IRIS group, PR was 28%, median PFS 7.8 months and the median OS 16.5 months. In general, therapy was well tolerated; main non-hematological toxicities were fatigue and diarrhea. Conclusion: S-1 monotherapy, SOx and IRIS were well tolerated for older patients with mCRC and could become alternative regimens in older mCRC patients. These regimens are now further evaluated in the randomized ongoing NORDIC9 trial.
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- 2016
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37. Impact of <scp> KRAS </scp> , <scp> BRAF </scp> , <scp> PIK3CA </scp> , <scp> TP5 3 </scp> status and intraindividual mutation heterogeneity on outcome after liver resection for colorectal cancer metastases
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Arild Horn, Jon-Helge Angelsen, Halfdan Sorbye, Inger Marie Løes, Stian Knappskog, Heike Immervoll, and Per Eystein Lønning
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0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,Mutation rate ,endocrine system diseases ,Colorectal cancer ,medicine.medical_treatment ,Gene mutation ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,neoplasms ,Univariate analysis ,business.industry ,Genetic heterogeneity ,medicine.disease ,digestive system diseases ,030104 developmental biology ,030220 oncology & carcinogenesis ,Mutation (genetic algorithm) ,KRAS ,Hepatectomy ,business - Abstract
We determined prognostic impact of KRAS, BRAF, PIK3CA and TP53 mutation status and mutation heterogeneity among 164 colorectal cancer (CRC) patients undergoing liver resections for metastatic disease. Mutation status was determined by Sanger sequencing of a total of 422 metastatic deposits. In univariate analysis, KRAS (33.5%), BRAF (6.1%) and PIK3CA (13.4%) mutations each predicted reduced median time to relapse (TTR) (7 vs. 22, 3 vs. 16 and 4 vs. 17 months; p
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- 2016
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38. SO-22 Atypical non-V600E BRAF (aBRAF) mutations as a prognostic and predictive factor in real-life metastatic colorectal cancer patients from the Nordic countries
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Soili Kytölä, Halfdan Sorbye, M. Keinänen, T. Salminen, Raija Kallio, L. Nieminen, L. Nunes, P. Halonen, T. Kuopio, Bengt Glimelius, J. Kononen, R. Ristamäki, Annamarja Lamminmäki, Jari Sundström, Eetu Heervä, Pia Österlund, Per Pfeiffer, Annika Ålgars, Helena Isoniemi, Emerik Osterlund, Ari Ristimäki, and Leena-Maija Soveri
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Oncology ,0303 health sciences ,medicine.medical_specialty ,Colorectal cancer ,business.industry ,Hematology ,medicine.disease ,Predictive factor ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,In real life ,business ,V600E ,030304 developmental biology - Published
- 2020
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39. SO-35 Tumor infiltrating CD3 lymphocytes and CD68 macrophages are associated with long-time survival in metastatic colorectal cancer patients treated with chemotherapy
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Anita Sveen, Jarle Bruun, Halfdan Sorbye, Aud Svindland, Geir Egil Eide, Kristine Aasebø, Christian H. Bergsland, Ragnhild A. Lothe, Marianne Grønlie Guren, Per Pfeiffer, Arild Nesbakken, Bengt Glimelius, Anca Dragomir, and Fredrik Pontén
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Chemotherapy ,biology ,business.industry ,Colorectal cancer ,CD68 ,medicine.medical_treatment ,CD3 ,Hematology ,medicine.disease ,Oncology ,Cancer research ,biology.protein ,Medicine ,business - Published
- 2020
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40. O-19 Feasibility of switching to S-1 upon other fluoropyrimidine-related cardiotoxicity during chemotherapy for solid tumors
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Helga Hagman, Raija Ristamäki, Gabor Liposits, R. Röckert, Eetu Heervä, Per Pfeiffer, S. Kinos, R. Kwakman, Raija Kallio, Raymond S. McDermott, Carl Henrik Shah, A. Teske, E. van Werkhoven, Leena-Maija Soveri, Annika Ålgars, Halfdan Sorbye, C.J.A. Punt, Petra Flygare, Pia Österlund, T. Salminen, P. Halonen, and Bengt Glimelius
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Oncology ,0303 health sciences ,Cardiotoxicity ,medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Hematology ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,business ,030304 developmental biology - Published
- 2020
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41. Feasibility of switching to S-1 after other fluoropyrimidine-related cardiotoxicity during chemotherapy for solid tumors
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Gabor Liposits, Raymond S. McDermott, Raija Kallio, Halfdan Sorbye, Bengt Glimelius, Johannes J.M. Kwakman, Annika Ålgars, Erik van Werkhoven, T. Salminen, Rebecka Röckert, Petra Flygare, Cornelis J. A. Punt, Helga Hagman, Eetu Heervä, Per Pfeiffer, P. Halonen, L. M. Soveri, Sampsa Kinos, Carl-Henrik Shah, and Pia Österlund
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Oncology ,Cancer Research ,medicine.medical_specialty ,Chemotherapy ,Cardiotoxicity ,business.industry ,medicine.medical_treatment ,Cancer ,POLK ,medicine.disease ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,business ,030215 immunology - Abstract
7037 Background: Fluoropyrimidines (FP) are the cornerstone of chemotherapy in many solid tumors and linked to cardiotoxicity (CarTx) in about 5% (Polk, Cancer Treat Rev 2013), often leading to FP discontinuation. CarTx may be less common with S-1 and successful switch from other FP has been reported (Kwakman, EJC 2017). Methods: This 6-country, 12-center, cohort study included patients with solid tumors (ICD10 C15-C21, C24-25, C50, C80) who experienced FP-related CarTx. Primary endpoint was recurrent (R) CarTx during S-1 therapy after switch from any other FP. Results: CarTx during capecitabine (n = 124), continuous (n = 13) or bolus 5-fluorouracil (n = 4) was reported for 141 patients who switched to S-1 therapy. CarTx was chest pain including vasospasm without cardiac findings (55%), acute coronary syndrome or myocardial infarction (32%), atrial fibrillation (4%), heart failure/cardiomyopathy (4%), tachy-/bradycardia (3%), and/or other (15%). CarTx was grade 3-4 in 55%, appeared on cycle 1-2 in 89%, and at median 4 days (range 0-466) from FP initiation (Table). Causality was judged related in 26%, probable in 60%, and possible in 14%. Action with FP causing CarTx was permanent discontinuation in 91%. Treatment intent was curative in 70%. Cumulative incidence of RCarTx with S-1 was 3.5% (CI95%, 1.2-8.4%) and median time to R-CarTx was 11 (range 6-195) days. Four (out of 141) had grade 1 and one grade 2 R-CarTx. Three were judged possibly related to S-1 and 2 not related. S-1 was discontinued in one patient and continued in 4 (for 63-252 days) without action (n = 2), with dose reduction (n = 1), or delay (n = 1). There were no differences in demographic or risk factors regarding R-CarTx on S-1 (Table). Conclusions: FP-related CarTx is often severe, occurs early, and leads to permanent FP discontinuation. Switching to S-1-based therapy is safe, with, at the most, grade 1-2 R-CarTx in only 3.5%, and rarely leads to treatment discontinuation (0.7%), allowing patients to continue on an FP-based regimen. Clinical trial information: NCT04260269 . [Table: see text]
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- 2020
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42. The Problem of High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms: Well-Differentiated Neuroendocrine Tumors, Neuroendocrine Carcinomas, and Beyond
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Halfdan, Sorbye, Eric, Baudin, and Aurel, Perren
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Pancreatic Neoplasms ,Neuroendocrine Tumors ,Carcinoma ,Humans ,Carcinoma, Neuroendocrine ,Gastrointestinal Neoplasms - Abstract
High-grade gastroenteropancreatic neuroendocrine neoplasms are well-differentiated neuroendocrine tumors or poorly differentiated small/large cell neuroendocrine carcinoma. Distinguishing these entities relies on different genetic backgrounds and resulting different biology. The new classification creates several problems. Almost all clinical treatment data on neuroendocrine neoplasms do not stratify between well and poorly differentiated, providing insufficient help in treatment selection. Treatment of gastroenteropancreatic neuroendocrine neoplasms should separate between well-differentiated neuroendocrine tumors and neuroendocrine carcinoma, and depends on primary tumor site, stage, proliferation rate, and clinical course. This article addresses how to diagnose and treat gastroenteropancreatic neuroendocrine neoplasms, focusing on well-differentiated neuroendocrine tumors versus neuroendocrine carcinomas.
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- 2018
43. Cost-effectiveness of liver transplantation in patients with colorectal metastases confined to the liver
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Halfdan Sorbye, Paal Joranger, Pål-Dag Line, Svein Dueland, Eline Aas, Gudrun Maria Waaler Bjørnelv, Bjørn Edwin, and Åsmund Avdem Fretland
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Oncology ,medicine.medical_specialty ,Cost effectiveness ,medicine.medical_treatment ,Cost-Benefit Analysis ,Antineoplastic Agents ,Liver transplantation ,03 medical and health sciences ,0302 clinical medicine ,Carcinoembryonic antigen ,Life Expectancy ,Internal medicine ,medicine ,Humans ,Survival rate ,Randomized Controlled Trials as Topic ,biology ,business.industry ,Liver Neoplasms ,Cancer ,Health Care Costs ,medicine.disease ,Chemotherapy regimen ,Markov Chains ,Quality-adjusted life year ,Liver Transplantation ,Transplantation ,030220 oncology & carcinogenesis ,biology.protein ,030211 gastroenterology & hepatology ,Surgery ,Quality-Adjusted Life Years ,Health Expenditures ,business ,Colorectal Neoplasms - Abstract
Background Patients with non-resectable colorectal metastases are currently treated with chemotherapy. However, liver transplantation can increase the 5-year survival rate from 9 to 56 per cent if the cancer is confined to the liver. The aim of this study was to estimate the cost-effectiveness of liver transplantation for colorectal liver metastases. Methods A Markov model with a lifetime perspective was developed to estimate the life-years, quality-adjusted life-years (QALYs), direct healthcare costs and cost-effectiveness for patients with non-resectable colorectal liver metastases who received liver transplantation or chemotherapy alone. Results In non-selected cohorts, liver transplantation increased patients' life expectancy by 3·12 life-years (2·47 QALYs), at an additional cost of €209 143, giving an incremental cost-effectiveness ratio (ICER) of €67 140 per life-year (€84 667 per QALY) gained. In selected cohorts (selection based on tumour diameter, time since primary cancer, carcinoembryonic antigen levels and response to chemotherapy), the effect of liver transplantation increased to 4·23 life-years (3·41 QALYs), at a higher additional cost (€230 282), and the ICER decreased to €54 467 per life-year (€67 509 per QALY) gained. Given a willingness to pay of €70 500, the likelihood of transplantation being cost-effective was 0·66 and 0·94 (0·23 and 0·67 QALYs) for non-selected and selected cohorts respectively. Conclusion Liver transplantation was cost-effective but only for highly selected patients. This might be possible in countries with good access to grafts and low waiting list mortality.
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- 2018
44. Review on adjuvant chemotherapy for rectal cancer – why do treatment guidelines differ so much?
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Mette Karen Yilmaz, Laurids Østergaard Poulsen, Per Pfeiffer, Camilla Qvortrup, Halfdan Sorbye, and Ursula Falkmer
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Oncology ,Antimetabolites, Antineoplastic ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Adenocarcinoma ,Preoperative care ,Disease-Free Survival ,law.invention ,Randomized controlled trial ,law ,Internal medicine ,Preoperative Care ,medicine ,Rectal Adenocarcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Randomized Controlled Trials as Topic ,Postoperative Care ,Chemotherapy ,Rectal Neoplasms ,business.industry ,Chemoradiotherapy ,Hematology ,General Medicine ,medicine.disease ,Radiation therapy ,Chemotherapy, Adjuvant ,Practice Guidelines as Topic ,Fluorouracil ,business ,Adjuvant - Abstract
Background. The use of postoperative adjuvant chemotherapy is controversial for rectal adenocarcinoma. Both international and national guidelines display a great span varying from recommending no adjuvant chemotherapy at all, over single drug 5-fluororuacil (5-FU), to combinations of 5-FU/oxaliplatin.Methods. A review of the literature was made identifying 24 randomized controlled trials on adjuvant treatment of rectal cancer based on about 10 000 patients. The trials were subdivided into a number of clinically relevant subgroups.Results. As regards patients treated with preoperative (chemo) radiotherapy, four randomized studies were found where use of adjuvant chemotherapy showed no benefit in survival. Three trials were found in which a subset of patients received preoperative (chemo) radiotherapy. Two of these trials showed a statistically significant benefit of adjuvant chemotherapy. Twenty trials were identified in which the patients did not receive preoperative (chemo) radiotherapy, including five Asian studies in which a statistically significant benefit from adjuvant chemotherapy was reported.Conclusions. Most of the data found did not support the use of postoperative adjuvant chemotherapy for patients already treated with preoperative (chemo) radiotherapy. For patients not treated preoperatively, several studies support the use of single agent 5-FU chemotherapy. Treatment guidelines seem to differ according to if preoperative chemoradiation is considered of importance for use of adjuvant chemotherapy and if adjuvant colon cancer studies are considered transferrable to rectal cancer patients regardless of the molecular differences.
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- 2015
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45. Intact and cleaved plasma soluble urokinase receptor in patients with metastatic colorectal cancer treated with oxaliplatin with or without cetuximab
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Tormod Kyrre Guren, Line Schmidt Tarpgaard, Nils Brünner, Hans Jørgen Nielsen, Ida K. Lund, José M.A. Moreira, Halfdan Sorbye, Ib Jarle Christensen, Bengt Glimelius, Kjell Magne Tveit, Gunilla Høyer-Hansen, and Per Pfeiffer
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Oncology ,Cancer Research ,medicine.medical_specialty ,biology ,Cetuximab ,business.industry ,Colorectal cancer ,medicine.disease_cause ,medicine.disease ,Oxaliplatin ,Urokinase receptor ,SuPAR ,Internal medicine ,biology.protein ,Medicine ,Biomarker (medicine) ,KRAS ,Epidermal growth factor receptor ,business ,neoplasms ,medicine.drug - Abstract
Circulating forms of the urokinase plasminogen activator receptor (uPAR) are associated with prognosis in patients with colorectal cancer. Preclinical studies have shown that uPAR can influence the state of phosphorylation and signalling activity of the epidermal growth factor receptor (EGFR) in a ligand-independent manner. The purpose of the study was to evaluate whether plasma soluble intact and cleaved uPAR(I-III)+(II-III) levels could identify a subpopulation of patients with metastatic colorectal cancer (mCRC) where treatment with cetuximab would have a beneficial effect. Plasma samples were available from 453 patients treated in the NORDIC VII study. Patients were randomized between FLOX and FLOX + cetuximab. The levels of uPAR(I-III)+(II-III) were determined by time-resolved fluorescence immunoassay. We demonstrated that higher baseline plasma uPAR(I-III)+(II-III) levels were significantly associated with shorter progression-free survival (PFS) (HR = 1.30, 1.14-1.48, p = 0.0001) and overall survival (OS) (HR = 1.75, 1.52-2.02, p
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- 2015
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46. Prognostic role of carcinoembryonic antigen and carbohydrate antigen 19-9 in metastatic colorectal cancer: a BRAF-mutant subset with high CA 19-9 level and poor outcome
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Maria Thomsen, Julia S. Johansen, Bengt Glimelius, Tormod Kyrre Guren, Eva Skovlund, Nils Bolstad, Kjell Magne Tveit, Kjell Nustad, Thoralf Christoffersen, Per Pfeiffer, Halfdan Sorbye, and Elin H. Kure
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0301 basic medicine ,Oncology ,Adult ,Male ,Proto-Oncogene Proteins B-raf ,Cancer Research ,medicine.medical_specialty ,CA-19-9 Antigen ,Colorectal cancer ,medicine.medical_treatment ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Carcinoembryonic antigen ,Internal medicine ,medicine ,Humans ,Neoplasm Metastasis ,Survival rate ,Aged ,Cancer och onkologi ,Chemotherapy ,biology ,Performance status ,business.industry ,Middle Aged ,medicine.disease ,Prognosis ,digestive system diseases ,Carcinoembryonic Antigen ,Survival Rate ,030104 developmental biology ,Cancer and Oncology ,030220 oncology & carcinogenesis ,Mutation ,biology.protein ,ras Proteins ,Alkaline phosphatase ,CA19-9 ,Female ,business ,Colorectal Neoplasms ,V600E - Abstract
Background Mutation status of RAS and BRAF, as well as serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9), are biomarkers used in clinical management of patients with gastrointestinal cancers. This study aimed to examine the prognostic role of these biomarkers in a patient population that started first-line chemotherapy for unresectable metastatic colorectal cancer (mCRC) in the NORDIC-VII study. Methods CEA and CA 19-9 were measured in serum samples from 545 patients obtained before the start of chemotherapy. Four hundred and ninety-four patients had detectable levels of carbohydrate antigen 19-9 (CA 19-9). RAS (exons 2–4) and BRAF (V600E) mutation status were available from 440 patients. Overall survival (OS) was estimated in patient groups defined by serum CEA or CA 19-9 levels using cut-off values of 5 µg/L and 35 kU/L, respectively, in the total population and in subgroups according to RAS and BRAF mutation status. Results For both CEA and CA 19-9, elevated serum levels were associated with reduced OS in adjusted analyses which included RAS and BRAF mutation status, baseline World Health Organization performance status, and levels of alkaline phosphatase and C-reactive protein. The negative prognostic information provided by an elevated CA 19-9 level was particularly marked in patients with BRAF mutation (hazard ratio = 4.35, interaction P = 0.003, in an adjusted model for OS). Conclusions High baseline serum concentrations of CEA and CA 19-9 provide independent information of impaired prognosis in mCRC. In patients with BRAF-mutant tumours, elevated serum CA 19-9 may identify a subgroup with highly aggressive disease and could contribute to improving therapeutic decisions.
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- 2017
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47. Comparative study of lung and extrapulmonary poorly differentiated neuroendocrine carcinomas: A SEER database analysis of 162,983 cases
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Arvind, Dasari, Kathan, Mehta, Lauren A, Byers, Halfdan, Sorbye, and James C, Yao
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Male ,Lung Neoplasms ,Incidence ,Middle Aged ,Prognosis ,Small Cell Lung Carcinoma ,Survival Analysis ,United States ,Article ,Carcinoma, Neuroendocrine ,Humans ,Female ,Aged ,Gastrointestinal Neoplasms ,SEER Program - Abstract
Extrapulmonary neuroendocrine carcinomas (NECs) are poorly studied and are managed similar to lung NECs, which may not account for differences between the 2 groups of tumors as well as the heterogeneity within extrapulmonary NEC.Data from the Surveillance, Epidemiology, and End Results program between 1973 and 2012 were used to estimate the relative percentages of lung NECs and subgroups of extrapulmonary NECs, epidemiological patterns at these sites, and the median and 5-year overall survival rates.Of 162,983 NEC cases, 14,732 were extrapulmonary; of these, 5509 were gastrointestinal (37.44%), 4151 were of unknown primary (28.2%), and 5072 were of other sites (34.4%). Lung NEC had the highest percentage of small cell morphology (95.2%) and gastrointestinal NEC had the least (38.7%), with the rest being other morphologies. Significant differences were noted with regard to median age (range, 48-74 years), percentage of cases of distant stage disease (24%-77%), and incidence according to sex and race. The median survival of patients with lung NEC was 7.6 months, that for patients with gastrointestinal NEC was 7.5 months (range, 25.1 months for NEC at the small intestine to 5.7 months for NEC at the pancreas), and that for patients with unknown NEC was 2.5 months. The 5-year survival rate for patients with local stage disease ranged from 58% to 60% for NECs of the female genital tract and small intestine to 25% for esophageal NECs. The primary tumor site remained statistically significant for survival even after adjusting for known prognostic variables (P.0001).To the authors' knowledge, the current study is the largest study of NECs performed to date and also the first with comprehensive epidemiological data. Significant differences in incidence patterns and large variations in survival depending on anatomical site and morphological subtype were noted. A curative approach is possible for patients with nonmetastatic NECs. Cancer 2018;124:807-15. © 2017 American Cancer Society.
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- 2017
48. A
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Jan P, Dumanski, Chiara, Rasi, Peyman, Björklund, Hanna, Davies, Abir S, Ali, Malin, Grönberg, Staffan, Welin, Halfdan, Sorbye, Henning, Grønbæk, Janet L, Cunningham, Lars A, Forsberg, Lars, Lind, Erik, Ingelsson, Peter, Stålberg, Per, Hellman, and Eva, Tiensuu Janson
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Adult ,Male ,Research ,cancer predisposition ,Middle Aged ,familial cancer ,DNA Glycosylases ,DNA excision-repair pathway ,Neuroendocrine Tumors ,Intestinal Neoplasms ,Humans ,oxidative stress ,Female ,small intestinal carcinoid ,Germ-Line Mutation ,Aged - Abstract
The genetics behind predisposition to small intestinal neuroendocrine tumors (SI-NETs) is largely unknown, but there is growing awareness of a familial form of the disease. We aimed to identify germline mutations involved in the carcinogenesis of SI-NETs. The strategy included next-generation sequencing of exome- and/or whole-genome of blood DNA, and in selected cases, tumor DNA, from 24 patients from 15 families with the history of SI-NETs. We identified seven candidate mutations in six genes that were further studied using 215 sporadic SI-NET patients. The result was compared with the frequency of the candidate mutations in three control cohorts with a total of 35,688 subjects. A heterozygous variant causing an amino acid substitution p.(Gly396Asp) in the MutY DNA glycosylase gene (MUTYH) was significantly enriched in SI-NET patients (minor allele frequencies 0.013 and 0.003 for patients and controls respectively) and resulted in odds ratio of 5.09 (95% confidence interval 1.56–14.74; P value = 0.0038). We also found a statistically significant difference in age at diagnosis between familial and sporadic SI-NETs. MUTYH is involved in the protection of DNA from mutations caused by oxidative stress. The inactivation of this gene leads to specific increase of G:C- > T:A transversions in DNA sequence and has been shown to cause various cancers in humans and experimental animals. Our results suggest that p.(Gly396Asp) in MUTYH, and potentially other mutations in additional members of the same DNA excision-repair pathway (such as the OGG1 gene) might be involved in driving the tumorigenesis leading to familial and sporadic SI-NETs.
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- 2017
49. Health-related quality of life in patients with metastatic colorectal cancer, association with systemic inflammatory response and RAS and BRAF mutation status
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Eva Skovlund, Bengt Glimelius, Thoralf Christoffersen, Marianne Grønlie Guren, Per Pfeiffer, Julia S. Johansen, Elin H. Kure, Tormod Kyrre Guren, Kjell Magne Tveit, Maria Thomsen, Halfdan Sorbye, and Marianne Jensen Hjermstad
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0301 basic medicine ,Oncology ,Adult ,Male ,Proto-Oncogene Proteins B-raf ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Health Status ,Cetuximab ,medicine.disease_cause ,GTP Phosphohydrolases ,Proto-Oncogene Proteins p21(ras) ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Journal Article ,Biomarkers, Tumor ,Humans ,In patient ,Aged ,Health related quality of life ,Inflammation ,Mutation ,Chemotherapy ,business.industry ,Cancer ,Membrane Proteins ,Middle Aged ,medicine.disease ,digestive system diseases ,humanities ,030104 developmental biology ,C-Reactive Protein ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,Cisplatin ,business ,Colorectal Neoplasms ,medicine.drug - Abstract
Background The aim of this study was to evaluate the effect of cetuximab on health-related quality of life (HRQoL) in the NORDIC-VII trial on metastatic colorectal cancer (mCRC), and to assess HRQoL in relation to RAS and BRAF mutation status and inflammatory biomarkers. Patient and methods HRQoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) at baseline, after every fourth cycle of chemotherapy, and at the end of treatment. HRQoL during 12 cycles of chemotherapy was evaluated over time, compared between treatment arms, and assessed for association with tumour mutation status and inflammatory markers. Results QLQ-C30 was completed by 512 patients (90%) before start of treatment. HRQoL variables were well balanced across treatment arms at baseline, and no statistically significant differences during treatment were seen. Patients with BRAF -mutated tumours reported poorer HRQoL at baseline and subsequent time points than patients with RAS -mutated or RAS / BRAF wild-type tumours. Patients with high serum interleukin-6 (IL-6) or C-reactive protein (CRP) had markedly impaired HRQoL compared to patients with normal levels. There was a statistically significant association between reduction in IL-6 and CRP levels and improvement in HRQoL during treatment from baseline to cycle 4. Conclusion The addition of cetuximab to chemotherapy did not affect HRQoL in mCRC patients. Patients with BRAF -mutated tumours have both a worse prognosis and a poor HRQoL. The associations between levels of systemic inflammatory markers and reduced HRQoL suggest that the patients might benefit from anti-inflammatory treatment.
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- 2017
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50. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasms: Systemic Therapy - Chemotherapy
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Martyn Caplin, Marianne Pavel, Vera Gorbounova, Juan Manuel O'Connor, Jie Chen, Jenny Falkerby, Rocio Garcia-Carbonero, Nicola Fazio, Juan W. Valle, Frederico Costa, Wouter W. de Herder, Anja Rinke, Catherine Lombard-Bohas, Matthew H. Kulke, Barbro Eriksson, Halfdan Sorbye, and Internal Medicine
- Subjects
Oncology ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Dacarbazine ,Rectum ,030209 endocrinology & metabolism ,Neuroendocrine tumors ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Endocrinology ,Internal medicine ,Medicine ,Adverse effect ,Etoposide ,Chemotherapy ,Manchester Cancer Research Centre ,Endocrine and Autonomic Systems ,business.industry ,ResearchInstitutes_Networks_Beacons/mcrc ,medicine.disease ,Irinotecan ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,business ,Progressive disease ,medicine.drug - Abstract
Systemic chemotherapy is indicated in progressive or bulky advanced pancreatic neuroendocrine tumors (NETs) and in grade 3 (G3) neuroendocrine neoplasms (NENs) as per ENETS Guidelines. Chemotherapy may be considered in NETs of other sites (lung, thymus, stomach, colon, rectum) under certain conditions (e.g., when Ki-67 is at a high level (upper G2 range), in rapidly progressive disease and/or after failure of other therapies, or if somatostatin receptor imaging is negative). An ENETS Consensus Conference was held in Antibes (2015) to ellaborate guidelines on the standards of care of different diagnostic procedures and therapeutic interventions in NENs. This article provides guidanceon chemotherapy including therapeutic indications, dosing schedules, adverse events (including prevention and management), drug interactions and evaluation of treatment effect for the chemotherapy agents most commonly used in NENs (streptozocin, dacarbazine, streptozocin, fluoropyrimidines, platinum compounds, etoposide and irinotecan).
- Published
- 2017
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