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Re-induction with immune checkpoint blockade (ICB) needs to be considered in many patients with uveal melanoma (UM) due to limited systemic treatment options. Here, we provide hitherto the first analysis of ICB re-induction in UM. A total of 177 patients with metastatic UM treated with ICB were included from German skin cancer centers and the German national skin cancer registry (ADOReg). To investigate the impact of ICB re-induction, two cohorts were compared: patients who received at least one ICB re-induction (cohort A, n = 52) versus those who received only one treatment line of ICB (cohort B, n = 125). In cohort A, a transient benefit of overall survival (OS) was observed at 6 and 12 months after the treatment start of ICB. There was no significant difference in OS between both groups (p = 0.1) with a median OS of 16.2 months (cohort A, 95% CI: 11.1–23.8) versus 9.4 months (cohort B, 95% CI: 6.1–14.9). Patients receiving re-induction of ICB (cohort A) had similar response rates compared to those receiving ICB once. Re-induction of ICB may yield a clinical benefit for a small subgroup of patients even after resistance or development of toxicities.
Analysis of the Frequency of Kidney Toxicity in Preclinical Safety Studies using the eTOX Database
(2022)
This research aimed to obtain reliable data on the frequency of different
types of renal toxicity findings in 28-day oral gavage studies in Wistar rats, their
consistency across species and study duration, as well as the correlation between histopathological endpoints and routinely used clinical chemistry parameters indicative of kidney injury. Analysis of renal histopathological findings was
carried out through extraction of information from the IMI eTOX database.
Spontaneous renal histopathological findings in 28-day oral gavage studies in control Wistar rats and beagle dogs confirmed tubular basophilia and renal
dilation as the most frequent incidental findings in controls, whereas necrosis
and glomerulosclerosis were not identified at all or only rarely as a background
lesion.
Histopathological evidence of necrosis and glomerulosclerosis was associated with changes in clinical chemistry parameters in 28-day oral gavage
Wistar rat studies. Necrosis was frequently accompanied by a statistically significant rise in serum creatinine and serum urea, whereas serum albumin was
frequently found to decrease statistically significantly in treatment groups in
which necrosis was recorded. In contrast to necrosis, glomerulosclerosis was
not associated with statistically significant changes in serum creatinine and urea
in any of the 28-day oral gavage Wistar rat treatment groups, but appears to be
best reflected by a pattern of statistically significantly lowered serum albumin
and serum protein together with a statistically significant increase in serum cholesterol. As might have been expected based on the high background incidences
of tubular basophilia and dilation, no consistent changes in any of the clinical
chemistry parameters were evident in animals in which renal lesions were confined to renal tubular basophilia or dilation. In summary, the routinely provided
clinical chemistry parameters are rather insensitive - novel kidney biomarkers
such as Cystatin C, β-trace protein and Kidney injury molecule 1 should further
be evaluated and integrated into routine preclinical and clinical practice. However, evaluation of clinical chemistry data was limited by the lack of individual
animal data. Even though an extensive amount of preclinical studies is accessible
through the eTOX database, comparison of consistency across time was limited
by the limited number of shorter- and longer term studies conducted with the
compounds identified as causing renal histopathological changes within a 28-
day study in rats. A high consistency across time for both treatment-related tubular basophilia and treatment-related dilation cannot be confirmed for either of
the two effects as these two findings were both induced only rarely in studies
over a different treatment-duration other than 28 days after administration of the
compounds which provoked the respective effect in a 28-day study. For the
finding of necrosis consistency across time was low with the exception of
“AZ_GGA_200002321”, in which renal papillary necrosis was identified consistently throughout different treatment durations (2, 4, 26, 104 weeks). No shorter and longer-term studies were available for the compounds identified as causing
glomerulosclerosis within a 28-day study in rats.
No consistent findings of the selected histopathological endpoints were
identified in any of the corresponding 28-day oral gavage beagle dog studies
after treatment with the identical compounds, which caused the respective effect after 28-day treatment in rats. However, in the overwhelming majority of
cases, beagle dogs were administered lower doses in these studies in comparison to the corresponding 28-day Wistar rat studies.
Searching the eTOX database yielded no 28-day oral gavage studies in
Wistar and Wistar Han rats in which accumulation of hyaline droplets, tubular
atrophy or hyperplasia was recorded. Only one 28-day oral gavage Wistar rat
study was identified with the histopathological result of neutrophilic inflammation. Consequently, evaluation of these four renal findings in relation to clinical
chemistry parameters and consistency across time and species cannot be
made.
In summary, this work contributes knowledge through mining and evaluating the eTOX database on a variety of specific renal endpoints that frequently
occur after administration of trial substances in 28-day oral gavage studies in
Wistar rats in the field of preclinical toxicity with specific focus on their frequency relation to background findings, as well as consistency across time and species. Targeted statistical evaluation of in vivo data within joint research ventures
such as the eTOX project, presents an enormous opportunity for an innovative
future way of aiding preclinical research towards a more efficient research in the
preclinical stage of drug development. This could be achieved through the augmentation of methodological strategies and possibly novel software tools in order to predict in vivo toxicology of new molecular entities by means of information that is already available before early stages of the drug development
pipeline begin.
Background: There is a lack of predictive models to identify patients at risk of high neoadjuvant chemoradiotherapy (CRT)-related acute toxicity in rectal cancer. Patient and Methods: The CAO/ARO/AIO-04 trial was divided into a development (n = 831) and a validation (n = 405) cohort. Using a best subset selection approach, predictive models for grade 3–4 acute toxicity were calculated including clinicopathologic characteristics, pretreatment blood parameters, and baseline results of quality-of-life questionnaires and evaluated using the area under the ROC curve. The final model was internally and externally validated. Results: In the development cohort, 155 patients developed grade 3–4 toxicities due to CRT. In the final evaluation, 15 parameters were included in the logistic regression models using best-subset selection. BMI, gender, and emotional functioning remained significant for predicting toxicity, with a discrimination ability adjusted for overfitting of AUC 0.687. The odds of experiencing high-grade toxicity were 3.8 times higher in the intermediate and 6.4 times higher in the high-risk group (p < 0.001). Rates of toxicity (p = 0.001) and low treatment adherence (p = 0.007) remained significantly different in the validation cohort, whereas discrimination ability was not significantly worse (DeLong test 0.09). Conclusion: We developed and validated a predictive model for toxicity using gender, BMI, and emotional functioning. Such a model could help identify patients at risk for treatment-related high-grade toxicity to assist in treatment guidance and patient participation in shared decision making.
Purpose
Dose-escalated external beam radiation therapy (EBRT) and EBRT + high-dose-rate brachytherapy (HDR-BT) boost are guideline-recommended treatment options for localized prostate cancer. The purpose of this study was to compare long-term outcome and toxicity of dose-escalated EBRT versus EBRT + HDR-BT boost.
Methods
From 2002 to 2019, 744 consecutive patients received either EBRT or EBRT + HDR-BT boost, of whom 516 patients were propensity score matched. Median follow-up was 95.3 months. Cone beam CT image-guided EBRT consisted of 33 fractions of intensity-modulated radiation therapy with simultaneous integrated boost up to 76.23 Gy (D\(_{Mean}\)). Combined treatment was delivered as 46 Gy (D\(_{Mean}\)) EBRT, followed by two fractions HDR-BT boost with 9 Gy (D\(_{90\%}\)). Propensity score matching was applied before analysis of the primary endpoint, estimated 10-year biochemical relapse-free survival (bRFS), and the secondary endpoints metastasis-free survival (MFS) and overall survival (OS). Prognostic parameters were analyzed by Cox proportional hazard modelling. Genitourinary (GU)/gastrointestinal (GI) toxicity evaluation used the Common Toxicity Criteria for Adverse Events (v5.0).
Results
The estimated 10-year bRFS was 82.0% vs. 76.4% (p = 0.075) for EBRT alone versus combined treatment, respectively. The estimated 10-year MFS was 82.9% vs. 87.0% (p = 0.195) and the 10-year OS was 65.7% vs. 68.9% (p = 0.303), respectively. Cumulative 5‑year late GU ≥ grade 2 toxicities were seen in 23.6% vs. 19.2% (p = 0.086) and 5‑year late GI ≥ grade 2 toxicities in 11.1% vs. 5.0% of the patients (p = 0.002); cumulative 5‑year late grade 3 GU toxicity occurred in 4.2% vs. 3.6% (p = 0.401) and GI toxicity in 1.0% vs. 0.3% (p = 0.249), respectively.
Conclusion
Both treatment groups showed excellent long-term outcomes with low rates of severe toxicity.