193 results match your criteria: "Mannheim University Medical Center[Affiliation]"

Examining nirogacestat for adults with progressing desmoid tumors who require systemic treatment.

Expert Opin Pharmacother

November 2024

Sarcoma Unit, Mannheim Cancer Center (MCC), Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.

Article Synopsis
  • - Desmoid tumor (DT) is a rare and aggressive type of tumor that can develop anywhere in the body, and medical therapies are crucial for patients needing treatment.
  • - Nirogacestat, a newly approved γ-secretase inhibitor, is the first FDA-approved drug specifically for treating DTs and works by targeting the NOTCH signaling pathway.
  • - Despite the introduction of Nirogacestat, there is still a lack of high-quality evidence for systemic treatments for DTs, and physicians must consider various factors when choosing a treatment plan, as well as monitor long-term safety and efficacy.
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Background: Typically, researchers and clinicians determine the agenda in sarcoma research. However, patient involvement can have a meaningful impact on research. Therefore, the Patient-Powered Research Network (PPRN) of the Sarcoma Patient Advocacy Global Network (SPAGN) set up a Priority Setting Partnership (PSP).

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Introduction: Ewing sarcoma (ES), is a rare cancer affecting children, adolescents and adults. After VIDE (vincristine-ifosfamide-doxorobucin-etoposide) induction chemotherapy, Busulfan-Melphalan (BuMel) high-dose chemotherapy followed by autologous hematopoietic stem cells transplantation improved outcomes in unfavourable localized ES, but with more toxicities than conventional chemotherapy (VAI: Vincristine-dactinomycin-Ifosfamide). We evaluated whether the risk of acute toxicity associated with BuMel compared to VAI varied according to age in patients recruited in the R2Loc and R2Pulm randomised trials of the Euro-E.

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Precise classification of sarcomas is crucial to optimal clinical management. In this prospective, multicenter, observational study within the Hellenic Group of Sarcoma and Rare Cancers (HGSRC), we assessed the effect of expert pathology review, coupled with the application of molecular diagnostics, on the diagnosis and management of sarcoma patients. Newly diagnosed sarcoma patients were addressed by their physicians to one of the two sarcoma pathologists of HGSRC for histopathological diagnostic assessment.

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Current Management of Desmoid Tumors: A Review.

JAMA Oncol

August 2024

Department of Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy.

Article Synopsis
  • Desmoid tumors (DT) are rare, aggressive growths that have historically been treated primarily with surgery, but recent trends suggest a shift towards less invasive treatment options.
  • A consensus meeting held in Milan in June 2023 aimed to update global guidelines for DT management, bringing together over 90 experts and patient advocates to discuss new strategies and treatments.
  • The updated guidelines emphasize the importance of local therapies and include information on the latest medical agents, particularly γ-secretase inhibitors, to ensure informed and effective management of DT in specialized referral centers.
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Article Synopsis
  • - Desmoid tumors (DT) are rare, locally aggressive sarcomas that often affect younger females (under 40), primarily causing high symptom burden and significant reductions in quality of life, despite having a good overall survival rate.
  • - Common symptoms include pain, fatigue, and insomnia, with some patients experiencing disfigurement or mobility issues; anxiety and depression rates in DT patients can mirror those in more severe cancers.
  • - The GOunder/Desmoid Tumor Research Foundation's DEsmoid Symptom/Impact Scale (GODDESS) evaluates patient-reported outcomes specific to DT, aiding in clinical trials to incorporate patient perspectives as new treatments are developed.
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Article Synopsis
  • Patients with ruptured gastrointestinal stromal tumors (GIST) tend to have a worse prognosis and limited information exists on the effect of adjuvant imatinib on their survival.
  • A study analyzed the recurrence-free (RFS) and overall survival (OS) of 358 patients with localized GIST, 20% of whom had reported ruptures, finding that those with ruptures experienced lower RFS and OS compared to those without ruptures.
  • The study concluded that while adjuvant imatinib for 3 years didn’t significantly enhance survival for ruptured GIST patients compared to 1 year, those with specific genetic mutations showed improved OS with longer treatment.
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The management of sarcomas in specialist centers delivers significant benefits. In much of the world, specialists are not available, and the development of expertise is identified as a major need. However, the terms 'specialist' or 'expert' center are rarely defined.

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Active surveillance and emerging medical treatment options for desmoid: when and for whom?

Curr Opin Oncol

July 2024

Department of Medical Oncology, University of Heidelberg, Mannheim University Medical Center, Mannheim Cancer Center (MCC), Sarcoma Unit, Mannheim, Germany.

Article Synopsis
  • This article reviews updated strategies for managing desmoid tumors, highlighting recent research and approaches.
  • Active surveillance has emerged as the main management technique, showing about 50% of cases stabilize or regress without immediate intervention, supported by recent studies with notable progression-free survival rates.
  • Additional randomized trials have investigated medical treatments for more aggressive cases, showing that drugs like sorafenib, pazopanib, and nirogacestat have potential benefits in improving patient outcomes.
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Technical considerations for isolated limb perfusion: A consensus paper.

Eur J Surg Oncol

June 2024

Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background: Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity.

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Developing new drugs or generating evidence for existing drugs in new indications for ultra-rare cancers is complex and carries a high-risk of failure. This gets even harder in ultra-rare tumours, which have an annual incidence of 1 per 1,000,000 population or less. Here, we illustrate the problem of adequate evidence generation in ultra-rare tumours, using Alveolar Soft-Part Sarcomas (ASPS) - an ultra-rare sarcoma newly diagnosed in approximately 60 persons a year in the European Union - as an exemplar case showing challenges in development despite being potentially relevant for classes of agents.

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Article Synopsis
  • E-TRAB was a study aimed at evaluating the value of geriatric assessments in older patients with soft tissue sarcoma (STS) receiving trabectedin as a first-line treatment.
  • The study involved 69 older patients, with an average age of 78, and assessed their overall survival, quality of life, and treatment-related toxicities using various assessment tools.
  • Findings indicated that while trabectedin was generally safe, certain predictors from the geriatric assessments, such as the Long Timed Up and Go test and CARG score, were linked to outcomes like overall survival and hospitalizations related to treatment side effects.
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Objectives: The development of desmoid tumors (DT) is associated with trauma, which is an aspect with medicolegal relevance. The objective of this study was to analyze the proportion and type of trauma (surgical, blunt/fracture, implants), its lag time, and mutations of the CTNNB1 gene in patients with sporadic DT.

Methods: We analyzed a prospectively kept database of 381 females and 171 males, median age at disease onset 37.

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Introduction: Sarcomas are rare cancers and very heterogeneous in their location, histological subtype, and treatment. Health-Related Quality of Life (HRQoL) of sarcoma patients has rarely been investigated in longitudinal studies.

Methods: Here, we assessed adult sarcoma patients and survivors between September 2017 and February 2020, and followed-up for one year in 39 study centers in Germany.

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Article Synopsis
  • The study examined how different types of extremity soft-tissue sarcomas (eSTS) responded to isolated limb perfusion (ILP) treatment across 17 specialized centers, focusing on response rates based on imaging and clinical data.
  • The analysis included 1109 patients, revealing that undifferentiated pleomorphic sarcoma, synovial sarcoma, and myxofibrosarcoma were the most common eSTS subtypes.
  • The results showed that ILP led to a high overall response rate (68%) and limb salvage rate (88%), particularly with better outcomes for Kaposi sarcoma, angiosarcoma, and clear cell sarcoma compared to other subtypes.
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Ten recommendations for sarcoma surgery: consensus of the surgical societies based on the German S3 guideline "Adult Soft Tissue Sarcomas".

Langenbecks Arch Surg

July 2023

Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.

Purpose: The evidence-based (S3) guideline "Adult Soft Tissue Sarcomas" (AWMF Registry No. 032/044OL) published by the German Guideline Program in Oncology (GGPO) covers all aspects of sarcoma treatment with 229 recommendations. Representatives of all medical specialties involved in sarcoma treatment contributed to the guideline.

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Local Therapies for Metastatic Sarcoma: Why, When, and How?

Am Soc Clin Oncol Educ Book

June 2023

Mannheim University Medical Center, University of Heidelberg Germany, Mannheim, Germany.

Management of patients with advanced sarcoma has been evolving in recent decades, from a one-fit-all perspective to a more refined, personalized, and multidisciplinary approach. In parallel, the evolution of local therapies (radiotherapy, surgical and interventional radiology techniques) has contributed to the improvement of survival of patients with advanced sarcoma. In this article, we review the evidence regarding local treatments in advanced sarcoma, as well as its integration with systemic therapies, to provide the reader a wider and deeper perspective on the management of patients with metastatic sarcoma.

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Sarcoma Research with Cancer Registry Data: Data and Peculiarities of Germany in the Light of Other Countries.

Oncol Res Treat

September 2023

Division of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.

Article Synopsis
  • This study investigates the potential and challenges of cancer registry-based research on sarcomas in Germany, comparing it to similar databases in the US and Europe, focusing on data quality and completeness.
  • Data from 16 German cancer registries was analyzed, covering adult malignant sarcomas diagnosed between 2000 and 2018, with detailed assessment of demographics, tumor types, and survival rates.
  • Out of 35,091 initial cases, 28,311 patients remained after data cleaning, revealing trends in sarcoma occurrences by age and sex, common tumor types, and the primary sites of metastasis, primarily in the lungs.
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Purpose: Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of locally advanced and metastatic gastrointestinal stromal tumours (GISTs). Patients are experiencing prolonged survival but often at the expense of their health-related quality of life. It is not only the physical side effects that impact GIST patients' daily lives but also the psychological and social challenges they have to deal with.

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New treatments for desmoid tumors.

Curr Opin Oncol

July 2023

University of Heidelberg, Mannheim University Medical Center (UMM), Mannheim Cancer Center (MCC), Mannheim, Germany.

Purpose Of Review: Desmoid tumor is a rare disease of intermediate malignancy characterized by a locally aggressive monoclonal, fibroblastic proliferation and accompanied by a variable and often unpredictable clinical course. The purpose of this review is to give an overview on the emerging new systemic treatment options for this intriguing disease for which no established or approved drugs are available yet.

Recent Findings: Over decades, surgical resection has been the established initial treatment approach; however, more recently, a paradigm shift has been introduced towards a more conservative treatment strategy.

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Article Synopsis
  • Treatment concepts in oncology are becoming personalized and diverse, requiring continuous monitoring of patient care through real-world data, which the DKTK's Clinical Communication Platform (CCP) facilitates.
  • The CCP connects 14 cancer centers and analyzes data from over 600,000 patients, focusing on diverse demographic details, diagnoses, treatment responses, and extensive biosample collections.
  • Through its sizable and detailed dataset, the cohort aids translational cancer research, enhances understanding of various cancers, and supports clinical trial design and evaluation in real-world settings.
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Purpose: Limited data are available about the influence of KIT and PDGFRA mutations on overall survival (OS) of patients with gastrointestinal stromal tumor (GIST) treated with adjuvant imatinib.

Patients And Methods: The Scandinavian Sarcoma Group XVIII/AIO multicenter trial accrued 400 patients with a high risk for GIST recurrence after macroscopically complete surgery between February 4, 2004, and September 29, 2008. The patients received adjuvant imatinib 400 mg/day for either 1 year or 3 years based on random allocation.

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Introduction: Soft tissue sarcomas (STSs) are rare diseases. A high level of standardization and centralization was lacking in Germany until 2018.

Methods: By developing an evidence-based guideline and a certification system for sarcoma centres, foundations for structured, guideline-based, and centralized sarcoma care were defined.

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Nirogacestat, a γ-Secretase Inhibitor for Desmoid Tumors.

N Engl J Med

March 2023

From Sarcoma Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York (M.G.), and Northwell Health Cancer Institute, New Hyde Park (T.P.) - all in New York; the Department of Sarcoma Medical Oncology, Division of Cancer Medicine, University of Texas M.D. Anderson Cancer Center, Houston (R.R.); the Department of Oncology, McGill University, Montreal (T.A.); the Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven (P.S.), the Department of Medical Oncology, Ghent University Hospital, Ghent University, Ghent (L.L.), and King Albert II Cancer Institute, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels (F.M.) - all in Belgium; the Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam (W.T.G.), and the Department of Medical Oncology, Leiden University Medical Center, Leiden (H.G.) - both in the Netherlands; the Department of Medicine, University of Colorado Cancer Center, Aurora (B.A.W.); Duke Cancer Institute, Duke University Medical Center (R.F.R.), and PharPoint Research (S.M.) - both in Durham, NC; SpringWorks Therapeutics, Stamford (A.L., L.M.S.), and Smilow Cancer Hospital, Yale Cancer Center, Yale School of Medicine, Yale University, New Haven (H.D.) - both in Connecticut; the Department of Hematology and Oncology, Mayo Clinic, Jacksonville (S.A.), and Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami (G.D.) - both in Florida; the Sarcoma Oncology Center, Santa Monica (S.C.), the David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (N.F.), and the Department of Medicine, Division of Oncology, Stanford Cancer Institute, Stanford (N.Q.B.) - all in California; the Sarcoma and Bone Cancer Treatment Center, Dana-Farber Cancer Institute and Harvard Medical School (P.M.), and the Henri and Belinda Termeer Center for Targeted Therapies, Massachusetts General Hospital Cancer Center (G.M.C.) - both in Boston; Washington University in St. Louis, St. Louis (B.A.V.T.); the Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, and Fondazione Policlinico Universitario Campus Bio-Medico - both in Rome (B.V.), the Osteoncology, Bone and Soft Tissue Sarcoma, and Innovative Therapy Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna (E.P.), the Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (S.S.), and Medical Oncology, Candiolo Cancer Institute FPO-IRCCS, Candiolo (G.G.) - all in Italy; the Royal Marsden NHS Foundation Trust (C.B.) and the Department of Medical Oncology, University College London Hospital Foundation Trust (P.D.) - both in London; the University of Michigan Rogel Cancer Center, Ann Arbor (R.C.); the Ohio State University Comprehensive Cancer Center, Columbus (G.T.), and the Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati (J.G.P.); the Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee (J.C.), and the University of Wisconsin Carbone Cancer Center, Madison (H.H.B.); the Division of Hematology and Oncology, Department of Medicine, University of Pennsylvania, Philadelphia (L.H.), and the University of Pittsburgh Medical Center, Pittsburgh (M.A.B.); the Sarcoma Center Berlin-Brandenburg, Helios Klinikum Berlin-Buch, Berlin (P.R.), and the University of Heidelberg, Mannheim University Medical Center, Mannheim Cancer Center, Sarcoma Unit, Mannheim (B.K.) - both in Germany; the Knight Cancer Institute, Oregon Health and Science University, Portland (L.E.D., S.K.); and the Division of Medical Oncology, University of Washington, the Clinical Research Division, Fred Hutchinson Cancer Research Center, and Seattle Cancer Care Alliance, Seattle (E.L.).

Article Synopsis
  • * ! The trial showed that nirogacestat significantly improved progression-free survival (76% event-free at 2 years) compared to placebo (44%), with a higher rate of objective responses (41% vs. 8%).
  • * ! While nirogacestat had notable benefits, it also caused common side effects like diarrhea (84%) and nausea (54%), and 75% of women of childbearing potential experienced issues related to ovarian function.
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