Matti Aapro

University of Leeds, Leeds, England, United Kingdom

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Publications (238)1284.28 Total impact

  • Cancer Research 05/2015; 75(9 Supplement):P5-15-19-P5-15-19. DOI:10.1158/1538-7445.SABCS14-P5-15-19 · 9.28 Impact Factor
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    ABSTRACT: Chemotherapy-induced nausea and vomiting (CINV) is a common adverse event associated with anticancer treatment that can have a significant adverse impact on patient health-related quality of life and that can potentially undermine the effectiveness of chemotherapy. Traditional regimens to prevent CINV generally involved a combination of a corticosteroid plus a 5-hydroxytryptamine (5HT3) receptor antagonist (RA). In the past 10 years, antiemetic treatment has greatly advanced with the availability of the neurokinin-1 receptor antagonist (NK1 RA) aprepitant and its prodrug fosaprepitant. NK1 RAs have a different mechanism of action in CINV than corticosteroids and 5HT3 RAs, thus their use can complement traditional antiemetic drugs and can enhance control of CINV. This review examined accumulated data regarding the safety and efficacy of aprepitant and fosaprepitant over the decade since the first regulatory approval. Data from key studies of aprepitant and fosaprepitant in the prevention of CINV in patients receiving moderately and highly emetogenic chemotherapy were explored, as were recommendations in currently available guidelines for their use. In addition, their use as antiemetic therapy in special patient populations was highlighted. Future perspectives on potential uses of aprepitant and fosaprepitant for indications other than CINV are presented. ©AlphaMed Press.
    The Oncologist 03/2015; 20(4). DOI:10.1634/theoncologist.2014-0229 · 4.54 Impact Factor
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    ABSTRACT: A number of cancer therapy agents are cleared by the kidney and may affect renal function, including cytotoxic chemotherapy agents, molecular targeted therapies, analgesics, antibiotics, radiopharmaceuticals and radiation therapy, and bone-targeted therapies. Many of these agents can be nephrotoxic including, targeted cancer therapies. The incidence, severity, and pattern of renal toxicities may vary according to the respective target of the drug. Here we review the renal effects associated with a selection of currenty approved targeted cancer therapies, directed to VEGF/VEGFR, EGFR, HER2, BRAF, ALK, PD1/PDL1, RANKL, mTOR. The early diagnosis and prompt treatment of these renal alterations are essential in the daily practice where molecular targeted therapies have a definitive role in the armamentarium used in many cancers. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
    Annals of Oncology 03/2015; DOI:10.1093/annonc/mdv136 · 6.58 Impact Factor
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    ABSTRACT: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma in the elderly, and is increasing in incidence. Although significant therapeutic advances have recently been made in the care of older patients with DLBCL, based upon results of randomized clinical trials, many older patients are not eligible for such trials due to comorbidities and functional decline. Pre-treatment evaluation of older patients to ascertain potential tolerance to therapy is especially important in therapeutic decisions for this population. Evaluation by performance status alone is insufficient, especially in the elderly, and consideration of the impact of comorbidities and functional/social decline needs to be included in such assessment. As part of an International Society of Geriatric Oncology (SIOG) task force, the issues of prognosis, comorbidities, geriatric assessment, and supportive care measures in older patients with DLBCL will be reviewed, and recommendations for assessment and allied care made.
    Journal of Geriatric Oncology 12/2014; 6(2). DOI:10.1016/j.jgo.2014.11.004 · 1.15 Impact Factor
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    ABSTRACT: In this article, we propose a frame of reference to approach complexity in clinical practice. Complexity is becoming a more and more common issue, due to the aging of the population, increased prevalence of polymorbidity, dwindling pool of home caregivers, and the social and economic issues associated with age. The case of a 79-year-old woman with hemiparesis from a previous stroke, breast cancer, and chronic myelogenous leukemia is analyzed. From the analysis of the case, we concluded that: there was an urgent need of a person charged with making the final medical recommendations to an older individual with multiple medical problems; patient autonomy may be limited by the need of a caregiver able to assist in the activity of daily living; active life expectancy is a major goal in the management of an older person; several courses of actions may be acceptable toward such goal.
    12/2014; 12(3). DOI:10.1007/s12682-014-0192-3
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    ABSTRACT: ABSTRACT Current guidelines recommend the combination of a neurokinin-1 (NK1) receptor antagonist (RA) and a 5-hydroxytryptamine-3 (5-HT3) RA, together with corticosteroids, in order to prevent chemotherapy-induced nausea and vomiting with anthracycline-cyclophosphamide and highly emetogenic chemotherapy, and it is to be considered with moderately emetogenic chemotherapy. Netupitant and palonosetron (NEPA) is a fixed-dose combination of netupitant, a novel, highly selective NK1 RA, and palonosetron, a new-generation 5-HT3 RA, targeting two major emetic pathways in a single oral capsule. In clinical trials, NEPA administered on day 1 together with dexamethasone was highly effective and well tolerated in the prevention of chemotherapy-induced nausea and vomiting in patients with solid tumors undergoing moderately emetogenic chemotherapy or highly emetogenic chemotherapy. NEPA offers maximal convenience, and as a simple guideline-based regimen, has the potential to improve adherence to guidelines.
    Future Oncology 10/2014; 11(4):1-13. DOI:10.2217/fon.14.260 · 2.61 Impact Factor
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    ABSTRACT: In 2010, the International Society of Geriatric Oncology (SIOG) developed treatment guidelines for men with prostate cancer who are older than 70 years old. In 2013, a new multidisciplinary SIOG working group was formed to update these recommendations. The consensus of the task force is that older men with prostate cancer should be managed according to their individual health status, not according to age. On the basis of a validated rapid health status screening instrument and simple assessment, the task force recommends that patients are classed into three groups for treatment: healthy or fit patients who should have the same treatment options as younger patients; vulnerable patients with reversible impairment who should receive standard treatment after medical intervention; and frail patients with non-reversible impairment who should receive adapted treatment.
    The Lancet Oncology 08/2014; 15(9):e404–e414. DOI:10.1016/S1470-2045(14)70018-X · 24.73 Impact Factor
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    ABSTRACT: Aim: We simulated the budget impact of biosimilar erythropoiesis-stimulating agent (ESA) in EU G5 countries. Materials & methods: Three models were built to estimate the number of patients who could be provided with antineoplastic therapy with rituximab, bevacizumab or trastuzumab from cost savings of biosimilar erythropoietin use in a hypothetical panel of 100,000 patients. The associated number of patients needed to convert to biosimilar ESA to provide such treatments was also calculated. Results: Under fixed dosing, the savings from 100% conversion were (sic)110,592,159, translating into an additional 9770 rituximab, 3912 bevacizumab, or 3713 trastuzumab treatments. Under weight-based dosing, the savings from 100% conversion were (sic)146,170,333, corresponding to an additional 12,913 rituximab, 5171 bevacizumab or 4908 trastuzumab treatments. The number of patients needed to convert ranged from four to 51. Conclusion: Using biosimilar ESA for supportive cancer care yields significant savings and increases accessibility to primary antineoplastic therapy in a budget neutral way.
    Future Oncology 08/2014; 10(9):1599-609. DOI:10.2217/fon.14.43 · 2.61 Impact Factor
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    ABSTRACT: The treatment of cancer presents specific concerns that are unique to the growing demographic of elderly patients. Because the incidence of cancer is strongly correlated with aging, the expansion of supportive care and other age-appropriate therapies will be of great importance as the population of elderly patients with cancer increases in the coming years. Elderly patients are especially likely to experience febrile neutropenia, complications from chemotherapy-induced nausea, anemia, osteoporosis (especially in patients diagnosed with breast or prostate cancer), depression, insomnia, and fatigue. These issues are often complicated by other chronic conditions related to age, such as diabetes and cardiac disease. For many patients, symptoms may be addressed both through lifestyle management and pharmaceutical approaches. Therefore, the key to improving quality of life for the elderly patient with cancer is an awareness of their specific needs and a familiarity with emergent treatment options.
    Journal of Clinical Oncology 07/2014; 32(24). DOI:10.1200/JCO.2014.55.3065 · 18.43 Impact Factor
  • Journal of Clinical Oncology 06/2014; 32(20). DOI:10.1200/JCO.2014.55.4352 · 18.43 Impact Factor
  • BMJ (online) 02/2014; 348:g1614. DOI:10.1136/bmj.g1614 · 16.38 Impact Factor
  • Lodovico Balducci, Matti Aapro
    Journal of Geriatric Oncology 01/2014; 5(1):116-118. DOI:10.1016/j.jgo.2013.11.003 · 1.15 Impact Factor
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    ABSTRACT: Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments.
    The Breast 10/2013; 22(5):593–605. DOI:10.1016/j.breast.2013.07.050 · 2.58 Impact Factor
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    ABSTRACT: Demographic, personal, clinical, and behavioral factors predicting chemotherapy-induced nausea and vomiting (CINV) have been assessed in the past, but inconsistencies exist in the literature, studies have methodological shortcomings, and many risk factors have been examined in cross-sectional studies and univariate analyses. To evaluate the predictive power of personal and treatment-related characteristics in the development of CINV, using a large and prospectively evaluated sample of a heterogeneous group of cancer patients receiving routine chemotherapy. This was a multicountry, multisite prospective study over three cycles of chemotherapy. Adult patients from eight European countries about to receive highly and moderately emetogenic chemotherapy were recruited. Clinicians completed a case report form at or before the initial chemotherapy treatment, recording patient demographic and baseline clinical characteristics. Participants completed a daily patient diary for six days per chemotherapy cycle describing their CINV experience. Baseline patient data also included a history of nausea/vomiting (yes/no), patient expectation of nausea (0-100 mm visual analogue scale [VAS]), prechemotherapy anxiety (0-100 mm VAS), and prechemotherapy nausea (0-100 mm VAS) measured during the 24-hour period before chemotherapy initiation. There were 991 evaluable patients with complete Cycle 1 data, 888 for Cycle 2 data, and 769 for Cycle 3 data. A complex picture of predictor variables was shown, with different contribution of variables to the acute, delayed, and overall phases of CINV. Key predictor variables included the use of antiemetics inconsistent with international guidelines, younger age, prechemotherapy nausea, and no CINV complete response in an earlier cycle (all at P < 0.05). Anxiety, history of nausea/vomiting, and expectations of nausea were important predictors for some phases and cycles but not consistently across the CINV pathway. The results of this study provide clarity for the relative contribution of a set of characteristics in the development of CINV. Following evidence-based clinical antiemetic guidelines is of paramount importance, alongside treating patients with increased risk for CINV more aggressively, which both could lead to more optimal CINV management. These data can assist clinicians in making decisions about the antiemetic management of their patients.
    Journal of pain and symptom management 09/2013; 47(5). DOI:10.1016/j.jpainsymman.2013.06.012 · 2.74 Impact Factor
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    ABSTRACT: IntroductionThe Anemia Cancer Treatment study assessed hemoglobin (Hb) outcomes following treatment with erythropoiesis-stimulating agents (ESA) in anemic (Hb ≤ 11 g/dL) patients in Europe. We replicated the original analyses stratifying by age, namely patients aged ≥ 70 (n = 637) versus those aged < 70 (n = 1555).Materials and methodsA secondary analysis of Hb outcomes was assessed over 8–10 weeks. Treatment response criteria included increases of Hb ≥ 1 g/dL, Hb ≥ 1 g/dL over 8 weeks, and Hb ≥ 2 g/dL over the course of the study period.ResultsMean Hb increased from similar levels of 9.5 g/dL [p = not significant (ns)] at visit one to 10.9 g/dL (p = ns) at visit three (both p < 0.001). Patients aged ≥ 70 had higher mean Hb at visit two (10.6 g/dL vs. 10.3 g/dL, p < 0.001). Cohorts did not differ in treatment response rates (all p = ns). Mean performance status differed between cohorts at each visit (all p ≤ 0.011); both groups showed significant improvements (both p < 0.001). Immediacy of response was a consistent determinant but was more pronounced among patients aged ≥ 70. Less consistent determinants included performance status in the age ≥ 70 group, as well as hematological malignancy and Hb at ESA start in the age < 70 group. The proportion of variance in Hb outcomes attributable to treatment center ranged from 0.090 to 0.289 in the age ≥ 70 cohort and 0.126 to 0.361 in the age < 70 cohort.Conclusions Both groups achieved similar Hb levels with the age ≥ 70 cohort showing a higher initial evolution rate and potentially a different Hb response trajectory. Patients age ≥ 70 were more likely to benefit from ESAs if showing an early erythropoietic response and exhibiting no or little impairment in performance status. Differential attribution of variability in older vs. younger adults suggests that individualization of ESA therapy may facilitate Hb response in geriatric patients with cancer.
    Journal of Geriatric Oncology 04/2013; 4(2):196–201. DOI:10.1016/j.jgo.2012.09.058 · 1.15 Impact Factor
  • Luigi Celio, Matti Aapro
    Journal of Clinical Oncology 02/2013; 31(10). DOI:10.1200/JCO.2012.47.2209 · 18.43 Impact Factor
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    ABSTRACT: The efficacy and tolerability of intravenous (i.v.) iron in managing cancer-related anemia and iron deficiency has been clinically evaluated and reviewed recently. However, long-term data in cancer patients are not available; yet, long-term i.v. iron treatment in hemodialysis patients is not associated with increased cancer risk. This review summarizes epidemiological and nonclinical data on the role of iron in carcinogenesis. In humans, epidemiological data suggest correlations between certain cancers and increased iron exposure or iron overload. Nonclinical models that investigated whether iron can enhance carcinogenesis provide only limited evidence relevant for cancer patients since they were typically based on high iron doses as well as injection routes and iron formulations which are not used in the clinical setting. Nevertheless, in the absence of long-term outcome data from prospectively defined trials in i.v. iron-treated cancer patients, iron supplementation should be limited to periods of concomitant anti-tumor treatment.
    Critical reviews in oncology/hematology 01/2013; 89(1). DOI:10.1016/j.critrevonc.2013.10.008 · 4.05 Impact Factor
  • Lodovico Balducci, Matti Aapro
    Journal of Geriatric Oncology 01/2013; · 1.15 Impact Factor
  • Richard Chapell, Matti S Aapro
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    ABSTRACT: Various antiemetic agents are commonly administered during and after chemotherapy to prevent nausea and vomiting depending on the emetogenic risk. Data specific for patients older than 65 are rarely discussed and it is often assumed that such patients have less risk of nausea and vomiting and might not need the same prevention. To determine whether response to antiemetic regimens incorporating aprepitant varies with patient age, we combined previously unpublished subgroup analyses from four previously published studies. Risk ratios were combined using standard meta-analytic techniques to determine whether antiemetic regimens including aprepitant lead to more complete responses to antiemetic therapy than regimens without aprepitant, among patients aged 65 and over. Patients aged 65 and over have a significantly greater chance of experiencing a complete response (no vomiting or use of rescue therapy) to antiemetic treatment when aprepitant is included in the antiemetic regimen (Risk Ratio 1.25, 95% Confidence Interval 1.11 to 1.40, p=0.0002) than when it is not. This risk ratio is not significantly different (Q=0.281, p=0.596) from the risk ratio calculated for patients under age 65 (1.30, 95% Confidence Interval 1.19 to 1.42), from the same set of studies. This meta-analysis combines studies utilizing different antiemetic regimens and different patient populations. Only a single efficacy outcome is included, and safety is not assessed. We conclude that for both the under 65years and the age 65 and over populations, antiemetic regimens including aprepitant, along with a 5-HT3 antagonist and a corticosteroid, are more effective in reducing chemotherapy-induced nausea and vomiting than regimens that do not include aprepitant.
    Journal of Geriatric Oncology 01/2013; 4(1):78-83. DOI:10.1016/j.jgo.2012.08.008 · 1.15 Impact Factor
  • Matti S Aapro
    Breast Care 12/2012; 7(6):434-5. DOI:10.1159/000346342 · 0.91 Impact Factor

Publication Stats

7k Citations
1,284.28 Total Impact Points

Institutions

  • 2014
    • University of Leeds
      Leeds, England, United Kingdom
  • 2011–2014
    • Moffitt Cancer Center
      Tampa, Florida, United States
    • Hospital Clínic de Barcelona
      Barcino, Catalonia, Spain
  • 2000–2014
    • Institut Multidisciplinaire d'Oncologie - Clinique de Genolier
      Vaud, Switzerland
  • 2012
    • Mater Misericordiae University Hospital
      • Department of Surgery
      Dublin, Leinster, Ireland
  • 2007
    • Pennsylvania State University
      University Park, Maryland, United States
    • University of Vermont
      Burlington, Vermont, United States
    • Galway University Hospitals
      Gaillimh, Connaught, Ireland
    • Martin Luther University of Halle-Wittenberg
      • Poliklinik für Innere Medizin IV (Hämatologie und Onkologie)
      Halle, Saxony-Anhalt, Germany
    • Memorial Sloan-Kettering Cancer Center
      New York City, New York, United States
  • 2002
    • INRCA Istituto Nazionale di Ricovero e Cura per Anziani
      Ancona, The Marches, Italy
  • 1994–2000
    • IEO - Istituto Europeo di Oncologia
      • Department of Medical Oncology
      Milano, Lombardy, Italy
  • 1991–1998
    • University of Geneva
      • • Department of Rehabilitation and Geriatrics
      • • Division of Oncology
      Genève, GE, Switzerland
  • 1997
    • St. Elizabeth's Medical Center
      Boston, Massachusetts, United States