Matti Aapro

University of Leeds, Leeds, England, United Kingdom

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Publications (243)1301.63 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study is to examine the real-world treatment patterns and outcomes of chemotherapy-induced (febrile) neutropenia (chemotherapy-induced (CIN)/febrile neutropenia (FN)) prophylaxis with biosimilar filgrastim (Zarzio®). MONITOR-GCSF is an international (12 countries), multi-center (140), prospective (max. six cycles), observational, open-label, pharmaco-epidemiologic study of cancer patients (n = 1447) treated with myelosuppressive chemotherapy across a total of 6,213 cycles and receiving prophylaxis with Zarzio®. Data were analyzed using both the patient and cycle as unit of analysis. Most (72.3 %) received primary prophylaxis; dosed mainly (53.2 %) at 30 MIU but differentiated by weight, chemotoxicity, and tumor type; and mainly (53.2 %) initiated in the 24-72h post-chemotherapy window but differentiated by prophylaxis type, tumor type, and chemotoxicity and for modal/median duration of 5 days. Relative to European Organisation for Research and Treatment of Cancer (EORTC) guidelines, 56.6 % were correctly prophylacted, 17.4 % under-prophylacted, and 26.0 % over-prophylacted. The following incidence rates were recorded: CIN grade 4 13.2 % of patients and 3.9 % of cycles, FN 5.9 % of patients and 1.4 % of cycles, CIN/FN-related hospitalizations 6.1 % of patients and 1.5 % of cycles, CIN/FN-related chemotherapy disturbances 9.5 % of patients and 2.8 % of cycles, and composite outcomes index 22.3 % of patients and 6.7 % of cycles. Rates varied by type of prophylaxis and tumor, chemotoxicity, initiation day, and prophylaxis duration. There were 1834 musculoskeletal events with 24.7 % of patients reporting bone pain of any grade (mostly mild to moderate), and 148 adverse drug reactions, including 4 serious, were recorded in 76 patients. The clinical and safety outcomes are well within the range of historically reported data for originator filgrastim underscoring the clinical effectiveness and safety of biosimilar filgrastim in daily clinical practice.
    Supportive Care Cancer 08/2015; DOI:10.1007/s00520-015-2861-z · 2.50 Impact Factor
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    ABSTRACT: Data from two noninferiority trials of a dexamethasone-sparing regimen were assessed for the impact of acute nausea and vomiting on delayed outcome in patients undergoing moderately emetogenic chemotherapy (MEC) or anthracycline plus cyclophosphamide (AC). Chemo-naive patients were randomized to receive palonosetron (0.25 mg IV) plus dexamethasone (8 mg IV) on day 1 of chemotherapy, or the same regimen followed by oral dexamethasone on days 2 and 3 in the MEC (n = 237) and AC (n = 380) cohorts. Patients were divided into two groups according to whether or not they experienced vomiting and/or moderate-to-severe nausea during the acute phase (high- and low-risk groups, respectively). Primary efficacy endpoint was the complete protection (CP) against delayed vomiting and moderate-to-severe nausea. Patient's satisfaction (0-100 mm visual analog scale) was also analyzed. Among the 209 low-risk patients undergoing MEC, delayed CP occurred in 82.9 % of those who received single-dose dexamethasone and 89.8 % of those who received 3-day dexamethasone (P = 0.165). Of the 271 low-risk patients undergoing AC, CP was achieved in 71.7 % of those treated with single-dose dexamethasone and 84.2 % treated with 3-day dexamethasone (P = 0.019). In spite of these observations, the patient satisfaction data was not influenced by dexamethasone regimen. In both cohorts, occurrence of acute vomiting or moderate-to-severe nausea was the key independent-predictor for delayed vomiting or nausea, respectively. The dexamethasone-sparing regimen provides adequate delayed protection in patients undergoing MEC who are at low risk for delayed symptoms, and can still be discussed for low-risk AC patients as the daily difference in control is modest. Additional dexamethasone doses can be customized on the basis of occurrence or absence of acute symptoms in the first cycle of MEC and even AC.
    Supportive Care in Cancer 08/2015; DOI:10.1007/s00520-015-2871-x · 2.50 Impact Factor
  • 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
  • Vito Lorusso · Meinolf Karthaus · Matti Aapro
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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
  • Ivo Abraham · Lucy Han · Diana Sun · Karen MacDonald · Matti Aapro
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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
  • Luigi Celio · Filippo de Braud · Matti Aapro
    Journal of Clinical Oncology 06/2014; 32(20). DOI:10.1200/JCO.2014.55.4352 · 18.43 Impact Factor
  • Mark Lawler · Peter Selby · Matti S Aapro · Sean Duffy
    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

Publication Stats

7k Citations
1,301.63 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