Skip to main content
Top
Published in: BMC Cancer 1/2006

Open Access 01-12-2006 | Research article

Weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) as first-line chemotherapy for elderly patients with advanced gastric cancer: results of a phase II trial

Authors: D Santini, F Graziano, V Catalano, M Di Seri, E Testa, AM Baldelli, P Giordani, A La Cesa, B Spalletta, B Vincenzi, A Russo, M Caraglia, V Virzi, S Cascinu, G Tonini

Published in: BMC Cancer | Issue 1/2006

Login to get access

Abstract

Background

Elderly patients have been often excluded from or underrepresented in the study populations of combination chemotherapy trials. The primary end point of this study was to determine the response rate and the toxicity of the weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) regimen in elderly patients with advanced gastric cancer. The secondary objective was to measure the time to disease progression and the survival time.

Methods

Chemotherapy-naive patients with advanced gastric cancer aged 70 or older were considered eligible for study entry. Patients received weekly oxaliplatin 40 mg/m2, fluorouracil 500 mg/m2 and folinic acid 250 mg/m2. All drugs were given intravenously on a day-1 schedule.

Results

A total of 42 elderly patients were enrolled. Median age was 73 years and all patients had metastatic disease. The response rate according to RECIST criteria was 45.2% (95% CIs: 30%–56%) with two complete responses, 17 partial responses, 13 stable diseases and 10 progressions, for an overall tumor rate control of 76.2% (32 patients). Toxicity was generally mild and only three patients discontinued treatment because of treatment related adverse events. The most common treatment-related grade 3/4 adverse events were fatigue (7.1%), diarrhoea (4.8%), mucositis (2.4%), neurotoxicity (2.4%) and neutropenia (4.8%). The median response duration was 5.3 months (95% CIs: 2.13 – 7.34), the median time to disease progression was 5.0 months (95% CIs: 3.75 – 6.25) and the median survival time was 9.0 months (95% CIs: 6.18 – 11.82).

Conclusion

OXALF represents an active and well-tolerated treatment modality for elderly patients with locally advanced and metastatic gastric cancer.
Appendix
Available only for authorised users
Literature
1.
go back to reference Talarico L, Chen G, Pazdur R: Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol. 2004, 22: 4626-31. 10.1200/JCO.2004.02.175.CrossRefPubMed Talarico L, Chen G, Pazdur R: Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol. 2004, 22: 4626-31. 10.1200/JCO.2004.02.175.CrossRefPubMed
2.
go back to reference Cascinu S, Labianca R, Alessandroni P, Marcellini M, Silva RR, Pancera G, Testa E, Martignoni G, Barni S, Frontini L, Zaniboni A, Luporini G, Cellerino R, Catalano G: Intensive weekly chemotherapy for advanced gastric cancer using fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin, glutathione, and filgrastim: a report from the Italian Group for the Study of Digestive Tract Cancer. J Clin Oncol. 1997, 11: 3313-3319. Cascinu S, Labianca R, Alessandroni P, Marcellini M, Silva RR, Pancera G, Testa E, Martignoni G, Barni S, Frontini L, Zaniboni A, Luporini G, Cellerino R, Catalano G: Intensive weekly chemotherapy for advanced gastric cancer using fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin, glutathione, and filgrastim: a report from the Italian Group for the Study of Digestive Tract Cancer. J Clin Oncol. 1997, 11: 3313-3319.
3.
go back to reference Cascinu S, Scartozzi M, Labianca R, Catalano V, Silva RR, Barni S, Zaniboni A, D'Angelo A, Salvagni S, Martignoni G, Beretta GD, Graziano F, Berardi R, Franciosi V: High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer [GISCAD]. Br J Cancer. 2004, 8: 1521-5. 10.1038/sj.bjc.6601752.CrossRef Cascinu S, Scartozzi M, Labianca R, Catalano V, Silva RR, Barni S, Zaniboni A, D'Angelo A, Salvagni S, Martignoni G, Beretta GD, Graziano F, Berardi R, Franciosi V: High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer [GISCAD]. Br J Cancer. 2004, 8: 1521-5. 10.1038/sj.bjc.6601752.CrossRef
4.
go back to reference Graziano F, Santini D, Testa E, Catalano V, Beretta GD, Mosconi S, Tonini G, Lai V, Labianca R, Cascinu S: A phase II study of weekly cisplatin, 6S-stereoisomer leucovorin and fluorouracil as first-line chemotherapy for elderly patients with advanced gastric cancer. Br J Cancer. 2003, 8: 1428-32. 10.1038/sj.bjc.6601280.CrossRef Graziano F, Santini D, Testa E, Catalano V, Beretta GD, Mosconi S, Tonini G, Lai V, Labianca R, Cascinu S: A phase II study of weekly cisplatin, 6S-stereoisomer leucovorin and fluorouracil as first-line chemotherapy for elderly patients with advanced gastric cancer. Br J Cancer. 2003, 8: 1428-32. 10.1038/sj.bjc.6601280.CrossRef
5.
go back to reference Raymond E, Faivre S, Woynarowski JM, Chaney SG: Oxaliplatin: mechanism of action and antineoplastic activity. Semin Oncol. 1998, 4-12. Suppl 5 Raymond E, Faivre S, Woynarowski JM, Chaney SG: Oxaliplatin: mechanism of action and antineoplastic activity. Semin Oncol. 1998, 4-12. Suppl 5
6.
go back to reference Al-Batran SE, Atmaca A, Hegewisch-Becker S, Jaeger D, Hahnfeld S, Rummel MJ, Seipelt G, Rost A, Orth J, Knuth A, Jaeger E: Phase II trial of biweekly infusional fluorouracil, folinic acid, and oxaliplatin in patients with advanced gastric cancer. J Clin Oncol. 2004, 4: 658-63. 10.1200/JCO.2004.07.042.CrossRef Al-Batran SE, Atmaca A, Hegewisch-Becker S, Jaeger D, Hahnfeld S, Rummel MJ, Seipelt G, Rost A, Orth J, Knuth A, Jaeger E: Phase II trial of biweekly infusional fluorouracil, folinic acid, and oxaliplatin in patients with advanced gastric cancer. J Clin Oncol. 2004, 4: 658-63. 10.1200/JCO.2004.07.042.CrossRef
7.
go back to reference Chao Y, Yeh KH, Chang CJ, Chen LT, Chao TY, Wu MF, Chang CS, Chang JY, Chung CY, Kao WY, Hsieh RK, Cheng AL: Phase II study of weekly oxaliplatin and 24-h infusion of high-dose 5-fluorouracil and folinic acid in the treatment of advanced gastric cancer. Br J Cancer. 2004, 3: 453-8. 10.1038/sj.bjc.6601985.CrossRef Chao Y, Yeh KH, Chang CJ, Chen LT, Chao TY, Wu MF, Chang CS, Chang JY, Chung CY, Kao WY, Hsieh RK, Cheng AL: Phase II study of weekly oxaliplatin and 24-h infusion of high-dose 5-fluorouracil and folinic acid in the treatment of advanced gastric cancer. Br J Cancer. 2004, 3: 453-8. 10.1038/sj.bjc.6601985.CrossRef
8.
go back to reference De Vita F, Orditura M, Matano E, Bianco R, Carlomagno C, Infusino S, Damiano V, Simeone E, Diadema MR, Lieto E, Castellano P, Pepe S, De Placido S, Galizia G, Di Martino N, Ciardiello F, Catalano G, Bianco AR: A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid [FOLFOX-4] as first-line treatment of advanced gastric cancer patients. Br J Cancer. 2005, 9: 1644-9. 10.1038/sj.bjc.6602573.CrossRef De Vita F, Orditura M, Matano E, Bianco R, Carlomagno C, Infusino S, Damiano V, Simeone E, Diadema MR, Lieto E, Castellano P, Pepe S, De Placido S, Galizia G, Di Martino N, Ciardiello F, Catalano G, Bianco AR: A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid [FOLFOX-4] as first-line treatment of advanced gastric cancer patients. Br J Cancer. 2005, 9: 1644-9. 10.1038/sj.bjc.6602573.CrossRef
9.
go back to reference Louvet C, Andre T, Tigaud JM, Gamelin E, Douillard JY, Brunet R, Francois E, Jacob JH, Levoir D, Taamma A, Rougier P, Cvitkovic E, de Gramont A: Phase II study of oxaliplatin, fluorouracil, and folinic acid in locally advanced or metastatic gastric cancer patients. J Clin Oncol. 2002, 20: 4543-4548. 10.1200/JCO.2002.02.021.CrossRefPubMed Louvet C, Andre T, Tigaud JM, Gamelin E, Douillard JY, Brunet R, Francois E, Jacob JH, Levoir D, Taamma A, Rougier P, Cvitkovic E, de Gramont A: Phase II study of oxaliplatin, fluorouracil, and folinic acid in locally advanced or metastatic gastric cancer patients. J Clin Oncol. 2002, 20: 4543-4548. 10.1200/JCO.2002.02.021.CrossRefPubMed
10.
go back to reference Lordick F, Lorenzen S, Stollfuss J, Vehling-Kaiser U, Kullmann F, Hentrich M, Zumschlinge R, Dietzfelbinger H, Thoedtmann J, Hennig M, Seroneit T, Bredenkamp R, Duyster J, Peschel C: Phase II study of weekly oxaliplatin plus infusional fluorouracil and folinic acid [FUFOX regimen] as first-line treatment in metastatic gastric cancer. Br J Cancer. 2005, 93: 190-4. 10.1038/sj.bjc.6602697.CrossRefPubMedPubMedCentral Lordick F, Lorenzen S, Stollfuss J, Vehling-Kaiser U, Kullmann F, Hentrich M, Zumschlinge R, Dietzfelbinger H, Thoedtmann J, Hennig M, Seroneit T, Bredenkamp R, Duyster J, Peschel C: Phase II study of weekly oxaliplatin plus infusional fluorouracil and folinic acid [FUFOX regimen] as first-line treatment in metastatic gastric cancer. Br J Cancer. 2005, 93: 190-4. 10.1038/sj.bjc.6602697.CrossRefPubMedPubMedCentral
11.
go back to reference Sumpter K, Harper-Wynne C, Cunningham D, Rao S, Tebbutt N, Norman AR, Ward C, Iveson T, Nicolson M, Hickish T, Hill M, Oates J: Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer. 2005, 92: 1976-83. 10.1038/sj.bjc.6602572.CrossRefPubMedPubMedCentral Sumpter K, Harper-Wynne C, Cunningham D, Rao S, Tebbutt N, Norman AR, Ward C, Iveson T, Nicolson M, Hickish T, Hill M, Oates J: Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer. 2005, 92: 1976-83. 10.1038/sj.bjc.6602572.CrossRefPubMedPubMedCentral
12.
go back to reference Scott WK, Macera CA, Cornman CB, Sharpe PA: Functional health status as a predictor of mortality in men and women over 65. J Clin Epidemiol. 1997, 50: 291-296. 10.1016/S0895-4356(96)00365-4.CrossRefPubMed Scott WK, Macera CA, Cornman CB, Sharpe PA: Functional health status as a predictor of mortality in men and women over 65. J Clin Epidemiol. 1997, 50: 291-296. 10.1016/S0895-4356(96)00365-4.CrossRefPubMed
13.
go back to reference Balducci L, Yates J: General guidelines for management of older patients with cancer. Oncology. 2000, 14: 221-227.PubMed Balducci L, Yates J: General guidelines for management of older patients with cancer. Oncology. 2000, 14: 221-227.PubMed
14.
go back to reference Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000, 3: 205-16. 10.1093/jnci/92.3.205.CrossRef Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000, 3: 205-16. 10.1093/jnci/92.3.205.CrossRef
15.
go back to reference Kranenbarg EK, Van de Velde CJ: Gastric cancer in the elderly. Eur J Surg Oncol. 1998, 5: 384-90. 10.1016/S0748-7983(98)92062-5.CrossRef Kranenbarg EK, Van de Velde CJ: Gastric cancer in the elderly. Eur J Surg Oncol. 1998, 5: 384-90. 10.1016/S0748-7983(98)92062-5.CrossRef
16.
go back to reference Wilke H, Preusser P, Fink U, Achterrath W, Lenaz L, Stahl M, Schober C, Link H, Meyer HJ, Lucke B: High dose folinic acid/etoposide/5-fluorouracil in advanced gastric cancer: a phase II study in elderly patients or patients with cardiac risk. Invest New Drugs. 1990, 8: 65-70. 10.1007/BF00216926.CrossRefPubMed Wilke H, Preusser P, Fink U, Achterrath W, Lenaz L, Stahl M, Schober C, Link H, Meyer HJ, Lucke B: High dose folinic acid/etoposide/5-fluorouracil in advanced gastric cancer: a phase II study in elderly patients or patients with cardiac risk. Invest New Drugs. 1990, 8: 65-70. 10.1007/BF00216926.CrossRefPubMed
17.
go back to reference Cascinu S, Fedeli A, Catalano G: Etoposide, leucovorin 5-fluorouracil and interferon alpha-2b in elderly gastric cancer patients: a pilot study. Cancer Chemother Pharmacol. 1994, 34: 72-74.CrossRefPubMed Cascinu S, Fedeli A, Catalano G: Etoposide, leucovorin 5-fluorouracil and interferon alpha-2b in elderly gastric cancer patients: a pilot study. Cancer Chemother Pharmacol. 1994, 34: 72-74.CrossRefPubMed
18.
go back to reference Cascinu G, Catalano G: Intensive weekly chemotherapy for elderly gastric cancer patients using 5-fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin and gluthatione with the support of G-CSF. Tumori. 1995, 81: 32-35.PubMed Cascinu G, Catalano G: Intensive weekly chemotherapy for elderly gastric cancer patients using 5-fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin and gluthatione with the support of G-CSF. Tumori. 1995, 81: 32-35.PubMed
19.
go back to reference Di Bartolomeo M, Bajetta E, de Braud F, Bochicchio AM, Gebbia V, Bozzetti F, Doci R, Bonfanti G, Cozzaglio L: Phase II study of the etoposide, leucovorin and fluorouracil combination for patients with advanced gastric cancer unsuitable for aggressive chemotherapy. Oncology. 1995, 52: 41-44.CrossRefPubMed Di Bartolomeo M, Bajetta E, de Braud F, Bochicchio AM, Gebbia V, Bozzetti F, Doci R, Bonfanti G, Cozzaglio L: Phase II study of the etoposide, leucovorin and fluorouracil combination for patients with advanced gastric cancer unsuitable for aggressive chemotherapy. Oncology. 1995, 52: 41-44.CrossRefPubMed
20.
go back to reference Hartung G, Hofheinz R, Buchheidt D, Rost A, Brecht A, Forche K, Schroder M, Wojatschek C, Fritze D, Hehlmann R, Queisser W: Combination of bolus 5-fluorouracil, folinic acid and mitomycin-C in advanced gastric cancer: results of a phase II trial. Onkologie. 2000, 23: 444-447. 10.1159/000027215.PubMed Hartung G, Hofheinz R, Buchheidt D, Rost A, Brecht A, Forche K, Schroder M, Wojatschek C, Fritze D, Hehlmann R, Queisser W: Combination of bolus 5-fluorouracil, folinic acid and mitomycin-C in advanced gastric cancer: results of a phase II trial. Onkologie. 2000, 23: 444-447. 10.1159/000027215.PubMed
21.
go back to reference Ikeda N, Shimada Y, Ohtsu A, Boku N, Tsuji Y, Saito H, Koizumi W, Iwase H, Yoshida S, Fukuda H: A phase II study of doxifluridine in elderly patients with advanced gastric cancer: the Japan Clinical Oncology Group study [JCOG 9410]. Jpn J Clin Oncol. 2002, 32: 90-94. 10.1093/jjco/hyf022.CrossRefPubMed Ikeda N, Shimada Y, Ohtsu A, Boku N, Tsuji Y, Saito H, Koizumi W, Iwase H, Yoshida S, Fukuda H: A phase II study of doxifluridine in elderly patients with advanced gastric cancer: the Japan Clinical Oncology Group study [JCOG 9410]. Jpn J Clin Oncol. 2002, 32: 90-94. 10.1093/jjco/hyf022.CrossRefPubMed
22.
go back to reference Kim DY, Kim JH, Lee SH, Kim TY, Heo DS, Bang YJ, Kim NK: Phase II study of oxaliplatin, 5-fluorouracil and leucovorin in previously platinum-treated patients with advanced gastric cancer. Ann Oncol. 2003, 14: 383-387. 10.1093/annonc/mdg106.CrossRefPubMed Kim DY, Kim JH, Lee SH, Kim TY, Heo DS, Bang YJ, Kim NK: Phase II study of oxaliplatin, 5-fluorouracil and leucovorin in previously platinum-treated patients with advanced gastric cancer. Ann Oncol. 2003, 14: 383-387. 10.1093/annonc/mdg106.CrossRefPubMed
23.
go back to reference Waters JS, Norman A, Cunningham D, Scarffe JH, Webb A, Harper P, Joffe JK, Mackean M, Mansi J, Leahy M, Hill A, Oates J, Rao S, Nicolson M, Hickish T: Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: Results of a randomized trial. Br J Cancer. 1999, 80: 269-272. 10.1038/sj.bjc.6690350.CrossRefPubMedPubMedCentral Waters JS, Norman A, Cunningham D, Scarffe JH, Webb A, Harper P, Joffe JK, Mackean M, Mansi J, Leahy M, Hill A, Oates J, Rao S, Nicolson M, Hickish T: Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: Results of a randomized trial. Br J Cancer. 1999, 80: 269-272. 10.1038/sj.bjc.6690350.CrossRefPubMedPubMedCentral
24.
go back to reference De Vita F, Orditura M, Matano E, Bianco R, Carlomagno C, Infusino S, Damiano V, Simeone E, Diadema MR, Lieto E, Castellano P, Pepe S, De Placido S, Galizia G, Di Martino N, Ciardiello F, Catalano G, Bianco AR: A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid [FOLFOX-4] as first-line treatment of advanced gastric cancer patients. Br J Cancer. 2005, 92: 1644-9. 10.1038/sj.bjc.6602573.CrossRefPubMedPubMedCentral De Vita F, Orditura M, Matano E, Bianco R, Carlomagno C, Infusino S, Damiano V, Simeone E, Diadema MR, Lieto E, Castellano P, Pepe S, De Placido S, Galizia G, Di Martino N, Ciardiello F, Catalano G, Bianco AR: A phase II study of biweekly oxaliplatin plus infusional 5-fluorouracil and folinic acid [FOLFOX-4] as first-line treatment of advanced gastric cancer patients. Br J Cancer. 2005, 92: 1644-9. 10.1038/sj.bjc.6602573.CrossRefPubMedPubMedCentral
25.
go back to reference Webb A, Cunningham D, Scarffe JH, Harper P, Norman A, Joffe JK, Hughes M, Mansi J, Findlay M, Hill A, Oates J, Nicolson M, Hickish T, O'Brien M, Iveson T, Watson M, Underhill C, Wardley A, Meehan M: Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol. 1997, 15: 261-267.CrossRefPubMed Webb A, Cunningham D, Scarffe JH, Harper P, Norman A, Joffe JK, Hughes M, Mansi J, Findlay M, Hill A, Oates J, Nicolson M, Hickish T, O'Brien M, Iveson T, Watson M, Underhill C, Wardley A, Meehan M: Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol. 1997, 15: 261-267.CrossRefPubMed
26.
go back to reference Vanhoefer U, Rougier P, Wilke H, Ducreux MP, Lacave AJ, Van Cutsem E, Planker M, Santos JG, Piedbois P, Paillot B, Bodenstein H, Schmoll HJ, Bleiberg H, Nordlinger B, Couvreur ML, Baron B, Wils JA: Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil, and doxorubicin versus etoposide, leucovorin, and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: A trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. J Clin Oncol. 2000, 18: 2648-2657.PubMed Vanhoefer U, Rougier P, Wilke H, Ducreux MP, Lacave AJ, Van Cutsem E, Planker M, Santos JG, Piedbois P, Paillot B, Bodenstein H, Schmoll HJ, Bleiberg H, Nordlinger B, Couvreur ML, Baron B, Wils JA: Final results of a randomized phase III trial of sequential high-dose methotrexate, fluorouracil, and doxorubicin versus etoposide, leucovorin, and fluorouracil versus infusional fluorouracil and cisplatin in advanced gastric cancer: A trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. J Clin Oncol. 2000, 18: 2648-2657.PubMed
Metadata
Title
Weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) as first-line chemotherapy for elderly patients with advanced gastric cancer: results of a phase II trial
Authors
D Santini
F Graziano
V Catalano
M Di Seri
E Testa
AM Baldelli
P Giordani
A La Cesa
B Spalletta
B Vincenzi
A Russo
M Caraglia
V Virzi
S Cascinu
G Tonini
Publication date
01-12-2006
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2006
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-6-125

Other articles of this Issue 1/2006

BMC Cancer 1/2006 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine