Phase I and pharmacokinetic study of farletuzumab in solid tumors

3084

Background: Farletuzumab (F) is a humanized monoclonal antibody against folate receptor α (FRA). Expression of FRA is reported to be 90% and 40% in ovarian cancer (OC) and gastric cancer (GC), respectively. The purpose of the study is to assess tolerability, pharmacokinetic profile and preliminary antitumor effect in solid tumors. Methods: Patients with OC or FRA expressing solid tumor who are resistant to standard treatments are eligible in the study. After pharmacokinetic (PK) run-in, F was administered by IV injection repeating every week until disease progression. PK profile was analyzed on day1 to day 10 in PK run-in and on day 22 to 29 in cycle 1. Dose limiting toxicities (DLTs) were defined as G4 hematological and G3/4 non-hematological toxicities by NCI-CTCAE. Dose escalation was planed in 4 cohorts (50, 100, 200 and 400mg/m2). Results: Sixteen patients (14 OC and 2GC) received F infusion. Neither DLTs nor G3/4 toxicities were reported in all cohorts. As adverse events, G1/2 infusion reaction (44%), headache (44%), cytokine release syndrome (38%), nausea (31%) and appetite loss (31%) were observed and medically managed. AUC and Cmax.were increased dose-dependently and linear PK profiles were identified with median clearance between 6.02 and 10.54 mL/hr/m2 in each cohort. No tumor shrinkage was recorded, but long-term disease stabilization for 22+ mos. and 10+ mos. were observed in one patient with clear cell OC (100mg/m2) and one patient with GC (400 mg/m2), respectively. No cumulative toxicities were observed in these 2 patients. Conclusions: The toxicities of F in Japanese patients were manageable with similar PK profile as compared with the US population (Konner et al. Clin Cancer Res 2010: 16; 5288-95). Long term disease stabilization is observed in subpopulation of clear cell OC and GC.

The estimation of life-time for the patients who acquired resistance to standard chemotherapies

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Background: Prognostication is important for the advanced cancer patients to make the most for the rest of their life. We examined the accuracy of oncologists’ clinical predictions of survival (CPS) and the factors that oncologists referred to in cancer patients who acquired resistance to standard chemotherapies. We also examined how oncologists share the information about the survival with patients and their family. Methods: Fourteen oncologists treating major adult solid malignancies (breast, lung, gastrointestinal, pancreatic, gynecologic cancer and sarcoma) participated in this observational prospective cohort study between Oct 2010 and Oct 2011. The oncologists were asked to fill in the questionnaire about CPS when patients acquired resistance to standard chemotherapies. Results: The data of 52 patients were available for analysis. The median CPS was 92 days (Interquartile range [IQR], 61 - 168), and the median actual survival (AS) was 80 days (IQR, 35 to 148). The median difference between CPS and AS (|CPS-AS|) was 21 (IQR, -26 to 50) days. According to Pearson correlation between CPS and AS (r = 0.55, p < 0.001), log(CPS) and log(AS) (r = 0.69, p < 0.001) and spearman correlation between CPS and AS (r = 0.66, p < 0.001), it was statistically considered CPS corresponded to AS. The proportion of patients with |CPS-AS| were as follows; within a week, 6%; within 2 weeks, 14%; and within 4weeks, 42%. Concordance rate between CPS and AS was more accurate in gastric and ovarian cancer while it depended on the oncologists. Although, age, oral intake, the number of chemotherapy regimens and the prognostic factors that oncologists referred to were not related with |CPS-AS|. Eighteen patients (35 %) were informed about the prognosis and thirty-seven patients (71 %) were provided with information about palliative care unit. Thirty-three patients (64 %) received best supportive care alone and eighteen patients (35 %) received further chemotherapies. Conclusions: Oncologists’ predictions generally correlated with AS. As long as the prediction of survival is based on the prognostic factors that oncologists referred to, CPS can be correct to within as least 4 weeks.

A randomized, phase III trial of paclitaxel plus carboplatin (TC) versus paclitaxel plus cisplatin (TP) in stage IVb, persistent or recurrent cervical cancer: Japan Clinical Oncology Group study (JCOG0505)

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Background: TC is a less toxic regimen in terms of milder nephropathy, neuropathy and no need of hospitalization. This multicenter phase III trial was designed to evaluate the clinical benefits of TC compared with TP which is current standard chemotherapy for stage IVB or recurrent cervical cancer. Methods: Patients (pts) with stage IVB or recurrent cervical cancer; not amenable to curative therapy; 0-1 prior platinum; no prior taxanes; were randomized with minimization method to either TP (T 135 mg/m2 24h d1 + P 50 mg/m2 2h d2) or TC (T 175 mg/m2 3h d1 + C AUC5 1h d1), both for maximum 6 cycles every 21 days. Primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival (PFS), toxicities, and the proportion of non-hospitalization periods (NHP) as a surrogate for QoL. The trial was powered at least 70% to confirm the non-inferiority of TC to TP (threshold hazard ratio [HR] 1.29) in terms of OS, and the planned sample size was 250 pts with one-sided alpha 5%. HR is estimated by a stratified Cox regression. Results: From 2/06 to 11/09, 253 pts were enrolled. 71% pts of TP arm and TC arm each received 6 cycles. Median follow-up is 17.4 mo. Results are as below. As an alpha level for an interim analysis was less than 0.0001, significance level for the final analysis is approximately 5% even after the multiplicity adjustment. Conclusions: This first randomized controlled trial comparing carboplatin doublet with cisplatin doublet showed significant non-inferiority of TC in terms of OS. More feasible and less toxic TC can be recommended as the new standard treatment for stage IVB or recurrent cervical cancer. [Table: see text]

Long-term follow-up of a randomized trial comparing conventional paclitaxel and carboplatin with dose-dense weekly paclitaxel and carboplatin in women with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer: JGOG 3016 trial

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Background: The primary analysis of the JGOG3016 trial (Lancet 2009, 374:1331) showed that dose-dense weekly administration with paclitaxel and carboplatin (dd-TC) demonstrated statistically significant efficiency over tri-weekly administration withTC (c-TC) as first-line chemotherapy in patients with stage II-IV epithelial ovarian, fallopian tube or primary peritoneal cancer. We report the long-term follow-up results on progression-free survival (PFS) and overall survival (OS). Methods: Patients with stage II to IV ovarian cancer were randomly assigned to receive c-TC (carboplatin AUC 6 and paclitaxel 180 mg/m2 on day 1) or dd-TC (carboplatin AUC 6 on day 1 and paclitaxel 80 mg/m2 on day 1, 8, 15). The treatments were repeated every 3 weeks for six cycles; in responding patients, additional three cycles were administered. Results: The analysis included eligible 631 patients. At 6.4 years of median follow-up, there continues to be a highly statistically significant improvement in median PFS in favor of the dd-TC group compared with the c-TC group (28.1 vs. 17.5 months, hazard ratio [HR] 0.75, 95% CI, 0.62-0.91; P=0.0037). Median survival has not yet been reached in the dd-TC group, and OS at 5 years was higher in the dd-TC group than the c-TC group (58.6% vs. 51.0%, HR 0.79, 95% CI, 0.63-0.99; P =0.0448). Conclusions: The dd-TC improves long-term PFS and OS in patients with advanced epithelial ovarian cancer.

Attitudes regarding informing clinical study result to participants in Japan

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Background: Informing the participants about study result is increased demand in recent years. Some studies reported that almost all participants want to receive study result. However, how much information do participants want and how do researcher offer were not mentioned. Moreover there were concerned about resource for providing study result and the attitude regarding informing result to participants in Japan was not studied. The purpose of this study was aimed to discuss and propose the way of informing study results to Japanese participants. Methods: Summarizing study result and a self-administrated questionnaire survey were conducted. Summary was created from abstract of academic paper with lay language and illustration using color. Objective study was Oral Uracil and Tegafur Compared With Classic Cyclophosphamide, Methotrexate, Fluorouracil As Postoperative Chemotherapy in Patients With Node-Negative, High-Risk Breast Cancer: National Surgical Adjuvant Study for Breast Cancer 01 Trial “N-SAS-BC01 trial”(J Clin Oncol 2009). Objective subject was participants of N-SAS-BC01 trial in National Cancer Center Hospital. A cross table and inductive analyze were performed. Results: Summary of result was made A4 (letter size) form 4sheet. 58 patients responded to questionnaire of 116 patients (50%). In 58 responders, 92% of them preferred to be informed of the result. About 80% of responders answered that summary was clear to understand and 30% of them reported that the document should contain more information. The way of receive result preferred by the mail. When the result included bad news, 67% of responders wanted to receive result; on the other hand, three patients answered that they would not to receive because of psychological harmful influence. Conclusions: These answers suggested that participants in Japan desired to inform study result. Therefore, Clinical study result should be provided participants whenever it takes time to get results, including bad news in a careful way. Summary of result should be created using lay language and illustration. Planning the cost, keeping participant contact list, and noticing participants that study result would be informed were needed at the start of the study.

Taxane-induced peripheral neuropathy and health-related quality of life in postoperative breast cancer patients undergoing adjuvant chemotherapy: N-SAS BC 02, a randomized clinical trial

PURPOSE

To elucidate whether adjuvant taxane monotherapy is a feasible and tolerable for postoperative breast cancer patients, we evaluated the severity of chemotherapy-induced peripheral neuropathy (CIPN) and the relative tolerability of regimens by health-related quality of life (HRQOL) assessment in node-positive breast cancer patients treated with taxane-containing regimens.

METHODS

We evaluated CIPN and HRQOL in the first 300 patients enrolled in a larger (1,060 total) multicenter phase III trial randomized to one of four adjuvant regimens: (1) anthracycline-cyclophosphamide followed by paclitaxel (ACP), (2) AC followed by docetaxel (ACD), (3) paclitaxel alone (PTX), or (4) docetaxel alone (DTX). CIPN was assessed by the Patient Neurotoxicity Questionnaire (PNQ) and the National Cancer Institute Common Toxicity Criteria, and HRQOL by Functional Assessment of Cancer Therapy-General (FACT-G). CIPN and HRQOL scores were compared between ACP and ACD vs. PTX and DTX, and ACP and PTX vs. ACD and DTX.

RESULTS

PNQ sensory scores were significantly higher in patients treated with taxane monotherapy compared to treatment with AC followed by taxane (P = .003). No significant differences in PNQ sensory scores were observed between the ACP and PTX vs. ACD and DTX regimens (P = .669). Regardless of taxane regimen, PNQ severity scores for CIPN appear to be largely reversible within 1 year of adjuvant treatment. No significant difference in FACT-G scores was observed between any regimens during the study treatments.

CONCLUSIONS

Patient-reported CIPN was significantly more severe with single-agent adjuvant taxane compared to AC followed by taxane treatment; however, the HRQOL findings support that single-agent taxane treatment is tolerable.

Dose-dense therapy is of benefit in primary treatment of ovarian cancer? In favor

Paclitaxel and carboplatin given every 3 weeks is the current standard treatment in first-line chemotherapy regimens for ovarian cancer. The concept of 'dose-dense therapy' is based on the hypothesis that a shortening interval of the doses of cytotoxic agents will be more effective for tumor-cell kill. Recently published phase III trials in breast cancer have shown that dose-dense weekly paclitaxel improves response and survival. The Japanese Gynecologic Oncology Group reported a phase III study comparing the conventional 3-weekly paclitaxel and carboplatin schedule versus dose-dense weekly paclitaxel and 3-weekly carboplatin for advanced epithelial ovarian cancer, fallopian tube cancer or primary peritoneal cancer. The progression-free survival, as the primary endpoint of this study, was significantly prolonged with the dose-dense treatment [28 versus 17.2 months; hazard ratio (HR): 0.71; 95% confidence interval (CI): 0.58-0.88; P=0.0015], as was the overall survival at 3 years (72.1% versus 65.1%; HR 0.75; 95% CI: 0.57-0.98; P=0.03). Dose-dense weekly paclitaxel plus carboplatin represents a new treatment option in women with advanced epithelial ovarian cancer.

Familial glucocorticoid deficiency in five Arab kindreds with homozygous point mutations of the ACTH receptor (MC2R): genotype and phenotype correlations

BACKGROUND/AIMS

Familial glucocorticoid deficiency type 1 (FGD1) is a rare autosomal-recessive disorder resulting from defective ACTH receptor (melanocortin receptor type 2, MC2R). Individuals with this condition usually present in infancy or early childhood with the signs and symptoms of isolated glucocorticoid deficiency. To date, hypothyroidism has been reported as an associated feature in a few cases. The clinical findings along with MC2R genetic analysis of five Arab kindreds are described.

SUBJECTS/METHODS

The subjects were children with the clinical and biochemical features of FGD1. Three patients had associated thyroid dysfunction and two patients had associated growth hormone deficiency (GHD). Mutation analysis of MC2R was performed by direct gene sequencing.

RESULTS

Analysis of the MC2R gene revealed a homozygous insertion of a cytosine nucleotide between codons 153 and 154 (c.459_460insC) in all of the patients. This mutation would be expected to cause a translation frame shift after codon 154 and a premature termination codon at 248 of the MC2R mRNA (p.I154fsX248).

CONCLUSIONS

Associated thyroid dysfunction and GHD were clinical features in the Bedouin patients with FGD1 caused by identical homozygous frameshift mutation in the MC2R gene.

Standardized centile curves and reference intervals of serum insulin-like growth factor-I (IGF-I) levels in a normal Japanese population using the LMS method

Measurements of insulin-like growth factor-I (IGF-I) are useful not only for diagnosis and management of patients with growth hormone (GH)-related disorders but also for assessing nutritional status. We reported population-based references of serum IGF-I in 1996. However, they did not properly reflect data in the transition period from puberty to maturity. The aim of the present study was to re-establish a set of normative data for IGF-I for the Japanese population. The study included 1,685 healthy Japanese subjects (845 males, 840 females) from 0 to 83 years old. Subjects suffering from diseases that could affect IGF-I levels were excluded. Obese or extremely thin adult subjects were also excluded. IGF-I concentrations were determined by commercially available immunoradiometric assays. The reference intervals were calculated using the LMS method. Median IGF-I levels reached 310 ng/mL in males at the age of 14 years and 349 ng/mL in females at the age of 13 years, falling to 124 ng/mL and 103 ng/mL, respectively, by the age of 70 years. The mean pretreatment IGF-1 SD scores in patients with severe GH deficiency (GHD) obtained from the database of the Foundation for Growth Science and from clinical studies for adult GHD were -2.1±1.6 and -4.9±2.5, respectively. The present study established age- and gender-specific normative IGF-I data for the Japanese population and showed the utility of these references for screening patients with severe GHD.

Dose-dense chemotherapy and neoadjuvant chemotherapy for ovarian cancer

Two of the innovative chemotherapeutic approaches to ovarian cancer treatment, dose-dense chemotherapy and neoadjuvant chemotherapy, will be discussed herein. The primary concept of dose-dense chemotherapy is to administer the same cumulative dose of chemotherapy over a shorter period. Increased dose density is achieved by reducing the interval between each dose of chemotherapy. The Japanese Gynecologic Oncology Group (JGOG) first demonstrated the survival advantage of dose-dense weekly administration of paclitaxel in 2009. However, there are unanswered questions, such as the question of dose-dense carboplatin versus less dose-intensive regimens. Clear cell or mucinous carcinomas seem to need other strategies, such as targeted agents. The aim of neoadjuvant chemotherapy is to reduce tumor volume or spread before main treatment. This could then make the main procedures easier or less invasive, just like breast-conserving surgery after neoadjuvant chemotherapy. In advanced ovarian cancer, standard procedure is maximum primary debulking surgery followed by chemotherapy. Recently, a prospective randomized trial demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to the standard procedure. However, there are several questions that remain unanswered, such as the suitable number of chemotherapy cycles before interval debulking surgery. Some of those questions regarding dose-dense chemotherapy or neoadjuvant chemotherapy may be resolved by ongoing or future prospective trials.

P5-14-27: Prognostic Factors of Node-Negative, High Risk and 1–3 Positive Lymph Nodes Breast Cancer by Intrinsic Subtype in Patients with Adjuvant Chemotherapy

Purpose: St. Gallen 2007 categorized high risk, node-negative breast cancer (HNBC) and 1–3 lymph nodes positive BC (LNBC) without HER2 overexpression as intermediate risk. We hypothesized that triple negative BC (TNBC) and hormone-receptor positive without HER2 overexpression (H-BC) in intermediate risk have different prognostic factor in patients with adjuvant chemotherapy (AdC).

Methods: We examined disease-free survival (PFS) and overall survival (OS) of TNBC and H-BC with regard to potential prognostic factors. All the patients included in this study were categorized intermediate risk by St.Gallen 2007 and received AdC.

Results: A total of 470 patients were identified; H-BC (n=360) and TNBC (n=110). Age (&lt;35) was significantly associated with DFS in TNBC while it was not in H-BC (p=0.0.1 and p=0.63, respectively). Tumor size (&gt;2cm) and tumor grade related to DFS in H-BC but not in TNBC. Tumor grade was not associated with DFS in both H-BC and TNBC (p=0.64 and p=0.91, respectively). Lymph node metastasis was a significant factor of DFS only for H-BC (p=0.009 and p=0.19). Conclusions: In TNBC, age was only a significant factor associated with DFS while in H-BC, lymph node status and tumor size rather age related to DFS.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-14-27.

Fabry disease superimposed on overt autoimmune hypothyroidism

Fabry disease (FD) is an X-linked recessive disorder caused by lysosomal α-galactosidase A deficiency. FD is characterized by the systemic accumulation of globotriaosylceramide with involvement of the heart, kidney, brain and gastrointestinal system. Recently, nonautoimmune thyroid dysfunction was recognized as an additional clinical feature of FD. In the present study, we describe a patient suffering from FD superimposed on overt autoimmune hypothyroidism. The patient was an 11-yr-old boy who presented with goiter and stunted growth, and was diagnosed with primary hypothyroidism due to autoimmune thyroiditis. During levothyroxine replacement therapy, the patient complained of burning pain in his feet and was diagnosed as suffering from FD based on low blood α-galactosidase A activity. In conclusion, we have described the first FD patient preceded by overt autoimmune hypothyroidism.

What factors affect the place of end-of-life care for patients with metastatic breast cancer?

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Background: Despite the early detection and treatment, advanced breast cancer is still impossible to cure. Palliative care has become the standard of care at the time of end-of-life (EOL). However, there are limited data about the degree of access to such care and the factors that affect the choice of place to die. The purpose of this study is to identify factors that affect the place of EOL care in patients with metastatic breast cancer in Japan.

Methods: Our study included breast cancer patients who were diagnosed with recurrence or metastatic diseases between 2004 and 2010 at the National Cancer Center Hospital and received EOL care. The following data were obtained: treatments, place of EOL care, and social background such as age, whether patients had young children, whether patients had elderly family members who needed nursing care, whether patients had jobs at the time of recurrence, and where they lived in.

Results: Overall, 124 patients met our inclusion criteria. Among them, only 13% of patients received EOL care at home and 43.5% of patients at hospices, while 43.5% of patients died in acute care beds. Patients who had jobs at the time of recurrence were significantly more likely to receive EOL care in acute care beds (odds ratio 2.46; 95% CI 1.04−5.83). Other social backgrounds were not significantly related to the place of EOL care.

Conclusions: A sizable proportion of patients, especially patients who had jobs at the time of recurrence, received acute care at the EOL and did not have access to palliative care at home or hospices. Familial backgrounds were not the determinant to choose the place of EOL.

Use of squamous cell carcinoma antigen as a biomarker of chemotherapy response in patients with metastatic cervical carcinoma

OBJECTIVE

To examine the use of squamous cell carcinoma antigen (SCCA) as a biomarker of chemotherapy response in patients who underwent chemotherapy for metastatic cervical carcinoma.

STUDY DESIGN

The study population consisted of patients who underwent first-line chemotherapy for metastatic cervical carcinoma between 1999 and 2009. SCCA levels were serially measured before, during and after chemotherapy. Radiographic responses were evaluated according to the criteria of the World Health Organization. A logistic model was used to determine the best prediction model, and internal and external validation of the prediction model were performed to compare the areas under the receiver operating characteristic curves (AUCs).

RESULTS

In total, 55 patients were included in the analysis. Data for 32 patients enrolled in various clinical trials were used to develop the prediction model. Patients who achieved a radiographic response showed a significant decline in SCCA levels between the second and third cycles of chemotherapy, whereas patients who did not achieve a radiographic response showed constant SCCA levels over the same period. The prediction model was developed on the basis of changes in the SCCA level between the second and third cycles of chemotherapy (AUC=0.832) and the baseline SCCA level. The AUC after external validation, calculated using the data of the clinical practice population (n=22), was 0.871.

CONCLUSIONS

A response to chemotherapy was possible for patients in whom SCCA levels declined between the second and third cycles of chemotherapy.

Second-line chemotherapy in patients with primary unknown cancer

PURPOSE

There are few existing reports on the efficacy of second-line chemotherapy in patients with cancer of unknown primary site (CUP). The aim of this study was to identify characteristics of CUP patients linked to a positive response to chemotherapy.

METHODS

We retrospectively studied the clinical outcomes of second-line chemotherapy in patients with CUP who had previously been treated with platinum-based first-line chemotherapy.

RESULTS

A total of 27 patients received second-line chemotherapy. Of these patients, 5 (19%) showed an objective response to second-line chemotherapy; 4 of these patients had shown a favorable response to first-line chemotherapy and had a chemotherapy-free interval (CFI) of more than 4.5 months. Among the 8 patients in whom the CFI was more than 4.5 months, 4 (50%) showed an objective response to platinum-based second-line chemotherapy, whereas among the 16 patients with a CFI of less than 4.5 months, only 1 (6%) showed a response to any chemotherapeutic regimen.

CONCLUSIONS

The response to second-line chemotherapy in CUP patients who had received platinum-based first-line treatment seemed to be associated with the response to first-line chemotherapy and the CFI. Although it remains unclear whether second-line chemotherapy might contribute to a survival benefit in patients with CUP, patients who show a favorable response to first-line chemotherapy and also a relatively prolonged CFI appear to be likely to benefit from second-line chemotherapy.