The prognostic significance of left ventricular ejection fraction in patients with advanced cancer treated in phase I clinical trials

BACKGROUND

New targeted agents may cause acute cardiac events. The purpose of our study was to investigate the incidence and the prognostic significance of left ventricular ejection fraction (LVEF) in phase I trials.

PATIENTS AND METHODS

Between October 2008 and September 2011, the records of 1166 consecutive patients with advanced cancer treated in the Phase I Clinic who underwent echocardiography were retrospectively reviewed.

RESULTS

Most of the patients were White (78%), and the most common tumor types were colorectal cancer and melanoma. Of 1166 patients, 177 (15.2%) patients had an LVEF of <50%. No difference in overall survival (OS) between patients with LVEF ≥ 50% and patients with LVEF < 50% was seen (median OS 7.4 versus 7.0 months, P = 0.84). Patients with LVEF ≤ 35% had shorter survival compared with those with LVEF between 35% and 50% (median 4.2 versus 8.0 months; P = 0.005). In multivariate analysis of patients with LVEF < 50%, independent factors predicting longer survival were LVEF > 35%, ≤2 prior systemic therapies, ≤2 metastatic sites, and normal lactate dehydrogenase and albumin levels.

CONCLUSION

Echocardiography would improve patient selection for enrollment in phase I clinical trials. These data suggest that it is safe to treat patients with LVEF between 35% and 50%.

First-in-human study of pbi-05204, an oleander-derived inhibitor of akt, fgf-2, nf-κΒ and p70s6k, in patients with advanced solid tumors

BACKGROUND

PBI-05204, a Nerium oleander extract (NOE) containing the cardiac glycoside oleandrin, inhibits the α-3 subunit of Na-K ATPase, as well as FGF-2 export, Akt and p70S6K, hence attenuating mTOR activity. This first-in-human study determined the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of PBI-05204 in patients with advanced cancer. Methods Forty-six patients received PBI-05204 by mouth for 21 of 28 days (3 + 3 trial design). Dose was escalated 100% using an accelerated titration design until grade 2 toxicity was observed. Plasma PK and mTOR effector (p70S6K and pS6) protein expressions were evaluated. Results Dose-limiting toxicities (grade 3 proteinuria, fatigue) were observed at dose level 8 (0.3383 mg/kg/day). Common possible drug-related adverse were fatigue (26 patients, 56.5%), nausea (19 patients, 41.3%) and diarrhea (15 patients, 32.6 %). Electrocardiogram monitoring revealed grade 1 atrioventricular block (N = 10 patients) and grade 2 supraventricular tachycardia (N = 1). The MTD was DL7 (0.2255 mg/kg) where no toxicity of grade ≥ 3 was observed in seven patients treated. Seven patients (15%) had stable disease > 4 months. Mean peak oleandrin concentrations up to 2 ng/mL were achieved, with area under the curves 6.6 to 25.5 μg/L*hr and a half-life range of 5-13 h. There was an average 10% and 35% reduction in the phosphorylation of Akt and pS6 in PBMC samples in 36 and 32 patients, respectively, tested between predose and 21 days of treatment. Conclusions PBI-05204 was well tolerated in heavily pretreated patients with advanced solid tumors. The recommended Phase II dose is 0.2255 mg/kg/day.

Leptin-mediated regulation of ICAM-1 is Rho/ROCK dependent and enhances gastric cancer cell migration

Background:

Our previous study indicates that leptin enhances gastric cancer (GC) invasion. However, the exact effect of leptin on GC metastasis and its underlying mechanism remain unclear. Intercellular adhesion molecule-1 (ICAM-1), a major molecule in stabilising cell–cell and cell–extracellular matrix interactions, is overexpressed and has crucial roles in tumour metastasis.

Methods:

Here, we investigated leptin and ICAM-1 expression in GC tissues. Furthermore, we characterised the influence of leptin on ICAM-1 expression in GC cells and elucidated the underlying mechanism.

Results:

Leptin and ICAM-1 were overexpressed in GC tissues, and a strong positive correlation was observed. They were also related with clinical stage or lymph node metastasis. Furthermore, leptin induced GC cell (AGS and MKN-45) migration by upregulating ICAM-1, and knockdown of ICAM-1 by small interference RNA (siRNA) blocked this process. Cell surface ICAM-1, as well as soluble ICAM-1 (sICAM-1), was also enhanced by leptin. Moreover, leptin increased ICAM-1 expression through Rho/ROCK pathway, which was attenuated by pharmacological inhibition of Rho (C3 transferase) or its downstream effector kinase Rho-associated protein kinase (ROCK) (Y-27632).

Conclusions:

Our findings indicate that leptin enhances GC cell migration by increasing ICAM-1 through Rho/ROCK pathway, which might provide new insight into the significance of leptin in GC.

Predictive value of fetal fibronectin on the embryonic loss of patients with recurrent spontaneous abortion in early pregnancy

OBJECTIVE

This work aims to investigate the predictive value of fetal fibronectin (fFN) in embryonic loss of patients with recurrent spontaneous abortion (RSA) in early pregnancy.

MATERIALS AND METHODS

Eighty-four patients with RSA in early pregnancy were selected as the test group and 31 healthy women in early pregnancy were selected as the control group. The ages and number of previous abortions, along with other information, were recorded. These patients underwent a fFN test, and their pregnancy outcome was followed up until 14 weeks.

RESULTS

The incidence of spontaneous abortion was 20.24% in the test group and 9.68% in the control group. The positive fFN [fFN (+)] rate was 57.14% in the test group and 12.90% in the control group, indicating a statistically significant difference (p < 0.01, chi2 = 17.89). The incidence of spontaneous abortion was 29.17% (14/48) in the fFN (+) group and 8.33% (3/36) in the fFN (-) group, indicating a statistically significant difference (p < 0.05, chi2 = 5.53). The sensitivity, specificity, and positive and negative predictive values in the prediction of abortion in fFN (+) patients of the test group were 82.35%, 49.25%, 29.17%, and 91.67%, respectively.

CONCLUSION

If detected at an early stage of pregnancy, fFN in patients with RSA is largely related to the prediction of abortion and facilitates the evaluation of pregnancy outcomes.

Abstract P1-08-18: PIK/AKT/MTOR pathway activation in triple negative breast cancer and outcomes with matched therapy in phase I clinical trials: Response in both patients with and without direct molecular alterations

Introduction

The PI3K/AKT/MTOR pathway is a known driver in triple negative breast cancers (TNBC). We analyzed patients with TNBC seen in our Phase I clinic including molecular subtyping and correlation with response to therapies targeting the PI3K/AKT/mTOR pathway.

Methods

Patients with advanced TNBC [negative (&lt;1%) expression for estrogen and progesterone receptors and negative Her 2 (&lt;/ = 1+ by IHC or non-amplified by FISH)] whose tumors had undergone molecular profiling (including PIK3CA/PTEN mutation analysis and/or PTEN immunohistochemistry (IHC)). We evaluated sequential patients seen in the Phase I clinic at M.D. Anderson Cancer Center treated on at least one Phase I clinical trial and correlated molecular status with clinical outcomes on therapy. Molecular profiling methods including hotspot analysis, next generation sequencing and IHC.

Results

Forty-four patients (median age 56, range 27-81; all female; white race76%) with a median of 2 (0-7) prior therapies (40% received ≥3 prior systemic therapies) and 2 metastatic sites (range, 1-6) were included. Histology: invasive ductal carcinoma 29 (66%), metaplastic 12 (27%), other 3 (7%). Nine out of 42 patients tested (19%) had a PIK3CA mutation and, 11 out of 33 patients tested (33%) demonstrated PTEN loss on IHC and 2 patients had PTEN mutations. Altogether, 21 out of 44 patients had at least one alteration in the PI3K/AKT/mTOR pathway. Sixteen of these 21 patients received “matched” therapy consisting of at least one agent targeting the PI3K/AKT/mTOR pathway. Four out of 16 patients (25%) with at least one molecular alteration, treated with one or more regimens containing at least one agent targeting the PI3K/AKT/mTOR pathway (“matched” therapy), demonstrated clinical benefit: complete response (CR) (N = 1)/partial response (PR) (N = 1)/stable disease ≥ 6 months (SD) (N = 2). Similarly, three out of 12 patients (25%) who did not demonstrate a direct molecular alteration in the PI3K/AKT/mTOR pathway and who were treated with PI3K-directed therapy, had either CR (N = 1)/PR (N = 1)/SD ≥ 6 months (N = 1). Twenty-eight patients received PI3K/AKT/mTOR pathway directed therapy yielding CR (N = 2), PR (N = 3) and CR/PR/ SD ≥ 6 months (N = 1) while those who received other therapies had CR (N = 0), PR (N = 1) and CR/PR/SD&gt;6mo (N = 3)and a median TTF of 3.1 (2.1-4.8) vs. 1.8 (1.4-2.5) months (p = 0.23).

Conclusions

A significant percentage of patients with TNBC demonstrate a direct alteration in the PI3K/AKT/mTOR pathway. Our data shows that PI3K-directed therapies benefit both those patients with and without direct molecular alterations in this pathway. Further molecular testing results will be presented. This data suggests that there may be additional molecular alterations that activate PI3K/AKT/mTOR in patients with TNBC.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-18.

Polybrominated diphenyl ethers (PBDEs) in house dust in Beijing, China

Eleven house dust samples were collected in Beijing to quantify 42 different polybrominated diphenyl ethers (PBDEs). Total PBDEs concentrations ranged from 140 to 1,300 ng g(-1). The dominant PBDEs congener identified was BDE 209, which made up more than 70% of all PBDEs congeners. Concentrations of PBDEs in Chinese house dust were lower than in other countries. The most polluted areas were electronics shops and households. It is likely that PBDEs exposure is a potential threat for Beijing residents, particularly toddlers.

Tumor marker and measurement fluctuations may not reflect treatment efficacy in patients with medullary thyroid carcinoma on long-term RET inhibitor therapy

BACKGROUND

RET kinase inhibitors have significant activity in patients with medullary thyroid carcinoma (MTC).

PATIENTS AND METHODS

We retrospectively reviewed the electronic medical record for patterns of calcitonin, carcinoembryonic antigen (CEA) and tumor measurement responses in consecutive patients with MTC who received treatment with a RET inhibitor for at least 6 months.

RESULTS

Twenty-six patients who received RET kinase inhibitors for at least 6 months were included. All patients experienced an initial decline in calcitonin; 20 (77%) demonstrated later fluctuations in calcitonin, which spiked above baseline levels in 9 individuals (35%). Twenty of the 22 patients (91%) with elevated CEA experienced a decline with treatment, with 11 individuals (50%) later demonstrating transient fluctuations in CEA, including spikes above baseline in 7 patients (32%). Ten of the 26 patients (38%) also demonstrated short-lived fluctuations in RECIST measurements, including changes of over 20% from nadir values. Vacillations in calcitonin, CEA and measurements often occurred repeatedly in individual patients and did not regularly correlate with each other.

CONCLUSIONS

Repeated transient fluctuations in tumor markers and measurements are a characteristic of patients with MTC receiving treatment with RET inhibitors, and such short-term vacillations may not reflect responsiveness over the long term.

CLINICAL TRIALS INCLUDED

NCT00215605; NCT00244972; NCT00121680; NCT00495872.

Melanoma patients in a phase I clinic: molecular aberrations, targeted therapy and outcomes

BACKGROUND

The purpose of the study was to assess the outcome of patients with advanced melanoma treated with matched molecularly targeted therapy.

PATIENTS AND METHODS

We reviewed 160 consecutive patients with metastatic melanoma treated in the phase I program (N = 35 protocols). Treatment was considered to be 'matched' (N = 84) if at least one drug in the regimen was known to inhibit the functional activity of at least one of the patient's mutations.

RESULTS

Of 160 patients, 134 (83.7%) had adequate tissue for molecular analysis; 69% (110 of 160) had ≥1 mutation: 61.2% (82 of 134), BRAF; 20.7% (23 of 111), NRAS; 2.6% (2 of 77), KIT; 2.3% (1 of 44), KRAS; 20% (1 of 5), GNAQ; 11.1% (1 of 9), P53 and 2.6% (1 of 39), coexisting mutations in BRAF and PIK3CA. Eighty-four patients (52.4%) were treated with matched-targeted agents, most of whom had BRAF mutations (N = 74). Twenty-six percent of patients (41 of 160) achieved a complete or partial remission (CR/PR) [40% (34 of 84)) on a matched phase I protocol versus 9.2% (7 of 76) for those on a non-matched study (P ≤ 0.0001)]. The median progression-free survival (PFS) (95% CI) was longer for patients treated on a matched phase I trial than on their prior first standard treatment [5.27 (4.10, 6.44) versus 3.10 (1.92, 4.28) months, P = 0.023], but not on non-matched phase I treatment. Multivariable analysis showed that matched therapy was an independent predictor of higher CR/PR rates, prolonged PFS and survival.

CONCLUSIONS

For melanoma patients, especially those with BRAF mutations, administering molecularly matched agents can be associated with better outcomes, including longer PFS compared with their first-line systemic therapy.

Aberrations in the epidermal growth factor receptor gene in 958 patients with diverse advanced tumors: implications for therapy

BACKGROUND

Epidermal growth factor receptor (EGFR) mutations are associated with the response to EGFR inhibitors in patients with non-small-cell lung cancer (NSCLC). We sought to investigate EGFR aberrations in patients with diverse advanced cancers.

PATIENTS AND METHODS

Patients referred to the phase I clinic were evaluated for the presence of EGFR mutations and response to therapy.

RESULTS

EGFR aberrations were detected in 34 of 958 patients (3.5%). Though EGFR mutations were most frequent in NSCLC (21 of 131, 16%), they were also present in a variety of other solid tumors (13 of 827 patients, 1.6%) including adrenocortical (1/10 patients), skin (1/24), breast (1/55), carcinoid (1/8), cholangiocarcinoma (1/20), head and neck (1/61), ovarian (1/84), parathyroid (1/1), salivary gland (1/20), renal (1/17), sarcoma (2/38), and thymic carcinomas (1/7). Of the 13 EGFR aberration-positive non-NSCLC patients (median number of prior systemic therapies = 3), 6 had treatment with an EGFR inhibitor. Two patients (diagnosis = parathyroid tumor and basal cell carcinoma) achieved stable disease (SD), lasting 6 and 7 months, respectively.

CONCLUSION

We found EGFR aberrations in 1.6% of a large group of patients with diverse tumors other than NSCLC, and treatment with an EGFR inhibitor could be associated with prolonged SD.

Mitochondrial haplogroup B4 may be a protective factor to oral lichen planus susceptibility in Chinese

OBJECTIVE

Oral lichen planus (OLP) is a common inflammatory disorder with a higher prevalence among women than men. The pathogenesis of OLP is still unclear, and its heredity is not well characterized. Maternal inheritance of mitochondrial DNA (mtDNA) indicates its importance in human ethnic group classification as well disease susceptibility. So, this study was conducted to find whether mtDNA haplogroup associates with OLP susceptibility in Chinese, and determine the influence of C-stretch structure of mtDNA on OLP susceptibility.

SUBJECTS AND METHODS

We sequenced three hypervariable regions of mtDNA from 242 patients with OLP and 237 healthy controls. The association between mtDNA haplogroups and OLP is tested by chi-square test.

RESULTS

Seventeen kinds of haplogroups were identified, and the frequency of haplogroup B4 was significantly higher in control group than that of the OLP group (P = 0.013, OR=0.429). In female samples, B4 declared even more significance (P = 0.003, OR=0.296). Meanwhile, the haplotypes of C-stretch in mtDNA did not have any significant difference between case-control groups.

CONCLUSIONS

Mitochondrial DNA haplogroup B4 might have a protective effect to OLP, and its protective effect resides predominantly in women. However, the association between C-stretch haplotype and OLP susceptibility still needs more patients for evaluation.

The p53-Bak apoptotic signaling axis plays an essential role in regulating differentiation of the ocular lens

The tumor suppressor p53 is a master regulator of apoptosis and also plays a key role in cell cycle checking. In our previous studies, we demonstrated that p53 directly regulates Bak in mouse JB6 cells (Qin et al. 2008. Cancer Research. 68(11):4150) and that p53-Bak signaling axis plays an important role in mediating EGCG-induced apoptosis. Here, we demonstrate that the same p53-Bak apoptotic signaling axis executes an essential role in regulating lens cell differentiation. First, during mouse lens development, p53 is expressed and differentially phosphorylated at different residues. Associated with p53 expression, Bak is also significantly expressed during mouse lens development. Second, human p53 directly regulates Bak promoter and Bak expression in p53 knockout mice (p53-/-) was significantly downregulated. Third, during in vitro bFGF-induced lens cell differentiation, knockdown of p53 or Bak leads to significant inhibition of lens cell differentiation. Fourth, besides the major distribution of Bak in cytoplasm, it is also localized in the nucleus in normal lens or bFGF-induced differentiating lens cells. Finally, p53 and Bak are co-localized in both cytoplasm and nucleus, and their interaction regulates the stability of p53. Together, these results demonstrate for the first time that the p53-Bak apoptotic signaling axis plays an essential role in regulating lens differentiation.

Abstract P5-20-09: Tumor mutational analysis and therapy outcomes for patients (pts) with metastatic/unresectable locally advanced myoepithelial/metaplastic breast cancer treated with PI3K targeted therapy

Background: Metaplastic breast cancers are considered a chemorefractory subset of triple negative breast cancers. Molecular profiling has demonstrated that metaplastic tumors are enriched for epithelial-to-mesenchymal transition (EMT), frequently express myoepithelial differentiation, make up a component of the ‘claudin-low’ subtype, and harbor relatively high rates of mutations/activation of the PI3kinase pathway (Hennessy, Cancer Research, 2009; Prat, Breast Cancer Res, 2010).

Methods: Data from pts with myoepithelial/metaplastic breast cancer treated within the Center for Targeted Therapy using regimens with known inhibitors of the PI3K pathway were evaluated to determine response to therapy. Mutational analyses were performed in archived tumor samples when available.

Results: 23 pts have been treated using 6 different therapy regimens and one pt was treated on two separate clinical trials for a total of 24 analyzable outcomes. Patients were treated with liposomal doxorubicin, bevacizumab and the mTOR inhibitor, temsirolimus (DAT, n=17); liposomal doxorubicin and temsirolimus (DT, n=1); paclitaxel, bevacizumab and temsirolimus (TAT, n=3); paclitaxel and temsirolimus (TT, n=1), paclitaxel in combination with an experimental PI3K inhibitor (TEx, n=1), or temsirolimus alone (tem, n=1). Response was measured every two cycles using RECIST criteria. Most pts had received prior chemotherapy, median of 2 prior regimens (range 0–7). Three patients were not evaluated for response, one who died of pneumonia during cycle 2 (DAT) and two who have not yet completed 2 cycles of therapy (DAT, TEx). Response rate (CR+PR) was 35% (CR = 2, PR=4, SD≥6 months=2, SD&lt;6 months=2, PD/death=7) with the anthracycline based regimens, DAT and DT; whereas, stable disease was the best response seen thus far with the paclitaxel based regimens or temsirolimus alone: TAT (SD&lt;6months=2, PD=1), TT (SD&lt;6months=1), tem (SD&lt;6months=1). 8 of 9 tumors tested (89%) were found to have mutations that would lead to activation of the PI3K pathway: PIK3CA=5 (62%), PTEN=2 (25%) and NF2=1(13%). The two patients with CR from DAT had mutations in NF2 and PIK3CA, respectively. Both patients remain in CR (2+ years and 1+ year respectively) after discontinuing protocol therapy, and both continue maintenance everolimus.

Conclusion: Activating mutations in the PI3K pathway are common in metaplastic breast cancers, a tumor subtype that shares molecular features with claudin-low and mesenchymal/mesenchymal-stem cell like triple negative breast cancers. DAT has demonstrated activity in myoepithelial/metaplastic breast cancer including two durable CRs to therapy. This regimen should be explored in larger, randomized trials to test superiority to chemotherapy alone.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-20-09.

Correlation between plasma amino acid profiles and the various stages of hepatitis B infection

The amino acid metabolism in patients with hepatitis B virus (HBV) infection is significantly changed. In this study, we analyzed the relationship between the amino acid profiles and varying clinical stages of HBV infection, and investigated their significance. The plasma amino acid concentrations in 115 patients with HBV infection and 32 healthy donors were detected and analyzed, and the main indicators of liver function were measured. Correlation analysis was performed between the amino acid profiles (Fischer's ratio, branched-chain amino acid to tyrosine ratio [BTR]) and the key indicators of liver function in patients with HBV infection. Fisher's ratio and the BTR of patients with HBV infection was found to differ from that of the healthy controls, and was also found to significantly correlate with the stage of HBV infection. Changes in the BTR were closely related to the level of key indicators of liver function, and a significant relationship was detected between the Fischer's ratio and the BTR (r=0.928, p<0.001). These results suggest that Fischer's ratio and the BTR can indirectly reflect the degree of liver cell injury. Determining and tracking the plasma amino acid profiles could, therefore, be used for the diagnosis, treatment selection, and prognosis of patients with varying stages of HBV infection.

Electrocardiograms (ECGs) in phase I anticancer drug development: the MD Anderson Cancer Center experience with 8518 ECGs

BACKGROUND

Cardiac sequelae from oncologic drugs are important in early cancer drug development. Prolongation of the corrected QT interval (QTc) by noncardiac drugs is the most common cause of drug development delays, nonapprovals and postmarketing withdrawals by the US Food and Drug Administration.

PATIENTS AND METHODS

We analyzed 8518 electrocardiograms (ECGs) in 525 consecutive cancer patients enrolled in 22 industry-sponsored phase I clinical trials, starting 1 January 2006.

RESULTS

Seventy-four patients [14%, 95% confidence interval (CI) 11% to 17%] with normal QTc at baseline had QTc intervals above upper limit of normal after treatment initiation; 33 (6%, 95% CI 4% to 9%) had prolonged QTc intervals at baseline, and only one (3%, 95% CI 0% to 16%) worsened after dosing. Seven of 33 patients (21%, 95% CI 9% to 39%) with prolonged baseline QTc had normalization of QTc intervals after dosing. All QTc prolongations were clinically insignificant; study drugs were continued uneventfully. Two of 525 patients (0.4%, 95% CI 0% to 1%) experienced cardiac serious adverse events (myocardial infarction possibly related to drug and unstable atrial flutter related to metastatic disease). Both cardiac events were detected by clinical assessment, not surveillance ECGs.

CONCLUSION

Frequent ECG monitoring provided no clinically significant information in 525 patients in early phase trials.