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Buechel M, McGinnis A, Vesely SK, Wade KS, Moore KN, Gunderson CC. Consideration of older patients for enrollment in phase 1 clinical trials: Exploring treatment related toxicities and outcomes. Gynecol Oncol 2018; 149:28-32. [DOI: 10.1016/j.ygyno.2017.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022]
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Harrington J, Carter L, Basu B, Cook N. Drug development and clinical trial design in pancreatico-biliary malignancies. Curr Probl Cancer 2018; 42:73-94. [PMID: 29402439 DOI: 10.1016/j.currproblcancer.2018.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/27/2017] [Accepted: 01/04/2018] [Indexed: 02/08/2023]
Abstract
Pancreatico-biliary (P-B) tumors arise from the pancreas, bile duct, and ampulla of Vater. Despite their close anatomical location, they have different etiology and biology. However, they uniformly share a poor prognosis, with no major improvements observed in overall survival over decades, even in the face of progress in diagnostic imaging and surgical techniques, and advances in systemic and loco-regional radiation therapies. To date, cytotoxic treatment has been associated with modest benefits in the advanced disease setting, and survival for patients with stage IV disease has not exceeded a year. Therefore, there is a pressing need to identify better treatments which may impact more significantly. Frequently, encouraging signals of potential efficacy for novel agents in early phase clinical trials have been followed by disappointing failures in larger phase III trials, raising the valid question of how drug development can be optimized for patients with pancreatic adenocarcinoma and biliary tract malignancies. In this article we summarize the current therapeutic options for these patients and their limitations. The biological context of these cancers is reviewed, highlighting features that may make them resistant to standard chemotherapeutics and could be potential therapeutic targets. We discuss the role of early phase clinical trials, defined as phase I and non-randomised phase II trials, within the clinical context and current therapeutic landscape of P-B tumors and postulate how translational studies and trial design may enable better realization of emerging targets together with a proposed model for future patient management. A detailed summary of current phase I clinical trials in P-B tumors is provided.
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Affiliation(s)
- Jennifer Harrington
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Louise Carter
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Bristi Basu
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Department of Oncology, University of Cambridge, Cambridge, UK
| | - Natalie Cook
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK.
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53
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Basic Statistics and Clinical Studies in Radiation Oncology. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_57-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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54
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Yap C, Billingham LJ, Cheung YK, Craddock C, O'Quigley J. Dose Transition Pathways: The Missing Link Between Complex Dose-Finding Designs and Simple Decision-Making. Clin Cancer Res 2017; 23:7440-7447. [PMID: 28733440 DOI: 10.1158/1078-0432.ccr-17-0582] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/30/2017] [Accepted: 07/17/2017] [Indexed: 11/16/2022]
Abstract
The ever-increasing pace of development of novel therapies mandates efficient methodologies for assessment of their tolerability and activity. Evidence increasingly support the merits of model-based dose-finding designs in identifying the recommended phase II dose compared with conventional rule-based designs such as the 3 + 3 but despite this, their use remains limited. Here, we propose a useful tool, dose transition pathways (DTP), which helps overcome several commonly faced practical and methodologic challenges in the implementation of model-based designs. DTP projects in advance the doses recommended by a model-based design for subsequent patients (stay, escalate, de-escalate, or stop early), using all the accumulated information. After specifying a model with favorable statistical properties, we utilize the DTP to fine-tune the model to tailor it to the trial's specific requirements that reflect important clinical judgments. In particular, it can help to determine how stringent the stopping rules should be if the investigated therapy is too toxic. Its use to design and implement a modified continual reassessment method is illustrated in an acute myeloid leukemia trial. DTP removes the fears of model-based designs as unknown, complex systems and can serve as a handbook, guiding decision-making for each dose update. In the illustrated trial, the seamless, clear transition for each dose recommendation aided the investigators' understanding of the design and facilitated decision-making to enable finer calibration of a tailored model. We advocate the use of the DTP as an integral procedure in the co-development and successful implementation of practical model-based designs by statisticians and investigators. Clin Cancer Res; 23(24); 7440-7. ©2017 AACR.
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Affiliation(s)
- Christina Yap
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom.
| | - Lucinda J Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Charlie Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
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55
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Smyth LM, Monson KR, Jhaveri K, Drilon A, Li BT, Abida W, Iyer G, Gerecitano JF, Gounder M, Harding JJ, Voss MH, Makker V, Ho AL, Razavi P, Iasonos A, Bialer P, Lacouture ME, Teitcher JB, Erinjeri JP, Katabi N, Fury MG, Hyman DM. A phase 1b dose expansion study of the pan-class I PI3K inhibitor buparlisib (BKM120) plus carboplatin and paclitaxel in PTEN deficient tumors and with dose intensified carboplatin and paclitaxel. Invest New Drugs 2017; 35:742-750. [PMID: 28281183 PMCID: PMC5591764 DOI: 10.1007/s10637-017-0445-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/23/2017] [Indexed: 12/26/2022]
Abstract
Purpose We previously reported the phase I dose escalation study of buparlisib, a pan-class 1A PI3K inhibitor, combined with platinum/taxane-based chemotherapy in patients with advanced solid tumors. The combination was well tolerated and promising preliminary efficacy was observed in PTEN deficient tumors. This phase I dose expansion study now evaluates buparlisib plus high dose carboplatin and paclitaxel in unselected patients with advanced solid tumors and buparlisib plus standard dose carboplatin and paclitaxel in patients with PTEN deficient tumors (ClinicalTrials.gov, NCT01297452). Methods There were two expansion cohorts: Cohort A received continuous buparlisib (100 mg/daily) orally plus high dose carboplatin AUC 6 and paclitaxel 200 mg/m2; Cohort B treated patients with PTEN deficient tumors only and they received the recommended phase II dose (RP2D) of continuous buparlisib (100 mg/daily) orally plus standard dose carboplatin AUC 5 and paclitaxel 175 mg/m2. Both cohorts received chemotherapy intravenously on day 1 of the 21-day cycle with pegfilgrastim support. Primary endpoint in Cohort A was to evaluate the safety and tolerability of chemotherapy dose intensification with buparlisib and in Cohort B was to describe preliminary efficacy of the combination among patients with tumors harboring a PTEN mutation or homozygous deletion. Results 14 subjects were enrolled, 7 in Cohort A and 7 in Cohort B. Dose reductions were required in 5 (71%) and 3 (43%) patients, in cohort A and B respectively. Grade 3 adverse events in Cohort A included lymphopenia (n = 5 [71%]), hyperglycemia (n = 2, [29%]), diarrhea (n = 2, [29%]) and rash (n = 2, [29%]) and in cohort B included lymphopenia (n = 5 [71%]), hyperglycemia (n = 4 [57%]) and neutropenia (n = 2 [29%]. The mean number of cycles on protocol was 6. The overall objective response rate was 14% (2 /14). No objective responses were observed in the PTEN deficient cohort. Four out of 6 patients with stable disease (SD) had SD or better for ≥6 cycles, 2 of which had PTEN deficient tumors. Conclusion The addition of buparlisib to high dose carboplatin and paclitaxel was not tolerable. The combination did not reveal significant clinical activity amongst a small and heterogenous group of PTEN deficient tumors.
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Affiliation(s)
- Lillian M Smyth
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA.
| | - Kelsey R Monson
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Komal Jhaveri
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Alexander Drilon
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Bob T Li
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Wassim Abida
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Gopa Iyer
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - John F Gerecitano
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Mrinal Gounder
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - James J Harding
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Martin H Voss
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Vicky Makker
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Alan L Ho
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Pedram Razavi
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Philip Bialer
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Jerrold B Teitcher
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Joseph P Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Matthew G Fury
- Oncology Clinical Sciences, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - David M Hyman
- Department of Medicine, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center (MSKCC), 1275 York Avenue, New York, NY, USA
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56
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Soekmadji C, Corcoran NM, Oleinikova I, Jovanovic L, Ramm GA, Nelson CC, Jenster G, Russell PJ. Extracellular vesicles for personalized therapy decision support in advanced metastatic cancers and its potential impact for prostate cancer. Prostate 2017; 77:1416-1423. [PMID: 28856701 DOI: 10.1002/pros.23403] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 12/31/2022]
Abstract
The use of circulating tumor cells (CTCs) and circulating extracellular vesicles (EVs), such as exosomes, as liquid biopsy-derived biomarkers for cancers have been investigated. CTC enumeration using the CellSearch based platform provides an accurate insight on overall survival where higher CTC counts indicate poor prognosis for patients with advanced metastatic cancer. EVs provide information based on their lipid, protein, and nucleic acid content and can be isolated from biofluids and analyzed from a relatively small volume, providing a routine and non-invasive modality to monitor disease progression. Our pilot experiment by assessing the level of two subpopulations of small EVs, the CD9 positive and CD63 positive EVs, showed that the CD9 positive EV level is higher in plasma from patients with advanced metastatic prostate cancer with detectable CTCs. These data show the potential utility of a particular EV subpopulation to serve as biomarkers for advanced metastatic prostate cancer. EVs can potentially be utilized as biomarkers to provide accurate genotypic and phenotypic information for advanced prostate cancer, where new strategies to design a more personalized therapy is currently the focus of considerable investigation.
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Affiliation(s)
- Carolina Soekmadji
- Department of Cell and Molecular Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Niall M Corcoran
- Australian Prostate Cancer Research Centre Epworth, and Department of Surgery, University of Melbourne, Australia
| | - Irina Oleinikova
- Department of Urology, Queensland Health, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lidija Jovanovic
- Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Grant A Ramm
- Department of Cell and Molecular Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Colleen C Nelson
- Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Guido Jenster
- Department of Urology, Erasmus Medical Centre, R,otterdam, The Netherlands
| | - Pamela J Russell
- Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
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57
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Novel Early Phase Clinical Trial Design in Oncology. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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58
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Paoletti X, Drubay D, Collette L. Dose-Finding Methods: Moving Away from the 3 + 3 to Include Richer Outcomes. Clin Cancer Res 2017. [PMID: 28630213 DOI: 10.1158/1078-0432.ccr-17-1306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The most commonly used method for dose finding, the 3 + 3, has poor performance. New adaptive designs are more efficient. Nevertheless, they have reached a maximum performance level, and further improvement requires either larger sample sizes or outcomes measures richer than the simplistic severe toxicity measured at cycle 1. Clin Cancer Res; 23(15); 3977-9. ©2017 AACRSee related article by Yan et al., p. 3994.
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Affiliation(s)
- Xavier Paoletti
- Biostatistics and Epidemiology Department, Gustave Roussy Cancer Center, Villejuif, France. .,Université Paris 11 Saclay and INSERM U1018 CESP OncoStat, Villejuif, France
| | - Damien Drubay
- Biostatistics and Epidemiology Department, Gustave Roussy Cancer Center, Villejuif, France.,Université Paris 11 Saclay and INSERM U1018 CESP OncoStat, Villejuif, France
| | - Laurence Collette
- European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium
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59
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Joshi AD, Botham RC, Schlein LJ, Roth HS, Mangraviti A, Borodovsky A, Tyler B, Joslyn S, Looper JS, Podell M, Fan TM, Hergenrother PJ, Riggins GJ. Synergistic and targeted therapy with a procaspase-3 activator and temozolomide extends survival in glioma rodent models and is feasible for the treatment of canine malignant glioma patients. Oncotarget 2017; 8:80124-80138. [PMID: 29113289 PMCID: PMC5655184 DOI: 10.18632/oncotarget.19085] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/09/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose Glioblastoma is a deadly brain cancer with a median survival time of ∼15 months. Ionizing radiation plus the DNA alkylator temozolomide (TMZ) is the current standard therapy. PAC-1, a procaspase-3 activating small molecule, is blood-brain barrier penetrant and has previously demonstrated ability to synergize with diverse pro-apoptotic chemotherapeutics. We studied if PAC-1 could enhance the activity of TMZ, and whether addition of PAC-1 to standard treatment would be feasible in spontaneous canine malignant gliomas. Experimental Design Using cell lines and online gene expression data, we identified procaspase-3 as a potential molecular target for most glioblastomas. We investigated PAC-1 as a single agent and in combination with TMZ against glioma cells in culture and in orthotopic rodent models of glioma. Three dogs with spontaneous gliomas were treated with an analogous human glioblastoma treatment protocol, with concurrent PAC-1. Results Procaspase-3 is expressed in gliomas, with higher gene expression correlating with increased tumor grade and decreased prognosis. PAC-1 is cytotoxic to glioma cells in culture and active in orthotopic rodent glioma models. PAC-1 added to TMZ treatments in cell culture increases apoptotic death, and the combination significantly increases survival in orthotopic glioma models. Addition of PAC-1 to TMZ and radiation was well-tolerated in 3 out of 3 pet dogs with spontaneous glioma, and partial to complete tumor reductions were observed. Conclusions Procaspase-3 is a clinically relevant target for treatment of glioblastoma. Synergistic activity of PAC-1/TMZ in rodent models and the demonstration of feasibility of the combined regime in canine patients suggest potential for PAC-1 in the treatment of glioblastoma.
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Affiliation(s)
- Avadhut D Joshi
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rachel C Botham
- Department of Chemistry, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Lisa J Schlein
- Department of Pathobiology, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Howard S Roth
- Department of Chemistry, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Antonella Mangraviti
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alexandra Borodovsky
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Betty Tyler
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jayme S Looper
- Department of Veterinary Clinical Sciences, Louisiana State University, Baton Rouge, LA, USA
| | - Michael Podell
- Department of Neurology, MedVet Chicago, Chicago, IL, USA
| | - Timothy M Fan
- Department of Veterinary Clinical Medicine, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Paul J Hergenrother
- Department of Chemistry, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Gregory J Riggins
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Costa R, Costa RB, Talamantes SM, Helenoswki I, Carneiro BA, Chae YK, Gradishar WJ, Kurzrock R, Giles FJ. Analyses of selected safety endpoints in phase 1 and late-phase clinical trials of anti-PD-1 and PD-L1 inhibitors: prediction of immune-related toxicities. Oncotarget 2017; 8:67782-67789. [PMID: 28978071 PMCID: PMC5620211 DOI: 10.18632/oncotarget.18847] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/31/2017] [Indexed: 02/07/2023] Open
Abstract
Purpose Anti-PD1 and PD-L1 antibodies are associated with immune-related adverse effects (irAEs). This analysis aims to assess the discrepancies between frequencies of irAEs observed in phase 1 trials with those seen in late-phase trials and to evolve the field of drug development. Methods PubMed search was conducted for articles published until December of 2016. Trials needed to have at least one of the study arms consisting of nivolumab, pembrolizumab or atezolizumab monotherapy. Trials were matched based on compound used and similarity of populations. All toxicities were reported as frequencies and percentages. P-values to assess differences between matches and non-matches of phase 1 and late-phase trials and between early and late-phase trials themselves were obtained via Fisher's exact test. Odds ratios were obtained via logistic regression. Results Our search yielded 15 late-phase and 10 matching phase 1 trials; n = 4823 and n = 1650, respectively. The most common AEs seen in phase 1 trials were also observed in late-phase trials except for phase 1 trials (median n = 118) with < 118 patients (P = 0.048). Rash, pruritus, and diarrhea were the most frequently irAEs reported. Only colitis was more frequent in late-phase studies (P = 0.045). Conclusion Toxicities of anti-PD-1 and PD-L1 observed in phase 1 trials and late-phase trials are similar. There is positive correlation between phase 1 trial sample size and concordance of toxicity frequencies seen in late-phase studies. In conclusion, current immunotherapy phase 1 trials are appropriate in assessing safety profile of anti-PD-1 and PD-L1 antibodies.
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Affiliation(s)
- Ricardo Costa
- Division of Hematology Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rubens B Costa
- Division of Hematology Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah M Talamantes
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Irene Helenoswki
- Northwestern University Department of Preventive Medicine, Chicago, Illinois, USA
| | - Benedito A Carneiro
- Division of Hematology Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Young Kwang Chae
- Division of Hematology Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William J Gradishar
- Division of Hematology Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy, Moores Cancer Center, University of California at San Diego, La Jolla, California, USA
| | - Francis J Giles
- Division of Hematology Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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61
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Huang X, Magnus J, Kaimal V, Karmali P, Li J, Walls M, Prudente R, Sung E, Sorourian M, Lee R, Davis S, Yang X, Estrella H, Lee EC, Chau BN, Pavlicek A, Zabludoff S. Lipid Nanoparticle-Mediated Delivery of Anti-miR-17 Family Oligonucleotide Suppresses Hepatocellular Carcinoma Growth. Mol Cancer Ther 2017; 16:905-913. [PMID: 28167506 DOI: 10.1158/1535-7163.mct-16-0613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common human malignancies with poor prognosis and urgent unmet medical need. Aberrant expression of multiple members of the miR-17 family are frequently observed in HCC, and their overexpression promotes tumorigenic properties of HCC cells. However, whether pharmacologic inhibition of the miR-17 family inhibits HCC growth remains unknown. In this study, we validated that the miR-17 family was upregulated in a subset of HCC tumors and cell lines and its inhibition by a tough decoy inhibitor suppressed the growth of Hep3B and HepG2 cells, which overexpress the miR-17 family. Furthermore, inhibition of the miR-17 family led to a global derepression of direct targets of the family in all three HCC cell lines tested. Pathway analysis of the deregulated genes indicated that the genes associated with TGFβ signaling pathway were highly enriched in Hep3B and HepG2 cells. A miR-17 family target gene signature was established and used to identify RL01-17(5), a lipid nanoparticle encapsulating a potent anti-miR-17 family oligonucleotide. To address whether pharmacologic modulation of the miR-17 family can inhibit HCC growth, RL01-17(5) was systemically administrated to orthotopic Hep3B xenografts. Suppression of Hep3B tumor growth in vivo was observed and tumor growth inhibition correlated with induction of miR-17 family target genes. Together, this study provides proof-of-concept for targeting the miR-17 family in HCC therapy. Mol Cancer Ther; 16(5); 905-13. ©2017 AACR.
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Affiliation(s)
| | - Jill Magnus
- Regulus Therapeutics Inc., San Diego, California
| | - Vivek Kaimal
- Regulus Therapeutics Inc., San Diego, California
| | | | - Jian Li
- Regulus Therapeutics Inc., San Diego, California
| | | | | | - Eric Sung
- Regulus Therapeutics Inc., San Diego, California
| | | | - Robin Lee
- Regulus Therapeutics Inc., San Diego, California
| | - Scott Davis
- Regulus Therapeutics Inc., San Diego, California
| | - Xia Yang
- Regulus Therapeutics Inc., San Diego, California
| | | | - Edmund C Lee
- Regulus Therapeutics Inc., San Diego, California
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Jairath V, Levesque BG, Vande Casteele N, Khanna R, Mosli M, Hindryckx P, Travis S, Duijvestein M, Rimola J, Panes J, D'Haens G, Sandborn WJ, Feagan BG. Evolving Concepts in Phases I and II Drug Development for Crohn's Disease. J Crohns Colitis 2017; 11:246-255. [PMID: 27487793 DOI: 10.1093/ecco-jcc/jjw137] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/16/2016] [Accepted: 06/29/2016] [Indexed: 02/08/2023]
Abstract
The highest attrition rates during drug development programmes occur at the proof of concept stage. Given the large number of molecules under development for Crohn's disease, a need exists to improve the efficiency of early drug development by fast-tracking promising agents and terminating ineffective ones. Multiple opportunities are available to achieve these goals, including the use of more responsive outcome measures, and the incorporation of sophisticated pharmacokinetic modelling and/or highly specific pharmacodynamic markers into exposure-based dosing regimens and novel trial designs. In this article we review these strategies and propose an integrated paradigm of early drug development in Crohn's disease.
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Affiliation(s)
- Vipul Jairath
- Department of Medicine, University of Western Ontario, London, ON, Canada.,Robarts Clinical Trials Inc., Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
| | - Barrett G Levesque
- Robarts Clinical Trials Inc., Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Niels Vande Casteele
- Robarts Clinical Trials Inc., Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA.,KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Reena Khanna
- Department of Medicine, University of Western Ontario, London, ON, Canada.,Robarts Clinical Trials Inc., Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Mahmoud Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Pieter Hindryckx
- Robarts Clinical Trials Inc., Robarts Research Institute, University of Western Ontario, London, ON, Canada.,University Hospital of Ghent, Ghent, Belgium
| | - Simon Travis
- Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jordi Rimola
- Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Julian Panes
- Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Geert D'Haens
- Robarts Clinical Trials Inc., Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - William J Sandborn
- Robarts Clinical Trials Inc., Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G Feagan
- Department of Medicine, University of Western Ontario, London, ON, Canada .,Robarts Clinical Trials Inc., Robarts Research Institute, University of Western Ontario, London, ON, Canada.,Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
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63
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Shibata S, Wayama Y, Tsuyuki A, Matsushita M, Chiba K, Matsuki E, Okamoto S, Suzuki T. An Empirical Study of the Prescription Pattern of Drugs for Hematological Malignancies in Japan from 2010–2014. Biol Pharm Bull 2017; 40:894-901. [DOI: 10.1248/bpb.b17-00111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Shoyo Shibata
- Division of Basic Biological Sciences, Faculty of Pharmacy, Keio University
| | - Yusuke Wayama
- Division of Basic Biological Sciences, Faculty of Pharmacy, Keio University
| | - Ai Tsuyuki
- Division of Basic Biological Sciences, Faculty of Pharmacy, Keio University
| | - Maiko Matsushita
- Division of Clinical Physiology and Therapeutics, Faculty of Pharmacy, Keio University
| | - Koji Chiba
- Laboratory of Clinical Pharmacology, Faculty of Pharmacy, Yokohama University of Pharmacy
| | - Eri Matsuki
- Department of Medicine, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | - Takeshi Suzuki
- Division of Basic Biological Sciences, Faculty of Pharmacy, Keio University
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64
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Systematic comparison of the statistical operating characteristics of various Phase I oncology designs. Contemp Clin Trials Commun 2016; 5:34-48. [PMID: 29740620 PMCID: PMC5936704 DOI: 10.1016/j.conctc.2016.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 11/21/2022] Open
Abstract
Dose finding Phase I oncology designs can be broadly categorized as rule based, such as the 3 + 3 and the accelerated titration designs, or model based, such as the CRM and Eff-Tox designs. This paper systematically reviews and compares through simulations several statistical operating characteristics, including the accuracy of maximum tolerated dose (MTD) selection, the percentage of patients assigned to the MTD, over-dosing, under-dosing, and the trial dose-limiting toxicity (DLT) rate, of eleven rule-based and model-based Phase I oncology designs that target or pre-specify a DLT rate of ∼0.2, for three sets of true DLT probabilities. These DLT probabilities are generated at common dosages from specific linear, logistic, and log-logistic dose-toxicity curves. We find that all the designs examined select the MTD much more accurately when there is a clear separation between the true DLT rate at the MTD and the rates at the dose level immediately above and below it, such as for the DLT rates generated using the chosen logistic dose-toxicity curve; the separations in these true DLT rates depend, in turn, not only on the functional form of the dose-toxicity curve but also on the investigated dose levels and the parameter set-up. The model based mTPI, TEQR, BOIN, CRM and EWOC designs perform well and assign the greatest percentages of patients to the MTD, and also have a reasonably high probability of picking the true MTD across the three dose-toxicity curves examined. Among the rule-based designs studied, the 5 + 5 a design picks the MTD as accurately as the model based designs for the true DLT rates generated using the chosen log-logistic and linear dose-toxicity curves, but requires enrolling a higher number of patients than the other designs. We also find that it is critical to pick a design that is aligned with the true DLT rate of interest. Further, we note that Phase I trials are very small in general and hence may not provide accurate estimates of the MTD. Thus our work provides a map for planning Phase I oncology trials or developing new ones.
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65
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Collins DC, Sundar R, Lim JSJ, Yap TA. Towards Precision Medicine in the Clinic: From Biomarker Discovery to Novel Therapeutics. Trends Pharmacol Sci 2016; 38:25-40. [PMID: 27871777 DOI: 10.1016/j.tips.2016.10.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 02/08/2023]
Abstract
Precision medicine continues to be the benchmark to which we strive in cancer research. Seeking out actionable aberrations that can be selectively targeted by drug compounds promises to optimize treatment efficacy and minimize toxicity. Utilizing these different targeted agents in combination or in sequence may further delay resistance to treatments and prolong antitumor responses. Remarkable progress in the field of immunotherapy adds another layer of complexity to the management of cancer patients. Corresponding advances in companion biomarker development, novel methods of serial tumor assessments, and innovative trial designs act synergistically to further precision medicine. Ongoing hurdles such as clonal evolution, intra- and intertumor heterogeneity, and varied mechanisms of drug resistance continue to be challenges to overcome. Large-scale data-sharing and collaborative networks using next-generation sequencing (NGS) platforms promise to take us further into the cancer 'ome' than ever before, with the goal of achieving successful precision medicine.
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Affiliation(s)
- Dearbhaile C Collins
- The Institute of Cancer Research and Royal Marsden Hospital, Downs Road, London SM2 5PT, UK
| | - Raghav Sundar
- The Institute of Cancer Research and Royal Marsden Hospital, Downs Road, London SM2 5PT, UK
| | - Joline S J Lim
- The Institute of Cancer Research and Royal Marsden Hospital, Downs Road, London SM2 5PT, UK
| | - Timothy A Yap
- The Institute of Cancer Research and Royal Marsden Hospital, Downs Road, London SM2 5PT, UK.
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66
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Dose-Seeking Phase I Trials for Currently Approved Molecular-Targeted Therapies in the USA: The Dose-Limiting Toxicity Definition Issue. Pharmaceut Med 2016. [DOI: 10.1007/s40290-016-0138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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