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Decker T, Overkamp F, Rösel S, Nusch A, Göhler T, Indorf M, Sahlmann J, Trarbach T. A randomized phase II study of paclitaxel alone versus paclitaxel plus sorafenib in second- and third-line treatment of patients with HER2-negative metastatic breast cancer (PASO). BMC Cancer 2017; 17:499. [PMID: 28743247 PMCID: PMC5526236 DOI: 10.1186/s12885-017-3492-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/20/2017] [Indexed: 01/07/2023] Open
Abstract
Background We conducted an open-label, randomized, two-arm multi-center study to assess the efficacy and safety of paclitaxel versus paclitaxel + sorafenib in patients with locally advanced or metastatic HER2-negative breast cancer. Methods Patients were randomly assigned to receive either paclitaxel monotherapy (80 mg/m2) weekly (3 weeks on, 1 week off) plus sorafenib 400 mg orally, twice a day taken continuously throughout 28 day cycles. Sorafenib dose was gradually escalated from a starting dose of 200 mg twice a day. The primary endpoint was progression free survival (PFS). Results A pre-planned efficacy interim analysis was performed on the data of 60 patients, 30 patients in each treatment arm. Median PFS was estimated at 6.6 months (95% CI: 5.1 to 9.0) in patients randomized to single-agent paclitaxel (Arm A) and 5.6 months (95% CI: 3.8 to 6.5) in patients randomized to paclitaxel-sorafenib combination (Arm B) therapy. Contrary to the hypothesis, the treatment effect was statistically significant in favor of paclitaxel monotherapy (hazard ratio 1.80, 95% CI: 1.02 to 3.20; log-rank test P = 0.0409). It was decided to stop the trial early for futility. Median OS was also in favor of Arm A (20.7 months (95% CI: 16.4 to 26.7) versus 12.1 months (95% CI: 5.8 to 20.4) in Arm B. Clinical control was achieved in 28 patients (93.3%) in Arm A and in 21 patients 70.0% in Arm B. Overall response rate was met in 43.3% of patients in Arm A and in 40.0% in Arm B. Toxicities were increased in Arm B with higher rates of diarrhea, nausea, neutropenia, hand-foot skin reaction (HFSR) and anorexia, Grad 3 and 4 toxicities were rare. Conclusions In this pre-planned interim analysis, paclitaxel-sorafenib combination therapy was not found to be superior to paclitaxel monotherapy with regard to the primary end point, progression-free survival. The trial was therefore discontinued early. There was no indication of more favorable outcomes for combination therapy in secondary efficacy end points. As expected, the safety and toxicity profile of the combination therapy was less favorable compared to monotherapy. Overall, this trial did not demonstrate that adding sorafenib to second- or third-line paclitaxel provides any clinical benefit to patients with HER2-negative advanced or metastatic breast cancer. Cautious dosing using a sorafenib ramp up schedule might have contributed to negative results. Trial registration The study was registered at EudraCT (No 2009–018025-73) and retrospectively registered at Clinical trials.gov on March 17, 2011 (NCT01320111).
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Affiliation(s)
| | | | | | - Arnd Nusch
- Practice for Haematology and internal Oncology, Velbert, Germany
| | | | | | | | - Tanja Trarbach
- iOMEDICO, Freiburg, Germany.,Center for Tumor Biology and Integrative Medicine Clinics Wilhelmshaven, Wilhelmshaven, Germany
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Zhang J, Wang L, Wang Z, Wang B, Cao J, Lv F, Zhang S, Shao Z, Hu X. Whether low-dose metronomic oral cyclophosphamide improves the response to docetaxel in first-line treatment of non-triple-negative metastatic breast cancer. Oncotarget 2017; 8:79527-79536. [PMID: 29108332 PMCID: PMC5668065 DOI: 10.18632/oncotarget.18539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/04/2017] [Indexed: 11/26/2022] Open
Abstract
Oral metronomic chemotherapy may target tumor cells indirectly via antiangiogenic activity, restoration of anticancer immune response, or induction of tumor dormancy. We initiated the single-center, randomized, open-label, phase II study to determine whether the addition of metronomic cyclophosphamide to docetaxel (T) (w/o trastuzumab) improves overall response rate (ORR) as first-line treatment among patients with non-triple-negative metastatic breast cancer (MBC). Eligible patients with previously untreated non-triple-negative MBC were randomly assigned (1:1) to receive 3-weekly cycles of Metro-TC (T 75mg/m2, d1 plus oral cyclophosphamide 50 mg daily) or T alone. All patients received treatment until disease progression, unacceptable toxicity, or withdrawal of consent. The primary endpoint was ORR. Finally, 35 patients were randomized to Metro-TC group while 31 to T group. Median treatment cycles of T for both groups were 8. ORR was not improved by addition of metronomic cyclophosphamide to T (71.4% vs. 51.6%; P = 0.09). There was no statistically significant difference with regard to progression free survival (median 18.5 vs. 11.7 months; P = 0.07) or overall survival (median 33.7 vs. 33.6 months; P = 0.84) between the two group. Grade 3/4 adverse events (eg. neutropenia [100% vs. 100%], febrile neutropenia [29% vs. 29%], and neurotoxicity [6% vs. 3%]) were also comparable. There were no treatment-related deaths. We conclude that concomitant administration of metronomic cyclophosphamide and T does not appear to be a significantly active schedule for first-line treatment of non-triple-negative MBC.
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Affiliation(s)
- Jian Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Leiping Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhonghua Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Biyun Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangfang Lv
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sheng Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xichun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Nasir A, Holzer TR, Chen M, Man MZ, Schade AE. Differential expression of VEGFR2 protein in HER2 positive primary human breast cancer: potential relevance to anti-angiogenic therapies. Cancer Cell Int 2017; 17:56. [PMID: 28533703 PMCID: PMC5438568 DOI: 10.1186/s12935-017-0427-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/12/2017] [Indexed: 12/28/2022] Open
Abstract
Background Clinically relevant predictive biomarkers to tailor anti-angiogenic therapies to breast cancer (BRC) patient subpopulations are an unmet need. Methods We analyzed tumor vascular density and VEGFR2 protein expression in various subsets of primary human BRCs (186 females; Mean age: 59 years; range 33–88 years), using a tissue microarray. Discrete VEGFR2+ and CD34+ tumor vessels were manually scored in invasive ductal, lobular, mixed ductal-lobular and colloid (N = 139, 22, 18, 7) BRC cores. Results The observed CD34+ and VEGFR2+ tumor vascular counts in individual cases were heterogeneous. Mean CD34+ and VEGFR2+ tumor vessel counts were 11 and 3.4 per tumor TMA core respectively. Eighty-nine of 186 (48%) cases had >10 CD34+ tumor vessels, while 97/186 (52%) had fewer CD34+ vessels in each TMA core. Of 169 analyzable cores in the VEGFR2 stained TMA, 90 (53%) showed 1–5 VEGFR2+ tumor vessels/TMA core, while 42/169 (25%) cores had no detectable VEGFR2+ tumor vessels. Thirteen of 169 (8%) cases also showed tumor cell (cytoplasmic/membrane) expression of VEGFR2. Triple-negative breast cancers (TNBCs) appeared to be less vascular (Mean VD = 9.8, range 0–34) than other breast cancer subtypes. Overall, VEGFR2+ tumor vessel counts were significantly higher in HER2+ as compared to HR+ (p = 0.04) and TNBC (p = 0.02) tissues. Compared to HER2− cases, HER2+ breast cancers had higher VEGFR2+ tumor vessel counts (p = 0.007). Conclusion Characterization of pathologic angiogenesis in HER2+ breast cancer provides scientific rationale for future investigation of clinical activity of agents targeting the VEGF/VEGFR2 axis in this clinically aggressive breast cancer subtype.
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Affiliation(s)
- Aejaz Nasir
- Diagnostic and Experimental Pathology, Eli Lilly and Company, Indianapolis, IN USA.,Eli Lilly and Company, Lilly Corporate Center, DC0424, Indianapolis, IN 46285 USA
| | - Timothy R Holzer
- Diagnostic and Experimental Pathology, Eli Lilly and Company, Indianapolis, IN USA
| | - Mia Chen
- Diagnostic and Experimental Pathology, Eli Lilly and Company, Indianapolis, IN USA
| | - Michael Z Man
- Oncology Statistics, Eli Lilly and Company, Indianapolis, IN USA
| | - Andrew E Schade
- Diagnostic and Experimental Pathology, Eli Lilly and Company, Indianapolis, IN USA
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Bronte G, Andreis D, Bravaccini S, Maltoni R, Cecconetto L, Schirone A, Farolfi A, Fedeli A, Serra P, Donati C, Amadori D, Rocca A. Sorafenib for the treatment of breast cancer. Expert Opin Pharmacother 2017; 18:621-630. [PMID: 28335647 DOI: 10.1080/14656566.2017.1309024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Breast cancer treatment includes many options depending on the tumor clinicopathological profile, which groups breast cancer into various subtypes. Bevacizumab is currently the only drug capable of targeting angiogenesis in breast cancer. Sorafenib has also been studied in combination with other agents. Areas covered: Pharmacological aspects of sorafenib, including results from preclinical studies on breast cancer cells; findings about clinical efficacy and safety in both single-arm and randomized clinical trials; ongoing trials. Expert opinion: Since sorafenib as a single agent has shown limited efficacy in breast cancer, its combination with other drugs is under investigation. Dose reduction is the main challenge when sorafenib is combined with chemotherapy or endocrine therapy. Although randomized phase-II trials on sorafenib plus chemotherapy versus chemotherapy alone have shown potential benefits in progression-free survival, preliminary results from a phase-III study in combination with capecitabine are negative. The definitive results of this trial and results from other ongoing phase-II trials will determine further developments of sorafenib in breast cancer. Although these additional data could help determine the most appropriate dose, drug combination and patient settings, a confirmation of the preliminary negative results reported in the phase-III trial are likely to discourage further use of sorafenib in breast cancer, given its non-negligible toxicity, lack of predicting markers, and the number of more promising drugs for breast cancer.
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Affiliation(s)
- Giuseppe Bronte
- a Department of Medical Oncology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Daniele Andreis
- b Unit of Biostatistics and Clinical Trials , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Sara Bravaccini
- c Biosciences Laboratory , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Roberta Maltoni
- a Department of Medical Oncology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Lorenzo Cecconetto
- a Department of Medical Oncology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Alessio Schirone
- a Department of Medical Oncology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Alberto Farolfi
- a Department of Medical Oncology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Anna Fedeli
- a Department of Medical Oncology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Patrizia Serra
- b Unit of Biostatistics and Clinical Trials , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Caterina Donati
- d Oncology Pharmacy , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Dino Amadori
- a Department of Medical Oncology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
| | - Andrea Rocca
- a Department of Medical Oncology , Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS , Meldola , Italy
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Vahdat LT, Layman R, Yardley DA, Gradishar W, Salkeni MA, Joy A, Garcia AA, Ward P, Khatcheressian J, Sparano J, Rodriguez G, Tang S, Gao L, Dalal RP, Kauh J, Miller K. Randomized Phase II Study of Ramucirumab or Icrucumab in Combination with Capecitabine in Patients with Previously Treated Locally Advanced or Metastatic Breast Cancer. Oncologist 2017; 22:245-254. [PMID: 28220020 PMCID: PMC5344637 DOI: 10.1634/theoncologist.2016-0265] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Icrucumab (ICR) and ramucirumab (RAM) bind vascular endothelial growth factor (VEGF) receptors 1 and 2 (VEGFR-1 and -2), respectively. This open-label, randomized phase II study evaluated their efficacy and safety in combination with capecitabine (CAP) in patients with previously treated unresectable, locally advanced or metastatic breast cancer. METHODS Patients were randomly assigned (1:1:1) to receive CAP (1,000 mg/m2 orally twice daily, days 1-14) alone or in combination with RAM (10 mg/kg intravenously [IV], days 1 and 8) (RAM + CAP) or ICR (12 mg/kg IV, days 1 and 8) (ICR + CAP) every 21 days. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), tumor response, safety, and pharmacokinetics. RESULTS Of 153 patients randomized, 150 received treatment. Median PFS (95% confidence interval) was 22.1 (12.1-36.1) weeks on RAM + CAP, 7.3 (6.3-13.0) weeks on ICR + CAP, and 19.0 (12.1-24.3) weeks on CAP (hazard ratios [HRs]: 0.691, p = .1315, RAM + CAP versus CAP; 1.480, p = .0851, ICR + CAP versus CAP). Median OS was 67.4 weeks on RAM + CAP, 62.1 weeks on ICR + CAP, and 71.6 weeks on CAP (HRs: 1.833, p = .0283, RAM + CAP versus CAP; 1.468, p = .1550, ICR + CAP versus CAP). There was no statistically significant difference in PFS or OS between either combination arm and CAP. Treatment-related adverse events more frequent (by ≥10%) on RAM + CAP than on CAP were constipation, decreased appetite, headache, epistaxis, and hypertension. Those more frequent (by ≥10%) on ICR + CAP than CAP were anemia, increased lacrimation, periorbital edema, nausea, vomiting, peripheral edema, facial edema, dehydration, and dyspnea. CONCLUSION Combining RAM or ICR with CAP did not improve PFS in the targeted study population. The Oncologist 2017;22:245-254 IMPLICATIONS FOR PRACTICE: Icrucumab and ramucirumab are recombinant human IgG1 monoclonal antibodies that bind vascular endothelial growth factor (VEGF) receptors 1 and 2 (VEGFR-1 and -2), respectively. VEGFR-1 activation on endothelial and tumor cell surfaces increases tumor vascularization and growth and supports tumor growth via multiple mechanisms, including contributions to angiogenesis and direct promotion of cancer cell proliferation. Strong preclinical and clinical evidence suggests key roles for VEGF and angiogenesis in breast cancer growth, invasion, and metastasis. This randomized phase II study evaluated the efficacy and safety of each antibody in combination with capecitabine in patients with previously treated unresectable, locally advanced or metastatic breast cancer.
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Affiliation(s)
- Linda T Vahdat
- Weill Cornell Breast Center, Weill Cornell Medicine, New York, New York, USA
| | | | | | - William Gradishar
- Northwestern University Feinburg School of Medicine, Chicago, Illinois, USA
| | - Mohamad A Salkeni
- Mary Babb Randolph Cancer Center, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Anil Joy
- University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Agustin A Garcia
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Patrick Ward
- Oncology Hematology Care Incorporated, Cincinnati, Ohio, USA
| | | | - Joseph Sparano
- Weiler Division, Montefiore Medical Center, Bronx, New York, USA
| | | | - Shande Tang
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ling Gao
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Rita P Dalal
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - John Kauh
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Kathy Miller
- Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, Indiana, USA
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Chiavenna SM, Jaworski JP, Vendrell A. State of the art in anti-cancer mAbs. J Biomed Sci 2017; 24:15. [PMID: 28219375 PMCID: PMC5319201 DOI: 10.1186/s12929-016-0311-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/13/2016] [Indexed: 12/31/2022] Open
Abstract
Following Milstein’s discovery, the monoclonal antibodies (mAbs) became a basic tool for biomedical science. In cancer field, since the first mAb was approved by the FDA a great improvement took place making of them a therapeutic option for many cancer types in the current clinical practice. Today, mAbs are being developed to target different molecules with different mechanisms of action and its target potential is unlimited. However, this huge and fast growing new field needs to be organized to better understand the treatment options we have to confront different cancer diseases. Current cancer targeted immunotherapies aim to achieve different goals like the regulation of osteoclast function, the delivery of cytotoxic drugs into tumor cells and the blockade of oncogenic pathways, neo-angiogenesis and immune checkpoints. Here, we reviewed the most relevant therapeutic mAbs for solid tumors available in current clinical practice.
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Affiliation(s)
- S M Chiavenna
- Ferrer Advanced Biotherapeutics, Ferrer Internacional, Barcelona, Spain.
| | - J P Jaworski
- Institute of Virology, CICVyA, INTA - CONICET, Castelar, Buenos Aires, Argentina
| | - A Vendrell
- Faculty of Medicine, CEFYBO - CONICET/University of Buenos Aires, C.A.B.A., Argentina
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Anti-angiogenic treatment in breast cancer: Facts, successes, failures and future perspectives. Cancer Treat Rev 2017; 53:98-110. [PMID: 28088074 DOI: 10.1016/j.ctrv.2016.12.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 01/06/2023]
Abstract
Angiogenesis is one of the hallmarks of cancer and a crucial requisite in the development of tumors. Interrupting this process by blocking the vascular endothelial growth factor (VEGF) with the monoclonal antibody bevacizumab has been considered a possible breakthrough in the treatment of various types of cancer, especially for advanced disease. However in breast cancer, studies have shown ambivalent results causing debate about the value of this drug. In this article, we review the evidence for anti-angiogenic treatment options for breast cancer, as well as discuss the possible factors limiting the effectiveness of anti-angiogenic agents and offer a recommendation regarding the future research on these therapies for the treatment of breast cancer.
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Masuda N, Iwata H, Aogi K, Xu Y, Ibrahim A, Gao L, Dalal R, Yoshikawa R, Sasaki Y. Safety and pharmacokinetics of ramucirumab in combination with docetaxel in Japanese patients with locally advanced or metastatic breast cancer: a Phase Ib study. Jpn J Clin Oncol 2016; 46:1088-1094. [PMID: 27608646 DOI: 10.1093/jjco/hyw127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 12/16/2023] Open
Abstract
OBJECTIVE The primary objective of this study was to investigate the safety and tolerability and to confirm the recommended dose of the anti-vascular endothelial growth factor receptor 2 monoclonal antibody ramucirumab in combination with docetaxel in Japanese patients with metastatic/locally advanced breast cancer. METHODS In this multicenter, single-arm, Phase Ib trial, eligibility criteria included: 20 years or older, Eastern Cooperative Oncology Group performance status of 0/1 and confirmed diagnosis of human epidermal growth factor receptor 2-negative metastatic/locally recurrent inoperable breast adenocarcinoma. Patients received docetaxel (75 mg/m2) followed by ramucirumab (10 mg/kg) on Day 1 of 21-day cycles. Recommended dose was defined as <33% dose-limiting toxicities in dose-limiting toxicity-evaluable patients in Cycle 1. The safety, pharmacokinetics, immunogenicity and antitumor activity were examined. RESULTS Seven patients were treated. Most adverse events were mild to moderate. Two patients during Cycle 1 experienced a dose-limiting toxicity; one patient each experienced Grade 3 febrile neutropenia and Grade 3 gingivitis. Both dose-limiting toxicities subsequently resolved. No patients discontinued study therapies during Cycle 1. Four serious adverse events were possibly related to ramucirumab in combination with docetaxel. Anti-ramucirumab antibodies were not detected. Pharmacokinetic analysis revealed low total body clearance and long apparent terminal elimination half-life (~7-12 days). Partial response was reported in four patients. CONCLUSIONS The combination of ramucirumab and docetaxel was tolerable in female Japanese patients with breast cancer. Ramucirumab 10 mg/kg in combination with docetaxel (75 mg/m2) was confirmed as the recommended dose among Japanese patients, supporting its use in future studies.
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Affiliation(s)
- Norikazu Masuda
- Department of Surgery, Breast Oncology, National Hospital Organization, Osaka National Hospital, Osaka
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya
| | - Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization, Shikoku Cancer Center, Ehime, Japan
| | - Yihuan Xu
- Lilly Research Laboratory, Eli Lilly and Company, Bridgewater, NJ, USA
| | - Ayman Ibrahim
- Lilly Research Laboratory, Eli Lilly and Company, Bridgewater, NJ, USA
| | - Ling Gao
- Lilly Research Laboratory, Eli Lilly and Company, Bridgewater, NJ, USA
| | - Rita Dalal
- Lilly Research Laboratory, Eli Lilly and Company, Bridgewater, NJ, USA
| | | | - Yasutsuna Sasaki
- Division of Medical Oncology, Department of Medicine, Saitama University International Medical Center, Saitama, Japan
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Yardley DA, Reeves J, Dees EC, Osborne C, Paul D, Ademuyiwa F, Soliman H, Guthrie T, Andersen J, Krekow L, Choksi J, Daniel B, Danso M, Favret A, Oommen S, Brufsky A, Bromund JL, Lin Y, Ibrahim AB, Richards PD. Ramucirumab With Eribulin Versus Eribulin in Locally Recurrent or Metastatic Breast Cancer Previously Treated With Anthracycline and Taxane Therapy: A Multicenter, Randomized, Phase II Study. Clin Breast Cancer 2016; 16:471-479.e1. [PMID: 27569274 DOI: 10.1016/j.clbc.2016.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/18/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Use of antiangiogenic agents in treatment of metastatic breast cancer (MBC) remains controversial. We evaluated the efficacy and safety of ramucirumab and eribulin versus eribulin alone as third- to fifth-line therapy in women with advanced breast cancer. PATIENTS AND METHODS In this randomized (1:1), open-label, phase II study, US women aged 18 years or older with 2 to 4 previous chemotherapy regimens for locally recurrent or MBC, previous anthracycline and taxane treatment, and Eastern Cooperative Oncology Group performance status of 0 or 1 received ramucirumab with eribulin or eribulin alone in 21-day cycles (eribulin 1.4 mg/m2 intravenously on days 1 and 8; ramucirumab 10 mg/kg intravenously on day 1). Randomization was stratified according to previous antiangiogenic therapy and triple-negative status. The primary end point was progression-free survival (PFS) in the intention to treat population. RESULTS One hundred forty-one women were randomized to ramucirumab with eribulin (n = 71) or eribulin alone (n = 70). Median PFS for ramucirumab with eribulin was 4.4 months (95% confidence interval [CI], 3.1-6.7) compared with 4.1 months (95% CI, 3.2-5.6) for eribulin (hazard ratio [HR], 0.83; 95% CI, 0.56-1.23; P = .35). Median overall survival in patients who received ramucirumab with eribulin was 13.5 months (95% CI, 10.4-17.9) compared with 11.5 months (95% CI, 9.0-17.3) in patients who received eribulin alone (HR, 0.91; 95% CI, 0.59-1.41; P = .68); objective response rate was 21% (13 of 62 patients) for the combination and 28% (17 of 60 patients) for eribulin alone. No unexpected toxicity was identified for the combination. CONCLUSION Ramucirumab combined with eribulin did not significantly improve PFS in advanced MBC.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, Tennessee Oncology PLLC, Nashville, TN.
| | - James Reeves
- Florida Cancer Specialists and Research Institute, Fort Myers, FL
| | - E Claire Dees
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Cynthia Osborne
- Baylor Charles A. Sammons Cancer Center, US Oncology Research, Dallas, TX
| | - Devchand Paul
- Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO
| | - Foluso Ademuyiwa
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Hatem Soliman
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Jay Andersen
- Northwest Cancer Specialists, PC, US Oncology Research, Portland, OR
| | - Lea Krekow
- Texas Oncology-Bedford, US Oncology Research, Bedford, TX
| | - Janak Choksi
- Medical Oncologist, Alamance Regional Medical Center, Burlington, NC
| | | | - Michael Danso
- Virginia Oncology Associates, US Oncology Research, Norfolk, VA
| | - Anne Favret
- Virginia Cancer Specialists, PC, US Oncology Research, Fairfax, VA
| | - Sanjay Oommen
- Texas Oncology-Fort Worth, US Oncology Research, Fort Worth, TX
| | - Adam Brufsky
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Magee-Women's Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jane L Bromund
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN
| | - Yong Lin
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN
| | | | - Paul D Richards
- Oncology and Hematology Associates of Southwest Virginia, US Oncology Research, Salem, VA
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60
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Gu G, Dustin D, Fuqua SA. Targeted therapy for breast cancer and molecular mechanisms of resistance to treatment. Curr Opin Pharmacol 2016; 31:97-103. [PMID: 27883943 DOI: 10.1016/j.coph.2016.11.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/23/2016] [Accepted: 11/07/2016] [Indexed: 01/05/2023]
Abstract
In recent years, clinical trials investigating new drugs and therapeutic combinations have led to promising advances in breast cancer therapy. Subtyping breast cancers into hormone receptor (HR) positive, epidermal growth factor receptor (HER2) positive, and triple negative breast cancer (TNBC) is currently the basis of diagnosing and treating this disease. In addition to endocrine and HER2-targeted therapies in their respective subtypes, evidence from recent preclinical studies have shown several targetable pathways that overcome resistance in the clinical setting. The mTOR inhibitor everolimus and the CDK4/6 inhibitor palbociclib have been approved in HR-positive metastatic breast cancer (MBC) due to improved disease-free survival (DFS). Adding pertuzumab to trastuzumab in combination with taxanes further improves DFS in HER2-positive breast cancer. Targeted therapy to the heterogeneous group of TNBC is needed in combination with chemotherapy. However, patient selection and predictive biomarker development remains a big challenge for targeted therapy development in TNBC.
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Affiliation(s)
- Guowei Gu
- Lester & Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Derek Dustin
- Lester & Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Suzanne Aw Fuqua
- Lester & Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Dan L Duncan Cancer Center, One Baylor Plaza, Houston, TX 77030, USA.
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61
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Mackey JR, McCarthy N, Gelmon KA, Verma S, Fresco R, Thireau F, Fung H, Martín M. Final Survival Analysis of ROSE/TRIO-012. J Clin Oncol 2016; 34:3714-3715. [PMID: 27480148 DOI: 10.1200/jco.2016.68.9182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Sunil Verma
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | | | | | - Helena Fung
- Translational Research in Oncology, Edmonton, Alberta, Canada
| | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain
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62
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Tian R, Yan H, Zhang F, Sun P, Zheng X, Zhu Y, Wang Q, He J. Incidence and relative risk of hemorrhagic events associated with ramucirumab in cancer patients: a systematic review and meta-analysis. Oncotarget 2016; 7:66182-66191. [PMID: 27507055 PMCID: PMC5323225 DOI: 10.18632/oncotarget.11097] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/10/2016] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to investigate the overall incidence and relative risk (RR) of hemorrhagic events in cancer patients treated with ramucirumab. 298 potentially relevant citations on ramucirumab from Pubmed, Web of Science and the Cochrane Database, as well as abstracts presented at conferences (all up to March 2016) were identified through our initial search. Only phase II and III prospective clinical trials of ramucirumab among cancer patients with toxicity records on hemorrhagic events were selected for final analysis. Data was extracted from the original studies by two independent reviewers. The overall incidence, RR, and 95% confidence intervals (CI) were calculated using fixed or random effects models according to the heterogeneity of the enrolled studies. The statistical analysis was performed by STATA version 11.0 (Stata Corporation, College Station, TX). 4963 patients with a variety of solid tumors from eleven eligible studies were selected into our analysis. The results demonstrated that the overall incidences of all-grade and high-grade hemorrhagic events in cancer patients were 27.6% (95% CI, 18.7-36.5%) and 2.3% (95% CI, 1.3-3.2%), respectively. The RR of hemorrhagic events of ramucirumab compared to control was significantly increased for low-grade (RR, 2.06; 95% CI, 1.85-2.29, p < 0.001), but not for high-grade (RR, 1.19, 95% CI, 0.80-1.76, p=0.39) hemorrhagic events. Hemorrhagic events associated with ramucirumab are modest and manageable while patients could continue to receive ramucizumab treatment to achieve their maximum clinical benefits.
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Affiliation(s)
- Rui Tian
- Department of Pathology, Anhui Cancer Hospital, Hefei, Anhui, China
| | - Hong Yan
- Department of Pathology, Anhui Cancer Hospital, Hefei, Anhui, China
| | - Fei Zhang
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Peng Sun
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Xucai Zheng
- Department of Head, Neck and Breast Surgery, Anhui Cancer Hospital, Hefei, Anhui, China
| | - Yi Zhu
- Department of Gynaecology and Obstetrics, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Qing Wang
- Department of Gynaecology and Obstetrics, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Jie He
- Department of Pathology, Anhui Cancer Hospital, Hefei, Anhui, China
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63
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Sonnenblick A, Pondé N, Piccart M. Metastatic breast cancer: The Odyssey of personalization. Mol Oncol 2016; 10:1147-59. [PMID: 27430154 PMCID: PMC5423195 DOI: 10.1016/j.molonc.2016.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/27/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022] Open
Abstract
Metastatic breast cancer is the most frequent cause of cancer death for women worldwide. In the last 15 years, a large number of new agents have entered clinical use, a result of the dramatic increase in our understanding of the molecular underpinnings of metastatic breast cancer. However, while these agents have led to better outcomes, they are also at the root cause of increasing financial pressure on healthcare systems. Moreover, decision making in an era where every year new agents are added to the therapeutic armamentarium has also become a significant challenge for medical oncologists. In the present article, we will provide an ample review on the most recent developments in the field of treatment of the different subtypes of metastatic breast cancer with a critical discussion on the slow progress made in identifying response biomarkers. New hopes in the form of ctDNA monitoring and functional imaging will be presented.
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Affiliation(s)
- A Sonnenblick
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 125, B 1000 Brussels, Belgium; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - N Pondé
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 125, B 1000 Brussels, Belgium
| | - M Piccart
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 125, B 1000 Brussels, Belgium.
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64
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Liu L, Zhao X, Zou H, Bai R, Yang K, Tian Z. Hypoxia Promotes Gastric Cancer Malignancy Partly through the HIF-1α Dependent Transcriptional Activation of the Long Non-coding RNA GAPLINC. Front Physiol 2016; 7:420. [PMID: 27729869 PMCID: PMC5037220 DOI: 10.3389/fphys.2016.00420] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/06/2016] [Indexed: 01/16/2023] Open
Abstract
Hypoxia-inducible factor (HIF) activates the transcription of genes involved in cancer progression. Recently, HIF was reported to regulate the transcription of non-coding RNAs. Here, we show that the transcription of a long non-coding RNA (lncRNA), Gastric Adenocarcinoma Associated, Positive CD44 Regulator, Long Intergenic Non-Coding RNA (GAPLINC), is directly activated by HIF-1α in gastric cancer (GC). GAPLINC was overexpressed in GC tissues and promoted tumor migration and invasive behavior. GAPLINC overexpression was associated with poor prognosis in GC patients. Luciferase reporter assays and chromatin immunoprecipitation assays confirmed that HIF-1α binds to the promoter region of GAPLINC and activates its transcription. GAPLINC knockdown inhibited hypoxia-induced tumor proliferation in vivo. Taken together, our results identified a novel role for HIF transcriptional pathways in GC tumorigenesis mediated by the regulation of the lncRNA GAPLINC, and suggest GAPLINC as a novel therapeutic target for reversing chemoradioresistance and prolonging survival.
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Affiliation(s)
- Lei Liu
- General Surgery Department, Shengjing Hospital, China Medical University Shenyang, China
| | - Xihe Zhao
- Oncology Department, Shengjing Hospital, China Medical University Shenyang, China
| | - Huawei Zou
- Oncology Department, Shengjing Hospital, China Medical University Shenyang, China
| | - Rubing Bai
- General Surgery Department, The Forth Hospital, China Medical University Shenyang, China
| | - Keyu Yang
- General Surgery Department, The Forth Hospital, China Medical University Shenyang, China
| | - Zhong Tian
- General Surgery Department, Shengjing Hospital, China Medical University Shenyang, China
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Tiwari P. Ramucirumab: Boon or bane. J Egypt Natl Canc Inst 2016; 28:133-40. [PMID: 27025409 DOI: 10.1016/j.jnci.2016.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/21/2022] Open
Abstract
Ramucirumab is the recent addition to the list of monoclonal antibodies being tried in various malignancies. It has been approved in non-small cell lung cancer, gastric cancer and colorectal cancer after progression of one or more lines of therapies in the advanced setting. Though randomized trials have shown benefit, cost effectiveness is questionable. Moreover, the benefits shown are marginal, putting a question mark over its clinical usage. This review summarizes the latest evidence on ramucirumab.
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Affiliation(s)
- Priya Tiwari
- Department of Medical Oncology, DR. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India.
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66
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Triple negative breast cancer: looking for the missing link between biology and treatments. Oncotarget 2016; 6:26560-74. [PMID: 26387133 PMCID: PMC4694936 DOI: 10.18632/oncotarget.5306] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/24/2015] [Indexed: 12/11/2022] Open
Abstract
The so called “Triple Negative Breast Cancer” (TNBC) represents approximately 15-20% of breast cancers. This acronym simply means that the tumour does not express oestrogen receptor (ER) and progesterone receptor (PR) and does not exhibit amplification of the human epidermal growth factor receptor 2 (HER2) gene. Despite this unambiguous definition, TNBCs are an heterogeneous group of tumours with just one common clinical feature: a distinctly aggressive nature with higher rates of relapse and shorter overall survival in the metastatic setting compared with other subtypes of breast cancer. Because of the absence of well-defined molecular targets, cytotoxic chemotherapy is currently the only treatment option for TNBC. In the last decades, the use of more aggressive chemotherapy has produced a clear improvement of the prognosis in women with TNBC, but this approach results in an unacceptable deterioration in the quality of life, also if some support therapies try to relieve patients from distress. In addition, there is the general belief that it is impossible to further improve the prognosis of TNBC patients with chemotherapy alone. In view of that, there is a feverish search for new “clever drugs” able both to rescue chemo-resistant, and to reduce the burden of chemotherapy in chemo-responsive TNBC patients. A major obstacle to identifying actionable targets in TNBC is the vast disease heterogeneity both inter-tumour and intra-tumour and years of study have failed to demonstrate a single unifying alteration that is targetable in TNBC. TNBC is considered the subtype that best benefits from the neoadjuvant model, since the strong correlation between pathological Complete Response and long-term Disease-Free-Survival in these patients. In this review, we discuss the recent discoveries that have furthered our understanding of TNBC, with a focus on the subtyping of TNBC. We also explore the implications of these discoveries for future treatments and highlight the need for a completely different type of clinical trials.
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Wang Z, Zhang J, Zhang L, Liu P, Xie Y, Zhou Q. Risk of gastrointestinal perforation in cancer patients receiving ramucirumab: a meta-analysis of randomized controlled trials. J Chemother 2016; 28:328-34. [PMID: 26099278 DOI: 10.1179/1973947815y.0000000053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Although existing evidence from clinical trials has demonstrated manifestation of gastrointestinal perforation with the use of ramucirumab, overall risks have yet to be reported. Therefore, we performed a meta-analysis of published randomized controlled trials (RCTs) to get a better understanding of the overall incidence and risk of gastrointestinal perforation associated with ramucirumab. METHODS The PubMed and Web of Science databases as well as abstracts presented at American Society of Clinical Oncology conferences were searched to identify relevant studies published up to 01 May 2015. Eligible studies included randomized trials of ramucirumab either alone or in combination with another agent compared with the control arm without ramucirumab and that reported gastrointestinal perforation event. Overall incidence, relative risk (RR) and 95% confidence intervals (CI) were computed using fixed- or random-effects models depending on the heterogeneity of the included studies. RESULTS A total of 4579 patients with a variety of solid malignancies from six RCTs were included in our meta-analysis. The incidence of gastrointestinal perforation related to ramucirumab was 1.5% (95% CI 1.1-2.1%) with a mortality of 29.8% (95% CI 14.9-50.7%). The RR of gastrointestinal perforation associated with ramucirumab was 2.56 (95% CI 1.29-5.09; P = 0.007). CONCLUSIONS Treatment with the ramucirumab is associated with a significant increase in risk of gastrointestinal perforation in cancer patients.
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Affiliation(s)
- Zexing Wang
- a Department of Oncology , Wuhu No. 2 People's Hospital Affiliated to Wannan Medical College , Anhui Province , China
| | - Jun Zhang
- a Department of Oncology , Wuhu No. 2 People's Hospital Affiliated to Wannan Medical College , Anhui Province , China
| | - Liang Zhang
- b Department of Urology and Institute of Prostatic Diseases , Wuhu No. 2 People's Hospital Affiliated to Wannan Medical College , Anhui Province , China
| | - Pengying Liu
- a Department of Oncology , Wuhu No. 2 People's Hospital Affiliated to Wannan Medical College , Anhui Province , China
| | - Yamin Xie
- a Department of Oncology , Wuhu No. 2 People's Hospital Affiliated to Wannan Medical College , Anhui Province , China
| | - Qin Zhou
- a Department of Oncology , Wuhu No. 2 People's Hospital Affiliated to Wannan Medical College , Anhui Province , China
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68
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Falcon BL, Chintharlapalli S, Uhlik MT, Pytowski B. Antagonist antibodies to vascular endothelial growth factor receptor 2 (VEGFR-2) as anti-angiogenic agents. Pharmacol Ther 2016; 164:204-25. [PMID: 27288725 DOI: 10.1016/j.pharmthera.2016.06.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Interaction of numerous signaling pathways in endothelial and mesangial cells results in exquisite control of the process of physiological angiogenesis, with a central role played by vascular endothelial growth factor receptor 2 (VEGFR-2) and its cognate ligands. However, deregulated angiogenesis participates in numerous pathological processes. Excessive activation of VEGFR-2 has been found to mediate tissue-damaging vascular changes as well as the induction of blood vessel expansion to support the growth of solid tumors. Consequently, therapeutic intervention aimed at inhibiting the VEGFR-2 pathway has become a mainstay of treatment in cancer and retinal diseases. In this review, we introduce the concepts of physiological and pathological angiogenesis, the crucial role played by the VEGFR-2 pathway in these processes, and the various inhibitors of its activity that have entered the clinical practice. We primarily focus on the development of ramucirumab, the antagonist monoclonal antibody (mAb) that inhibits VEGFR-2 and has recently been approved for use in patients with gastric, colorectal, and lung cancers. We examine in-depth the pre-clinical studies using DC101, the mAb to mouse VEGFR-2, which provided a conceptual foundation for the role of VEGFR-2 in physiological and pathological angiogenesis. Finally, we discuss further clinical development of ramucirumab and the future of targeting the VEGF pathway for the treatment of cancer.
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Abstract
Phase III randomized controlled trials (RCT) in oncology fail to lead to registration of new therapies more often than RCTs in other medical disciplines. Most RCTs are sponsored by the pharmaceutical industry, which reflects industry's increasing responsibility in cancer drug development. Many preclinical models are unreliable for evaluation of new anticancer agents, and stronger evidence of biologic effect should be required before a new agent enters the clinical development pathway. Whenever possible, early-phase clinical trials should include pharmacodynamic studies to demonstrate that new agents inhibit their molecular targets and demonstrate substantial antitumor activity at tolerated doses in an enriched population of patients. Here, we review recent RCTs and found that these conditions were not met for most of the targeted anticancer agents, which failed in recent RCTs. Many recent phase III RCTs were initiated without sufficient evidence of activity from early-phase clinical trials. Because patients treated within such trials can be harmed, they should not be undertaken. The bar should also be raised when making decisions to proceed from phase II to III and from phase III to marketing approval. Many approved agents showed only better progression-free survival than standard treatment in phase III trials and were not shown to improve survival or its quality. Introduction of value-based pricing of new anticancer agents would dissuade the continued development of agents with borderline activity in early-phase clinical trials. When collaborating with industry, oncologists should be more critical and better advocates for cancer patients.
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Affiliation(s)
- Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana and University of Ljubljana, Ljubljana, Slovenia
| | - Alberto Ocana
- Translational Oncology Unit, Albacete University Hospital, Albacete, Spain
| | - Eitan Amir
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada
| | - Ian F Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Canada.
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A Decade of Experience in Developing Preclinical Models of Advanced- or Early-Stage Spontaneous Metastasis to Study Antiangiogenic Drugs, Metronomic Chemotherapy, and the Tumor Microenvironment. Cancer J 2016. [PMID: 26222079 DOI: 10.1097/ppo.0000000000000134] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The clinical circumstance of treating spontaneous metastatic disease, after resection of primary tumors, whether advanced/overt or microscopic in nature, is seldom modeled in mice and may be a major factor in explaining the frequent discordance between preclinical and clinical therapeutic outcomes where the trend is "overprediction" of positive results in preclinical mouse model studies. To evaluate this hypothesis, a research program was initiated a decade ago to develop multiple models of metastasis in mice, using variants of human tumor cell lines selected in vivo for enhanced spontaneous metastatic aggressiveness after surgical resection of established orthotopic primary tumors. These models have included breast, renal, and colorectal carcinomas; ovarian cancer (but without prior surgery); and malignant melanoma. They have been used primarily for experimental therapeutic investigations involving various antiangiogenic drugs alone or with chemotherapy, especially "metronomic" low-dose chemotherapy. The various translational studies undertaken have revealed a number of clinically relevant findings. These include the following: (i) the potential of metronomic chemotherapy, especially when combined with a vascular endothelial growth factor pathway targeting drug to successfully treat advanced metastatic disease; (ii) the development of relapsed spontaneous brain metastases in mice with melanoma or breast cancer whose systemic metastatic disease is successfully controlled for a period with a given therapy; (iii) foreshadowing the failure of adjuvant antiangiogenic drug-based phase III trials; (iv) recapitulating the failure of oral antiangiogenic tyrosine kinase inhibitors plus standard chemotherapy in contrast to the modest successes of antiangiogenic antibodies plus chemotherapy in metastatic breast cancer; and (v) revealing "vessel co-option" and absence of angiogenesis as a determinant of intrinsic resistance or minimal responsiveness to antiangiogenic therapy in lung metastases. Developing similar models of metastatic disease but involving mouse tumors grown in syngeneic immunocompetent mice may also prove useful for future translational studies of immune therapy-based treatments.
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Torres S, Simmons C, Boileau JF, McLeod D, Martins I, Trudeau M. Patterns in target-directed breast cancer research. SPRINGERPLUS 2016; 5:109. [PMID: 26877907 PMCID: PMC4735094 DOI: 10.1186/s40064-016-1736-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/18/2016] [Indexed: 11/20/2022]
Abstract
We undertake an analysis of ongoing BC targeted therapy trials registered to CT.gov to describe patterns of ongoing clinical research, highlight gaps in current research programs and identify ways of optimizing ongoing initiatives. A search of clinicaltrials.gov was conducted on September 4, 2013 to identify ongoing randomized phase II and III trials of targeted therapies in BC. A total of 280 trials were analyzed, the majority conducted in either human epidermal growth factor receptor 2 (HER2)-positive (n = 79, 28.2 %) or hormone receptor (HR)-positive (n = 104, 37.1 %) populations. Less than half of all trials were conducted in populations selected to match the agent under investigation (n = 126, 45 %). HER2-directed therapy is the single most investigated class of targeted agents (n = 73, 26.1 %), but trials investigating anti-angiogenic agents are also common (n = 49, 17.5 %). The most common new classes of agents under investigation in HR-positive and triple negative (TN)/BRCA-positive disease, are non-receptor protein kinase-inhibitors (n = 12; 11.5 %) and poly (ADP-ribose) polymerase inhibitors (n = 6; 30 %), respectively. The majority of regimens combine new targeted agents with either chemotherapy (n = 164, 58.6 %) or endocrine therapy (n = 113, 40.4 %); a total of 8 trials (2.8 %) investigated peptide-drug conjugates. The most frequently utilized end-points were pathological complete response in the neo-adjuvant setting (n = 36, 52.9 %) and time-to-event end-points in the adjuvant and advanced settings (77.3 and 72.6 %, respectively). Our findings suggest a need for more target-matched agent development, maintenance of a value-based focus in research and a need for the clinical development of agents to treat TN/BRCA-positive and HR-positive BC.
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Affiliation(s)
- Sofia Torres
- />Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 023, Toronto, ON M4N 3M5 Canada
| | - Christine Simmons
- />British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC V5Z 4E6 Canada
| | - Jean-François Boileau
- />Jewish General Hospital Segal Cancer Centre, 3755 Côte-Ste-Catherine Road, Montreal, QC Canada
| | - Deanna McLeod
- />Kaleidoscope Strategic, 146 Marion Street, Toronto, ON M6R 1E7 Canada
| | - Ilidio Martins
- />Kaleidoscope Strategic, 146 Marion Street, Toronto, ON M6R 1E7 Canada
| | - Maureen Trudeau
- />Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 023, Toronto, ON M4N 3M5 Canada
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Wang K, Qu X, Wang Y, Dong W, Shen H, Zhang T, Ni Y, Liu Q, Du J. The Impact of Ramucirumab on Survival in Patients with Advanced Solid Tumors: A Systematic Review and Meta-Analysis of Randomized II/III Controlled Trials. Clin Drug Investig 2016; 36:27-39. [PMID: 26547200 DOI: 10.1007/s40261-015-0355-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Ramucirumab is a fully immunoglobulin G (lgG) monoclonal antibody targeting vascular endothelial growth factor receptor type 2 (VEGFR2). Previous clinical trials suggested ramucirumab could improve the survival and increase the risk of adverse effects. Here, we aimed to assess the efficacy and safety of ramucirumab in the treatment of advanced solid tumors. METHODS Publications were searched from Pubmed, Embase database and clinicaltrials.gov. Hazard ratio (HR) and 95% confidence interval (95% CI) were calculated to evaluate efficacy, and the risk ratio (RR) for adverse effects. RESULTS Ten relevant studies were included. Ramucirumab resulted in significant benefit in overall survival [OS, HR and 95% CI 0.87 (0.82-0.93), I(2): 0.0%] and progression-free survival [PFS, HR and 95% CI 0.74 (0.66-0.82), I(2): 67.4%]. Also the difference of time to progression (TTP) and objective response rate (ORR) between two groups were also significant [0.70 (0.57-0.88) and 1.78 (1.40-2.25), respectively]. Ramucirumab could increase the risk of total adverse effects (TAEs, of any grade) by 1% (from 0 to 2%) and severe adverse effects (SAEs, grade > 2) by 17% (from 9 to 26%). The most frequently occurring TAEs were fatigue (54.71%), neutropenia (42.74%), bleeding (37.55%), nausea (34.63%) and stomatitis (33.74%). Most frequently occurring SAEs (grade ≥3) were neutropenia (33.43%), fatigue (12.08%), leukopenia (10.59%), hypertension (8.99%) and liver injury (8.74%). CONCLUSION Ramucirumab could improve OS and PFS for patients suffering from advanced solid tumors. Ramucirumab could increase the risk of TAEs and SAEs.
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Affiliation(s)
- Kai Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Xiao Qu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Ying Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Wei Dong
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Hongchang Shen
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Tiehong Zhang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Yang Ni
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China
| | - Qi Liu
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China.
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China.
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, 324 Jingwu Road, Jinan, 250021, People's Republic of China.
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Li Y, Liang XY, Yue YQ, Sheng L, Liu JK, Wang ZY, Chen G. Does the addition of drugs targeting the vascular endothelial growth factor pathway to first-line chemotherapy increase complete response? A meta-analysis of randomized clinical trials. Tumour Biol 2015; 37:6297-306. [PMID: 26619847 DOI: 10.1007/s13277-015-4493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
Abstract
Drugs targeting the vascular endothelial growth factor (VEGF) and its receptor (VEGFR) signaling (anti-VEGF/VEGFR drugs) are the most validated anti-angiogenic strategies for cancer treatment. Complete response (CR) is a rare event in cancer patients receiving chemotherapy. A meta-analysis was conducted to determine whether adding anti-VEGF/VEGFR drugs to chemotherapy can further increase the chance of CR in the first-line therapy. Relevant databases were systematically searched for the period 2000-2015. Eligible studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The incidence, relative risk (RR), and 95 % confidence intervals (CIs) were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies. A total of 12,453 patients from 28 randomized controlled trials were included. The overall incidence of CR in patients treated with anti-VEGF/VEGFR drugs plus chemotherapy was 1.5 % (95 % CI, 1.0-2.0 %) compared to 1.1 % (95 % CI, 0.7-1.4 %) in the chemotherapy-alone arm. Adding anti-VEGF/VEGFR drugs was associated with significant improvement of CR (RR, 1.52, 95 % CI, 1.18-1.95, P = 0.001). When stratified by drug type, adding VEGFR tyrosin kinase inhibitors (TKIs) did not increase the chance of CR (RR, 0.87, 95 % CI, 0.51-1.49; P = 0.614). The addition of bevacizumab with 7.5 mg/kg every 3 weeks, but not 15 mg/kg every 3 weeks, significantly improves the CR (7.5 mg, RR, 2.43, 95 % CI, 1.64-3.60, P = 0.000; 15 mg, RR, 1.07, 95 % CI, 0.63-1.81, P = 0.799). In subgroup analysis, a significant improvement of CR by the addition of anti-VEGF/VEGFR drugs was observed in patients with colorectal cancer (RR, 2.10, 95 % CI 1.21-3.63, P = 0.008), ovarian cancer (RR, 3.07; 95 % CI, 1.68-5.62, P = 0.000), and patients who are treated with platinum-based regimens (RR, 1.78, 95 % CI, 1.23-2.59, P = 0.002). Low-dose bevacizumab, rather than VEGFR TKIs or high-dose bevacizumab, can increase the chance of CR in patients receiving chemotherapy.
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Affiliation(s)
- Yan Li
- Department of Urology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201500, China
| | - Xin-Yue Liang
- Institute of Clinical Pharmacology, Qilu Hospital, Shandong University, Shandong, China
| | - Yi-Qi Yue
- Department of Gynecology, Xuhui District Central Hospital, Shanghai, China
| | - Lei Sheng
- Centre for Personalised Cancer Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Ji-Kai Liu
- Department of Urology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201500, China
| | - Zhan-Yu Wang
- Department of Urology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201500, China
| | - Gang Chen
- Department of Urology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201500, China.
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74
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Abdel-Rahman O, ElHalawani H. Risk of oral and gastrointestinal mucosal injury in patients with solid tumors treated with ramucirumab: a systematic review and meta-analysis. Expert Opin Drug Saf 2015; 14:1495-506. [PMID: 26313327 DOI: 10.1517/14740338.2015.1074677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We performed a systematic review and meta-analysis of the risk of oral and gastrointestinal (GI) mucosal injury associated with ramucirumab. PATIENTS AND METHODS Eligible studies included randomized Phase II and III trials of patients with solid tumors on ramucirumab: describing events of stomatitis, diarrhea, GI perforation and GI hemorrhage. RESULTS Our search strategy yielded 167 potentially relevant citations from Pubmed/Medline, CENTRAL Cochrane registry, European society of medical oncology meeting abstracts and American Society of Clinical Oncology meeting library. After exclusion of ineligible studies, a total of 11 clinical trials were considered eligible for the meta-analysis. The RR of all-grade stomatitis, diarrhea, GI perforation and GI hemorrhage were 1.62 (95% CI 1.31 - 2.00; p < 0.00001), 1.15 (95% CI 1.07 - 1.24; p < 0.0001), 3.29 (95% CI 1.54 - 7.04; p = 0.002) and 1.92 (95% CI 1.03 - 3.57; p = 0.04), respectively. The RR of high-grade stomatitis, diarrhea, GI perforation and GI hemorrhage were 2.72 (95% CI 1.76 - 4.19; p < 0.00001), 1.28 (95% CI 0.96 - 1.71; p = 0.09), 3.37 (95% CI 1.51 - 7.54; p = 0.03) and 1.26 (95% CI 0.79 - 2.01; p = 0.34), respectively. CONCLUSIONS Our meta-analysis has demonstrated that ramucirumab-based combination treatment is associated with an increased risk of high-grade stomatitis and GI perforation compared to control treatment.
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Affiliation(s)
- Omar Abdel-Rahman
- a Ain Shams University, Clinical Oncology Department, Faculty of Medicine , Lotfy Elsayed Street, Cairo 11665, Egypt +20 33 028 656 ;
| | - Hesham ElHalawani
- a Ain Shams University, Clinical Oncology Department, Faculty of Medicine , Lotfy Elsayed Street, Cairo 11665, Egypt +20 33 028 656 ;
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Abdel-Rahman O, ElHalawani H. Risk of hematological toxicities in patients with solid tumors treated with ramucirumab: a meta-analysis. Future Oncol 2015; 11:2949-61. [PMID: 26422782 DOI: 10.2217/fon.15.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND We performed a meta-analysis of the risk of hematological adverse events associated with ramucirumab. METHODS Eligible studies included randomized Phase II and III trials of patients with solid tumors on ramucirumab, describing events of anemia, leucopenia, neutropenia, febrile neutropenia and thrombocytopenia. RESULTS A total of 11 clinical trials were considered eligible for the meta-analysis. The relative risks of all-grade anemia, leucopenia, neutropenia, febrile neutropenia and thrombocytopenia were 0.88 (95% CI: 0.80-0.96; p = 0.007), 1.13 (95% CI: 0.85-1.49; p = 0.41), 1.25 (95% CI: 1.08-1.44; p = 0.002), 1.63 (95% CI: 1.30-2.06; p < 0.0001), 1.91 (95% CI: 1.52-2.42; p < 0.00001), respectively. CONCLUSION Our meta-analysis has demonstrated an increased risk of febrile neutropenia, all-grade and high-grade neutropenia and thrombocytopenia with ramucirumab-based treatment compared with control.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hesham ElHalawani
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
Gastric cancer is currently the third most common cause of cancer deaths worldwide. Prognosis remains poor with most patients presenting with advanced or metastatic disease. A better understanding of angiogenesis has led to the investigation of drugs that inhibit the vascular endothelial growth factor (VEGF) pathway including anti-VEGF antibody therapy (eg, bevacizumab), inhibitors of angiogenic receptor tyrosine kinases (eg, sunitinib, sorafenib, apatinib, regorafenib), and inhibitors of vascular endothelial growth factor receptors (VEGFRs) (eg, ramucirumab). Ramucirumab, a VEGFR-2 inhibitor, is the first anti-angiogenic agent approved by the US Food and Drug Administration for use in the treatment of advanced gastric cancers. This review will focus on the clinical utility and potential use of ramucirumab in advanced gastric cancer.
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Affiliation(s)
- Matthew MK Chan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Central Coast Cancer Centre, Gosford Hospital, Gosford, NSW, Australia
| | - Katrin M Sjoquist
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
| | - John R Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Affiliation(s)
| | - Vincent Houé
- Translational Research in Oncology, Edmonton, Alberta, Canada
| | | | | | - Rodrigo Fresco
- Translational Research in Oncology, Edmonton, Alberta, Canada
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Lee HJ, Ryu H, Choi YS, Song IC, Yun HJ, Jo DY, Kim S. Just Toxicity, or Toxicity As a Biomarker of Efficacy of Ramucirumab in Breast Cancer? J Clin Oncol 2015. [PMID: 26195714 DOI: 10.1200/jco.2015.60.8992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Hyo Jin Lee
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Hyewon Ryu
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Yoon Seok Choi
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Ik-Chan Song
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Hwan-Jung Yun
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Deog-Yeon Jo
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
| | - Samyong Kim
- School of Medicine, Chungnam National University and Chungnam National University Hospital; and Cancer Research Institute, Chungnam National University, Daejeon, Republic of Korea
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79
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Abdel-Rahman O, ElHalawani H. Proteinuria in Patients with Solid Tumors Treated with Ramucirumab: A Systematic Review and Meta-Analysis. Chemotherapy 2015; 60:325-33. [PMID: 26302785 DOI: 10.1159/000437253] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/29/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND We performed a systematic review and meta-analysis of the risk of proteinuria associated with ramucirumab. METHODS Eligible studies included randomized phase II and III trials of patients with solid tumors on ramucirumab, describing events of all-grade and high-grade proteinuria. RESULTS Our search strategy yielded 170 potentially relevant citations from PubMed/Medline, CENTRAL Cochrane database, ASCO and ESMO meeting libraries. After exclusion of ineligible studies, a total of 11 clinical trials were considered eligible for the meta-analysis. The relative risk (RR) of all-grade proteinuria was 3.31 (95% CI 2.48-4.42; p < 0.00001). Moreover, the RR of high-grade proteinuria was 5.28 (95% CI 2.32-12.01; p < 0.0001). CONCLUSIONS Our meta-analysis has demonstrated that ramucirumab use is associated with an increased risk of all-grade and high-grade proteinuria. Early detection strategies should be employed in those patients to prevent the progression to more sinister renal disease.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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80
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Calvetti L, Pilotto S, Carbognin L, Ferrara R, Caccese M, Tortora G, Bria E. The coming of ramucirumab in the landscape of anti-angiogenic drugs: potential clinical and translational perspectives. Expert Opin Biol Ther 2015; 15:1359-70. [PMID: 26190526 DOI: 10.1517/14712598.2015.1071350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Angiogenesis plays a pivotal role in the development and progression of tumors and it represents a crucial target for therapeutic strategies. Until now, regulatory agencies approved antiangiogenic agents targeting the VEGF and multi-target agents carrying antiangiogenic and anti-proliferative effects. They often provide only a modest survival benefit and their role in clinical practice is debated. The limited efficacy may be partially explained by the complexity of the molecular background of angiogenic processes, composed of several pathways interacting with both tumor cells and the microenvironment. AREAS COVERED Ramucirumab is a fully human monoclonal antibody selectively binding and inhibiting the VEGF receptor 2 (VEGFR-2), a crucial molecule involved in angiogenesis. A series of Phase I-II trials conducted in a wide spectrum of malignancies reported promising antitumor activity. In 2014, data from large Phase III clinical trials in gastrointestinal, lung and breast malignancies were released. EXPERT OPINION Considering the evidences of efficacy emerging from the available Phase III trials, the antiangiogenic approach emerged as a promising strategy particularly for the treatment of gastric cancer. Nevertheless, the identification and validation of potentially predictive biomarkers are necessary to improve the selection of patients and the globally awaited clinical benefit.
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Affiliation(s)
- Lorenzo Calvetti
- University of Verona, Azienda Ospedaliera Universitaria Integrata, Medical Oncology , P.le L.A. Scuro 10, 37124 Verona , Italy
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81
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Shimodaira Y, Elimova E, Wadhwa R, Shiozaki H, Charalampakis N, Planjery V, Blum MA, Esteralla JS, Rogers JE, Song S, Ajani JA. Ramucirumab for the treatment of gastroesophageal cancers. Expert Opin Orphan Drugs 2015; 3:737-746. [DOI: 10.1517/21678707.2015.1040390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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82
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Hofheinz RD, Lorenzen S. Ramucirumab as second-line treatment for patients with metastatic esophagogastric adenocarcinoma. Expert Rev Anticancer Ther 2015; 15:607-14. [PMID: 26035718 DOI: 10.1586/14737140.2015.1052412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ramucirumab is a fully humanized monoclonal antibody targeting the extracellular domain of the VEGF receptor 2. It prevents ligand binding to VEGF receptor 2 and receptor-mediated pathway activation in endothelial cells. After promising Phase I trial results in a variety of tumor types, two pivotal placebo-controlled Phase III trials conducted in patients with pretreated metastatic esophagogastric adenocarcinoma demonstrated significant clinical activity regarding the prolongation of overall survival both as monotherapy (REGARD study) and in combination with paclitaxel (RAINBOW study). Currently, ramucirumab is being investigated in the first-line treatment of esophagogastric adenocarcinoma in combination with capecitabine and cisplatin in a Phase III trial (RAINFALL).
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Affiliation(s)
- Ralf-Dieter Hofheinz
- University Hospital Mannheim, Ruprecht Karls University Heidelberg, Mannheim, Germany
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83
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Zhao Y, Adjei AA. Targeting Angiogenesis in Cancer Therapy: Moving Beyond Vascular Endothelial Growth Factor. Oncologist 2015; 20:660-73. [PMID: 26001391 DOI: 10.1634/theoncologist.2014-0465] [Citation(s) in RCA: 390] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/06/2015] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Angiogenesis, or the formation of new capillary blood vessels, occurs primarily during human development and reproduction; however, aberrant regulation of angiogenesis is also a fundamental process found in several pathologic conditions, including cancer. As a process required for invasion and metastasis, tumor angiogenesis constitutes an important point of control of cancer progression. Although not yet completely understood, the complex process of tumor angiogenesis involves highly regulated orchestration of multiple signaling pathways. The proangiogenic signaling molecule vascular endothelial growth factor (VEGF) and its cognate receptor (VEGF receptor 2 [VEGFR-2]) play a central role in angiogenesis and often are highly expressed in human cancers, and initial clinical efforts to develop antiangiogenic treatments focused largely on inhibiting VEGF/VEGFR signaling. Such approaches, however, often lead to transient responses and further disease progression because angiogenesis is regulated by multiple pathways that are able to compensate for each other when single pathways are inhibited. The platelet-derived growth factor (PDGF) and PDGF receptor (PDGFR) and fibroblast growth factor (FGF) and FGF receptor (FGFR) pathways, for example, provide potential escape mechanisms from anti-VEGF/VEGFR therapy that could facilitate resumption of tumor growth. Accordingly, more recent treatments have focused on inhibiting multiple signaling pathways simultaneously. This comprehensive review discusses the limitations of inhibiting VEGF signaling alone as an antiangiogenic strategy, the importance of other angiogenic pathways including PDGF/PDGFR and FGF/FGFR, and the novel current and emerging agents that target multiple angiogenic pathways for the treatment of advanced solid tumors. IMPLICATIONS FOR PRACTICE Significant advances in cancer treatment have been achieved with the development of antiangiogenic agents, the majority of which have focused on inhibition of the vascular endothelial growth factor (VEGF) pathway. VEGF targeting alone, however, has not proven to be as efficacious as originally hoped, and it is increasingly clear that there are many interconnected and compensatory pathways that can overcome VEGF-targeted inhibition of angiogenesis. Maximizing the potential of antiangiogenic therapy is likely to require a broader therapeutic approach using a new generation of multitargeted antiangiogenic agents.
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Affiliation(s)
- Yujie Zhao
- Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Alex A Adjei
- Roswell Park Cancer Institute, Buffalo, New York, USA
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84
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Santos LVD, Cruz MR, Lopes GDL, Lima JPDSN. VEGF-A levels in bevacizumab-treated breast cancer patients: a systematic review and meta-analysis. Breast Cancer Res Treat 2015; 151:481-9. [PMID: 25947646 DOI: 10.1007/s10549-015-3410-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/29/2015] [Indexed: 11/27/2022]
Abstract
Bevacizumab may improve outcomes of patients with breast cancer, but the absence of an established biomarker hampers patient selection and researchers´ ability to demonstrate a clear survival benefit. Its putative target, circulating VEGF-A, emerged as the main candidate and we sought to identify the relationship between VEGF-A levels and outcomes through systematic review. We searched electronic databases and meeting proceedings for randomized controlled trials (RCTs) comparing the addition of bevacizumab to standard chemotherapy for breast cancer. RCTs were included if outcomes were presented separately according to VEGF-A plasma levels. Random-effects model were applied to calculate the pooled hazard ratios for progression-free survival, event-free survival (EFS), comprising disease recurrence, progression or any-cause death, and overall survival (OS), with respective confidence intervals (95 % CI). High and low VEGF-A levels subgroups followed each trial definition, and results were compared using the interaction test. Heterogeneity was calculated using χ (2) test (I (2)). Three trials enrolled a total of 3748 patients. 1713 patients had baseline VEGF-A levels in plasma available for assessment and were included. One trial added bevacizumab in the adjuvant setting (N = 2591) and two on first-line metastatic disease with taxane-based therapy (N = 1160) There was no interaction between VEGF-A levels and study setting (adjuvant vs. first line therapy). Bevacizumab improved PFS of patients with above median VEGF-A plasma levels (HR 0.56; 95 % CI 0.43-0.73; P < 0.001; I (2) = 0 %), but not of those with below median VEGF-A levels (HR 0.89; 95 % CI 0.68-1.15; P = 0.37; I (2) = 0 %), with relevant differences between these two groups, P-for interaction = 0.02. The same happened with EFS (VEGF-A above median HR 0.62; 95 % CI 0.39-0.79; P < 0.001; I (2) = 11 %; below median HR 0.89; 95 % CI 0.71-1.14; P = 0.98; I (2) = 17 %; P-for interaction = 0.03). OS data were not available. VEGF-A level is a reasonable candidate biomarker for bevacizumab in the treatment of breast cancer. Further studies have to confirm its surrogacy in overall survival and in other scenarios including other anti-angiogenic therapies.
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Affiliation(s)
- Lucas Vieira dos Santos
- Departamento de Oncologia Clinica, Hemomed Instituto de Oncologia e Hematologia, São Paulo, Brazil
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85
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Schumock GT, Li EC, Suda KJ, Wiest MD, Stubbings J, Matusiak LM, Hunkler RJ, Vermeulen LC. National trends in prescription drug expenditures and projections for 2015. Am J Health Syst Pharm 2015; 72:717-36. [DOI: 10.2146/ajhp140849] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago
| | - Edward C. Li
- Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
| | - Katie J. Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Research Associate Professor, University of Illinois at Chicago
| | - Michelle D. Wiest
- Pharmacy Services, UC Health, Cincinnati, OH, Clinical Associate Professor, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati
| | - Joann Stubbings
- Department of Pharmacy Systems, Outcomes and Policy, and Assistant Director, Specialty Pharmacy Services, College of Pharmacy, University of Illinois at Chicago
| | | | | | - Lee C. Vermeulen
- Center for Clinical Knowledge Management, UW Health, Madison, WI, and Clinical Professor, School of Pharmacy, University of Wisconsin, Madison
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86
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Wang J, Wang Z, Zhao Y. Incidence and risk of hypertension with ramucirumab in cancer patients: a meta-analysis of published studies. Clin Drug Investig 2015; 35:221-8. [PMID: 25697774 DOI: 10.1007/s40261-015-0272-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Ramucirumab is a novel antiangiogenic agent approved as second-line therapy for patients with advanced stomach cancer and gastroesophageal junction adenocarcinoma. Although existing evidence from clinical trials has demonstrated hypertension is one of the major adverse events of this agent, overall risks have yet to be reported. METHODS We carried out a meta-analysis of published studies to determine the overall incidence and relative risk (RR) of hypertension associated with ramucirumab. Statistical analyses were conducted to calculate the summary incidence, RRs, and 95 % confidence intervals (CIs) by using a random effects model. RESULTS Eleven studies with a total of 3,851 patients with multiple cancers were included. The overall incidence of all-grade hypertension was 20.0 % (95 % CI 15.0-26.0) with 8.6 % (95 % CI 6.3-11.7) being high-grade hypertension. The risk of developing hypertension was greater in ramucirumab-treated patients (RR for all grades 2.77, 95 % CI 1.94-3.94, p < 0.001, RR for high-grade 3.58, 95 % CI 2.45-5.23, p < 0.001). CONCLUSIONS Administration of ramucirumab to patients with cancer is associated with increased risk of hypertension.
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Affiliation(s)
- Jianhua Wang
- Department of General Surgery, Jiansu Province of Traditional Chinese Medicine, 100 Shizi Street, Hongshan Road, Nanjing, 210028, Jiangsu, People's Republic of China
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87
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Joy A, Ghosh M, Fernandes R, Clemons M. Systemic treatment approaches in her2-negative advanced breast cancer-guidance on the guidelines. Curr Oncol 2015; 22:S29-42. [PMID: 25848337 PMCID: PMC4381789 DOI: 10.3747/co.22.2360] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Despite advancements in the treatment of early-stage breast cancer, many patients still develop disease recurrence; others present with de novo metastatic disease. For most patients with advanced breast cancer, the primary treatment intent is noncurative-that is, palliative-in nature. The goals of treatment should therefore focus on maximizing symptom control and extending survival. Treatments should be evaluated on an individualized basis in terms of evidence, but also with full respect for the wishes of the patient in terms of acceptable toxicity. Given the availability of extensive reviews on the roles of endocrine therapy and her2 (human epidermal growth factor receptor 2)-targeted therapies for advanced disease, we focus here mainly on treatment guidelines for the non-endocrine management of her2-negative advanced breast cancer in a Canadian health care context.
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Affiliation(s)
- A.A. Joy
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - M. Ghosh
- Department of Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - R. Fernandes
- Division of Medical Oncology, University of Ottawa and The Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - M.J. Clemons
- Division of Medical Oncology, University of Ottawa and The Ottawa Hospital Research Institute, The Ottawa Hospital Cancer Centre, Ottawa, ON
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88
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Content of endothelial progenitor cells in autologous stem cell grafts predict survival after transplantation for multiple myeloma. Biol Blood Marrow Transplant 2015; 21:840-7. [PMID: 25689789 DOI: 10.1016/j.bbmt.2014.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/23/2014] [Indexed: 12/18/2022]
Abstract
Multiple myeloma (MM) is considered an incurable B cell malignancy, although many patients can benefit from high-dose therapy with autologous stem cell transplantation (ASCT) as a first-line treatment. In non-Hodgkin lymphoma (NHL), ASCT is usually performed after relapse with curative intent. Disease progression is often associated with increased angiogenesis, in which endothelial progenitor cells (EPC) may have a central role. Here, we investigated the clinical impact of EPC levels in peripheral blood stem cell (PBSC) autografts for MM and NHL patients who received ASCT. EPC were identified by flow cytometry as aldehyde dehydrogenase(hi) CD34(+) vascular endothelial growth factor receptor 2(+) CD133(+) cells in both MM and NHL autografts. In MM, there was a positive correlation between EPC percentage and serum (s)-β2-microglobulin levels (r(2) = .371, P = .002). Unlike for NHL patients, MM patients with high numbers of infused EPC (EPC cells per kilogram) during ASCT had significant shorter progression-free survival (PFS) (P = .035), overall survival (P = .044) and time to next treatment (P = .009). In multivariate analysis, EPC cells per kilogram was a significant independent negative prognostic indicator of PFS (P = .03). In conclusion, the presence of high number of EPC in PBSC grafts is associated with adverse prognosis after ASCT in MM.
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89
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Bozza C, Fontanella C, Buoro V, Mansutti M, Aprile G. Novel antiangiogenic drugs for the management of breast cancer: new approaches for an old issue? Expert Rev Clin Pharmacol 2015; 8:251-65. [PMID: 25597501 DOI: 10.1586/17512433.2015.1001837] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Since angiogenesis plays an important role in cancer growth, infiltration and metastasis, many agents targeting this pathway have been developed over the last decade. Antiangiogenic drugs interfere with this process and may inhibit neoplastic growth or induce tumor dormancy by blocking the expanding network of newly formed capillaries. Despite the initial promise, targeting angiogenesis in breast cancer has not reached major breakthroughs. Nevertheless, the immunologic role of VEGF deserves to be further explored. We aim to describe the biological mechanisms which underlie the role of angiogenesis in breast cancer carcinogenesis, to depict its contribution to the metastatic process and to review the most important clinical trials testing angiogenic inhibitors in breast cancer, including monoclonal antibodies and novel small molecules.
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Affiliation(s)
- Claudia Bozza
- Department of Medical Oncology, University Hospital of Udine, 33100 Udine, Italy
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91
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Fontanella C, Ongaro E, Bolzonello S, Guardascione M, Fasola G, Aprile G. Clinical advances in the development of novel VEGFR2 inhibitors. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:123. [PMID: 25568876 PMCID: PMC4260048 DOI: 10.3978/j.issn.2305-5839.2014.08.14] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 08/22/2014] [Indexed: 12/28/2022]
Abstract
Angiogenesis inhibitors have produced significant advances in the treatment of several tumors including colorectal, lung, ovarian and renal carcinomas. These agents, however, modestly impact on the overall cure rate, and their activity is often limited because of the early outbreak of redundant pathways or resistance mechanisms. Moreover, no clear predictive factor has been identified for treatment selection in the clinic. Preclinical evidence suggest that antibodies targeting the vascular endothelial growth factor (VEGF) axis may exert their activity throughout the inhibition of VEGF receptor 2 (VEGFR2) phosphorylation, a key factor in the cancer angiogenic process. Among other molecules, ramucirumab, an intravenously administered, fully humanized monoclonal antibody (mAb) targeting the extracellular domain of the receptor, and apatinib, a potent oral inhibitor of the intracellular domain, are emerging as original antiangiogenic opportunities. This up-to-date review focuses on the development of VEGFR2 inhibitors across multiple cancers and presents results of the most recent researches, ranging from early phase I studies to randomized phase III trials, in which those drugs have been tested as a single-agent or in combination with different chemotherapy regimens.
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Affiliation(s)
- Caterina Fontanella
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | - Elena Ongaro
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | - Silvia Bolzonello
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | | | - Gianpiero Fasola
- Department of Medical Oncology, University and General Hospital, Udine, Italy
| | - Giuseppe Aprile
- Department of Medical Oncology, University and General Hospital, Udine, Italy
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Aprile G, Rijavec E, Fontanella C, Rihawi K, Grossi F. Ramucirumab: preclinical research and clinical development. Onco Targets Ther 2014; 7:1997-2006. [PMID: 25378934 PMCID: PMC4218907 DOI: 10.2147/ott.s61132] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Ramucirumab (IMC-1121B, LY3009806), a fully humanized monoclonal antibody directed against the extracellular domain of vascular endothelial growth factor receptor 2 (VEGFR-2), is a new therapeutic option that selectively inhibits the human VEGFR-2 with a much greater affinity than its natural ligands. Based on the promising results of both preclinical and early clinical studies, ramucirumab has been tested in different tumor types either alone or in combination with chemotherapy. While it has recently been granted its first US Food and Drug Administration approval for use as a single agent in patients with advanced or metastatic gastric cancer or gastroesophageal junction carcinoma, its role for metastatic breast cancer or advanced non-small-cell lung cancer is still debated. The aims of this review are to recall and discuss the most significant preclinical and clinical studies that led to the development of ramucirumab and to present the results of the randomized clinical trials that have tested its efficacy in different malignancies, including gastric and lung cancer.
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Affiliation(s)
- Giuseppe Aprile
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Erika Rijavec
- Lung Cancer Unit, National Cancer Institut “San Martino”, Genoa, Italy
| | | | - Karim Rihawi
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | - Francesco Grossi
- Lung Cancer Unit, National Cancer Institut “San Martino”, Genoa, Italy
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