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Moreno L, Pearson ADJ, Paoletti X, Jimenez I, Geoerger B, Kearns PR, Zwaan CM, Doz F, Baruchel A, Vormoor J, Casanova M, Pfister SM, Morland B, Vassal G. Early phase clinical trials of anticancer agents in children and adolescents - an ITCC perspective. Nat Rev Clin Oncol 2017; 14:497-507. [PMID: 28508875 DOI: 10.1038/nrclinonc.2017.59] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the past decade, the landscape of drug development in oncology has evolved dramatically; however, this paradigm shift remains to be adopted in early phase clinical trial designs for studies of molecularly targeted agents and immunotherapeutic agents in paediatric malignancies. In drug development, prioritization of drugs on the basis of knowledge of tumour biology, molecular 'drivers' of disease and a drug's mechanism of action, and therapeutic unmet needs are key elements; these aspects are relevant to early phase paediatric trials, in which molecular profiling is strongly encouraged. Herein, we describe the strategy of the Innovative Therapies for Children with Cancer (ITCC) Consortium, which advocates for the adoption of trial designs that enable uninterrupted patient recruitment, the extrapolation from studies in adults when possible, and the inclusion of expansion cohorts. If a drug has neither serious dose-related toxicities nor a narrow therapeutic index, then studies should generally be started at the adult recommended phase II dose corrected for body surface area, and act as dose-confirmation studies. The use of adaptive trial designs will enable drugs with promising activity to progress rapidly to randomized studies and, therefore, will substantially accelerate drug development for children and adolescents with cancer.
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Affiliation(s)
- Lucas Moreno
- Paediatric Phase I-II Clinical Trials Unit, Paediatric Haematology &Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Andrew D J Pearson
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; and at the Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - Xavier Paoletti
- Biostatistics and Epidemiology, INSERM U1018, Gustave Roussy, Paris, France
| | - Irene Jimenez
- Department of Paediatric, Adolescents and Young Adults Oncology, Institut Curie; and at the University Paris Descartes, Paris, France
| | - Birgit Geoerger
- Department of Paediatric and Adolescent Oncology, CNRS UMR 8203 Vectorology and Anticancer Treatments, Gustave Roussy, University Paris-Sud, Villejuif, France
| | - Pamela R Kearns
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - C Michel Zwaan
- Department of Paediatric Oncology/Haematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, Netherlands
| | - Francois Doz
- Department of Paediatric, Adolescents and Young Adults Oncology, Institut Curie; and at the University Paris Descartes, Paris, France
| | - Andre Baruchel
- Department of Paediatric Haematology, Hôpital Robert Debré, AP-HP; and at the University Paris Diderot, Paris, France
| | - Josef Vormoor
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University; and at the Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefan M Pfister
- German Cancer Research Center (DKFZ); German Cancer Consortium (DKTK); and at the Heidelberg University Hospital, Heidelberg, Germany
| | - Bruce Morland
- Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France
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Abstract
PURPOSE OF REVIEW The prognosis of patients with unresectable or metastatic chondrosarcoma of the bone is poor. Chondrosarcomas are in general resistant to chemotherapy and radiotherapy. This review discusses recent developments in the characterization of molecular pathways involved in the oncogenesis of chondrosarcoma that should be explored to improve prognosis of patients with advanced chondrosarcoma. RECENT FINDINGS The different oncogenic pathways for chondrosarcoma have become better defined. These include alterations in pathways such as isocitrate dehydrogenase mutation, hedgehog signalling, the retinoblastoma protein and p53 pathways, apoptosis and survival mechanisms, and several tyrosine kinases. These specific alterations can be employed for use in clinical interventions in advanced chondrosarcoma. SUMMARY As many different genetic alterations in chondrosarcoma have been identified, it is of the utmost importance to classify druggable targets that may improve the prognosis of chondrosarcoma patients. In recent years an increased number of trials evaluating targeted therapies are being conducted. As chondrosarcoma is an orphan disease consequently all studies are performed with small numbers of patients. The results of clinical studies so far have been largely disappointing. Therapeutic intervention studies of these new targets emerging from preclinical studies are of highest importance to improve prognosis of chondrosarcoma patients with advanced disease.
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Wagner MJ, Gopalakrishnan V, Ravi V, Livingston JA, Conley AP, Araujo D, Somaiah N, Zarzour MA, Ratan R, Wang WL, Patel SR, Lazar A, Ludwig JA, Benjamin RS. Vincristine, Ifosfamide, and Doxorubicin for Initial Treatment of Ewing Sarcoma in Adults. Oncologist 2017; 22:1271-1277. [PMID: 28710342 DOI: 10.1634/theoncologist.2016-0464] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/09/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are no clinical trials specifically addressing chemotherapy for adults with Ewing sarcoma (ES). Five-year event-free survival (EFS) of adults on pediatric studies of ES (44%-47%) is worse than that of children treated with the same therapy (69%). The object of this study was to review the results of therapy with vincristine, ifosfamide, and doxorubicin (VID) in the multidisciplinary treatment of adults with ES at our institution. MATERIALS AND METHODS Charts for adults treated for ES from 1995 to 2011 were retrospectively reviewed. Clinician-reported radiographic tumor response, type of local therapy, pathologic response, and survival data were collected. RESULTS Seventy-one patients were identified who received VID as initial therapy. The median age was 25 (range: 16-64). Forty-two patients (59%) presented with a localized disease and 29 patients (41%) presented with a distant metastasis. Of all patients treated with VID, 83.6% showed a radiological response. Patients who presented with a localized disease had a 5-year overall survival (OS) of 68% (median not reached), compared with 10.3% (median: 1.9 years) in those who presented with distant metastases. Five-year EFS was 67%. The nine patients with a pelvic primary tumor had inferior 5-year OS (42%) to the 33 with primary tumors at other sites (75%). The 5-year OS of those who had greater than or equal to 95% necrosis after neoadjuvant VID (n = 20; 5-year OS: 84%) was superior to those who had less than 95% necrosis (n = 13; 5-year OS: 53%). CONCLUSION In adults with primary ES, VID combined with an adjuvant strategy based on post-treatment percent necrosis has favorable outcomes compared with historical adult controls. IMPLICATIONS FOR PRACTICE Ewing sarcoma (ES) is a rare tumor in adults, and there are no dedicated clinical trials in the adult population. Most therapy is modeled after the published pediatric studies, although the small numbers of adult patients included on those studies did significantly worse than the children. We modeled our treatment on other adult sarcomas and reviewed the charts of 71 adult patients with ES treated with vincristine, ifosfamide, and doxorubicin (VID). In adults with primary ES, VID combined with an adjuvant strategy based on post-treatment percent necrosis has favorable outcomes compared with historical adult controls.
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Affiliation(s)
- Michael J Wagner
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Vinod Ravi
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - J Andrew Livingston
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anthony P Conley
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dejka Araujo
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria A Zarzour
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ravin Ratan
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Wei-Lien Wang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shreyaskumar R Patel
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexander Lazar
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph A Ludwig
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert S Benjamin
- Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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104
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Gvozdenovic A, Boro A, Born W, Muff R, Fuchs B. A bispecific antibody targeting IGF-IR and EGFR has tumor and metastasis suppressive activity in an orthotopic xenograft osteosarcoma mouse model. Am J Cancer Res 2017; 7:1435-1449. [PMID: 28744395 PMCID: PMC5523026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023] Open
Abstract
Osteosarcoma is a highly aggressive bone cancer and the second most frequent cause of cancer-associated death in childhood and adolescence. Pulmonary metastases account for the high mortality rate in osteosarcoma patients. Therefore, novel therapeutic approaches, efficiently restraining the metastatic disease, are mandatory for a significant improvement of the currently poor patients' survival. Although initial studies with antibodies targeting insulin-like growth factor receptor (IGF-IR) showed promising potential for the treatment of patients with bone and soft tissue sarcomas, phase II clinical trials revealed variable results, which implied activation of alternative signaling pathways leading to therapy resistance. Since a cross-talk between IGF-IR and the epidermal growth factor receptor (EGFR) has been demonstrated in several cancer types, co-targeting of these two receptors was considered in the present study as a valuable therapeutic strategy to overcome single-agent treatment resistance in osteosarcoma. The effects of IGF-IR and/or EGFR targeting by intraperitoneal administration of the monospecific IGF-IR antibody R1507 or the EGFR antibody Cetuximab or the bispecific IGF-IR/EGFR antibody XGFR* on primary tumor growth and pulmonary metastasis were investigated in an intratibial human xenograft osteosarcoma mouse model. In vitro functional assays demonstrated that targeting IGF-IR and EGFR didn't affect osteosarcoma cell viability, but inhibited ligand-activated intracellular signaling and cell migratory capacity. The blocking potential of ligand-induced signaling in vitro was similar for all antibodies, but, in vivo, only XGFR* treatment significantly inhibited intratibial primary tumor growth and pulmonary metastasis. The therapeutic response to XGFR* was associated with an infiltration of innate immune system effector cells into the tumor microenvironment. Taken together, our study highlights the bispecific anti-IGF-IR/EGFR antibody XGFR* as an innovative promising effective candidate for the treatment of metastatic osteosarcoma and provides the rationale for future clinical studies.
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Affiliation(s)
- Ana Gvozdenovic
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University HospitalZurich, Switzerland
| | - Aleksandar Boro
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University HospitalZurich, Switzerland
| | - Walter Born
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University HospitalZurich, Switzerland
| | - Roman Muff
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University HospitalZurich, Switzerland
| | - Bruno Fuchs
- Laboratory for Orthopedic Research, Department of Orthopedics, Balgrist University HospitalZurich, Switzerland
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FUS–DDIT3 Fusion Protein-Driven IGF-IR Signaling is a Therapeutic Target in Myxoid Liposarcoma. Clin Cancer Res 2017. [DOI: 10.1158/1078-0432.ccr-17-0130] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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106
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Schirripa M, Zhang W, Heinemann V, Cao S, Okazaki S, Yang D, Loupakis F, Berger MD, Ning Y, Miyamoto Y, Suenaga M, Gopez RF, West JD, Hanna D, Barzi A, Falcone A, Stintzing S, Lenz HJ. Single nucleotide polymorphisms in the IGF-IRS pathway are associated with outcome in mCRC patients enrolled in the FIRE-3 trial. Int J Cancer 2017; 141:383-392. [PMID: 28369940 DOI: 10.1002/ijc.30715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/03/2017] [Accepted: 03/14/2017] [Indexed: 12/21/2022]
Abstract
The Insulin-like growth factor (IGF)/IGF-receptor pathway with its scaffolding proteins Insulin Receptor Substrate (IRS)1 and IRS2 are crucial regulators of metabolism and progression in metastatic colorectal cancer (mCRC). The goal of the study was the identification of predictive and prognostic markers among IRS1, IRS2, IGF1 and IGF-1R SNPs in mCRC patients enrolled in the FIRE-3 trial. Four SNPs of IRS (IRS1 rs1801278, rs1801123; IRS2 rs1805097, rs2289046) and four SNPs of IGF1-IGFR1 (rs6214, rs6220, rs2946834, rs2016347) were analyzed by PCR/direct-sequencing in the FIRE-3 trial. The relation of SNPs with PFS and OS was evaluated through Kaplan-Meier method and log-rank test in the overall population and in subgroup according to RAS status and treatment arm. In the overall population IRS1 rs1801123 C/- carriers (N= 105) achieved significantly worse OS compared to T/T (N = 464) in univariate (HR = 1.32 [95%CI 1.03-1.70], p = 0.029) and in multivariable. Similar results were observed among RAS wild type. Patients with IGF1 rs2946834 T/- variant (N= 280) achieved improved PFS compared to C/C (N = 257) in univariate (HR = 0.77 [95%CI 0.64-0.92], p = 0.004) and in multivariable. In the RAS wild-type subgroup IGF1 rs2946834 T/- carriers showed better PFS and OS compared to C/C (univariate HR for PFS = 0.65 [95%CI 0.51-0.81], p < 0.001; multivariable HR for PFS = 0.63 [95%CI 0.50-0.81], p < 0.001). IRS1 rs1801123 SNP was identified as a new prognostic marker for mCRC. IGF1 rs2946834 was confirmed as prognostic factor in the overall population and in RAS wild type patients. Our findings underline the importance of IGF downstream signaling pathway in RAS wild-type mCRC patient.
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Affiliation(s)
- Marta Schirripa
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Wu Zhang
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Volker Heinemann
- Department of Medical Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Shu Cao
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Satoshi Okazaki
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Dongyun Yang
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Fotios Loupakis
- Oncologia Medica 1, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Martin D Berger
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Yan Ning
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Yuji Miyamoto
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Mitsukuni Suenaga
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Roel F Gopez
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Jordan D West
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Diana Hanna
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Afsaneh Barzi
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
| | - Alfredo Falcone
- Polo Oncologico, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | - Sebastian Stintzing
- Department of Medical Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Heinz-Josef Lenz
- Medical Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, 90033
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Smith TJ, Kahaly GJ, Ezra DG, Fleming JC, Dailey RA, Tang RA, Harris GJ, Antonelli A, Salvi M, Goldberg RA, Gigantelli JW, Couch SM, Shriver EM, Hayek BR, Hink EM, Woodward RM, Gabriel K, Magni G, Douglas RS. Teprotumumab for Thyroid-Associated Ophthalmopathy. N Engl J Med 2017; 376:1748-1761. [PMID: 28467880 PMCID: PMC5718164 DOI: 10.1056/nejmoa1614949] [Citation(s) in RCA: 414] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thyroid-associated ophthalmopathy, a condition commonly associated with Graves' disease, remains inadequately treated. Current medical therapies, which primarily consist of glucocorticoids, have limited efficacy and present safety concerns. Inhibition of the insulin-like growth factor I receptor (IGF-IR) is a new therapeutic strategy to attenuate the underlying autoimmune pathogenesis of ophthalmopathy. METHODS We conducted a multicenter, double-masked, randomized, placebo-controlled trial to determine the efficacy and safety of teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, in patients with active, moderate-to-severe ophthalmopathy. A total of 88 patients were randomly assigned to receive placebo or active drug administered intravenously once every 3 weeks for a total of eight infusions. The primary end point was the response in the study eye. This response was defined as a reduction of 2 points or more in the Clinical Activity Score (scores range from 0 to 7, with a score of ≥3 indicating active thyroid-associated ophthalmopathy) and a reduction of 2 mm or more in proptosis at week 24. Secondary end points, measured as continuous variables, included proptosis, the Clinical Activity Score, and results on the Graves' ophthalmopathy-specific quality-of-life questionnaire. Adverse events were assessed. RESULTS In the intention-to-treat population, 29 of 42 patients who received teprotumumab (69%), as compared with 9 of 45 patients who received placebo (20%), had a response at week 24 (P<0.001). Therapeutic effects were rapid; at week 6, a total of 18 of 42 patients in the teprotumumab group (43%) and 2 of 45 patients in the placebo group (4%) had a response (P<0.001). Differences between the groups increased at subsequent time points. The only drug-related adverse event was hyperglycemia in patients with diabetes; this event was controlled by adjusting medication for diabetes. CONCLUSIONS In patients with active ophthalmopathy, teprotumumab was more effective than placebo in reducing proptosis and the Clinical Activity Score. (Funded by River Vision Development and others; ClinicalTrials.gov number, NCT01868997 .).
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Affiliation(s)
- Terry J Smith
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - George J Kahaly
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Daniel G Ezra
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - James C Fleming
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Roger A Dailey
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Rosa A Tang
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Gerald J Harris
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Alessandro Antonelli
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Mario Salvi
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Robert A Goldberg
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - James W Gigantelli
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Steven M Couch
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Erin M Shriver
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Brent R Hayek
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Eric M Hink
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Richard M Woodward
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Kathleen Gabriel
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Guido Magni
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
| | - Raymond S Douglas
- From the Department of Ophthalmology and Visual Sciences, Kellogg Eye Center (T.J.S., R.S.D.), and the Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine (T.J.S.), University of Michigan Medical School, Ann Arbor; the Department of Medicine, Johannes Gutenberg University Medical Center, Mainz, Germany (G.J.K.); Moorfields Eye Hospital, London (D.G.E.); the University of Tennessee Health Science Center, Memphis (J.C.F.); the Oculofacial Plastic Surgery Division, Oregon Health and Science University, Portland (R.A.D.); Eye Wellness Center, Neuro-Ophthalmology of Texas, Houston (R.A.T.); the Department of Ophthalmology, Medical College of Wisconsin, Milwaukee (G.J.H.); the Department of Clinical and Experimental Medicine, University of Pisa, Pisa (A.A.), and the Endocrinology and Diabetology Unit, Fondazione IRCCS Ca' Granda, University of Milan, Milan (M.S.) - both in Italy; the Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles (R.A.G.); the University of Nebraska Medical Center, Omaha (J.W.G.); Barnes-Jewish Hospital, Washington University, St. Louis (S.M.C.); the Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City (E.M.S.); the Department of Ophthalmology, Emory University, Atlanta (B.R.H.); the Department of Ophthalmology, University of Colorado, Aurora (E.M.H.); and River Vision Development, New York (R.M.W., K.G., G.M.)
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Wu J, Chen K, Zhang F, Jin J, Zhang N, Li D, Ying L, Chen W, Yu H, Mao W, Su D. Overcoming Linsitinib intrinsic resistance through inhibition of nuclear factor-κB signaling in esophageal squamous cell carcinoma. Cancer Med 2017; 6:1353-1361. [PMID: 28440057 PMCID: PMC5463077 DOI: 10.1002/cam4.1068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/20/2017] [Accepted: 03/04/2017] [Indexed: 12/30/2022] Open
Abstract
The aim of this study is to evaluate the efficacy of insulin-like growth factor 1 receptor (IGF-1R) inhibitor Linsitinib, in esophageal squamous cell carcinoma (ESCC), and to characterize special biomarker to screen Linsitinib-sensitive patients as well as explore the molecular-resistant mechanism to Linsitinib in ESCC. Our study evaluated the sensitivity of insulin-like growth factor 1 receptor (IGF-1R) inhibitor, Linsitinib in ESCC cells with MTT assay. After Linsitinib treatment, the expressions of downstream signaling molecules and apoptosis pathways were measured by western blot. And the antitumor effect of Linsitinib and JSH-23, an inhibitor of nuclear factor-κB transcriptional activity, was analyzed both as single agent and in combination in ESCC. Apoptosis, cell viability, and clonogenic survival analysis were also investigated. The sensitivity of Linsitinib was relatively variable in patient-derived primary ESCC cells as well as in human commercial cell lines. And the downstream AKT/mTOR and ERK signaling pathways were inhibited by Linsitinib, while phosphorylation level of NF-κB p65 was obviously activated to reduce apoptosis effect in Linsitinib-resistant cell lines. Most importantly, blockage of NF-κB activity by JSH-23 could sensitize resistant cells to Linsitinib treatment. Results from this study demonstrated that the intrinsic resistance to Linsitinib was predominantly mediated by NF-κB activation in ESCC. Moreover, combination of Linsitinib and JSH-23 as therapy provides a novel strategy to overcome resistance to Linsitinib in ESCC.
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Affiliation(s)
- Junzhou Wu
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China
| | - Kaiyan Chen
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China.,Department of Oncology, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Fanrong Zhang
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China
| | - Jiaoyue Jin
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China
| | - Nan Zhang
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China
| | - Dan Li
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China.,Department of Oncology, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lisha Ying
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China
| | - Wei Chen
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China
| | - Herbert Yu
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Hawaii, USA
| | - Weimin Mao
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China
| | - Dan Su
- Cancer Research Institute, Zhejiang Cancer Hospital & Key Laboratory Diagnosis and Treatment Technology on Thoracic Oncology of Zhejiang Province, Hangzhou, China
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109
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Majzner RG, Heitzeneder S, Mackall CL. Harnessing the Immunotherapy Revolution for the Treatment of Childhood Cancers. Cancer Cell 2017; 31:476-485. [PMID: 28366678 DOI: 10.1016/j.ccell.2017.03.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/21/2017] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
Abstract
Cancer immunotherapies can be classified into agents that amplify natural immune responses (e.g., checkpoint inhibitors) versus synthetic immunotherapies designed to initiate new responses (e.g., monoclonal antibodies [mAbs], chimeric antigen receptors [CARs]). Checkpoint inhibitors mediate unprecedented benefit in some adult cancers, but have not demonstrated significant activity in pediatric cancers, likely due their paucity of neoantigens. In contrast, synthetic immunotherapies such as mAbs and CAR T cells demonstrate impressive effects against childhood cancers. Intense efforts are underway to enhance the effectiveness of pediatric cancer immunotherapies through improved engineering of synthetic immunotherapies and by combining these with agents designed to amplify immune responses.
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Affiliation(s)
- Robbie G Majzner
- Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
| | | | - Crystal L Mackall
- Department of Pediatrics, Stanford University, Stanford, CA 94305, USA; Parker Institute for Cancer Immunotherapy at Stanford, Stanford Cancer Institute, Stanford University, 265 Campus Drive, G3141A, MC5456, Stanford, CA 94305, USA.
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110
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Huang D, Yang F, Wang Y, Guan X. Mechanisms of resistance to selective estrogen receptor down-regulator in metastatic breast cancer. Biochim Biophys Acta Rev Cancer 2017; 1868:148-156. [PMID: 28344099 DOI: 10.1016/j.bbcan.2017.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/18/2017] [Accepted: 03/21/2017] [Indexed: 02/07/2023]
Abstract
Based on the prominent role estrogen receptor (ER) plays in breast cancer, endocrine therapy has been developed to block the ER pathway and has shown great effectiveness. Fulvestrant, the first selective ER down-regulator (SERD), was demonstrated to completely suppress ERα and notably efficient. However, resistance to fulvestrant occurs, either intrinsic or acquired during the treatment. Several potential mechanisms inducing fulvestrant resistance have been proposed, composed of activated ERα-independent compensatory growth factor signaling, stimulated downstream kinases, altered cell cycle mediators, etcetera. Experimentally, combinations of fulvestrant with targeted treatments were reported to eliminate the resistance and improve the effect of fulvestrant. Meanwhile, some clinical trials associated with the targeted combination therapies are in progress. This review focuses on the underlying mechanisms that contribute to fulvestrant resistance in ER-positive breast cancer and provides an overview of combined fulvestrant with targeted agents to shed light on optimal therapies for patients with ER-positive breast cancer.
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Affiliation(s)
- Doudou Huang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, PR China
| | - Fang Yang
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, PR China
| | - Yucai Wang
- Department of Oncology, Mayo Clinic, Rochester, MN, United States
| | - Xiaoxiang Guan
- Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, PR China.
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Kirschner A, Thiede M, Grünewald TGP, Alba Rubio R, Richter GHS, Kirchner T, Busch DH, Burdach S, Thiel U. Pappalysin-1 T cell receptor transgenic allo-restricted T cells kill Ewing sarcoma in vitro and in vivo. Oncoimmunology 2017; 6:e1273301. [PMID: 28344885 PMCID: PMC5353903 DOI: 10.1080/2162402x.2016.1273301] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/09/2016] [Accepted: 12/10/2016] [Indexed: 01/06/2023] Open
Abstract
Pregnancy-associated plasma protein-A (PAPPA), also known as pappalysin, is a member of the insulin-like growth factor (IGF) family. PAPPA acts as a protease, cleaving IGF inhibitors, i.e., IGF binding proteins (IGFBPs), thereby setting free IGFs. The insulin/IGF-axis is involved in cancer in general and in Ewing sarcoma (ES) in particular. ES is a highly malignant bone tumor characterized by early metastatic spread. PAPPA is associated with various cancers. It is overexpressed and required for proliferation in ES. PAPPA also stimulates normal bone growth. We isolated HLA-A*02:01+/peptide-restricted T cells from A*02:01− healthy donors directed against PAPPA, generated by priming with A*02:01+ PAPPA peptide loaded dendritic cells. After TCR identification, retrovirally TCR transduced CD8+ T cells were assessed for their in vitro specificity and in vivo efficacy in human ES bearing Rag2−/−γc−/− mice. Engraftment in mice and tumor infiltration of TCR transgenic T cells in the mice was evaluated. The TCR transgenic T cell clone PAPPA-2G6 demonstrated specific reactivity toward HLA-A*02:01+/PAPPA+ ES cell lines. We furthermore detected circulating TCR transgenic T cells in the blood in Rag2−/−γc−/− mice and in vivo engraftment in bone marrow. Tumor growth in mice with xenografted ES was significantly reduced after treatment with PAPPA-2G6 TCR transgenic T cells in contrast to controls. Tumors of treated mice revealed tumor-infiltrating PAPPA-2G6 TCR transgenic T cells. In summary, we demonstrate that PAPPA is a first-rate target for TCR-based immunotherapy of ES.
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Affiliation(s)
- Andreas Kirschner
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München , München, Germany
| | - Melanie Thiede
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München , München, Germany
| | - Thomas G P Grünewald
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology of the LMU Munich, München, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rebeca Alba Rubio
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology of the LMU Munich , München, Germany
| | - Günther H S Richter
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München, München, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Kirchner
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology of the LMU Munich, München, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Comprehensive Cancer Center (CCC) Munich, München, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München , München, Germany
| | - Stefan Burdach
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München, München, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Comprehensive Cancer Center (CCC) Munich, München, Germany
| | - Uwe Thiel
- Laboratory for Functional Genomics and Transplantation Biology, Department of Pediatrics and Children's Cancer Research Center, Klinikum rechts der Isar, Technische Universität München , München, Germany
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Wu W, Ma J, Shao N, Shi Y, Liu R, Li W, Lin Y, Wang S. Co-Targeting IGF-1R and Autophagy Enhances the Effects of Cell Growth Suppression and Apoptosis Induced by the IGF-1R Inhibitor NVP-AEW541 in Triple-Negative Breast Cancer Cells. PLoS One 2017; 12:e0169229. [PMID: 28046018 PMCID: PMC5207513 DOI: 10.1371/journal.pone.0169229] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/13/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is the most intractable type of breast cancer, and there is a lack of effective targeted therapy. Insulin-like growth factor-1 receptor (IGF-1R) is reportedly a potential target for TNBC treatment. However, satisfying treatment outcomes in breast cancer patients have yet to be achieved with IGF-1R-targeted agents. METHODS To confirm whether inhibiting IGF-1R could induce autophagy, we detected autophagy-related proteins by western blotting and immunofluorescence staining of LC3-II. The IGF-1R inhibitor NVP-AEW541, autophagy inhibitor 3-methyladenine (3-MA) and Atg7 small interfering RNA (siRNA) were used to further investigate the effects of autophagy induced by IGF-1R inhibition in TNBC cells. The CCK8 assay, EdU assay, apoptosis and cell cycle analyses were applied to test cell function after treatment. RESULTS NVP-AEW541 markedly induced autophagy in TNBC cells by increasing the levels of the autophagy-related protein Beclin-1 and the LC3-II/LC-I ratio and reducing the selective autophagy substrate p62. Joint application of 3-MA or Atg7 siRNA enhanced the cell growth inhibition and apoptosis effects of NVP-AEW541 by arresting cells at G1/G0 phase and increasing Bax expression and decreasing that of Bcl-2. CONCLUSION Targeting IGF-1R in TNBC induces cell-protective autophagy, thereby weakening the therapeutic effect of agents directed toward IGF-1R. Our findings reveal that combined use autophagy-disrupting agents can enhance the therapeutic efficacy of IGF-1R inhibitors in TNBC cells and may provide a valuable treatment strategy for IGF-1R inhibitor-based therapies for TNBC and other IGF-1 signaling-associated tumors.
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Affiliation(s)
- Weibin Wu
- Department of Breast Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jieyi Ma
- Laboratory of General Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nan Shao
- Department of Breast Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yawei Shi
- Department of Breast Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruiming Liu
- Laboratory of General Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen Li
- Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yin Lin
- Department of Breast Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shenming Wang
- Department of Breast Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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113
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Chemotherapy and Other Systemic Approaches to Adult Sarcomas. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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114
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Grohar PJ, Janeway KA, Mase LD, Schiffman JD. Advances in the Treatment of Pediatric Bone Sarcomas. Am Soc Clin Oncol Educ Book 2017; 37:725-735. [PMID: 28561686 PMCID: PMC6066791 DOI: 10.1200/edbk_175378] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bone tumors make up a significant portion of noncentral nervous system solid tumor diagnoses in pediatric oncology patients. Ewing sarcoma and osteosarcoma, both with distinct clinical and pathologic features, are the two most commonly encountered bone cancers in pediatrics. Although mutations in the germline have classically been more associated with osteosarcoma, there is recent evidence germline alterations in patients with Ewing sarcoma also play a significant role in pathogenesis. Treatment advances in this patient population have lagged behind that of other pediatric malignancies, particularly targeted interventions directed at the biologic underpinnings of disease. Recent advances in biologic and genomic understanding of these two cancers has expanded the potential for therapeutic advancement and prevention. In Ewing sarcoma, directed focus on inhibition of EWSR1-FLI1 and its effectors has produced promising results. In osteosarcoma, instead of a concentrated focus on one particular change, largely due to tumor heterogeneity, a more diversified approach has been adopted including investigations of growth factors inhibitors, signaling pathway inhibitors, and immune modulation. Continuing recently made treatment advances relies on clinical trial design and enrollment. Clinical trials should include incorporation of biological findings; specifically, for Ewing sarcoma, assessment of alternative fusions and, for osteosarcoma, stratification utilizing biomarkers. Expanded cancer genomics knowledge, particularly with solid tumors, as it relates to heritability and incorporation of family history has led to early identification of patients with cancer predisposition. In these patients through application of cost-effective evidence-based screening techniques the ultimate goal of cancer prevention is becoming a realization.
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Affiliation(s)
- Patrick J Grohar
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Katherine A Janeway
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Luke D Mase
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Joshua D Schiffman
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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115
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Grohar PJ, Janeway KA, Mase LD, Schiffman JD. Advances in the Treatment of Pediatric Bone Sarcomas. Am Soc Clin Oncol Educ Book 2017; 37. [PMID: 28561686 PMCID: PMC6066791 DOI: 10.14694/edbk_175378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Bone tumors make up a significant portion of noncentral nervous system solid tumor diagnoses in pediatric oncology patients. Ewing sarcoma and osteosarcoma, both with distinct clinical and pathologic features, are the two most commonly encountered bone cancers in pediatrics. Although mutations in the germline have classically been more associated with osteosarcoma, there is recent evidence germline alterations in patients with Ewing sarcoma also play a significant role in pathogenesis. Treatment advances in this patient population have lagged behind that of other pediatric malignancies, particularly targeted interventions directed at the biologic underpinnings of disease. Recent advances in biologic and genomic understanding of these two cancers has expanded the potential for therapeutic advancement and prevention. In Ewing sarcoma, directed focus on inhibition of EWSR1-FLI1 and its effectors has produced promising results. In osteosarcoma, instead of a concentrated focus on one particular change, largely due to tumor heterogeneity, a more diversified approach has been adopted including investigations of growth factors inhibitors, signaling pathway inhibitors, and immune modulation. Continuing recently made treatment advances relies on clinical trial design and enrollment. Clinical trials should include incorporation of biological findings; specifically, for Ewing sarcoma, assessment of alternative fusions and, for osteosarcoma, stratification utilizing biomarkers. Expanded cancer genomics knowledge, particularly with solid tumors, as it relates to heritability and incorporation of family history has led to early identification of patients with cancer predisposition. In these patients through application of cost-effective evidence-based screening techniques the ultimate goal of cancer prevention is becoming a realization.
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Affiliation(s)
- Patrick J Grohar
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Katherine A Janeway
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Luke D Mase
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Joshua D Schiffman
- From the Van Andel Research Institute/Helen DeVos Children's Hospital, Grand Rapids, MI; Harvard Medical School, Boston, MA; Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Department of Pediatrics and Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Armakolas N, Armakolas A, Antonopoulos A, Dimakakos A, Stathaki M, Koutsilieris M. The role of the IGF-1 Ec in myoskeletal system and osteosarcoma pathophysiology. Crit Rev Oncol Hematol 2016; 108:137-145. [DOI: 10.1016/j.critrevonc.2016.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 10/05/2016] [Accepted: 11/13/2016] [Indexed: 11/28/2022] Open
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The Role of PDGFR-β Activation in Acquired Resistance to IGF-1R Blockade in Preclinical Models of Rhabdomyosarcoma. Transl Oncol 2016; 9:540-547. [PMID: 27835791 PMCID: PMC5114528 DOI: 10.1016/j.tranon.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/09/2016] [Indexed: 11/23/2022] Open
Abstract
To determine what alternative pathways may act as mechanisms of bypass resistance to type 1 insulin-like growth factor receptor (IGF-1R) blockade in rhabdomyosarcoma (RMS), we compared expression of receptor tyrosine kinase activity in a number of IGF-1R antibody-resistant and -sensitive RMS cell lines. We found that platelet-derived growth factor receptor β (PDGFR-β) activity was upregulated in three xenograft-derived IGF-1R antibody-resistant cell lines that arose from a highly sensitive fusion-positive RMS cell line (Rh41). Furthermore, we identified four additional fusion-negative RMS cell lines that similarly upregulated PDGFR-β activity when selected for IGF-1R antibody resistance in vitro. In the seven cell lines described, we observed enhanced growth inhibition when cells were treated with dual IGF-1R and PDGFR-β inhibition in vitro. In vivo studies have confirmed the enhanced effect of targeting IGF-1R and PDGFR-β in several mouse xenograft models of fusion-negative RMS. These findings suggest that PDGFR-β acts as a bypass resistance pathway to IGF-1R inhibition in a subset of RMS. Therapy co-targeting these receptors may be a promising new strategy in RMS care.
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118
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Koshkin VS, Bolejack V, Schwartz LH, Wahl RL, Chugh R, Reinke DK, Zhao B, O JH, Patel SR, Schuetze SM, Baker LH. Assessment of Imaging Modalities and Response Metrics in Ewing Sarcoma: Correlation With Survival. J Clin Oncol 2016; 34:3680-3685. [PMID: 27573658 DOI: 10.1200/jco.2016.68.1858] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite the rapidly increasing use of [18F]fluorodeoxyglucose (FDG) -positron emission tomography (PET), the comparison of anatomic and functional imaging in the assessment of clinical outcomes has been lacking. In addition, there has not been a rigorous evaluation of how common radiologic criteria or the location of the radiology reader (local v central) compare in the ability to predict benefit. In this study, we aimed to compare the effectiveness of various radiologic response assessments for the prediction of overall survival (OS) within the same data set of patients with sarcoma. METHODS We analyzed assessments made during a clinical trial of a novel IGF1R antibody in Ewing sarcoma: PET Response Criteria in Solid Tumors (PERCIST) for functional imaging and WHO criteria (performed locally and centrally), RECIST, and volumetric analysis for anatomic imaging. We compared the effectiveness of the various criteria for the prediction of progression and survival. RESULTS For volume analysis, progression-defined as cumulative lesion volume increase of 100% at 6 weeks-was the optimal cutoff for decreased OS (P < .001). Assessment of the day-9 FDG-PET scan was associated with reduced OS in progressors compared with nonprogressors (P = .001) and with improved OS in responders compared with nonresponders. Significant variations in response (18% to 44%) and progression (9% to 50%) were observed between the different criteria. The comparison of central and local interpretation of anatomic imaging produced similar outcomes. PET was superior to anatomic imaging in identification of a response. Volume analysis identified the most responders among the anatomic imaging criteria. CONCLUSION An early signal with FDG-PET on day 9 and volume analysis were the best predictors of benefit. Validation of the volumetric analysis is required.
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Affiliation(s)
- Vadim S Koshkin
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanessa Bolejack
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lawrence H Schwartz
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard L Wahl
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rashmi Chugh
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Denise K Reinke
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Binsheng Zhao
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joo H O
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shreyaskumar R Patel
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scott M Schuetze
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laurence H Baker
- Vadim S. Koshkin, Cleveland Clinic, Cleveland, OH; Vanessa Bolejack, Cancer Research and Biostatistics, Seattle, WA; Lawrence H. Schwartz, Binsheng Zhao, Columbia University Medical Center, New York, NY; Richard L. Wahl, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO; Rashmi Chugh, Scott M. Schuetze, Laurence H. Baker, University of Michigan Medical School; Denise K. Reinke, Sarcoma Alliance for Research Through Collaboration, Ann Arbor, MI; Joo H. O, The Catholic University of Korea; Seoul St Mary's Hospital, Seoul, Republic of Korea; and Shreyaskumar R. Patel, The University of Texas MD Anderson Cancer Center, Houston, TX
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Subbiah V, Hess KR, Khawaja MR, Wagner MJ, Tang C, Naing A, Fu S, Janku F, Piha-Paul S, Tsimberidou AM, Herzog CE, Ludwig JA, Patel S, Ravi V, Benjamin RS, Meric-Bernstam F, Hong DS. Evaluation of Novel Targeted Therapies in Aggressive Biology Sarcoma Patients after progression from US FDA approved Therapies. Sci Rep 2016; 6:35448. [PMID: 27748430 PMCID: PMC5066200 DOI: 10.1038/srep35448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/29/2016] [Indexed: 01/09/2023] Open
Abstract
Prognosis of patients with advanced sarcoma after progression from FDA approved therapies remains grim. In this study, clinical outcomes of 100 patients with advanced sarcoma who received treatment on novel targeted therapy trials were evaluated. Outcomes of interest included best response, clinical benefit rate, progression-free survival (PFS) and overall survival (OS). Median patient age was 48 years (range 14-80). Patients had received a median of 2 prior lines of systemic treatment. Phase I treatments were anti-VEGF-based (n = 45), mTOR inhibitor-based (n = 15), and anti-VEGF + mTOR inhibitor-based (n = 17) or involved other targets (n = 23). Best responses included partial response (n = 4) and stable disease (n = 57). Clinical benefit rate was 36% (95% confidence interval 27-46%). Median OS was 9.6 months (95% Confidence Interval 8.1-14.2); median PFS was 3.5 months (95% Confidence Interval 2.4-4.7). RMH prognostic score of 2 or 3 was associated with lower median OS (log-rank p-value < 0.0001) and PFS (log-rank p-value 0.0081). Receiving cytotoxic chemotherapy as part of phase I trial was also associated with shorter median OS (log-rank p-value 0.039). Patients with advanced sarcoma treated on phase I clinical trials had a clinical benefit rate of 36% and RMH score predicted survival.
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Affiliation(s)
- Vivek Subbiah
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Kenneth R. Hess
- Division of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Muhammad Rizwan Khawaja
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Michael J. Wagner
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Chad Tang
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Apostolia M. Tsimberidou
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Cynthia E. Herzog
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - Joseph A. Ludwig
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas
| | - Robert S. Benjamin
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
| | - David S. Hong
- Department of Investigational Cancer Therapeutics (A Phase I Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston 77030, Texas, USA
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Insulin-like Growth Factor Receptor Inhibition as Maintenance Therapy for Metastatic Ewing Sarcoma. J Pediatr Hematol Oncol 2016; 38:563-9. [PMID: 27322713 DOI: 10.1097/mph.0000000000000616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite the advances in oncology, the survival of children with Ewing Sarcoma metastatic at diagnosis continues to be 27% 3-year event-free survival and 34% 3-year overall survival. In other words, 7 of 10 children die within 3 years of their initial diagnosis despite intense chemotherapy, local treatment (radiation/surgery), and/or high dose busulfan-melphalan and autologous stem-cell transplantation. A chief contributor to this morbidity and mortality is the difficulty eradicating the tumor using present therapeutic modalities. Despite the extensive surgery, intensive chemotherapy and radiation, those left with a significant bulk of residual tumor relapse within a year of completing treatment. This case report suggests that in children left with a significant tumor burden after completing chemotherapy, a prolonged period of stability can be achieved with biological agents targeting the underlying molecular drivers. In this particular case we used figitumumab, an antibody targeting the insulin-like growth factor type 1 receptor pathway, a documented target in Ewing Sarcoma. Although not curative, these agents provide a better quality of life.
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Anderson PM, Bielack SS, Gorlick RG, Skubitz K, Daw NC, Herzog CE, Monge OR, Lassaletta A, Boldrini E, Pápai Z, Rubino J, Pathiraja K, Hille DA, Ayers M, Yao S, Nebozhyn M, Lu B, Mauro D. A phase II study of clinical activity of SCH 717454 (robatumumab) in patients with relapsed osteosarcoma and Ewing sarcoma. Pediatr Blood Cancer 2016; 63:1761-70. [PMID: 27362300 PMCID: PMC5129487 DOI: 10.1002/pbc.26087] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/19/2016] [Accepted: 04/28/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Robatumumab (19D12; MK-7454 otherwise known as SCH717454) is a fully human antibody that binds to and inhibits insulin-like growth factor receptor-1 (IGF-1R). This multiinstitutional study (P04720) determined the safety and clinical efficacy of robatumumab in three separate patient groups with resectable osteosarcoma metastases (Group 1), unresectable osteosarcoma metastases (Group 2), and Ewing sarcoma metastases (Group 3). PROCEDURE Robatumumab infusions were administered every 2 weeks and were well tolerated with minimal toxicity. Centrally reviewed response data were available for 144 patients. RESULTS Low disease burden was important for osteosarcoma response: three of 31 patients had complete response or partial response (PR) by Response Evaluation Criteria in Solid Tumors (RECIST) in resectable patients (Group 1) versus zero of 29 in unresectable patients (Group 2); median overall survival was 20 months in Group 1 versus 8.2 months in Group 2. In centrally reviewed patients with Ewing sarcoma with PET-CT data (N = 84/115), there were six PR, 23 stable disease, and 55 progression of disease by RECIST at 2 months. Patients with Ewing sarcoma had a median overall survival of 6.9 months. However, responding patients with Ewing sarcoma were allowed to continue on treatment after study closure. A minority of patients with metastatic Ewing sarcoma showed clinical responses and have remained healthy after receiving 25-115 doses of robatumumab with remissions of >4 years duration (N = 6). CONCLUSIONS These findings show that although the IGF-1R remains an attractive treatment target, additional research is needed to identify responders and/or means to achieve durable remissions in order to successfully exploit IGF-1R signal blockade in Ewing sarcoma (clinicaltrials.gov: NCT00617890).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Brian Lu
- Merck & Co., IncKenilworthNew Jersey
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Clinical studies in humans targeting the various components of the IGF system show lack of efficacy in the treatment of cancer. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2016; 772:105-122. [PMID: 28528684 DOI: 10.1016/j.mrrev.2016.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 01/28/2023]
Abstract
The insulin-like growth factors (IGFs) system regulates cell growth, differentiation and energy metabolism and plays crucial role in the regulation of key aspects of tumor biology, such as cancer cell growth, survival, transformation and invasion. The current focus for cancer therapeutic approaches have shifted from the conventional treatments towards the targeted therapies and the IGF system has gained a great interest as anti-cancer therapy. The proliferative, anti-apoptotic and transformation effects of IGFs are mainly triggered by the ligation of the type I IGF receptor (IGF-IR). Thus, aiming at developing novel and effective cancer therapies, different strategies have been employed to target IGF system in human malignancies, including but not limited to ligand or receptor neutralizing antibodies and IGF-IR signaling inhibitors. In this review, we have focused on the clinical studies that have been conducted targeting the various components of the IGF system for the treatment of different types of cancer, providing a description and the challenges of each targeting strategy and the degree of success.
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Lamhamedi-Cherradi SE, Menegaz BA, Ramamoorthy V, Vishwamitra D, Wang Y, Maywald RL, Buford AS, Fokt I, Skora S, Wang J, Naing A, Lazar AJ, Rohren EM, Daw NC, Subbiah V, Benjamin RS, Ratan R, Priebe W, Mikos AG, Amin HM, Ludwig JA. IGF-1R and mTOR Blockade: Novel Resistance Mechanisms and Synergistic Drug Combinations for Ewing Sarcoma. J Natl Cancer Inst 2016; 108:djw182. [PMID: 27576731 DOI: 10.1093/jnci/djw182] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/17/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Therapies cotargeting insulin-like growth factor receptor 1 (IGF-1R) and mammalian target of rapamycin (mTOR) have demonstrated remarkable, albeit short-lived, clinical responses in a subset of Ewing sarcoma (ES) patients. However, the mechanisms of resistance and applicable strategies for overcoming drug resistance to the IGF-1R/mTOR blockade are still undefined. METHODS To elucidate predominant mechanism(s) of acquired drug resistance while identifying synergistic drug combinations that improve clinical efficacy, we generated more than 18 ES cell lines resistant to IGF-1R- or mTOR-targeted therapy. Two small-molecule inhibitors of IGF-1R were chosen, NVP-ADW-742 (IGF-1R-selective) and OSI-906 (a dual IGF-1R/insulin receptor alpha [IR-α] inhibitor). Reverse-phase protein lysate arrays (RPPAs) revealed proteomic changes linked to IGF-1R/mTOR resistance, and selected proteins were validated in cell-based assays, xenografts, and within human clinical samples. All statistical tests were two-sided. RESULTS Novel mechanisms of resistance (MOR) emerged after dalotuzumab-, NVP-ADW-742-, and OSI-906-based targeting of IGF-1R. MOR to dalotuzumab included upregulation of IRS1, PI3K, and STAT3, as well as p38 MAPK, which was also induced by OSI-906. pEIF4E(Ser209), a key regulator of Cap-dependent translation, was induced in ridaforolimus-resistant ES cell lines. Unique drug combinations targeting IGF-1R and PI3K-alpha or Mnk and mTOR were synergistic in vivo and vitro (P < .001) as assessed respectively by Mantel-Cox and isobologram testing. CONCLUSIONS We discovered new druggable targets expressed by chemoresistant ES cells, xenografts, and relapsed human tumors. Joint suppression of these newfound targets, in concert with IGF-1R or mTOR blockade, should improve clinical outcomes.
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Affiliation(s)
- Salah-Eddine Lamhamedi-Cherradi
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Brian A Menegaz
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Vandhana Ramamoorthy
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Deeksha Vishwamitra
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Ying Wang
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Rebecca L Maywald
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Adriana S Buford
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Izabela Fokt
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Stanislaw Skora
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Jing Wang
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Aung Naing
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Alexander J Lazar
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Eric M Rohren
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Najat C Daw
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Vivek Subbiah
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Robert S Benjamin
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Ravin Ratan
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Waldemar Priebe
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Antonios G Mikos
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Hesham M Amin
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
| | - Joseph A Ludwig
- Departments of Sarcoma Medical Oncology (SELC, BAM, VR, RSB, RR, JAL), Hematopathology (DV, HMA), Bioinformatics and Computational Biology (YW, JW), Investigational Cancer Therapeutics (AN, VS), Pediatrics-Patient Care (NCD), Experimental Therapeutics (IF, SS, WP), and Pathology (AJL), The University of Texas MD Anderson Cancer Center, Houston, TX; Departments of Radiology (EMR) and Molecular & Human Genetics (RLM), Baylor College of Medicine, Houston, TX; Department of Pediatric-Oncology, Texas Children's Hospital. Houston, TX (ASB); Departments of Chemical and Biomolecular Engineering and Bioengineering, Rice University, Houston, TX (AGM)
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Functional, chemical genomic, and super-enhancer screening identify sensitivity to cyclin D1/CDK4 pathway inhibition in Ewing sarcoma. Oncotarget 2016; 6:30178-93. [PMID: 26337082 PMCID: PMC4745789 DOI: 10.18632/oncotarget.4903] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/07/2015] [Indexed: 11/25/2022] Open
Abstract
Ewing sarcoma is an aggressive bone and soft tissue tumor in children and adolescents, with treatment remaining a clinical challenge. This disease is mediated by somatic chromosomal translocations of the EWS gene and a gene encoding an ETS transcription factor, most commonly, FLI1. While direct targeting of aberrant transcription factors remains a pharmacological challenge, identification of dependencies incurred by EWS/FLI1 expression would offer a new therapeutic avenue. We used a combination of super-enhancer profiling, near-whole genome shRNA-based and small-molecule screening to identify cyclin D1 and CDK4 as Ewing sarcoma-selective dependencies. We revealed that super-enhancers mark Ewing sarcoma specific expression signatures and EWS/FLI1 target genes in human Ewing sarcoma cell lines. Particularly, a super-enhancer regulates cyclin D1 and promotes its expression in Ewing sarcoma. We demonstrated that Ewing sarcoma cells require CDK4 and cyclin D1 for survival and anchorage-independent growth. Additionally, pharmacologic inhibition of CDK4 with selective CDK4/6 inhibitors led to cytostasis and cell death of Ewing sarcoma cell lines in vitro and growth delay in an in vivo Ewing sarcoma xenograft model. These results demonstrated a dependency in Ewing sarcoma on CDK4 and cyclin D1 and support exploration of CDK4/6 inhibitors as a therapeutic approach for patients with this disease.
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Goldman JW, Mendenhall MA, Rettinger SR. Hyperglycemia Associated With Targeted Oncologic Treatment: Mechanisms and Management. Oncologist 2016; 21:1326-1336. [PMID: 27473045 DOI: 10.1634/theoncologist.2015-0519] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/09/2016] [Indexed: 12/15/2022] Open
Abstract
: Molecularly targeted cancer therapy has rapidly changed the landscape of oncologic care, often improving patients' prognosis without causing as substantial a quality-of-life decrement as cytotoxic chemotherapy does. Nevertheless, targeted agents can cause side effects that may be less familiar to medical oncologists and that require the attention and expertise of subspecialists. In this review, we focus on hyperglycemia, which can occur with use of new anticancer agents that interact with cell proliferation pathways. Key mediators of these pathways include the tyrosine kinase receptors insulin growth factor receptor 1 (IGF-1R) and epidermal growth factor receptor (EGFR), as well as intracellular signaling molecules phosphatidylinositol 3-kinase (PI3K), AKT, and mammalian target of rapamycin (mTOR). We summarize available information on hyperglycemia associated with agents that inhibit these molecules within the larger context of adverse event profiles. The highest incidence of hyperglycemia is observed with inhibition of IGF-1R or mTOR, and although the incidence is lower with PI3K, AKT, and EGFR inhibitors, hyperglycemia is still a common adverse event. Given the interrelationships between the IGF-1R and cell proliferation pathways, it is important for oncologists to understand the etiology of hyperglycemia caused by anticancer agents that target those pathways. We also discuss monitoring and management approaches for treatment-related hyperglycemia for some of these agents, with a focus on our experience during the clinical development of the EGFR inhibitor rociletinib. IMPLICATIONS FOR PRACTICE Treatment-related hyperglycemia is associated with several anticancer agents. Many cancer patients may also have preexisting or undiagnosed diabetes or glucose intolerance. Screening can identify patients at risk for hyperglycemia before treatment with these agents. Proper monitoring and management of symptoms, including lifestyle changes and pharmacologic intervention, may allow patients to continue benefiting from use of anticancer agents.
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Affiliation(s)
- Jonathan W Goldman
- Division of Hematology and Oncology, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Melody A Mendenhall
- Division of Hematology and Oncology, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Sarah R Rettinger
- Endocrinology Medical Group of Orange County, Inc., Orange, California, USA
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Awasthi N, Scire E, Monahan S, Grojean M, Zhang E, Schwarz MA, Schwarz RE. Augmentation of response to nab-paclitaxel by inhibition of insulin-like growth factor (IGF) signaling in preclinical pancreatic cancer models. Oncotarget 2016; 7:46988-47001. [PMID: 27127884 PMCID: PMC5216918 DOI: 10.18632/oncotarget.9029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/16/2016] [Indexed: 12/21/2022] Open
Abstract
Nab-paclitaxel has recently shown greater efficacy in pancreatic ductal adenocarcinoma (PDAC). Insulin like growth factor (IGF) signaling proteins are frequently overexpressed in PDAC and correlate with aggressive tumor phenotype and poor prognosis. We evaluated the improvement in nab-paclitaxel response by addition of BMS-754807, a small molecule inhibitor of IGF-1R/IR signaling, in preclinical PDAC models. In subcutaneous xenografts using AsPC-1 cells, average net tumor growth in different therapy groups was 248.3 mm3 in controls, 42.4 mm3 after nab-paclitaxel (p = 0.002), 93.3 mm3 after BMS-754807 (p = 0.01) and 1.9 mm3 after nab-paclitaxel plus BMS-754807 (p = 0.0002). In subcutaneous xenografts using Panc-1 cells, average net tumor growth in different therapy groups was: 294.3 mm3 in controls, 23.1 mm3 after nab-paclitaxel (p = 0.002), 118.2 mm3 after BMS-754807 (p = 0.02) and -87.4 mm3 (tumor regression) after nab-paclitaxel plus BMS-754807 (p = 0.0001). In peritoneal dissemination model using AsPC-1 cells, median animal survival was increased compared to controls (21 days) after therapy with nab-paclitaxel (40 days, a 90% increase, p = 0.002), BMS-754807 (27 days, a 29% increase, p = 0.01) and nab-paclitaxel plus BMS-754807 (47 days, a 124% increase, p = 0.005), respectively. Decrease in proliferation and increase in apoptosis by nab-paclitaxel and BMS-754807 therapy correlated with their in vivo antitumor activity. In vitro analysis revealed that the addition of IC25 dose of BMS-754807 decreased the nab-paclitaxel IC50 of PDAC cell lines. BMS-754807 therapy decreased phospho-IGF-1R/IR and phospho-AKT expression, and increased cleavage of caspase-3 and PARP-1. These results support the potential of BMS-754807 in combination with nab-paclitaxel as an effective targeting option for pancreatic cancer therapy.
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Affiliation(s)
- Niranjan Awasthi
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA
- Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, USA
| | - Emily Scire
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, USA
| | - Sheena Monahan
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA
| | - Meghan Grojean
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Eric Zhang
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA
| | - Margaret A. Schwarz
- Department of Pediatrics, Indiana University School of Medicine, South Bend, IN, USA
- Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, USA
| | - Roderich E. Schwarz
- Department of Surgery, Indiana University School of Medicine, South Bend, IN, USA
- Indiana University Health Goshen Center for Cancer Care, Goshen, IN, USA
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Iams WT, Lovly CM. Molecular Pathways: Clinical Applications and Future Direction of Insulin-like Growth Factor-1 Receptor Pathway Blockade. Clin Cancer Res 2016; 21:4270-7. [PMID: 26429980 DOI: 10.1158/1078-0432.ccr-14-2518] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The IGF1R signaling pathway is a complex and tightly regulated network that is critical for cell proliferation, growth, and survival. IGF1R is a potential therapeutic target for patients with many different malignancies. This brief review summarizes the results of clinical trials targeting the IGF1R pathway in patients with breast cancer, sarcoma, and non-small cell lung cancer (NSCLC). Therapeutic agents discussed include both monoclonal antibodies to IGF1R (dalotuzumab, figitumumab, cixutumumab, ganitumab, R1507, AVE1642) and newer IGF1R pathway targeting strategies, including monoclonal antibodies to IGF1 and IGF2 (MEDI-573 and BI 836845) and a small-molecule tyrosine kinase inhibitor of IGF1R (linsitinib). The pullback of trials in patients with breast cancer and NSCLC based on several large negative trials is noted and contrasted with the sustained success of IGF1R inhibitor monotherapy in a subset of patients with sarcoma. Several different biomarkers have been examined in these trials with varying levels of success, including tumor expression of IGF1R and its pathway components, serum IGF ligand levels, alternate pathway activation, and specific molecular signatures of IGF1R pathway dependence. However, there remains a critical need to define predictive biomarkers in order to identify patients who may benefit from IGF1R-directed therapies. Ongoing research focuses on uncovering such biomarkers and elucidating mechanisms of resistance, as this therapeutic target is currently being analyzed from the bedside to bench.
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Affiliation(s)
- Wade T Iams
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christine M Lovly
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, Tennessee. Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
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Frappaz D, Federico SM, Pearson ADJ, Gore L, Macy ME, DuBois SG, Aerts I, Iannone R, Geschwindt R, Van Schanke A, Wang R, Geoerger B. Phase 1 study of dalotuzumab monotherapy and ridaforolimus-dalotuzumab combination therapy in paediatric patients with advanced solid tumours. Eur J Cancer 2016; 62:9-17. [PMID: 27185573 DOI: 10.1016/j.ejca.2016.03.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
Abstract
AIM Dalotuzumab is a highly specific, humanised immunoglobulin G1 monoclonal antibody against insulin-like growth factor receptor 1. This multicenter phase 1 study (NCT01431547) explored the safety and pharmacokinetics of dalotuzumab monotherapy (part 1) and the combination of dalotuzumab with the mammalian target of rapamycin inhibitor ridaforolimus (part 2) in paediatric patients with advanced solid tumours. METHODS Dalotuzumab was administered intravenously every 3 weeks starting at 900 mg/m(2) and escalating to 1200 and 1500 mg/m(2). Combination therapy included intravenous dalotuzumab at the defined single-agent recommended phase 2 dose (RP2D) and oral ridaforolimus 28 mg/m(2) daily (days 1-5), repeated weekly. Pharmacokinetic studies were performed to evaluate the mean serum trough dalotuzumab concentration, which guided the RP2D. RESULTS Twenty-four patients were enrolled (part 1, n = 20; part 2, n = 4). No dose-limiting toxicities were observed in patients receiving dalotuzumab alone. One patient experienced dose-limiting stomatitis in the combination arm. Pharmacokinetic data showed dose-dependent increases in exposure (area under the curve from zero to infinity [AUC0-∞]) (87,900, 164,000, and 186,000 h*mg/ml for the 900, 1200, and 1500 mg/m(2) dose levels, respectively), maximum serum concentration (Cmax) (392, 643, and 870 mg/ml), and serum trough concentration (Ctrough) (67.1, 71.6, and 101 mg/ml). The mean half-life was 265, 394, and 310 h, respectively. Dalotuzumab pharmacokinetics were not affected by coadministration with ridaforolimus. One of six patients with Ewing sarcoma had confirmed partial response to dalotuzumab monotherapy at 900 mg/m(2). Time to response was 41 d, and progression occurred at 126 d. CONCLUSION Dalotuzumab was well tolerated in paediatric patients with advanced solid malignancies. The RP2D of dalotuzumab is 900 mg/m(2) (ClinicalTrials.gov identifier: NCT01431547, Protocol PN062).
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Affiliation(s)
- Didier Frappaz
- Institut d'Hématologie et d'Oncologie pédiatrique, Place Professeur Joseph Renaut, 69008 Lyon, France
| | - Sara M Federico
- Department of Oncology, MS 260, Room C6067, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA
| | - Andrew D J Pearson
- The Institute of Cancer Research, The Royal Marsden Hospital, 15 Cotswold Road, Sutton, Surrey SM2 5NG, UK
| | - Lia Gore
- Department of Pediatrics, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA; Childrens Hospital of Colorado, 13123 East 16th Avenue, B115, Aurora, CO 80045-7106, USA
| | - Margaret E Macy
- Department of Pediatrics, University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA; Childrens Hospital of Colorado, 13123 East 16th Avenue, B115, Aurora, CO 80045-7106, USA
| | - Steven G DuBois
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Isabelle Aerts
- Department of Pediatric Oncology, Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - Robert Iannone
- Clinical Research, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Ryan Geschwindt
- Clinical Research, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Arne Van Schanke
- Quantitative Solutions B.V., Pivot Park Molenweg 79, 5349 AC Oss, The Netherlands
| | - Rui Wang
- BARDS, MSD R&D (China) Co. Ltd., Universal Business Park, No. 10 Jiu Xianqiao Road, Chao Yang District, Beijing 100015, China
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, Univ. Paris-Sud, 114, rue Edouard Vaillant, 94805 Villejuif, France.
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129
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Potratz J, Tillmanns A, Berning P, Korsching E, Schaefer C, Lechtape B, Schleithoff C, Unland R, Schäfer KL, Müller-Tidow C, Jürgens H, Dirksen U. Receptor tyrosine kinase gene expression profiles of Ewing sarcomas reveal ROR1 as a potential therapeutic target in metastatic disease. Mol Oncol 2016; 10:677-92. [PMID: 26739507 PMCID: PMC5423155 DOI: 10.1016/j.molonc.2015.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/11/2015] [Accepted: 12/12/2015] [Indexed: 01/10/2023] Open
Abstract
Receptor tyrosine kinases (RTKs) have provided molecular targets for the development of novel, prognosis-improving agents in many cancers; however, resistances to these therapies occur. On the cellular level, one resistance mechanism is attributed to functional RTK redundancies and compensatory cross-signaling, leading to perception of RTKs as signaling and target networks. To provide a basis for better exploitation of this network in Ewing sarcoma, we generated comprehensive qPCR gene expression profiles of RTKs in Ewing sarcoma cell lines and 21 untreated primary tumors. Key findings confirm broad-spectrum RTK expressions with potential for signaling redundancy. Profile analyses with regard to patient risk-group further revealed several individual RTKs of interest. Among them, VEGFR3 and TIE1 showed high-level expressions and also were suggestive of poor prognosis in localized tumors; underscoring the relevance of angiogenic signaling pathways and tumor-stroma interactions in Ewing sarcoma. Of note, compared to localized disease, tumors derived from metastatic disease were marked by global high-level RTK expressions. Nine individual RTKs were significantly over-expressed, suggesting contributions to molecular mechanisms of metastasis. Of these, ROR1 is being pursued as therapeutic target in leukemias and carcinomas, but un-characterized in sarcomas. We demonstrate expression of ROR1 and its putative ligand Wnt5a in Ewing sarcomas, and of an active ROR1 protein variant in cell lines. ROR1 silencing impaired cell migration in vitro. Therefore, ROR1 calls for further evaluation as a therapeutic target in metastatic Ewing sarcoma; and described as a pseudo-kinase with several isoforms, underlines these additional complexities arising in our understanding of RTK signaling networks.
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Affiliation(s)
- Jenny Potratz
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Amelie Tillmanns
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Philipp Berning
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Eberhard Korsching
- Institute of Bioinformatics, Westfälische-Wilhelms Universität Münster, Niels-Stensen-Strasse 12, 48149 Münster, Germany
| | - Christiane Schaefer
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Birgit Lechtape
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Carolin Schleithoff
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Rebekka Unland
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Karl-Ludwig Schäfer
- Institute of Pathology, University Medical Center Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Carsten Müller-Tidow
- Department of Inner Medicine IV, Hematology and Oncology, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle (Saale), Germany
| | - Heribert Jürgens
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Uta Dirksen
- Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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130
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Noujaim J, Payne LS, Judson I, Jones RL, Huang PH. Phosphoproteomics in translational research: a sarcoma perspective. Ann Oncol 2016; 27:787-94. [PMID: 26802162 DOI: 10.1093/annonc/mdw030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/11/2016] [Indexed: 02/11/2024] Open
Abstract
Phosphoproteomics has been extensively used as a preclinical research tool to characterize the phosphorylated components of the cancer proteome. Advances in the field have yielded insights into new drug targets, mechanisms of disease progression and drug resistance, and biomarker discovery. However, application of this technology to clinical research has been challenging because of practical issues relating to specimen integrity and tumour heterogeneity. Beyond these limitations, phosphoproteomics has the potential to play a pivotal role in translational studies and contribute to advances in different tumour groups, including rare disease sites like sarcoma. In this review, we propose that deploying phosphoproteomic technologies in translational research may facilitate the identification of better defined predictive biomarkers for patient stratification, inform drug selection in umbrella trials and identify new combinations to overcome drug resistance. We provide an overview of current phosphoproteomic technologies, such as affinity-based assays and mass spectrometry-based approaches, and discuss their advantages and limitations. We use sarcoma as an example to illustrate the current challenges in evaluating targeted kinase therapies in clinical trials. We then highlight useful lessons from preclinical studies in sarcoma biology to demonstrate how phosphoproteomics may address some of these challenges. Finally, we conclude by offering a perspective and list the key measures required to translate and benchmark a largely preclinical technology into a useful tool for translational research.
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Affiliation(s)
- J Noujaim
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - L S Payne
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - I Judson
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK Division of Clinical Studies
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK Division of Clinical Studies
| | - P H Huang
- Division of Cancer Biology, The Institute of Cancer Research, London, UK
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131
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England CG, Kamkaew A, Im HJ, Valdovinos HF, Sun H, Hernandez R, Cho SY, Dunphy EJ, Lee DS, Barnhart TE, Cai W. ImmunoPET Imaging of Insulin-Like Growth Factor 1 Receptor in a Subcutaneous Mouse Model of Pancreatic Cancer. Mol Pharm 2016; 13:1958-66. [PMID: 27054683 PMCID: PMC4897730 DOI: 10.1021/acs.molpharmaceut.6b00132] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
![]()
The role of insulin-like
growth factor-1 receptor (IGF-1R) in cancer
tumorigenesis was established decades ago, yet there are limited studies
evaluating the imaging and therapeutic properties of anti-IGF-1R antibodies.
Noninvasive imaging of IGF-1R may allow for optimized patient stratification
and monitoring of therapeutic response in patients. Herein, this study
reports the development of a Zirconium-89 (89Zr)-labeled
anti-IGF-1R antibody (89Zr-Df-1A2G11) for PET imaging of
pancreatic cancer. Successful chelation and radiolabeling of the antibody
resulted in a highly stable construct that could be used for imaging
IGF-1R expressing tumors in vivo. Western blot and flow cytometry
studies showed that MIA PaCa-2, BxPC-3, and AsPC-1 pancreatic cancer
cell lines expressed high, moderate, and low levels of IGF-1R, respectively.
These three pancreatic cancer cell lines were subcutaneously implanted
into mice. By employing the PET imaging technique, the tumor accumulation
of 89Zr-Df-1A2G11 was found to be dependent on the level
of IGF-1R expression. Tumor accumulation of 89Zr-Df-1A2G11
was 8.24 ± 0.51, 5.80 ± 0.54, and 4.30 ± 0.42 percentage
of the injected dose (%ID/g) in MIA PaCa-2, BxPC-3, and AsPC-1-derived
tumor models at 120 h postinjection, respectively (n = 4). Biodistribution studies and ex vivo immunohistochemistry confirmed
these findings. In addition, 89Zr-labeled nonspecific human
IgG (89Zr-Df-IgG) displayed minimal uptake in IGF-1R positive
MIA PaCa-2 tumor xenografts (3.63 ± 0.95%ID/g at 120 h postinjection; n = 4), demonstrating that 89Zr-Df-1A2G11 accumulation
was highly specific. This study provides initial evidence that our 89Zr-labeled IGF-1R-targeted antibody may be employed for imaging
a wide range of malignancies. Antibodies may be tracked in vivo for
several days to weeks with 89Zr, which may enhance image
contrast due to decreased background signal. In addition, the principles
outlined in this study can be employed for identifying patients that
may benefit from anti-IGF-1R therapy.
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Affiliation(s)
| | | | - Hyung-Jun Im
- Department of Molecular Medicine and Biopharmaceutical Sciences, Department of Nuclear Medicine, Seoul National University , Seoul 110-744, Korea
| | | | | | | | | | - Edward J Dunphy
- NeoClone Biotechnologies International , Madison, Wisconsin 53713, United States
| | - Dong Soo Lee
- Department of Molecular Medicine and Biopharmaceutical Sciences, Department of Nuclear Medicine, Seoul National University , Seoul 110-744, Korea
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132
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Insulin Receptor Substrate Adaptor Proteins Mediate Prognostic Gene Expression Profiles in Breast Cancer. PLoS One 2016; 11:e0150564. [PMID: 26991655 PMCID: PMC4798554 DOI: 10.1371/journal.pone.0150564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/15/2016] [Indexed: 01/08/2023] Open
Abstract
Therapies targeting the type I insulin-like growth factor receptor (IGF-1R) have not been developed with predictive biomarkers to identify tumors with receptor activation. We have previously shown that the insulin receptor substrate (IRS) adaptor proteins are necessary for linking IGF1R to downstream signaling pathways and the malignant phenotype in breast cancer cells. The purpose of this study was to identify gene expression profiles downstream of IGF1R and its two adaptor proteins. IRS-null breast cancer cells (T47D-YA) were engineered to express IRS-1 or IRS-2 alone and their ability to mediate IGF ligand-induced proliferation, motility, and gene expression determined. Global gene expression signatures reflecting IRS adaptor specific and primary vs. secondary ligand response were derived (Early IRS-1, Late IRS-1, Early IRS-2 and Late IRS-2) and functional pathway analysis examined. IRS isoforms mediated distinct gene expression profiles, functional pathways, and breast cancer subtype association. For example, IRS-1/2-induced TGFb2 expression and blockade of TGFb2 abrogated IGF-induced cell migration. In addition, the prognostic value of IRS proteins was significant in the luminal B breast tumor subtype. Univariate and multivariate analyses confirmed that IRS adaptor signatures correlated with poor outcome as measured by recurrence-free and overall survival. Thus, IRS adaptor protein expression is required for IGF ligand responses in breast cancer cells. IRS-specific gene signatures represent accurate surrogates of IGF activity and could predict response to anti-IGF therapy in breast cancer.
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133
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Schanzer JM, Wartha K, Moessner E, Hosse RJ, Moser S, Croasdale R, Trochanowska H, Shao C, Wang P, Shi L, Weinzierl T, Rieder N, Bacac M, Ries CH, Kettenberger H, Schlothauer T, Friess T, Umana P, Klein C. XGFR*, a novel affinity-matured bispecific antibody targeting IGF-1R and EGFR with combined signaling inhibition and enhanced immune activation for the treatment of pancreatic cancer. MAbs 2016; 8:811-27. [PMID: 26984378 PMCID: PMC4966845 DOI: 10.1080/19420862.2016.1160989] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) and the insulin-like growth factor-1 receptor (IGF-1R) play critical roles in tumor growth, providing a strong rationale for the combined inhibition of IGF-1R and EGFR signaling in cancer therapy. We describe the design, affinity maturation, in vitro and in vivo characterization of the bispecific anti-IGF-1R/EGFR antibody XGFR*. XGFR* is based on the bispecific IgG antibody XGFR, which enabled heterodimerization of an IGF-1R binding scFab heavy chain with an EGFR-binding light and heavy chain by the "knobs-into-holes" technology. XGFR* is optimized for monovalent binding of human EGFR and IGF-1R with increased binding affinity for IGF-1R due to affinity maturation and highly improved protein stability to oxidative and thermal stress. It bears an afucosylated Fc-portion for optimal induction of antibody-dependent cell-mediated cytotoxicity (ADCC). Stable Chinese hamster ovary cell clones with production yields of 2-3 g/L were generated, allowing for large scale production of the bispecific antibody. XGFR* potently inhibits EGFR- and IGF-1R-dependent receptor phosphorylation, reduces tumor cell proliferation in cells with heterogeneous levels of IGF-1R and EGFR receptor expression and induces strong ADCC in vitro. A comparison of pancreatic and colorectal cancer lines demonstrated superior responsiveness to XGFR*-mediated signaling and tumor growth inhibition in pancreatic cancers that frequently show a high degree of IGF-1R/EGFR co-expression. XGFR* showed potent anti-tumoral efficacy in the orthotopic MiaPaCa-2 pancreatic xenograft model, resulting in nearly complete tumor growth inhibition with significant number of tumor remissions. In summary, the bispecific anti-IGF-1R/EGFR antibody XGFR* combines potent signaling and tumor growth inhibition with enhanced ADCC induction and represents a clinical development candidate for the treatment of pancreatic cancer.
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Affiliation(s)
- Juergen M Schanzer
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Katharina Wartha
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Ekkehard Moessner
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Ralf J Hosse
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Samuel Moser
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Rebecca Croasdale
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Halina Trochanowska
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Cuiying Shao
- c Pharma Research and Early Development, Roche Innovation Center Shanghai , Cai Lun Road, Shanghai , China
| | - Peng Wang
- c Pharma Research and Early Development, Roche Innovation Center Shanghai , Cai Lun Road, Shanghai , China
| | - Lei Shi
- c Pharma Research and Early Development, Roche Innovation Center Shanghai , Cai Lun Road, Shanghai , China
| | - Tina Weinzierl
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Natascha Rieder
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Marina Bacac
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Carola H Ries
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Hubert Kettenberger
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Tilman Schlothauer
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Thomas Friess
- a Roche Pharma Research and Early Development, Roche Innovation Center Munich , Nonnenwald, Penzberg , Germany
| | - Pablo Umana
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
| | - Christian Klein
- b Roche Pharma Research and Early Development, Roche Innovation Center Zurich , Wagistrasse, Schlieren , Switzerland
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The role of radiotherapy in local control of nonextremity Ewing sarcomas. TUMORI JOURNAL 2016; 102:162-7. [PMID: 26917407 DOI: 10.5301/tj.5000478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the results of radiotherapy and the prognostic factors affecting local control in nonextremity Ewing sarcomas. METHODS Between 1995 and 2011, 44 patients with nonextremity Ewing sarcomas were treated with radiotherapy. Tumor localizations were pelvis in 23, spine in 13, thoracic region in 5, and cranium in 3 patients. Tumor size was ≥8 cm in 56.8% of patients. Distant metastases were present in 19 of the patients at the time of diagnosis (43.1%). All patients were treated with 12 weeks of neoadjuvant chemotherapy followed by surgery and radiotherapy (45-54 Gy) or radiotherapy alone (54-64.8 Gy). Radiotherapy was applied due to microscopic residue (R1) in 5 patients after the operation and macroscopic tumor in 39 patients (macroscopic residue [R2] and nonresectable tumor). RESULTS Median follow-up was 49 months (range 9-195). Local failures developed in 7 patients (15.9%) and local control at 5 years was 81.4%. Local recurrence was detected in 6 patients (6/38) who did not have residual tumor after RT. Progression was detected in 1 patient (1/6) who had residual tumor. All those patients with local failure experienced further distant metastases. Possible prognostic factors such as age (≤17 vs >17), tumor localization, tumor volume (≤8 cm vs >8 cm), and M status at diagnosis (0 vs 1) were not related to local control. CONCLUSIONS Radiotherapy, either alone or adjuvant to surgery, provides local control in 80% of nonextremity Ewing sarcomas and plays an important role in treatment.
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135
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Vo KT, Edwards JV, Epling CL, Sinclair E, Hawkins DS, Grier HE, Janeway KA, Barnette P, McIlvaine E, Krailo MD, Barkauskas DA, Matthay KK, Womer RB, Gorlick RG, Lessnick SL, Mackall CL, DuBois SG. Impact of Two Measures of Micrometastatic Disease on Clinical Outcomes in Patients with Newly Diagnosed Ewing Sarcoma: A Report from the Children's Oncology Group. Clin Cancer Res 2016; 22:3643-50. [PMID: 26861456 DOI: 10.1158/1078-0432.ccr-15-2516] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/29/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Flow cytometry and RT-PCR can detect occult Ewing sarcoma cells in the blood and bone marrow. These techniques were used to evaluate the prognostic significance of micrometastatic disease in Ewing sarcoma. EXPERIMENTAL DESIGN Newly diagnosed patients with Ewing sarcoma were enrolled on two prospective multicenter studies. In the flow cytometry cohort, patients were defined as "positive" for bone marrow micrometastatic disease if their CD99(+)/CD45(-) values were above the upper limit in 22 control patients. In the PCR cohort, RT-PCR on blood or bone marrow samples classified the patients as "positive" or "negative" for EWSR1/FLI1 translocations. The association between micrometastatic disease burden with clinical features and outcome was assessed. Coexpression of insulin-like growth factor-1 receptor (IGF-1R) on detected tumor cells was performed in a subset of flow cytometry samples. RESULTS The median total bone marrow CD99(+)CD45(-) percent was 0.0012% (range 0%-1.10%) in the flow cytometry cohort, with 14 of 109 (12.8%) of Ewing sarcoma patients defined as "positive." In the PCR cohort, 19.6% (44/225) patients were "positive" for any EWSR1/FLI1 translocation in blood or bone marrow. There were no differences in baseline clinical features or event-free or overall survival between patients classified as "positive" versus "negative" by either method. CD99(+)CD45(-) cells had significantly higher IGF-1R expression compared with CD45(+) hematopoietic cells (mean geometric mean fluorescence intensity 982.7 vs. 190.9; P < 0.001). CONCLUSIONS The detection of micrometastatic disease at initial diagnosis by flow cytometry or RT-PCR is not associated with outcome in newly diagnosed patients with Ewing sarcoma. Flow cytometry provides a tool to characterize occult micrometastatic tumor cells for proteins of interest. Clin Cancer Res; 22(14); 3643-50. ©2016 AACR.
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Affiliation(s)
- Kieuhoa T Vo
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco School of Medicine, San Francisco, California
| | - Jeremy V Edwards
- Department of Pediatrics, Walter Reed Army Medical Center, Washington, DC
| | - C Lorrie Epling
- Division of Experimental Medicine Core Immunology Laboratory, UCSF Benioff Children's Hospital, University of California, San Francisco School of Medicine, San Francisco, California
| | - Elizabeth Sinclair
- Division of Experimental Medicine Core Immunology Laboratory, UCSF Benioff Children's Hospital, University of California, San Francisco School of Medicine, San Francisco, California
| | - Douglas S Hawkins
- Division of Hematology/Oncology, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Holcombe E Grier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Katherine A Janeway
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Phillip Barnette
- Department of Pediatric Hematology/Oncology, Center for Children's Cancer Research, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Elizabeth McIlvaine
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mark D Krailo
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Donald A Barkauskas
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Katherine K Matthay
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco School of Medicine, San Francisco, California
| | - Richard B Womer
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Richard G Gorlick
- Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Stephen L Lessnick
- Center for Childhood Cancer and Blood Disorders at Nationwide Children's Hospital and the Division of Hematology, Oncology, and BMT at The Ohio State University, Columbus, Ohio
| | - Crystal L Mackall
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Steven G DuBois
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco School of Medicine, San Francisco, California.
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Benjamin RS, Wagner MJ, Livingston JA, Ravi V, Patel SR. Chemotherapy for bone sarcomas in adults: the MD anderson experience. Am Soc Clin Oncol Educ Book 2016:e656-60. [PMID: 25993237 DOI: 10.14694/edbook_am.2015.35.e656] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Increasing age is an adverse prognostic factor in the treatment of primary bone tumors. There are few published data on treatment of primary bone tumors in adults. This paper presents data from the Department of Sarcoma Medical Oncology at The University of Texas MD Anderson Cancer Center, summarizing our treatment results. To treat primary osteosarcoma, we used 90 mg/m2 of doxorubicin as a continuous intravenous infusion over 48 to 96 hours and 120 to 160 mg/m2 of cisplatin intravenously or intra-arterially. Initially, we found a marked difference in postoperative continuous disease-free survival (CDFS) between those with 90% or greater (i.e., good response) tumor necrosis and those with less than 90% (i.e., poor response) tumor necrosis. The sequential addition of high-dose methotrexate and ifosfamide to patients with poorly responding disease improved their CDFS to that of patients with good response. Older patients and those who have tumors with variant histology have inferior outcomes. Evaluation of subsequent patients revealed similar outcomes for those with good or poor response to induction therapy, supporting our practice of adaptation of postoperative chemotherapy to the results of preoperative chemotherapy. PET-CT is the best imaging modality to screen for a response with tumors inside bone. To treat Ewing sarcoma, we have employed 2 mg of vincristine, 75 to 90 mg/m2 of doxorubicin as a 72-hour infusion, and 2.5 g/m2 of ifosfamide over 3 hours daily for 4 doses (i.e., vincristine, doxorubicin, and ifosfamide [VAI]). Preliminary analysis indicates a higher CDFS when adjusted for patient age than seen with the standard alternating regimen used in pediatrics. A screening MRI of the pelvis and spine can detect subtle metastatic disease in bone or bone marrow that is missed by other imaging modalities or blind biopsy. Chondrosarcoma is treated surgically or on investigational protocols. Giant cell tumor of bone is usually managed surgically, but multiple options exist for medical treatment, and therapy is individualized with embolization, denosumab, and interferon.
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Affiliation(s)
- Robert S Benjamin
- From the Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael J Wagner
- From the Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Andrew Livingston
- From the Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vinod Ravi
- From the Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shreyaskumar R Patel
- From the Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
Curative therapy for both osteosarcoma and Ewing sarcoma requires the combination of effective systemic therapy and local control of all macroscopic tumors. Systemic therapy for osteosarcoma consists of multiagent chemotherapy. The most common regimen uses cisplatin, doxorubicin, and high-dose methotrexate. Addition of ifosfamide and etoposide to treatment for patients with poor initial response to therapy does not improve outcome. Addition of interferon to treatment for patients with favorable initial response does not improve outcome. Addition of liposomal muramyl tripeptide to chemotherapy may improve overall survival. Systemic therapy for Ewing sarcoma consists of multiagent chemotherapy including doxorubicin, vincristine, etoposide, and cyclophosphamide and/or ifosfamide. Increased dose intensity of therapy, either by shortening the intervals between cycles of chemotherapy or by increasing doses of chemotherapy, improves outcome. Regimens such as irinotecan/temozolomide or cyclophosphamide/topotecan have shown activity in metastatic recurrent Ewing sarcoma. Trials are ongoing to evaluate the addition of these drugs to existing multiagent regimens in order to test their ability to improve outcome. High-dose systemic therapy with autologous stem cell reconstitution is being tested for patients at high risk for recurrence; definitive results await completion of a prospective randomized trial.
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Affiliation(s)
- Paul A Meyers
- From Weill Cornell Medical Center, New York, NY, and Memorial Sloan Kettering Cancer Center, New York, NY
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138
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Hyun O J, Luber BS, Leal JP, Wang H, Bolejack V, Schuetze SM, Schwartz LH, Helman LJ, Reinke D, Baker LH, Wahl RL. Response to Early Treatment Evaluated with 18F-FDG PET and PERCIST 1.0 Predicts Survival in Patients with Ewing Sarcoma Family of Tumors Treated with a Monoclonal Antibody to the Insulinlike Growth Factor 1 Receptor. J Nucl Med 2016; 57:735-40. [PMID: 26795289 DOI: 10.2967/jnumed.115.162412] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED The aim of this study was to assess the prognostic and predictive value of early quantitative (18)F-FDG PET to monitor therapy with an antibody to the insulinlike growth factor 1 receptor (IGF-1R antibody) in patients with Ewing sarcoma family of tumors (ESFT). METHODS (18)F-FDG PET images at baseline and approximately 9 d after initiation of IGF-1R antibody therapy in 115 patients with refractory or relapsed ESFT were prospectively obtained as part of the Sarcoma Alliance for Research through Collaboration trial. Responses were centrally evaluated by PERCIST 1.0 in 93 patients. The 9-d PET responses were correlated to overall survival (OS), progression-free survival (PFS), and clinical benefit after 6 wk of therapy based on clinical observation and CT response by World Health Organization anatomic criteria. RESULTS The median OS was 8.1 mo (95% confidence interval, 6.4-10.0 mo). When PERCIST was used, patients with progressive metabolic disease showed shorter OS (median, 4.7 mo) than patients without progression (median, 10.0 mo; P = 0.001). Progressive metabolic disease on day-9 PET was associated with a significantly higher risk of death (hazard ratio, 2.8; 95% confidence interval, 1.5-5.5). Changes in (18)F-FDG uptake after 9 d of therapy had an area under the curve of receiver-operating characteristic of 0.71 to predict 1-y OS. The area under the curve was 0.63 to predict progression at 3 mo and 0.79 to predict clinical benefit after 6 wk of therapy. CONCLUSION Treatment response by quantitative (18)F-FDG PET assessed by PERCIST 1.0 as early as 9 d into IGF-1R antibody therapy in patients with ESFT can predict the OS, PFS, and clinical response to therapy.
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Affiliation(s)
- Joo Hyun O
- Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brandon S Luber
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey P Leal
- Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hao Wang
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Scott M Schuetze
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Lee J Helman
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland; and
| | | | - Laurence H Baker
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Richard L Wahl
- Division of Nuclear Medicine, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
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139
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Wan X, Yeung C, Heske C, Mendoza A, Helman LJ. IGF-1R Inhibition Activates a YES/SFK Bypass Resistance Pathway: Rational Basis for Co-Targeting IGF-1R and Yes/SFK Kinase in Rhabdomyosarcoma. Neoplasia 2016; 17:358-66. [PMID: 25925378 PMCID: PMC4415145 DOI: 10.1016/j.neo.2015.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/02/2015] [Accepted: 03/09/2015] [Indexed: 02/07/2023] Open
Abstract
The insulin-like growth factor 1 receptor (IGF-1R) has surfaced as a significant target in multiple solid cancers due to its fundamental roles in pro-survival and anti-apoptotic signaling. However, development of resistance to IGF-1R blockade represents a significant hindrance and limits treatment efficacy in the clinic. In this study, we identified acquired resistance to IGF-1R blockade with R1507, an antibody against IGF-1R, and with BMS-754807, a small molecular inhibitor of IGF-1R/insulin receptor (IR). We showed that treatment with an IGF-IR antibody, R1507, or an IR/IGF-IR kinase inhibitor, BMS-754807, was associated with increased activation of YES/SRC family tyrosine kinase (SFK) in rhabdomyosarcoma (RMS). Combining anti–IGF-1R agents with SFK inhibitors resulted in blockade of IGF-1R inhibition–induced activation of YES/SFK and displayed advantageous antitumor activity in vitro and in vivo. Our data provide evidence that IGF-1R blockade results in activation of the YES/SRC family kinase bypass resistance pathway in vitro and in vivo. This may be of particular clinical relevance since both Yes and IGF components are overexpressed in RMS. Increased YES/SFK activation might serve as a clinical biomarker for predicting tumor resistance to IGF-1R inhibition. Dual inhibition of IGF-1R and SFK may have a broader and enhanced clinical benefit for patients with RMS.
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Affiliation(s)
- Xiaolin Wan
- Molecular Oncology Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
| | - Choh Yeung
- Molecular Oncology Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Christine Heske
- Molecular Oncology Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Arnulfo Mendoza
- Molecular Oncology Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Lee J Helman
- Molecular Oncology Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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140
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van Maldegem AM, Bovée JVMG, Peterse EFP, Hogendoorn PCW, Gelderblom H. Ewing sarcoma: The clinical relevance of the insulin-like growth factor 1 and the poly-ADP-ribose-polymerase pathway. Eur J Cancer 2016; 53:171-80. [PMID: 26765686 DOI: 10.1016/j.ejca.2015.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/05/2015] [Accepted: 09/15/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the last three decades the outcome for patients with localised Ewing sarcoma (ES) has improved significantly since the introduction of multimodality primary treatment. However, for patients with (extra-) pulmonary metastatic and/or non-resectable relapsed disease the outcome remains poor and new treatment options are urgently needed. Currently the insulin-like growth factor 1 receptor (IGF-1R) pathway and the poly-ADP(adenosinediphosphate)-ribose-polymerase (PARP) pathway are being investigated for potential targeted therapies. IGF-1R: The IGF-1R pathway is known to be deregulated by the EWSR1-FLI1 translocation which makes it a potential target for therapy. Clinical trials have been reported in which only ES patients were treated with an IGF-1R inhibitor, either as single agent or in combination. In total 291 ES patients were included in these trials, in which two (0.7%) complete responses, 32 (11%) partial responses of which some durable, and 61 (21%) stable diseases were observed. PARP: In the presence of a PARP inhibitor DNA strand breaks cannot be efficiently repaired, leading to cell death. The first phase II trial with ES patients was recently published and showed no clinical responses, which may have been due to the drug being non-effective as a single agent. DISCUSSION The IGF-1R pathway is an interesting target for ES and should be explored further, as biomarkers to select patients that might benefit from treatment are lacking. PARP inhibitors as single agent have so far failed to show improvement in outcome. Future directions include dual insulin receptor/IGF-1R blockade with linsitinib as well as chemotherapy-PARP combinations. Both therapeutic strategies are currently being explored.
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Affiliation(s)
- Annemiek M van Maldegem
- Department of Clinical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Elleke F P Peterse
- Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Pancras C W Hogendoorn
- Department of Pathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Hans Gelderblom
- Department of Clinical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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141
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Patel SR. Fifty years of advances in sarcoma treatment: moving the needle from conventional chemotherapy to targeted therapy. Am Soc Clin Oncol Educ Book 2015:259-62. [PMID: 24857084 DOI: 10.14694/edbook_am.2014.34.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Much of the progress in systemic therapy for sarcomas was accomplished in the first half of the last 5 decades. Various chemotherapeutic agents were tested in the 70s through the 80s and became part of the standard of care for this patient population. During the decade of the 90s, dose intensification became feasible as a result of improved supportive care and the availability of growth factors, thus maximizing the therapeutic potential of this class of agents. However, response rates and survival plateaued and it became obvious that newer and mechanistically different agents were needed to improve the therapeutic index and gain further enhancement of outcomes. Since early 2000, primarily inspired by the experience with imatinib in gastrointestinal stromal tumors (GISTs), several targeted therapies have been tested in sarcomas with modest success. The major limitations encountered include the lack of drivers and actionable targets for bone and soft tissue sarcomas with complex genomic profiles. Continued investigations and sequencing of larger numbers of these rare and heterogeneous malignancies could shed some light on a path toward improved outcomes.
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Affiliation(s)
- Shreyaskumar R Patel
- From the Sarcoma Center, The University of Texas MD Anderson Cancer Center, Houston, TX
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142
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Jamitzky S, Krueger AC, Janneschuetz S, Piepke S, Kailayangiri S, Spurny C, Rossig C, Altvater B. Insulin-like growth factor-1 receptor (IGF-1R) inhibition promotes expansion of human NK cells which maintain their potent antitumor activity against Ewing sarcoma cells. Pediatr Blood Cancer 2015; 62:1979-85. [PMID: 26131572 DOI: 10.1002/pbc.25619] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/08/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with primary metastatic or relapsed Ewing sarcomas (EwS) have a poor prognosis. While inhibitory insulin-like growth factor 1 receptor (IGF-1R)-specific antibodies have shown single agent activity in some patients with refractory disease, effective therapeutic targeting will rely on optimal combinations with conventional or innovative therapies. Specifically, combination of inhibitory IGF-1R antibodies with adoptive transfer of activated natural killer (NK) cells may have therapeutic benefit in EwS without adding toxicity. PROCEDURE We investigated the in vitro effects of IGF-1R targeting on the immunological profile of EwS cells and on the survival and tumor targeting capacity of K-562-activated NK cells. RESULTS IGF-1R inhibition reliably reduced EwS cell viability without affecting expression of immune-modulatory and MHC molecules. In NK cells, we observed a significant superior expansion following in vitro activation in the presence of IGF-1R-specific antibodies, while expression of differentiation markers and activating receptors remained unaffected. Activated NK cells coincubated with EwS cells showed potent degranulation responses unaffected by IGF-1R inhibition. These findings were reproducible in a stimulator cell-free NK cell expansion system, suggesting that direct effects of IGF-R1 antibodies on the IGF-R1 pathway in NK cells induce their activation and expansion. CONCLUSIONS Activated human NK cells respond to IGF-1R inhibition with superior expansion kinetics while maintaining potent antitumor responses against EwS. Combination of adoptive NK cell transfer with IGF-1R targeting may be an efficient means to eliminate minimal residual disease after conventional therapy and thereby rescue patients at the highest risk of relapse.
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Affiliation(s)
- Silke Jamitzky
- Department of Pediatric Hematology and Oncology, University Childreńs Hospital Muenster, Muenster, Germany
| | - Andrea-Caroline Krueger
- Department of Pediatric Hematology and Oncology, University Childreńs Hospital Muenster, Muenster, Germany
| | - Saskia Janneschuetz
- Department of Pediatric Hematology and Oncology, University Childreńs Hospital Muenster, Muenster, Germany
| | | | - Sareetha Kailayangiri
- Department of Pediatric Hematology and Oncology, University Childreńs Hospital Muenster, Muenster, Germany
| | - Christian Spurny
- Department of Pediatric Hematology and Oncology, University Childreńs Hospital Muenster, Muenster, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology and Oncology, University Childreńs Hospital Muenster, Muenster, Germany.,Cells-in-Motion Cluster of Excellence (EXC 1003-CiM), University of Muenster, Muenster, Germany
| | - Bianca Altvater
- Department of Pediatric Hematology and Oncology, University Childreńs Hospital Muenster, Muenster, Germany
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143
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Cellular and Antibody Based Approaches for Pediatric Cancer Immunotherapy. J Immunol Res 2015; 2015:675269. [PMID: 26587548 PMCID: PMC4637498 DOI: 10.1155/2015/675269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022] Open
Abstract
Progress in the use of traditional chemotherapy and radiation-based strategies for the treatment of pediatric malignancies has plateaued in the past decade, particularly for patients with relapsing or therapy refractory disease. As a result, cellular and humoral immunotherapy approaches have been investigated for several childhood cancers. Several monoclonal antibodies are now FDA approved and commercially available, some of which are currently considered standard of practice. There are also several new cellular immunotherapy approaches under investigation, including chimeric antigen receptor (CAR) modified T cells, cancer vaccines and adjuvants, and natural killer (NK) cell therapies. In this review, we will discuss previous studies on pediatric cancer immunotherapy and new approaches that are currently being investigated in clinical trials.
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144
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Anderson JL, Park A, Akiyama R, Tap WD, Denny CT, Federman N. Evaluation of In Vitro Activity of the Class I PI3K Inhibitor Buparlisib (BKM120) in Pediatric Bone and Soft Tissue Sarcomas. PLoS One 2015; 10:e0133610. [PMID: 26402468 PMCID: PMC4581723 DOI: 10.1371/journal.pone.0133610] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/29/2015] [Indexed: 01/05/2023] Open
Abstract
Pediatric bone and soft tissue sarcomas often display increased Akt phosphorylation through up regulation of insulin-like growth factor (IGF1) signaling. Additionally, Akt signaling has been linked to resistance to IGF1 receptor (IGF1R) and mTOR (mammalian target of rapamycin) inhibitors in sarcoma, further demonstrating the role of Akt in tumor survival. This suggests targeting components of the PI3K/Akt pathway may be an effective therapeutic strategy. Here, we investigated the in vitro activity of the pan-class I PI3K inhibitor buparlisib (BKM120) in pediatric bone and soft tissue sarcomas. Buparlisib inhibited activation of Akt and signaling molecules downstream of mTORC1 (mTOR complex 1) in Ewing sarcoma, osteosarcoma, and rhabdomyosarcoma cell lines. Anti-proliferative effects were observed in both anchorage dependent and independent conditions and apoptosis was induced within 24 hours of drug treatment. Buparlisib demonstrated cytotoxicity as a single agent, but was found to be more effective when used in combination. Synergy was observed when buparlisib was combined with the IGF1R inhibitor NVP-AEW541 and the mTORC1 inhibitor rapamycin. The addition of NVP-AEW541 also further reduced phospho-Akt levels and more potently induced apoptosis compared to buparlisib treatment alone. Additionally, the combination of buparlisib with the MEK1/2 inhibitor trametinib resulted in synergy in sarcoma cell lines possessing MAPK pathway mutations. Taken together, these data indicate buparlisib could be a novel therapy for the treatment of pediatric bone and soft tissue sarcomas.
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Affiliation(s)
- Jennifer L. Anderson
- Department of Pediatrics, Division of Hematology/Oncology, Gwynne Hazen Cherry Memorial Laboratories, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Ann Park
- Department of Pediatrics, Division of Hematology/Oncology, Gwynne Hazen Cherry Memorial Laboratories, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Ryan Akiyama
- Department of Pediatrics, Division of Hematology/Oncology, Gwynne Hazen Cherry Memorial Laboratories, University of California, Los Angeles, Los Angeles, California, United States of America
| | - William D. Tap
- Department of Medicine, Division of Solid Tumors, Sarcoma Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Christopher T. Denny
- Department of Pediatrics, Division of Hematology/Oncology, Gwynne Hazen Cherry Memorial Laboratories, University of California, Los Angeles, Los Angeles, California, United States of America
- Molecular Biology Institute, University of California, Los Angeles, Los Angeles, California, United States of America
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, United States of America
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Noah Federman
- Department of Pediatrics, Division of Hematology/Oncology, Gwynne Hazen Cherry Memorial Laboratories, University of California, Los Angeles, Los Angeles, California, United States of America
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California, United States of America
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California, United States of America
- * E-mail:
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145
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Sclafani F, Kim TY, Cunningham D, Kim TW, Tabernero J, Schmoll HJ, Roh JK, Kim SY, Park YS, Guren TK, Hawkes E, Clarke SJ, Ferry D, Frödin JE, Ayers M, Nebozhyn M, Peckitt C, Loboda A, Mauro DJ, Watkins DJ. A Randomized Phase II/III Study of Dalotuzumab in Combination With Cetuximab and Irinotecan in Chemorefractory, KRAS Wild-Type, Metastatic Colorectal Cancer. J Natl Cancer Inst 2015; 107:djv258. [PMID: 26405092 DOI: 10.1093/jnci/djv258] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 08/19/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Insulin-like growth factor type 1 receptor (IGF-1R) mediates resistance to epidermal growth factor receptor (EGFR) inhibition and may represent a therapeutic target. We conducted a multicenter, randomized, double blind, phase II/III trial of dalotuzumab, an anti-IGF-1R monoclonal antibody, with standard therapy in chemo-refractory, KRAS wild-type metastatic colorectal cancer. METHODS Eligible patients were randomly assigned to dalotuzumab 10mg/kg weekly (arm A), dalotuzumab 7.5mg/kg every alternate week (arm B), or placebo (arm C) in combination with cetuximab and irinotecan. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included exploratory biomarker analyses. All statistical tests were two-sided. RESULTS The trial was prematurely discontinued for futility after 344 eligible KRAS wild-type patients were included in the primary efficacy population (arm A = 116, arm B = 117, arm C = 111). Median PFS was 3.9 months in arm A (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 0.98 to 1.83, P = .07) and 5.4 months in arm B (HR = 1.13, 95% CI = 0.83 to 1.55, P = .44) compared with 5.6 months in arm C. Median OS was 10.8 months in arm A (HR = 1.41, 95% CI = 0.99 to 2.00, P = .06) and 11.6 months in arm B (HR = 1.26, 95% CI = 0.89 to 1.79, P = .18) compared with 14.0 months in arm C. Grade 3 or higher asthenia and hyperglycaemia occurred more frequently with dalotuzumab compared with placebo. In exploratory biomarker analyses, patients with high IGF-1 mRNA tumors in arm A had numerically better PFS (5.6 vs 3.6 months, HR = 0.59, 95% CI = 0.28 to 1.23, P = .16) and OS (17.9 vs 9.4 months, HR = 0.67, 95% CI = 0.31 to 1.45, P = .31) compared with those with high IGF-1 mRNA tumors in arm C. In contrast, in arm C high IGF-1 mRNA expression predicted lower response rate (17.6% vs 37.3%, P = .04), shorter PFS (3.6 vs 6.6 months, HR = 2.15, 95% CI = 1.15 to 4.02, P = .02), and shorter OS (9.4 vs 15.5 months, HR = 2.42, 95% CI = 1.21 to 4.82, P = .01). CONCLUSIONS Adding dalotuzumab to irinotecan and cetuximab was feasible but did not improve survival outcome. IGF-1R ligands are promising biomarkers for differential response to anti-EGFR and anti-IGF-1R therapies.
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Affiliation(s)
- Francesco Sclafani
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Tae Y Kim
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - David Cunningham
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM).
| | - Tae W Kim
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Josep Tabernero
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Hans J Schmoll
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Jae K Roh
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Sun Y Kim
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Young S Park
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Tormod K Guren
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Eliza Hawkes
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Steven J Clarke
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - David Ferry
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Jan-Erik Frödin
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Mark Ayers
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Michael Nebozhyn
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Clare Peckitt
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - Andrey Loboda
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - David J Mauro
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
| | - David J Watkins
- The Royal Marsden NHS Foundation Trust, London and Surrey, UK (FS, DC, EH, CP, DJW); Seoul National University College of Medicine, Seoul, Korea (TYK); Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (TWK); Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain (JT); University Clinic Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany (HJS); Yonsey Cancer Center, Yonsey University, College of Medicine, Seoul, Korea (JKR); Center for Colorectal Cancer, National Cancer Center, Seoul, Korea (SYK); Samsung Medical Center, Seoul, Korea (YSP); Oslo University Hospital, Oslo, Norway (TKG); Concord Repatriation General Hospital, Concord, Sydney, Australia (SJC); New Cross Hospital, Wolverhamptom, UK (DF); Karolinska University Hospital, Stockholm, Sweden (JEF); Merck & Co., Inc., Whitehouse Station, NJ (MA, MN, AL, DJM)
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146
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Huang X, Park H, Greene J, Pao J, Mulvey E, Zhou SX, Albert CM, Moy F, Sachdev D, Yee D, Rader C, Hamby CV, Loeb DM, Cairo MS, Zhou X. IGF1R- and ROR1-Specific CAR T Cells as a Potential Therapy for High Risk Sarcomas. PLoS One 2015; 10:e0133152. [PMID: 26173023 PMCID: PMC4501840 DOI: 10.1371/journal.pone.0133152] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/23/2015] [Indexed: 11/23/2022] Open
Abstract
Patients with metastatic or recurrent and refractory sarcomas have a dismal prognosis. Therefore, new targeted therapies are urgently needed. This study was designed to evaluate chimeric antigen receptor (CAR) T cells targeting the type I insulin-like growth factor receptor (IGF1R) or tyrosine kinase-like orphan receptor 1 (ROR1) molecules for their therapeutic potential against sarcomas. Here, we report that IGF1R (15/15) and ROR1 (11/15) were highly expressed in sarcoma cell lines including Ewing sarcoma, osteosarcoma, alveolar or embryonal rhabdomyosarcoma, and fibrosarcoma. IGF1R and ROR1 CAR T cells derived from eight healthy donors using the Sleeping Beauty (SB) transposon system were cytotoxic against sarcoma cells and produced high levels of IFN-γ, TNF-α and IL-13 in an antigen-specific manner. IGF1R and ROR1 CAR T cells generated from three sarcoma patients released significant amounts of IFN-γ in response to sarcoma stimulation. The adoptive transfer of IGF1R and ROR1 CAR T cells derived from a sarcoma patient significantly reduced tumor growth in pre-established, systemically disseminated and localized osteosarcoma xenograft models in NSG mice. Infusion of IGF1R and ROR1 CAR T cells also prolonged animal survival in a localized sarcoma model using NOD/scid mice. Our data indicate that both IGF1R and ROR1 can be effectively targeted by SB modified CAR T cells and that such CAR T cells may be useful in the treatment of high risk sarcoma patients.
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Affiliation(s)
- Xin Huang
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY, United States of America
| | - Haein Park
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY, United States of America
| | - Joseph Greene
- University of Minnesota College of Biological Sciences, Minneapolis, MN, United States of America
| | - James Pao
- New York Medical College School of Medicine, Valhalla, NY, United States of America
| | - Erin Mulvey
- New York Medical College School of Medicine, Valhalla, NY, United States of America
| | - Sophia X. Zhou
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States of America
| | - Catherine M. Albert
- Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States of America
| | - Fred Moy
- Department of Pathology, New York Medical College, Valhalla, NY, United States of America
| | - Deepali Sachdev
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States of America
| | - Douglas Yee
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States of America
| | - Christoph Rader
- Department of Cancer Biology, The Scripps Research Institute, Jupiter, FL, United States of America
- Department of Molecular Therapeutics, The Scripps Research Institute, Jupiter, FL, United States of America
| | - Carl V. Hamby
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, United States of America
| | - David M. Loeb
- Division of Pediatric Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States of America
| | - Mitchell S. Cairo
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY, United States of America
- Department of Pathology, New York Medical College, Valhalla, NY, United States of America
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, United States of America
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, United States of America
- Department of Medicine, New York Medical College, Valhalla, NY, United States of America
| | - Xianzheng Zhou
- Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY, United States of America
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, United States of America
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, United States of America
- * E-mail:
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147
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Capitini CM, Otto M, DeSantes KB, Sondel PM. Immunotherapy in pediatric malignancies: current status and future perspectives. Future Oncol 2015; 10:1659-78. [PMID: 25145434 DOI: 10.2217/fon.14.62] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Novel immune-based therapies are becoming available as additions to, and in some cases as alternatives to, the traditional treatment modalities such as chemotherapy, surgery and radiation that have improved outcomes for childhood cancer for decades. In this article, we will discuss what immunotherapies are being tested in the clinic, barriers to widespread application, and the future of immuno-oncology for childhood cancer. While in many cases, these therapies have shown dramatic responses in the setting of refractory or relapsed cancer, much remains to be learned about how to integrate these therapies into existing upfront regimens. The progress and challenges of developing immunotherapies for childhood cancer in a timely and cost-effective fashion will be discussed.
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Affiliation(s)
- Christian M Capitini
- Department of Pediatrics & Carbone Cancer Center, University of Wisconsin School of Medicine & Public Health, 1111 Highland Avenue, WIMR 4137, Madison, WI 53705, USA
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148
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Chugh R, Griffith KA, Davis EJ, Thomas DG, Zavala JD, Metko G, Brockstein B, Undevia SD, Stadler WM, Schuetze SM. Doxorubicin plus the IGF-1R antibody cixutumumab in soft tissue sarcoma: a phase I study using the TITE-CRM model. Ann Oncol 2015; 26:1459-64. [PMID: 25858498 DOI: 10.1093/annonc/mdv171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/27/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Insulin-like growth factor receptor (IGF-1R) has been studied as an oncologic target in soft tissue sarcoma (STS), but its role in sarcoma biology is unclear. Anti-IGF-1R antibody cixutumumab demonstrated acceptable toxicity but limited activity as a single agent in STS. We carried out a dose-escalation study of cixutumumab with doxorubicin to evaluate safety and dosing of the combination. PATIENTS AND METHODS Eligible patients with advanced STS were treated with cixutumumab intravenously on days 1/8/15 at one of three dose levels (A: 1 mg/kg, B: 3 mg/kg, C: 6 mg/kg) with doxorubicin at 75 mg/m(2) as a 48 h infusion on day 1 of a 21 day cycle. After six cycles of the combination, patients could receive cixutumumab alone. The Time-to-Event Continual Reassessment Method was used to estimate the probability of dose-limiting toxicity (DLT) and to assign patients to the dose with an estimated probability of DLT≤20%. RESULTS Between September 2008 and January 2012, 30 patients with advanced STS received a median of six cycles of therapy (range <1-22). Two DLTs were observed, grade 3 mucositis (dose level B) and grade 4 hyperglycemia (dose level C). Grade 2 and 3 reduced left ventricular ejection fraction was seen in three and two patients, respectively. Five partial responses were observed, and estimated progression-free survival was 5.3 months (95% confidence interval 3.0-6.3) in 26 response-assessable patients. Immunohistochemical staining of 11 available tumor samples for IGF-1R and phospho-IGF-1R was not significantly different among responders and non-responders, and serum analysis of select single-nucleotide polymorphisms did not predict for cardiotoxicity. CONCLUSION The maximum tolerated dose was doxorubicin 75 mg/m(2) on day 1 and cixitumumab 6 mg/kg on days 1/8/15 of a 21 day cycle. Cardiac toxicity was observed and should be monitored in subsequent studies, which should be considered in STS only if a predictive biomarker of benefit to anti-IGF-1R therapy is identified. TRIAL REGISTRATION ClinicalTrials.gov:NCT00720174.
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Affiliation(s)
- R Chugh
- Departments of Internal Medicine, University of Michigan, Ann Arbor
| | - K A Griffith
- Biostatistics, University of Michigan, Ann Arbor
| | - E J Davis
- Departments of Internal Medicine, University of Michigan, Ann Arbor
| | - D G Thomas
- Pathology, University of Michigan, Ann Arbor
| | - J D Zavala
- Cancer Clinical Trials Office, University of Chicago, Chicago
| | - G Metko
- Clinical Trials Office, University of Michigan, Ann Arbor
| | | | - S D Undevia
- Department of Medicine, University of Chicago, Chicago, USA
| | - W M Stadler
- Department of Medicine, University of Chicago, Chicago, USA
| | - S M Schuetze
- Departments of Internal Medicine, University of Michigan, Ann Arbor
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149
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Jiang Y, Ludwig J, Janku F. Targeted therapies for advanced Ewing sarcoma family of tumors. Cancer Treat Rev 2015; 41:391-400. [PMID: 25869102 DOI: 10.1016/j.ctrv.2015.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/17/2015] [Accepted: 03/20/2015] [Indexed: 12/30/2022]
Abstract
The prognosis of adolescent and young adult patients battling metastatic Ewing sarcoma family of tumors (ESFT) remains less than 30% despite the development of systemic therapies. In the era of personalized medicine, novel molecular targets have been tested in preclinical or clinical settings in ESFT. In this review, we focus on early clinical and translational research that identified multiple molecular targets, including IGF-1R; mTOR; tyrosine kinase inhibitors; EWS-FLI1-related targets, and others. Overall, novel targeted therapies demonstrated modest efficacy; however pronounced and durable antineoplastic responses have been observed in small subsets of treated patients, for example with IGF-1R antibodies. Identifying outcome-predicting biomarkers and overcoming treatment resistance remain major challenges. Due to the rarity of ESFT, multi-institutional collaboration efforts of clinicians, basic and translational scientists are needed in order to understand biology of therapeutic response or resistance, which can lead to development of novel therapeutic methods and improved patient outcomes.
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Affiliation(s)
- Yunyun Jiang
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Ludwig
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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150
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Heskamp S, Boerman OC, Molkenboer-Kuenen JDM, Koornstra RHT, Linn SC, Oyen WJG, van der Graaf WTA, van Laarhoven HWM. Dynamics of IGF-1R expression during endocrine breast cancer treatment. Mol Imaging Biol 2015; 16:529-37. [PMID: 24532107 DOI: 10.1007/s11307-014-0723-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim was to assess changes in insulin-like growth factor 1 receptor (IGF-1R) expression with immunoSPECT/CT and to study the dynamics of IGF-1R expression of human breast tumors during endocrine treatment. PROCEDURES Mice with MCF-7 xenografts were treated with estradiol or tamoxifen, and IGF-1R expression was measured by immunohistochemistry and immunoSPECT/CT using (111)In-R1507 (anti-IGF-1R antibody). Moreover, IGF-1R expression was analyzed immunohistochemically on 22 human breast tumors, treated preoperatively with endocrine therapy. RESULTS Estradiol resulted in an increased expression of IGF-1R, as measured by immunohistochemistry and immunoSPECT/CT. In contrast, tamoxifen resulted in a downregulation of IGF-1R, whereas this could not be measured with immunoSPECT/CT. A downregulation was also detectable in 9 out of 22 (41 %) human breast tumors after endocrine therapy. CONCLUSIONS Anti-estrogen treatment can cause a reduction in membranous IGF-1R expression. Based on these results, a combination of anti-IGF-1R antibodies with anti-estrogen therapy might not be a rational treatment strategy.
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Affiliation(s)
- Sandra Heskamp
- Department of Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands,
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