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Morgan RD, Clamp AR, Evans DGR, Edmondson RJ, Jayson GC. PARP inhibitors in platinum-sensitive high-grade serous ovarian cancer. Cancer Chemother Pharmacol 2018; 81:647-658. [PMID: 29464354 PMCID: PMC5854713 DOI: 10.1007/s00280-018-3532-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/25/2018] [Indexed: 12/18/2022]
Abstract
Purpose Poly(ADP-ribose) polymerase inhibitors (PARPi) have changed the management of high-grade serous ovarian cancer (HGSOC). The rationale for the development of PARPi was based on the concept of synthetic lethality, in which a cell can survive a deficiency of one gene/gene product, but may die if there is a deficiency in a combination of genes/gene products. In women with BRCA1/2 deficiency within their ovarian cancer tissue, inhibition of PARP imposes an intolerable burden of DNA damage repair deficiency and may induce cell death. Methods Clinical trials have evaluated PARPi as single-agent therapeutics and as maintenance treatment following platinum-based chemotherapy for HGSOC. Clinical data suggest the most impressive anti-tumour activity occurs in women with platinum-sensitive ovarian cancer and germline or somatic BRCA1/2 mutations (g/sBRCAmt). Results In the maintenance setting, randomised trials have shown that PARPi compared to placebo reduce the hazard ratio for the development of progressive disease to 0.2–0.27 for patients with a g/sBRCAmt; to 0.34–0.38 for patients with putative evidence of DNA damage repair deficiency; and to 0.35–0.45 in an unselected population with HGSOC. Furthermore, phase 1/2 trials have reported single-agent anti-tumour response rates in gBRCAmt of approximately 50% in platinum-sensitive and 25% in platinum-resistant disease. Conclusion Here, we discuss the evidence for the use of PARPi as single-agent therapeutics and maintenance treatment in HGSOC and evaluate the genetic assays used in clinical trials so far. We discuss the emerging role of platinum sensitivity as a broad eligibility criteria for the use of PARPi.
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Affiliation(s)
- Robert D Morgan
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Manchester Cancer Research Centre, The University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Andrew R Clamp
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.,Manchester Cancer Research Centre, The University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - D Gareth R Evans
- Division of Evolution and Genomic Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Richard J Edmondson
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Central Manchester NHS Foundation Trust, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Gordon C Jayson
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK. .,Manchester Cancer Research Centre, The University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK.
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Pettitt SJ, Lord CJ. PARP inhibitors and breast cancer: highlights and hang-ups. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2018. [DOI: 10.1080/23808993.2018.1438187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Stephen J. Pettitt
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
| | - Christopher J. Lord
- The CRUK Gene Function Laboratory and Breast Cancer Now Toby Robins Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
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303
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Sen T, Gay CM, Byers LA. Targeting DNA damage repair in small cell lung cancer and the biomarker landscape. Transl Lung Cancer Res 2018. [PMID: 29535912 DOI: 10.21037/tlcr.2018.02.03] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy that accounts for 14% of all lung cancer diagnoses. Despite decades of active research, treatment options for SCLC are limited and resistance to the few Food and Drug Administration (FDA) approved therapies develops rapidly. With no approved targeted agents to date, new therapeutic strategies are desperately needed. SCLC is characterized by high mutation burden, ubiquitous loss of TP53 and RB1, mutually exclusive amplification of MYC family members, thereby, high genomic instability. Studies in the past few years have demonstrated the potential of targeting the DNA damage response (DDR) pathway as a promising therapeutic strategy for SCLC. Inhibitors targeting DDR proteins have shown promise in preclinical models, and are under clinical investigation as single agents and in combination with cytotoxic therapies. Recent efforts to expand the therapeutic arsenal toward SCLC have focused in part on immune checkpoint inhibitors, such as agents targeting the receptor-ligand pair programmed cell death protein 1 (PD-1) and programmed death-ligand 1 (PD-L1). Clinical trials have confirmed activity of these agents in extensive stage (ES)-SCLC. However, while several patients had dramatic responses, overall response rates to immune checkpoint blockade (ICB) remain poor. As a result, there is an urgent need to develop rational combination therapies to enhance response rates to immunotherapy in SCLC. Identification of predictive biomarkers for patient stratification, identifying effective combinations to overcome adaptive resistance to DDR-targeted therapies and identifying strategies to enhance response to immunotherapy are areas of active investigation in SCLC.
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Affiliation(s)
- Triparna Sen
- Department of Thoracic and Head & Neck Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Carl M Gay
- Department of Thoracic and Head & Neck Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Averett Byers
- Department of Thoracic and Head & Neck Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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304
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Novel poly-ADP-ribose polymerase inhibitor combination strategies in ovarian cancer. Curr Opin Obstet Gynecol 2018; 30:7-16. [DOI: 10.1097/gco.0000000000000428] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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305
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Khiabanian H, Hirshfield KM, Goldfinger M, Bird S, Stein M, Aisner J, Toppmeyer D, Wong S, Chan N, Dhar K, Gheeya J, Vig H, Hadigol M, Pavlick D, Ansari S, Ali S, Xia B, Rodriguez-Rodriguez L, Ganesan S. Inference of Germline Mutational Status and Evaluation of Loss of Heterozygosity in High-Depth, Tumor-Only Sequencing Data. JCO Precis Oncol 2018; 2018:PO.17.00148. [PMID: 30246169 PMCID: PMC6148761 DOI: 10.1200/po.17.00148] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Inherited germline defects are implicated in up to 10% of human tumors, with particularly well-known roles in breast and ovarian cancers that harbor BRCA1/2-mutated genes. There is also increasing evidence for the role of germline alterations in other malignancies such as colon and pancreatic cancers. Mutations in familial cancer genes can be detected by high throughput sequencing (HTS), when applied to formalin-fixed paraffin-embedded (FFPE) tumor specimens. However, due to often lack of patient-matched control normal DNA and/or low tumor purity, there is limited ability to determine the genomic status of these alterations (germline versus somatic) and to assess the presence of loss of heterozygosity (LOH). These analyses, especially when applied to genes such as BRCA1/2, can have significant clinical implications for patient care. METHODS LOHGIC (LOH-Germline Inference Calculator) is a statistical model selection method to determine somatic-versus-germline status and predict LOH for mutations identified via clinical grade, high-depth, hybrid-capture tumor-only sequencing. LOHGIC incorporates statistical uncertainties inherent to HTS as well as specimen biases in tumor purity estimates, which we use to assess BRCA1/2 mutations in 1,636 specimens sequenced at Rutgers Cancer Institute of New Jersey. RESULTS Evaluation of LOHGIC with available germline sequencing from BRCA1/2 testing, demonstrates 93% accuracy, 100% precision, and 96% recall. This analysis highlights a differential tumor spectrum associated with BRCA1/2 mutations. CONCLUSION LOHGIC can assess LOH status for both germline and somatic mutations. It also can be applied to any gene with candidate, inherited mutations. This approach demonstrates the clinical utility of targeted sequencing in both identifying patients with potential germline alterations in tumor suppressor genes as well as estimating LOH occurrence in cancer cells, which may confer therapeutic relevance.
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Affiliation(s)
- Hossein Khiabanian
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Kim M. Hirshfield
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Mendel Goldfinger
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Simon Bird
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Mark Stein
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Joseph Aisner
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Deborah Toppmeyer
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Serena Wong
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Nancy Chan
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Kalyani Dhar
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Jinesh Gheeya
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Hetal Vig
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Mohammad Hadigol
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Dean Pavlick
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Sepand Ansari
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Siraj Ali
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Bing Xia
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Lorna Rodriguez-Rodriguez
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
| | - Shridar Ganesan
- Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Simon Bird, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Kalyani Dhar, Jinesh Gheeya, Hetal Vig, Mohammad Hadigol, Sepand Ansari, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Cancer Institute of New Jersey, Rutgers University; Hossein Khiabanian, Kim M. Hirshfield, Mendel Goldfinger, Mark Stein, Joseph Aisner, Deborah Toppmeyer, Serena Wong, Nancy Chan, Bing Xia, Lorna Rodriguez-Rodriguez, and Shridar Ganesan, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; and Dean Pavlick and Siraj Ali, Foundation Medicine, Cambridge, MA
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Ferrara R, Simionato F, Ciccarese C, Grego E, Cingarlini S, Iacovelli R, Bria E, Tortora G, Melisi D. The development of PARP as a successful target for cancer therapy. Expert Rev Anticancer Ther 2017; 18:161-175. [DOI: 10.1080/14737140.2018.1419870] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Roberto Ferrara
- Section of Oncology, Department of Medicine, Università degli Studi di Verona, Verona, Italy
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Francesca Simionato
- Section of Oncology, Department of Medicine, Università degli Studi di Verona, Verona, Italy
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Chiara Ciccarese
- Section of Oncology, Department of Medicine, Università degli Studi di Verona, Verona, Italy
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elisabetta Grego
- Section of Oncology, Department of Medicine, Università degli Studi di Verona, Verona, Italy
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Cingarlini
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Roberto Iacovelli
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emilio Bria
- Section of Oncology, Department of Medicine, Università degli Studi di Verona, Verona, Italy
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giampaolo Tortora
- Section of Oncology, Department of Medicine, Università degli Studi di Verona, Verona, Italy
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Melisi
- Section of Oncology, Department of Medicine, Università degli Studi di Verona, Verona, Italy
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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307
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Foy V, Schenk MW, Baker K, Gomes F, Lallo A, Frese KK, Forster M, Dive C, Blackhall F. Targeting DNA damage in SCLC. Lung Cancer 2017; 114:12-22. [PMID: 29173760 DOI: 10.1016/j.lungcan.2017.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/12/2017] [Accepted: 10/14/2017] [Indexed: 02/07/2023]
Abstract
SCLC accounts for 15% of lung cancer worldwide. Characterised by early dissemination and rapid development of chemo-resistant disease, less than 5% of patients survive 5 years. Despite 3 decades of clinical trials there has been no change to the standard platinum and etoposide regimen for first line treatment developed in the 1970's. The exceptionally high number of genomic aberrations observed in SCLC combined with the characteristic rapid cellular proliferation results in accumulation of DNA damage and genomic instability. To flourish in this precarious genomic context, SCLC cells are reliant on functional DNA damage repair pathways and cell cycle checkpoints. Current cytotoxic drugs and radiotherapy treatments for SCLC have long been known to act by induction of DNA damage and the response of cancer cells to such damage determines treatment efficacy. Recent years have witnessed improved understanding of strategies to exploit DNA damage and repair mechanisms in order to increase treatment efficacy. This review will summarise the rationale to target DNA damage response in SCLC, the progress made in evaluating novel DDR inhibitors and highlight various ongoing challenges for their clinical development in this disease.
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Affiliation(s)
- Victoria Foy
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, UK
| | - Maximilian W Schenk
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, UK
| | - Katie Baker
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence, UK
| | - Fabio Gomes
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Oncologia Medica, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Alice Lallo
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, UK
| | - Kristopher K Frese
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, UK
| | - Martin Forster
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute, University of Manchester, UK; Cancer Research UK Lung Cancer Centre of Excellence, UK
| | - Fiona Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Institute of Cancer Sciences, University of Manchester, Manchester, UK.
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308
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Eberst L, Brahmi M, Cassier PA. [DNA repair as a therapeutic target]. Bull Cancer 2017; 104:988-998. [PMID: 29132681 DOI: 10.1016/j.bulcan.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
The transmission of an intact and stable genetic code at each cell division relies on different DNA repair systems. Germline mutations of some of these genes cause cancer predisposition, whereas somatic mutations are frequently found in various cancer types, generating genomic instability. As a consequence, cancer cell becomes more susceptible to additional DNA damage. Pharmacological inhibition of DNA repair pathways exploits this frailty: it triggers more damages than cancer cell can tolerate, finally leading to apoptosis. The success of PARP (poly-ADP-ribose polymerase) inhibitors in BRCA1/2-mutated ovarian cancer shows the clinical relevance of this strategy. Herein, we explain the functioning of different DNA-repair pathways, describe the implicated proteins, and their close relation with cell-cycle checkpoints. We focus on novel therapeutic agents targeting DNA repair, their clinical results, and discuss challenges of combination therapies.
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Affiliation(s)
- Lauriane Eberst
- Centre Léon-Bérard, département de médecine, 28, rue Laennec, 69008 Lyon, France.
| | - Medhi Brahmi
- Centre Léon-Bérard, département de médecine, 28, rue Laennec, 69008 Lyon, France
| | - Philippe A Cassier
- Centre Léon-Bérard, département de médecine, 28, rue Laennec, 69008 Lyon, France
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309
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Corrado G, Salutari V, Palluzzi E, Distefano MG, Scambia G, Ferrandina G. Optimizing treatment in recurrent epithelial ovarian cancer. Expert Rev Anticancer Ther 2017; 17:1147-1158. [DOI: 10.1080/14737140.2017.1398088] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giacomo Corrado
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Vanda Salutari
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Eleonora Palluzzi
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Grazia Distefano
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Department of Health of Woman and Child, Gynecologic Oncology Unit, Catholic University of Sacred Heart, Rome, Italy
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310
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Ohmoto A, Yachida S. Current status of poly(ADP-ribose) polymerase inhibitors and future directions. Onco Targets Ther 2017; 10:5195-5208. [PMID: 29138572 PMCID: PMC5667784 DOI: 10.2147/ott.s139336] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Inhibitors of poly(ADP-ribose) polymerases (PARPs), which play a key role in DNA damage/repair pathways, have been developed as antitumor agents based on the concept of synthetic lethality. Synthetic lethality is the idea that cell death would be efficiently induced by simultaneous loss of function of plural key molecules, for example, by exposing tumor cells with inactivating gene mutation of BRCA-mediated DNA repair to chemically induced inhibition of PARPs. Indeed, three PARP inhibitors, olaparib, rucaparib and niraparib have already been approved in the US or Europe, mainly for the treatment of BRCA-mutant ovarian cancer. Clinical trials of various combinations of PARP inhibitors with cytotoxic or molecular-targeted agents are also underway. In particular, expanded applications of PARP inhibitors are anticipated following recent reports that defects in homologous recombination repair (HRR) are associated with mutations in repair genes other than BRCA1/BRCA2, such as ATM, ATR, PALB2, RAD51, CHEK1 and CHEK2, as well as with epigenetic loss of BRCA1 function through promoter methylation or overexpression of the BRCA2-interacting transcriptional repressor EMSY. Current topics of interest include selection of the best agent in each clinical context, identification of new treatment targets for HRR-proficient cases, and development of PARP inhibitor-based regimens that are less toxic and that prolong overall survival as well as progression-free survival. In addition, potential long-term side effects and suitable biomarkers for predicting efficacy and mechanisms of clinical resistance are in discussion. This review summarizes representative preclinical and clinical data for PARP inhibitors and discusses their potential for future applications to treat various malignancies.
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Affiliation(s)
- Akihiro Ohmoto
- Laboratory of Clinical Genomics, National Cancer Center Research Institute, Tokyo
| | - Shinichi Yachida
- Laboratory of Clinical Genomics, National Cancer Center Research Institute, Tokyo.,Department of Cancer Genome Informatics, Graduate School of Medicine, Faculty of Medicine, Osaka University, Osaka, Japan
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311
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Yurgelun MB. Germline Testing for Individuals With Pancreatic Cancer: The Benefits and Challenges to Casting a Wider Net. J Clin Oncol 2017; 35:3375-3377. [DOI: 10.1200/jco.2017.74.7535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Matthew B. Yurgelun
- Matthew B. Yurgelun, Dana-Farber Cancer Institute; Brigham & Women’s Hospital; and Harvard Medical School, Boston, MA
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312
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Bitler BG, Watson ZL, Wheeler LJ, Behbakht K. PARP inhibitors: Clinical utility and possibilities of overcoming resistance. Gynecol Oncol 2017; 147:695-704. [PMID: 29037806 DOI: 10.1016/j.ygyno.2017.10.003] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/01/2017] [Accepted: 10/03/2017] [Indexed: 12/21/2022]
Abstract
PARP inhibitors represent a major breakthrough in ovarian cancer care. Almost half of all ovarian cancers have deficiencies in the homologous recombination (HR) DNA repair pathway, namely BRCA1/2 mutations. Given the limited therapeutic options for recurrent ovarian cancer patients there has been a significant effort to develop novel therapies to exploit DNA repair deficiencies. In 2005 and 2006, inhibiting PARP enzymes was first observed to be highly effective against cancers with HR deficiencies. PARP inhibitors are being utilized in the clinic to manage recurrent ovarian cancers that display defects in the HR repair pathway. However, PARP inhibitors also show significant clinical benefit in patients without HR deficiencies. There are currently three FDA-approved PARP inhibitors for recurrent ovarian cancer and an additional two PARP inhibitors being evaluated in late stage clinical trials. Given the expanding clinical use of PARP inhibitors and the high likelihood of acquired resistance, there is a significant need for clinical strategies to manage PARP inhibitor resistant disease. This review will examine PARP inhibitors in the context of: indications and toxicities, novel biomarkers to predict response, targeted-therapy resistance, and potential approaches to manage resistant disease.
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Affiliation(s)
- Benjamin G Bitler
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, The University of Colorado, Aurora, CO, United States.
| | - Zachary L Watson
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, The University of Colorado, Aurora, CO, United States
| | - Lindsay J Wheeler
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, The University of Colorado, Aurora, CO, United States; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Colorado, Aurora, CO, United States
| | - Kian Behbakht
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, The University of Colorado, Aurora, CO, United States; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Colorado, Aurora, CO, United States.
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313
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Pasternak AL, Ward KM, Luzum JA, Ellingrod VL, Hertz DL. Germline genetic variants with implications for disease risk and therapeutic outcomes. Physiol Genomics 2017; 49:567-581. [PMID: 28887371 PMCID: PMC5668651 DOI: 10.1152/physiolgenomics.00035.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Genetic testing has multiple clinical applications including disease risk assessment, diagnosis, and pharmacogenomics. Pharmacogenomics can be utilized to predict whether a pharmacologic therapy will be effective or to identify patients at risk for treatment-related toxicity. Although genetic tests are typically ordered for a distinct clinical purpose, the genetic variants that are found may have additional implications for either disease or pharmacology. This review will address multiple examples of germline genetic variants that are informative for both disease and pharmacogenomics. The discussed relationships are diverse. Some of the agents are targeted for the disease-causing genetic variant, while others, although not targeted therapies, have implications for the disease they are used to treat. It is also possible that the disease implications of a genetic variant are unrelated to the pharmacogenomic implications. Some of these examples are considered clinically actionable pharmacogenes, with evidence-based, pharmacologic treatment recommendations, while others are still investigative as areas for additional research. It is important that clinicians are aware of both the disease and pharmacogenomic associations of these germline genetic variants to ensure patients are receiving comprehensive personalized care.
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Affiliation(s)
- Amy L Pasternak
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Kristen M Ward
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Jasmine A Luzum
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Vicki L Ellingrod
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, Michigan
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314
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PARP Inhibitors in Breast Cancer: Latest Evidence. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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315
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Goodall J, Mateo J, Yuan W, Mossop H, Porta N, Miranda S, Perez-Lopez R, Dolling D, Robinson DR, Sandhu S, Fowler G, Ebbs B, Flohr P, Seed G, Rodrigues DN, Boysen G, Bertan C, Atkin M, Clarke M, Crespo M, Figueiredo I, Riisnaes R, Sumanasuriya S, Rescigno P, Zafeiriou Z, Sharp A, Tunariu N, Bianchini D, Gillman A, Lord CJ, Hall E, Chinnaiyan AM, Carreira S, de Bono JS. Circulating Cell-Free DNA to Guide Prostate Cancer Treatment with PARP Inhibition. Cancer Discov 2017; 7:1006-1017. [PMID: 28450425 PMCID: PMC6143169 DOI: 10.1158/2159-8290.cd-17-0261] [Citation(s) in RCA: 312] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/15/2017] [Accepted: 04/26/2017] [Indexed: 12/13/2022]
Abstract
Biomarkers for more precise patient care are needed in metastatic prostate cancer. We have reported a phase II trial (TOPARP-A) of the PARP inhibitor olaparib in metastatic prostate cancer, demonstrating antitumor activity associating with homologous recombination DNA repair defects. We now report targeted and whole-exome sequencing of serial circulating cell-free DNA (cfDNA) samples collected during this trial. Decreases in cfDNA concentration independently associated with outcome in multivariable analyses (HR for overall survival at week 8: 0.19; 95% CI, 0.06-0.56; P = 0.003). All tumor tissue somatic DNA repair mutations were detectable in cfDNA; allele frequency of somatic mutations decreased selectively in responding patients (χ2P < 0.001). At disease progression, following response to olaparib, multiple subclonal aberrations reverting germline and somatic DNA repair mutations (BRCA2, PALB2) back in frame emerged as mechanisms of resistance. These data support the role of liquid biopsies as a predictive, prognostic, response, and resistance biomarker in metastatic prostate cancer.Significance: We report prospectively planned, serial, cfDNA analyses from patients with metastatic prostate cancer treated on an investigator-initiated phase II trial of olaparib. These analyses provide predictive, prognostic, response, and resistance data with "second hit" mutations first detectable at disease progression, suggesting clonal evolution from treatment-selective pressure and platinum resistance. Cancer Discov; 7(9); 1006-17. ©2017 AACR.See related commentary by Domchek, p. 937See related article by Kondrashova et al., p. 984See related article by Quigley et al., p. 999This article is highlighted in the In This Issue feature, p. 920.
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Affiliation(s)
- Jane Goodall
- The Institute of Cancer Research, London, United Kingdom
| | - Joaquin Mateo
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Wei Yuan
- The Institute of Cancer Research, London, United Kingdom
| | - Helen Mossop
- The Institute of Cancer Research, London, United Kingdom
| | - Nuria Porta
- The Institute of Cancer Research, London, United Kingdom
| | - Susana Miranda
- The Institute of Cancer Research, London, United Kingdom
| | - Raquel Perez-Lopez
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David Dolling
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Gemma Fowler
- The Institute of Cancer Research, London, United Kingdom
| | - Berni Ebbs
- The Institute of Cancer Research, London, United Kingdom
| | - Penny Flohr
- The Institute of Cancer Research, London, United Kingdom
| | - George Seed
- The Institute of Cancer Research, London, United Kingdom
| | - Daniel Nava Rodrigues
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gunther Boysen
- The Institute of Cancer Research, London, United Kingdom
| | - Claudia Bertan
- The Institute of Cancer Research, London, United Kingdom
| | - Mark Atkin
- The Institute of Cancer Research, London, United Kingdom
| | - Matthew Clarke
- The Institute of Cancer Research, London, United Kingdom
| | - Mateus Crespo
- The Institute of Cancer Research, London, United Kingdom
| | | | - Ruth Riisnaes
- The Institute of Cancer Research, London, United Kingdom
| | - Semini Sumanasuriya
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pasquale Rescigno
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Zafeiris Zafeiriou
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Adam Sharp
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Diletta Bianchini
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alexa Gillman
- The Institute of Cancer Research, London, United Kingdom
| | | | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Johann S de Bono
- The Institute of Cancer Research, London, United Kingdom.
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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316
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Sabari JK, Lok BH, Laird JH, Poirier JT, Rudin CM. Unravelling the biology of SCLC: implications for therapy. Nat Rev Clin Oncol 2017; 14:549-561. [PMID: 28534531 PMCID: PMC5843484 DOI: 10.1038/nrclinonc.2017.71] [Citation(s) in RCA: 309] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Small-cell lung cancer (SCLC) is an aggressive malignancy associated with a poor prognosis. First-line treatment has remained unchanged for decades, and a paucity of effective treatment options exists for recurrent disease. Nonetheless, advances in our understanding of SCLC biology have led to the development of novel experimental therapies. Poly [ADP-ribose] polymerase (PARP) inhibitors have shown promise in preclinical models, and are under clinical investigation in combination with cytotoxic therapies and inhibitors of cell-cycle checkpoints.Preclinical data indicate that targeting of histone-lysine N-methyltransferase EZH2, a regulator of chromatin remodelling implicated in acquired therapeutic resistance, might augment and prolong chemotherapy responses. High expression of the inhibitory Notch ligand Delta-like protein 3 (DLL3) in most SCLCs has been linked to expression of Achaete-scute homologue 1 (ASCL1; also known as ASH-1), a key transcription factor driving SCLC oncogenesis; encouraging preclinical and clinical activity has been demonstrated for an anti-DLL3-antibody-drug conjugate. The immune microenvironment of SCLC seems to be distinct from that of other solid tumours, with few tumour-infiltrating lymphocytes and low levels of the immune-checkpoint protein programmed cell death 1 ligand 1 (PD-L1). Nonetheless, immunotherapy with immune-checkpoint inhibitors holds promise for patients with this disease, independent of PD-L1 status. Herein, we review the progress made in uncovering aspects of the biology of SCLC and its microenvironment that are defining new therapeutic strategies and offering renewed hope for patients.
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Affiliation(s)
- Joshua K Sabari
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Benjamin H Lok
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, New York 10065, USA
| | - James H Laird
- New York University School of Medicine, 550 1st Avenue, New York, New York 10016, USA
| | - John T Poirier
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center
| | - Charles M Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center
- Weill Cornell Medical College, 1300 York Avenue, New York, New York 10065, USA
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317
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Understanding Resistance Mechanisms and Expanding the Therapeutic Utility of PARP Inhibitors. Cancers (Basel) 2017; 9:cancers9080109. [PMID: 28829366 PMCID: PMC5575612 DOI: 10.3390/cancers9080109] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 11/20/2022] Open
Abstract
Poly-(ADP-ribose) polymerase (PARP) inhibitors act through synthetic lethality in cells with defects in homologous recombination (HR) DNA repair caused by molecular aberrations such as BRCA mutations, and is approved for treatment in ovarian cancer, with promising clinical activity against other HR defective tumors including breast and prostate cancers. Three PARP inhibitors have been FDA approved, while another two have shown promising activity and are in late stage development. Nonetheless, both primary and secondary resistance to PARP inhibition have led to treatment failure, and the development of predictive biomarkers and the ability to identify and overcome mechanisms of resistance is vital for optimization of its clinical utility. Additionally, there has been evidence that PARP inhibition may have a therapeutic role beyond HR deficient tumors which warrants further investigation, both as single agent and in combination with other therapeutic modalities like cytotoxic chemotherapy, radiation, targeted therapy and immunotherapy. With new strategies to overcome resistance and expand its therapeutic utility, PARP inhibitors are likely to become a staple in our armamentarium of drugs in cancer therapeutics.
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318
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Robson M, Im SA, Senkus E, Xu B, Domchek SM, Masuda N, Delaloge S, Li W, Tung N, Armstrong A, Wu W, Goessl C, Runswick S, Conte P. Olaparib for Metastatic Breast Cancer in Patients with a Germline BRCA Mutation. N Engl J Med 2017; 377:523-533. [PMID: 28578601 DOI: 10.1056/nejmoa1706450] [Citation(s) in RCA: 2054] [Impact Index Per Article: 293.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Olaparib is an oral poly(adenosine diphosphate-ribose) polymerase inhibitor that has promising antitumor activity in patients with metastatic breast cancer and a germline BRCA mutation. METHODS We conducted a randomized, open-label, phase 3 trial in which olaparib monotherapy was compared with standard therapy in patients with a germline BRCA mutation and human epidermal growth factor receptor type 2 (HER2)-negative metastatic breast cancer who had received no more than two previous chemotherapy regimens for metastatic disease. Patients were randomly assigned, in a 2:1 ratio, to receive olaparib tablets (300 mg twice daily) or standard therapy with single-agent chemotherapy of the physician's choice (capecitabine, eribulin, or vinorelbine in 21-day cycles). The primary end point was progression-free survival, which was assessed by blinded independent central review and was analyzed on an intention-to-treat basis. RESULTS Of the 302 patients who underwent randomization, 205 were assigned to receive olaparib and 97 were assigned to receive standard therapy. Median progression-free survival was significantly longer in the olaparib group than in the standard-therapy group (7.0 months vs. 4.2 months; hazard ratio for disease progression or death, 0.58; 95% confidence interval, 0.43 to 0.80; P<0.001). The response rate was 59.9% in the olaparib group and 28.8% in the standard-therapy group. The rate of grade 3 or higher adverse events was 36.6% in the olaparib group and 50.5% in the standard-therapy group, and the rate of treatment discontinuation due to toxic effects was 4.9% and 7.7%, respectively. CONCLUSIONS Among patients with HER2-negative metastatic breast cancer and a germline BRCA mutation, olaparib monotherapy provided a significant benefit over standard therapy; median progression-free survival was 2.8 months longer and the risk of disease progression or death was 42% lower with olaparib monotherapy than with standard therapy. (Funded by AstraZeneca; OlympiAD ClinicalTrials.gov number, NCT02000622 .).
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Affiliation(s)
- Mark Robson
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Seock-Ah Im
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Elżbieta Senkus
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Binghe Xu
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Susan M Domchek
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Norikazu Masuda
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Suzette Delaloge
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Wei Li
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Nadine Tung
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Anne Armstrong
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Wenting Wu
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Carsten Goessl
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Sarah Runswick
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
| | - Pierfranco Conte
- From the Memorial Sloan Kettering Cancer Center, New York (M.R.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea (S.-A.I.); Medical University of Gdańsk, Gdańsk, Poland (E.S.); National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (B.X.), and the First Hospital of Jilin University, Changchun (W.L.) - both in China; Basser Center, University of Pennsylvania, Philadelphia (S.M.D.); National Hospital Organization, Osaka National Hospital, Osaka, Japan (N.M.); Institut Gustave Roussy, Villejuif, France (S.D.); Beth Israel Deaconess Medical Center, Dana-Farber Harvard Cancer Center, Boston (N.T.); Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, University of Manchester, Manchester (A.A.), and AstraZeneca, Macclesfield (S.R.) - both in the United Kingdom; AstraZeneca, Gaithersburg, MD (W.W., C.G.); and University of Padua and Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy (P.C.)
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Dhawan MS, Bartelink IH, Aggarwal RR, Leng J, Zhang JZ, Pawlowska N, Terranova-Barberio M, Grabowsky JA, Gewitz A, Chien AJ, Moasser M, Kelley RK, Maktabi T, Thomas S, Munster PN. Differential Toxicity in Patients with and without DNA Repair Mutations: Phase I Study of Carboplatin and Talazoparib in Advanced Solid Tumors. Clin Cancer Res 2017; 23:6400-6410. [PMID: 28790114 DOI: 10.1158/1078-0432.ccr-17-0703] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/24/2017] [Accepted: 08/04/2017] [Indexed: 11/16/2022]
Abstract
Purpose: The PARP inhibitor (PARPi) talazoparib may potentiate activity of chemotherapy and toxicity in cells vulnerable to DNA damage.Experimental Design: This phase I study evaluated the safety, tolerability, pharmacokinetics, and efficacy of talazoparib and carboplatin. Pharmacokinetic modeling explored associations between DNA vulnerability and hematologic toxicity.Results: Twenty-four patients (eight males; 16 females) with solid tumors were enrolled in four cohorts at 0.75 and 1 mg daily talazoparib and weekly carboplatin (AUC 1 and 1.5, every 2 weeks or every 3 weeks), including 14 patients (58%) with prior platinum treatment. Dose-limiting toxicities included grade 3 fatigue and grade 4 thrombocytopenia; the MTD was not reached. Grade 3/4 toxicities included fatigue (13%), neutropenia (63%), thrombocytopenia (29%), and anemia (38%). After cycle 2's dose, delays/reductions were required in all patients. One complete and two partial responses occurred in germline BRCA1/2 (gBRCA1/2) patients. Four patients showed stable disease beyond 4 months, three of which had known mutations in DNA repair pathways. Pharmacokinetic toxicity modeling suggests that after three cycles of carboplatin AUC 1.5 every 3 weeks and talazoparib 1 mg daily, neutrophil counts decreased 78% [confidence interval (CI), 87-68] from baseline in gBRCA carriers and 63% (CI, 72-55) in noncarriers (P < 0.001). Pharmacokinetic toxicity modeling suggests an intermittent, pulse dosing schedule of PARP inhibition, differentiated by gBRCA mutation status, may improve the benefit/risk ratio of combination therapy.Conclusions: Carboplatin and talazoparib showed efficacy in DNA damage mutation carriers, but hematologic toxicity was more pronounced in gBRCA carriers. Carboplatin is best combined with intermittent talazoparib dosing differentiated by germline and somatic DNA damage mutation carriers. Clin Cancer Res; 23(21); 6400-10. ©2017 AACR.
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Affiliation(s)
| | | | | | - Jim Leng
- University of California, San Francisco, San Francisco, CA
| | - Jenna Z Zhang
- University of California, San Francisco, San Francisco, CA
| | - Nela Pawlowska
- University of California, San Francisco, San Francisco, CA
| | | | | | - Andrew Gewitz
- University of California, San Francisco, San Francisco, CA
| | - Amy J Chien
- University of California, San Francisco, San Francisco, CA
| | - Mark Moasser
- University of California, San Francisco, San Francisco, CA
| | - Robin K Kelley
- University of California, San Francisco, San Francisco, CA
| | - Tayeba Maktabi
- University of California, San Francisco, San Francisco, CA
| | - Scott Thomas
- University of California, San Francisco, San Francisco, CA
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Machado KK, Gaillard SL. Emerging Therapies in the Management of High-Grade Serous Ovarian Carcinoma: a Focus on PARP Inhibitors. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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