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Beyaert SP, Loriot AE, Huyghe ND, Goebbels RM, Mendola A, Govaerts AS, Fortpied C, Baldin P, Licitra LF, Lalami Y, Clement PM, Machiels JPH, Schmitz S. Tumor Microenvironment Modifications Induced by Afatinib in Squamous Cell Carcinoma of the Head and Neck: A Window-of-Opportunity Study (EORTC-90111-24111). Clin Cancer Res 2023; 29:4076-4087. [PMID: 37531234 DOI: 10.1158/1078-0432.ccr-23-0645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/27/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE The EORTC-90111-24111 phase II window study evaluated afatinib versus no preoperative treatment in patients with primary squamous cell carcinoma of the head and neck (HNSCC). We investigated afatinib-induced tumor and microenvironment modifications by comparing pre- and posttreatment tumor biopsies. PATIENTS AND METHODS Thirty treatment-naïve patients with primary HNSCC were randomized. Twenty-five patients received afatinib for 14 days before surgery (40 mg 1×/day) and 5 patients were attributed to the control arm. Biopsies were taken at work-up and during surgery. Good quality RNA samples were used for omics analyses. The control arm was enlarged by samples coming from our previous similar window study. RESULTS IHC analyses of afatinib-treated tumor biopsies showed a decrease in pEGFR (P ≤ 0.05) and pERK (P ≤ 0.05); and an increase in CD3+ (P ≤ 0.01) and CD8+ (P ≤ 0.01) T-cell infiltration, and in CD3+ (P ≤ 0.05) T-cell density. RNA sequencing analyses of afatinib-treated tumor samples showed upregulation of inflammatory genes and increased expression scores of signatures predictive of response to programmed cell death protein 1 blockade (P ≤ 0.05). In posttreatment biopsies of afatinib-treated patients, two clusters were observed. Cluster 1 showed a higher expression of markers and gene sets implicated in epithelial-to-mesenchymal transition (EMT) and activation of cancer-associated fibroblasts (CAF) compared with cluster 2 and controls. CONCLUSIONS Short-term treatment with afatinib in primary HNSCC induces CD3+ and CD8+ tumor infiltration and, in some patients, EMT and CAF activation. These results open perspectives to overcome resistance mechanisms to anti-HER therapy and to potentiate the activity of immune checkpoint inhibitors.
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Affiliation(s)
- Simon P Beyaert
- Institut de Recherche Expérimentale et Clinique (IREC), pôle MIRO, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Axelle E Loriot
- Group of Computational Biology and Bioinformatics, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Nicolas D Huyghe
- Institut de Recherche Expérimentale et Clinique (IREC), pôle MIRO, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Rose-Marie Goebbels
- Institut de Recherche Expérimentale et Clinique (IREC), pôle MIRO, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Antonella Mendola
- Institut de Recherche Expérimentale et Clinique (IREC), pôle MIRO, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Anne-Sophie Govaerts
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Catherine Fortpied
- European Organization of Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Pamela Baldin
- Department of Pathology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Lisa F Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- University of Milan, Milan, Italy
| | - Yassine Lalami
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Paul M Clement
- Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Jean-Pascal H Machiels
- Institut de Recherche Expérimentale et Clinique (IREC), pôle MIRO, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Department of Medical Oncology, Institut Roi Albert II & Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sandra Schmitz
- Institut de Recherche Expérimentale et Clinique (IREC), pôle MIRO, Université catholique de Louvain (UCLouvain), Brussels, Belgium
- Department of Head & Neck Surgery, Institut Roi Albert II & Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Marret G, Borcoman E, Le Tourneau C. Window-of-opportunity clinical trials for biomarker discovery in head and neck squamous cell carcinoma. Curr Opin Oncol 2023; 35:158-165. [PMID: 36966501 DOI: 10.1097/cco.0000000000000940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
PURPOSE OF REVIEW We review the window-of-opportunity clinical trials that have been reported in head and neck squamous cell carcinoma (HNSCC), and discuss their challenges. RECENT FINDINGS Limited treatment options exist in HNSCC. Cetuximab, an mAb targeting epidermal growth factor receptor, and the PD-1 inhibitors nivolumab and pembrolizumab, are the only drugs that improved overall survival in the recurrent and/or metastatic setting. Both cetuximab and nivolumab improve overall survival by less than 3 months, potentially because of the lack of predictive biomarkers. The only validated predictive biomarker to date is protein ligand PD-L1 expression that predicts the efficacy of pembrolizumab in first-line, nonplatinum refractory recurrent and/or metastatic HNSCC. The identification of biomarkers of efficacy of new drugs is key to avoid administering toxic drugs to patients who will not benefit from them, and to expect increased drug efficacy in the biomarker-positive group of patients. One way of identifying such biomarkers are the window-of-opportunity trials in which drugs are given for a short period of time before the definitive treatment, with the aim to collect samples for translational research. These trials differ from neoadjuvant strategies where efficacy is the primary endpoint. SUMMARY We show that these trials were safe and successful in identifying biomarkers.
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Affiliation(s)
- Grégoire Marret
- Department of Drug Development and Innovation (D3i), Institut Curie
| | - Edith Borcoman
- Department of Drug Development and Innovation (D3i), Institut Curie
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie
- INSERM U900, Institut Curie, Paris-Saclay University, Paris, France
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Porosnicu M, O’Brien Cox A, Waltonen JD, Bunch PM, D’Agostino R, Lycan TW, Taylor R, Williams DW, Chen X, Shukla K, Kouri BE, Walker T, Kucera G, Patwa HS, Sullivan CA, Browne JD, Furdui CM. Early [18]FDG PET/CT scan predicts tumor response in head and neck squamous cell cancer patients treated with erlotinib adjusted per smoking status. Front Oncol 2022; 12:939118. [PMID: 36110959 PMCID: PMC9468744 DOI: 10.3389/fonc.2022.939118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
Translational Relevance Evaluation of targeted therapies is urgently needed for the majority of patients with metastatic/recurrent head and neck squamous cell carcinoma (HNSCC) who progress after immunochemotherapy. Erlotinib, a targeted inhibitor of epidermal growth factor receptor pathway, lacks FDA approval in HNSCC due to inadequate tumor response. This study identifies two potential avenues to improve tumor response to erlotinib among patients with HNSCC. For the first time, this study shows that an increased erlotinib dose of 300 mg in smokers is well-tolerated and produces similar plasma drug concentration as the regular dose of 150 mg in non-smokers, with increased study-specific defined tumor response. The study also highlights the opportunity for improved patient selection for erlotinib treatment by demonstrating that early in-treatment [18]FDG PET/CT is a potential predictor of tumor response, with robust statistical correlations between metabolic changes on early in-treatment PET (4-7 days through treatment) and anatomic response measured by end-of-treatment CT. Purpose Patients with advanced HNSCC failing immunochemotherapy have no standard treatment options. Accelerating the investigation of targeted drug therapies is imperative. Treatment with erlotinib produced low response rates in HNSCC. This study investigates the possibility of improved treatment response through patient smoking status-based erlotinib dose optimization, and through early in-treatment [18]FDG PET evaluation to differentiate responders from non-responders. Experimental design In this window-of-opportunity study, patients with operable HNSCC received neoadjuvant erlotinib with dose determined by smoking status: 150 mg (E150) for non-smokers and 300 mg (E300) for active smokers. Plasma erlotinib levels were measured using mass spectrometry. Patients underwent PET/CT before treatment, between days 4-7 of treatment, and before surgery (post-treatment). Response was measured by diagnostic CT and was defined as decrease in maximum tumor diameter by ≥ 20% (responders), 10-19% (minimum-responders), and < 10% (non-responders). Results Nineteen patients completed treatment, ten of whom were smokers. There were eleven responders, five minimum-responders, and three non-responders. Tumor response and plasma erlotinib levels were similar between the E150 and E300 patient groups. The percentage change on early PET/CT and post-treatment PET/CT compared to pre-treatment PET/CT were significantly correlated with the radiologic response on post-treatment CTs: R=0.63, p=0.0041 and R=0.71, p=0.00094, respectively. Conclusion This pilot study suggests that early in-treatment PET/CT can predict response to erlotinib, and treatment with erlotinib dose adjusted according to smoking status is well-tolerated and may improve treatment response in HNSCC. These findings could help optimize erlotinib treatment in HNSCC and should be further investigated. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT00601913, identifier NCT00601913.
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Affiliation(s)
- Mercedes Porosnicu
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
- *Correspondence: Mercedes Porosnicu, ; Cristina M. Furdui,
| | - Anderson O’Brien Cox
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Joshua D. Waltonen
- Department of Otolaryngology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Paul M. Bunch
- Department of Radiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Ralph D’Agostino
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Thomas W. Lycan
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Richard Taylor
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Dan W. Williams
- Department of Radiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Xiaofei Chen
- Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Kirtikar Shukla
- Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Brian E. Kouri
- Department of Radiology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Tiffany Walker
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
- Department of Cancer Biology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Gregory Kucera
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
- Department of Cancer Biology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Hafiz S. Patwa
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
- Department of Otolaryngology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Christopher A. Sullivan
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
- Department of Otolaryngology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - J. Dale Browne
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
- Department of Otolaryngology, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Cristina M. Furdui
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
- Department of Internal Medicine, Section on Molecular Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- *Correspondence: Mercedes Porosnicu, ; Cristina M. Furdui,
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Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS. Poor treatment tolerance in head and neck cancer patients with low muscle mass. Head Neck 2022; 44:844-850. [PMID: 35020252 PMCID: PMC11412609 DOI: 10.1002/hed.26978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/05/2021] [Accepted: 01/03/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). METHODS A prospective cohort of patients with operable HNSCC requiring microvascular reconstruction was evaluated. Low CPSMI was calculated using preoperative CT neck imaging. Poor treatment tolerance, a composite measure of incomplete therapy or severe morbidity/mortality during treatment, was the primary outcome. RESULTS One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10-5.93) and delay to adjuvant therapy (OR 4.48, 95%CI 1.07-27.6) after adjusting for multiple confounders. CONCLUSION Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Lady Davis Institute of the Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Terral Patel
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Varun Vendra
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lauren Gardiner
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Jeanne Kergoat
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Division of Geriatrics, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark W Kubik
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katie S Traylor
- Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaum S Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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5
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Guida JL, Agurs-Collins T, Ahles TA, Campisi J, Dale W, Demark-Wahnefried W, Dietrich J, Fuldner R, Gallicchio L, Green PA, Hurria A, Janelsins MC, Jhappan C, Kirkland JL, Kohanski R, Longo V, Meydani S, Mohile S, Niedernhofer LJ, Nelson C, Perna F, Schadler K, Scott JM, Schrack JA, Tracy RP, van Deursen J, Ness KK. Strategies to Prevent or Remediate Cancer and Treatment-Related Aging. J Natl Cancer Inst 2021; 113:112-122. [PMID: 32348501 PMCID: PMC7850536 DOI: 10.1093/jnci/djaa060] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
Up to 85% of adult cancer survivors and 99% of adult survivors of childhood cancer live with an accumulation of chronic conditions, frailty, and/or cognitive impairments resulting from cancer and its treatment. Thus, survivors often show an accelerated development of multiple geriatric syndromes and need therapeutic interventions. To advance progress in this area, the National Cancer Institute convened the second of 2 think tanks under the auspices of the Cancer and Accelerated Aging: Advancing Research for Healthy Survivors initiative. Experts assembled to share evidence of promising strategies to prevent, slow, or reverse the aging consequences of cancer and its treatment. The meeting identified research and resource needs, including geroscience-guided clinical trials; comprehensive assessments of functional, cognitive, and psychosocial vulnerabilities to assess and predict age-related outcomes; preclinical and clinical research to determine the optimal dosing for behavioral (eg, diet, exercise) and pharmacologic (eg, senolytic) therapies; health-care delivery research to evaluate the efficacy of integrated cancer care delivery models; optimization of intervention implementation, delivery, and uptake; and patient and provider education on cancer and treatment-related late and long-term adverse effects. Addressing these needs will expand knowledge of aging-related consequences of cancer and cancer treatment and inform strategies to promote healthy aging of cancer survivors.
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Affiliation(s)
- Jennifer L Guida
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Tanya Agurs-Collins
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Judith Campisi
- Buck Institute for Research on Aging, Novato, CA, USA
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | | | | | - Jorg Dietrich
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rebecca Fuldner
- Division of Aging Biology, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Gallicchio
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Paige A Green
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Michelle C Janelsins
- Department of Surgery and Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
| | - Chamelli Jhappan
- Division of Cancer Biology, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - James L Kirkland
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Ronald Kohanski
- Division of Aging Biology, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Valter Longo
- University of Southern California, Los Angeles, California, USA
- IFOM Institute, Milan, Italy
| | - Simin Meydani
- Jean Mayer USDA Human Nutritional Research Center on Aging, Tufts University, Boston, MA, USA
| | - Supriya Mohile
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Laura J Niedernhofer
- Department of Biochemistry, Molecular Biology, and Biophysics, Institute on the Biology of Aging and Metabolism, University of Minnesota, Minneapolis, MN, USA
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank Perna
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Keri Schadler
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Russell P Tracy
- Departments of Pathology & Laboratory Medicine, and Biochemistry, Larner College of Medicine, University of Vermont, Colchester, VT, USA
| | | | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Ou FS, An MW, Ruppert AS, Mandrekar SJ. Discussion of Trial Designs for Biomarker Identification and Validation Through the Use of Case Studies. JCO Precis Oncol 2019; 3:PO.19.00051. [PMID: 32190807 PMCID: PMC7079723 DOI: 10.1200/po.19.00051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 12/29/2022] Open
Abstract
With the launch of the National Cancer Institute's Precision Medicine Initiative in 2015, there has been a shift to trial designs that tailor health care solutions to individual patients by using a screening platform and by moving away from the one-trial/one-biomarker-at-a-time approach. To make precision medicine a reality, it is critical to identify and validate potential biomarkers to help select patients who will truly benefit from a targeted therapy. In this article, we discuss five trial designs: enrichment, umbrella, basket, subgroup, and window of opportunity. For each trial design, we describe the design characteristics, use ongoing or completed trials as case studies, provide any recent advances to the trial design, and discuss advantages and disadvantages of each design.
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Farlow JL, Birkeland AC, Swiecicki PL, Brenner JC, Spector ME. Window of opportunity trials in head and neck cancer. ACTA ACUST UNITED AC 2019; 5. [PMID: 31321307 PMCID: PMC6638557 DOI: 10.20517/2394-4722.2018.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) has a large global burden of disease and poor survival outcomes. Recent targeted therapies and immunotherapies have been explored in HNSCC, but there has been limited translation to clinical practice outside of recurrent or metastatic cases. Window of opportunity settings, where novel agents are administered between cancer diagnosis and planned definitive therapy, have begun to be employed in HNSCC. Tumor tissue biopsies are obtained at diagnosis and after the investigation treatment, along with other biospecimens and radiographic exams. Thus, this study design can characterize the safety profiles, pharmacodynamics, and initial tumor responses to novel therapies in a treatment-naïve subject. Early window studies have also identified potential biomarkers to predict sensitivity or resistance to treatments. However, these early investigations have revealed multiple challenges associated with this trial design. In this review, we discuss recent window of opportunity trials in HNSCC and how they inform design considerations for future studies.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrew C Birkeland
- Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA 94303, USA
| | - Paul L Swiecicki
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, Division of Hematology and Oncology, Ann Arbor Veterans Medical Center, Ann Arbor, MI 48105, USA
| | - J Chad Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
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