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Rubinstein MM, Hyman DM, Caird I, Won H, Soldan K, Seier K, Iasonos A, Tew WP, O'Cearbhaill RE, Grisham RN, Hensley ML, Troso-Sandoval T, Sabbatini P, Guillen J, Selcuklu SD, Zimel C, Torrisi J, Aghajanian C, Makker V. Phase 2 study of LY3023414 in patients with advanced endometrial cancer harboring activating mutations in the PI3K pathway. Cancer 2019; 126:1274-1282. [PMID: 31880826 DOI: 10.1002/cncr.32677] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND PI3K pathway activation is common in endometrial cancer. We evaluated the safety and efficacy of the dual PI3K/mTOR inhibitor, LY3023414, in patients with advanced endometrial cancer harboring activating mutations in the PI3K pathway. METHODS We conducted a single-arm phase 2 study of monotherapy LY3023414. Eligible patients had advanced endometrial cancer of any grade, prior management with 1-4 cytotoxic lines, and PI3K pathway activation prospectively defined as a loss-of-function PTEN alteration or activating alteration in PIK3CA, AKT1, PIK3R1, PIK3R2, or MTOR. The primary objective was best overall response rate (ORR) per RECIST 1.1. RESULTS Twenty-eight patients were treated; histologies included endometroid (39%), carcinosarcoma (25%), serous (21%), and mixed (14%). Patients were heavily pretreated, with a median of 2 prior cytotoxic lines (range, 1-3). The most common alterations involved PIK3CA (68%), PTEN (43%), and PIK3R1 (32%). In the 25 efficacy-evaluable patients, the ORR was 16% (90% CI, 7%-100%), and the clinical benefit rate was 28% (90% CI, 16%-100%). Four patients had a confirmed partial response, and 2 responses lasted for >9 months. The median progression-free survival and overall survival were 2.5 months (95% CI, 1.2-3.0) and 9.2 months (95% CI, 5.0-15.9), respectively. The most common all-grade treatment-related adverse events were anemia (71%), hyperglycemia (71%), hypoalbuminemia (68%), and hypophosphatemia (61%). No correlation between molecular alterations and response was observed. CONCLUSION In patients with heavily pretreated advanced endometrial cancer prospectively selected for tumors with activating PI3K pathway mutations, LY3023414 demonstrated modest single-agent activity and a manageable safety profile.
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Affiliation(s)
- Maria M Rubinstein
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David M Hyman
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Imogen Caird
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helen Won
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Krysten Soldan
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kenneth Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexia Iasonos
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William P Tew
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Roisin E O'Cearbhaill
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Rachel N Grisham
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Tiffany Troso-Sandoval
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Paul Sabbatini
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Joyce Guillen
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - S Duygu Selcuklu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Zimel
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jean Torrisi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Carol Aghajanian
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Vicky Makker
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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Charo LM, Plaxe SC. Recent advances in endometrial cancer: a review of key clinical trials from 2015 to 2019. F1000Res 2019; 8:F1000 Faculty Rev-849. [PMID: 31231511 PMCID: PMC6567288 DOI: 10.12688/f1000research.17408.1] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 01/08/2023] Open
Abstract
In the past few years, we have seen several important advances in understanding of and therapy for endometrial cancer. This review highlights key recent abstracts and publications in endometrial cancer from 2015 to 2019. We focus on clinical trials in surgical staging and the utility of sentinel lymph node mapping, adjuvant treatment for high-risk disease and HER2/neu-positive serous tumors, combination therapy for recurrent disease, molecular biology, and immunotherapy.
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Affiliation(s)
- Lindsey M. Charo
- Rebecca and John Moores UC San Diego Cancer Center, 3855 Health Sciences Drive #0987, La Jolla, CA, 92093-0987, USA
| | - Steven C. Plaxe
- Rebecca and John Moores UC San Diego Cancer Center, 3855 Health Sciences Drive #0987, La Jolla, CA, 92093-0987, USA
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Nishio S, Shimokawa M, Tasaki K, Nasu H, Yoshimitsu T, Matsukuma K, Terada A, Tsuda N, Kawano K, Ushijima K. A phase II trial of irinotecan in patients with advanced or recurrent endometrial cancer and correlation with biomarker analysis. Gynecol Oncol 2018; 150:432-437. [PMID: 30037491 DOI: 10.1016/j.ygyno.2018.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Chemotherapy for advanced or recurrent endometrial cancer requires further development. Irinotecan hydrochloride (CPT-11) suppresses tumor growth in several endometrial cancer strains. The present study evaluated the anti-tumor activity and toxicity of CPT-11 in patients with advanced or recurrent endometrial cancer. METHODS Enrolled patients had advanced endometrial cancer with measurable lesions and received 2 pretreatment regimens. A 90-minute intravenous infusion of CPT-11 (100 mg/m2) was given on days 1, 8, and 15 of a 4-week cycle, aiming for an effect with ≤2 cycles. Treatment was continued until the primary disease worsened or severe toxicity occurred. The primary endpoint was response rate, and the secondary endpoints were progression-free survival, overall survival, and adverse events. Antitumor effect and adverse events were evaluated according to RECIST version 1.1 and NCI-CTC AE version 3.0, respectively. RESULTS Twenty-two patients were registered (11 endometrioid carcinomas and 11 serous carcinomas). The median duration of the treatment-free interval (TFI) was 7.5 months, and the median number of administered cycles per patient was 4. Response rate was 36.4% (complete response: 1 patient, partial response: 7 patients). Clinical benefit rate, including stable disease, was 77.3%. Median progression-free and overall survival was 4.4 and 18.4 months, respectively. Observed adverse events included grade 4 hematotoxicity (neutropenia and thrombocytopenia), and grade 2 or 3 non-hematotoxicity (diarrhea). All adverse events were manageable. Biomarker predictors of therapeutic effectiveness were not observed. CONCLUSION As a single agent, CPT-11 has anti-tumor activity for advanced or recurrent endometrial cancer and has manageable adverse events.
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Affiliation(s)
- Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan.
| | | | - Kazuto Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan
| | - Hiroki Nasu
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan
| | - Teruyuki Yoshimitsu
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan
| | - Ken Matsukuma
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan
| | - Atsumu Terada
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan
| | - Naotake Tsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan
| | - Kouichiro Kawano
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Japan
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Arend RC, Jones BA, Martinez A, Goodfellow P. Endometrial cancer: Molecular markers and management of advanced stage disease. Gynecol Oncol 2018; 150:569-580. [PMID: 29843906 DOI: 10.1016/j.ygyno.2018.05.015] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022]
Abstract
Endometrial cancer is the most prevalent gynecologic cancer in the United States. Over the last 10 years, death rates from endometrial cancer have been rising about 1.4% per year. Traditionally endometrial cancer treatment has been driven by stage and histology. Recent studies have, however, shown that cancers of the same stage and histology have very distinct molecular and genomic profiles. Translational research is progressing rapidly and endometrial cancer-specific precision medicine is evolving. The first tissue agnostic therapy based on the molecular profile of the tumor was approved by the FDA this year. The approval of immune checkpoint inhibitor, pembrolizumab (anti-PD-1), for all solid tumors with defective DNA mismatch repair, could benefit 20-30% of patients with advanced endometrial cancer. Other genomic changes and molecular markers in endometrial cancer, such as hormone receptor status, could lead to more tailored therapy in the future. Pre-clinical and clinical investigations of targeted therapies suggest efficacy for some agents. Single agent targeted therapies, however, have modest activity. Identifying biomarkers that effectively determine response to targeted therapy remains a challenge. The next generation of clinical trials will focus on novel combinations and how to best utilize the advances that have been made in sequencing technology and bioinformatics. Although there is currently an immense body of data and many options for obtaining genomic characteristics of endometrial cancer, how to interpret and utilize this data is still being explored. This review will summarize the important trials that have led to the treatment options we have for advanced and/or recurrent endometrial cancer and discuss the important studies that have led to a better understanding of the distinctive molecular and genomic profiles within endometrial cancer. We will review the current status of biomarker-driven targeted therapy in endometrial cancer and the rationale behind ongoing clinical trials that are utilizing novel targeted agents.
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Affiliation(s)
- Rebecca C Arend
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Bayley A Jones
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Alba Martinez
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul Goodfellow
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, United States
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Miyamoto M, Takano M, Kuwahara M, Soyama H, Kato K, Matuura H, Sakamoto T, Takasaki K, Aoyama T, Yoshikawa T, Furuya K. Efficacy of combination chemotherapy using irinotecan and nedaplatin for patients with recurrent and refractory endometrial carcinomas: preliminary analysis and literature review. Cancer Chemother Pharmacol 2017; 81:111-117. [PMID: 29124328 DOI: 10.1007/s00280-017-3454-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to retrospectively evaluate the efficacy and toxicity of an irinotecan hydrochloride (CPT) and nedaplatin (N) combination therapy for recurrent and refractory endometrial carcinoma, administered based on UGT1A1 genotype. METHODS Between 2009 and 2017, 21 patients who received CPT-N therapy for recurrent endometrial carcinoma as second- or third-line chemotherapy at our hospital were identified. The CPT-N regimen included 40-70 mg/m2 of CPT-11 on days 1, 8, and 15, and 50 mg/m2 of nedaplatin on day 1, q4 weeks. RESULTS The median patient age was 63 years. The number of prior chemotherapeutic regimens ranged from 1 to 2. Two patients had prior pelvic irradiation. The response rate [ratio of complete remission (CR) to partial remission (PR)] of CPT-N therapy was 3 of 21 (14.3%), and clinical benefit rate (CBR) [the combined percentages of CR, PR, and stable disease (SD)] was 9 of 21 (42.8%). Toxicities included grade 3 neutropenia [4 (19.0%) cases], grade 3 febrile neutropenia [2 (9.5%) cases], and grade 3 diarrhea [3 (14.3%) cases]; all resolved with conservative treatment. Patients with a wild-type UGT1A1 status received higher doses of CPT-11 (p = 0.048) and had similar RR and CBR compared to those with a UGT1A1*6 and *28 status. There were no significant differences in frequencies of hematological or non-hematological toxicities, regardless of UGT1A1 status. CONCLUSIONS The CPT-N regimen for recurrent and refractory endometrial carcinoma had tolerable side effects and significant efficacy. This regimen is a viable treatment option for endometrial carcinoma.
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Affiliation(s)
- Morikazu Miyamoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan.
| | - Masashi Takano
- Department of Clinical Oncology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Mika Kuwahara
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Hiroaki Soyama
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Kento Kato
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Hiroko Matuura
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Takahiro Sakamoto
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Kazuki Takasaki
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Tadashi Aoyama
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Tomoyuki Yoshikawa
- Department of Clinical Oncology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
| | - Kenichi Furuya
- Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, 359-8513, Japan
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Moore KN, Sill MW, Tenney ME, Darus CJ, Griffin D, Werner TL, Rose PG, Behrens R. A phase II trial of trebananib (AMG 386; IND#111071), a selective angiopoietin 1/2 neutralizing peptibody, in patients with persistent/recurrent carcinoma of the endometrium: An NRG/Gynecologic Oncology Group trial. Gynecol Oncol 2015; 138:513-8. [PMID: 26171911 PMCID: PMC4692151 DOI: 10.1016/j.ygyno.2015.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/06/2015] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Ang1 & 2 (angiopoietin-1; -2) interact with Tie2 receptors on endothelial cells to mediate vascular remodeling in an angiogenesis signaling pathway distinct from the VEGF axis. Trebananib is a peptide Fc fusion protein that binds Ang1 and 2 and prevents interaction with Tie2. The efficacy of trebananib in recurrent/persistent endometrial cancer (EC) was studied. METHODS The primary objective was to determine the frequency of patients with objective tumor responses (ORR) and event-free survival for ≥6months (6-month EFS) and determine toxicity of trebananib at a dose and schedule of 15mg/kg, IV QW. Recurrent/persistent EC, measurable disease, and ≤2 prior chemotherapy lines were required. RESULTS Thirty-two patients were eligible and treated. The most common histologies were G1/2 endometrioid (31%), G3 endometrioid (28%) and serous (31.3%). 78% of patients had 1 prior regimen. Patients received 1-9+ cycles of trebananib; 24 patients (75%) received ≤2cycles. One patient had a partial response (3.1%); 8 patients had stable disease (25%) and 5 patients (15.6%) had 6 month EFS. Median progression-free survival and overall-survival were 1.97 months (90% CI 1.77-2.1) and 6.6 months (90% CI 4.01-14.75), respectively. Most common adverse events (AEs) were fatigue, anemia, and GI issues. Grade 3 and 4 AEs were: GI 31 and 0%; vascular 22 and 0%; metabolism/nutrition 19 and 3%; and general (including edema) 16 and 0%. CONCLUSIONS Trebananib has insufficient single agent activity in recurrent EC to warrant further investigation at this dose/schedule.
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Affiliation(s)
- Kathleen N Moore
- Stephenson Oklahoma Cancer Center, 800 NE 10th Street, Oklahoma City, OK 73104, United States.
| | - Michael W Sill
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, United States.
| | - Meaghan E Tenney
- University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, United States.
| | - Christopher J Darus
- Maine Medical Center, 102 Campus Drive Unit 116, Scarborough, ME 04074, United States.
| | - David Griffin
- Upstate Carolina CCOP Oncology Research, 101 East Wood Street, Spartanburg, SC 29303, United States.
| | - Theresa L Werner
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope, Salt Lake City, UT 84112, United States.
| | - Peter G Rose
- Cleveland Clinic Foundation, 9500 Euclid Avenue, A81, Cleveland, OH 44106, United States.
| | - Robert Behrens
- Cancer Center of Iowa, Iowa Wide Oncology Research Coalition, 1221 Pleasant Street, Suite 450, Des Moines IA 50309, United States.
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Slomovitz BM, Jiang Y, Yates MS, Soliman PT, Johnston T, Nowakowski M, Levenback C, Zhang Q, Ring K, Munsell MF, Gershenson DM, Lu KH, Coleman RL. Phase II study of everolimus and letrozole in patients with recurrent endometrial carcinoma. J Clin Oncol 2015; 33:930-6. [PMID: 25624430 DOI: 10.1200/jco.2014.58.3401] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The phosphoinositol-3 kinase (PI3K) pathway is frequently dysregulated in endometrial cancer (EC). Hormonal manipulation leads to response in some patients with EC, but resistance derived from PI3K pathway activation has been documented. Targeting mammalian target of rapamycin (mTOR) may overcome endocrine resistance. We conducted a two-institution phase II trial of everolimus and letrozole in women with recurrent EC. PATIENTS AND METHODS Patients were considered incurable, had measurable disease, and were treated with up to two prior cytotoxic regimens. Everolimus was administered orally at 10 mg daily and letrozole was administered orally at 2.5 mg daily. Each cycle consisted of 4 weeks of therapy. Patients were treated until progression, toxicity, or complete response (CR). The primary end point was the clinical benefit rate (CBR), which was defined as CR, partial response, or stable disease (≥ 16 weeks) by RECIST 1.0 criteria. Translational studies were performed to correlate biomarkers with response. RESULTS Thirty-eight patients were enrolled (median age, 62 years; range, 24 to 82 years). Thirty-five patients were evaluable for response. The CBR was 40% (14 of 35 patients); the median number of cycles among responders was 15 (range, seven to 29 cycles). The confirmed objective response rate (RR) was 32% (11 of 35 patients; nine CRs and two partial responses; median, 15 cycles; range, eight to 29 cycles). Twenty percent of patients (seven of 35 patients) were taken off treatment after a prolonged CR and at the discretion of the treating clinician. None of the patients discontinued treatment as a result of toxicity. Serous histology was the best predictor of lack of response. Patients with endometrioid histology and CTNNB1 mutations responded well to everolimus and letrozole. CONCLUSION Everolimus plus letrozole results in a high CBR and RR in patients with recurrent EC. Further development of this combination in recurrent endometrioid EC is under way.
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Affiliation(s)
- Brian M Slomovitz
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Yunyun Jiang
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Melinda S Yates
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Pamela T Soliman
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Taren Johnston
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Maureen Nowakowski
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Charles Levenback
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Qian Zhang
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Kari Ring
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Mark F Munsell
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - David M Gershenson
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Karen H Lu
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Robert L Coleman
- Brian M. Slomovitz, Yunyun Jiang, Melinda S. Yates, Pamela T. Soliman, Taren Johnston, Charles Levenback, Qian Zhang, Kari Ring, Mark F. Munsell, David M. Gershenson, Karen H. Lu, and Robert L. Coleman, The University of Texas MD Anderson Cancer Center, Houston, TX; Brian M. Slomovitz and Maureen Nowakowski, Morristown Medical Center, Morristown, NJ; and Brian M. Slomovitz, Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL.
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Dellinger TH, Monk BJ. Systemic therapy for recurrent endometrial cancer: a review of North American trials. Expert Rev Anticancer Ther 2014; 9:905-16. [DOI: 10.1586/era.09.54] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tanasova M, Sturla SJ. Chemistry and biology of acylfulvenes: sesquiterpene-derived antitumor agents. Chem Rev 2012; 112:3578-610. [PMID: 22482429 DOI: 10.1021/cr2001367] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Marina Tanasova
- ETH Zurich, Institute of Food, Nutrition and Health, Zurich, Switzerland
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Aghajanian C, Sill MW, Darcy KM, Greer B, McMeekin DS, Rose PG, Rotmensch J, Barnes MN, Hanjani P, Leslie KK. Phase II trial of bevacizumab in recurrent or persistent endometrial cancer: a Gynecologic Oncology Group study. J Clin Oncol 2011; 29:2259-65. [PMID: 21537039 PMCID: PMC3107744 DOI: 10.1200/jco.2010.32.6397] [Citation(s) in RCA: 209] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 02/22/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Bevacizumab, a recombinant humanized monoclonal antibody against vascular endothelial growth factor-A (VEGF-A), has clinical activity in multiple tumor types. We conducted a phase II trial to assess the activity and tolerability of single-agent bevacizumab in recurrent or persistent endometrial cancer (EMC). PATIENTS AND METHODS Eligible patients had persistent or recurrent EMC after receiving one to two prior cytotoxic regimens, measurable disease, and Gynecologic Oncology Group performance status of ≤ 2. Treatment consisted of bevacizumab 15 mg/kg intravenously every 3 weeks until disease progression or prohibitive toxicity. VEGF-A was assessed by immunohistochemistry in archival tumor and by enzyme-linked immunosorbent assay in pretreatment plasma. Primary end points were progression-free survival (PFS) at 6 months and overall response rate. RESULTS Fifty-six patients were enrolled. Fifty-two patients were eligible and evaluable. Median age was 62 years, and prior treatment consisted of one or two regimens in 33 (63.5%) and 19 (36.5%) patients, respectively. Twenty-nine patients (55.8%) received prior radiation. Adverse events were consistent with those expected with bevacizumab treatment. No GI perforations or fistulae were seen. Seven patients (13.5%) experienced clinical responses (one complete response and six partial responses; median response duration, 6.0 months), and 21 patients (40.4%) survived progression free for at least 6 months. Median PFS and overall survival times were 4.2 and 10.5 months, respectively. Suggested associations were observed between high VEGF-A and adjusted hazard of death or tumor response when evaluated in tumor/plasma or plasma, respectively. CONCLUSION Bevacizumab is well tolerated and active based on PFS at 6 months in recurrent or persistent EMC and warrants further investigation.
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Affiliation(s)
- Carol Aghajanian
- Gynecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Moore KN, Tian C, McMeekin DS, Thigpen JT, Randall ME, Gallion HH. Does the progression-free interval after primary chemotherapy predict survival after salvage chemotherapy in advanced and recurrent endometrial cancer? Cancer 2010; 116:5407-14. [DOI: 10.1002/cncr.25480] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 05/08/2010] [Accepted: 05/11/2010] [Indexed: 11/06/2022]
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12
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Schilder RJ, Blessing JA, Shahin MS, Miller DS, Tewari KS, Muller CY, Warshal DP, McMeekin S, Rotmensch J. A Phase 2 Evaluation of Irofulven as Second-line Treatment of Recurrent or Persistent Intermediately Platinum-Sensitive Ovarian or Primary Peritoneal Cancer. Int J Gynecol Cancer 2010; 20:1137-41. [DOI: 10.1111/igc.0b013e3181e8df36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Miller DS, Blessing JA, Drake RD, Higgins R, McMeekin DS, Puneky LV, Krasner CN. A phase II evaluation of pemetrexed (Alimta, LY231514, IND #40061) in the treatment of recurrent or persistent endometrial carcinoma: a phase II study of the Gynecologic Oncology. Gynecol Oncol 2009; 115:443-6. [PMID: 19804902 DOI: 10.1016/j.ygyno.2009.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 09/04/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the anti-tumor activity of pemetrexed in patients with advanced or recurrent carcinoma of the endometrium and to determine the nature and degree of toxicity. METHODS A multicenter phase II trial was conducted by the Gynecologic Oncology Group (GOG). Patients must have had advanced or recurrent measurable carcinoma of the endometrium and failed one prior chemotherapy regimen. Pemetrexed at a dose of 900 mg/m(2) was administered as an IV infusion over 10 min every 21 days. RESULTS From May 1, 2006 to July 31, 2007, 27 patients were entered by 10 member institutions of the GOG with two patients being deemed ineligible. A total of 101 cycles were administered with 28% of patients receiving five or more cycles. Overall, the treatment was well tolerated. More serious toxicities (grade 3 and 4) included anemia in 20%, leukopenia in 40%, neutropenia in 48%, and constitutional in 16%. No treatment-related deaths were reported. One patient (4%) had a partial response. Eleven patients (44%) had stable disease and eleven (44%) patients had increasing disease. Response could not be assessed in two patients (7%). Median progression-free survival was 2.7 months and overall survival was 9.4 months. CONCLUSION Pemetrexed has minimal activity in the treatment of recurrent or persistent endometrial carcinoma at the dose and schedule tested.
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Affiliation(s)
- David Scott Miller
- Division of Gynecologic Oncology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Room J7-124, Dallas, TX 75390-9032, USA.
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15
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Conjugates of the fungal cytotoxin illudin M with improved tumour specificity. Bioorg Med Chem 2008; 16:8592-7. [DOI: 10.1016/j.bmc.2008.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 07/31/2008] [Accepted: 08/04/2008] [Indexed: 11/18/2022]
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Kelner MJ, McMorris TC, Rojas RJ, Estes LA, Suthipinijtham P. Synergy of Irofulven in combination with various anti-metabolites, enzyme inhibitors, and miscellaneous agents in MV522 lung carcinoma cells: marked interaction with gemcitabine and 5-fluorouracil. Invest New Drugs 2008; 26:407-15. [PMID: 18227973 DOI: 10.1007/s10637-008-9113-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 01/09/2008] [Indexed: 11/24/2022]
Abstract
The novel agent Irofulven (HMAF, NSC 683863) has demonstrated significant antitumor activity against solid tumors in various xenograft models and human clinical trials. The antitumor potential of combining irofulven with 72 different anti-metabolite, enzyme inhibiting, and miscellaneous agents was investigated in this study. The human lung carcinoma MV522 cell line and its corresponding xenograft model were used to evaluate the activity of irofulven in combination with these different agents. Irofulven in combination with select anti-metabolites, notably cytidine or adenine-derived agents, displayed strong synergistic activity in both in vitro and in vivo studies. Agents demonstrating strong synergistic interaction with irofulven included gemcitabine, cyclocytidine, cytarabine, fludarabine phosphate, cladribine, and 5-fluorouracil. Other anti-metabolites, enzyme inhibitors, and a variety of miscellaneous agents failed to interact beneficially when administered in combination with irofulven. The therapeutic activity of irofulven is enhanced considerably when irofulven is combined with select anti-metabolite agents, and further clinical evaluation of these combinations is warranted. The synergistic interaction with these combinations may stem from a variety of actions including inhibition of the nucleotide excision repair (NER) pathway, topoisomerase I activity, and caspase-dependent and independent induction of apoptosis.
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Affiliation(s)
- Michael J Kelner
- Department of Pathology, University of California, San Diego, USA.
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Bomgaars LR, Megason GC, Pullen J, Langevin AM, Dale Weitman S, Hershon L, Kuhn JG, Bernstein M, Blaney SM. Phase I trial of irofulven (MGI 114) in pediatric patients with solid tumors. Pediatr Blood Cancer 2006; 47:163-8. [PMID: 16317728 DOI: 10.1002/pbc.20686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE We performed a Phase I trial of irofulven (MGI 114) to determine the maximum tolerated dose (MTD), the dose-limiting toxicity (DLT), and the plasma pharmacokinetics of irofulven in children < or=21 years of age with refractory/recurrent malignancies. EXPERIMENTAL DESIGN Thirty-five patients were entered into the study, of whom 34 were eligible. Patients received Irofulven daily x 5 days every 28 days over 10 min, following pre-treatment with ondansetron (0.45 mg/kg) and dexamethasone (12 mg/m(2)). The initial dose of irofulven was 8 mg/m(2) daily, with subsequent escalations to 10, 13, and 17 mg/m(2). Plasma pharmacokinetic samples were obtained in a subset patients. RESULTS Thirty-two patients were assessable for toxicity, and 30 were assessable for response. In heavily pre-treated patients, dose-limiting thrombocytopenia was observed in two patients at the 8 mg/m(2)/day, and in one patient at the 6 mg/m(2)/day dose level. In less heavily pre-treated patients, proteinuria and elevated creatinine were dose limiting in two patients at the 17 mg/m(2)/day dose level. At 13 mg/m(2)/day, constipation, hyperkalemia with elevated creatinine, and thrombocytopenia was dose limiting in three patients. There were no complete or partial responses. One patient with poorly differentiated carcinoma had stable disease and received 11 courses of therapy. Patients demonstrated a lower systemic exposure and greater clearance than adults treated at similar dose levels. CONCLUSION The MTD of irofulven administered daily x 5 every 28 days with concomitant ondansetron and dexamethasone is 6 mg/m(2)/day in heavily pre-treated patients and 10 mg/m(2)/day in less heavily pre-treated patients.
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Affiliation(s)
- Lisa R Bomgaars
- Texas Children's Cancer Center/Baylor College of Medicine, Houston, Texas 77030, USA.
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Yeo W, Boyer M, Chung HC, Ong SYK, Lim R, Zee B, Ma B, Lam KC, Mo FKF, Ng EKW, Ho R, Clarke S, Roh JK, Beale P, Rha SY, Jeung HC, Soo R, Goh BC, Chan ATC. Irofulven as first line therapy in recurrent or metastatic gastric cancer: a phase II multicenter study by the Cancer Therapeutics Research Group (CTRG). Cancer Chemother Pharmacol 2006; 59:295-300. [PMID: 16783579 DOI: 10.1007/s00280-006-0270-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 05/11/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the tolerability and efficacy of irofulven, a DNA interacting acylfulvene analog, as first line therapy for patients with recurrent or metastatic gastric cancer. PATIENTS AND METHODS Twenty-three patients with recurrent or metastatic gastric cancer received irofulven at a dose of 0.45 mg/kg administered intravenously over 30-min infusion (up to a maximum of 50 mg), on days 1 and 8, every 3 weeks. RESULTS The median number of cycles delivered per patient was 2 (range 1-6). Two patients (9%) had >or= 1-week delay in administration of subsequent cycle of chemotherapy. For the day 8 chemotherapy, dose reductions were required in seven patients (30%); dose omitting occurred in five patients (22%). Grade 3/4 anemia and neutropenia occurred in 22 and 17% of patients, respectively. There was no grade 4 thrombocytopenia and no neutropenic fever was observed. Of the 20 evaluable patients, there were no responses observed, 3 patients had stable disease after 2 cycles of treatment which was not confirmed by a further assessment. Median overall survival was 6.05 months (95% CI 4.55-9.39). CONCLUSIONS Irofulven was tolerated at the dose of 0.45 mg/kg on days 1 and 8, every 3 weeks but showed no evidence of antitumor activity in patients with advanced gastric cancer.
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Affiliation(s)
- W Yeo
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Seiden MV, Gordon AN, Bodurka DC, Matulonis UA, Penson RT, Reed E, Alberts DS, Weems G, Cullen M, McGuire WP. A phase II study of irofulven in women with recurrent and heavily pretreated ovarian cancer. Gynecol Oncol 2005; 101:55-61. [PMID: 16260029 DOI: 10.1016/j.ygyno.2005.09.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 09/19/2005] [Accepted: 09/22/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the safety and efficacy of a novel illudin S derivative, irofulven (MGI-114), in patients with recurrent ovarian cancer who had received extensive prior chemotherapy. METHODS The trial was an open label phase II study. Patients initially enrolled in this study were treated every 14 days with a dose of 24 mg/m2. Unexpected retinal toxicity associated with this dose and schedule lead to modification of the dosing to 0.55 mg/kg on the same schedule with a maximum individual dose of 50 mg. Dose reductions were permitted based on both hematologic and non-hematologic toxicities. RESULTS Seventy-four women were accrued and stratified into two cohorts including 58 women with platinum-resistant disease and 16 with platinum-sensitive disease. Non-hematologic toxicities included nausea, vomiting, and fatigue. Thirty-one women had between one and six visual symptoms, most were Grade 1 and 2 in nature. The majority of visual toxicities resolved either during treatment or post-treatment with irofulven. There was one partial response in each cohort with 19 (33%) and 8 (50%) of women having stable disease in the platinum-resistant and platinum-sensitive cohorts, respectively. CONCLUSIONS Irofulven at 24 mg/m2 on every 14-day schedule is associated with significant retinal toxicity in this patient population. Dosing at 0.55 mg/kg has persistent retinal toxicity, yet demonstrated only limited anti-tumor activity in a population of women who had received extensive prior chemotherapy.
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Affiliation(s)
- Michael V Seiden
- Gynecologic Oncology Research Program at Dana Farber/Partners Cancer Care Program, Boston, MA 02115, USA.
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Hotta K, Ueoka H. New cytotoxic agents: a review of the literature. Crit Rev Oncol Hematol 2005; 55:45-65. [PMID: 15927843 DOI: 10.1016/j.critrevonc.2005.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 01/01/2005] [Accepted: 01/28/2005] [Indexed: 10/25/2022] Open
Abstract
The goal of treatment for patients with advanced cancer is to prolong survival, control symptoms, and reduce disease-related complications. Despite the introduction of many cytotoxic agents during the past decade, only modest improvement in survival has been achieved. In order to urgently improve these situations, new cytotoxic agents as well as molecular-targeted agents are now under investigation. In this article, we reviewed the latest information regarding antitumor activity, toxicity, pharmacokinetics, and clinical application of the new cytotoxic agents.
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Affiliation(s)
- Katsuyuki Hotta
- Health and Environmental Center, Okayama University, 2-1-1, Tsushimanaka, Okayama 700-8530, Japan.
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Zaidman BZ, Yassin M, Mahajna J, Wasser SP. Medicinal mushroom modulators of molecular targets as cancer therapeutics. Appl Microbiol Biotechnol 2005; 67:453-68. [PMID: 15726350 DOI: 10.1007/s00253-004-1787-z] [Citation(s) in RCA: 244] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 09/27/2004] [Accepted: 10/02/2004] [Indexed: 02/07/2023]
Abstract
Empirical approaches to discover anticancer drugs and cancer treatments have made limited progress in the past several decades in finding a cure for cancer. The expanded knowledge of the molecular basis of tumorigenesis and metastasis, together with the inherently vast structural diversity of natural compounds found in mushrooms, provided unique opportunities for discovering new drugs that rationally target the abnormal molecular and biochemical signals leading to cancer. This review focuses on mushroom low-molecular-weight secondary metabolites targeting processes such as apoptosis, angiogenesis, metastasis, cell cycle regulation, and signal transduction cascades. Also discussed in this review are high-molecular-weight polysaccharides or polysaccharide-protein complexes from mushrooms that appear to enhance innate and cell-mediated immune responses, exhibit antitumor activities in animals and humans, and demonstrate the anticancer properties of selenium compounds accumulated in mushrooms.
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Affiliation(s)
- Ben-Zion Zaidman
- Biodiversity and Biotechnology Center of Cryptogamic Plants and Fungi, The Institute of Evolution, University of Haifa, Mount Carmel, Israel
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