1
|
Cai H, Du X, Deng Y, Cao D, Wang L, Wu Z, Zhang X, Xu J, Xie B. Pharmacokinetics and apparent Michaelis constant for metabolite conversion of sorafenib in healthy and hepatocellular carcinoma-bearing rats. Bioanalysis 2024; 16:461-473. [PMID: 38530220 PMCID: PMC11216244 DOI: 10.4155/bio-2023-0215] [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: 10/18/2023] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
Aim: Investigation of the pharmacokinetics of sorafenib (SRF) in rats with hepatocellular carcinoma (HCC). Methods: A reproducible ultra-HPLC-MS method for simultaneous determination of serum SRF, N-hydroxymethyl sorafenib and N-demethylation sorafenib. Results: Both the maximum serum concentrations (2.5-times) and the area under the serum concentration-time curve from 0 h to infinity (4.5-times) of SRF were observed to be significantly higher, with a greater than 3.0-fold decrease in the clearance rate in the HCC-bearing rats compared with these values in healthy animals. Further study revealed approximately 3.8- and 3.2-times increases in the apparent Michaelis constant for N-hydroxymethyl sorafenib and N-demethylation sorafenib conversions in the HCC-bearing rats. Conclusion: The low efficiency for the SRF conversions was a key contributor to the increased serum concentrations of SRF.
Collapse
Affiliation(s)
- Hongxin Cai
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics & Digital Health of Zhejiang Province, Jiaxing University, Jiaxing, 314001, China
| | - Xiaoyue Du
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics & Digital Health of Zhejiang Province, Jiaxing University, Jiaxing, 314001, China
| | - Yufeng Deng
- School of Pharmaceutical Science, Nanchang University, Nanchang, 330001, China
| | - Dejian Cao
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics & Digital Health of Zhejiang Province, Jiaxing University, Jiaxing, 314001, China
| | - Lele Wang
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics & Digital Health of Zhejiang Province, Jiaxing University, Jiaxing, 314001, China
| | - Zhiguo Wu
- School of Pharmaceutical Science, Nanchang University, Nanchang, 330001, China
| | - Xianchao Zhang
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics & Digital Health of Zhejiang Province, Jiaxing University, Jiaxing, 314001, China
| | - Jinbiao Xu
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics & Digital Health of Zhejiang Province, Jiaxing University, Jiaxing, 314001, China
| | - Baogang Xie
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310000, China
- Medical College of Jiaxing University, Key Laboratory of Medical Electronics & Digital Health of Zhejiang Province, Jiaxing University, Jiaxing, 314001, China
| |
Collapse
|
2
|
Känkänen V, Fernandes M, Liu Z, Seitsonen J, Hirvonen SP, Ruokolainen J, Pinto JF, Hirvonen J, Balasubramanian V, Santos HA. Microfluidic preparation and optimization of sorafenib-loaded poly(ethylene glycol-block-caprolactone) nanoparticles for cancer therapy applications. J Colloid Interface Sci 2023; 633:383-395. [PMID: 36462264 DOI: 10.1016/j.jcis.2022.11.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
The use of amphiphilic block copolymers to generate colloidal delivery systems for hydrophobic drugs has been the subject of extensive research, with several formulations reaching the clinical development stages. However, to generate particles of uniform size and morphology, with high encapsulation efficiency, yield and batch-to-batch reproducibility remains a challenge, and various microfluidic technologies have been explored to tackle these issues. Herein, we report the development and optimization of poly(ethylene glycol)-block-(ε-caprolactone) (PEG-b-PCL) nanoparticles for intravenous delivery of a model drug, sorafenib. We developed and optimized a glass capillary microfluidic nanoprecipitation process and studied systematically the effects of formulation and process parameters, including different purification techniques, on product quality and batch-to-batch variation. The optimized formulation delivered particles with a spherical morphology, small particle size (dH < 80 nm), uniform size distribution (PDI < 0.2), and high drug loading degree (16 %) at 54 % encapsulation efficiency. Furthermore, the stability and in vitro drug release were evaluated, showing that sorafenib was released from the NPs in a sustained manner over several days. Overall, the study demonstrates a microfluidic approach to produce sorafenib-loaded PEG-b-PCL NPs and provides important insight into the effects of nanoprecipitation parameters and downstream processing on product quality.
Collapse
Affiliation(s)
- Voitto Känkänen
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014 Helsinki, Finland; Drug Carrier and Depot Systems, Bayer Oy, FI-20210 Turku, Finland.
| | - Micaela Fernandes
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014 Helsinki, Finland; iMed-ULisboa, Faculty of Pharmacy, University of Lisbon, 1649-003 Lisbon, Portugal; Department of Biomedical Engineering, W.J. Kolff Institute for Biomedical Engineering and Materials Science, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan, 1, 9713 AV Groningen, the Netherlands
| | - Zehua Liu
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014 Helsinki, Finland
| | - Jani Seitsonen
- Nanomicroscopy Center, Aalto University, Puumiehenkuja, 2, FI-02150 Espoo, Finland
| | - Sami-Pekka Hirvonen
- Department of Chemistry, Faculty of Science, University of Helsinki, P.O. Box 55, 00014 Helsinki, Finland
| | - Janne Ruokolainen
- Nanomicroscopy Center, Aalto University, Puumiehenkuja, 2, FI-02150 Espoo, Finland
| | - João F Pinto
- iMed-ULisboa, Faculty of Pharmacy, University of Lisbon, 1649-003 Lisbon, Portugal
| | - Jouni Hirvonen
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014 Helsinki, Finland
| | | | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, FI-00014 Helsinki, Finland; Department of Biomedical Engineering, W.J. Kolff Institute for Biomedical Engineering and Materials Science, University Medical Center Groningen, University of Groningen, Ant. Deusinglaan, 1, 9713 AV Groningen, the Netherlands.
| |
Collapse
|
3
|
Yu Y, Ren Y, Wang C, Li Z, Niu F, Li Z, Ye Q, Wang J, Yan Y, Liu P, Qian L, Xiong Y. Arginase 2 negatively regulates sorafenib-induced cell death by mediating ferroptosis in melanoma. Acta Biochim Biophys Sin (Shanghai) 2022; 54:1658-1670. [PMID: 36604146 PMCID: PMC9828469 DOI: 10.3724/abbs.2022166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Ferroptosis, a newly defined and iron-dependent cell death, morphologically and biochemically differs from other cell deaths. Melanoma is a serious type of skin cancer, and the poor efficacy of current therapies causes a major increase in mortality. Sorafenib, a multiple kinase inhibitor, has been evaluated in clinical phase trials of melanoma patients, which shows modest efficacy. Emerging evidence has demonstrated that arginase 2 (Arg2), type 2 of arginase, is elevated in various types of cancers including melanoma. To investigate the role and underlying mechanism of Arg2 in sorafenib-induced ferroptosis in melanoma, reverse transcriptase-quantitative polymerase chain reaction, western blot analysis, adenovirus and lentivirus transduction, and in vivo tumor homograft model experiments were conducted. In this study, we show that sorafenib treatment leads to melanoma cell death and a decrease in Arg2 at both the mRNA and protein levels. Knockdown of Arg2 increases lipid peroxidation, which contributes to ferroptosis, and decreases the phosphorylation of Akt. In contrast, overexpression of Arg2 rescues sorafenib-induced ferroptosis, which is prevented by an Akt inhibitor. In addition, genetic and pharmacological suppression of Arg2 is able to ameliorate the anticancer activity of sorafenib in melanoma cells in vitro and in tumor homograft models. We also show that Arg2 suppresses ferroptosis by activating the Akt/GPX4 signaling pathway, negatively regulating sorafenib-induced cell death in melanoma cells. Our study not only uncovers a novel mechanism of ferroptosis in melanoma but also provides a new strategy for the clinical applications of sorafenib in melanoma treatment.
Collapse
Affiliation(s)
- Yi Yu
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Yuanyuan Ren
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Caihua Wang
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Zhuozhuo Li
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Fanglin Niu
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Zi Li
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Qiang Ye
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Jiangxia Wang
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Yuan Yan
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China
| | - Ping Liu
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Department of EndocrinologyXi’an No.3 Hospitalthe Affiliated Hospital of Northwest UniversityNorthwest UniversityXi’an710069China,Correspondence address. Tel: +86-29-61816169; (P.L.) / Tel: +86-29-61816169; (L.Q.) /Tel: +86-29-88302411; (Y.X.) @
| | - Lu Qian
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Department of EndocrinologyXi’an No.3 Hospitalthe Affiliated Hospital of Northwest UniversityNorthwest UniversityXi’an710069China,Correspondence address. Tel: +86-29-61816169; (P.L.) / Tel: +86-29-61816169; (L.Q.) /Tel: +86-29-88302411; (Y.X.) @
| | - Yuyan Xiong
- Xi’an Key Laboratory of Cardiovascular and Cerebrovascular DiseasesXi’an No.3 HospitalFaculty of Life Sciences and MedicineNorthwest UniversityXi’an710018China,Key Laboratory of Resource Biology and Biotechnology in Western ChinaMinistry of EducationSchool of MedicineNorthwest UniversityXi’an710069China,Correspondence address. Tel: +86-29-61816169; (P.L.) / Tel: +86-29-61816169; (L.Q.) /Tel: +86-29-88302411; (Y.X.) @
| |
Collapse
|
4
|
Guchelaar NAD, van Eerden RAG, Groenland SL, Doorn LV, Desar IME, Eskens FALM, Steeghs N, van Erp NP, Huitema ADR, Mathijssen RHJ, Koolen SLW. Feasibility of therapeutic drug monitoring of sorafenib in patients with liver or thyroid cancer. Biomed Pharmacother 2022; 153:113393. [PMID: 35834987 DOI: 10.1016/j.biopha.2022.113393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Sorafenib is a tyrosine-kinase inhibitor approved for the treatment of renal cell carcinoma, hepatocellular carcinoma, thyroid carcinoma, and desmoid fibromatosis. As high inter-individual variability exists in exposure, there is a scientific rationale to pursue therapeutic drug monitoring (TDM). We investigated the feasibility of TDM in patients on sorafenib and tried to identify sub-groups in whom pharmacokinetically (PK) guided-dosing might be of added value. METHODS We included patients who started on sorafenib (between October 2017 and June 2020) at the recommended dose of 400 mg BID or with a step-up dosing schedule. Plasma trough levels (Ctrough) were measured at pre-specified time-points. Increasing the dose was advised if Ctrough was below the target of 3750 ng/mL and toxicity was manageable. RESULTS A total of 150 samples from 36 patients were collected. Thirty patients (83 %) had a Ctrough below the prespecified target concentration at a certain time point during treatment. Toxicity from sorafenib hampered dosing according to target Ctrough in almost half of the patients. In 11 patients, dosing was adjusted based on Ctrough. In three patients, this resulted in an adequate Ctrough without additional toxicity four weeks after the dose increase. In the remaining eight patients, dose adjustment based on Ctrough did not result in a Ctrough above the target or caused excessive toxicity. CONCLUSIONS TDM for sorafenib is not of added value in daily clinical practice. In most cases, toxicity restricts the possibility of dose escalations.
Collapse
Affiliation(s)
- Niels A D Guchelaar
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Ruben A G van Eerden
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Stefanie L Groenland
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Leni van Doorn
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ferry A L M Eskens
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Neeltje Steeghs
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Nielka P van Erp
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Pharmacy, Prinses Máxima Center for Pediatric Oncology, University Medical Center Utrecht, the Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Stijn L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Pharmacy, Erasmus Medical Center, Rotterdam, the Netherlands
| | | |
Collapse
|
5
|
Escudero-Ortiz V, Domínguez-Leñero V, Catalán-Latorre A, Rebollo-Liceaga J, Sureda M. Relevance of Therapeutic Drug Monitoring of Tyrosine Kinase Inhibitors in Routine Clinical Practice: A Pilot Study. Pharmaceutics 2022; 14:pharmaceutics14061216. [PMID: 35745789 PMCID: PMC9228468 DOI: 10.3390/pharmaceutics14061216] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The main goal of treatment in cancer patients is to achieve the highest therapeutic effectiveness with the least iatrogenic toxicity. Tyrosine kinase inhibitors (TKIs) are anticancer oral agents, usually administered at fixed doses, which present high inter- and intra-individual variability due to their pharmacokinetic characteristics. Therapeutic drug monitoring (TDM) can be used to optimize the use of several types of medication. OBJECTIVE We evaluated the use of TDM of TKIs in routine clinical practice through studying the variability in exposure to erlotinib, imatinib, lapatinib, and sorafenib and dose adjustment. MATERIALS AND METHODS We conducted a retrospective analytical study involving patients who received treatment with TKIs, guided by TDM and with subsequent recommendation of dose adjustment. The quantification of the plasma levels of the different drugs was performed using high-performance liquid chromatography (HPLC). The Clinical Research Ethics Committee of the Hospital Quirónsalud Torrevieja approved this study. RESULTS The inter-individual variability in the first cycle and in the last monitored cycle was 46.2% and 44.0% for erlotinib, 48.9 and 50.8% for imatinib, 60.7% and 56.0% for lapatinib and 89.7% and 72.5% for sorafenib. Relationships between exposure and baseline characteristics for erlotinib, imatinib, lapatinib and sorafenib were not statistically significant for any of the variables evaluated (weight, height, body surface area (BSA), age and sex). Relationships between height (p = 0.021) and BSA (p = 0.022) were statistically significant for sorafenib. No significant relationships were observed between Ctrough and progression-free survival (PFS) or overall survival (OS) for any drug, except in the case of sunitinib (correlation between Ctrough and PFS p = 0.023) in the exposure-efficacy analysis. CONCLUSIONS Erlotinib, imatinib, lapatinib and sorafenib show large inter-individual variability in exposure. TDM entails a significant improvement in exposure and enables more effective and safe use of TKIs in routine clinical practice.
Collapse
Affiliation(s)
- Vanesa Escudero-Ortiz
- Plataforma de Oncología, Hospital Quirónsalud Torrevieja, 03184 Torrevieja, Spain; (V.E.-O.); (A.C.-L.); (J.R.-L.)
- Pharmacy and Clinical Nutrition Group, Universidad CEU Cardenal Herrera, 03203 Elche, Spain
| | | | - Ana Catalán-Latorre
- Plataforma de Oncología, Hospital Quirónsalud Torrevieja, 03184 Torrevieja, Spain; (V.E.-O.); (A.C.-L.); (J.R.-L.)
| | - Joseba Rebollo-Liceaga
- Plataforma de Oncología, Hospital Quirónsalud Torrevieja, 03184 Torrevieja, Spain; (V.E.-O.); (A.C.-L.); (J.R.-L.)
| | - Manuel Sureda
- Plataforma de Oncología, Hospital Quirónsalud Torrevieja, 03184 Torrevieja, Spain; (V.E.-O.); (A.C.-L.); (J.R.-L.)
- Correspondence:
| |
Collapse
|
6
|
Huh KY, Hwang SJ, Park SY, Lim HJ, Jin MY, Oh JS, Yu KS, Chung JY. Population Pharmacokinetic Modelling and Simulation to Determine the Optimal Dose of Nanoparticulated Sorafenib to the Reference Sorafenib. Pharmaceutics 2021; 13:pharmaceutics13050629. [PMID: 33925058 PMCID: PMC8145937 DOI: 10.3390/pharmaceutics13050629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/17/2021] [Accepted: 04/24/2021] [Indexed: 11/16/2022] Open
Abstract
Sorafenib, an oral multikinase inhibitor, exhibits a highly variable absorption profile due to enterohepatic reabsorption and poor solubility. SYO-1644 improved the solubility of sorafenib by nanoparticulation technology leading to enhanced bioavailability. To evaluate the pharmacokinetically equivalent dose of SYO-1644 to the reference Nexavar® 200 mg, a randomized, open-label, replicated two-period study was conducted in healthy volunteers. A total of 32 subjects orally received a single dose of the following assigned treatment under a fasted state in the first period and repeated once more in the second period with a two-week washout: SYO-1644 100, 150 and 200 mg and Nexavar® 200 mg. Pharmacokinetic (PK) samples were collected up to 168 h post-dose. The PK profile was evaluated by both non-compartmental analysis and population PK method. With the final model, 2 × 2 crossover trial scenarios with Nexavar® 200 mg and each dose of SYO-1644 ranging from 100 to 150 mg were repeated 500 times by Monte Carlo simulation, and the proportion of bioequivalence achievement was assessed. Transit absorption compartments, followed by a one-compartment model with first-order elimination and enterohepatic reabsorption components were selected as the final model. The simulation results demonstrated that the SYO-1644 dose between 120 and 125 mg could yielded the highest proportion of bioequivalence.
Collapse
Affiliation(s)
- Ki-Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul National University, Seoul 03080, Korea; (K.-Y.H.); (S.-j.H.); (J.-s.O.); (K.-S.Y.)
| | - Se-jung Hwang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul National University, Seoul 03080, Korea; (K.-Y.H.); (S.-j.H.); (J.-s.O.); (K.-S.Y.)
| | - Sang-Yeob Park
- Samyang Biopharmaceuticals Corp., Gyeonggi-do 13488, Korea; (S.-Y.P.); (H.-J.L.); (M.-y.J.)
| | - Hye-Jung Lim
- Samyang Biopharmaceuticals Corp., Gyeonggi-do 13488, Korea; (S.-Y.P.); (H.-J.L.); (M.-y.J.)
| | - Mir-yung Jin
- Samyang Biopharmaceuticals Corp., Gyeonggi-do 13488, Korea; (S.-Y.P.); (H.-J.L.); (M.-y.J.)
| | - Jae-seong Oh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul National University, Seoul 03080, Korea; (K.-Y.H.); (S.-j.H.); (J.-s.O.); (K.-S.Y.)
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul National University, Seoul 03080, Korea; (K.-Y.H.); (S.-j.H.); (J.-s.O.); (K.-S.Y.)
| | - Jae-Yong Chung
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Bundang Hospital, Gyeonggi-do 13620, Korea
- Correspondence: ; Tel.: +82-31-787-3955; Fax: +82-31-787-4091
| |
Collapse
|
7
|
Ba HL, Mbatchi L, Gattacceca F, Evrard A, Lacarelle B, Blanchet B, Ciccolini J, Salas S. Pharmacogenetics and pharmacokinetics modeling of unexpected and extremely severe toxicities after sorafenib intake. Pharmacogenomics 2021; 21:173-179. [PMID: 31967518 DOI: 10.2217/pgs-2019-0127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 53-year-old woman with papillary thyroid cancer treated with 800 mg sorafenib therapy rapidly experienced grade 3 toxicities. Dosing was reduced in a step-wise manner with several treatment discontinuations down to 200 mg every 2 days but severe toxicities continued. Plasma drug monitoring showed high exposure, even at low dose. Dosing was then further reduced at 200 mg every 3 days and tolerance was finally acceptable (i.e., grade 1 toxicity) with stable disease upon RECIST imaging. Pharmacogenetic investigations showed polymorphisms affecting both UGT1A9 (UGT1A9-rs3832043) and nuclear receptor PXR (NR1I2-rs3814055, NR1I2-rs2472677 and NR1I2-rs10934498), possibly resulting in downregulation of liver metabolizing enzymes of sorafenib (i.e., CYP and UGT). Patient's clearance (0.48 l/h) estimated by Bayesian approach was consistently lower than usually described. This is the first time that, in addition to mutations affecting UGT1A9, genetic polymorphisms of NR1I2 have possibly been associated with both plasma overexposure and severe toxicities upon sorafenib intake.
Collapse
Affiliation(s)
- Hai le Ba
- SMARTc Unit, CRCM, Inserm U1068, Aix Marseille University, Marseille, France
| | - Litaty Mbatchi
- Clinical Biochemistry Department, Caremeau University Hospital of Nîmes, Nîmes, France
| | - Florence Gattacceca
- SMARTc Unit, CRCM, Inserm U1068, Aix Marseille University, Marseille, France
| | - Alexandre Evrard
- Clinical Biochemistry Department, Caremeau University Hospital of Nîmes, Nîmes, France
| | - Bruno Lacarelle
- SMARTc Unit, CRCM, Inserm U1068, Aix Marseille University, Marseille, France
| | - Benoit Blanchet
- Biologie du Médicament - Toxicologie, Hôpital Cochin, AP-HP, Paris, France
| | - Joseph Ciccolini
- SMARTc Unit, CRCM, Inserm U1068, Aix Marseille University, Marseille, France
| | - Sébastien Salas
- Medical Oncology Unit, La Timone University Hospital of Marseille Assistance Publique Hôpitaux de Marseille, Marseille, France
| |
Collapse
|
8
|
Hopkins AM, Menz BD, Wiese MD, Kichenadasse G, Gurney H, McKinnon RA, Rowland A, Sorich MJ. Nuances to precision dosing strategies of targeted cancer medicines. Pharmacol Res Perspect 2020; 8:e00625. [PMID: 32662214 PMCID: PMC7358594 DOI: 10.1002/prp2.625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 01/05/2023] Open
Abstract
Selecting the dose of a targeted cancer medicine that is most appropriate for a specific individual is a rational approach to maximize therapeutic outcomes and minimize toxicity. There are many different options for optimizing the dose of targeted cancer medicines and the purpose of this review is to provide a comprehensive comparison of the main options explored in prospective studies. Precision initial dose selection of targeted cancer therapies has been minimally explored to date; however, concentration, toxicity, and therapeutic outcome markers are used to guide on-therapy dose adaption of targeted cancer therapies across several medicines and cancers. While a specific concentration, toxicity, or therapeutic outcome marker commonly dominates an investigated precision on-therapy dose adaption strategy, greater attention to simultaneously account for exposure, toxicity, therapeutic outcomes, disease status, time since treatment initiation and patient preferences are required for optimal patient outcomes. To enable successful implementation of precision dosing strategies for targeted cancer medicines into clinical practice, future prospective studies aiming to develop strategies should consider these elements in their design.
Collapse
Affiliation(s)
- Ashley M. Hopkins
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Bradley D. Menz
- Division of PharmacySouthern Adelaide Local Health Network, Flinders Medical CentreAdelaideSouth AustraliaAustralia
| | - Michael D. Wiese
- School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - Ganessan Kichenadasse
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Howard Gurney
- Department of Medical OncologyWestmead HospitalSydneyNew South WalesAustralia
| | - Ross A. McKinnon
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Andrew Rowland
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Michael J. Sorich
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| |
Collapse
|
9
|
Azimian F, Hamzeh-Mivehroud M, Shahbazi Mojarrad J, Hemmati S, Dastmalchi S. Synthesis and biological evaluation of diaryl urea derivatives designed as potential anticarcinoma agents using de novo structure-based lead optimization approach. Eur J Med Chem 2020; 201:112461. [PMID: 32663641 DOI: 10.1016/j.ejmech.2020.112461] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
To develop inhibitors blocking VEGFR2 and the Raf/MEK/ERK mitogen-activated protein kinase signaling pathway new compounds based on sorafenib were designed, synthesized and biologically evaluated. Using de novo design method, a library of new ligands was generated and expanded. Considering in silico binding affinity towards VEGFR2, synthetic feasibility, and drug-likeness property, some of the designed ligands were selected for synthesis and screening for their in vitro antiproliferative activities against two cancer cell lines (HT-29 and A549). Four compounds (13a, 14a, 14l and 15b) exhibited stronger antiproliferative activity (with IC50 values of 13.27, 6.62, 12.74, 3.38 μM, respectively) against HT-29 cells compared to that of the positive reference drug sorafenib (IC50 = 17.28 μM). Notably, compound 15b demonstrated the highest activity, and in particular, it induced HT-29 apoptosis, increased intracellular reactive oxygen species level, arrested cell cycle at G0/G1 phase, and influenced the expression of apoptosis- and cell cycle-related proteins. 15b compound can effectively block the Raf/MEK/ERK pathway and inhibit VEGFR2 phosphorylation. Molecular docking revealed that 15b can bind well to the active site of VEGFR2 receptor. Collectively, 15b may be considered as a promising compound amenable for further investigation for the development of new anticancer agents.
Collapse
Affiliation(s)
- Fereshteh Azimian
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Medicinal Chemistry, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Hamzeh-Mivehroud
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Medicinal Chemistry, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javid Shahbazi Mojarrad
- Department of Medicinal Chemistry, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran; Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Salar Hemmati
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Siavoush Dastmalchi
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Medicinal Chemistry, School of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
10
|
Sorafenib administered using a high-dose, pulsatile regimen in patients with advanced solid malignancies: a phase I exposure escalation study. Cancer Chemother Pharmacol 2020; 85:931-940. [PMID: 32274565 PMCID: PMC7188706 DOI: 10.1007/s00280-020-04065-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/24/2020] [Indexed: 01/07/2023]
Abstract
Background (Pre)clinical evidence is accumulating that intermittent exposure to increased doses of protein kinase inhibitors may improve their treatment benefit. In this phase I trial, the safety of high-dose, pulsatile sorafenib was studied. Patients and methods High-dose sorafenib was administered once weekly in exposure escalation cohorts according to a 3 + 3 design. Drug monitoring was performed in weeks 1–3 and doses were adjusted to achieve a predefined target plasma area under the curve (AUC)(0–12 h). The effect of low gastric pH on improving sorafenib exposure was investigated by intake of the acidic beverage cola. Results Seventeen patients with advanced malignancies without standard treatment options were included. Once weekly, high-dose sorafenib exposure was escalated up to a target AUC(0–12 h) of 125–150 mg/L/h, achieving a twofold higher Cmax compared to standard continuous dosing. Dose-limiting toxicity was observed in three patients: grade 3 duodenal perforation (2800 mg sorafenib), grade 5 multiorgan failure (2800 mg sorafenib) and grade 5 biliary tract perforation (3600 mg sorafenib). The mean difference between observed and target AUC(0–12 h) was 45% (SD ± 56%) in week 1 using a fixed starting dose of sorafenib compared to 2% (SD ± 32%) in week 3 as a result of drug monitoring (P = 0.06). Dissolving sorafenib in cola, instead of water, did not improve sorafenib exposure. Clinical benefit with stable disease as the best response was observed in two patients. Conclusion Treatment with high-dose, once weekly sorafenib administration resulted in dose-limiting toxicity precluding dose escalation above the exposure cohort of 125–150 mg/L/h. Drug monitoring was a successful strategy to pursue a target exposure. Electronic supplementary material The online version of this article (10.1007/s00280-020-04065-5) contains supplementary material, which is available to authorized users.
Collapse
|
11
|
Louveau B, Jouenne F, Kaguelidou F, Landras A, Goldwirt L, Mourah S. The key role of oncopharmacology in therapeutic management, from common to rare cancers: A literature review. Therapie 2020; 75:183-193. [DOI: 10.1016/j.therap.2020.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/15/2019] [Indexed: 01/18/2023]
|
12
|
Seebacher NA, Stacy AE, Porter GM, Merlot AM. Clinical development of targeted and immune based anti-cancer therapies. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2019; 38:156. [PMID: 30975211 PMCID: PMC6460662 DOI: 10.1186/s13046-019-1094-2] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/07/2019] [Indexed: 02/08/2023]
Abstract
Cancer is currently the second leading cause of death globally and is expected to be responsible for approximately 9.6 million deaths in 2018. With an unprecedented understanding of the molecular pathways that drive the development and progression of human cancers, novel targeted therapies have become an exciting new development for anti-cancer medicine. These targeted therapies, also known as biologic therapies, have become a major modality of medical treatment, by acting to block the growth of cancer cells by specifically targeting molecules required for cell growth and tumorigenesis. Due to their specificity, these new therapies are expected to have better efficacy and limited adverse side effects when compared with other treatment options, including hormonal and cytotoxic therapies. In this review, we explore the clinical development, successes and challenges facing targeted anti-cancer therapies, including both small molecule inhibitors and antibody targeted therapies. Herein, we introduce targeted therapies to epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), human epidermal growth factor receptor 2 (HER2), anaplastic lymphoma kinase (ALK), BRAF, and the inhibitors of the T-cell mediated immune response, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein-1 (PD-1)/ PD-1 ligand (PD-1 L).
Collapse
Affiliation(s)
- N A Seebacher
- Faculty of Medicine, The University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - A E Stacy
- Faculty of Medicine, The University of Notre Dame, Darlinghurst, New South Wales, 2010, Australia
| | - G M Porter
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Kensington, New South Wales, 2031, Australia
| | - A M Merlot
- Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Kensington, New South Wales, 2031, Australia. .,School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, 2031, Australia. .,UNSW Centre for Childhood Cancer Research, Faculty of Medicine, University of New South Wales, Kensington, New South Wales, 2031, Australia.
| |
Collapse
|
13
|
Lagunin AA, Dubovskaja VI, Rudik AV, Pogodin PV, Druzhilovskiy DS, Gloriozova TA, Filimonov DA, Sastry NG, Poroikov VV. CLC-Pred: A freely available web-service for in silico prediction of human cell line cytotoxicity for drug-like compounds. PLoS One 2018; 13:e0191838. [PMID: 29370280 PMCID: PMC5784992 DOI: 10.1371/journal.pone.0191838] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/11/2018] [Indexed: 11/19/2022] Open
Abstract
In silico methods of phenotypic screening are necessary to reduce the time and cost of the experimental in vivo screening of anticancer agents through dozens of millions of natural and synthetic chemical compounds. We used the previously developed PASS (Prediction of Activity Spectra for Substances) algorithm to create and validate the classification SAR models for predicting the cytotoxicity of chemicals against different types of human cell lines using ChEMBL experimental data. A training set from 59,882 structures of compounds was created based on the experimental data (IG50, IC50, and % inhibition values) from ChEMBL. The average accuracy of prediction (AUC) calculated by leave-one-out and a 20-fold cross-validation procedure during the training was 0.930 and 0.927 for 278 cancer cell lines, respectively, and 0.948 and 0.947 for cytotoxicity prediction for 27 normal cell lines, respectively. Using the given SAR models, we developed a freely available web-service for cell-line cytotoxicity profile prediction (CLC-Pred: Cell-Line Cytotoxicity Predictor) based on the following structural formula: http://way2drug.com/Cell-line/.
Collapse
Affiliation(s)
- Alexey A. Lagunin
- Department for Bioinformatics, Institute of Biomedical Chemistry, Moscow, Russia
- Department for Bioinformatics, Medico-Biologic Faculty, Pirogov Russian National Research Medical University, Moscow, Russia
- * E-mail:
| | | | - Anastasia V. Rudik
- Department for Bioinformatics, Institute of Biomedical Chemistry, Moscow, Russia
| | - Pavel V. Pogodin
- Department for Bioinformatics, Institute of Biomedical Chemistry, Moscow, Russia
| | | | | | - Dmitry A. Filimonov
- Department for Bioinformatics, Institute of Biomedical Chemistry, Moscow, Russia
| | - Narahari G. Sastry
- Centre for Molecular Modeling, CSIR-Indian Institute of Chemical Technology, Hyderabad, India
| | - Vladimir V. Poroikov
- Department for Bioinformatics, Institute of Biomedical Chemistry, Moscow, Russia
| |
Collapse
|
14
|
Bellesoeur A, Boudou-Rouquette P, Thomas-Schoemann A, Joly C, Tlemsani C, Vidal M, Goldwasser F, Blanchet B. Individualized Pazopanib Dosing-Letter. Clin Cancer Res 2017; 23:6377. [PMID: 29030334 DOI: 10.1158/1078-0432.ccr-17-1873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/27/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Audrey Bellesoeur
- Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France.,Université Paris Descartes, Paris, France.,CARPEM, Paris, France
| | - Pascaline Boudou-Rouquette
- Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France.,Université Paris Descartes, Paris, France.,CARPEM, Paris, France
| | - Audrey Thomas-Schoemann
- Department of Pharmacokinetics and Pharmacochemisty, Hôpital Cochin, AP-HP, Paris, France. .,CARPEM, Paris, France
| | - Charlotte Joly
- Department of Medical Oncology, Hôpital Henri Mondor, AP-HP, Paris, France
| | - Camille Tlemsani
- Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France.,Université Paris Descartes, Paris, France.,CARPEM, Paris, France
| | - Michel Vidal
- Department of Pharmacokinetics and Pharmacochemisty, Hôpital Cochin, AP-HP, Paris, France.,CARPEM, Paris, France
| | - François Goldwasser
- Department of Medical Oncology, Hôpital Cochin, AP-HP, Paris, France.,Université Paris Descartes, Paris, France.,CARPEM, Paris, France
| | - Benoit Blanchet
- Department of Pharmacokinetics and Pharmacochemisty, Hôpital Cochin, AP-HP, Paris, France.,CARPEM, Paris, France
| |
Collapse
|
15
|
Lucas CJ, Martin JH. Pharmacokinetic-Guided Dosing of New Oral Cancer Agents. J Clin Pharmacol 2017; 57 Suppl 10:S78-S98. [DOI: 10.1002/jcph.937] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/10/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Catherine J. Lucas
- Discipline of Clinical Pharmacology, School of Medicine and Public Health; University of Newcastle; New South Wales Australia
| | - Jennifer H. Martin
- Discipline of Clinical Pharmacology, School of Medicine and Public Health; University of Newcastle; New South Wales Australia
| |
Collapse
|
16
|
Clinical pharmacology of anti-angiogenic drugs in oncology. Crit Rev Oncol Hematol 2017; 119:75-93. [PMID: 28916378 DOI: 10.1016/j.critrevonc.2017.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 12/14/2022] Open
Abstract
Abnormal vasculature proliferation is one of the so-called hallmarks of cancer. Angiogenesis inhibitor therapies are one of the major breakthroughs in cancer treatment in the last two decades. Two types of anti-angiogenics have been approved: monoclonal antibodies and derivatives, which are injected and target the extracellular part of a receptor, and protein kinase inhibitors, which are orally taken small molecules targeting the intra-cellular Adenosine Triphosphate -pocket of different kinases. They have become an important part of some tumors' treatment, both in monotherapy or in combination. In this review, we discuss the key pharmacological concepts and the major pitfalls of anti-angiogenic prescriptions. We also review the pharmacokinetic and pharmacodynamics profile of all approved anti-angiogenic protein kinase inhibitors and the potential role of surrogate markers and of therapeutic drug monitoring.
Collapse
|
17
|
Morrissey KM, Benet LZ, Ware JA. Commentary on: "Influence of OATP1B1 Function on the Disposition of Sorafenib-β-D-Glucuronide". Clin Transl Sci 2017; 10:240-241. [PMID: 28664655 PMCID: PMC5504478 DOI: 10.1111/cts.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/26/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- K M Morrissey
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| | - L Z Benet
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - J A Ware
- Department of Clinical Pharmacology, Genentech, Inc., South San Francisco, California, USA
| |
Collapse
|
18
|
Fenton SE, Sosman JA, Chandra S. Emerging growth factor receptor antagonists for the treatment of advanced melanoma. Expert Opin Emerg Drugs 2017; 22:165-174. [PMID: 28562096 DOI: 10.1080/14728214.2017.1336537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Therapy for metastatic melanoma has undergone a rapid transformation over the past 5-10 years. Advances in immunotherapy with checkpoint inhibitors, including both anti-CTLA-4 and anti-PD-1/PD-L1, have led to durable responses in up to 50% of patients. As our understanding of the processes driving the transformation of melanocytes has improved, progress in targeted therapies has also continued. Areas covered: Angiogenesis and the tumor's dependence on an expanded vascular supply has been a target for novel therapies since the 1970's, as this tissue is derived from endothelial cells that are genetically stable in adults. A phase II trial studying combined therapy with bevacizumab (an inhibitor of angiogenesis) and ipilimumab found promising results. Other agents such as sorafenib have not been as successful, failing to extend progression free or overall survival in clinical trials. In this paper other targeted growth factor inhibitors will also be discussed. Expert opinion: Ultimately, melanoma may not be vulnerable solely to chemotherapy or targeted therapy, but may be efficaciously treated with immunotherapy due to its high mutational rate resulting in the expression of numerous neo-antigens. Therapies with combinations of agents including growth factor receptor and either other targeted therapies or immunotherapy may be a promising complimentary approach.
Collapse
|
19
|
Gore ME, Jones RJ, Ravaud A, Kuczyk M, Demkow T, Bearz A, Shapiro J, Strauss UP, Porta C. Sorafenib dose escalation in treatment-naïve patients with metastatic renal cell carcinoma: a non-randomised, open-label, Phase 2b study. BJU Int 2017; 119:846-853. [DOI: 10.1111/bju.13740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Robert J. Jones
- Beatson West of Scotland Cancer Centre; University of Glasgow; Glasgow UK
| | | | | | | | - Alessandra Bearz
- Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie; Warszawa Poland
| | | | - Uwe Phillip Strauss
- IRCCS Policlinico San Matteo, Medicina Interna ed Oncologia Medica; Pavia Italy
| | - Camillo Porta
- Bayer HealthCare Pharmaceuticals Inc.; Whippany NJ USA
| |
Collapse
|
20
|
Rovithi M, de Haas RR, Honeywell RJ, Poel D, Peters GJ, Griffioen AW, Verheul HMW. Alternative scheduling of pulsatile, high dose sunitinib efficiently suppresses tumor growth. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2016; 35:138. [PMID: 27604186 PMCID: PMC5013589 DOI: 10.1186/s13046-016-0411-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/25/2016] [Indexed: 01/11/2023]
Abstract
Background Increased exposure to multitargeted kinase inhibitor sunitinib is associated with improved outcome, emphasizing the importance of maintaining adequate dosing and drug levels. The currently approved schedule (50 mg daily, four weeks on, two weeks off) precludes further dose-intensification. Recent data suggest that sunitinib, although initially developed as an antiangiogenic agent, has direct antitumor activity. Methods In this study, we tested whether a chemotherapy-like schedule of pulsatile high dose sunitinib would result in improved antitumor activity. Results In vitro, a single exposure to 20 μM sunitinib for 6-9 h resulted in complete inhibition of tumor cell growth and cell death conveyed through activation of caspases and autophagy upregulation. Notably, repeated exposure of tumor cells to pulses of high concentrations of sunitinib did not induce resistance. In vivo, once-weekly treatment with high dose sunitinib of tumors growing on the chorioallantoic membrane (CAM) of the chicken embryo significantly impaired tumor growth by 57 % compared to vehicle, outperforming the daily, standard scheduling. Conclusions These results prompted the initiation of a phase I clinical trial, where intermittent, high dose sunitinib is being investigated in patients with advanced solid tumors (registration number and date: NCT02058901, 30 September 2013, respectively). The trial is actively recruiting patients and promising preliminary indications of antitumor activity have been observed.
Collapse
Affiliation(s)
- Maria Rovithi
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Richard R de Haas
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Richard J Honeywell
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Dennis Poel
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Godefridus J Peters
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Arjan W Griffioen
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
21
|
Digklia A, Michielin O. The cutting edge of metastatic melanoma therapy. Melanoma Manag 2016; 3:217-229. [PMID: 30190891 DOI: 10.2217/mmt-2016-0026] [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: 05/05/2016] [Accepted: 06/16/2016] [Indexed: 11/21/2022] Open
Abstract
The past decade has witnessed impressive new developments for the treatment of melanoma. The discovery of key oncogenic driver mutations, upon which tumor establishment and progression are dependent, changed the prognosis of patients with stage IV disease. Extensive preclinical and clinical studies have shown high response rates and survival benefits over conventional chemotherapies provided by target-specific inhibitors of BRAF- or NRAS-activating mutations. Recent genomic analyses of melanoma have also given new potentially targetable driver mutations. In addition, the quickened pace of development of immune checkpoint inhibitors for the treatment of melanoma offers the unique opportunity to provide a long-term clinical benefit. In this emerging era, predictive biomarkers for the selection of patients are required to help us develop an optimal therapeutic strategy.
Collapse
Affiliation(s)
- Antonia Digklia
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Bugnon 46, 1011 Lausanne, Switzerland
| | - Olivier Michielin
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Bugnon 46, 1011 Lausanne, Switzerland
| |
Collapse
|
22
|
How ‘Optimal’ are Optimal Sampling Times for Tyrosine Kinase Inhibitors in Cancer? Practical Considerations. Clin Pharmacokinet 2016; 55:1171-1177. [DOI: 10.1007/s40262-016-0394-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
23
|
Willemsen AECAB, Lubberman FJE, Tol J, Gerritsen WR, van Herpen CML, van Erp NP. Effect of food and acid-reducing agents on the absorption of oral targeted therapies in solid tumors. Drug Discov Today 2016; 21:962-76. [PMID: 26995271 DOI: 10.1016/j.drudis.2016.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 02/17/2016] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Abstract
Oral targeted therapies represent an increasingly important group of drugs within modern oncology. With the shift from intravenously to orally administered drugs, drug absorption is a newly introduced factor in drug disposition. The process of absorption can have a large effect on inter- and intrasubject variability in drug exposure and thereby potentially treatment benefit or the severity of toxicities. The intake of oral targeted therapies with food and concomitant use of acid-reducing agents (ARAs) can significantly affect drug absorption. The size and direction of the effect of food and ARAs on drug absorption varies among drugs as a result of different chemical characteristics. Therefore, an awareness and understanding of these effects for each drug is essential to optimize patient outcomes.
Collapse
Affiliation(s)
- Annelieke E C A B Willemsen
- Radboud university medical center, Department of Medical Oncology, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands.
| | - Floor J E Lubberman
- Radboud university medical center, Department of Pharmacy, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands
| | - Jolien Tol
- Jeroen Bosch Hospital, Department of Medical Oncology, P.O. Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
| | - Winald R Gerritsen
- Radboud university medical center, Department of Medical Oncology, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands
| | - Carla M L van Herpen
- Radboud university medical center, Department of Medical Oncology, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands
| | - Nielka P van Erp
- Radboud university medical center, Department of Pharmacy, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands
| |
Collapse
|
24
|
Kanbayashi Y, Hosokawa T, Yasui K, Hongo F, Yamaguchi K, Moriguchi M, Miki T, Itoh Y. Predictive factors for sorafenib-induced hand–foot skin reaction using ordered logistic regression analysis. Am J Health Syst Pharm 2016; 73:e18-23. [DOI: 10.2146/ajhp150129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Yuko Kanbayashi
- Department of Hospital Pharmacy and Pain Treatment and Palliative Care Unit, University Hospital
| | - Toyoshi Hosokawa
- Pain Treatment and Palliative Care Unit, University Hospital, and Professor, Department of Pain Management and Palliative Care Medicine, Graduate School of Medical Science (GSMS)
| | | | | | | | | | | | - Yoshito Itoh
- Departments of Gastroenterology and Hepatology and Urology, GSMS, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
25
|
Design, synthesis, and biological evaluation of novel quinazolinyl-diaryl urea derivatives as potential anticancer agents. Eur J Med Chem 2016; 107:12-25. [DOI: 10.1016/j.ejmech.2015.10.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/21/2015] [Accepted: 10/27/2015] [Indexed: 12/19/2022]
|
26
|
Worden F, Fassnacht M, Shi Y, Hadjieva T, Bonichon F, Gao M, Fugazzola L, Ando Y, Hasegawa Y, Park DJ, Shong YK, Smit JWA, Chung J, Kappeler C, Meinhardt G, Schlumberger M, Brose MS. Safety and tolerability of sorafenib in patients with radioiodine-refractory thyroid cancer. Endocr Relat Cancer 2015; 22:877-87. [PMID: 26370187 PMCID: PMC4570090 DOI: 10.1530/erc-15-0252] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Effective adverse event (AE) management is critical to maintaining patients on anticancer therapies. The DECISION trial was a multicenter, randomized, double-blind, placebo-controlled, Phase 3 trial which investigated sorafenib for treatment of progressive, advanced, or metastatic radioactive iodine-refractory, differentiated thyroid carcinoma. Four hundred and seventeen adult patients were randomized (1:1) to receive oral sorafenib (400 mg, twice daily) or placebo, until progression, unacceptable toxicity, noncompliance, or withdrawal. Progression-free survival, the primary endpoint of DECISION, was reported previously. To elucidate the patterns and management of AEs in sorafenib-treated patients in the DECISION trial, this report describes detailed, by-treatment-cycle analyses of the incidence, prevalence, and severity of hand-foot skin reaction (HFSR), rash/desquamation, hypertension, diarrhea, fatigue, weight loss, increased serum thyroid stimulating hormone, and hypocalcemia, as well as the interventions used to manage these AEs. By-cycle incidence of the above-selected AEs with sorafenib was generally highest in cycle 1 or 2 then decreased. AE prevalence generally increased over cycles 2-6 then stabilized or declined. Among these AEs, only weight loss tended to increase in severity (from grade 1 to 2) over time; severity of HFSR and rash/desquamation declined over time. AEs were mostly grade 1 or 2, and were generally managed with dose interruptions/reductions, and concomitant medications (e.g. antidiarrheals, antihypertensives, dermatologic preparations). Most dose interruptions/reductions occurred in early cycles. In conclusion, AEs with sorafenib in DECISION were typically grade 1 or 2, occurred early during the treatment course, and were manageable over time.
Collapse
MESH Headings
- Adenocarcinoma, Follicular/drug therapy
- Adenocarcinoma, Follicular/enzymology
- Adenocarcinoma, Follicular/radiotherapy
- Adenoma, Oxyphilic/drug therapy
- Adenoma, Oxyphilic/enzymology
- Adenoma, Oxyphilic/radiotherapy
- Aged
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/enzymology
- Carcinoma, Papillary/radiotherapy
- Diarrhea/chemically induced
- Diarrhea/drug therapy
- Diarrhea/epidemiology
- Disease-Free Survival
- Drug Eruptions/drug therapy
- Drug Eruptions/epidemiology
- Drug Eruptions/etiology
- Drug Resistance, Neoplasm
- Dyspnea/chemically induced
- Dyspnea/epidemiology
- Fatigue/chemically induced
- Fatigue/epidemiology
- Female
- Humans
- Hypertension/chemically induced
- Hypertension/drug therapy
- Hypertension/epidemiology
- Hypocalcemia/chemically induced
- Hypocalcemia/epidemiology
- Incidence
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Niacinamide/adverse effects
- Niacinamide/analogs & derivatives
- Niacinamide/therapeutic use
- Phenylurea Compounds/adverse effects
- Phenylurea Compounds/therapeutic use
- Prevalence
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Radiopharmaceuticals/therapeutic use
- Sorafenib
- Thyroid Neoplasms/drug therapy
- Thyroid Neoplasms/enzymology
- Thyroid Neoplasms/radiotherapy
- Weight Loss/drug effects
Collapse
Affiliation(s)
- Francis Worden
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin Fassnacht
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Yuankai Shi
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Tatiana Hadjieva
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Françoise Bonichon
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ming Gao
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura Fugazzola
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Yuichi Ando
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yasuhisa Hasegawa
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Do Joon Park
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Young Kee Shong
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Johannes W A Smit
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Chung
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian Kappeler
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gerold Meinhardt
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin Schlumberger
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcia S Brose
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
27
|
Do K, Cao L, Kang Z, Turkbey B, Lindenberg ML, Larkins E, Holkova B, Steinberg SM, Raffeld M, Peer CJ, Figg WD, Eugeni M, Jacobs P, Choyke P, Wright JJ, Doroshow JH, Kummar S. A Phase II Study of Sorafenib Combined With Cetuximab in EGFR-Expressing, KRAS-Mutated Metastatic Colorectal Cancer. Clin Colorectal Cancer 2015; 14:154-61. [PMID: 25861837 PMCID: PMC6657351 DOI: 10.1016/j.clcc.2015.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/19/2015] [Accepted: 02/26/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mutations in the KRAS gene predict for resistance to anti-epidermal growth factor receptor (EGFR) therapies, including cetuximab. Upregulation of vascular endothelial growth factor (VEGF)-A has been implicated in resistance to anti-EGFR treatment. Abrogation of the VEGF and RAS/RAF/MEK/ERK pathways has the potential to restore cetuximab sensitivity. PATIENTS AND METHODS Adult patients with histologically documented, measurable, EGFR-expressing, KRAS-mutated metastatic colorectal cancer (mCRC) that had progressed after 5-fluorouracil-based regimens were treated with sorafenib 400 mg orally twice daily and intravenous cetuximab weekly in 28-day cycles. The primary endpoint was the response rate (complete response, partial response, and stable disease at 4 cycles). The secondary endpoints included plasma biomarker analysis of angiogenic cytokines and correlative imaging studies with dynamic contrast-enhanced magnetic resonance imaging and zirconium 89-panitumumab. RESULTS Of the 30 patients enrolled, 26 were evaluable for response. Of the 26 patients evaluated, 4 had stable disease at 4 cycles and 1 had stable disease at 8 cycles. The median progression-free survival was 1.84 months. The common toxicities were rash, diarrhea, and liver enzyme elevations. Of the angiogenic cytokines evaluated, only the placental growth factor increased significantly with treatment (P < .0001). No pharmacodynamic parameters were associated with the treatment response. CONCLUSION We report the results of a trial that combined cetuximab and sorafenib for the treatment of KRAS-mutated mCRC, with correlative imaging studies and pharmacodynamic angiogenic cytokine profiling as downstream markers of EGFR and VEGF receptor (VEGFR) signaling. No objective responses were observed. Additional development of biomarkers for patient selection is needed to evaluate combined EGFR and VEGFR blockade as a therapeutic option in KRAS-mutated CRC.
Collapse
Affiliation(s)
- Khanh Do
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Liang Cao
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Zhigang Kang
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Baris Turkbey
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | | | - Erin Larkins
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Beata Holkova
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Seth M Steinberg
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Mark Raffeld
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Cody J Peer
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - William D Figg
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Michelle Eugeni
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Paula Jacobs
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Peter Choyke
- Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - John J Wright
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Shivaani Kummar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD.
| |
Collapse
|
28
|
Kuczynski EA, Lee CR, Man S, Chen E, Kerbel RS. Effects of Sorafenib Dose on Acquired Reversible Resistance and Toxicity in Hepatocellular Carcinoma. Cancer Res 2015; 75:2510-9. [PMID: 25908587 DOI: 10.1158/0008-5472.can-14-3687] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/23/2015] [Indexed: 12/31/2022]
Abstract
Acquired evasive resistance is a major limitation of hepatocellular carcinoma (HCC) treatment with the tyrosine kinase inhibitor (TKI) sorafenib. Recent findings suggest that resistance to sorafenib may have a reversible phenotype. In addition, loss of responsiveness has been proposed to be due to a gradual decrease in sorafenib plasma levels in patients. Here, the possible mechanisms underlying reversible sorafenib resistance were investigated using a Hep3B-hCG orthotopic human xenograft model of locally advanced HCC. Tissue and plasma sorafenib and metabolite levels, downstream antitumor targets, and toxicity were assessed during standard and dose-escalated sorafenib treatment. Drug levels were found to decline significantly over time in mice treated with 30 mg/kg sorafenib, coinciding with the onset of resistance but a greater magnitude of change was observed in tissues compared with plasma. Skin rash also correlated with drug levels and tended to decrease in severity over time. Drug level changes appeared to be partially tumor dependent involving induction of tumoral CYP3A4 metabolism, with host pretreatment alone unable to generate resistance. Escalation from 30 to 60 mg/kg sorafenib improved antitumor efficacy but worsened survival due to excessive body weight loss. Microvessel density was inhibited by sorafenib treatment but remained suppressed over time and dose increase. In conclusion, tumor CYP3A4 induction by sorafenib is a novel mechanism to account for variability in systemic drug levels; however, declining systemic sorafenib levels may only be a minor resistance mechanism. Escalating the dose may be an effective treatment strategy, provided toxicity can be controlled.
Collapse
Affiliation(s)
| | - Christina R Lee
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Shan Man
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada
| | - Eric Chen
- Department of Medical Oncology, Princess Margaret Hospital, Toronto, Canada
| | - Robert S Kerbel
- Department of Medical Biophysics, University of Toronto, Toronto, Canada. Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.
| |
Collapse
|
29
|
Funck-Brentano E, Alvarez JC, Longvert C, Abe E, Beauchet A, Funck-Brentano C, Saiag P. Plasma vemurafenib concentrations in advanced BRAFV600mut melanoma patients: impact on tumour response and tolerance. Ann Oncol 2015; 26:1470-5. [PMID: 25899783 DOI: 10.1093/annonc/mdv189] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 04/13/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Vemurafenib improves survival in advanced BRAFV600(mut) melanoma patients, but tolerance is often poor and resistance frequently occurs, without predictive factor. Our aim was to investigate for the first time a relationship between plasma vemurafenib concentration (PVC) and efficacy or tolerance. METHODS Plasma samples from unresectable metastatic BRAFV600(mut) melanoma patients treated with vemurafenib monotherapy were prospectively collected at each tumour response evaluation (RECIST 1.1) or when adverse event occurred (CTCAE 4.0). PVC was measured with liquid chromatography-tandem mass spectrometry. Herein, we report on PVC at steady state (≥14 days after vemurafenib introduction or dose modification). Samples collected after first melanoma progression were excluded from the response analysis. All samples were analysed in the tolerance analysis. We kept the closest collected sample from the onset of each adverse effect or the one with the highest PVC in the absence of this adverse effect. Comparisons of means (Student's t-tests and Wilcoxon rank sum tests) and of frequencies (χ(2) tests) were carried out. A logistic regression analysis identified predictors of progression. RESULTS We included 105 plasma samples in 23 patients (10M/13F). Initial vemurafenib dose was 960 mg b.i.d., reduced by 25% (8 patients) or 50% (2 patients) for intolerance in 10 patients (44%). PVC displayed high inter-individual variability (13.0-109.8 µg/ml, median 54.0). Mean PVC was lower at time of first progression (38.8 ± 19.7 µg/ml) than mean PVC found when tumour was stable or in partial or complete response (56.4 ± 21.0 µg/ml, P = 0.013, 21 patients). Logistic regression revealed that having a low PVC (P = 0.01) or brain metastasis (P = 0.01) were both significantly and independently associated with tumour progression. High PVC was not statistically significantly associated with the occurrence of adverse effects. CONCLUSION PVC at steady state is highly variable and low PVC was associated with tumour progression, suggesting a new path to melanoma resistance to vemurafenib.
Collapse
Affiliation(s)
- E Funck-Brentano
- Department of Dermatology, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt University of Versailles-Saint-Quentin-en-Yvelines, Research Unit EA 4340 'Biomarkers in Cancerology and in Hemato-oncology', Boulogne-Billancourt
| | - J C Alvarez
- Department of Toxicology, AP-HP, Raymond Poincaré Hospital, Boulogne-Billancourt University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt
| | - C Longvert
- Department of Dermatology, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt University of Versailles-Saint-Quentin-en-Yvelines, Research Unit EA 4340 'Biomarkers in Cancerology and in Hemato-oncology', Boulogne-Billancourt
| | - E Abe
- Department of Toxicology, AP-HP, Raymond Poincaré Hospital, Boulogne-Billancourt University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt
| | - A Beauchet
- University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt Department of Public Health, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt
| | - C Funck-Brentano
- INSERM, CIC-1421 and UMR ICAN 1166, Paris Department of Pharmacology and CIC-1421, AP-HP, Pitié-Salpêtrière Hospital, Paris Department of Pharmacology and UMR ICAN 1166, Faculty of Medicine, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - P Saiag
- Department of Dermatology, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt University of Versailles-Saint-Quentin-en-Yvelines, Research Unit EA 4340 'Biomarkers in Cancerology and in Hemato-oncology', Boulogne-Billancourt
| |
Collapse
|
30
|
Individualized dosing of tyrosine kinase inhibitors: are we there yet? Drug Discov Today 2015; 20:18-36. [DOI: 10.1016/j.drudis.2014.09.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/25/2014] [Accepted: 09/12/2014] [Indexed: 12/11/2022]
|
31
|
A phase I study of high-dose interleukin-2 with sorafenib in patients with metastatic renal cell carcinoma and melanoma. J Immunother 2014; 37:180-6. [PMID: 24598448 PMCID: PMC3966917 DOI: 10.1097/cji.0000000000000023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study was designed to evaluate the safety and feasibility of high-dose interleukin-2 (HD IL-2) followed by sorafenib in patients with metastatic melanoma (MM) and renal cell carcinoma (RCC). Biomarkers relevant to the antitumor effects of IL-2 that may be altered by sorafenib including the percentages of natural T-regulatory cells (Tregs), myeloid-derived suppressor cells (MDSC), and STAT5 phosphorylation (pSTAT5) in T cells were evaluated. We hypothesized that the proposed treatment schedule is feasible and safe and may lead to enhanced tumor response. A phase I dose escalation trial was conducted in patients with either metastatic RCC or MM. HD IL-2 (600,000 IU/kg IV q8h×8–12 doses) was administered on days 1–5 and 15–19, followed by sorafenib on days 29–82. The sorafenib dose was escalated. The percentage of Tregs, MDSC, and pSTAT5 in T cells were evaluated in peripheral blood by flow cytometry. Twelve of the 18 patients were evaluable for dose-limiting toxicity. No dose-limiting toxicity was observed. The treatment-related toxicity was predictable and did not seem to be additive with this schedule of administration. Partial responses were seen in 3 patients. No significant changes in the percentage of circulating Treg and MDSC were observed, whereas sorafenib did not adversely affect the ability of IL-2 to induce pSTAT5 in T cells. HD IL-2 followed by sorafenib was safe and feasible in patients with MM and RCC and did not adversely affect T-cell signaling through STAT5 in response to IL-2.
Collapse
|
32
|
RUSSO ANGELA, FICILI BARTOLOMEA, CANDIDO SAVERIO, PEZZINO FRANCAMARIA, GUARNERI CLAUDIO, BIONDI ANTONIO, TRAVALI SALVATORE, McCUBREY JAMESA, SPANDIDOS DEMETRIOSA, LIBRA MASSIMO. Emerging targeted therapies for melanoma treatment (review). Int J Oncol 2014; 45:516-24. [PMID: 24899250 PMCID: PMC4091965 DOI: 10.3892/ijo.2014.2481] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/03/2014] [Indexed: 12/14/2022] Open
Abstract
Cutaneous melanoma is an aggressive cancer with a poor prognosis for patients with advanced disease. The identification of several key molecular pathways implicated in the pathogenesis of melanoma has led to the development of novel therapies for this devastating disease. In melanoma, both the Ras/Raf/MEK/ERK (MAPK) and the PI3K/AKT (AKT) signalling pathways are constitutively activated through multiple mechanisms. Targeting various effectors of these pathways with pharmacologic inhibitors may inhibit melanoma cell growth and angiogenesis. Ongoing clinical trials provide hope to improve progression-free survival of patients with advanced melanoma. This review summarizes the most relevant studies focused on the specific action of these new molecular targeted agents. Mechanisms of resistance to therapy are also discussed.
Collapse
Affiliation(s)
- ANGELA RUSSO
- Laboratory of Translational Oncology and Functional Genomics, Section of General Pathology and Oncology, Department of Biomedical Sciences, University of Catania, I-95124 Catania, Italy
| | - BARTOLOMEA FICILI
- Laboratory of Translational Oncology and Functional Genomics, Section of General Pathology and Oncology, Department of Biomedical Sciences, University of Catania, I-95124 Catania, Italy
| | - SAVERIO CANDIDO
- Laboratory of Translational Oncology and Functional Genomics, Section of General Pathology and Oncology, Department of Biomedical Sciences, University of Catania, I-95124 Catania, Italy
| | - FRANCA MARIA PEZZINO
- Laboratory of Translational Oncology and Functional Genomics, Section of General Pathology and Oncology, Department of Biomedical Sciences, University of Catania, I-95124 Catania, Italy
| | - CLAUDIO GUARNERI
- Department of Social Territorial Medicine, Section of Dermatology, University of Messina, I-98125 Messina, Italy
| | - ANTONIO BIONDI
- Department of Surgery, University of Catania, I-95124 Catania, Italy
| | - SALVATORE TRAVALI
- Laboratory of Translational Oncology and Functional Genomics, Section of General Pathology and Oncology, Department of Biomedical Sciences, University of Catania, I-95124 Catania, Italy
| | - JAMES A. McCUBREY
- Department of Microbiology and Immunology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - DEMETRIOS A. SPANDIDOS
- Department of Virology, Medical School, University of Crete, Heraklion 71003, Crete, Greece
| | - MASSIMO LIBRA
- Laboratory of Translational Oncology and Functional Genomics, Section of General Pathology and Oncology, Department of Biomedical Sciences, University of Catania, I-95124 Catania, Italy
| |
Collapse
|
33
|
Huillard O, Boissier E, Blanchet B, Thomas-Schoemann A, Cessot A, Boudou-Rouquette P, Durand JP, Coriat R, Giroux J, Alexandre J, Vidal M, Goldwasser F. Drug safety evaluation of sorafenib for treatment of solid tumors: consequences for the risk assessment and management of cancer patients. Expert Opin Drug Saf 2014; 13:663-73. [PMID: 24693873 DOI: 10.1517/14740338.2014.907270] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Sorafenib is a multi-tyrosine kinase inhibitor (TKI). Considerable clinical experience has been accumulated since its first Phase III clinical trial in metastatic renal cancer patients in 2007. The management of its early acute toxicity in fit patients is well known. The management of prolonged treatment becomes the new challenge. AREAS COVERED Using sorafenib as a key word for PubMed search, we review preclinical and clinical data and discuss the pharmacokinetics and pharmacodynamics of sorafenib, its acute and cumulative toxicities and their consequences for patient management. EXPERT OPINION The systematic multi-disciplinary risk assessment of cancer patients prior to TKI initiation reduces the risks of acute and late toxicity, especially drug-drug interactions and arterial risks. Sarcopenia is now identified as a major risk of severe toxicity. The very diverse clinical pictures of cumulative toxicity must be known. The monitoring of sorafenib systemic exposure is helpful especially in elderly patients. Moreover, at disease progression, it allows distinguishing between underexposure to sorafenib and truly acquired resistance to the drug. The optimal use of sorafenib should allow improving the reported results of flat-dose. Finally, most of this knowledge could be used for the development and optimal use of the other TKIs.
Collapse
Affiliation(s)
- Olivier Huillard
- Paris Descartes University, Cochin Hospital, AP-HP, Medical Oncology Department, Angiogenesis Inhibitors Multidisciplinary Study Group (CERIA) , Paris , France +33 1 58 41 17 46 ; +33 1 58 41 17 45 ;
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Fractionation of daily dose increases the predicted risk of severe sorafenib-induced hand-foot syndrome (HFS). Cancer Chemother Pharmacol 2013; 73:287-97. [PMID: 24253177 DOI: 10.1007/s00280-013-2352-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The objective was to quantify the risk dynamics for the sorafenib-induced hand-foot syndrome (HFS) and to explore by simulations the dose-toxicity relationships according to different dosing regimens. PATIENTS AND METHODS Eighty-nine patients treated with sorafenib were considered: Treatment duration and regimen, and number and frequency of HFS observations were highly variable. A nonlinear mixed-effect model was built to link sorafenib administrations to the risk of each HFS score, through a latent variable model. Model evaluation was driven by goodness-of-fit and simulation-based diagnostics. Impact of sorafenib regimen on HFS dynamics was evaluated by simulations. A surrogate measure of benefit-to-risk ratio was calculated by using the concept of utility function, accounting for efficacy on tumor growth inhibition and severe HFS risk. RESULTS AND DISCUSSION An original pharmacokinetic-pharmacodynamic model for sorafenib-induced HFS, including the kinetics of a latent variable model, relating sorafenib administrations, per se its exposure, to HFS dynamics is proposed. From the model simulations, it appears that the more the daily dose is fractioned, the more the patients are at risk of HFS. Interestingly, the number of daily occasions was found more influential than the dose itself. Taking into account tumor growth inhibition in the utility function, the twice-daily administration schedule is favored for daily doses >600 mg. This approach illustrates how understanding the dynamic relationship between drug administrations and a limiting adverse event may help to control toxicity and adequately adjust treatment modalities.
Collapse
|
35
|
Abstract
Genetic and genomic analyses of melanocytic tumors have yielded new opportunities for improvements in diagnostic accuracy for the distinction of nevus from melanoma and better selection of patients affected by melanoma for targeted treatment. Since chromosomal copy number changes are commonly found in malignant melanoma, but rare in melanocytic nevi, cytogenetic assays have emerged as a promising ancillary study for the workup of melanocytic tumors with ambiguous light microscopic features. Comparative genomic hybridization (CGH) permits assessment of the full set of chromosomes, but requires a significant amount of lesional tissue, and may fail to detect aberrations in a minor subpopulation of tumor cells. Fluorescence in situ hybridization (FISH) is the cytogenetic assay of choice for limited amounts of tissue. FISH targets only specific chromosomes, with inherent limitations in test sensitivity and specificity. FISH analysis is also heavily dependent on individual experience. Molecular studies have identified distinct sets of mutations in melanoma and/or nevi. These mutations have become clinically relevant for targeted therapy of patients with advanced disease, especially for the treatment of patients with metastatic melanoma carrying the BRAF(V600) or KIT mutations. However, mutation analysis can on occasion also be used for diagnostic purposes.
Collapse
Affiliation(s)
- Klaus J Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, New York 10065.
| |
Collapse
|
36
|
Fukudo M, Ito T, Mizuno T, Shinsako K, Hatano E, Uemoto S, Kamba T, Yamasaki T, Ogawa O, Seno H, Chiba T, Matsubara K. Exposure–Toxicity Relationship of Sorafenib in Japanese Patients with Renal Cell Carcinoma and Hepatocellular Carcinoma. Clin Pharmacokinet 2013; 53:185-96. [DOI: 10.1007/s40262-013-0108-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
37
|
Klinac D, Gray ES, Millward M, Ziman M. Advances in personalized targeted treatment of metastatic melanoma and non-invasive tumor monitoring. Front Oncol 2013; 3:54. [PMID: 23515890 PMCID: PMC3601325 DOI: 10.3389/fonc.2013.00054] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/28/2013] [Indexed: 12/19/2022] Open
Abstract
Despite extensive scientific progress in the melanoma field, treatment of advanced stage melanoma with chemotherapeutics and biotherapeutics has rarely provided response rates higher than 20%. In the past decade, targeted inhibitors have been developed for metastatic melanoma, leading to the advent of more personalized therapies of genetically characterized tumors. Here we review current melanoma treatments and emerging targeted molecular therapies. In particular we discuss the mutant BRAF inhibitors Vemurafenib and Dabrafenib, which markedly inhibit tumor growth and advance patients' overall survival. However this response is almost inevitably followed by complete tumor relapse due to drug resistance hampering the encouraging initial responses. Several mechanisms of resistance within and outside the MAPK pathway have now been uncovered and have paved the way for clinical trials of combination therapies to try and overcome tumor relapse. It is apparent that personalized treatment management will be required in this new era of targeted treatment. Circulating tumor cells (CTCs) provide an easily accessible means of monitoring patient relapse and several new approaches are available for the molecular characterization of CTCs. Thus CTCs provide a monitoring tool to evaluate treatment efficacy and early detection of drug resistance in real time. We detail here how advances in the molecular analysis of CTCs may provide insight into new avenues of approaching therapeutic options that would benefit personalized melanoma management.
Collapse
Affiliation(s)
- Dragana Klinac
- School of Medical Sciences, Edith Cowan UniversityPerth, WA, Australia
| | - Elin S. Gray
- School of Medical Sciences, Edith Cowan UniversityPerth, WA, Australia
| | - Michael Millward
- School of Medicine and Pharmacology, University of Western AustraliaCrawley, WA, Australia
| | - Mel Ziman
- School of Medical Sciences, Edith Cowan UniversityPerth, WA, Australia
- School of Pathology and Laboratory Medicine, University of Western AustraliaCrawley, WA, Australia
| |
Collapse
|
38
|
Abraham BP, Sellin JH. Drug-induced, factitious, & idiopathic diarrhoea. Best Pract Res Clin Gastroenterol 2012; 26:633-48. [PMID: 23384808 DOI: 10.1016/j.bpg.2012.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/07/2012] [Accepted: 11/07/2012] [Indexed: 01/31/2023]
Abstract
The aetiology of diarrhoea can often be simple to identify, but in some cases may pose a challenge. The diagnosis of drug-induced diarrhoea can easily be sorted based on timing of the symptom with onset of a new drug. Treatment can vary from simply monitoring and eventual resolution with continuation of the drug, to discontinuation of the offending agent. In cases where a drug cannot always be stopped, additional medications can help control the symptom. Factitious diarrhoea can present a diagnostic challenge if the evaluating physician does not suspect its possibility. Typically a careful history, and in some cases, stool testing can provide clues. The diagnosis of idiopathic diarrhoea is often made when exhaustive testing provides no definite aetiology and the goal of management is supportive care and symptomatic treatment.
Collapse
Affiliation(s)
- Bincy P Abraham
- Baylor College of Medicine, 1709 Dryden St., Suite 800, Houston, TX 77030, USA.
| | | |
Collapse
|