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Li Q, Lin J, Hao G, Xie A, Liu S, Tang B. Nephrotoxicity of targeted therapy used to treat lung cancer. Front Immunol 2024; 15:1369118. [PMID: 39026680 PMCID: PMC11254629 DOI: 10.3389/fimmu.2024.1369118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024] Open
Abstract
Lung cancer is the leading cause of cancer-related death worldwide, especially non-small cell lung cancer. Early diagnosis and better treatment choices have already provided a more promising prognosis for cancer patients. In targeted therapy, antagonists target specific genes supporting cancer growth, proliferation and metastasis. With the incorporation of targeted therapies in routine cancer therapy, it is imperative that the array of toxicities associated with these agents must be well-recognized and managed, especially since these toxicities are distinct from those seen with conventional cytotoxic agents. Drug-related nephrotoxicity has attracted attention when initiating cancer therapy. Our review aims to summarize the adverse renal effects caused by targeted therapy during lung cancer treatment, mainly focusing on EGFR and ALK tyrosine kinase inhibitors. Also, we discuss the possible mechanism of the side effect and provide managements to help improve the renal function in clinical practice.
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Affiliation(s)
- Qiuling Li
- Department of Nephrology, Blood Purification Center, Zhongshan People’s Hospital, Zhongshan, China
| | - Jieshan Lin
- Department of Nephrology, Blood Purification Center, Zhongshan People’s Hospital, Zhongshan, China
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Guojun Hao
- Department of Nephrology, Blood Purification Center, Zhongshan People’s Hospital, Zhongshan, China
| | - Aihua Xie
- Department of Nephrology, Blood Purification Center, Zhongshan People’s Hospital, Zhongshan, China
| | - Shuangxin Liu
- Department of Nephrology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Bin Tang
- Department of Nephrology, Blood Purification Center, Zhongshan People’s Hospital, Zhongshan, China
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Khalil HH, El-Sheshtawy MM, Khattab SN, Abu-Serie MM, Shehat MG, Teleb M, Haiba NS. Chemosensitization of non-small cell lung cancer to sorafenib via non-hydroxamate s-triazinedione-based MMP-9/10 inhibitors. Bioorg Chem 2024; 144:107155. [PMID: 38306827 DOI: 10.1016/j.bioorg.2024.107155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Non-small cell lung cancer (NSCLC) continues to be a leading cause of cancer death. Its fatality is associated with angiogenesis and metastasis. While VEGFR inhibitors are expected to be the central pillar for halting lung cancer, several clinical reports declared their subpar activities as monotherapy. These results directed combination studies of VEGFR inhibitors, especially sorafenib (Nexavar®), with various chemotherapeutic agents. Matrix metalloproteinase (MMP) inhibitors are seldom utilized in such combinations despite the expected complementary therapeutic outcome. This could be attributed to the clinical unsuitability of MMP inhibitors from the hydroxamate family. Herein, we report new non-hydroxamate s-triazinedione-based inhibitors of MMP-9 (6b; IC50 = 0.112 μM), and MMP-10 (6e; IC50 = 0.076 μM) surpassing the hydroxamate inhibitor NNGH for chemosensitization of NSCLC to sorafenib. MMPs inhibition profiling of the hits revealed MMP-9 over -2 and MMP-10 over -13 selectivity. 6b and 6e were potent (IC50 = 0.139 and 0.136 µM), safe (SI up to 6.77) and superior to sorafenib (IC50 = 0.506 µM, SI = 6.27) against A549 cells. When combined with sorafenib, the studied MMP inhibitors enhanced its cytotoxic efficacy up to 26 folds as confirmed by CI and DRI values for 6b (CI = 0.160 and DRI = 22.175) and 6e (CI = 0.096 and DRI = 29.060). 6b and 6e exerted anti-invasive activities in A549 cells as single agents (22.66 and 39.67 %) and in sorafenib combinations (29.96 and 91.83 %) compared to untreated control. Both compounds downregulated VEGF in A549 cells by approximately 70 % when combined with sorafenib, highlighting enhanced anti-angiogenic activities. Collectively, combinations of 6b and 6e with sorafenib demonstrated synergistic NSCLC cytotoxicity with pronounced anti-invasive and anti-angiogenic activities introducing a promising start point for preclinical studies.
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Affiliation(s)
- Hosam H Khalil
- Chemistry Department, Faculty of Science, Alexandria University, Alexandria 21321, Egypt
| | - Mohamed M El-Sheshtawy
- Chemistry Department, Faculty of Science, Alexandria University, Alexandria 21321, Egypt
| | - Sherine N Khattab
- Chemistry Department, Faculty of Science, Alexandria University, Alexandria 21321, Egypt.
| | - Marwa M Abu-Serie
- Medical Biotechnology Department, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications (SRTA-City), Egypt
| | - Michael G Shehat
- Department of Microbiology and Immunology, Faculty of Pharmacy, Alexandria University, 21521 Alexandria, Egypt
| | - Mohamed Teleb
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Alexandria University, 21521 Alexandria, Egypt; Cancer Nanotechnology Research Laboratory (CNRL), Faculty of Pharmacy, Alexandria University, 21521 Alexandria, Egypt
| | - Nesreen S Haiba
- Department of Physics and Chemistry, Faculty of Education, Alexandria University, Egypt
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Abd El-Hafeez T, Shams MY, Elshaier YAMM, Farghaly HM, Hassanien AE. Harnessing machine learning to find synergistic combinations for FDA-approved cancer drugs. Sci Rep 2024; 14:2428. [PMID: 38287066 PMCID: PMC10825182 DOI: 10.1038/s41598-024-52814-w] [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: 11/09/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
Combination therapy is a fundamental strategy in cancer chemotherapy. It involves administering two or more anti-cancer agents to increase efficacy and overcome multidrug resistance compared to monotherapy. However, drug combinations can exhibit synergy, additivity, or antagonism. This study presents a machine learning framework to classify and predict cancer drug combinations. The framework utilizes several key steps including data collection and annotation from the O'Neil drug interaction dataset, data preprocessing, stratified splitting into training and test sets, construction and evaluation of classification models to categorize combinations as synergistic, additive, or antagonistic, application of regression models to predict combination sensitivity scores for enhanced predictions compared to prior work, and the last step is examination of drug features and mechanisms of action to understand synergy behaviors for optimal combinations. The models identified combination pairs most likely to synergize against different cancers. Kinase inhibitors combined with mTOR inhibitors, DNA damage-inducing drugs or HDAC inhibitors showed benefit, particularly for ovarian, melanoma, prostate, lung and colorectal carcinomas. Analysis highlighted Gemcitabine, MK-8776 and AZD1775 as frequently synergizing across cancer types. This machine learning framework provides a valuable approach to uncover more effective multi-drug regimens.
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Affiliation(s)
- Tarek Abd El-Hafeez
- Department of Computer Science, Faculty of Science, Minia University, El-Minia, Egypt.
- Computer Science Unit, Deraya University, El-Minia, Egypt.
| | - Mahmoud Y Shams
- Faculty of Artificial Intelligence, Kafrelsheikh University, Kafr El-Sheikh, Egypt
- Scientific Research Group in Egypt (SRGE), Cairo, Egypt
| | - Yaseen A M M Elshaier
- Department of Organic and Medicinal Chemistry, Faculty of Pharmacy, University of Sadat City, Sadat City, Menoufia, Egypt
| | - Heba Mamdouh Farghaly
- Department of Computer Science, Faculty of Science, Minia University, El-Minia, Egypt
| | - Aboul Ella Hassanien
- Faculty of Computers and Artificial Intelligence, Cairo University, Cairo, Egypt.
- Scientific Research Group in Egypt (SRGE), Cairo, Egypt.
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Lazzaro A, Hartshorn KL. A Comprehensive Narrative Review on the History, Current Landscape, and Future Directions of Hepatocellular Carcinoma (HCC) Systemic Therapy. Cancers (Basel) 2023; 15:cancers15092506. [PMID: 37173972 PMCID: PMC10177076 DOI: 10.3390/cancers15092506] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
We provide a comprehensive review of current approved systemic treatment strategies for advanced hepatocellular carcinoma (HCC), starting with the phase III clinical trial of sorafenib which was the first to definitively show a survival benefit. After this trial, there was an initial period of little progress. However, in recent years, an explosion of new agents and combinations of agents has resulted in a markedly improved outlook for patients. We then provide the authors' current approach to therapy, i.e., "How We Treat HCC". Promising future directions and important gaps in therapy that persist are finally reviewed. HCC is a highly prevalent cancer worldwide and the incidence is growing due not only to alcoholism, hepatitis B and C, but also to steatohepatitis. HCC, like renal cell carcinoma and melanoma, is a cancer largely resistant to chemotherapy but the advent of anti-angiogenic, targeted and immune therapies have improved survival for all of these cancers. We hope this review will heighten interest in the field of HCC therapies, provide a clear outline of the current data and strategy for treatment, and sensitize readers to new developments that are likely to emerge in the near future.
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Affiliation(s)
- Alexander Lazzaro
- Department of Medicine, Boston Medical Center, Boston, MA 02118, USA
| | - Kevan L Hartshorn
- Section of Hematology Oncology, Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center, Boston, MA 02118, USA
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Small Molecule Inhibitors for Hepatocellular Carcinoma: Advances and Challenges. Molecules 2022; 27:molecules27175537. [PMID: 36080304 PMCID: PMC9457820 DOI: 10.3390/molecules27175537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 12/12/2022] Open
Abstract
According to data provided by World Health Organization, hepatocellular carcinoma (HCC) is the sixth most common cause of deaths due to cancer worldwide. Tremendous progress has been achieved over the last 10 years developing novel agents for HCC treatment, including small-molecule kinase inhibitors. Several small molecule inhibitors currently form the core of HCC treatment due to their versatility since they would be more easily absorbed and have higher oral bioavailability, thus easier to formulate and administer to patients. In addition, they can be altered structurally to have greater volumes of distribution, allowing them to block extravascular molecular targets and to accumulate in a high concentration in the tumor microenvironment. Moreover, they can be designed to have shortened half-lives to control for immune-related adverse events. Most importantly, they would spare patients, healthcare institutions, and society as a whole from the burden of high drug costs. The present review provides an overview of the pharmaceutical compounds that are licensed for HCC treatment and other emerging compounds that are still investigated in preclinical and clinical trials. These molecules are targeting different molecular targets and pathways that are proven to be involved in the pathogenesis of the disease.
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Chen H, Kuhn J, Lamborn KR, Abrey LE, DeAngelis LM, Lieberman F, Robins HI, Chang SM, Yung WKA, Drappatz J, Mehta MP, Levin VA, Aldape K, Dancey JE, Wright JJ, Prados MD, Cloughesy TF, Wen PY, Gilbert MR. Phase I/II study of sorafenib in combination with erlotinib for recurrent glioblastoma as part of a 3-arm sequential accrual clinical trial: NABTC 05-02. Neurooncol Adv 2020; 2:vdaa124. [PMID: 33235994 DOI: 10.1093/noajnl/vdaa124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Receptor tyrosine kinases such as epidermal growth factor receptors (EGFRs) and their downstream signaling pathways such as the Ras-Raf-mitogen-activated protein kinase (MAPK) pathway play important roles in glioblastoma (GBM). This study investigated the safety, pharmacokinetics, and efficacy of sorafenib (Ras/Raf/MAPK inhibitor) in combination with erlotinib (EGFR inhibitor) for treatment of recurrent GBMs. Methods Patients with recurrent GBM were eligible. A novel sequential accrual trial design was used, where patients were sequentially accrued into separate treatment arms in phase I and phase II investigations to optimize recruitment efficiency. In phase I, a standard 3 + 3 format was used to identify dose-limiting toxicities (DLTs), determine maximum tolerated dose (MTD), and investigate pharmacokinetics. Phase II followed a 2-stage design with the primary endpoint being 6-month progression-free survival (PFS6). Results Sixteen patients were recruited for phase I, and the MTD was determined to be sorafenib 200 mg twice daily and erlotinib 100 mg once daily. DLTs include Grade 3 hypertension, Grade 3 elevated liver transaminases, and Grade 4 elevated lipase. While erlotinib did not affect sorafenib levels, sorafenib reduced erlotinib levels. In phase II, 3 of 19 stage 1 participants were progression free at 6 months. This did not meet the predetermined efficacy endpoint, and the trial was terminated. Conclusion This study identified the MTD and DLTs for sorafenib and erlotinib combination therapy for recurrent GBMs; however, efficacy data did not meet the primary endpoint. This study also demonstrates the feasibility of a novel sequential accrual clinical trial design that optimizes patient recruitment for multiarm studies, which is particularly effective for multicenter clinical trials.
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Affiliation(s)
- Huanwen Chen
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - John Kuhn
- Division of Pharmacology, University of Texas, San Antonio, Texas, USA
| | - Kathleen R Lamborn
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Lauren E Abrey
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Frank Lieberman
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - H Ian Robins
- Departments of Medicine, Human Oncology, and Neurology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - W K Alfred Yung
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jan Drappatz
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida, USA
| | - Victor A Levin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - John J Wright
- Investigational Drug Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael D Prados
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Timothy F Cloughesy
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Hulin A, Stocco J, Bouattour M. Clinical Pharmacokinetics and Pharmacodynamics of Transarterial Chemoembolization and Targeted Therapies in Hepatocellular Carcinoma. Clin Pharmacokinet 2020; 58:983-1014. [PMID: 31093928 DOI: 10.1007/s40262-019-00740-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The management of hepatocellular carcinoma (HCC) is based on a multidisciplinary decision tree. Treatment includes loco-regional therapy, mainly transarterial chemoembolization, for intermediate-stage HCC and systemic therapy with oral tyrosine kinase inhibitors (TKIs) for advanced HCC. Transarterial chemoembolization involves hepatic intra-arterial infusion with either conventional procedure or drug-eluting-beads. The aim of the loco-regional procedure is to deliver treatment as close as possible to the tumor both to embolize the tumor area and to enhance efficacy and minimize systemic toxicity of the anticancer drug. Pharmacokinetic studies applied to transarterial chemoembolization are rare and pharmacodynamic studies even rarer. However, all available studies lead to the same conclusions: use of the transarterial route lowers systemic exposure to the cytotoxic drug and leads to much higher tumor drug concentrations than does a similar dose via the intravenous route. However, reproducibility of the procedure remains a major problem, and no consensus exists regarding the choice of anticancer drug and its dosage. Systemic therapy with TKIs is based on sorafenib and lenvatinib as first-line treatment and regorafenib and cabozantinib as second-line treatment. Clinical use of TKIs is challenging because of their complex pharmacokinetics, with high liver metabolism yielding both active metabolites and their common toxicities. Changes in liver function over time with the progression of HCC adds further complexity to the use of TKIs. The challenges posed by TKIs and the HCC disease process means monitoring of TKIs is required to improve clinical management. To date, only partial data supporting sorafenib monitoring is available. Results from further pharmacokinetic/pharmacodynamic studies of these four TKIs are eagerly awaited and are expected to permit such monitoring and the development of consensus guidelines.
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Affiliation(s)
- Anne Hulin
- APHP, Laboratory of Pharmacology, GH Henri Mondor, EA7375, University Paris Est Creteil, 94010, Creteil, France
| | - Jeanick Stocco
- APHP, HUPNVS, Department of Clinical Pharmacy and Pharmacology, Beaujon University Hospital, 92110, Clichy, France
| | - Mohamed Bouattour
- APHP, HUPNVS, Department of Digestive Oncology, Beaujon University Hospital, 92110, Clichy, France.
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Dhanwal V, Katoch A, Singh A, Chakraborty S, Faheem MM, Kaur G, Nayak D, Singh N, Goswami A, Kaur N. Self-assembled organic nanoparticles of benzimidazole analogue exhibit enhanced uptake in 3D tumor spheroids and oxidative stress induced cytotoxicity in breast cancer. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 97:467-478. [PMID: 30678934 DOI: 10.1016/j.msec.2018.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/15/2018] [Accepted: 12/11/2018] [Indexed: 12/30/2022]
Abstract
Organic nanoparticles (ONPs) possess great research interests for their promising effects in the enhancement of bioactivity including anticancer activity with less toxicity. The present study describes the preparation, characterization and biological evaluation of aqueous phase ONPs of potent 1,2-disubstituted benzimidazole derivative (BZ6) for anticancer activity. BZ6-ONPs were characterized through UV-absorption and fluorescence spectroscopic analysis for their photo-physical properties. DLS, TEM and SEM studies were carried out for morphological and structural analysis. Cytotoxicity determination on a panel of four different cancer cell lines (MCF-7, MiaPaca-2, HT-29 and HCT-116) revealed that the BZ6-ONPs show highest activity in human breast cancer MCF-7 cells. Surprisingly, the BZ6-ONPs were found to be non-toxic towards normal breast epithelial fR2 cells. Additionally, the FITC-ONPs showed enhanced uptake in 3D tumor spheroids of MCF-7 cells compared to the free FITC. BZ6-ONPs strongly halted cell proliferation and induced apoptosis, possibly through oxidative stress-mediated reactive oxygen species (ROS) generation and loss of mitochondrial membrane potential (MMP) in MCF-7 cells. Moreover, molecular mechanism-based studies revealed that BZ6-ONPs downregulated AKT/NF-κB/vimentin/survivin-mediated oncogenic signaling pathway promoting cell proliferation and malignancy. In a nutshell, BZ6-ONPs are therapeutically efficacious, which needs further development as a treatment option in human mammary gland carcinomas.
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Affiliation(s)
- Vandna Dhanwal
- Centre for Nanoscience & Nanotechnology (U.I.E.A.S.T), Panjab University, Chandigarh 160014, India; Cancer Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu 180001, India
| | - Archana Katoch
- Cancer Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu 180001, India
| | - Amanpreet Singh
- Department of Chemistry, Indian Institute of Technology Ropar (IIT Ropar), Roopnagar, Punjab 140001, India
| | - Souneek Chakraborty
- Cancer Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu 180001, India
| | - Mir Mohd Faheem
- Cancer Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu 180001, India
| | - Gaganpreet Kaur
- Centre for Nanoscience & Nanotechnology (U.I.E.A.S.T), Panjab University, Chandigarh 160014, India
| | - Debasis Nayak
- Cancer Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu 180001, India
| | - Narinder Singh
- Department of Chemistry, Indian Institute of Technology Ropar (IIT Ropar), Roopnagar, Punjab 140001, India
| | - Anindya Goswami
- Cancer Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Canal Road, Jammu 180001, India.
| | - Navneet Kaur
- Department of Chemistry, Panjab University, Chandigarh 160014, India.
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Keane FK, Hong TS, Zhu AX. Evolving Systemic Therapy in Hepatocellular Carcinoma: Current Management and Opportunities for Integration With Radiotherapy. Semin Radiat Oncol 2018; 28:332-341. [PMID: 30309643 DOI: 10.1016/j.semradonc.2018.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The majority of patients with hepatocellular carcinoma (HCC) present with advanced disease. While first-line therapy with sorafenib is considered standard of care for patients with advancedHCC, outcomes remain poor. Despite early evidence of antitumor activity from Phase II trials of multiple other tyrosine kinase inhibitors, Phase III trials have largely failed to show an improvement insurvival outcomes over sorafenib. Given the encouraging early results with liver-directed radiotherapy for patients with advanced HCC, there is an increased interest in combination of these therapies tooptimize patient outcomes and improve survival by maximizing both local and distant disease control. Phase II trials of checkpoint inhibitors in HCC have also reported encouraging results, and Phase IIItrials are ongoing. Trials of combining radiotherapy with immunotherapy in solid tumors have shown intriguing results, potentially reflecting the opportunity for synergistic effects with the use of both modalities.
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Affiliation(s)
- Florence K Keane
- Massachusetts General Hospital, Department of Radiation Oncology, Harvard Medical School, Boston, MA.
| | - Theodore S Hong
- Massachusetts General Hospital, Department of Radiation Oncology, Harvard Medical School, Boston, MA.
| | - Andrew X Zhu
- Massachusetts General Hospital, Division of Hematology-Oncology, Department of Medicine, Harvard Medical School, Boston, MA.
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Harrington JA, Hernandez-Guerrero TC, Basu B. Early Phase Clinical Trial Designs - State of Play and Adapting for the Future. Clin Oncol (R Coll Radiol) 2017; 29:770-777. [PMID: 29108786 DOI: 10.1016/j.clon.2017.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022]
Abstract
The process of anti-cancer drug development is complex, with high attrition rates. Factors that may optimise this process include well-constructed and relevant pre-clinical testing and use of biomarkers for patient selection. However, the design of early phase clinical trials will probably play a vital role in both the robust clinical investigation of new targeted therapies and in streamlining drug development. In this overview, we assess current concepts in phase I clinical trials, highlighting issues and opportunities to improve their meaningfulness. The particular challenge of how to design combination trials is addressed, with focus on the potential of new adaptive and model-based designs.
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Affiliation(s)
- J A Harrington
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - T C Hernandez-Guerrero
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - B Basu
- Department of Oncology, University of Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
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Yin J, Paoletti X, Sargent DJ, Mandrekar SJ. Repeated measures dose-finding design with time-trend detection in the presence of correlated toxicity data. Clin Trials 2017; 14:611-620. [PMID: 28764555 DOI: 10.1177/1740774517723829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Phase I trials are designed to determine the safety, tolerability, and recommended phase 2 dose of therapeutic agents for subsequent testing. The dose-finding paradigm has thus traditionally focused on identifying the maximum tolerable dose of an agent or combination therapy under the assumption that there is a non-decreasing relationship between dose-toxicity and dose-efficacy. The dose is typically determined based on the probability of severe toxicity observed during the first treatment cycle. A novel endpoint, the total toxicity profile, was previously developed to account for the multiple toxicity types and grades experienced in the first cycle. More recently, this was extended to a repeated measures design based on the total toxicity profile to account for longitudinal toxicities over multiple treatment cycles in the absence of within-patient correlation. METHODS In this work, we propose to extend the design in the presence of within-patient correlation. Furthermore, we provide a framework to detect a toxicity time trend (toxicity increasing, decreasing, or stable) over multiple treatment cycles. We utilize a linear mixed model in the Bayesian framework, with the addition of Bayesian risk functions for decision-making in dose assignment. RESULTS The performance of this design was evaluated using simulation studies and real data from a phase I trial. We demonstrated that using available toxicity data from all cycles of treatment improves the accuracy of maximum tolerated dose identification and allows for the detection of a time trend. The performance is consistent regardless of the strength of the within-patient correlation. In addition, the use of a quasi-continuous total toxicity profile score significantly increased the power to detect time trends compared to when binary data only were used. CONCLUSION The increased interest in molecularly targeted agents and immunotherapies in oncology necessitates innovative phase I study designs. Our proposed framework provides a tool to tackle some of the challenges presented by these novel agents, specifically through the ability to understand patterns of toxicity over time, which is important in the cases of cumulative or late toxicities.
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Affiliation(s)
- Jun Yin
- 1 Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Xavier Paoletti
- 2 Biostatistics and Epidemiology Department, INSERM CESP, OncoStat, Institut Gustave Roussy, Villejuif, France
| | - Daniel J Sargent
- 1 Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Zhang J, Zong Y, Xu GZ, Xing K. Erlotinib for advanced hepatocellular carcinoma. A systematic review of phase II/III clinical trials. Saudi Med J 2017; 37:1184-1190. [PMID: 27761555 PMCID: PMC5303794 DOI: 10.15537/smj.2016.11.16267] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives: To evaluate the efficacy and safety of erlotinib for the treatment of advanced hepatocellular carcinoma (HCC). Methods: A systematic literature search was undertaken in June 2015. Phase II/III trials of erlotinib for the treatment of advanced HCC were included. A descriptive analysis was applied. The study was conducted in College of Medicine, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China, between June 2015 and January 2016. Results: Ten trials, comprising 9 phase II and one phase III trial, were included in the systematic review. The tumor response rate was 0% in 4 of the phase II trials, <10% in 3 of the phase II trials and the phase III trial, and >20% in 2 of the phase II trials. The disease control rate was 42.5-79.6% in most studies. Three studies reported a median progression-free survival (PFS) of 6.5-9.0 months, although PFS was <3.5 months in most studies. Most trials reported a median overall survival of 6.25-15.65 months. The most frequent grade 3/4 toxicities were fatigue (11.9%), diarrhea (10%), increased alanine and aspartate transaminases (7.3%), and rash/desquamation (6.9%). Conclusion: Erlotinib provides efficacious and well-tolerated treatment for advanced HCC. However, more detailed investigations of HCC pathogenesis and evaluation of sensitive patient subsets are needed to improve outcomes of patients with advanced HCC. Additional well-designed, randomized, controlled trials are needed to evaluate the efficacy and safety of erlotinib as monotherapy or combination with other drugs for advanced HCC.
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Affiliation(s)
- Jing Zhang
- Department of Hepatopathy, The eighth hospital of Xi'an, Xi'an, China. E-mail.
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Yin J, Shen S. Challenges and Innovations in Phase I Dose-Finding Designs for Molecularly Targeted Agents and Cancer Immunotherapies. JOURNAL OF BIOMETRICS & BIOSTATISTICS 2017; 7. [PMID: 28616356 PMCID: PMC5467542 DOI: 10.4172/2155-6180.1000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Phase I oncology trials are designed to identify a safe dose with an acceptable toxicity profile. In traditional phase I dose-finding design, the dose is typically determined based on the probability of severe toxicity observed during the first treatment cycle. The recent development of molecularly targeted agents and cancer immunotherapies call for new innovations in phase I designs, because of prolonged treatment cycles often involved. Various phase I designs using toxicity and efficacy endpoints from multiple treatment cycles have been developed for these new treatment agents. Here, we will review the novel endpoints and designs for the phase I oncology clinical trials.
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Affiliation(s)
- Jun Yin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Shihao Shen
- Department of Microbiology, Immunology, & Molecular Genetics, UCLA, Los Angeles, CA 90024, USA
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Mattina J, Carlisle B, Hachem Y, Fergusson D, Kimmelman J. Inefficiencies and Patient Burdens in the Development of the Targeted Cancer Drug Sorafenib: A Systematic Review. PLoS Biol 2017; 15:e2000487. [PMID: 28158308 PMCID: PMC5291369 DOI: 10.1371/journal.pbio.2000487] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/06/2017] [Indexed: 02/06/2023] Open
Abstract
Failure in cancer drug development exacts heavy burdens on patients and research systems. To investigate inefficiencies and burdens in targeted drug development in cancer, we conducted a systematic review of all prelicensure trials for the anticancer drug, sorafenib (Bayer/Onyx Pharmaceuticals). We searched Embase and MEDLINE databases on October 14, 2014, for prelicensure clinical trials testing sorafenib against cancers. We measured risk by serious adverse event rates, benefit by objective response rates and survival, and trial success by prespecified primary endpoint attainment with acceptable toxicity. The first two clinically useful applications of sorafenib were discovered in the first 2 efficacy trials, after five drug-related deaths (4.6% of 108 total) and 93 total patient-years of involvement (2.4% of 3,928 total). Thereafter, sorafenib was tested in 26 indications and 67 drug combinations, leading to one additional licensure. Drug developers tested 5 indications in over 5 trials each, comprising 56 drug-related deaths (51.8% of 108 total) and 1,155 patient-years (29.4% of 3,928 total) of burden in unsuccessful attempts to discover utility against these malignancies. Overall, 32 Phase II trials (26% of Phase II activity) were duplicative, lacked appropriate follow-up, or were uninformative because of accrual failure, constituting 1,773 patients (15.6% of 11,355 total) participating in prelicensure sorafenib trials. The clinical utility of sorafenib was established early in development, with low burden on patients and resources. However, these early successes were followed by rapid and exhaustive testing against various malignancies and combination regimens, leading to excess patient burden. Our evaluation of sorafenib development suggests many opportunities for reducing costs and unnecessary patient burden in cancer drug development.
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Affiliation(s)
- James Mattina
- Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, McGill University, Montréal, Quebec, Canada
| | - Benjamin Carlisle
- Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, McGill University, Montréal, Quebec, Canada
| | - Yasmina Hachem
- Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, McGill University, Montréal, Quebec, Canada
| | - Dean Fergusson
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jonathan Kimmelman
- Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, McGill University, Montréal, Quebec, Canada
- * E-mail:
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15
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Abstract
Global incidence and mortality of hepatocellular carcinoma (HCC) has increased over the past two decades. Although transplantation and surgical resection offer a chance for cure and long-term survival, most patients present with more advanced tumor stage when these therapies are not possible. Although rarely curative, locoregional therapy with transarterial chemoembolization or radioembolization offers a survival benefit for those with liver-isolated HCC who are not amenable to curative therapies. Patients with metastatic disease or macrovascular invasion are treated with systemic therapy; however, median survival remains below 1 year. Patients with severe liver dysfunction or poor performance status should be treated with best supportive care given poor prognosis and no survival benefit for treatment. Lack of predictive and prognostic biomarkers in intermediate and advanced HCC tumors has hampered integration of clinical and molecular data to aid tailoring treatment decisions. However, with increasingly complex treatment decisions, optimal outcomes are achieved through multidisciplinary care.
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Abstract
Scientists have identified the impact of angiogenesis on tumor growth and survival. Among other efficient drugs, several small-molecule tyrosine kinase inhibitors (TKIs) targeting the vascular endothelial growth factor receptor (VEGFR) have been developed and have already been integrated into the treatment of various advanced malignancies. This review provides a compilation of current knowledge on the pharmacokinetic aspects of all VEGFR-TKIs already approved by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) and of those still under investigation. Additional information on substance metabolism, potential for drug-drug interactions (DDIs), and the need for dose adaptation in patients with predominant renal and/or hepatic impairment has been included. All TKIs introduced in this review were administered orally, allowing for easy drug handling for healthcare professionals and patients. For almost all substances, the maximum plasma concentrations were reached within a short period of time. The majority of the substances showed a high plasma protein binding and their excretion occurred via the feces and, to a lesser extent, via the urine. In most cases, dose adaptation in patients with mild to moderate renal or hepatic impairment is not recommended. Cytochrome P450 (CYP) 3A4 was found to play a crucial role in the drug metabolic processes of many compounds. In order to prevent unwanted DDIs, co-administration of VEGFR TKIs together with CYP3A4 inhibitors or inducers should be avoided. Throughout all TKIs, the data indicate high inter-individual variability. The causes of this are still unclear and require further research to allow for individualization of treatment regimens.
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17
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Jhaveri KD, Wanchoo R, Sakhiya V, Ross DW, Fishbane S. Adverse Renal Effects of Novel Molecular Oncologic Targeted Therapies: A Narrative Review. Kidney Int Rep 2016; 2:108-123. [PMID: 29318210 PMCID: PMC5720524 DOI: 10.1016/j.ekir.2016.09.055] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 12/21/2022] Open
Abstract
Novel targeted anti-cancer therapies have resulted in improvement in patient survival compared to standard chemotherapy. Renal toxicities of targeted agents are increasingly being recognized. The incidence, severity, and pattern of renal toxicities may vary according to the respective target of the drug. Here we review the adverse renal effects associated with a selection of currently approved targeted cancer therapies, directed to EGFR, HER2, BRAF, MEK, ALK, PD1/PDL1, CTLA-4, and novel agents targeted to VEGF/R and TKIs. In summary, electrolyte disorders, renal impairment and hypertension are the most commonly reported events. Of the novel targeted agents, ipilumumab and cetuximab have the most nephrotoxic events reported. The early diagnosis and prompt recognition of these renal adverse events are essential for the general nephrologist taking care of these patients.
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Affiliation(s)
- Kenar D Jhaveri
- Department of Internal Medicine, Division of Kidney Diseases and Hypertension, Hofstra Northwell School of Medicine, Northwell Health, Great Neck, New York, USA
| | - Rimda Wanchoo
- Department of Internal Medicine, Division of Kidney Diseases and Hypertension, Hofstra Northwell School of Medicine, Northwell Health, Great Neck, New York, USA
| | - Vipulbhai Sakhiya
- Department of Internal Medicine, Division of Kidney Diseases and Hypertension, Hofstra Northwell School of Medicine, Northwell Health, Great Neck, New York, USA
| | - Daniel W Ross
- Department of Internal Medicine, Division of Kidney Diseases and Hypertension, Hofstra Northwell School of Medicine, Northwell Health, Great Neck, New York, USA
| | - Steven Fishbane
- Department of Internal Medicine, Division of Kidney Diseases and Hypertension, Hofstra Northwell School of Medicine, Northwell Health, Great Neck, New York, USA
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18
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Yin J, Qin R, Ezzalfani M, Sargent DJ, Mandrekar SJ. A Bayesian dose-finding design incorporating toxicity data from multiple treatment cycles. Stat Med 2016; 36:67-80. [PMID: 27633877 DOI: 10.1002/sim.7134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/16/2016] [Accepted: 08/25/2016] [Indexed: 01/05/2023]
Abstract
Phase I oncology trials are designed to identify a safe dose with an acceptable toxicity profile. The dose is typically determined based on the probability of severe toxicity observed during the first treatment cycle, although patients continue to receive treatment for multiple cycles. In addition, the toxicity data from multiple types and grades are typically summarized into a single binary outcome of dose-limiting toxicity. A novel endpoint, the total toxicity profile, was previously developed to account for the multiple toxicity types and grades. In this work, we propose to account for longitudinal repeated measures of total toxicity profile over multiple treatment cycles, accounting for cumulative toxicity during dosing-finding. A linear mixed model was utilized in the Bayesian framework, with addition of Bayesian risk functions for decision-making in dose assignment. The performance of this design is evaluated using simulation studies and compared with the previously proposed quasi-likelihood continual reassessment method (QLCRM) design. Twelve clinical scenarios incorporating four different locations of maximum tolerated dose and three different time trends (decreasing, increasing, and no effect) were investigated. The proposed repeated measures design was comparable with the QLCRM when only cycle 1 data were utilized in dose-finding; however, it demonstrated an improvement over the QLCRM when data from multiple cycles were used across all scenarios. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jun Yin
- Department of Health Sciences Research, Mayo Clinic, 55905, Rochester, MN, U.S.A
| | - Rui Qin
- Department of Health Sciences Research, Mayo Clinic, 55905, Rochester, MN, U.S.A
| | - Monia Ezzalfani
- Biostatistics Department, Institut Gustave-Roussy, Villejuif, France
| | - Daniel J Sargent
- Department of Health Sciences Research, Mayo Clinic, 55905, Rochester, MN, U.S.A
| | - Sumithra J Mandrekar
- Department of Health Sciences Research, Mayo Clinic, 55905, Rochester, MN, U.S.A
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Liu J, Liu Q, Yang C, Sun Y, Zhang Y, Huang P, Zhou J, Liu Q, Chu L, Huang F, Deng L, Dong A, Liu J. cRGD-Modified Benzimidazole-based pH-Responsive Nanoparticles for Enhanced Tumor Targeted Doxorubicin Delivery. ACS APPLIED MATERIALS & INTERFACES 2016; 8:10726-10736. [PMID: 27058429 DOI: 10.1021/acsami.6b01501] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Finding a smart cancer drug delivery carrier with long blood circulation, enhanced cancer targeting, and quick drug release in tumors is critical for efficient cancer chemotherapy. Herein, we design a cRGD-polycarboxybetaine methacrylate-b-polybenzimidazole methacrylate (cRGD-PCB-b-PBBMZ) copolymer to self-assemble into smart drug-loaded nanoparticles (cRGD-PCM NPs) which can target αvβ3 integrin overexpressed cancer tissue by cRGD peptide unit and release drug quickly in cancer cells by protonation of benzimidazole groups. The outer PCB layer can resist protein adhesion, and there are only about 10% of proteins in mouse serum adhered to the surface of PCM NPs. With the pKa value of 5.08 of the benzimidazole units, DOX can be released from NPs in pH 5.0 PBS. cRGD-PCM NPs can bring more DOX into HepG2 cells than nontargeting PCM NPs, and there has high DOX release rate in HepG2 cells because of the protonation of benzimidazole groups in endosome and lysosome. MTT assay verifies that higher cellular uptake of DOX causes higher cytotoxicity. Furthermore, the results of ex vivo imaging studies confirm that cRGD-PCM/DOX NPs can successfully deliver DOX into tumor tissue from the injection site. Therefore, the multifunctional cRGD-PCM NPs show great potential as novel nanocarriers for targeting cancer chemotherapy.
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Affiliation(s)
- Jinjian Liu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science, Peking Union Medical College , Tianjin 300192, People's Republic of China
| | | | - Cuihong Yang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science, Peking Union Medical College , Tianjin 300192, People's Republic of China
| | - Yu Sun
- Department of Polymer Science and Technology, School of Chemical Engineering and Technology, Tianjin University , Tianjin 300072, People's Republic of China
| | - Yumin Zhang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science, Peking Union Medical College , Tianjin 300192, People's Republic of China
| | - Pingsheng Huang
- Department of Polymer Science and Technology, School of Chemical Engineering and Technology, Tianjin University , Tianjin 300072, People's Republic of China
| | - Junhui Zhou
- Department of Polymer Science and Technology, School of Chemical Engineering and Technology, Tianjin University , Tianjin 300072, People's Republic of China
| | - Qiang Liu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science, Peking Union Medical College , Tianjin 300192, People's Republic of China
| | - Liping Chu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science, Peking Union Medical College , Tianjin 300192, People's Republic of China
| | - Fan Huang
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science, Peking Union Medical College , Tianjin 300192, People's Republic of China
| | - Liandong Deng
- Department of Polymer Science and Technology, School of Chemical Engineering and Technology, Tianjin University , Tianjin 300072, People's Republic of China
| | - Anjie Dong
- Department of Polymer Science and Technology, School of Chemical Engineering and Technology, Tianjin University , Tianjin 300072, People's Republic of China
| | - Jianfeng Liu
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Science, Peking Union Medical College , Tianjin 300192, People's Republic of China
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20
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Hubbard JM, Kim G, Borad MJ, Johnson E, Qin R, Lensing J, Puttabasavaiah S, Wright J, Erlichman C, Grothey A. Phase I trial of FOLFIRI in combination with sorafenib and bevacizumab in patients with advanced gastrointestinal malignancies. Invest New Drugs 2015; 34:96-103. [PMID: 26581401 DOI: 10.1007/s10637-015-0308-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/09/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND A previous phase II trial in patients with chemorefractory metastatic colorectal cancer demonstrated a 63 % disease control rate with a combination of bevacizumab and sorafenib. This phase I trial sought to determine the maximum tolerable dose (MTD) of bevacizumab and sorafenib combined with standard cytotoxic therapy for advanced gastrointestinal (GI) cancers. METHODS A standard 3 + 3 trial design utilized 3 escalating sorafenib dose levels: (1) 200 mg daily, days 3-7, 10-14; (2) 200 mg twice daily, days 3-6, 10-13; and (3) 200 mg twice daily, days 3-7, 10-14 combined with standard dose FOLFIRI (5-fluouracil, leucovorin, and irinotecan) and bevacizumab (5 mg/kg), repeated every 14 days. RESULTS Fifteen patients were evaluable for safety and response assessment. There were no dose limiting toxicities (DLTs) at dose level 1 or 2. At dose level 3, two patients experienced DLTs (asymptomatic grade 3 hypophosphatemia, grade 3 dehydration and diarrhea). The MTD was determined to be dose level 2: sorafenib 200 mg twice daily, days 3-6, 10-13 combined with FOLFIRI and bevacizumab at standard doses. Four patients had a partial response and 8 had stable disease as best response (disease control rate of 80 %). Three patients with CRC had disease control >12 months. CONCLUSIONS The MTD of this regimen is sorafenib 200 mg twice daily, days 3-6, 10-13 combined with standard doses of FOLFIRI and bevacizumab. Dual antiangiogenic treatment combined with cytotoxic therapy may provide prolonged disease stabilization for select patients with advanced GI malignancies.
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Affiliation(s)
- Joleen M Hubbard
- Mayo Clinic Rochester, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - George Kim
- University of Florida Health Oncology, Jacksonville, FL, USA
| | | | | | - Rui Qin
- Regeneron Pharmaceuticals, Basking Ridge, NJ, USA
| | - Janet Lensing
- Mayo Clinic Rochester, 200 First Street, SW, Rochester, MN, 55905, USA
| | | | - John Wright
- Investigational Drug Branch of the Cancer Therapy Evaluation Program, Bethesda, MD, USA
| | - Charles Erlichman
- Mayo Clinic Rochester, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Axel Grothey
- Mayo Clinic Rochester, 200 First Street, SW, Rochester, MN, 55905, USA
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21
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Gao JJ, Shi ZY, Xia JF, Inagaki Y, Tang W. Sorafenib-based combined molecule targeting in treatment of hepatocellular carcinoma. World J Gastroenterol 2015; 21:12059-12070. [PMID: 26576091 PMCID: PMC4641124 DOI: 10.3748/wjg.v21.i42.12059] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/28/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Sorafenib is the only and standard systematic chemotherapy drug for treatment of advanced hepatocellular carcinoma (HCC) at the current stage. Although sorafenib showed survival benefits in large randomized phase III studies, its clinical benefits remain modest and most often consist of temporary tumor stabilization, indicating that more effective first-line treatment regimens or second-line salvage therapies are required. The molecular pathogenesis of HCC is very complex, involving hyperactivated signal transduction pathways such as RAS/RAF/MEK/ERK and PI3K/AKT/mTOR and aberrant expression of molecules such as receptor tyrosine kinases and histone deacetylases. Simultaneous or sequential abrogation of these critical pathways or the functions of these key molecules involved in angiogenesis, proliferation, and apoptosis may yield major improvements in the management of HCC. In this review, we summarize the emerging sorafenib-based combined molecule targeting for HCC treatment and analyze the rationales of these combinations.
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Ferrari SM, Politti U, Spisni R, Materazzi G, Baldini E, Ulisse S, Miccoli P, Antonelli A, Fallahi P. Sorafenib in the treatment of thyroid cancer. Expert Rev Anticancer Ther 2015; 15:863-74. [PMID: 26152651 DOI: 10.1586/14737140.2015.1064770] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sorafenib has been evaluated in several Phase II and III studies in patients with locally advanced/metastatic radioactive iodine-refractory differentiated thyroid carcinomas (DTCs), reporting partial responses, stabilization of the disease and improvement of progression-free survival. Best responses were observed in lung metastases and minimal responses in bone lesions. On the basis of these studies, sorafenib was approved for the treatment of metastatic DTC in November 2013. Few studies suggested that reduction of thyroglobulin levels, or of average standardized uptake value at the fluorodeoxyglucose-PET, could be helpful for the identification of responding patients; but further studies are needed to confirm these results. Tumor genetic marker levels did not have any prognostic or predictive role in DTC patients.The most common adverse events observed included skin toxicity and gastrointestinal and constitutional symptoms. Encouraging results have also been observed in patients with medullary thyroid cancer. Many studies are ongoing to evaluate the long-term efficacy and tolerability of sorafenib in DTC patients.
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Affiliation(s)
- Silvia Martina Ferrari
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
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23
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Terada T, Noda S, Inui KI. Management of dose variability and side effects for individualized cancer pharmacotherapy with tyrosine kinase inhibitors. Pharmacol Ther 2015; 152:125-34. [PMID: 25976912 DOI: 10.1016/j.pharmthera.2015.05.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022]
Abstract
Molecular-targeted therapies with tyrosine kinase inhibitors (TKIs) have provided a major breakthrough in cancer treatment. These agents are given orally and demonstrated to be substrates for drug transporters. In clinical settings, TKIs are mainly used at a fixed dose, but wide interpatient variability has been observed in their pharmacokinetics and/or pharmacodynamics. Genetic polymorphisms of ABC transporters, drug-drug interaction and adherence are among the factors causing such variation. To overcome these problems, therapeutic drug monitoring has been applied in clinical practice for patient care. Skin disorders are frequently observed as adverse drug reactions when using TKIs, and are commonly managed by symptomatic therapy based on clinical experience. Recent studies have provided some insights into the molecular mechanisms underlying skin disorders induced by TKIs. This review article summarizes the accumulated clinical and basic pharmacological evidence of TKIs, focusing on erlotinib, sorafenib and sunitinib.
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Affiliation(s)
- Tomohiro Terada
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu City, Shiga 520-2192, Japan.
| | - Satoshi Noda
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu City, Shiga 520-2192, Japan
| | - Ken-Ichi Inui
- Kyoto Pharmaceutical University, Yamashina-ku, Kyoto 607-8414, Kyoto, Japan
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Zhu AX, Rosmorduc O, Evans TRJ, Ross PJ, Santoro A, Carrilho FJ, Bruix J, Qin S, Thuluvath PJ, Llovet JM, Leberre MA, Jensen M, Meinhardt G, Kang YK. SEARCH: a phase III, randomized, double-blind, placebo-controlled trial of sorafenib plus erlotinib in patients with advanced hepatocellular carcinoma. J Clin Oncol 2015; 33:559-66. [PMID: 25547503 DOI: 10.1200/jco.2013.53.7746] [Citation(s) in RCA: 407] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare the clinical outcomes of sorafenib plus either erlotinib or placebo in patients with advanced hepatocellular carcinoma (HCC) in a multicenter, multinational, randomized, phase III trial. PATIENTS AND METHODS Patients with advanced HCC and underlying Child-Pugh class A cirrhosis, who were naive to systemic treatment (N = 720), were randomly assigned to sorafenib plus either erlotinib (n = 362) or placebo (n = 358). The primary end point was overall survival (OS). RESULTS Median OS was similar in the sorafenib plus erlotinib and sorafenib plus placebo groups (9.5 v 8.5 months, respectively; hazard ratio [HR], 0.929; P = .408), as was median time to progression (3.2 v 4.0 months, respectively; HR, 1.135; P = .18). In the sorafenib/erlotinib arm versus the sorafenib/placebo arm, the overall response rate trended higher (6.6% v 3.9%, respectively; P = .102), whereas the disease control rate was significantly lower (43.9% v 52.5%, respectively; P = .021). The median durations of treatment with sorafenib were 86 days in the sorafenib/erlotinib arm and 123 days in the sorafenib/placebo arm. In the sorafenib/erlotinib and sorafenib/placebo arms, the rates of treatment-emergent serious AEs (58.0% v 54.6%, respectively) and drug-related serious AEs (21.0% v 22.8%, respectively) were similar. AEs matched the known safety profiles of both agents, but rates of rash/desquamation, anorexia, and diarrhea were higher in the sorafenib/erlotinib arm, whereas rates of alopecia and hand-foot skin reaction were higher in the sorafenib/placebo arm. Withdrawal rates for AEs during cycles 1 to 3 were higher in the sorafenib/erlotinib arm. CONCLUSION Adding erlotinib to sorafenib did not improve survival in patients with advanced HCC.
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Affiliation(s)
- Andrew X Zhu
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Olivier Rosmorduc
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - T R Jeffry Evans
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Paul J Ross
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Armando Santoro
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Flair Jose Carrilho
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jordi Bruix
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Shukui Qin
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Paul J Thuluvath
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Josep M Llovet
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Marie-Aude Leberre
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Markus Jensen
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gerold Meinhardt
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yoon-Koo Kang
- Andrew X. Zhu, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; Olivier Rosmorduc, Service d'Hépatologie, Hôpital Saint-Antoine, Paris; Marie-Aude Leberre, Bayer HealthCare Pharmaceuticals, Loos, France; T.R. Jeffry Evans, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow; Paul J. Ross, King's College Hospital, London, United Kingdom; Armando Santoro, Humanitas Cancer Center, Milan, Italy; Flair Jose Carrilho, University of São Paulo School of Medicine, São Paulo, Brazil; Jordi Bruix and Josep M. Llovet, Barcelona Clínic Liver Cancer Group, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona; Josep M. Llovet, Institució Catalana de Recerca I Estudis Avançats, Catalonia, Spain; Shukui Qin, People's Liberation Army Cancer Center of Nanjing Bayi Hospital, Jiangsu, China; Paul J. Thuluvath, Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD; Josep M. Llovet, Mount Sinai Liver Cancer Program, Mount Sinai School of Medicine, New York, NY; Markus Jensen, Bayer Vital GmbH, Leverkusen, Germany; Gerold Meinhardt, Bayer HealthCare Pharmaceuticals, Montville, NJ; and Yoon-Koo Kang, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Abstract
INTRODUCTION Sorafenib is an oral multikinase inhibitor that targets tumor cell angiogenesis and proliferation. Drug-associated cutaneous adverse events, such as alopecia and hand-foot skin reaction, occur frequently. Sorafenib-related side effects affecting hair, nails, and skin are summarized and the characteristics of sorafenib-treated patients who developed acneiform facial lesions are reviewed to present the clinical features of these individuals. CASE REPORT A man with sorafenib-associated facial acneiform lesions mimicking those of chloracne is described. DISCUSSION PubMed was used to search the following terms, separately and in combination: acne, acneiform eruption, chloracne, cutaneous adverse events, hepatocellular carcinoma, renal cell carcinoma, skin side effects, and sorafenib. Inclusion criteria for selecting papers to be reviewed included case reports and studies that described cutaneous and mucosal adverse side effects associated with sorafenib. All papers fulfilling inclusion criteria were reviewed and relevant manuscripts, along with their reference citations, were evaluated. Five patients-a woman with liver epithelioid hemangioendothelioma, three men with metastatic renal cell carcinoma, and a man with hepatocellular carcinoma-have developed sorafenib-associated facial acneiform eruption. The eruption typically occurred after 4 weeks of treatment at a dose of 400 mg twice daily. The lesions presented as either papules and pustules (2 patients) or, similar in appearance and distribution to chloracne, only open and closed comedones (3 patients). The sorafenib-associated facial acneiform eruption partially improved after initiating topical antibiotics, keratolytics, and/or retinoids; however, progressive improvement or resolution occurred after lowering the daily dose or discontinuation of sorafenib. CONCLUSIONS Sorafenib-associated facial acneiform eruption is a rarely occurring cutaneous adverse event that has only been observed in five individuals. The skin lesions usually presented after 4 weeks of sorafenib (at a dose of 400 mg twice daily) treatment. The morphology and distribution of the lesions mimicked those of chloracne in three of the patients. Two of the patients also had other drug-related skin side effects. Topical acne-directed therapy was only partially effective in clearing the lesions; lowering the dose or discontinuation of sorafenib resulted in progressive improvement or resolution of the facial acneiform eruption.
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Fallahi P, Ferrari SM, Santini F, Corrado A, Materazzi G, Ulisse S, Miccoli P, Antonelli A. Sorafenib and thyroid cancer. BioDrugs 2014; 27:615-28. [PMID: 23818056 DOI: 10.1007/s40259-013-0049-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sorafenib (Nexavar) is a multikinase inhibitor, which has demonstrated both anti-proliferative and anti-angiogenic properties in vitro and in vivo, inhibiting the activity of targets present in the tumor cell [c-RAF (proto-oncogene serine/threonine-protein kinase), BRAF, (V600E)BRAF, c-KIT, and FMS-like tyrosine kinase 3] and in tumor vessels (c-RAF, vascular endothelial growth factor receptor-2, vascular endothelial growth factor receptor-3, and platelet-derived growth factor receptor β). For several years, sorafenib has been approved for the treatment of hepatocellular carcinoma and advanced renal cell carcinoma. After previous studies showing that sorafenib was able to inhibit oncogenic RET mutants, (V600E)BRAF, and angiogenesis and growth of orthotopic anaplastic thyroid cancer xenografts in nude mice, some clinical trials demonstrated the effectiveness of sorafenib in advanced thyroid cancer. Currently, the evaluation of the clinical safety and efficacy of sorafenib for the treatment of advanced thyroid cancer is ongoing. This article reviews the anti-neoplastic effect of sorafenib in thyroid cancer. Several completed (or ongoing) studies have evaluated the long-term efficacy and tolerability of sorafenib in patients with papillary and medullary aggressive thyroid cancer. The results suggest that sorafenib is a promising therapeutic option in patients with advanced thyroid cancer that is not responsive to traditional therapeutic strategies.
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Affiliation(s)
- Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
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Harding JJ, Abou-Alfa GK. Treating advanced hepatocellular carcinoma: How to get out of first gear. Cancer 2014; 120:3122-30. [PMID: 24898783 DOI: 10.1002/cncr.28850] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 04/03/2014] [Accepted: 04/23/2014] [Indexed: 12/24/2022]
Abstract
Hepatocellular carcinoma is a common malignancy with a poor prognosis. Sorafenib is the only systemic therapy known to improve the overall survival of patients with advanced disease. The clinical benefit of sorafenib is modest and the mechanistic basis for its activity is unknown. Four phase 3 clinical trials have failed to improve on sorafenib in the frontline setting and no agent has been shown to impact outcomes after sorafenib failure. Several factors have contributed to this recent stall in drug development but new approaches hold promise and currently are being investigated. This review will focus on the current pipeline of experimental therapeutics for patients with advanced hepatocellular carcinoma and shed a light on scientific limitations that hamper the advancement of new therapies for this disease, and ways around it.
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Affiliation(s)
- James J Harding
- Department of Medicine, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
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Cardin DB, Goff L, Li CI, Shyr Y, Winkler C, DeVore R, Schlabach L, Holloway M, McClanahan P, Meyer K, Grigorieva J, Berlin J, Chan E. Phase II trial of sorafenib and erlotinib in advanced pancreatic cancer. Cancer Med 2014; 3:572-9. [PMID: 24574334 PMCID: PMC4101748 DOI: 10.1002/cam4.208] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/08/2014] [Indexed: 12/23/2022] Open
Abstract
This trial was designed to assess efficacy and safety of erlotinib with sorafenib in the treatment of patients with advanced pancreatic adenocarcinoma. An exploratory correlative study analyzing pretreatment serum samples using a multivariate protein mass spectrometry-based test (VeriStrat®), previously shown to correlate with outcomes in lung cancer patients treated with erlotinib, was performed. Patients received sorafenib 400 mg daily along with erlotinib 150 mg daily with a primary endpoint of 8-week progression free survival (PFS) rate. Pretreatment serum sample analysis by VeriStrat was done blinded to clinical and outcome data; the endpoints were PFS and overall survival (OS). Difference between groups (by VeriStrat classification) was assessed using log-rank P values; hazard ratios (HR) were obtained from Cox proportional hazards model. Thirty-six patients received study drug and were included in the survival analysis. Eight-week PFS rate of 46% (95% confidence interval (CI): 0.32–0.67) did not meet the primary endpoint of a rate ≥70%. Thirty-two patients were included in the correlative analysis, and VeriStrat “Good” patients had superior PFS (HR = 0.18, 95% CI: 0.06–0.57; P = 0.001) and OS (HR = 0.31 95% CI: 0.13–0.77, P = 0.008) compared to VeriStrat “Poor” patients. Grade 3 toxicities of this regimen included fever, anemia, diarrhea, dehydration, rash, and altered liver function. This study did not meet the primary endpoint, and this combination will not be further pursued. In this small retrospective analysis, the proteomic classification was significantly associated with clinical outcomes and is being further evaluated in ongoing studies.
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Affiliation(s)
- Dana B Cardin
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Thomas-Schoemann A, Blanchet B, Bardin C, Noé G, Boudou-Rouquette P, Vidal M, Goldwasser F. Drug interactions with solid tumour-targeted therapies. Crit Rev Oncol Hematol 2013; 89:179-96. [PMID: 24041628 DOI: 10.1016/j.critrevonc.2013.08.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/11/2013] [Accepted: 08/16/2013] [Indexed: 12/20/2022] Open
Abstract
Drug interactions are an on-going concern in the treatment of cancer, especially when targeted therapies, such as tyrosine kinase inhibitors (TKI) or mammalian target of rapamycin (mTOR) inhibitors, are being used. The emergence of elderly patients and/or patients with both cancer and other chronic co-morbidities leads to polypharmacy. Therefore, the risk of drug-drug interactions (DDI) becomes a clinically relevant issue, all the more so as TKIs and mTOR inhibitors are essentially metabolised by cytochrome P450 enzymes. These DDIs can result in variability in anticancer drug exposure, thus favouring the selection of resistant cellular clones or the occurrence of toxicity. This review provides a comprehensive overview of DDIs that involve targeted therapies approved by the FDA for the treatment of solid tumours for more than 3 years (sorafenib, sunitinib, erlotinib, gefitinib, imatinib, lapatinib, everolimus, temsirolimus) and medicinal herb or drugs. This review also provides some guidelines to help oncologists and pharmacists in their clinical practice.
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Affiliation(s)
- Audrey Thomas-Schoemann
- Centre d'Étude et de Recours aux Inhibiteurs de l'Angiogénèse, Paris, France; UF de Pharmacocinétique et Pharmacochimie, Groupement des Hôpitaux Paris Centre, 75014 Paris, France.
| | - Benoit Blanchet
- Centre d'Étude et de Recours aux Inhibiteurs de l'Angiogénèse, Paris, France; UF de Pharmacocinétique et Pharmacochimie, Groupement des Hôpitaux Paris Centre, 75014 Paris, France
| | - Christophe Bardin
- UF de Pharmacocinétique et Pharmacochimie, Groupement des Hôpitaux Paris Centre, 75014 Paris, France
| | - Gaëlle Noé
- UF de Pharmacocinétique et Pharmacochimie, Groupement des Hôpitaux Paris Centre, 75014 Paris, France
| | - Pascaline Boudou-Rouquette
- Centre d'Étude et de Recours aux Inhibiteurs de l'Angiogénèse, Paris, France; Service d'Oncologie Médicale, Groupement des Hôpitaux Paris Centre, AP-HP, Paris, France
| | - Michel Vidal
- Centre d'Étude et de Recours aux Inhibiteurs de l'Angiogénèse, Paris, France; UF de Pharmacocinétique et Pharmacochimie, Groupement des Hôpitaux Paris Centre, 75014 Paris, France; UMR 8638 CNRS, UFR des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Sorbonne Paris Cité, 75270 Paris, France
| | - François Goldwasser
- Centre d'Étude et de Recours aux Inhibiteurs de l'Angiogénèse, Paris, France; Service d'Oncologie Médicale, Groupement des Hôpitaux Paris Centre, AP-HP, Paris, France
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31
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Li F, Zhao C, Wang L. Molecular-targeted agents combination therapy for cancer: developments and potentials. Int J Cancer 2013; 134:1257-69. [PMID: 23649791 DOI: 10.1002/ijc.28261] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 04/25/2013] [Indexed: 11/10/2022]
Abstract
Although chemotherapy has advanced into the era of targeted drugs, the antitumor efficacies of current therapies are limited, most likely because of the high degree of cancer clonal heterogeneity, intratumor genetic heterogeneity and cell signal complexity. As shutdown of a single target does not necessarily eradicate the cancer, the use of combinations of molecular-targeted agents (MATs) has been proposed, and some pioneering research has been conducted to examine the efficacy of this strategy. In this article, the clinical and preclinical studies that are underway in an attempt to improve the anticancer efficacy of chemotherapies through combination strategies are summarized. Studies of combining cytotoxic agents with MATs, coinhibiting two or more targets in a single pathway or coinhibiting parallel or compensatory pathways as well as specific combinations will be introduced, and the antitumor potentials of each combination strategy will be evaluated.
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Affiliation(s)
- Feifei Li
- Key Laboratory of Cell Proliferation and Regulation Biology, Ministry of Education, Beijing Normal University, Beijing, China; Gene Engineering and Biotechnology Beijing Key Laboratory, Beijing Normal University, Beijing, China; Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing, China
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Noda S, Shioya M, Hira D, Fujiyama Y, Morita SY, Terada T. Pharmacokinetic interaction between sorafenib and prednisolone in a patient with hepatocellular carcinoma. Cancer Chemother Pharmacol 2013; 72:269-72. [DOI: 10.1007/s00280-013-2187-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/20/2013] [Indexed: 01/17/2023]
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Pan G, Ke S, Zhao J. Comparison of the efficacy and safety of single-agent erlotinib and doublet molecular targeted agents based on erlotinib in advanced non-small cell lung cancer (NSCLC): a systematic review and meta-analysis. Target Oncol 2013; 8:107-16. [PMID: 23516098 DOI: 10.1007/s11523-013-0272-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 03/10/2013] [Indexed: 12/19/2022]
Abstract
In patients with advanced non-small cell lung cancer (NSCLC), the benefit-to-risk ratio of doublet-targeted agents versus single agent is not clear. A systematic review and quantitative meta-analysis were, therefore, undertaken to evaluate the available evidence from randomized trials. This study aims to evaluate the efficacy and safety of erlotinib versus doublets (erlotinib plus another targeted agent) in advanced NSCLC and, if adequate data are available, to investigate whether or not predefined patient groups benefit more or less from doublet-targeted therapy based on erlotinib. Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled clinical trials were conducted in which any erlotinib was compared with doublets based on erlotinib in patients with NSCLC who had failed to respond to any previous chemotherapy regimen. Two review authors independently selected studies for inclusion in the review and extracted data. A systematic review and meta-analysis based on aggregate data extracted from trial publications were carried out to assess the effectiveness of doublets (erlotinib plus another targeted drug) in NSCLC treatment. The efficacy outcomes were objective response rate (ORR), complete response plus partial response; disease control rate (DCR), complete response plus partial response and stable disease; and 1-year overall survival (OS). The adverse effects (AEs) were also considered. This involved identifying eligible randomized controlled trials (RCTs) and extracting aggregate data from the reports of these RCTs. Hazard ratios were calculated from published summary statistics and then combined to give pooled estimates of treatment efficacy. This meta-analysis comprised five studies including 2,100 patients (mean age 63; 1,224 men and 876 women; 118 stage IIIB and 1,180 stage IV; 441 squamous cell cancers, 1,287 adenocarcinomas, and 372 other pathological types). Doublets regimen significantly improved ORR [hazard ratio (HR) 1.49, 1.13-1.98, p < 0.05] and DCR (HR 1.25, 1.12-1.39, p < 0.05) compared with single erlotinib, but 1-year OS was not significantly improved for doublets [HR 1.06; 95 % confidence interval (CI), 0.95-1.18]. All-grade rash, anemia, diarrhea, anorexia, and fatigue were not significantly different between doublet and erlotinib groups (HR 1.25, 0.99-1.58; 0.98, 0.78-1.24; 1.43, 0.97-2.11; 1.18, 0.84-1.65; and 1.23, 0.86-1.77, respectively). The total grade of ≥3 AEs was also not significantly different (HR 1.40, 95 % CI 0.97-2.01). Compared with single-agent erlotinib, doublets (erlotinib plus another targeted agent) significantly improve ORR and DCR, but not OS, and induce no significance of more frequent and serious AEs. The benefit-to-risk ratio of doublets in advanced NSCLC may be more favorable than that of single-agent. The results of this systematic review suggest that patients with advanced NSCLC might benefit from doublet-targeted therapy based on erlotinib compared to erlotinib alone. However, an individual patient data systematic review and meta-analysis are needed to give us a more reliable assessment of the size of benefits and to explore whether doublet therapy may be more or less effective for particular types of patients.
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Affiliation(s)
- Gaofeng Pan
- Department of Thoracic and Cardiovascular Surgery, Zhongnan Hospital, Wuhan University, 169 Donghu Road, Wuchang, Wuhan, Hubei, 430071, People's Republic of China
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Phase I pharmacokinetic and pharmacodynamic study of lapatinib in combination with sorafenib in patients with advanced refractory solid tumors. Eur J Cancer 2013; 49:989-98. [DOI: 10.1016/j.ejca.2012.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/12/2012] [Accepted: 10/16/2012] [Indexed: 12/16/2022]
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Park SR, Davis M, Doroshow JH, Kummar S. Safety and feasibility of targeted agent combinations in solid tumours. Nat Rev Clin Oncol 2013; 10:154-68. [PMID: 23358316 DOI: 10.1038/nrclinonc.2012.245] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The plethora of novel molecular-targeted agents (MTAs) has provided an opportunity to selectively target pathways involved in carcinogenesis and tumour progression. Combination strategies of MTAs are being used to inhibit multiple aberrant pathways in the hope of optimizing antitumour efficacy and to prevent development of resistance. While the selection of specific agents in a given combination has been based on biological considerations (including the role of the putative targets in cancer) and the interactions of the agents used in combination, there has been little exploration of the possible enhanced toxicity of combinations resulting from alterations in multiple signalling pathways in normal cell biology. Owing to the complex networks and crosstalk that govern normal and tumour cell proliferation, inhibiting multiple pathways with MTA combinations can result in unpredictable disturbances in normal physiology. This Review focuses on the main toxicities and the lack of tolerability of some common MTA combinations, particularly where evidence of enhanced toxicity compared to either agent alone is documented or there is development of unexpected toxicity. Toxicities caused by MTA combinations highlight the need to introduce new preclinical testing paradigms early in the drug development process for the assessment of chronic toxicities resulting from such combinations.
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Affiliation(s)
- Sook Ryun Park
- Division of Cancer Treatment and Diagnosis, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 31, Room 3A44, 31 Center Drive, Bethesda, MD 20892, USA
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Peereboom DM, Ahluwalia MS, Ye X, Supko JG, Hilderbrand SL, Phuphanich S, Nabors LB, Rosenfeld MR, Mikkelsen T, Grossman SA. NABTT 0502: a phase II and pharmacokinetic study of erlotinib and sorafenib for patients with progressive or recurrent glioblastoma multiforme. Neuro Oncol 2013; 15:490-6. [PMID: 23328813 DOI: 10.1093/neuonc/nos322] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The signal transduction pathways of epidermal growth factor receptor and Ras are both important in the growth of glioblastoma multiforme (GBM). We hypothesized that inhibition of both pathways would improve the survival time of patients with recurrent GBM. METHODS Patients with recurrent/progressive GBM with 0-2 prior chemotherapy regimens received erlotinib 150 mg once daily and sorafenib 400 mg twice daily until progression. The primary endpoint was overall survival. Pharmacokinetic sampling was performed during cycle 1. RESULTS The median overall survival was 5.7 months. Progression-free survival at 6 months was 14%. Toxicity was manageable. Clearance of erlotinib was markedly enhanced by sorafenib. CONCLUSION The study did not meet its objective of a 30% increase in overall survival time compared with historical controls. Erlotinib and sorafenib have significant pharmacokinetic interactions that may negatively impact the efficacy of the combination regimen.
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Ang C, O'Reilly EM, Abou-Alfa GK. Targeted agents and systemic therapy in hepatocellular carcinoma. Recent Results Cancer Res 2013; 190:225-46. [PMID: 22941024 DOI: 10.1007/978-3-642-16037-0_15] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cytotoxic chemotherapy, hormonal agents, and immunotherapy have been tested in hepatocellular cancer (HCC) with marginal efficacy to date. Recent insights into the molecular pathogenesis of HCC have identified several aberrant signaling pathways that have served as targets for novel therapeutic agents. These discoveries have been translated into the clinical realm with the use of the antiangiogenic and the Raf kinase inhibitor, sorafenib, and have revealed the potential of targeted agents to produce clinically meaningful survival benefits in patients with advanced HCC. Efforts continue in the quest to improve the outcome of HCC patients through the development and evaluation of other targeted agents, and to better understand the interactions between the underlying disease biology and response to therapy. Several pathways are now implicated in hepatocarcinogenesis and agents that target these pathways continue to be developed.
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Affiliation(s)
- Celina Ang
- Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Zhu AX. Molecularly targeted therapy for advanced hepatocellular carcinoma in 2012: current status and future perspectives. Semin Oncol 2012; 39:493-502. [PMID: 22846866 DOI: 10.1053/j.seminoncol.2012.05.014] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Improving the overall survival for patients with advanced hepatocellular carcinoma (HCC) requires development of effective systemic therapy. Despite the successful approval and extensive application of sorafenib, the prognosis for patients with advanced HCC remains poor and the benefits with sorafenib are modest. In the past few years, there have been renewed and continued interests and active research in developing other molecularly targeted agents in HCC. While the initial efforts are focusing on anti-angiogenic therapy, other agents targeting the epidermal growth factor-receptor, mammalian target of rapamycin (mTOR), hepatocyte growth factor/c-Met among others have entered HCC clinical trials. Combining different molecularly targeted agents or combining targeted agents with chemotherapy represent other strategies under investigation. This review will attempt to summarize the current status of other molecularly targeted agents or regimens beyond sorafenib under development in advanced HCC and the future perspectives.
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Affiliation(s)
- Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, USA.
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Aissi S, Ben Mrad M, Zarraa S, Bounedjar A, Laabidi S, Boussen H. [Targeted therapies: towards a new toxicology?]. PATHOLOGIE-BIOLOGIE 2012; 60:234-238. [PMID: 22743098 DOI: 10.1016/j.patbio.2012.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
Targeted therapies (TT) represent since 10 years, an interesting progress in oncology for many cancers in adjuvant, neoadjuvant or palliative situation. The development of this new class of drugs, with an original mechanism of action, their easy administration, mainly per os, and a particular toxicity profile different from "classical" chemotherapy (CT) leads them entering in the therapeutic arsenal of breast, digestive tract, lung and hematologic cancers, in association with CT. Medical oncologists took rapidly the train of TT, managing a new and original skin, digestive, cardiovascular, endocrine and pulmonary toxicity profile, that remains relatively less important than "classical" CT.
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Affiliation(s)
- S Aissi
- Service de carcinologie médicale, hôpital Abderrahman-Mami, rue Abderrahmen-Mami, 2080 Ariana-Tunis, Tunisie
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Abstract
Following the encouraging results of sorafenib in advanced hepatocellular carcinoma (HCC), targeted therapy has become a new direction of research in the treatment of HCC. Emerging data provide evidence that the pathogenesis and progression of HCC are mediated by a number of molecular defects and dysregulated pathways. Novel targeted therapies are designed to inhibit the aberrant pathways at a molecular level with an aim to improve the clinical outcome. For the past few years, an increasing number of targeted agents have been tested in HCC in the clinical setting. This review aims to summarize the current status of clinical development of targeted therapy in HCC, with focus on novel agents targeting angiogenesis, signal transduction and epigenetic dysregulation of tumors. The review also discusses the lessons learned from outcomes of completed clinical trials and provides perspectives on future clinical trials in HCC.
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Affiliation(s)
- Stephen L Chan
- State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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JAK2 Inhibition: Reviewing a New Therapeutical Option in Myeloproliferative Neoplasms. Adv Hematol 2012; 2012:535709. [PMID: 22400031 PMCID: PMC3286888 DOI: 10.1155/2012/535709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/29/2011] [Accepted: 12/04/2011] [Indexed: 01/17/2023] Open
Abstract
JAK2 is a tyrosine kinase gene that plays an essential role in the development of normal haematopoiesis. Hyperactivation of JAK2 occurs in myeloproliferative neoplasms by different mechanisms. As a consequence, JAK2 inhibitors have been designed to suppress the cytokine signalling cascade caused by the constitutive activation of JAK2. In clinical trials, JAK2 inhibitors are efficient in decreasing spleen size, controlling clinical symptoms, and improving quality of life in patients with myeloproliferative neoplasms. However, JAK2 inhibitors are unable to target uncommitted hematopoietic progenitors responsible of the initiation of the myeloproliferative disease. It is expected that, in order to cure the myeloproliferative disease, JAK2 inhibitors should be combined with other drugs to target simultaneously different pathways and to target the initiator hematopoietic cell population in myeloproliferative disorders. Taking advantage of the inhibition of the cytokine cascade of JAK2 inhibitors, these compounds are going to be used not only to treat patients with hematological neoplasms but may also be beneficial to treat patients with rheumatoid arthritis or other inflammatory diseases.
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Nabors LB, Supko JG, Rosenfeld M, Chamberlain M, Phuphanich S, Batchelor T, Desideri S, Ye X, Wright J, Gujar S, Grossman SA. Phase I trial of sorafenib in patients with recurrent or progressive malignant glioma. Neuro Oncol 2011; 13:1324-30. [PMID: 21954442 DOI: 10.1093/neuonc/nor145] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sorafenib is an inhibitor of multiple kinases that has demonstrated antiproliferative and antiangiogenic activity in a number of in vitro and in vivo model systems. A phase I study was conducted to determine the maximum tolerated dose (MTD) of sorafenib in patients with recurrent malignant glioma. Sorafenib was given orally, twice a day (BID), continuously in 28-day cycles. The dose was escalated in 2 groups of patients stratified by use of enzyme-inducing antiseizure drugs (± EIASDs). Dose-limiting toxicity (DLT) was defined as any grades 3-4 nonhematological toxicity, grade 4 hematological toxicity, and febrile neutropenia. The number of evaluable patients enrolled in the +EIASD and -EIASD arms were 23 and 24, respectively. DLTs were predominantly dermatological and gastrointestinal effects, as observed in previous clinical trials of sorafenib. The MTD was 600 mg BID for patients receiving EIASDs and 800 mg BID for those who were not. The plasma pharmacokinetics of sorafenib were not significantly affected by the concurrent administration of EIASDs. The MTD of sorafenib given orally BID on a continuous basis was established as 600 mg BID in patients with malignant glioma who were concurrently receiving EIASDs and 800 mg BID in those who were not. Further evaluation is warranted of sorafenib at the recommended MTD against recurrent or progressive malignant glioma in combination with other molecularly targeted drugs or in the newly diagnosed setting concurrent with chemoradiation.
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Affiliation(s)
- L B Nabors
- University of Alabama at Birmingham, Birmingham, AL, USA
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Di Gion P, Kanefendt F, Lindauer A, Scheffler M, Doroshyenko O, Fuhr U, Wolf J, Jaehde U. Clinical Pharmacokinetics of Tyrosine Kinase Inhibitors. Clin Pharmacokinet 2011; 50:551-603. [DOI: 10.2165/11593320-000000000-00000] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Scheffler M, Di Gion P, Doroshyenko O, Wolf J, Fuhr U. Clinical Pharmacokinetics of Tyrosine Kinase Inhibitors. Clin Pharmacokinet 2011; 50:371-403. [DOI: 10.2165/11587020-000000000-00000] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Oral complications of targeted cancer therapies: A narrative literature review. Oral Oncol 2011; 47:441-8. [DOI: 10.1016/j.oraloncology.2011.03.028] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/23/2011] [Accepted: 03/28/2011] [Indexed: 01/08/2023]
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Spigel DR, Burris HA, Greco FA, Shipley DL, Friedman EK, Waterhouse DM, Whorf RC, Mitchell RB, Daniel DB, Zangmeister J, Bass JD, Hainsworth JD. Randomized, double-blind, placebo-controlled, phase II trial of sorafenib and erlotinib or erlotinib alone in previously treated advanced non-small-cell lung cancer. J Clin Oncol 2011; 29:2582-9. [PMID: 21576636 DOI: 10.1200/jco.2010.30.7678] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Sorafenib, an oral multikinase inhibitor, has shown preliminary activity in non-small-cell lung cancer (NSCLC). Patients with advanced NSCLC were treated with erlotinib with or without sorafenib in this multicenter phase II trial. PATIENTS AND METHODS Key eligibility criteria included the following: stage IIIB or IV NSCLC; one to two prior regimens; Eastern Cooperative Oncology Group performance status of 0 to 2; and measurable disease. Patients were randomly assigned 2:1 to sorafenib (400 mg orally twice a day) plus erlotinib (150 mg orally daily) or placebo plus erlotinib and stratified by squamous/nonsquamous histology and prior bevacizumab. Treatment efficacy, measured by progression-free survival (PFS) and overall response rate (ORR), was compared. Treatment of 168 patients allowed detection of 40% improvement in the historical PFS of 2.2 months with single-agent erlotinib. RESULTS One hundred sixty-eight patients enrolled from February 2008 to February 2009. Clinical characteristics of the two groups were similar. ORRs for sorafenib/erlotinib and placebo/erlotinib were 8% and 11%, respectively (P = .56); disease control rates were 54% and 38%, respectively (P = .056). Median PFS was 3.38 months for sorafenib/erlotinib versus 1.94 months for placebo/erlotinib (hazard ratio, 0.86; 95% CI, 0.60 to 1.22; P = .196). Seventy-two patients consented to analyses of tumor epidermal growth factor receptor (EGFR). In 67 patients with EGFR wild-type (WT) tumors, median PFS was 3.38 months for sorafenib/erlotinib versus 1.77 months for placebo/erlotinib (P = .018); median overall survival (OS) was 8 months for sorafenib/erlotinib versus 4.5 months for placebo/erlotinib (P = .019). An OS advantage for sorafenib/erlotinib was suggested among 43 patients with fluorescent in situ hybridization (FISH) EGFR-negative tumors (P = .064). Both regimens were tolerable, with modest toxicity increase with sorafenib. CONCLUSION Although there was little difference in ORR or PFS, subset analyses in EGFR WT and EGFR FISH-negative patients suggest a benefit for the combination of erlotinib/sorafenib compared with single-agent erlotinib with respect to PFS and OS.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, 250 25th Ave North, Ste 110, Nashville, TN 37203, USA.
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O’Mahar SE, Campbell TC, Hoang T, Seo S, Kim K, Larson MM, Marcotte SM, LoConte NK, Traynor AM. Phase I study of sunitinib and erlotinib in advanced nonsquamous non-small cell lung cancer. J Thorac Oncol 2011; 6:951-3. [PMID: 21623267 PMCID: PMC3359645 DOI: 10.1097/jto.0b013e31820db227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Erlotinib has prolonged survival in unselected patients with advanced non-small cell lung cancer, whereas sunitinib has yielded promising rates of disease control in previously treated patients. We conducted a dose escalation study of this combination to determine the maximum tolerated dose of sunitinib in combination with a fixed dose of erlotinib and to evaluate the toxicities of this combination. METHODS Patients with advanced nonsquamous non-small cell lung cancer were treated at two dose levels: sunitinib at either 25 mg or 37.5 mg, with erlotinib 150 mg. Both drugs were given once daily, continuously. RESULTS Eleven patients enrolled from November 2007 to October 2009. No dose-limiting toxicities occurred. Grade 3/4 adverse events at least possibly related to treatment were seen in seven patients (64%). Six patients (54%) required dose modifications, and three (27%) discontinued study treatment due to toxicity. Rates of grade 3 diarrhea and mucositis exceeded those seen with single-agent erlotinib or sunitinib. One patient (9%) attained a partial response lasting 16.3 months. CONCLUSIONS Although no dose-limiting toxicities occurred, it is difficult to recommend erlotinib 150 mg and sunitinib 37.5 mg daily as the phase II dose for this combination due to the high rate of adverse events. Because of the overlapping toxicity profile of each agent, this combination was poorly tolerated in our population.
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Affiliation(s)
- Shannon E. O’Mahar
- Department of Medicine, Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Toby C. Campbell
- Department of Medicine, Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tien Hoang
- Department of Medicine, Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Songwon Seo
- Department of Biostatistics and Medical Information, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - KyungMann Kim
- Department of Biostatistics and Medical Information, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Martha M. Larson
- Department of Medicine, Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sarah M. Marcotte
- Department of Medicine, Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Noelle K. LoConte
- Department of Medicine, Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anne M. Traynor
- Department of Medicine, Division of Hematology & Oncology, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Postel-Vinay S, Gomez-Roca C, Molife LR, Anghan B, Levy A, Judson I, De Bono J, Soria JC, Kaye S, Paoletti X. Phase I Trials of Molecularly Targeted Agents: Should We Pay More Attention to Late Toxicities? J Clin Oncol 2011; 29:1728-35. [PMID: 21444876 DOI: 10.1200/jco.2010.31.9236] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Phase I trials traditionally aim at determining the recommended phase II dose (RP2D) using grade ≥ 3 toxicity data from cycle 1 (C1) only. This design dates from the era of conventional chemotherapy and may not be relevant for new molecularly targeted agents (MTAs) usually administered in a chronic fashion and for which late or moderate toxicities may deserve particular attention. Patients and Methods All consecutive patients treated in phase I trials of MTAs at the Royal Marsden Hospital and Institut Gustave Roussy between January 2005 and July 2008 were included. Gastrointestinal, skin, and clinical renal toxicities of any grade and grades 3 to 4 toxic events of any type occurring at any cycle on treatment were recorded. Doses administered, treatment interruptions, dose modifications, and prescription of comedications were analyzed. Results A total of 445 patients (1,566 cycles; median treatment duration, 55 days) were included in 36 eligible trials; 790 toxicities (590, grade 1; 176, grade, 2; 24 grades, 3 to 4) and 1,819 toxicities (1,521, grade 1; 265, grade 2; 33, grades 3 to 4) were recorded during and after C1, respectively; 57% of the grades 3 to 4 toxicities occurred after C1; 50% of patients presented their worst-grade toxicity after C1. The risk of grades 3 to 4 toxicity was 3% in cycles 1 to 6 and was almost null afterwards. No cumulative toxicities were observed. Median toxicity duration was 15 days, with comedication administered in 68% of events. Conclusion Moderate and severe toxicities occur regularly after the first cycle in phase I trials of MTAs and may deserve increased attention in the RP2D process for these agents.
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Affiliation(s)
- Sophie Postel-Vinay
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - Carlos Gomez-Roca
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - L. Rhoda Molife
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - Bhavesh Anghan
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - Antonin Levy
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - Ian Judson
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - Johann De Bono
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - Jean-Charles Soria
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - Stan Kaye
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
| | - Xavier Paoletti
- From the Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; the Institut Gustave Roussy, Université Paris XI, Villejuif; and Institut Curie INSERM U900, Paris, France
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Adjei AA, Blumenschein GR, Mandrekar S, Hillman S, Gatzemeier U, Heigener D. Long-term safety and tolerability of sorafenib in patients with advanced non-small-cell lung cancer: a case-based review. Clin Lung Cancer 2011; 12:212-7. [PMID: 21726819 DOI: 10.1016/j.cllc.2011.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 09/27/2010] [Accepted: 10/01/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sorafenib, a small-molecule inhibitor of multiple kinases involved in tumor growth and progression, is approved for the treatment of advanced renal-cell carcinoma and advanced hepatocellular carcinoma. Encouraging activity and good tolerability of daily oral sorafenib, either as a single agent or in combination with gefitinib, have been demonstrated in phase I-II trials in patients with advanced non-small-cell lung cancer (NSCLC). Currently, minimal data are available describing the long-term safety and tolerability of sorafenib in patients with NSCLC. MATERIALS AND METHODS We describe a series of 12 patients with advanced NSCLC (derived from 1 phase I and 2 phase II trials) who achieved long-term (ie, > 12 months) disease control and continued to receive sorafenib alone or in combination with gefitinib beyond the end of the study in which they were enrolled. RESULTS The safety profile of sorafenib administered on a long-term basis did not differ significantly from that seen previously in the shorter term. The majority of adverse events (AEs) were Grade 1-2 in severity. Five of the 12 patients experienced no ≥ Grade 3 AEs. There was no evidence of increased frequency or severity of AEs over time, or of late AEs, and no patient in this series discontinued study treatment because of AEs. CONCLUSION In patients with advanced NSCLC who achieve a prolonged response or stable disease with sorafenib given as a single agent or as part of a combination regimen, sorafenib treatment could be continued until disease progression without major long-term safety or tolerability problems.
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Affiliation(s)
- Alex A Adjei
- Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Flaherty KT, Lathia C, Frye RF, Schuchter L, Redlinger M, Rosen M, O'Dwyer PJ. Interaction of sorafenib and cytochrome P450 isoenzymes in patients with advanced melanoma: a phase I/II pharmacokinetic interaction study. Cancer Chemother Pharmacol 2011; 68:1111-8. [PMID: 21350850 DOI: 10.1007/s00280-011-1585-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 02/03/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND In vitro data indicate that the sorafenib is a moderate inhibitor of cytochrome P450 (CYP) enzymes, including CYP3A4, CYP2C19, and CYP2D6. This phase I/II study in patients with advanced melanoma evaluated the potential effect of sorafenib on the pharmacokinetics of midazolam, omeprazole, and dextromethorphan, specific substrates of CYP3A4, CYP2C19, and CYP2D6, respectively. METHODS Twenty-one patients received sorafenib 400 mg twice daily for 28 consecutive days. On days 1 and 28, a cocktail containing midazolam 2 mg, omeprazole 20 mg, and dextromethorphan 30 mg was administered. Pharmacokinetic analyses were performed on day 1 without sorafenib and day 28 after steady-state sorafenib exposure; sorafenib pharmacokinetics were evaluated on day 28. We defined an interaction to be excluded if the 90% confidence interval of the ratio of all day 28:day 1 analyses fell within a range from 0.80 to 1.25. RESULTS In all, 18 patients were evaluable. On day 28, area under the plasma concentration-time curve from time 0 to 12 h (AUC(0-12)) and maximum plasma concentration (C(max)) for sorafenib were 38.1 mg h/l and 4.9 mg/l, respectively. Day 28:day 1 ratios for AUC from time 0 extrapolated to infinity (AUC(0-inf)) and C(max) for midazolam were 0.85 and 0.98, respectively. Day 28:day 1 ratio for 5-OH-omeprazole:omeprazole plasma concentration at 3 h postdose was 1.26, slightly outside of the 0.80-1.25 range. Thus, an interaction could not be excluded, but is considered unlikely to be clinically significant. Day 28:day 1 ratio for dextromethorphan:dextrorphan concentration in urine was 0.94. Sorafenib had an acceptable safety profile. The most frequently observed grade 3-4 toxicities in cycle 1 included elevated lipase (19%) and hypertension (10%). CONCLUSIONS In this patient population, our results demonstrate that exposures of probes of CYP3A4, CYP2D6, or CYP2C19 activity are potentially altered by administration of sorafenib at 400 mg twice daily. However, these differences are sufficiently small that a clinically significant inhibition or induction of these important drug metabolizing P450 isoenzymes is unlikely. Clinical and, where possible, drug level monitoring may still be appropriate for drugs of narrow therapeutic range co-administered with sorafenib.
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Affiliation(s)
- Keith T Flaherty
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA.
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