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Monaghan NP, Duckett KA, Nguyen SA, Newman JG, Albergotti WG, Kejner AE. Vascular events in patients with head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1557-1572. [PMID: 38334324 DOI: 10.1002/hed.27675] [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: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To assess the incidence of vascular events in patients with head and neck cancer. REVIEW METHODS Primary studies identified through April 2023. Meta-analysis was performed. RESULTS There were 146 studies included in the systematic review. Rates of events were collected in the overall group, those with chemoprophylaxis, and those that underwent surgery, radiation, or chemotherapy. Of 1 184 160 patients, 4.3% had a vascular event. Radiation therapy had highest risk of overall events and stroke when compared to surgery and chemotherapy. Chemotherapy had a higher risk of stroke and overall events when compared to surgery. CONCLUSIONS Vascular events occur in 4%-5% of patients with head and neck cancer. Our data does not support the use of routine anticoagulation. Patients undergoing radiation therapy had the highest frequency of events.
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Affiliation(s)
- Neil P Monaghan
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey A Duckett
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason G Newman
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - W Greer Albergotti
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexandra E Kejner
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Ben-Ami T. Nasopharyngeal Carcinoma in Children, Current Treatment Approach. J Pediatr Hematol Oncol 2024; 46:117-124. [PMID: 38447121 PMCID: PMC10956687 DOI: 10.1097/mph.0000000000002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/04/2024] [Indexed: 03/08/2024]
Abstract
Nasopharyngeal carcinoma (NPC) is a rare and locally aggressive form of childhood cancer. Treatment of pediatric NPC includes chemotherapy and radiotherapy. Most studies on the treatment of pediatric NPC are single-arm studies. With current treatment protocols survival rates for patients with nonmetastatic disease exceed 80%, although most children will have long-term treatment-related late effects. Efforts to reduce early and late toxicities include reduced radiotherapy doses in children with good responses to induction chemotherapy. Further studies are needed to evaluate the role of immunotherapy in both the primary setting and in children with progressive or relapsed disease. This review summarizes current clinical approaches to the treatment of pediatric NPC.
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Zhou R, Zhou P, Yu YF, Lin Q, Wu SG. A Pilot Study of Anlotinib as a Combination Treatment in Advanced Nasopharyngeal Carcinoma. Curr Cancer Drug Targets 2024; 24:319-327. [PMID: 37563818 DOI: 10.2174/1568009623666230810121918] [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: 04/25/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
AIMS To investigate the short-term objective response and treatment toxicity of anlotinib as a combination treatment in patients with Recurrent or Metastatic Nasopharyngeal Carcinoma (RM-NPC). METHODS Patients with RM-NPC who received anlotinib as a combination treatment between March 2021 and July 2022 were retrospectively analyzed.The efficacy and safety of anlotinib as a combination treatment were analyzed. RESULTS A total of 17 patients with RM-NPC were included in this study. Of these patients, 2 (11.8%) had local recurrence, 4 (23.5%) had cervical lymph node recurrence, and 11 (64.9%) had distant failure. The most common metastatic site was the liver (47.1%), followed by the lung (23.5%) and bone (23.5%). Anlotinib was given as first-line treatment in 3 patients (17.6%), second lines treatment in 7 patients (41.2%), and third to six-lines treatment in 7 patients (41.2%). All patients received anlotinib combined with chemotherapy and/or immunotherapy. One patient achieved a complete response (5.9%), 7 patients had a partial response (41.2%), 5 patients had stable disease (29.4%), and 4 patients had progressive disease (23.5%). The overall disease control rate and the overall response rate were 76.5% and 47.1%, respectively. The median progression-free survival was 8.1 months, and the median overall survival was not reached. The incidence of grade 3 adverse events was 30%. No unexpected side effects or treatment-related death were observed. CONCLUSION Anlotinib, as a combination treatment, has a promising antitumor activity and a manageable safety profile in patients with RM-NPC. Our results add to the growing evidence that supports the benefits of combining antiangiogenic drugs in RM-NPC. Randomized controlled clinical trials investigating the evaluation of anlotinib are warranted.
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Affiliation(s)
- Rui Zhou
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China
| | - Ping Zhou
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China
| | - Yi-Feng Yu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China
| | - Qin Lin
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, People's Republic of China
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4
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Liang R. Precision drugs for recurrent or metastatic nasopharyngeal carcinoma (Review). Exp Ther Med 2023; 26:585. [PMID: 38023360 PMCID: PMC10665982 DOI: 10.3892/etm.2023.12284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/22/2023] [Indexed: 12/01/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a malignancy that is common in Southern China, South-East Asia and North Africa. Platinum-based chemotherapy is currently the main treatment option for the first-line therapy of recurrent and/or metastatic NPC (RM-NPC). However, the outcome of patients with advanced disease remains poor after treatment with standard chemotherapy, as patients eventually became resistant to chemotherapy. Other strategies, such as targeted therapy and immunotherapy, offer alternative options for patients due to their reported efficacy and manageable toxicities. This suggests that these modalities, either as monotherapy or in combination with chemotherapy, may serve as viable treatment options for RM-NPC. The present review provides a comprehensive summary of the clinical data of targeted therapy and immunotherapy for RM-NPC, with the aim of broadening the understanding of RM-NPC management.
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Affiliation(s)
- Renba Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518116, P.R. China
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5
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Fang Y, Su N, Zou Q, Cao Y, Xia Y, Tang L, Tian X, Liu P, Cai Q. Anlotinib as a third-line or further treatment for recurrent or metastatic nasopharyngeal carcinoma: a single-arm, phase 2 clinical trial. BMC Med 2023; 21:423. [PMID: 37936166 PMCID: PMC10631002 DOI: 10.1186/s12916-023-03140-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Treatment options beyond the first-line setting for recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) are limited. The role of the multitarget tyrosine kinase inhibitor anlotinib in RM-NPC is unclear. METHODS In this prospective, single-arm, phase 2 trial, patients with histologically confirmed RM-NPC and failure of at least two lines of prior systemic treatments were eligible. Anlotinib was given at 12 mg once daily on days 1-14 every 3 weeks until disease progression or intolerable toxicities. The primary end point was disease control rate, defined as the percentage of patients achieving complete response, partial response, or stable disease by RECIST criteria. RESULTS From April 2019 to March 2021, 39 patients were enrolled and received a median of 4 cycles (range, 0.5-20) of anlotinib treatment. Partial response and stable disease were observed in 8 and 20 patients, respectively. The disease control rate was 71.8%, and objective response rate was 20.5%. With a median follow-up of 17.2 months, the median progression-free survival was 5.7 months. The 12-month overall survival was 58.3%, and the median overall survival was not reached. The most frequent grade 3/4 treatment-related adverse events were hand-foot syndrome (23.7%), oral mucositis (21.0%), hypertension (7.9%), and triglyceride elevation (7.9%). Hemorrhage, all grade 1 or 2, occurred in 34.2% of the patients. CONCLUSIONS Anlotinib monotherapy exhibited promising anti-tumor activities and disease control for heavily pretreated RM-NPC patients with a tolerable toxicity profile. TRIAL REGISTRATION ClinicalTrials.gov: NCT03906058.
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Affiliation(s)
- Yu Fang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
| | - Ning Su
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, 510095, People's Republic of China
| | - Qihua Zou
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Yi Cao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Yi Xia
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Linquan Tang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Xiaopeng Tian
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Panpan Liu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Qingqing Cai
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
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Juarez-Vignon Whaley JJ, Afkhami M, Onyshchenko M, Massarelli E, Sampath S, Amini A, Bell D, Villaflor VM. Recurrent/Metastatic Nasopharyngeal Carcinoma Treatment from Present to Future: Where Are We and Where Are We Heading? Curr Treat Options Oncol 2023; 24:1138-1166. [PMID: 37318724 PMCID: PMC10477128 DOI: 10.1007/s11864-023-01101-3] [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] [Accepted: 04/24/2023] [Indexed: 06/16/2023]
Abstract
OPINION STATEMENT Nasopharyngeal carcinoma (NPC) is distinct in its anatomic location and biology from other epithelial head and neck cancer (HNC). There are 3 WHO subtypes, which considers the presence of Epstein-Barr virus (EBV) and other histopathology features. Despite the survival benefit obtained from modern treatment modalities and techniques specifically in the local and locally advanced setting, a number of patients with this disease will recur and subsequently die of distant metastasis, locoregional relapse, or both. In the recurrent setting, the ideal therapy approach continues to be a topic of discussion and current recommendations are platinum-based combination chemotherapy. Phase III clinical trials which led to the approval of pembrolizumab or nivolumab for head and neck squamous cell carcinoma (HNSCC) specifically excluded NPC. No immune checkpoint inhibitor therapy, to date, has been approved by the FDA to treat NPC although the National Comprehensive Cancer Network (NCCN) recommendations do include use of these agents. Hence, this remains the major challenge for treatment options. Nasopharyngeal carcinoma is challenging as it is really 3 different diseases, and much research is required to determine best options and sequencing of those options. This article is going to address the data to date and discuss ongoing research in EBV + and EBV - inoperable recurrent/metastatic NPC patients.
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Affiliation(s)
- Juan Jose Juarez-Vignon Whaley
- Health Science Research Center, Faculty of Health Science, Universidad Anahuac Mexico, State of Mexico, Naucalpan de Juárez, Mexico
| | - Michelle Afkhami
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Mykola Onyshchenko
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, 1500 East Duarte Road. , Duarte, CA, 91010, USA
| | - Erminia Massarelli
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, 1500 East Duarte Road. , Duarte, CA, 91010, USA
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center Duarte, Duarte, CA, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center Duarte, Duarte, CA, USA
| | - Diana Bell
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Victoria M Villaflor
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, 1500 East Duarte Road. , Duarte, CA, 91010, USA.
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7
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Lu N, Jiang YF, Xia WX, Huang Y, Xie CM, Xu C, Ye YF, Liu GY, Bei WX, Ke LR, Li WZ, Zhang C, Wang X, Liu Q, Chen X, Chen ZX, Xie C, Liang H, Xiang YQ. Efficacy and safety of sintilimab plus bevacizumab in metastatic nasopharyngeal carcinoma after failure of platinum-based chemotherapy: an open-label phase 2 study. EClinicalMedicine 2023; 62:102136. [PMID: 37593221 PMCID: PMC10430191 DOI: 10.1016/j.eclinm.2023.102136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023] Open
Abstract
Background There are limited treatment options for patients with metastatic nasopharyngeal carcinoma (mNPC) after failure of platinum-based chemotherapy. In this trial, we assessed the efficacy and safety of sintilimab plus bevacizumab in patients with mNPC where platinum-based chemotherapy has been ineffective. Methods This was a single-centre, open-label, single-arm, phase 2 trial in Guangzhou, China for patients with mNPC progressed after at least one line of systemic therapy. Eligible patients were between 18 and 75 years old, were histologically confirmed differentiated or undifferentiated non-keratinized NPC, were ineffective after platinum-based chemotherapy, and they had at least one measurable metastatic lesion assessed with Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST V.1.1) by investigators and unsuitable for local surgery or radiotherapy. Key exclusion criterion was previous treatment with anti-PD-1/PD-L1 antibodies plus anti-VEGF antibodies and high risk of hemorrhage or nasopharyngeal necrosis. Patients were enrolled and received sintilimab (200 mg) plus bevacizumab (7.5 mg/kg) intravenously every 3 weeks. Intention-to-treat population was included in primary endpoint analyses and safety analyses. The primary endpoint was objective response rate (ORR) assessed by investigators following the guidelines of RECIST V1.1. Key secondary endpoints were progression-free survival (PFS), overall survival (OS), duration of response (DOR), and safety. This trial is registered with ClinicalTrials.gov (NCT04872582). Findings Between July 29, 2021 and August 16, 2022, 33 patients were enrolled. Median age was 46 years (range, 18-64 years), and 63.6% of patients had previously received two or more lines of chemotherapy for metastatic disease. Median follow-up was 7.6 months (range, 4.1-17.5 months). ORR was 54.5% (95% CI, 36.4-71.9%) with 3 complete responses (9.1%) and 15 partial responses (45.5%). Median PFS was 6.8 months (95% CI, 5.2 months to not estimable). Median DOR was 7.2 months (95% CI, 4.4 months to not estimable). Median OS was not reached. The most common potential immune-related adverse event (AE) was Grade 1-2 hypothyroidism (42.4%). Treatment-related grade 3 or 4 AEs occurred in 7 patients (21.2%), including nasal necrosis (3/33), hypertension (1/33), pruritus (1/33), total bilirubin increased (1/33) and anaphylactic shock (1/33). No treatment-related deaths and severe epistaxis occurred. Interpretation This phase 2 trial showed that sintilimab plus bevacizumab demonstrated promising antitumour activity and manageable toxicities in patients with mNPC after failure of platinum-based chemotherapy. Further trials are warranted, and the detailed mechanisms need to be elucidated. Funding The Guangdong Basic and Applied Basic Research Foundation, the National Natural Science Foundation of China, the Natural Science Foundation of Guangdong Province, and the Science and Technology Planning Project of International Cooperation of Guangdong Province.
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Affiliation(s)
- Nian Lu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yao-Fei Jiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wei-Xiong Xia
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ying Huang
- Department of Radiotherapy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chuan-Miao Xie
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Cheng Xu
- Department of Radiotherapy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yan-Fang Ye
- Clinical Research Design Division, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guo-Ying Liu
- Department of Radiotherapy, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei-Xin Bei
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Liang-Ru Ke
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wang-Zhong Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Cheng Zhang
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xin Wang
- Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, United States
| | - Qin Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xi Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Zi-Xiong Chen
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Changqing Xie
- Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, United States
| | - Hu Liang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yan-Qun Xiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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8
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Ding X, Hua YJ, Zou X, Chen XZ, Zhang XM, Xu B, Ouyang YF, Tu ZW, Li HF, Duan CY, Zhang WJ, You R, Liu YP, Liu YL, Yang Q, Huang PY, Wang SN, Fan J, Chen MY. Camrelizumab plus famitinib in patients with recurrent or metastatic nasopharyngeal carcinoma treated with PD-1 blockade: data from a multicohort phase 2 study. EClinicalMedicine 2023; 61:102043. [PMID: 37415845 PMCID: PMC10319986 DOI: 10.1016/j.eclinm.2023.102043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023] Open
Abstract
Background Treatment options for patients with recurrent/metastatic nasopharyngeal carcinoma (RM-NPC) are not clear after progression on previous treatment with PD-(L)1 inhibitor; critical gaps in evidence remain for such cases. Immunotherapy combined with antiangiogenic therapy has been reported to have synergistic antitumor activity. Therefore, we evaluated the efficacy and safety of camrelizumab plus famitinib in patients with RM-NPC who failed treatment with PD-1 inhibitor-containing regimens. Methods This multicenter, adaptive Simon minimax two-stage, phase II study enrolled patients with RM-NPC refractory to at least one line of systemic platinum-containing chemotherapy and anti-PD-(L)1 immunotherapy. The patient received camrelizumab 200 mg every 3 weeks and famitinib 20 mg once per day. The primary endpoint was objective response rate (ORR), and the study could be stopped early as criterion for efficacy was met (>5 responses). Key secondary endpoints included time to response (TTR), disease control rate (DCR), progression-free survival (PFS), duration of response (DoR), overall survival (OS), and safety. This trial was registered with ClinicalTrials.gov, NCT04346381. Findings Between October 12, 2020, and December 6, 2021, a total of 18 patients were enrolled since six responses were observed. The ORR was 33.3% (90% CI, 15.6-55.4) and the DCR was 77.8% (90% CI, 56.1-92.0). The median TTR was 2.1 months, the median DoR was 4.2 months (90% CI, 3.0-not reach), and the median PFS was 7.2 months (90% CI, 4.4-13.3), with a median follow-up duration of 16.7 months. Treatment-related adverse events (TRAEs) of grade ≥3 were reported in eight (44.4%) patients, with the most common being decreased platelet count and/or neutropenia (n = 4, 22.2%). Treatment-related serious AEs occurred in six (33.3%) patients, and no deaths occurred due to TRAEs. Four patients developed grade ≥3 nasopharyngeal necrosis; two of them developed grade 3-4 major epistaxis, and they were cured by nasal packing and vascular embolization. Interpretation Camrelizumab plus famitinib exhibited encouraging efficacy and tolerable safety profiles in patients with RM-NPC who failed frontline immunotherapy. Further studies are needed to confirm and expand these findings. Funding Jiangsu Hengrui Pharmaceutical Co., Ltd.
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Affiliation(s)
- Xi Ding
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yi-Jun Hua
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiong Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Xiao-Zhong Chen
- Department of Head and Neck Tumor Radiotherapy, Cancer Hospital of the University of Chinese Academy of Sciences Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Xi-Mei Zhang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Bei Xu
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yan-Feng Ouyang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Zi-Wei Tu
- Department of Radiotherapy, Jiangxi Cancer Hospital, Nanchang 330029, China
| | - Hui-Feng Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Wei-Jing Zhang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - You-Ping Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Yong-Long Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Qi Yang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Pei-Yu Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shu-Ni Wang
- Clinical Research & Development, Jiangsu Hengrui Medicine Co., Ltd, Shenyang 110016, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
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9
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Ding X, Zhang WJ, You R, Zou X, Wang ZQ, Ouyang YF, Peng L, Liu YP, Duan CY, Yang Q, Lin C, Xie YL, Chen SY, Liu YL, Gu CM, Xie RQ, Huang PY, Hong MH, Hua YJ, Chen MY. Camrelizumab Plus Apatinib in Patients With Recurrent or Metastatic Nasopharyngeal Carcinoma: An Open-Label, Single-Arm, Phase II Study. J Clin Oncol 2023; 41:2571-2582. [PMID: 36735896 PMCID: PMC10414735 DOI: 10.1200/jco.22.01450] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/13/2022] [Accepted: 12/09/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Immune checkpoint inhibitors combined with antiangiogenic therapy reportedly have potential synergistic antitumor activity. We investigated the activity and safety of this regimen for recurrent/metastatic nasopharyngeal carcinoma (NPC). METHODS This single-arm, Simon two-stage study enrolled patients with recurrent/metastatic NPC who were refractory to at least first-line systemic therapy and treatment-naive to immune checkpoint inhibitors. The patients received camrelizumab 200 mg once every 3 weeks and apatinib 250 mg once per day. The primary end point was the objective response rate. Key secondary end points included disease control rate, progression-free survival, duration of response, overall survival, and safety. RESULTS Between October 14, 2020, and December 23, 2021, 58 patients were enrolled, and all were included in the efficacy and safety analysis set. The objective response rate was 65.5% (95% CI, 51.9 to 77.5), and the disease control rate was 86.2% (95% CI, 74.6 to 93.9). The median duration of response was not reached, and the median progression-free survival was 10.4 months (95% CI, 7.2 to 13.6), with a median follow-up duration of 12.4 months (range, 2.1-19.9 months). Treatment-related adverse events (TRAEs) of grade 3 or higher were reported in 34 (58.6%) patients, with the most common being hypertension (19.0%), nasopharyngeal necrosis (15.5%), headache (12.1%), AST elevation (10.3%), and creatine phosphokinase elevation (10.3%). Sixteen (27.6%) patients discontinued apatinib treatment before progression because of unbearable TRAEs, and the most common complication was nasopharyngeal necrosis (9/16; 56.3%). Recurrent nasopharyngeal lesions (odds ratio, 5.94 [95% CI, 1.45 to 24.24]) and reirradiation (odds ratio, 5.33 [95% CI, 1.15 to 24.79]) were significantly positively correlated with nasopharyngeal necrosis. CONCLUSION Camrelizumab plus apatinib had promising antitumor activity in patients with refractory recurrent/metastatic NPC who failed first-line therapy. Moderate to severe TRAEs were experienced by 58.6%, including nasopharyngeal necrosis associated with local recurrence and a history of reirradiation.
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Affiliation(s)
- Xi Ding
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Wei-Jing Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Xiong Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Zhi-Qiang Wang
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, P.R. China
| | - Yan-Feng Ouyang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Lan Peng
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - You-Ping Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, P.R. China
| | - Qi Yang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Chao Lin
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Yu-Long Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Si-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Yong-Long Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Chen-Mei Gu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Ruo-Qi Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Pei-Yu Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Ming-Huang Hong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
- Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yi-Jun Hua
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, P.R. China
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10
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Tang LQ, Li XY, Li ZM, Liu ZG, Lin MZ, Zhou H, Yu QW, Zhou J, Zhao C, Chen ZB, Wang XC, Peng JY, Chen QY, Fang WF, Yang YP, Zhang B, Xia LP, Hu PL, Hu WH, Li YJ, Mai HQ, Cai XY. The efficacy and safety of apatinib plus capecitabine in platinum-refractory metastatic and/or recurrent nasopharyngeal carcinoma: a prospective, phase II trial. BMC Med 2023; 21:94. [PMID: 36927541 PMCID: PMC10022300 DOI: 10.1186/s12916-023-02790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Previous studies have shown that monotherapy with apatinib, an oral tyrosine kinase inhibitor, has promising efficacy for treating recurrent or metastatic (RM) nasopharyngeal carcinoma (NPC) patients. In this study, we aimed to assess the efficacy and safety of apatinib combined with capecitabine as a second-line therapy or beyond for treating RM-NPC patients who failed the first-line platinum-based chemotherapy. METHODS In this single-arm, phase II study, we enrolled RM-NPC patients who had at least one measurable lesion according to the Response Evaluation Criteria in Solid Tumors (RECIST v1.1). The sample size was determined using Simon's two-stage design. All patients were administered with apatinib 500 mg once daily and capecitabine 1000 mg/m2 twice per day on days 1-14 of each 21-day cycle. The primary endpoint was the objective response rate (ORR), and the secondary endpoints comprised disease control rate (DCR), duration of response (DoR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS We enrolled 64 patients from September 2018 to August 2020. The ORR and DCR were 39.1% (95% CI, 27.1-52.1) and 85.9% (95% CI, 75.0-93.4), respectively. The median DoR was 14.4 months (95% CI, 7.8-21.0). As of April 20, 2021, the median follow-up duration was 12.0 months. The median PFS was 7.5 months (95% CI, 5.0-10.0) and the median OS was 15.7 months (95% CI, 11.3-20.1). The most common toxicities of any grade were anemia (75.0%), hand-foot syndrome (65.6%), and proteinuria (64.0%). Grade 3-4 toxicities were observed in 36 (56.3%) patients, with hypertension (14.1%), mucositis (12.4%), and fatigue (10.9%) most commonly observed. CONCLUSIONS Apatinib plus capecitabine shows promising efficacy as a second-line treatment option in pretreated platinum-refractory RM-NPC patients. Dose selection of this combination needs further investigation considering the toxicity. TRIAL REGISTRATION Chi-CTR1800017229.
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Affiliation(s)
- Lin-Quan Tang
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xiao-Yun Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zhi-Ming Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zhi-Gang Liu
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, People's Republic of China
| | - Miao-Zhen Lin
- Department of VIP Inpatient, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Huan Zhou
- Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Qi-Wen Yu
- Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jian Zhou
- Department of Medical Imaging, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Chong Zhao
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Ze-Bin Chen
- Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xi-Cheng Wang
- Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jia-Yu Peng
- Department of Oncology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Qiu-Yan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Wen-Feng Fang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yun-Peng Yang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Bei Zhang
- Department of VIP Inpatient, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Liang-Ping Xia
- Department of VIP Inpatient, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Pi-Li Hu
- Department of VIP Inpatient, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Wei-Han Hu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yi-Jie Li
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, People's Republic of China
| | - Hai-Qiang Mai
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xiu-Yu Cai
- Department of VIP Inpatient, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, 510060, Guangdong, People's Republic of China.
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11
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Xue S, Song G, Zhu Y, Zhang N, Tan Y. The efficacy and safety of VEGF/VEGFR inhibitors in patients with recurrent or metastatic nasopharyngeal carcinoma: A meta-analysis. Oral Oncol 2022; 135:106231. [PMID: 36327674 DOI: 10.1016/j.oraloncology.2022.106231] [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: 08/29/2022] [Revised: 10/20/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Molecular targeted therapies against vascular endothelial growth factor (VEGF) receptor (VEGFR) have been explored in the treatment of recurrent or metastatic nasopharyngeal carcinoma (rmNPC). We conducted a meta-analysis to evaluate the efficacy and safety of VEGF/VEGFR inhibitors for treating rmNPC. MATERIALS AND METHODS Electronic databases were searched for eligible literature. Data on the objective response rate (ORR), disease control rate (DCR), median progression-free survival (mPFS), median overall survival (mOS), PFS rate, OS rate, and drug-related adverse events (AEs) were extracted. RESULTS A total of 10 studies (published in 9 articles) that involved 357 patients were included. The pooled ORR was 37 % (95 % confidence interval [CI]: 17-60 %), the DCR was 70 % (95 % CI: 51-85 %), the mPFS was 5.69 months (95 % CI: 4.52-6.86), the mOS was 12.61 months (95 % CI: 10.23-14.99), the 1-year PFS rate was 34 % (95 % CI: 25-44 %), and the 1-year OS rate was 62 % (95 % CI: 38-83 %). The pooled incidence of grade 3/4 drug-related AEs was 27 %, while that of grade 5 AEs was 0.22 %. Further subgroup analysis showed that the pooled ORR and DCR for first-line VEGF inhibitors were 80 % (95 % CI: 74-86 %) and 94 % (CI: 82-100 %), respectively. CONCLUSION Our meta-analysis is the first report to demonstrate the efficacy and safety of VEGF/VEGFR inhibitors in patients with rmNPC. Targeting VEGF/VEGFR therapy added to first-line chemotherapy achieved an excellent ORR and DCR, while the improvement in response rates did not translate to a prominent OS benefit.
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Affiliation(s)
- Song Xue
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Ge Song
- Department of Oncology, Shandong Provincial Maternal and Child Health Care Hospital, Jinan 250014, China
| | - Yingming Zhu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Nianping Zhang
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan 250355, China
| | - Ying Tan
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan 250355, China.
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12
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Scarini JF, Lavareze L, Lima-Souza RAD, Emerick C, Gonçalves MT, Figueiredo-Maciel T, Vieira GDS, Kimura TDC, de Sá RS, Aquino IG, Fernandes PM, Kowalski LP, Altemani A, Mariano FV, Egal ESA. Head and neck squamous cell carcinoma: Exploring frontiers of combinatorial approaches with tyrosine kinase inhibitors and immune checkpoint therapy. Crit Rev Oncol Hematol 2022; 180:103863. [DOI: 10.1016/j.critrevonc.2022.103863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/20/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
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13
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You R, Zou X, Ding X, Zhang WJ, Zhang MX, Wang X, Xu HS, Liu YL, Ouyang YF, Duan CY, Gu CM, Wang ZQ, Liu YP, Hua YJ, Huang PY, Chen MY. Gemcitabine combined with apatinib and toripalimab in recurrent or metastatic nasopharyngeal carcinoma. MED 2022; 3:664-681.e6. [PMID: 36041429 DOI: 10.1016/j.medj.2022.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/07/2022] [Accepted: 07/27/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of a triple combination of gemcitabine (chemotherapy) plus apatinib (anti-vascular endothelial growth factor [VEGFR]) and toripalimab (anti-PD-1) (GAT) in recurrent/metastatic nasopharyngeal carcinoma (RM-NPC) is unclear. METHODS Between August 2019 and April 2020, 41 patients with RM-NPC were enrolled and received GAT for up to 6 cycles followed by apatinib and toripalimab. The primary endpoint was the safety. The secondary endpoints included the objective response rate (ORR) and progression-free survival (PFS). Integrated genomic and transcriptional analyses were conducted to identify the patients who benefited in response to this novel combination therapy. FINDINGS As of April 1, 2022, treatment-related grade 3 or 4 adverse events (AEs) occurred in 23 of 41 patients (56.1%, 95% confidence interval [CI] 41%-70.1%). G3-4 nasopharyngeal necrosis was observed in 9 (9/41, 21.9%) patients. High-risk factors for necrosis included repeated radiotherapy and an interval of less than 12 months from the last radiotherapy. The ORR was 90.2% (95% CI: 76.9%-97.2%). The median PFS was 25.8 months (95% CI: not reached (NR)-NR), and the 24-month PFS rate was 50.7% (95% CI: 34.0%-67.4%). MAS-related GPR family member F (MRGPRF) high expression in tumors correlated with poor PFS from the GAT therapy, characterized by high epithelial mesenchymal transition signatures. Serial circulating tumor DNA (ctDNA) sequencing could predict PFS outcomes to combination therapy. CONCLUSIONS GAT therapy exhibits a promising antitumor activity and manageable toxicities in patients with RM-NPC. Patients with repeated radiotherapy and an interval of less than 12 months from the last radiotherapy should be carefully selected for antiangiogenic therapies. MRGPRF expression and serial ctDNA monitoring could identify patients that derive benefits from the combination therapy. TRIAL REGISTRATION ClinicalTrials.gov: NCT04073784. FUNDING This research was funded by the National Natural Science Foundation of China (nos. 81772895 and 82002857), the Key-Area Research and Development of Guangdong Province (2020B1111190001), the Special Support Program for High-level Talents in Sun Yat-sen University Cancer Center, the Guangzhou Science and Technology Plan Project (202103010001), and the National "Ten Thousand Talents Program" Science and Technology Innovation Leading Talents (84000-41180005).
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Affiliation(s)
- Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Xiong Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Xi Ding
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Wei-Jing Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China; Department of Medical Imaging, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China
| | - Meng-Xia Zhang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Xiao Wang
- Novogene Co, Ltd, Beijing 100000, P.R. China
| | - Han-Shi Xu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Yong-Long Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Yan-Feng Ouyang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou 510515, P.R. China
| | - Chen-Mei Gu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Zhi-Qiang Wang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - You-Ping Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Yi-Jun Hua
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Pei Yu Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, P.R. China; Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, P.R. China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, P.R. China.
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14
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Xu JY, Wei XL, Wang YQ, Wang FH. Current status and advances of immunotherapy in nasopharyngeal carcinoma. Ther Adv Med Oncol 2022; 14:17588359221096214. [PMID: 35547095 PMCID: PMC9083041 DOI: 10.1177/17588359221096214] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/04/2022] [Indexed: 12/24/2022] Open
Abstract
The general immune landscape of nasopharyngeal carcinoma (NPC) renders immunotherapy suitable for patients with NPC. Immune checkpoint inhibitors (ICIs) based on programmed death-1/programmed death ligand-1 (PD-1/PD-L1) blockade have made a breakthrough with the approval of PD-1 inhibitor for refractory recurrence and/or metastatic (R/M NPC) and the approval of PD-1 inhibitor in combination with gemcitabine and cisplatin as first line for R/M NPC in 2021 in China. The incorporation of ICIs into the treatment paradigms of NPC has become a clinical hot spot and many prospective clinical studies are ongoing. In this review, we provide a comprehensive overview of the rationale for immunotherapy in NPC and current status, advances and challenges of immunotherapy in NPC based on published clinical data, and ongoing trials. We focus on the clinical application and advances of PD-1 inhibitor monotherapy and its combination with chemotherapy and summarize the clinical explorations of other immunotherapy approaches, for example, combination of PD-1/PD-L1 inhibitors with antiangiogenic inhibitor with molecular targeted agents, cancer vaccines, adaptive immunotherapy, and new ICI agents beyond PD-1/PD-L1 inhibitors in R/M NPC. We also describe the clinical studies’ status and challenges of ICIs-based immunomodulatory strategies in local advanced NPC and pay attention to the biomarker application for personalized immunotherapy of NPC in the hope to provide insights for clinical practice and future clinical studies.
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Affiliation(s)
- Jian-Ying Xu
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Xiao-Li Wei
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yi-Qin Wang
- Department of Clinical Medicine, Sun Yat-sen University, Guangzhou, P.R. China
| | - Feng-Hua Wang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, 651 Dong Feng Road East, Guangzhou 510060, Guangdong, P.R. China
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15
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Liu X, Guo L, Xie FY, Hu WH, Chen MY, He QM, Xu ZM, Zhang CQ, Peng YL, Tang LL, Mao YP, Sun R, Li JB, Argiris A, Hui EP, Sun Y, Ma J. Necrosis in a Biomarker-driven, Phase 2 Trial of Adjuvant Apatinib in Patients of Nasopharyngeal Carcinoma with Residual Epstein–Barr Virus DNA after Radiotherapy. Int J Radiat Oncol Biol Phys 2022; 113:1063-1071. [DOI: 10.1016/j.ijrobp.2022.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/20/2022] [Accepted: 04/30/2022] [Indexed: 12/09/2022]
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16
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Su ZY, Siak PY, Leong CO, Cheah SC. Nasopharyngeal Carcinoma and Its Microenvironment: Past, Current, and Future Perspectives. Front Oncol 2022; 12:840467. [PMID: 35311066 PMCID: PMC8924466 DOI: 10.3389/fonc.2022.840467] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/11/2022] [Indexed: 12/31/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is an epithelial malignancy that raises public health concerns in endemic countries. Despite breakthroughs in therapeutic strategies, late diagnosis and drug resistance often lead to unsatisfactory clinical outcomes in NPC patients. The tumor microenvironment (TME) is a complex niche consisting of tumor-associated cells, such as fibroblasts, endothelial cells, leukocytes, that influences tumor initiation, progression, invasion, and metastasis. Cells in the TME communicate through various mechanisms, of note, exosomes, ligand-receptor interactions, cytokines and chemokines are active players in the construction of TME, characterized by an abundance of immune infiltrates with suppressed immune activities. The NPC microenvironment serves as a target-rich niche for the discovery of potential promising predictive or diagnostic biomarkers and the development of therapeutic strategies. Thus, huge efforts have been made to exploit the role of the NPC microenvironment. The whole picture of the NPC microenvironment remains to be portrayed to understand the mechanisms underlying tumor biology and implement research into clinical practice. The current review discusses the recent insights into the role of TME in the development and progression of NPC which results in different clinical outcomes of patients. Clinical interventions with the use of TME components as potential biomarkers or therapeutic targets, their challenges, and future perspectives will be introduced. This review anticipates to provide insights to the researchers for future preclinical, translational and clinical research on the NPC microenvironment.
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Affiliation(s)
- Zhi Yi Su
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Pui Yan Siak
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Chee-Onn Leong
- Centre of Cancer and Stem Cells Research, International Medical University, Kuala Lumpur, Malaysia.,Institute for Research, Development and Innovation, International Medical University, Kuala Lumpur, Malaysia
| | - Shiau-Chuen Cheah
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
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17
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Zhang Y, Luo F, Ma YX, Liu QW, Yang YP, Fang WF, Huang Y, Zhou T, Li J, Pan HM, Yang L, Qin SK, Zhao HY, Zhang L. OUP accepted manuscript. Oncologist 2022; 27:e453-e462. [PMID: 35445718 PMCID: PMC9177108 DOI: 10.1093/oncolo/oyab076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/30/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yang Zhang
- Department of Clinical Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Fan Luo
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Yu-Xiang Ma
- Department of Clinical Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Qian-Wen Liu
- Department of Clinical Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Yun-Peng Yang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Wen-Feng Fang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Yan Huang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Ting Zhou
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Jin Li
- Department of Medical Oncology, Tongji University Shanghai East Hospital, Shanghai, People’s Republic of China
| | - Hong-Ming Pan
- Department of Internal Medical Oncology, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Lei Yang
- Haihe Biopharma Co., Ltd, Shanghai, People’s Republic of China
| | - Shu-Kui Qin
- Shu-Kui Qin, PLA Cancer Center of Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China;
| | - Hong-Yun Zhao
- Hong-Yun Zhao, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, People’s Republic of China;
| | - Li Zhang
- Corresponding authors: Li Zhang, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong Province, People’s Republic of China;
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18
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Liu Z, Chen Y, Su Y, Hu X, Peng X. Nasopharyngeal Carcinoma: Clinical Achievements and Considerations Among Treatment Options. Front Oncol 2021; 11:635737. [PMID: 34912697 PMCID: PMC8667550 DOI: 10.3389/fonc.2021.635737] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a severe malignancy arising from the nasopharyngeal epithelium and is southern China's third most common cancer. With the advancement of treatment methods, early-stage NPC patients usually have a better prognosis and more prolonged survival period than those with other malignant tumors. Most treatment failures are due to distant metastasis or a locally advanced stage of NPC in the initial diagnosis. In addition, approximately 10% of patients develop local recurrence, and 10%-20% of patients experience distant metastasis after treatment. These patients have a poor prognosis, with a median survival of only approximately 10-15 months. In the rapid development of treatment options, the efficacy and safety of some treatments have been validated and approved for first-line treatment, while those of other treatments remain unclear. The present study aims to provide a comprehensive overview of recent advances in NPC treatment and explain the various therapeutic possibilities in treating locally advanced, recurrent, and metastatic NPC patients.
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Affiliation(s)
- Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Chen
- Department of Medical Oncology, Cancer Center, the State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yonglin Su
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Rehabilitation, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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19
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Zhou T, Yang Y, Ma S, Lin L, Zhou T, Zhang C, Ding X, Wang R, Feng G, Chen Y, Xu R, Huang Y, Zhang L. Bevacizumab versus placebo in combination with paclitaxel and carboplatin as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma: a multicentre, randomised, open-label, phase II trial. ESMO Open 2021; 6:100313. [PMID: 34837744 PMCID: PMC8637468 DOI: 10.1016/j.esmoop.2021.100313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The value of anti-angiogenesis antibody therapy in recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) remains unknown. We carried out a phase II study to evaluate the addition of bevacizumab to paclitaxel plus carboplatin in R/M NPC. MATERIALS AND METHODS A total of 80 patients with previously untreated R/M NPC were randomly assigned (1 : 1) to CPB or CP groups to receive carboplatin (area under the curve 6) and paclitaxel (175 mg/m2) intravenously every 3 weeks for a maximum of six cycles in combination with or without bevacizumab (7.5 mg/kg), respectively. The primary endpoint was progression-free survival (PFS) as per investigators, and the secondary endpoints were PFS as per independent review committee (IRC), overall survival (OS), objective response rate (ORR), and safety. This study was registered with ClinicalTrials.gov (NCT02250599). RESULTS The median PFS as per investigators was 7.5 months [95% confidence interval (CI), 6.53-8.45 months] in the CPB group and 6.5 months (95% CI, 5.53-7.52 months) in the CP group (P = 0.148), which were similar to IRC-assessed PFS. The median OS was also alike between CPB and CP arms (21.0 versus 24.7 months; P = 0.326). ORRs were 87.2% and 72.5%, respectively (P = 0.105). However, the tumor-shrinking rate was higher in the CPB arm than in the CP arm (P = 0.035). No differences in grade 3 or higher adverse events between the groups were observed. CONCLUSIONS Addition of bevacizumab to paclitaxel plus carboplatin as first-line treatment did not prolong PFS and OS in patients with R/M NPC but improved tumor-shrinking rate. These results indicated that bevacizumab plus chemotherapy might be an optional choice for NPC with heavy tumor load or those pursuing short-term efficacy in neoadjuvant and concurrent chemotherapy.
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Affiliation(s)
- T Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Y Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - S Ma
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - L Lin
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - T Zhou
- Department of Radiotherapy, Cancer Center of Guangzhou Medical University, Guangzhou, China
| | - C Zhang
- Department of Radiotherapy, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - X Ding
- Department of Medical Oncology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, Guangdong, China
| | - R Wang
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - G Feng
- Department of Medical Oncology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Y Chen
- Department of Medical Oncology, Hainan General Hospital, Hainan, China
| | - R Xu
- Department of Medical Oncology, Shenzhen People's Hospital, Shenzhen, China
| | - Y Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - L Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Guangzhou, China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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20
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Zhu QY, Zhao GX, Li Y, Talakatta G, Mai HQ, Le QT, Young LS, Zeng MS. Advances in pathogenesis and precision medicine for nasopharyngeal carcinoma. MedComm (Beijing) 2021; 2:175-206. [PMID: 34766141 PMCID: PMC8491203 DOI: 10.1002/mco2.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a squamous carcinoma with apparent geographical and racial distribution, mostly prevalent in East and Southeast Asia, particularly concentrated in southern China. The epidemiological trend over the past decades has suggested a substantial reduction in the incidence rate and mortality rate due to NPC. These results may reflect changes in lifestyle and environment, and more importantly, a deeper comprehension of the pathogenic mechanism of NPC, leading to much progress in the preventing, screening, and treating for this cancer. Herein, we present the recent advances on the key signal pathways involved in pathogenesis of NPC, the mechanism of Epstein‐Barr virus (EBV) entry into the cell, and the progress of EBV vaccine and screening biomarkers. We will also discuss in depth the development of various therapeutic approaches including radiotherapy, chemotherapy, surgery, targeted therapy, and immunotherapy. These research advancements have led to a new era of precision medicine in NPC.
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Affiliation(s)
- Qian-Ying Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Sun Yat-sen University Cancer Center (SYSUCC) Guangzhou China
| | - Ge-Xin Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Sun Yat-sen University Cancer Center (SYSUCC) Guangzhou China
| | - Yan Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Sun Yat-sen University Cancer Center (SYSUCC) Guangzhou China
| | - Girish Talakatta
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Sun Yat-sen University Cancer Center (SYSUCC) Guangzhou China
| | - Hai-Qiang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Sun Yat-sen University Cancer Center (SYSUCC) Guangzhou China
| | - Quynh-Thu Le
- Department of Radiation Oncology Stanford California
| | - Lawrence S Young
- Warwick Medical School University of Warwick Coventry United Kingdom
| | - Mu-Sheng Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy Sun Yat-sen University Cancer Center (SYSUCC) Guangzhou China
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21
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Wong KCW, Hui EP, Lo KW, Lam WKJ, Johnson D, Li L, Tao Q, Chan KCA, To KF, King AD, Ma BBY, Chan ATC. Nasopharyngeal carcinoma: an evolving paradigm. Nat Rev Clin Oncol 2021; 18:679-695. [PMID: 34194007 DOI: 10.1038/s41571-021-00524-x] [Citation(s) in RCA: 182] [Impact Index Per Article: 60.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
The past three decades have borne witness to many advances in the understanding of the molecular biology and treatment of nasopharyngeal carcinoma (NPC), an Epstein-Barr virus (EBV)-associated cancer endemic to southern China, southeast Asia and north Africa. In this Review, we provide a comprehensive, interdisciplinary overview of key research findings regarding NPC pathogenesis, treatment, screening and biomarker development. We describe how technological advances have led to the advent of proton therapy and other contemporary radiotherapy approaches, and emphasize the relentless efforts to identify the optimal sequencing of chemotherapy with radiotherapy through decades of clinical trials. Basic research into the pathogenic role of EBV and the genomic, epigenomic and immune landscape of NPC has laid the foundations of translational research. The latter, in turn, has led to the development of new biomarkers and therapeutic targets and of improved approaches for individualizing immunotherapy and targeted therapies for patients with NPC. We provide historical context to illustrate the effect of these advances on treatment outcomes at present. We describe current preclinical and clinical challenges and controversies in the hope of providing insights for future investigation.
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Affiliation(s)
- Kenneth C W Wong
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Edwin P Hui
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kwok-Wai Lo
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Wai Kei Jacky Lam
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - David Johnson
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Lili Li
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Qian Tao
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Kwan Chee Allen Chan
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ka-Fai To
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ann D King
- Department of Diagnostic Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Brigette B Y Ma
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.
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22
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Yi C, Lai SL, Tsang CM, Artemenko M, Shuen Tang MK, Pang SW, Lo KW, Tsao SW, Wong AST. A three-dimensional spheroid-specific role for Wnt-β-catenin and Eph-ephrin signaling in nasopharyngeal carcinoma cells. J Cell Sci 2021; 134:271163. [PMID: 34338780 DOI: 10.1242/jcs.256461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/20/2021] [Indexed: 12/11/2022] Open
Abstract
One of the greatest unmet needs hindering the successful treatment of nasopharyngeal carcinomas (NPCs) is for representative physiological and cost-effective models. Although Epstein-Barr virus (EBV) infection is consistently present in NPCs, most studies have focused on EBV-negative NPCs. For the first time, we established and analyzed three-dimensional (3D) spheroid models of EBV-positive and EBV-negative NPC cells and compared these to classical two-dimensional (2D) cultures in various aspects of tumor phenotype and drug responses. Compared to 2D monolayers, the 3D spheroids showed significant increases in migration capacity, stemness characteristics, hypoxia and drug resistance. Co-culture with endothelial cells, which mimics essential interactions in the tumor microenvironment, effectively enhanced spheroid dissemination. Furthermore, RNA sequencing revealed significant changes at the transcriptional level in 3D spheroids compared to expression in 2D monolayers. In particular, we identified known (VEGF, AKT and mTOR) and novel (Wnt-β-catenin and Eph-ephrin) cell signaling pathways that are activated in NPC spheroids. Targeting these pathways in 3D spheroids using FDA-approved drugs was effective in monoculture and co-culture. These findings provide the first demonstration of the establishment of EBV-positive and EBV-negative NPC 3D spheroids with features that resemble advanced and metastatic NPCs. Furthermore, we show that NPC spheroids have potential use in identifying new drug targets.
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Affiliation(s)
- Canhui Yi
- School of Biological Sciences, University of Hong Kong, Pokfulam Road, Hong Kong
| | - Sook Ling Lai
- School of Biological Sciences, University of Hong Kong, Pokfulam Road, Hong Kong
| | - Chi Man Tsang
- Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Margarita Artemenko
- School of Biological Sciences, University of Hong Kong, Pokfulam Road, Hong Kong
| | - Maggie Kei Shuen Tang
- School of Biological Sciences, University of Hong Kong, Pokfulam Road, Hong Kong.,Laboratory for Synthetic Chemistry and Chemical Biology Limited, 17W, Hong Kong Science and Technology Parks, New Territories, Hong Kong
| | - Stella W Pang
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong.,Centre for Biosystems, Neuroscience, and Nanotechnology, City University of Hong Kong, Kowloon, Hong Kong
| | - Kwok Wai Lo
- Department of Anatomical and Cellular Pathology and State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sai Wah Tsao
- School of Biomedical Sciences, University of Hong Kong, Sassoon Road, Hong Kong
| | - Alice Sze Tsai Wong
- School of Biological Sciences, University of Hong Kong, Pokfulam Road, Hong Kong
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23
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Hyytiäinen A, Wahbi W, Väyrynen O, Saarilahti K, Karihtala P, Salo T, Al-Samadi A. Angiogenesis Inhibitors for Head and Neck Squamous Cell Carcinoma Treatment: Is There Still Hope? Front Oncol 2021; 11:683570. [PMID: 34195084 PMCID: PMC8236814 DOI: 10.3389/fonc.2021.683570] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/17/2021] [Indexed: 01/27/2023] Open
Abstract
Background Head and neck squamous cell carcinoma (HNSCC) carries poor survival outcomes despite recent progress in cancer treatment in general. Angiogenesis is crucial for tumour survival and progression. Therefore, several agents targeting the pathways that mediate angiogenesis have been developed. We conducted a systematic review to summarise the current clinical trial data examining angiogenesis inhibitors in HNSCC. Methods We carried out a literature search on three angiogenesis inhibitor categories—bevacizumab, tyrosine kinase inhibitors and endostatin—from Ovid MEDLINE, Cochrane Library, Scopus and ClinicalTrials.gov database. Results Here, we analysed 38 clinical trials, total of 1670 patients, investigating 12 angiogenesis inhibitors. All trials were in phase I or II, except one study in phase III on bevacizumab. Angiogenesis inhibitors were used as mono- and combination therapies together with radio-, chemo-, targeted- or immunotherapy. Among 12 angiogenesis inhibitors, bevacizumab was the most studied drug, included in 13 trials. Although bevacizumab appeared effective in various combinations, it associated with high toxicity levels. Endostatin and lenvatinib were well-tolerated and their anticancer effects appeared promising. Conclusions Most studies did not show benefit of angiogenesis inhibitors in HNSCC treatment. Additionally, angiogenesis inhibitors were associated with considerable toxicity. However, some results appear encouraging, suggesting that further investigations of angiogenesis inhibitors, particularly in combination therapies, for HNSCC patients are warranted. Systematic Review Registration PROSPERO (https://www.crd.york.ac.uk/prospero/), identifier CRD42020157144.
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Affiliation(s)
- Aini Hyytiäinen
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland.,Translational Immunology Programme, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Wafa Wahbi
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland.,Translational Immunology Programme, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Otto Väyrynen
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland
| | - Kauko Saarilahti
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Peeter Karihtala
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Centre and University of Helsinki, Helsinki, Finland
| | - Tuula Salo
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland.,Translational Immunology Programme, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Pathology, University of Helsinki, Helsinki, Finland.,Cancer Research and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Oulu Medical Research Centre, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Ahmed Al-Samadi
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland.,Translational Immunology Programme, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Ruan X, Liang JH, Pan Y, Cai R, Zhang RJ, He Z, Yang X, Niu Z, Jiang W. Apatinib for the treatment of metastatic or locoregionally recurrent nasopharyngeal carcinoma after failure of chemotherapy: A multicenter, single-arm, prospective phase 2 study. Cancer 2021; 127:3163-3171. [PMID: 34043812 DOI: 10.1002/cncr.33626] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The authors aimed to investigate the efficacy and safety of apatinib in patients with metastatic or locoregionally recurrent nasopharyngeal carcinoma (NPC). METHODS A multicenter, single-arm, prospective phase 2 study was conducted on patients (18-70 years of age) with metastatic or recurrent NPC who had failed chemotherapy. Patients with recurrent disease involving vascular structure invasion were excluded. All enrolled patients received apatinib (500 mg daily) in continuous 4-week cycles until disease progression or development of unacceptable toxicity. The primary end point of this study was objective response rate (ORR), and the secondary end points were progression-free survival (PFS), overall survival (OS), and toxicity. This study was registered with ClinicalTrials.gov (NCT03130270). RESULTS Between January 2017 and June 2018, 33 patients were enrolled. At the end of the data collection (May 20, 2020), the 33 patients had completed a total of 261.2 cycles of apatinib. Although 12 patients achieved a partial response, no patient achieved a complete response; thus, the ORR in the 33 patients was 36.4% (95% CI, 19.0%-53.7%). At the end of follow-up (median, 30 months; 95% CI, 24.9-35.1), median OS and median PFS were 16 months (95% CI, 14.6-17.4 months) and 5.0 months (95% CI, 3.6-6.4 months), respectively. The most common adverse events (grade 1/2) were hand-foot syndrome (18 [54.5%]), hypertension (14 [42.4%]), oral ulcer (8 [24.2%]), and proteinuria (4 [12.1%]). Two patients (1 with diabetes and 1 with hypertension) developed cerebral infarction. Grade 3/4 toxicities were uncommon. CONCLUSIONS Apatinib shows promising activity, with manageable toxicities, in patients with metastatic or locoregionally recurrent NPC. Further evaluation of apatinib in large-scale studies is warranted. LAY SUMMARY Clinical studies on vascular endothelial growth factor receptor (VEGFR)-targeted therapy for recurrent or metastatic nasopharyngeal carcinoma (NPC) are limited. A recent preclinical study that evaluated apatinib in models of NPC showed a high objective response rate and a favorable safety profile. Our data further confirmed good efficacy in patients with lung metastasis. Further studies of the efficacy and safety of apatinib combined with immune checkpoint inhibitors or chemotherapy in NPC is warranted.
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Affiliation(s)
- Xiaolan Ruan
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jin-Hui Liang
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, China
| | - Yufei Pan
- Department of Radiation Oncology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Rui Cai
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Rong Jun Zhang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Zhuokai He
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Xi Yang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Zhijie Niu
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Wei Jiang
- Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, Guilin, China
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25
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Efficacy and safety of apatinib in recurrent/metastatic nasopharyngeal carcinoma: A pilot study. Oral Oncol 2021; 115:105222. [PMID: 33610004 DOI: 10.1016/j.oraloncology.2021.105222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is no standard-of-care for recurrent, metastatic nasopharyngeal carcinoma (rmNPC) after first-line chemotherapy. Here, we report the efficacy and safety data of apatinib in rmNPC patients. METHODS Thirty-five biopsy-proven rmNPC patients received apatinib at 500 mg/day under a compassionate access programme. Primary end-point was objective response rate (ORR; RECIST v1.1). Kaplan-meier method was used to estimate progression-free survival (PFS) and overall survival (OS). Toxicity was assessed by CTCAE v4.0. RESULTS 82.9% (29 of 35) of patients had poly-metastatic rmNPC. All patients, except five, were platinum-refractory; 37.1% (13 of 35) received ≥ 2 lines. Median number of apatinib cycles was 4.0 (IQR: 2.0-8.0). ORR was 31.4% (11 of 35 [95% CI: 16.9-49.3]) and disease control rate was 74.3% (26 of 35 [95% CI: 56.7-87.5]); 11 (31.4%) and 4 (11.4%) patients demonstrated response for ≥ 6 and ≥ 12 months, respectively. Median PFS and OS was 3.9 (95% CI: 3.1-5.5) months and 5.8 (95% CI: 4.5-8.0) months, respectively. Among the ≥ 12-month responders, all patients had pre-apatinib EBV DNA titer of <700 (range: 353-622) copies/ml; this was consistent with the association of PFS with pre-apatinib EBV DNA titer (adjusted HR 3.364 [95% CI: 1.428-7.923] for ≥ 4000 copies/ml, P = 0.006). 42.9% (15 of 35) of patients required dose reduction. Nonetheless, only five (14.3%) patients suffered from G3 toxicities (two haematological, one hypertension, one hand-foot syndrome and one elevated aminotransferases). CONCLUSION Our data suggests potential efficacy of apatinib in rmNPC patients. Although incidence of severe toxicities was low, dose modification was required in 42.9% of patients.
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26
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Tao CJ, Zhang P, Zhou L, Hu QY, Chen XZ. Apatinib in treating patients with recurrent or metastatic nasopharyngeal carcinoma who had failed prior platinum-based chemotherapy. Transl Cancer Res 2020; 9:6392-6401. [PMID: 35117247 PMCID: PMC8799112 DOI: 10.21037/tcr-20-1773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022]
Abstract
Background Platinum-based chemotherapy is the standard first-line treatment for recurrent/metastatic nasopharyngeal carcinoma (NPC); however, there is no standard regimen for those who failed first-line treatment. This study aimed to evaluate the efficacy and safety of apatinib in treating patients with recurrent/metastatic NPC who failed prior platinum-based chemotherapy. Methods Patients aged 18–65 years with recurrent/metastatic NPC were treated with apatinib at an initial dose of 500 mg once daily and continued until disease progression, patient withdrawal, or unacceptable toxic effects. The primary endpoints were clinical benefit rate (CBR) and toxicity. Secondary endpoints included progression-free survival (PFS) and overall survival (OS). Results Nineteen patients were enrolled in this study. At the final follow-up, the CBR was 52.6% (95% CI: 29.8–76.2%) in the intention-to-treat population. The median PFS and OS were 3.7 (95% CI: 0.6–6.8) months and 12.9 (95% CI: 9.3–16.5) months, respectively. The most common grade 3–4 adverse events (AEs) were hand-foot syndrome [3 (15.8%)], neutropenia [2 (10.5%)], proteinuria [2 (10.5%)], oral mucosal pain [2 (10.5%)], hypertension [1 (5.3%)], hyponatremia [1 (5.3%)], artery dissection [1 (5.3%)], and nasopharyngeal hemorrhage [1 (5.3%)]. A serious AEs was reported in one patient who died of nasopharyngeal hemorrhage. Treatment with apatinib did not significantly influence patient-reported quality-of-life, except for nausea/vomiting and pain (P<0.05). Conclusions Apatinib achieved modest disease control with acceptable toxicity in recurrent/metastatic NPC patients pretreated with platinum-based chemotherapy.
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Affiliation(s)
- Chang-Juan Tao
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Peng Zhang
- Department of Medical oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Ling Zhou
- Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Qiao-Ying Hu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiao-Zhong Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, China
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27
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Chong WQ, Lim CM, Sinha AK, Tan CS, Chan GHJ, Huang Y, Kumarakulasinghe NB, Sundar R, Jeyasekharan AD, Loh WS, Tay JK, Yadav K, Wang L, Wong AL, Kong LR, Soo RA, Lau JA, Soon YY, Goh RM, Ho FCH, Chong SM, Lee SC, Loh KS, Tai BC, Lim YC, Goh BC. Integration of Antiangiogenic Therapy with Cisplatin and Gemcitabine Chemotherapy in Patients with Nasopharyngeal Carcinoma. Clin Cancer Res 2020; 26:5320-5328. [PMID: 32816944 DOI: 10.1158/1078-0432.ccr-20-1727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/26/2020] [Accepted: 08/04/2020] [Indexed: 12/08/2022]
Abstract
PURPOSE Induction cisplatin and gemcitabine chemotherapy is a standard treatment for locally advanced nasopharyngeal carcinoma (NPC). Inhibition of VEGF axis has been shown to promote maturation of microvasculature and improve perfusion. We conducted a four-arm study to assess the effect of two doses of either sunitinib or bevacizumab with chemotherapy in NPC. PATIENTS AND METHODS Patients with treatment-naïve locally advanced NPC were treated with three cycles of 3-weekly cisplatin and gemcitabine preceded by 1 week of anti-VEGF therapy for each cycle, followed by standard concurrent chemoradiation: arm A patients received 7 days of 12.5 mg/day sunitinib; arm B 7 days of 25 mg/day sunitinib; arm C bevacizumab 7.5 mg/kg infusion; arm D bevacizumab 2.5 mg/kg infusion. Patients with metastatic NPC were treated with up to six cycles of similar treatment without concurrent chemoradiation. RESULTS Complete metabolic response (mCR) by whole body 18FDG PET was highest in arm C (significant difference in four groups Fisher exact test P = 0.001; type 1 error = 0.05), with 42% mCR (95% confidence interval, 18-67) and 3-year relapse-free survival of 88% in patients with locally advanced NPC. Significant increase in pericyte coverage signifying microvascular maturation and increased immune cell infiltration was observed in posttreatment tumor biopsies in Arm C. Myelosuppression was more profound in sunitinib containing arms, and tolerability was established in arm C where hypertension was the most significant toxicity. CONCLUSIONS Bevacizumab 7.5 mg/kg with cisplatin and gemcitabine was well tolerated. Promising tumor response was observed and supported mechanistically by positive effects on tumor perfusion and immune cell trafficking into the tumor.
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Affiliation(s)
- Wan Qin Chong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Chwee Ming Lim
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Arvind Kumar Sinha
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Chee Seng Tan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Gloria Hui Jia Chan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Yiqing Huang
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | | | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Anand D Jeyasekharan
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, NUS, Singapore
| | - Woei Shyang Loh
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Joshua K Tay
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Kritika Yadav
- Cancer Science Institute of Singapore, NUS, Singapore
| | - Lingzhi Wang
- Cancer Science Institute of Singapore, NUS, Singapore.,Department of Pharmacology, National University of Singapore, Singapore
| | - Andrea L Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, NUS, Singapore
| | - Li Ren Kong
- Cancer Science Institute of Singapore, NUS, Singapore
| | - Ross Andrew Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, NUS, Singapore
| | | | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Robby Miguel Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Francis Cho Hao Ho
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Siew Meng Chong
- Department of Pathology, National University of Singapore, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.,Cancer Science Institute of Singapore, NUS, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology - Head and Neck Surgery, National University of Singapore, Singapore
| | - Bee Choo Tai
- School of Public Health, National University of Singapore, Singapore
| | - Yaw Chyn Lim
- Department of Pathology, National University of Singapore, Singapore.,Department of Physiology, National University of Singapore, Singapore
| | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore. .,Cancer Science Institute of Singapore, NUS, Singapore.,Department of Pharmacology, National University of Singapore, Singapore
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28
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Novel Therapies Boosting T Cell Immunity in Epstein Barr Virus-Associated Nasopharyngeal Carcinoma. Int J Mol Sci 2020; 21:ijms21124292. [PMID: 32560253 PMCID: PMC7352617 DOI: 10.3390/ijms21124292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/05/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant tumour of the head and neck affecting localised regions of the world, with the highest rates described in Southeast Asia, Northern Africa, and Greenland. Its high morbidity rate is linked to both late-stage diagnosis and unresponsiveness to conventional anti-cancer treatments. Multiple aetiological factors have been described including environmental factors, genetics, and viral factors (Epstein Barr Virus, EBV), making NPC treatment that much more complex. The most common forms of NPCs are those that originate from the epithelial tissue lining the nasopharynx and are often linked to EBV infection. Indeed, they represent 75–95% of NPCs in the low-risk populations and almost 100% of NPCs in high-risk populations. Although conventional surgery has been improved with nasopharyngectomy’s being carried out using more sophisticated surgical equipment for better tumour resection, recent findings in the tumour microenvironment have led to novel treatment options including immunotherapies and photodynamic therapy, able to target the tumour and improve the immune system. This review provides an update on the disease’s aetiology and the future of NPC treatments with a focus on therapies activating T cell immunity.
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29
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Parikh K, Mandrekar SJ, Allen‐Ziegler K, Esplin B, Tan AD, Marchello B, Adjei AA, Molina JR. A Phase II Study of Pazopanib in Patients with Malignant Pleural Mesothelioma: NCCTG N0623 (Alliance). Oncologist 2020; 25:523-531. [PMID: 31872928 PMCID: PMC7288653 DOI: 10.1634/theoncologist.2019-0574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/04/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Preclinical and clinical data have shown promise in using antiangiogenic agents to treat malignant pleural mesothelioma (MPM). We conducted this phase II study to evaluate the efficacy and toxicity of single-agent pazopanib in patients with MPM. MATERIALS AND METHODS Patients with MPM who had received 0-1 prior chemotherapy regimens were eligible to receive pazopanib at a dose of 800 mg daily. The primary endpoint was progression-free survival rate at 6 months (PFS6), with a preplanned interim analysis for futility. Secondary endpoints included overall survival (OS), PFS, adverse events assessment and clinical benefit (complete response, partial response [PR], and stable disease [SD]). RESULTS Thirty-four evaluable patients were enrolled, with a median age of 73 years (49-84). The trial was closed early because of lack of efficacy at the preplanned interim analysis. Only 8 patients (28.6%; 95% confidence interval [CI], 13.2-48.7%) in the first 28 evaluable were progression-free at 6 months. PFS6 was 32.4% (95% CI, 17.4-50.5). There were 2 PR (5.9%) and 16 SD (47.1%). The overall median PFS and OS were 4.2 months (95% CI, 2.0-6.0) and 11.5 months (95% CI: 5.3-18.2), respectively. The median PFS and OS for the previously untreated patients was 5.4 months (95% CI, 2.7-8.5) and 16.6 months (95% CI, 6.6-30.6), respectively; and 2.0 months (95% CI, 1.3-4.2) and 5.0 months (95% CI: 3.0-11.9), respectively, for the previously treated patients. Grade 3 or higher adverse events were observed in 23 patients (67.6%). CONCLUSION Single-agent pazopanib was poorly tolerated in patients with MPM. The primary endpoint of PFS6 was not achieved in the current study. ClinicalTrials.gov identification number. NCT00459862. IMPLICATIONS FOR PRACTICE Single-agent pazopanib did not meet its endpoint in this phase II trial in malignant mesothelioma. Pazopanib is well tolerated in mesothelioma patients with a manageable toxicity profile. There is a need to better identify signals of angiogenesis that can be targeted in mesothelioma. Encouraging findings in frontline treatment warrant further investigations in combination with chemotherapy or immunotherapy.
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Affiliation(s)
- Kaushal Parikh
- Division of Medical Oncology, Mayo ClinicRochesterMinnesotaUSA
- John Theurer Cancer CenterHackensackNew JerseyUSA
| | | | | | - Brandt Esplin
- Division of Medical Oncology, Mayo ClinicRochesterMinnesotaUSA
| | - Angelina D. Tan
- Alliance Statistics and Data Center, Mayo ClinicRochesterMinnesotaUSA
| | | | - Alex A. Adjei
- Division of Medical Oncology, Mayo ClinicRochesterMinnesotaUSA
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30
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Li L, Kong F, Zhang L, Li X, Fu X, Wang X, Wu J, Zhang F, Ren L, Zhang M. Apatinib, a novel VEGFR-2 tyrosine kinase inhibitor, for relapsed and refractory nasopharyngeal carcinoma: data from an open-label, single-arm, exploratory study. Invest New Drugs 2020; 38:1847-1853. [PMID: 32363427 PMCID: PMC7575486 DOI: 10.1007/s10637-020-00925-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
Purpose Apatinib, a new tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2, has shown promising efficacy against several solid cancers, but evidence of its efficacy against relapsed and refractory nasopharyngeal carcinoma is limited. We investigated the efficacy and safety of apatinib for relapsed and refractory nasopharyngeal carcinoma in an open-label, single-arm, phase II clinical trial. Fifty-one patients with relapsed and refractory nasopharyngeal carcinoma in the First Affiliated Hospital, Zhengzhou University, who met the inclusion criteria were enrolled in the study. All patients received apatinib at an initial dose of 500 mg daily (1 cycle = 28 days). The primary and secondary endpoints were overall response rate, progression-free survival, and overall survival. We evaluated treatment effects and recorded apatinib-related adverse events by performing regular follow-ups and workup. The overall response rate (complete and partial responses) was 31.37% (16/51). The median overall survival and progression-free survival were 16 (95% CI, 9.32–22.68) and 9 months (95% CI, 5.24–12.76), respectively. Most patients tolerated treatment-related adverse events of grades 1 and 2; hypertension (29, 56.86%), proteinuria (25, 49.02%), and hand–foot syndrome (27, 52.94%) were the most common adverse events. There were no treatment-related deaths. Apatinib showed good efficacy and safety in patients with relapsed and refractory NPC.
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Affiliation(s)
- Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China. .,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China.
| | - Fei Kong
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China
| | - Fangwen Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China
| | - Liangliang Ren
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China. .,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, China.
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31
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Zheng WH, He XJ, Chen FP, Lin L, Huang XD, Zhou HQ, Kou J, Lv JW, Ma J, Zhou GQ, Sun Y. Establishing M1 stage subdivisions by incorporating radiological features and Epstein-Barr virus DNA for metastatic nasopharyngeal carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:83. [PMID: 32175376 DOI: 10.21037/atm.2020.01.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Significance of plasma Epstein-Barr virus deoxyribonucleic acid (EBV DNA)-a proven robust indicator for nasopharyngeal carcinoma (NPC)-is not yet clarified in risk stratification of metastatic NPC (mNPC). We aim to establish effective M1 stage subdivisions in mNPC by integrating radiological features and EBV DNA at diagnosis of metastasis (mEBV DNA). Methods The study comprised 1,007 mNPC patients, including 817 metachronous mNPC (mmNPC) patients randomized into training (n=613) and internal validation (n=204) cohorts, and 190 synchronous mNPC (smNPC) patients defined as smNPC validation cohort. Primary clinical end-point was overall survival (OS). Covariate inclusion to recursive partitioning analysis (RPA)-generated risk stratification was qualified by a multivariable two-sided P<0.05. Performances of different models were compared using area under ROC curve (AUC), Harrell's concordance index (c-index) and Akaike information criterion (AIC). Results Compared with other simply image-based models, the ultimate RPA-EBV-stage presented a best performance [c-index =0.68 (training), 0.70 (internal validation), 0.64 (smNPC validation); AUC =0.69 (training), 0.72 (internal validation), 0.70 (smNPC validation)]: M1a (low mEBV DNA + oligo lesion), M1b (low mEBV DNA + multiple lesions), M1c (high mEBV DNA + no liver involvement), and M1d (high mEBV DNA + liver involvement). Corresponding 3-year OS rates were 49.9%, 33.4%, 22.6%, and 6.7%, respectively (P<0.001). In mmNPC patients, compared with chemotherapy alone, addition of local treatment demonstrated superiority in M1a and M1b; systemic therapy combined with targeted therapy conferred benefit on patients of M1c and M1d (P<0.05). Conclusions This RPA-EBV-stage provided favorable prognostic value for survival outcomes and could assist clinical and investigative management. Low-risk patients are considered suitable candidate for curative local treatment, and high-risk patients are recommended to undergo intensive systemic treatment.
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Affiliation(s)
- Wei-Hong Zheng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Xiao-Jun He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Fo-Ping Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Li Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Xiao-Dan Huang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Hua-Qiang Zhou
- State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jia Kou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Jia-Wei Lv
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, China
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32
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Wang S, Claret FX, Wu W. MicroRNAs as Therapeutic Targets in Nasopharyngeal Carcinoma. Front Oncol 2019; 9:756. [PMID: 31456943 PMCID: PMC6700302 DOI: 10.3389/fonc.2019.00756] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/26/2019] [Indexed: 12/12/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a malignancy of epithelial origin that is prone to local invasion and early distant metastasis. Although concurrent chemotherapy and radiotherapy improves the 5-year survival outcomes, persistent or recurrent disease still occurs. Therefore, novel therapeutic targets are needed for NPC patients. MicroRNAs (miRNAs) play important roles in normal cell homeostasis, and dysregulations of miRNA expression have been implicated in human cancers. In NPC, studies have revealed that miRNAs are dysregulated and involved in tumorigenesis, metastasis, invasion, resistance to chemo- and radiotherapy, and other disease- and treatment-related processes. The advantage of miRNA-based treatment approaches is that miRNAs can concurrently target multiple effectors of pathways involved in tumor cell differentiation and proliferation. Thus, miRNA-based cancer treatments, alone or combined with standard chemotherapy and/or radiotherapy, hold promise to improve treatment response and cure rates. In this review, we will summarize the dysregulation of miRNAs in NPC initiation, progression, and treatment as well as NPC-related signaling pathways, and we will discuss the potential applications of miRNAs as biomarkers and therapeutic targets in NPC patients. We conclude that miRNAs might be potential promising therapeutic targets in nasopharyngeal carcinoma.
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Affiliation(s)
- Sumei Wang
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Oncology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Postdoctoral Research Station, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - François-Xavier Claret
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Experimental Therapeutic Academic Program and Cancer Biology Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, United States
| | - Wanyin Wu
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Oncology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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33
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Lang J, Hu C, Lu T, Pan J, Lin T. Chinese expert consensus on diagnosis and treatment of nasopharyngeal carcinoma: evidence from current practice and future perspectives. Cancer Manag Res 2019; 11:6365-6376. [PMID: 31372041 PMCID: PMC6628961 DOI: 10.2147/cmar.s197544] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 05/16/2019] [Indexed: 12/22/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a rare type of head and neck cancer, with a higher incidence reported only in Southeast Asia and Northern Africa. Owing to the rarity of NPC occurrence, no internationally accepted consensus or guideline for its diagnosis and treatment is available. Based on the current evidences and practices, the Chinese experts on multidisciplinary diagnosis and treatment of NPC were designated to develop a national consensus for the treatment strategy of NPC. In this consensus, we report the development for improving the treatment efficacy and quality of life of NPC patients in China. The consensus also describes and recommends the role of multidisciplinary management approach in the management of NPC. A multidisciplinary team should include experts from different domains who can cater to the individualized needs of patients with NPC in a much more efficient manner. In addition, the team may also play a key role in developing guiding principles for future research, contributing to the improvement in the management of NPC.
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Affiliation(s)
- Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Taixiang Lu
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, People's Republic of China
| | - Tongyu Lin
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, and Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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Abstract
Introduction: Nasopharyngeal carcinoma (NPC) is a distinct head and neck squamous cell carcinoma in its etiological association of Epstein-Barr virus (EBV) infection, hidden anatomical location, remarkable racial and geographical distribution, and high incidence of locoregional recurrence or metastasis. Thanks to the advancements in proteomics in recent decades, more understanding of the disease etiology, carcinogenesis, and progression has been gained, potentially deciphering the molecular characteristics of the malignancy. Areas covered: In this review, we provide an overview of the proteomic aberrations that are likely involved or drive NPC development and progression, focusing on the contributions of major EBV-encoded factors, intercommunication with environment, protein features of high metastasis and therapy resistance, and protein-protein interactions that allow NPC cells to evade immune recognition and elimination. Finally, multistep carcinogenesis and subtypes of NPC from a proteomic perspective are inquired. Expert commentary: Proteomic studies have covered various aspects involved in NPC pathogenesis, yet much remains to be uncovered. Coherent study designs, optimal conditions for obtaining high-quality data, and compelling interpretation are critical in ensuring the emergence of good science out of NPC proteomics. NPC proteogenomics and proteoform analysis are two promising fields to promote the application of the proteomic findings from bench to bedside.
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Affiliation(s)
- Zhefeng Xiao
- a NHC Key Laboratory of Cancer Proteomics , Xiangya Hospital, Central South University , Changsha , P. R. China
| | - Zhuchu Chen
- a NHC Key Laboratory of Cancer Proteomics , Xiangya Hospital, Central South University , Changsha , P. R. China
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35
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Almobarak AA, Jebreel AB, Abu-Zaid A. Molecular Targeted Therapy in the Management of Recurrent and Metastatic Nasopharyngeal Carcinoma: A Comprehensive Literature Review. Cureus 2019; 11:e4210. [PMID: 31114729 PMCID: PMC6505721 DOI: 10.7759/cureus.4210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) is the most frequent malignancy arising in the nasopharynx. NPC, to a larger degree, substantially differs from the other malignancies of the head and neck, in terms of incidence, etiology, risk factors, molecular pathogenesis, clinical behavior, management and prognosis. Fundamentally, the management of NPC is entirely guided by the disease stage. Favorably, patients with early- stage disease have encouraging survival outcomes with stand-alone radiation therapy (RT), specifically following the emergence of intensity-modulated RT (IMRT). The reported five-year local control rates are outstanding, and they range from 70% to 90%. Unfortunately, around one-third (30%) of patients presents with loco-regional or distant recurrences, despite rigorous curative treatment in the intermediate (stage II) and advanced (stage III-IVB) NPC disease. At the present time, the management of recurrent and metastatic NPC is largely discouraging and presents significant challenges to the treating physicians. Broadly speaking, there are three management schemes utilized in the management of recurrent and metastatic NPC, namely: (i) palliative systemic chemotherapy, (ii) molecular targeted therapy, and (iii) immunotherapy. The goal of this study is to holistically review the existing body of literature on the utility and safety of molecular targeted therapy in the management of patients with recurrent and metastatic NPC, with a special focus on vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) targets.
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Affiliation(s)
| | - Alaeddin B Jebreel
- Otolaryngology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Ahmed Abu-Zaid
- Oncology, Alfaisal University College of Medicine, Riyadh, SAU
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36
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Perri F, Della Vittoria Scarpati G, Caponigro F, Ionna F, Longo F, Buonopane S, Muto P, Di Marzo M, Pisconti S, Solla R. Management of recurrent nasopharyngeal carcinoma: current perspectives. Onco Targets Ther 2019; 12:1583-1591. [PMID: 30881013 PMCID: PMC6396653 DOI: 10.2147/ott.s188148] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nasopharyngeal carcinoma is a rare disease in Western countries. Nevertheless, its incidence in China, Singapore, and other Eastern countries reaches 20 cases per 100,000 people. Being an extremely chemo- and radiosensitive disease, upfront treatment often consists in the association of intensity-modulated radiation therapy and concurrent cisplatin. Unfortunately, about 20% of the patients suffer from a radioresistant disease which recurs after upfront therapy. For these patients, mainly available therapeutic options consist in systemic therapy, in particular poly-chemotherapy. In those showing a single locoregional recurrence, chemotherapy is not considered to be the preferred approach and other different strategies may be employed. Re-irradiation and surgery are strategies that are always used more often, albeit related to high risk of morbidity. Immunotherapy and targeted therapy, such as heavy ions-based re-irradiations, are experimental but very intriguing options.
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Affiliation(s)
- F Perri
- Head and Neck/Sarcoma Medical Oncology Unit, INT IRCCS G Pascale, Naples, Italy,
| | | | - F Caponigro
- Head and Neck/Sarcoma Medical Oncology Unit, INT IRCCS G Pascale, Naples, Italy,
| | - F Ionna
- Department of Otolaryngology and Head and Neck Surgery, INT IRCCS G Pascale, Naples, Italy
| | - F Longo
- Department of Otolaryngology and Head and Neck Surgery, INT IRCCS G Pascale, Naples, Italy
| | - S Buonopane
- Department of Radiation Therapy, INT IRCCS G Pascale, Naples, Italy
| | - P Muto
- Department of Radiation Therapy, INT IRCCS G Pascale, Naples, Italy
| | - M Di Marzo
- Department of Abdominal Surgery, INT IRCCS G Pascale, Naples, Italy
| | - S Pisconti
- Medical Oncology Unit, POC SS Annunziata, Taranto, Italy
| | - R Solla
- Italian National Research Council, Institute of Biostructure and Bioimaging, Naples, Italy
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37
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Elevated SUV39H2 attributes to the progression of nasopharyngeal carcinoma via regulation of NRIP1. Biochem Biophys Res Commun 2019; 510:290-295. [PMID: 30709585 DOI: 10.1016/j.bbrc.2019.01.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 01/02/2023]
Abstract
Nasopharyngeal carcinoma (NPC) is a prevalent tumor in southern China and southeast Asia. Recent studies have demonstrated that viral infection, somatic genetic changes, and epigenetic changes synergistically contribute to NPC pathogenesis. Genome-wide studies show that epigenetic aberrations likely drive nasopharyngeal carcinoma development and progression. This work is aimed at investigating the effect of histone methyltransferase SUV39H2 in NPC. The elevated expression of SUV39H2 in NPC is observed by analyzing GSE53819 and GSE12452 downloaded from the Gene Expression Omnibus (GEO) database. SUV39H2 knockdown inhibits NPC proliferation and induces the apoptosis of cancer cells. At last, RNaseq analysis identifies a variety of SUV39H2 downstream genes related with cancer, in which, NRIP1 is identified as a critical downstream target of SUV39H2 in NPC. Taken together, these findings provide a theoretical basis for understating the biological roles of SUV39H2 in NPC.
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38
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Jin J, Du J, Wu Y. Apatinib monotherapy for advanced VEGFR-2-negative nasopharyngeal carcinoma: A case report. Medicine (Baltimore) 2019; 98:e13491. [PMID: 30608382 PMCID: PMC6344178 DOI: 10.1097/md.0000000000013491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Due to the anatomical and biological characteristics of nasopharyngeal carcinoma (NPC), radiotherapy is the standard treatment of choice. Recent advances in small molecule therapies targeting tumor angiogenesis also hold promise for the treatment of advanced NPC. PATIENT CONCERNS The patient's symptoms, including nasal obstruction, nasal bleeding, and headache, reappeared periodically and eventually became so severe that the patient's vision became impaired. In January 2016, the patient presented with blurred vision, diplopia, language impairment, left temporal paralysis, and bilateral eyelid ptosis. DIAGNOSIS Advanced NPC without metastasis in a 55-year-old man. INTERVENTIONS The patient refused treatment with radiotherapy or chemotherapy and was treated with Chinese herbal medicines. Following a worsening of symptoms, the patient was subsequently treated with apatinib monotherapy (0.25 g, once daily). OUTCOMES Symptom improvement, including decreased nasal bleeding and headache, was observed after 1 week of apatinib treatment. After 100 days of treatment, the patient was nearly asymptomatic with stable disease and improved quality of life. LESSONS For patients with advanced NPC who refuse standard radiotherapy and chemotherapy, apatinib monotherapy may be a suitable treatment option to improve symptoms and quality of life even in those with vascular endothelial growth factor receptor-negative tumors.
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Affiliation(s)
- Jun Jin
- Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan
| | - Jiahao Du
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanwei Wu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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39
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Chen Q, Tang L, Liu N, Han F, Guo L, Guo S, Wang J, Liu H, Ye Y, Zhang L, Liu L, Wang P, Li Y, He Q, Yang X, Tang Q, Li Y, Liang Y, Sun X, Xie C, Mo Y, Guo Y, Sun R, Mo H, Cao K, Guo X, Zeng M, Mai H, Ma J. Famitinib in combination with concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 1, open-label, dose-escalation Study. Cancer Commun (Lond) 2018; 38:66. [PMID: 30382933 PMCID: PMC6235389 DOI: 10.1186/s40880-018-0330-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 09/15/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Famitinib is a tyrosine kinase inhibitor against multiple targets, including vascular endothelial growth factor receptor 2/3, platelet-derived growth factor receptor, and stem cell factor receptor (c-kit). Previous studies have demonstrated anti-tumour activities of famitinib against a wide variety of advanced-stage solid cancers. We aimed to determine the safety and efficacy of famitinib with concurrent chemoradiotherapy (CCRT) in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). We also evaluated the feasibility of contrast-enhanced ultrasound (D-CEUS) as a predictor of early tumour response to famitinib and to correlate functional parameters with clinical efficacy. METHODS The trial was conducted in subjects with stage III or IVa-b NPC using a 3 + 3 design of escalating famitinib doses. Briefly, subjects received 2 weeks of famitinib monotherapy followed by 7 weeks of famitinib plus CCRT. D-CEUS of the neck lymph nodes was performed at day 0, 8 and 15 after famitinib was administered before starting concurrent chemoradiotherapy. End points included safety, tolerability and anti-tumour activity. RESULTS Twenty patients were enrolled (six each for 12.5, 16.5 and 20 mg and two for 25 mg). Two patients in the 25 mg cohort developed dose-limiting toxicities, including grade 4 thrombocytopenia and grade 3 hypertension. The most common grade 3/4 adverse events were leukopenia, neutropenia and radiation mucositis. D-CEUS tests showed that more than 60% of patients achieved a perfusion parameter response after 2 weeks taking famitinib alone, and the parameter response was associated with disease improvement. In the famitinib monotherapy stage, three patients (15%) showed partial responses. The complete response rate was 65% at the completion of treatment and 95% 3 months after the treatment ended. After a median follow-up of 44 months, the 3-year progression-free survival (PFS) and distant metastasis-free survival were 70% and 75%, respectively. Subjects with a decrease of perfusion parameter response, such as peak intensity decreased at least 30% after 1 week of famitinib treatment, had higher 3-year PFS (90.9% vs. 44.4%, 95% CI 73.7%-100% vs. 11.9%-76.9%, P < 0.001) than those with an increase or a reduction of less than 30%. CONCLUSIONS The recommended famitinib dose for phase II trial is 20 mg with CCRT for patients with local advanced NPC. D-CEUS is a reliable and early measure of efficacy for famitinib therapies. Further investigation is required to confirm the effects of famitinib plus chemoradiotherapy.
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Affiliation(s)
- Qiuyan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Linquan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Na Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Feng Han
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Ling Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Shanshan Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Jianwei Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Huai Liu
- Department of Radiation Oncology, Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, P. R. China
| | - Yanfang Ye
- Department of Science and Education, Sun Yat-sen Memorial Hospital, Guangzhou, 510120, P. R. China
| | - Lu Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, P. R. China
| | - Liting Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Pan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Yingqin Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Qingmei He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Xiaoqun Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Qingnan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Yang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - YuJing Liang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - XueSong Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Chuanmiao Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Imaging, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Yunxian Mo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Imaging, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Ying Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Clinical Trial Center, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Rui Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Haoyuan Mo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Kajia Cao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Musheng Zeng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China
| | - Haiqiang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.
| | - Jun Ma
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China.
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40
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Adkins D, Mehan P, Ley J, Siegel MJ, Siegel BA, Dehdashti F, Jiang X, Salama NN, Trinkaus K, Oppelt P. Pazopanib plus cetuximab in recurrent or metastatic head and neck squamous cell carcinoma: an open-label, phase 1b and expansion study. Lancet Oncol 2018; 19:1082-1093. [PMID: 30001987 DOI: 10.1016/s1470-2045(18)30350-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Angiogenesis is a hallmark of head and neck squamous cell carcinoma (HNSCC), and a mechanism of resistance to EGFR inhibition. We investigated the safety and potential activity of pazopanib, an angiogenesis inhibitor, plus cetuximab, an EGFR inhibitor, in patients with recurrent or metastatic HNSCC. METHODS We did an open-label, single-centre, dose-escalation phase 1b trial using a standard 3 + 3 design, followed by an expansion cohort phase. Eligible participants were patients with histologically or cytologically confirmed recurrent or metastatic HNSCC, aged at least 18 years, had measurable disease as per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, and an Eastern Cooperative Oncology Group performance status of 0-1. During dose escalation, pazopanib oral suspension was administered daily in 8-week cycles at doses of 200 mg/day, 400 mg/day, 600 mg/day, or 800 mg/day, with cetuximab given intravenously once per week (400 mg/m2 first dose and 250 mg/m2 in consecutive cycles). The primary endpoint was to determine the maximum tolerated dose or recommended phase 2 dose of pazopanib in combination with cetuximab. Analyses were done per protocol. This trial is registered with ClinicalTrials.gov, number NCT01716416, and it is ongoing but closed to accrual. FINDINGS Between June 5, 2013, and April 4, 2017, we enrolled 22 patients into the phase 1b, dose-escalation phase of the trial. A maximum tolerated dose of pazopanib in combination with cetuximab was not reached. Single dose-limiting toxic events (all grade 3) during dose escalation occurred with pazopanib 400 mg/day (neutropenia with infection), 600 mg/day (proteinuria), and 800 mg/day (fatigue). The established recommended phase 2 dose for the combination was 800 mg/day of pazopanib during cycles of 8 weeks each, plus cetuximab 400 mg/m2 on day 1 of cycle 1, then cetuximab 250 mg/m2 weekly. A further nine patients were enrolled into the expansion cohort and treated with the established recommended phase 2 dose. The most common (grade 3-4) adverse events for all patients were hypertension (ten [32%] of 31), lymphocyte count decrease (seven [23%]), and dysphagia (seven [23%]). There were no treatment-related deaths. 11 (35%; 95% CI 19·2-54·6) of 31 patients achieved an overall response, as assessed by the investigator; two (6%) had a complete response and nine (29%) a partial response. Tumour responses were also observed in six (55%) of 11 patients with platinum-naive and cetuximab-naive disease, three (25%) of 12 patients with cetuximab-resistant disease, and five (28%) of 18 patients with platinum-resistant disease. INTERPRETATION Pazopanib oral suspension at a dose of 800 mg/day was feasible to administer in combination with standard weekly cetuximab for patients with recurrent or metastatic HNSCC. Encouraging preliminary antitumour activity was observed with this combination therapy and warrants further validation in randomised trials. FUNDING GlaxoSmithKline and Novartis.
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Affiliation(s)
- Douglas Adkins
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA; Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA.
| | - Paul Mehan
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Jessica Ley
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - Marilyn J Siegel
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Barry A Siegel
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Farrokh Dehdashti
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Xuntian Jiang
- Metabolomics Facility, Washington University School of Medicine, St Louis, MO, USA
| | - Noha N Salama
- Department of Pharmaceutical and Administrative Sciences, St Louis College of Pharmacy, St Louis, MO, USA; Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Kathryn Trinkaus
- Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA; Siteman Cancer Center, Biostatistics Shared Resource, Washington University School of Medicine, St Louis, MO, USA
| | - Peter Oppelt
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
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Ma BBY, Lim WT, Goh BC, Hui EP, Lo KW, Pettinger A, Foster NR, Riess JW, Agulnik M, Chang AYC, Chopra A, Kish JA, Chung CH, Adkins DR, Cullen KJ, Gitlitz BJ, Lim DW, To KF, Chan KCA, Lo YMD, King AD, Erlichman C, Yin J, Costello BA, Chan ATC. Antitumor Activity of Nivolumab in Recurrent and Metastatic Nasopharyngeal Carcinoma: An International, Multicenter Study of the Mayo Clinic Phase 2 Consortium (NCI-9742). J Clin Oncol 2018; 36:1412-1418. [PMID: 29584545 DOI: 10.1200/jco.2017.77.0388] [Citation(s) in RCA: 289] [Impact Index Per Article: 48.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose This multinational study evaluated the antitumor activity of nivolumab in nasopharyngeal carcinoma (NPC). Tumor and plasma-based biomarkers were investigated in an exploratory analysis. Patients and Methods Patients with multiply pretreated recurrent or metastatic NPC were treated with nivolumab until disease progression. The primary end point was objective response rate (ORR) and secondary end points included survival and toxicity. The expression of programmed death-ligand 1 (PD-L1) and human leukocyte antigens A and B in archived tumors and plasma clearance of Epstein-Barr virus DNA were correlated with ORR and survival. Results A total of 44 patients were evaluated and the overall ORR was 20.5% (complete response, n = 1; partial response, n = 8). Nine patients received nivolumab for > 12 months (20%). The 1-year overall survival rate was 59% (95% CI, 44.3% to 78.5%) and 1-year progression-free survival (PFS) rate was 19.3% (95% CI, 10.1% to 37.2%). There was no statistical correlation between ORR and the biomarkers; however, a descriptive analysis showed that the proportion of patients who responded was higher among those with PD-L1 positive tumors (> 1% expression) than those with PD-L1-negative tumors. The loss of expression of one or both human leukocyte antigen class 1 proteins was associated with better PFS than when both proteins were expressed (1-year PFS, 30.9% v 5.6%; log-rank P = .01). There was no association between survival and PD-L1 expression or plasma Epstein-Barr virus DNA clearance. There was no unexpected toxicity to nivolumab. Conclusion Nivolumab has promising activity in NPC and the 1-year overall survival rate compares favorably with historic data in similar populations. Additional evaluation in a randomized setting is warranted. The biomarker results were hypothesis generating and validation in larger cohorts is needed.
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Affiliation(s)
- Brigette B Y Ma
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Wan-Teck Lim
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Boon-Cher Goh
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Edwin P Hui
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Kwok-Wai Lo
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Adam Pettinger
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Nathan R Foster
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Jonathan W Riess
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Mark Agulnik
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Alex Y C Chang
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Akhil Chopra
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Julie A Kish
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Christine H Chung
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Douglas R Adkins
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Kevin J Cullen
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Barbara J Gitlitz
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Dean W Lim
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Ka-Fai To
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - K C Allen Chan
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Y M Dennis Lo
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Ann D King
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Charles Erlichman
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Jun Yin
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Brian A Costello
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
| | - Anthony T C Chan
- Brigette B.Y. Ma, Edwin P. Hui, Kwok-Wai Lo, Ka-Fai To, K.C. Allen Chan, Y.M. Dennis Lo, Ann D. King, and Anthony T.C. Chan, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China; Wan-Teck Lim, National Cancer Centre; Boon-Cher Goh, National University Cancer Institute of Singapore; Alex Y.C. Chang, Johns Hopkins University School of Medicine; Akhil Chopra, OncoCare Cancer Centre, Singapore; Adam Pettinger, Nathan R. Foster, Charles Erlichman, Jun Yin, and Brian A. Costello, Mayo Clinic, Rochester, MN; Jonathan W. Riess, University of California Davis Comprehensive Cancer Center, Sacramento; Barbara J. Gitlitz, University of Southern California Keck School of Medicine, Los Angeles; Dean W. Lim, City of Hope Comprehensive Cancer Center, Duarte, CA; Mark Agulnik, Northwestern University, Evanston, IL; Julie A. Kish and Christine H. Chung, Moffitt Cancer Center, University of South Florida, Tampa, FL; Douglas R. Adkins, Washington University School of Medicine, St Louis, MO; Kevin J. Cullen, University of Maryland, Baltimore, MD
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Hui EP, Ma BBY, Loong HHF, Mo F, Li L, King AD, Wang K, Ahuja AT, Chan CML, Hui CWC, Wong CH, Chan ATC. Efficacy, Safety, and Pharmacokinetics of Axitinib in Nasopharyngeal Carcinoma: A Preclinical and Phase II Correlative Study. Clin Cancer Res 2018; 24:1030-1037. [PMID: 29301831 DOI: 10.1158/1078-0432.ccr-17-1667] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/27/2017] [Accepted: 12/19/2017] [Indexed: 11/16/2022]
Abstract
Purpose: We hypothesized that axitinib is active with an improved safety profile in nasopharyngeal carcinoma (NPC).Experimental Design: We evaluated axitinib in preclinical models of NPC and studied its efficacy in a phase II clinical trial in recurrent or metastatic NPC patients who progressed after at least one line of prior platinum-based chemotherapy. We excluded patients with local recurrence or vascular invasion. Axitinib was started at 5 mg twice daily in continuous 4-week cycles. Primary endpoint was clinical benefit rate (CBR), defined as the percentage of patients achieving complete response, partial response, or stable disease by RECIST criteria for more than 3 months.Results: We recruited 40 patients, who received a median of 3 lines of prior chemotherapy. Axitinib was administered for a mean of 5.6 cycles, with 16 patients (40%) receiving ≥6 cycles. Of 37 patients evaluable for response, CBR was 78.4% (95% CI, 65.6%-91.2%) at 3 months and 43.2% (30.4%-56.1%) at 6 months. Grade 3/4 toxicities were uncommon, including hypertension (8%), diarrhea (5%), weight loss (5%), and pain (5%). All hemorrhagic events were grade 1 (15%) or grade 2 (3%). Elevated diastolic blood pressure during the first 3 months of axitinib treatment was significantly associated with improved overall survival (HR, 0.29; 95% CI, 0.13-0.64, P = 0.0012). Patient-reported fatigue symptom was associated with hypothyroidism (P = 0.039). Axitinib PK parameters (Cmax and AUC(0-t)) were significantly correlated with tumor response, toxicity, and serum thyroid-stimulating hormone changes.Conclusions: Axitinib achieved durable disease control with a favorable safety profile in heavily pretreated NPC patients. Clin Cancer Res; 24(5); 1030-7. ©2018 AACR.
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Affiliation(s)
- Edwin P Hui
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Cancer Drug Testing Unit, Partner State Key Laboratory of Oncology in South China, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Brigette B Y Ma
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Cancer Drug Testing Unit, Partner State Key Laboratory of Oncology in South China, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Herbert H F Loong
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Frankie Mo
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Leung Li
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ann D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ki Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anil T Ahuja
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Charles M L Chan
- Tumor Marker Laboratory, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Connie W C Hui
- Cancer Drug Testing Unit, Partner State Key Laboratory of Oncology in South China, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi H Wong
- Cancer Drug Testing Unit, Partner State Key Laboratory of Oncology in South China, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anthony T C Chan
- Comprehensive Cancer Trials Unit, Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China. .,Cancer Drug Testing Unit, Partner State Key Laboratory of Oncology in South China, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Tumor Marker Laboratory, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Prawira A, Oosting SF, Chen TW, delos Santos KA, Saluja R, Wang L, Siu LL, Chan KKW, Hansen AR. Systemic therapies for recurrent or metastatic nasopharyngeal carcinoma: a systematic review. Br J Cancer 2017; 117:1743-1752. [PMID: 29065104 PMCID: PMC5729473 DOI: 10.1038/bjc.2017.357] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/08/2017] [Accepted: 09/21/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The majority of published studies in recurrent or metastatic nasopharyngeal carcinoma (RM-NPC) are single-arm trials. Reliable modelling of progression-free survival (PFS) and overall survival (OS) outcomes, therefore, is difficult. This study aim to analyse existent literature to estimate the relative efficacy of available systemic regimens in RM-NPC, as well as provide estimates of aggregate OS and PFS. METHODS We conducted a systematic search of MEDLINE, EMBASE and the Cochrane Library to March 2015. Clinical trials (in English only) investigating cytotoxic and molecularly targeted agents in adult patients with RM-NPC were included. All relevant studies were assessed for quality using Downs and Blacks (DB) checklist (maximum quality score of 27). Aggregate data analysis and Student's t-test were performed for all identified studies (model A). For studies that published analysable Kaplan-Meier curves, survival data were extracted and marginal proportional hazards models were constructed (model B). RESULTS A total of 56 studies were identified and included in model A, 26 of which had analysable Kaplan-Meier curves and were included in model B. The 26 studies in model B had significantly higher mean DB scores than the remaining 30 (17.3 vs 13.7, P=0.002). For patients receiving first line chemotherapy, the estimated median OS was 15.7 months by model A (95% CI, 12.3-19.1), and 19.3 months by model B (95% CI, 17.6-21.1). For patients undergoing second line or higher therapies (2nd+), the estimated median OS was 11.5 months by model A (95% CI 10.1-12.9), and 12.5 months by model B (95% CI 11.9-13.4). PFS estimates for patients undergoing first-line chemotherapy by model A was 7.6 months (95% CI, 6.2-9.0), and 8.0 months by model B (95% CI, 7.6-8.8). For patients undergoing therapy in the 2nd+ setting, the estimated PFS by model A was 5.4 months (95% CI, 3.8-7.0), and 5.2 months by model B (95% CI, 4.7-5.6). CONCLUSIONS We present the first aggregate estimates of OS and PFS for RM-NPC patients receiving first and second-line or higher treatment settings, which could inform the design of future clinical trials in this disease setting.
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Affiliation(s)
- A Prawira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - S F Oosting
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - T W Chen
- Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
| | | | - R Saluja
- University of Waterloo, Toronto, ON, Canada
| | - L Wang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - L L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - K K W Chan
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - A R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Nakanishi Y, Wakisaka N, Kondo S, Endo K, Sugimoto H, Hatano M, Ueno T, Ishikawa K, Yoshizaki T. Progression of understanding for the role of Epstein-Barr virus and management of nasopharyngeal carcinoma. Cancer Metastasis Rev 2017; 36:435-447. [PMID: 28819752 PMCID: PMC5613035 DOI: 10.1007/s10555-017-9693-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nasopharyngeal carcinoma (NPC) is very common in southern China and Southeast Asia. In regions where NPC is endemic, undifferentiated subtypes constitute most cases and are invariably associated with Epstein-Barr virus (EBV) infection, whereas the differentiated subtype is more common in other parts of the world. Undifferentiated NPC is a unique malignancy with regard to its epidemiology, etiology, and clinical presentation. Clinically, NPC is highly invasive and metastatic, but sensitive to both chemotherapy and radiotherapy (RT). Overall prognosis has dramatically improved over the past three decades because of advances in management, including the improvement of RT technology, the broader application of chemotherapy, and more accurate disease staging. Despite the excellent local control with modern RT, distant failure remains a challenging problem. Advances in molecular technology have helped to elucidate the molecular pathogenesis of NPC. This article reviews the contribution of EBV gene products to NPC pathogenesis and the current management of NPC.
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Affiliation(s)
- Yosuke Nakanishi
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Naohiro Wakisaka
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Satoru Kondo
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Kazuhira Endo
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Hisashi Sugimoto
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Miyako Hatano
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Takayoshi Ueno
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Kazuya Ishikawa
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan
| | - Tomokazu Yoshizaki
- Division of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Japan.
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Palliative systemic therapy for recurrent or metastatic nasopharyngeal carcinoma – How far have we achieved? Crit Rev Oncol Hematol 2017; 114:13-23. [DOI: 10.1016/j.critrevonc.2017.03.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/28/2017] [Indexed: 02/05/2023] Open
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Abstract
INTRODUCTION Nasopharyngeal carcinoma (NPC) is endemic to Southern China and Asia and is etiologically associated with the Epstein Barr virus (EBV). Whole exome and genome sequencing (WES, WGS) studies of NPC have reported several actionable therapeutic targets, and that the mutational load of NPC maybe comparable to that of squamous head and neck cancer. These unique biological characteristics have been exploited as potential targets and a wide range of investigational drugs are being investigated in clinical trials. Area covered: This review focused on the latest clinical development of the most promising classes of investigational agents in the treatment of advanced NPC. These include inhibitors of tumor angiogenesis, kinase signaling pathways and immunotherapy. Expert opinion: Checkpoint inhibitors and EBV-specific T-cell therapy have shown promising activity in early phase clinical trials, and are being further evaluated in randomized studies. For patients whose tumors express genetic alterations that are known to predict response to kinase inhibitors, novel trial designs such as an 'Umbrella' study may be considered given the abundance of targeted agents that are now available for clinical evaluation. It is envisioned that regulatory approval for new drugs for advanced NPC will occur in the near future.
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Affiliation(s)
- Brigette B Y Ma
- a State Key Laboratory in Oncology in South China , Sir YK Pao Centre for Cancer , Hong Kong SAR , China.,b Department of Clinical Oncology , Hong Kong Cancer Institute , Hong Kong SAR , China.,c Li Ka Shing Institute of Health Sciences , The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Edwin P Hui
- a State Key Laboratory in Oncology in South China , Sir YK Pao Centre for Cancer , Hong Kong SAR , China.,b Department of Clinical Oncology , Hong Kong Cancer Institute , Hong Kong SAR , China.,c Li Ka Shing Institute of Health Sciences , The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Anthony T C Chan
- a State Key Laboratory in Oncology in South China , Sir YK Pao Centre for Cancer , Hong Kong SAR , China.,b Department of Clinical Oncology , Hong Kong Cancer Institute , Hong Kong SAR , China.,c Li Ka Shing Institute of Health Sciences , The Chinese University of Hong Kong , Hong Kong SAR , China
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Lee VH, Kwong DL, Lam KO, Lai YC, Li Y, Tong CC, Ho PP, Chan WL, Wong LS, Leung DK, Chan SY, Chan FT, Leung TW, Lee AW. Metronomic oral cyclosphosphamide as third-line systemic treatment or beyond in patients with inoperable locoregionally advanced recurrent or metastatic nasopharyngeal carcinoma. Medicine (Baltimore) 2017; 96:e6518. [PMID: 28403082 PMCID: PMC5403079 DOI: 10.1097/md.0000000000006518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
There is no standard third-line or further systemic treatment for patients with inoperable locoregionally advanced recurrent or metastatic nasopharyngeal carcinoma (NPC). Metronomic oral cyclophosphamide provides an acceptable and cheap option for these heavily pretreated patients who had limited choices. We conducted a prospective phase II single-arm open-label study of metronomic oral cyclophosphamide. Patients with locoregionally advanced recurrent inoperable (rT3/T4, rN2-N3b) or metastatic (rM1) NPC who had Eastern Cooperative Oncology Group (ECOG) performance status (PS) (0-2) and had progressed after at least 2 lines of palliative systemic chemotherapy were eligible. They received oral cyclophosphamide between 50 and 150 mg once daily until progressive disease or unacceptable toxicity. Objective response rate (ORR), disease control rate (DCR), biochemical response (two consecutive declines of plasma EBV DNA after treatment), progression-free survival (PFS), overall survival (OS), and safety profiles were evaluated. A total of 56 patients were recruited. Thirty-three, 13, 6, 3, and 1 patients received cyclophosphamide as 3rd, 4th, 5th, 6th, and 7th line of therapy respectively. After a median follow-up of 9.95 months (range 1.76-59.51 months), the ORR was 8.9% and the DCR was 57.1%. The median PFS and OS were 4.47 and 9.20 months, respectively. Those with PS 1 had longer median PFS (5.49 months) compared to those with PS 2 (3.75 months, P = .011). Besides, those who had locoregionally recurrent disease had better PFS (8.97 months, 95% CI, 0.53-17.41 months) compared to those who had distant metastases (4.14 months, 95% CI, 2.53-5.75 months, P = .020). Multivariable analysis revealed that PS 1 (vs 2) (P = .020) and locoregional recurrence (vs metastasis) (P = .029) were the only significant independent prognostic factors of PFS. Around 16 (28.6%) patients developed grade ≥3 adverse events, including malaise (5.4%), hematological (8.9%), gastrointestinal (3.6%), feverish (3.6%), and hemorrhagic (1.8%) events. The median cost of the whole drug treatment was 51.65 US dollars (USD) (range 4.15-142.75 USD) (1 USD = 7.8 HK dollars [HKD]). Metronomic oral cyclophosphamide is an acceptable third-line or beyond systemic therapy for locoregionally advanced recurrent or metastatic NPC with acceptable toxicity and limited financial burden.
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Wang S, Pan Y, Zhang R, Xu T, Wu W, Zhang R, Wang C, Huang H, Calin CA, Yang H, Claret FX. Hsa-miR-24-3p increases nasopharyngeal carcinoma radiosensitivity by targeting both the 3'UTR and 5'UTR of Jab1/CSN5. Oncogene 2016; 35:6096-6108. [PMID: 27157611 PMCID: PMC5102828 DOI: 10.1038/onc.2016.147] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 12/18/2022]
Abstract
Radiotherapy is the standard therapy for nasopharyngeal carcinoma (NPC); however, radioresistance can hinder successful treatment. Here we report that microRNA (miR)-24 acts as a tumor suppressor and radiosensitizer in NPC cells and xenografts by targeting Jab1/CSN5. Although accumulating evidence has shown that Jab1/CSN5 functions as an oncoprotein in human cancers, its regulation through miRs has not been described. In this study, we found that Jab1/CSN5 functioned in a manner opposite to that of miR-24 in NPC tumorigenesis and radioresistance. We demonstrated that miR-24 inhibits Jab1/CSN5 translation via direct binding to its 3' untranslated region (3'UTR) and 5'UTR, leading to tumor growth inhibition, and sensitizes NPC tumors to radiation in vivo. Furthermore, silencing Jab1/CSN5 phenocopied the function of miR-24 in NPC cells after ionizing radiation treatment, resulting in increased apoptosis. Finally, we analyzed 50 paired samples of primary and matched recurrent NPC tissues from 25 NPC patients and subjected them to high-throughput genomic quantitative nuclease protection assay for quantifying simultaneously miR and mRNA levels. Our results showed that miR-24 levels were significantly decreased in recurrent NPC and that levels of Jab1/CSN5, as its target, were higher than those in primary NPC. Together, our findings indicate that miR-24 inhibits NPC tumor growth and increases NPC radiosensitivity by directly regulating Jab1/CSN5 and that both miR-24 and Jab1/CSN5 can serve as prognostic markers for NPC recurrence; this, in turn, may provide a promising therapeutic strategy for reversing NPC radioresistance.
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Affiliation(s)
- S Wang
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People's Republic of China.,Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y Pan
- Department of Pathology, Affiliated Hospital, Wuxi Medical School, Jiangnan University, Wuxi, People's Republic of China
| | - R Zhang
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - T Xu
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiation Oncology, First People's Hospital of Foshan, Affiliated with Sun Yat-Sen University, Foshan, People's Republic of China
| | - W Wu
- Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, People's Republic of China
| | - R Zhang
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Wang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - H Huang
- Department of Radiation, Oncology, Cancer Center, Shantou Central Hospital, Shantou, People's Republic of China
| | - C A Calin
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The Center for RNA Interference and Non-Coding RNAs, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - H Yang
- Department of Pathophysiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - F X Claret
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Experimental Therapeutics Academic Program and Cancer Biology Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA
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Saba NF, Salama JK, Beitler JJ, Busse PM, Cooper JS, Jones CU, Koyfman S, Quon H, Ridge JA, Siddiqui F, Worden F, Yao M, Yom SS. ACR Appropriateness criteria® for nasopharyngeal carcinoma. Head Neck 2016; 38:979-86. [PMID: 27131050 DOI: 10.1002/hed.24423] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) presents mostly with locally advanced disease and is treated with multimodal therapy; however, consensus is lacking for different clinical scenarios. METHODS The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. RESULTS The ACR Expert Panel on Radiation Oncology - Head and Neck Cancer developed consensus recommendations for guiding management of nasopharyngeal carcinoma. CONCLUSION Multidisciplinary evaluation is essential to guiding the optimal use of surgery, radiation, and systemic therapy in this disease. © 2015 Wiley Periodicals, Inc. Head Neck 38: 979-986, 2016.
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Affiliation(s)
- Nabil F Saba
- Emory University, Atlanta, Georgia, American Society of Clinical Oncology
| | | | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - Harry Quon
- Johns Hopkins University, Baltimore, Maryland
| | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, American College of Surgeons
| | | | - Francis Worden
- University of Michigan, Ann Arbor, Michigan, American Society of Clinical Oncology
| | - Min Yao
- University Hospitals Case Medical Center, Cleveland, Ohio
| | - Sue S Yom
- University of California San Francisco, San Francisco, California
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Xue C, Tian Y, Zhang J, Zhao Y, Zhan J, Fang W, Zhang L. Efficacy of BIBF 1120 or BIBF 1120 plus chemotherapy on nasopharyngeal carcinoma in vitro and in vivo. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:1173-80. [PMID: 27042009 PMCID: PMC4801128 DOI: 10.2147/dddt.s96634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose BIBF 1120 is a potent triple angiokinase inhibitor now being evaluated in many types of tumors. We examine the antitumor effects of BIBF 1120 on nasopharyngeal carcinoma (NPC) in vitro and in vivo. Materials and methods The effect of BIBF 1120 on NPC cell proliferation was evaluated using the Cell Counting Kit 8 assay. The activities of BIBF 1120 as a single agent and in combination with cisplatin (DDP) in NPC tumor xenografts were evaluated by measuring microvessel density and expression of vascular endothelial growth factor signaling. Results BIBF 1120 exhibited limited inhibition of the growth of three NPC cell lines. Concurrent administration of BIBF 1120 and DDP provided greater antitumor effects compared to that observed with the use of either inhibitor as a single agent in the NPC xenograft model. Microvessel density and expression of vascular endothelial growth factor signaling were significantly reduced. Conclusion BIBF 1120, either as a single agent or in combination with DDP, demonstrates significant antitumor and antiangiogenic effects in the NPC xenograft model. Our results indicate that BIBF 1120 administered in conjunction with chemotherapy might provide an effective treatment method for NPC.
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Affiliation(s)
- Cong Xue
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Ying Tian
- Department of Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Jing Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou Traditional Chinese Medicine University, Guangzhou, People's Republic of China
| | - Yuanyuan Zhao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Jianhua Zhan
- Department of Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Wenfeng Fang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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