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Salgia R, Mambetsariev I, Pharaon R, Fricke J, Baroz AR, Hozo I, Chen C, Koczywas M, Massarelli E, Reckamp K, Djulbegovic B. Evaluation of Omics-Based Strategies for the Management of Advanced Lung Cancer. JCO Oncol Pract 2020; 17:e257-e265. [PMID: 32639928 DOI: 10.1200/op.20.00117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Omic-informed therapy is being used more frequently for patients with non-small-cell lung cancer (NSCLC) being treated on the basis of evidence-based decision-making. However, there is a lack of a standardized framework to evaluate those decisions and understand the association between omics-based management strategies and survival among patients. Therefore, we compared outcomes between patients with lung adenocarcinoma who received omics-driven targeted therapy versus patients who received standard therapeutic options. PATIENTS AND METHODS This was a retrospective study of patients with advanced NSCLC adenocarcinoma (N = 798) at City of Hope who received genomic sequencing at the behest of their treating oncologists. A thoracic oncology registry was used as a clinicogenomic database to track patient outcomes. RESULTS Of 798 individuals with advanced NSCLC (median age, 65 years [range, 22-99 years]; 60% white; 50% with a history of smoking), 662 patients (83%) had molecular testing and 439 (55%) received targeted therapy on the basis of the omic-data. A fast-and-frugal decision tree (FFT) model was developed to evaluate the impact of omics-based strategy on decision-making, progression-free survival (PFS), and overall survival (OS). We calculated that the overall positive predictive value of the entire FFT strategy for predicting decisions regarding the use of tyrosine kinase inhibitor-based targeted therapy was 88% and the negative predictive value was 96%. In an adjusted Cox regression analysis, there was a significant correlation with survival benefit with the FFT omics-driven therapeutic strategy for both PFS (hazard ratio [HR], 0.56; 95% CI, 0.42 to 0.74; P < .001) and OS (HR, 0.51; 95% CI, 0.36 to 0.71; P < .001) as compared with standard therapeutic options. CONCLUSION Among patients with advanced NSCLC who received care in the academic oncology setting, omics-driven therapy decisions directly informed treatment in patients and was correlated with better OS and PFS.
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Affiliation(s)
- Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Isa Mambetsariev
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Rebecca Pharaon
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Jeremy Fricke
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Angel Ray Baroz
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Iztok Hozo
- Department of Mathematics, Indiana University Northwest, Gary, IN
| | - Chen Chen
- Applied AI and Data Science, City of Hope, Duarte, CA
| | - Marianna Koczywas
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Erminia Massarelli
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Karen Reckamp
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA.,Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Benjamin Djulbegovic
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
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2
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Comprehensive tumor profiling-guided therapy in rare or refractory solid cancer: A feasibility study in daily clinical practice. Bull Cancer 2020; 107:410-416. [DOI: 10.1016/j.bulcan.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 12/03/2019] [Accepted: 12/22/2019] [Indexed: 11/22/2022]
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3
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Mambetsariev I, Wang Y, Chen C, Nadaf S, Pharaon R, Fricke J, Amanam I, Amini A, Bild A, Chu P, Erhunmwunsee L, Kim J, Munu J, Pillai R, Raz D, Sampath S, Vora L, Qiu F, Smith L, Batra SK, Massarelli E, Koczywas M, Reckamp K, Salgia R. Precision medicine and actionable alterations in lung cancer: A single institution experience. PLoS One 2020; 15:e0228188. [PMID: 32045431 PMCID: PMC7012442 DOI: 10.1371/journal.pone.0228188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/10/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Oncology has become more reliant on new testing methods and a greater use of electronic medical records, which provide a plethora of information available to physicians and researchers. However, to take advantage of vital clinical and research data for precision medicine, we must initially make an effort to create an infrastructure for the collection, storage, and utilization of this information with uniquely designed disease-specific registries that could support the collection of a large number of patients. MATERIALS AND METHODS In this study, we perform an in-depth analysis of a series of lung adenocarcinoma patients (n = 415) with genomic and clinical data in a recently created thoracic patient registry. RESULTS Of the 415 patients with lung adenocarcinoma, 59% (n = 245) were female; the median age was 64 (range, 22-92) years with a median OS of 33.29 months (95% CI, 29.77-39.48). The most common actionable alterations were identified in EGFR (n = 177/415 [42.7%]), ALK (n = 28/377 [7.4%]), and BRAF V600E (n = 7/288 [2.4%]). There was also a discernible difference in survival for 222 patients, who had an actionable alteration, with a median OS of 39.8 months as compared to 193 wild-type patients with a median OS of 26.0 months (P<0.001). We identified an unprecedented number of actionable alterations [53.5% (222/415)], including distinct individual alteration rates, as compared with 15.0% and 22.3% in TCGA and GENIE respectively. CONCLUSION The use of patient registries, focused genomic panels and the appropriate use of clinical guidelines in community and academic settings may influence cohort selection for clinical trials and improve survival outcomes.
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Affiliation(s)
- Isa Mambetsariev
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Yingyu Wang
- Center for Informatics, City of Hope, Duarte, California, United States of America
| | - Chen Chen
- Center for Informatics, City of Hope, Duarte, California, United States of America
| | - Sorena Nadaf
- Center for Informatics, City of Hope, Duarte, California, United States of America
| | - Rebecca Pharaon
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Jeremy Fricke
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Idoroenyi Amanam
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, United States of America
| | - Andrea Bild
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Peiguo Chu
- Department of Pathology, City of Hope, Duarte, California, United States of America
| | - Loretta Erhunmwunsee
- Department of Thoracic Surgery, City of Hope, Duarte, California, United States of America
| | - Jae Kim
- Department of Thoracic Surgery, City of Hope, Duarte, California, United States of America
| | - Janet Munu
- Center for Informatics, City of Hope, Duarte, California, United States of America
| | - Raju Pillai
- Department of Pathology, City of Hope, Duarte, California, United States of America
| | - Dan Raz
- Department of Thoracic Surgery, City of Hope, Duarte, California, United States of America
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope, Duarte, California, United States of America
| | - Lalit Vora
- Department of Diagnostic Radiology, City of Hope, Duarte, California, United States of America
| | - Fang Qiu
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Lynette Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Surinder K. Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Erminia Massarelli
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Marianna Koczywas
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Karen Reckamp
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California, United States of America
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Integrating molecular nuclear imaging in clinical research to improve anticancer therapy. Nat Rev Clin Oncol 2019; 16:241-255. [PMID: 30479378 DOI: 10.1038/s41571-018-0123-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effective patient selection before or early during treatment is important to increasing the therapeutic benefits of anticancer treatments. This selection process is often predicated on biomarkers, predominantly biospecimen biomarkers derived from blood or tumour tissue; however, such biomarkers provide limited information about the true extent of disease or about the characteristics of different, potentially heterogeneous tumours present in an individual patient. Molecular imaging can also produce quantitative outputs; such imaging biomarkers can help to fill these knowledge gaps by providing complementary information on tumour characteristics, including heterogeneity and the microenvironment, as well as on pharmacokinetic parameters, drug-target engagement and responses to treatment. This integrative approach could therefore streamline biomarker and drug development, although a range of issues need to be overcome in order to enable a broader use of molecular imaging in clinical trials. In this Perspective article, we outline the multistage process of developing novel molecular imaging biomarkers. We discuss the challenges that have restricted the use of molecular imaging in clinical oncology research to date and outline future opportunities in this area.
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Gong J, Pan K, Fakih M, Pal S, Salgia R. Value-based genomics. Oncotarget 2018; 9:15792-15815. [PMID: 29644010 PMCID: PMC5884665 DOI: 10.18632/oncotarget.24353] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/19/2018] [Indexed: 12/18/2022] Open
Abstract
Advancements in next-generation sequencing have greatly enhanced the development of biomarker-driven cancer therapies. The affordability and availability of next-generation sequencers have allowed for the commercialization of next-generation sequencing platforms that have found widespread use for clinical-decision making and research purposes. Despite the greater availability of tumor molecular profiling by next-generation sequencing at our doorsteps, the achievement of value-based care, or improving patient outcomes while reducing overall costs or risks, in the era of precision oncology remains a looming challenge. In this review, we highlight available data through a pre-established and conceptualized framework for evaluating value-based medicine to assess the cost (efficiency), clinical benefit (effectiveness), and toxicity (safety) of genomic profiling in cancer care. We also provide perspectives on future directions of next-generation sequencing from targeted panels to whole-exome or whole-genome sequencing and describe potential strategies needed to attain value-based genomics.
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Affiliation(s)
- Jun Gong
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Kathy Pan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Sumanta Pal
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Ravi Salgia
- Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Jardim DL, Schwaederle M, Hong DS, Kurzrock R. An appraisal of drug development timelines in the Era of precision oncology. Oncotarget 2018; 7:53037-53046. [PMID: 27419632 PMCID: PMC5288167 DOI: 10.18632/oncotarget.10588] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 06/30/2016] [Indexed: 11/25/2022] Open
Abstract
The effects of incorporating a biomarker-based (personalized or precision) selection strategy on drug development timelines for new oncology drugs merit investigation. Here we accessed documents from the Food and Drug Administration (FDA) database for anticancer agents approved between 09/1998 and 07/2014 to compare drugs developed with and without a personalized strategy. Sixty-three drugs were included (28 [44%] personalized and 35 [56%] non-personalized). No differences in access to FDA-expedited programs were observed between personalized and non-personalized drugs. A personalized approach for drug development was associated with faster clinical development (Investigational New Drug [IND] to New Drug Application [NDA] submission; median = 58.8 months [95% CI 53.8-81.8] vs. 93.5 months [95% CI 73.9-112.9], P =.001), but a similar approval time (NDA submission to approval; median=6.0 months [95% CI 5.5-8.4] vs. 6.1 months [95% CI 5.9-8.3], P = .756) compared to a non-personalized strategy. In the multivariate model, class of drug stratified by personalized status (targeted personalized vs. targeted non-personalized vs. cytotoxic) was the only independent factor associated with faster total time of clinical drug development (clinical plus approval phase, median = 64.6 vs 87.1 vs. 112.7 months [cytotoxic], P = .038). Response rates (RR) in early trials were positively correlated with RR in registration trials (r = 0.63, P = <.001), and inversely associated with total time of drug development (r = -0.29, P = .049). In conclusion, targeted agents were developed faster than cytotoxic agents. Shorter times to approval were associated, in multivariate analysis, with a biomarker-based clinical development strategy.
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Affiliation(s)
| | - Maria Schwaederle
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA, USA
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7
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Simon R. Critical Review of Umbrella, Basket, and Platform Designs for Oncology Clinical Trials. Clin Pharmacol Ther 2017; 102:934-941. [PMID: 28795401 DOI: 10.1002/cpt.814] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/14/2017] [Accepted: 08/01/2017] [Indexed: 12/13/2022]
Abstract
The successful development of new drugs with a companion diagnostic based on genomic alteration of an oncogene has led to rethinking of all phases on clinical development of cancer drugs. We critically review some of the new clinical trial designs for biomarker-based cancer drug development. We try to clarify the objectives of the new designs and examine completed trials using these designs to evaluate what has been learned about these designs.
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8
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Schwartz LH, Litière S, de Vries E, Ford R, Gwyther S, Mandrekar S, Shankar L, Bogaerts J, Chen A, Dancey J, Hayes W, Hodi FS, Hoekstra OS, Huang EP, Lin N, Liu Y, Therasse P, Wolchok JD, Seymour L. RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer 2016; 62:132-7. [PMID: 27189322 DOI: 10.1016/j.ejca.2016.03.081] [Citation(s) in RCA: 1094] [Impact Index Per Article: 136.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/27/2016] [Indexed: 12/11/2022]
Abstract
The Response Evaluation Criteria in Solid Tumours (RECIST) were developed and published in 2000, based on the original World Health Organisation guidelines first published in 1981. In 2009, revisions were made (RECIST 1.1) incorporating major changes, including a reduction in the number of lesions to be assessed, a new measurement method to classify lymph nodes as pathologic or normal, the clarification of the requirement to confirm a complete response or partial response and new methodologies for more appropriate measurement of disease progression. The purpose of this paper was to summarise the questions posed and the clarifications provided as an update to the 2009 publication.
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Affiliation(s)
- Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA.
| | | | - Elisabeth de Vries
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Stephen Gwyther
- Department of Medical Imaging, East Surrey Hospital, Redhill, Surrey, UK
| | - Sumithra Mandrekar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Lalitha Shankar
- Clinical Trials Branch, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | | | - Alice Chen
- Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Janet Dancey
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - Wendy Hayes
- Exploratory Clinical & Translational Research, Bristol-Myers Squibb, Princeton, NJ, USA
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Erich P Huang
- National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Nancy Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | | | | | - Jedd D Wolchok
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical and Graduate Colleges, New York, NY, USA; Ludwig Institute for Cancer Research, New York, NY, USA
| | - Lesley Seymour
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
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Park HS, Lim SM, Kim S, Kim S, Kim HR, Kwack K, Lee MG, Kim JH, Moon YW. Pilot Study of a Next-Generation Sequencing-Based Targeted Anticancer Therapy in Refractory Solid Tumors at a Korean Institution. PLoS One 2016; 11:e0154133. [PMID: 27105424 PMCID: PMC4841558 DOI: 10.1371/journal.pone.0154133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 04/09/2016] [Indexed: 11/22/2022] Open
Abstract
We evaluated the preliminary efficacy and feasibility of a next-generation sequencing (NGS)-based targeted anticancer therapy in refractory solid tumors at a Korean institution. Thirty-six patients with advanced cancer underwent molecular profiling with NGS with the intent of clinical application of available matched targeted agents. Formalin-fixed paraffin-embedded (FFPE) tumors were sequenced using the Comprehensive Cancer Panel (CCP) or FoundationOne in the Clinical Laboratory Improvement Amendments-certified laboratory in the USA. Response evaluations were performed according to RECIST v1.1. Four specimens did not pass the DNA quality test and 32 specimens were successfully sequenced with CCP (n = 31) and FoundationOne (n = 1). Of the 32 sequenced patients, 10 (31.3%) were ≤40 years. Twelve patients (37.5%) had received ≥3 types of prior systemic therapies. Of 24 patients with actionable mutations, five were given genotype-matched drugs corresponding to actionable mutations: everolimus to PIK3CA mutation in parotid carcinosarcoma (partial response) and tracheal squamous cell carcinoma (stable disease; 21% reduction), sorafenib to PDGFRA mutation in auditory canal adenocarcinoma (partial response), sorafenib to BRAF mutation in microcytic adnexal carcinoma (progressive disease), and afatinib to ERBB2 mutation in esophageal adenocarcinoma (progressive disease). Nineteen of 24 patients with actionable mutations could not undergo targeted therapy based on genomic testing because of declining performance status (10/24, 41.7%), stable disease with previous treatment (5/24, 20.8%), and lack of access to targeted medication (4/24, 16.7%). NGS-based targeted therapy may be a good option in selected patients with refractory solid tumors. To pursue this strategy in Korea, lack of access to clinical-grade NGS assays and a limited number of genotype-matched targeted medications needs to be addressed and resolved.
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Affiliation(s)
- Hyung Soon Park
- Department of Pharmacology and Brain Korea 21 Plus Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Min Lim
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sora Kim
- Severance Biomedical Science Institute and Brain Korea 21 Plus Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Sangwoo Kim
- Severance Biomedical Science Institute and Brain Korea 21 Plus Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Ryun Kim
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - KyuBum Kwack
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam, Korea
| | - Min Goo Lee
- Department of Pharmacology and Brain Korea 21 Plus Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea
| | - Joo-Hang Kim
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yong Wha Moon
- Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Schwaederle M, Daniels GA, Piccioni DE, Kesari S, Fanta PT, Schwab RB, Shimabukuro KA, Parker BA, Kurzrock R. Next generation sequencing demonstrates association between tumor suppressor gene aberrations and poor outcome in patients with cancer. Cell Cycle 2016; 14:1730-7. [PMID: 25928476 PMCID: PMC4614790 DOI: 10.1080/15384101.2015.1033596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Next generation sequencing is transforming patient care by allowing physicians to customize and match treatment to their patients’ tumor alterations. Our goal was to study the association between key molecular alterations and outcome parameters. We evaluated the characteristics and outcomes (overall survival (OS), time to metastasis/recurrence, and best progression-free survival (PFS)) of 392 patients for whom next generation sequencing (182 or 236 genes) had been performed. The Kaplan-Meier method and Cox regression models were used for our analysis, and results were subjected to internal validation using a resampling method (bootstrap analysis). In a multivariable analysis (Cox regression model), the parameters that were statistically associated with a poorer overall survival were the presence of metastases at diagnosis (P = 0.014), gastrointestinal histology (P < 0.0001), PTEN (P < 0.0001), and CDKN2A alterations (P = 0.0001). The variables associated with a shorter time to metastases/recurrence were gastrointestinal histology (P = 0.004), APC (P = 0.008), PTEN (P = 0.026) and TP53 (P = 0.044) alterations. TP53 (P = 0.003) and PTEN (P = 0.034) alterations were independent predictors of a shorter best PFS. A personalized treatment approach (matching the molecular aberration with a cognate targeted drug) also correlated with a longer best PFS (P = 0.046). Our study demonstrated that, across diverse cancers, anomalies in specific tumor suppressor genes (PTEN, CDKN2A, APC, and/or TP53) were independently associated with a worse outcome, as reflected by time to metastases/recurrence, best PFS on treatment, and/or overall survival. These observations suggest that molecular diagnostic tests may provide important prognostic information in patients with cancer.
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Affiliation(s)
- Maria Schwaederle
- a Center for Personalized Cancer Therapy, and Division of Hematology and Oncology; UCSD Moores Cancer Center ; La Jolla , CA , USA
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11
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Molecular landscape of pancreatic cancer: implications for current clinical trials. Oncotarget 2016; 6:4553-61. [PMID: 25714017 PMCID: PMC4467098 DOI: 10.18632/oncotarget.2972] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/18/2022] Open
Abstract
Despite recent improvements, overall survival for advanced adenocarcinoma of the pancreas continues to be poor. In comparison to other tumor types that have enjoyed marked survival benefit by targeting aberrant cell signaling pathways, standard of care treatment for pancreatic cancer is limited to conventional cytotoxic chemotherapy. Multiple pathway aberrations have been documented in pancreatic cancer. A review of the COSMIC database reveals that most pancreatic cancers contain somatic mutations, with the five most frequent being KRAS, TP53, CDKN2A, SMAD4, and ARID1A, and multiple other abnormalities seen including, but not limited to, mutations in STK11/LKB1, FBXW7, PIK3CA, and BRAF. In the era of tumor profiling, these aberrations may provide an opportunity for new therapeutic approaches. Yet, searching clinicaltrials.gov for recent drug intervention trials for pancreatic adenocarcinoma, remarkably few (10 of 116 (8.6%)) new study protocols registered in the last three years included a molecular/biomarker stratification strategy. Enhanced efforts to target subsets of patients with pancreatic cancer in order to optimize therapy benefit are warranted.
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12
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Jardim DL, Fontes Jardim DL, Schwaederle M, Wei C, Lee JJ, Hong DS, Eggermont AM, Schilsky RL, Mendelsohn J, Lazar V, Kurzrock R. Impact of a Biomarker-Based Strategy on Oncology Drug Development: A Meta-analysis of Clinical Trials Leading to FDA Approval. J Natl Cancer Inst 2015; 107:djv253. [PMID: 26378224 DOI: 10.1093/jnci/djv253] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 08/17/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In order to ascertain the impact of a biomarker-based (personalized) strategy, we compared outcomes between US Food and Drug Administration (FDA)-approved cancer treatments that were studied with and without such a selection rationale. METHODS Anticancer agents newly approved (September 1998 to June 2013) were identified at the Drugs@FDA website. Efficacy, treatment-related mortality, and hazard ratios (HRs) for time-to-event endpoints were analyzed and compared in registration trials for these agents. All statistical tests were two-sided. RESULTS Fifty-eight drugs were included (leading to 57 randomized [32% personalized] and 55 nonrandomized trials [47% personalized], n = 38 104 patients). Trials adopting a personalized strategy more often included targeted (100% vs 65%, P < .001), oral (68% vs 35%, P = .001), and single agents (89% vs 71%, P = .04) and more frequently permitted crossover to experimental treatment (67% vs 28%, P = .009). In randomized registration trials (using a random-effects meta-analysis), personalized therapy arms were associated with higher relative response rate ratios (RRRs, compared with their corresponding control arms) (RRRs = 3.82, 95% confidence interval [CI] = 2.51 to 5.82, vs RRRs = 2.08, 95% CI = 1.76 to 2.47, adjusted P = .03), longer PFS (hazard ratio [HR] = 0.41, 95% CI = 0.33 to 0.51, vs HR = 0.59, 95% CI = 0.53 to 0.65, adjusted P < .001) and a non-statistically significantly longer OS (HR = 0.71, 95% CI = 0.61 to 0.83, vs HR = 0.81, 95% CI = 0.77 to 0.85, adjusted P = .07) compared with nonpersonalized trials. Analysis of experimental arms in all 112 registration trials (randomized and nonrandomized) demonstrated that personalized therapy was associated with higher response rate (48%, 95% CI = 42% to 55%, vs 23%, 95% CI = 20% to 27%, P < .001) and longer PFS (median = 8.3, interquartile range [IQR] = 5 vs 5.5 months, IQR = 5, adjusted P = .002) and OS (median = 19.3, IQR = 17 vs 13.5 months, IQR = 8, Adjusted P = .04). A personalized strategy was an independent predictor of better RR, PFS, and OS, as demonstrated by multilinear regression analysis. Treatment-related mortality rate was similar for personalized and nonpersonalized trials. CONCLUSIONS A biomarker-based approach was safe and associated with improved efficacy outcomes in FDA-approved anticancer agents.
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Affiliation(s)
- Denis L Jardim
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM).
| | - Denis L Fontes Jardim
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM).
| | - Maria Schwaederle
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM)
| | - Caimiao Wei
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM)
| | - J Jack Lee
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM)
| | - David S Hong
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM)
| | - Alexander M Eggermont
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM)
| | - Richard L Schilsky
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM)
| | - John Mendelsohn
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM)
| | - Vladimir Lazar
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM)
| | - Razelle Kurzrock
- Department of Clinical Medicine, Hemocentro da Unicamp, University of Campinas, Sao Paulo, Brazil (DLFJ); Department of Clinical Oncology, Hospital Sirio Libanes, Sao Paulo, Brazil (DLFJ); Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA (MS, RK); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (CW, JJL); Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX (DSH); Department of Functional Genomics, Institut Gustave Roussy, University Paris-Sud, Villejuif, France (AME, VL); Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France (AME, RLS, JM, VL, RK); American Society of Clinical Oncology, Alexandria, VA (RLS); The University of Texas MD Anderson Cancer Center, Houston, TX (JM).
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Schwaederle M, Zhao M, Lee JJ, Eggermont AM, Schilsky RL, Mendelsohn J, Lazar V, Kurzrock R. Impact of Precision Medicine in Diverse Cancers: A Meta-Analysis of Phase II Clinical Trials. J Clin Oncol 2015; 33:3817-25. [PMID: 26304871 DOI: 10.1200/jco.2015.61.5997] [Citation(s) in RCA: 324] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The impact of a personalized cancer treatment strategy (ie, matching patients with drugs based on specific biomarkers) is still a matter of debate. METHODS We reviewed phase II single-agent studies (570 studies; 32,149 patients) published between January 1, 2010, and December 31, 2012 (PubMed search). Response rate (RR), progression-free survival (PFS), and overall survival (OS) were compared for arms that used a personalized strategy versus those that did not. RESULTS Multivariable analysis (both weighted multiple linear regression and random effects meta-regression) demonstrated that the personalized approach, compared with a nonpersonalized approach, consistently and independently correlated with higher median RR (31% v 10.5%, respectively; P < .001) and prolonged median PFS (5.9 v 2.7 months, respectively; P < .001) and OS (13.7 v 8.9 months, respectively; P < .001). Nonpersonalized targeted arms had poorer outcomes compared with either personalized targeted therapy or cytotoxics, with median RR of 4%, 30%, and 11.9%, respectively; median PFS of 2.6, 6.9, and 3.3 months, respectively (all P < .001); and median OS of 8.7, 15.9, and 9.4 months, respectively (all P < .05). Personalized arms using a genomic biomarker had higher median RR and prolonged median PFS and OS (all P ≤ .05) compared with personalized arms using a protein biomarker. A personalized strategy was associated with a lower treatment-related death rate than a nonpersonalized strategy (median, 1.5% v 2.3%, respectively; P < .001). CONCLUSION Comprehensive analysis of phase II, single-agent arms revealed that, across malignancies, a personalized strategy was an independent predictor of better outcomes and fewer toxic deaths. In addition, nonpersonalized targeted therapies were associated with significantly poorer outcomes than cytotoxic agents, which in turn were worse than personalized targeted therapy.
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Affiliation(s)
- Maria Schwaederle
- Maria Schwaederle, Melissa Zhao, and Razelle Kurzrock, Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, CA; J. Jack Lee and John Mendelsohn, The University of Texas MD Anderson Cancer Center, Houston, TX; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Alexander M. Eggermont and Vladimir Lazar, Institut Gustave Roussy, University Paris-Sud; and Alexander M. Eggermont, Richard L. Schilsky, John Mendelsohn, Vladimir Lazar, and Razelle Kurzrock, Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France.
| | - Melissa Zhao
- Maria Schwaederle, Melissa Zhao, and Razelle Kurzrock, Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, CA; J. Jack Lee and John Mendelsohn, The University of Texas MD Anderson Cancer Center, Houston, TX; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Alexander M. Eggermont and Vladimir Lazar, Institut Gustave Roussy, University Paris-Sud; and Alexander M. Eggermont, Richard L. Schilsky, John Mendelsohn, Vladimir Lazar, and Razelle Kurzrock, Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France
| | - J Jack Lee
- Maria Schwaederle, Melissa Zhao, and Razelle Kurzrock, Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, CA; J. Jack Lee and John Mendelsohn, The University of Texas MD Anderson Cancer Center, Houston, TX; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Alexander M. Eggermont and Vladimir Lazar, Institut Gustave Roussy, University Paris-Sud; and Alexander M. Eggermont, Richard L. Schilsky, John Mendelsohn, Vladimir Lazar, and Razelle Kurzrock, Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France
| | - Alexander M Eggermont
- Maria Schwaederle, Melissa Zhao, and Razelle Kurzrock, Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, CA; J. Jack Lee and John Mendelsohn, The University of Texas MD Anderson Cancer Center, Houston, TX; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Alexander M. Eggermont and Vladimir Lazar, Institut Gustave Roussy, University Paris-Sud; and Alexander M. Eggermont, Richard L. Schilsky, John Mendelsohn, Vladimir Lazar, and Razelle Kurzrock, Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France
| | - Richard L Schilsky
- Maria Schwaederle, Melissa Zhao, and Razelle Kurzrock, Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, CA; J. Jack Lee and John Mendelsohn, The University of Texas MD Anderson Cancer Center, Houston, TX; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Alexander M. Eggermont and Vladimir Lazar, Institut Gustave Roussy, University Paris-Sud; and Alexander M. Eggermont, Richard L. Schilsky, John Mendelsohn, Vladimir Lazar, and Razelle Kurzrock, Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France
| | - John Mendelsohn
- Maria Schwaederle, Melissa Zhao, and Razelle Kurzrock, Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, CA; J. Jack Lee and John Mendelsohn, The University of Texas MD Anderson Cancer Center, Houston, TX; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Alexander M. Eggermont and Vladimir Lazar, Institut Gustave Roussy, University Paris-Sud; and Alexander M. Eggermont, Richard L. Schilsky, John Mendelsohn, Vladimir Lazar, and Razelle Kurzrock, Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France
| | - Vladimir Lazar
- Maria Schwaederle, Melissa Zhao, and Razelle Kurzrock, Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, CA; J. Jack Lee and John Mendelsohn, The University of Texas MD Anderson Cancer Center, Houston, TX; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Alexander M. Eggermont and Vladimir Lazar, Institut Gustave Roussy, University Paris-Sud; and Alexander M. Eggermont, Richard L. Schilsky, John Mendelsohn, Vladimir Lazar, and Razelle Kurzrock, Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France
| | - Razelle Kurzrock
- Maria Schwaederle, Melissa Zhao, and Razelle Kurzrock, Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, CA; J. Jack Lee and John Mendelsohn, The University of Texas MD Anderson Cancer Center, Houston, TX; Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Alexander M. Eggermont and Vladimir Lazar, Institut Gustave Roussy, University Paris-Sud; and Alexander M. Eggermont, Richard L. Schilsky, John Mendelsohn, Vladimir Lazar, and Razelle Kurzrock, Worldwide Innovative Network in Personalized Cancer Medicine, Villejuif, France
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14
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Randall JM, Millard F, Kurzrock R. Molecular aberrations, targeted therapy, and renal cell carcinoma: current state-of-the-art. Cancer Metastasis Rev 2015; 33:1109-24. [PMID: 25365943 DOI: 10.1007/s10555-014-9533-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Renal cell carcinoma (RCC) is among the most prevalent malignancies in the USA. Most RCCs are sporadic, but hereditary syndromes associated with RCC account for 2-3 % of cases and include von Hippel-Lindau, hereditary leiomyomatosis, Birt-Hogg-Dube, tuberous sclerosis, hereditary papillary RCC, and familial renal carcinoma. In the past decade, our understanding of the genetic mutations associated with sporadic forms of RCC has increased considerably, with the most common mutations in clear cell RCC seen in the VHL, PBRM1, BAP1, and SETD2 genes. Among these, BAP1 mutations are associated with aggressive disease and decreased survival. Several targeted therapies for advanced RCC have been approved and include sunitinib, sorafenib, pazopanib, axitinib (tyrosine kinase inhibitors (TKIs) with anti-vascular endothelial growth factor (VEGFR) activity), everolimus, and temsirolimus (TKIs that inhibit mTORC1, the downstream part of the PI3K/AKT/mTOR pathway). High-dose interleukin 2 (IL-2) immunotherapy and the combination of bevacizumab plus interferon-α are also approved treatments. At present, there are no predictive genetic markers to direct therapy for RCC, perhaps because the vast majority of trials have been evaluated in unselected patient populations, with advanced metastatic disease. This review will focus on our current understanding of the molecular genetics of RCC, and how this may inform therapeutics.
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Affiliation(s)
- J Michael Randall
- Department of Medicine, Division of Hematology/Oncology, UCSD Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, #0987, La Jolla, CA, 92093-0987, USA,
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15
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Schwaederle M, Daniels GA, Piccioni DE, Fanta PT, Schwab RB, Shimabukuro KA, Parker BA, Kurzrock R. On the Road to Precision Cancer Medicine: Analysis of Genomic Biomarker Actionability in 439 Patients. Mol Cancer Ther 2015; 14:1488-94. [PMID: 25852059 DOI: 10.1158/1535-7163.mct-14-1061] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/26/2015] [Indexed: 11/16/2022]
Abstract
Despite the increased use of molecular diagnostics, the extent to which patients who have these tests harbor potentially actionable aberrations is unclear. We retrospectively reviewed 439 patients with diverse cancers, for whom next-generation sequencing (mostly 236-gene panel) had been performed. Data pertaining to the molecular alterations identified, as well as associated treatment suggestions (on- or off-label, or experimental), were extracted from molecular diagnostic reports. Most patients (420/439; 96%) had at least one molecular alteration: 1,813 alterations (in 207 distinct genes) were identified [the majority being mutations (62%) or amplifications (29%)]. The three most common gene abnormalities were TP53 (44%), KRAS (16%), and PIK3CA (12%). The median number of alterations per patient was 3 (range, 0-16). Nineteen patients (4%) had no alterations; 48 patients (11%) had only one alteration; and 372 patients had two or more abnormalities (85%). The median number of potentially actionable anomalies per patient was 2 (range, 0-8). Most patients (393/439; 90%) had at least one potentially actionable alteration, and in all these cases the aberration could at least be targeted by an experimental drug in a clinical trial. A total of 307 patients (70%) had an alteration that was actionable with an approved drug, but in only 89 patients (20%) was the drug approved for their disease (on-label). Next-generation sequencing identified theoretically actionable aberrations in 90% of our patients. Many of the drugs are, however, experimental or would require off-label use. Strategies to address drug access for patients harboring potentially actionable mutations are needed.
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Affiliation(s)
- Maria Schwaederle
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, California.
| | - Gregory A Daniels
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, California
| | - David E Piccioni
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, California
| | - Paul T Fanta
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, California
| | - Richard B Schwab
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, California
| | - Kelly A Shimabukuro
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, California
| | - Barbara A Parker
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, California
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy, and Division of Hematology and Oncology, UCSD Moores Cancer Center, La Jolla, California
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Simon R, Blumenthal GM, Rothenberg ML, Sommer J, Roberts SA, Armstrong DK, LaVange LM, Pazdur R. The role of nonrandomized trials in the evaluation of oncology drugs. Clin Pharmacol Ther 2015; 97:502-7. [DOI: 10.1002/cpt.86] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 12/22/2014] [Accepted: 02/03/2015] [Indexed: 02/02/2023]
Affiliation(s)
- R Simon
- National Cancer Institute; Bethesda Maryland USA
| | - GM Blumenthal
- Food and Drug Administration (FDA); Silver Spring Maryland USA
| | | | - J Sommer
- Chordoma Foundation; Durham North Carolina USA
| | - SA Roberts
- Friends of Cancer Research; Washington DC USA
| | - DK Armstrong
- Johns-Hopkins Kimmel Cancer Center; Baltimore Maryland USA
| | - LM LaVange
- Food and Drug Administration (FDA); Silver Spring Maryland USA
| | - R Pazdur
- Pfizer, Inc.; New York New York USA
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Schwaederle M, Parker BA, Schwab RB, Fanta PT, Boles SG, Daniels GA, Bazhenova LA, Subramanian R, Coutinho AC, Ojeda-Fournier H, Datnow B, Webster NJ, Lippman SM, Kurzrock R. Molecular tumor board: the University of California-San Diego Moores Cancer Center experience. Oncologist 2014; 19:631-6. [PMID: 24797821 DOI: 10.1634/theoncologist.2013-0405] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE DNA sequencing tests are enabling physicians to interrogate the molecular profiles of patients' tumors, but most oncologists have not been trained in advanced genomics. We initiated a molecular tumor board to provide expert multidisciplinary input for these patients. MATERIALS AND METHODS A team that included clinicians, basic scientists, geneticists, and bioinformatics/pathway scientists with expertise in various cancer types attended. Molecular tests were performed in a Clinical Laboratory Improvement Amendments environment. RESULTS Patients (n = 34, since December 2012) had received a median of three prior therapies. The median time from physician order to receipt of molecular diagnostic test results was 27 days (range: 14-77 days). Patients had a median of 4 molecular abnormalities (range: 1-14 abnormalities) found by next-generation sequencing (182- or 236-gene panels). Seventy-four genes were involved, with 123 distinct abnormalities. Importantly, no two patients had the same aberrations, and 107 distinct abnormalities were seen only once. Among the 11 evaluable patients whose treatment had been informed by molecular diagnostics, 3 achieved partial responses (progression-free survival of 3.4 months, ≥6.5 months, and 7.6 months). The most common reasons for being unable to act on the molecular diagnostic results were that patients were ineligible for or could not travel to an appropriately targeted clinical trial and/or that insurance would not cover the cognate agents. CONCLUSION Genomic sequencing is revealing complex molecular profiles that differ by patient. Multidisciplinary molecular tumor boards may help optimize management. Barriers to personalized therapy include access to appropriately targeted drugs.
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Affiliation(s)
- Maria Schwaederle
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Barbara A Parker
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Richard B Schwab
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Paul T Fanta
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Sarah G Boles
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Gregory A Daniels
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Lyudmila A Bazhenova
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Rupa Subramanian
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alice C Coutinho
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Haydee Ojeda-Fournier
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Brian Datnow
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Nicholas J Webster
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Scott M Lippman
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Razelle Kurzrock
- Center for Personalized Cancer Therapy, Moores Cancer Center, Division of Hematology-Oncology, Department of Medicine, Department of Radiology, School of Medicine, Department of Pathology, School of Medicine, and Division of Endocrinology & Metabolism, Department of Medicine, University of California San Diego, La Jolla, California, USA
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Liu J, Gao L, Zhang H, Wang D, Wang M, Zhu J, Pang C, Wang C. Succinate dehydrogenase 5 (SDH5) regulates glycogen synthase kinase 3β-β-catenin-mediated lung cancer metastasis. J Biol Chem 2013; 288:29965-73. [PMID: 23983127 DOI: 10.1074/jbc.m113.450106] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We demonstrate that loss of succinate dehydrogenase 5 (SDH5) expression initiates epithelial-mesenchymal transition (EMT), which is visualized by the repression of E-cadherin and up-regulation of vimentin in lung cancer cell lines and clinical lung cancer specimens. In SDH5 knock-out mice, lung epithelial cells exhibited elevated mesenchymal markers, which is characteristic of EMT. Using a human lung xenograft-mouse model, we observed that knocking down endogenous SDH5 in human carcinoma cells leads to the development of multiple lymph node metastases. Moreover, our data indicate that SDH5 functions as a critical protein in regulating EMT by modulating the glycogen synthase kinase (GSK)-3β-β-catenin signaling pathway. These results reveal a critical role for SDH5 in EMT and suggest that SDH5 may be a prognostic biomarker and potential therapeutic target for lung cancer metastasis.
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Affiliation(s)
- Jun Liu
- From the Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
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