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Xie Y, Zhou F. Efficacy and safety of anti-angiogenic drug monotherapy and combination therapy for ovarian cancer: a meta-analysis and trial sequential analysis of randomized controlled trials. Front Pharmacol 2024; 15:1423891. [PMID: 38860165 PMCID: PMC11163095 DOI: 10.3389/fphar.2024.1423891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
Background As the development of novel anti-angiogenic drugs and the continuous evolution of guideline recommendations, the efficacy and safety of anti-angiogenic agents in ovarian cancer (OC) remains unclear. Consequently, a meta-analysis was carried out to assess the efficacy and safety of anti-angiogenic drug monotherapy and combination therapy for OC. Methods An exhaustive literature review was performed across multiple databases, including PubMed, Embase, Web of Science, and Cochrane, encompassing all relevant randomized controlled trials (RCTs) up until 6 April 2024. The evaluation of efficacy outcomes incorporated progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). Safety was assessed through the occurrence of any grade adverse events (AEs) and grade ≥3 AEs. Synthesis of the data involved the calculation of hazard ratios (HRs), relative risks (RRs), and their corresponding 95% confidence intervals (CIs) and prediction intervals (PIs). Trial sequential analysis was executed employing TSA v0.9.5.10 Beta software, STATA 12.0, and R software 4.3.1. Results In this meta-analysis, 35 RCTs were included, encompassing 16,199 subjects in total. The overall analysis indicated that anti-angiogenic drug combination therapy significantly improved PFS (HR [95% CI] = 0.678 [0.606-0.759], 95% PI: 0.415-1.108), OS (HR [95% CI] = 0.917 [0.870-0.966], 95% PI: 0.851-0.984), and ORR (RR [95% CI] = 1.441 [1.287-1.614], 95% PI: 1.032-2.014), but also increased the incidence of grade ≥3 AEs (RR [95% CI] = 1.137 [1.099-1.177], 95% PI: 1.011-1.252). The analysis did not corroborate any benefit of anti-angiogenic monotherapy over placebo concerning PFS (HR [95% CI] = 0.956 [0.709-1.288], 95% PI: 0.345-2.645) and OS (HR [95% CI] = 1.039 [0.921-1.173], 95% PI: 0.824-1.331). However, it was observed that monotherapy with anti-angiogenic drugs did increase the incidence of any grade AEs (RR [95% CI] = 1.072 [1.036-1.109], 95% PI: 0.709-1.592). Conclusion Our study confirmed the PFS, OS, and ORR benefits of anti-angiogenic drug combination therapy for OC patients. The efficacy results of anti-angiogenic monotherapy necessitates further evaluation as more RCTs become available. Clinicians should be vigilant of AEs when administering anti-angiogenic agents in a clinical setting.
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Affiliation(s)
| | - Fei Zhou
- Department of Obstetrics and Gynaecology, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Albain KS, Yau C, Petricoin EF, Wolf DM, Lang JE, Chien AJ, Haddad T, Forero-Torres A, Wallace AM, Kaplan H, Pusztai L, Euhus D, Nanda R, Elias AD, Clark AS, Godellas C, Boughey JC, Isaacs C, Tripathy D, Lu J, Yung RL, Gallagher RI, Wulfkuhle JD, Brown-Swigart L, Krings G, Chen YY, Potter DA, Stringer-Reasor E, Blair S, Asare SM, Wilson A, Hirst GL, Singhrao R, Buxton M, Clennell JL, Sanil A, Berry S, Asare AL, Matthews JB, DeMichele AM, Hylton NM, Melisko M, Perlmutter J, Rugo HS, Symmans WF, van’t Veer LJ, Yee D, Berry DA, Esserman LJ. Neoadjuvant Trebananib plus Paclitaxel-based Chemotherapy for Stage II/III Breast Cancer in the Adaptively Randomized I-SPY2 Trial-Efficacy and Biomarker Discovery. Clin Cancer Res 2024; 30:729-740. [PMID: 38109213 PMCID: PMC10956403 DOI: 10.1158/1078-0432.ccr-22-2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 10/11/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE The neutralizing peptibody trebananib prevents angiopoietin-1 and angiopoietin-2 from binding with Tie2 receptors, inhibiting angiogenesis and proliferation. Trebananib was combined with paclitaxel±trastuzumab in the I-SPY2 breast cancer trial. PATIENTS AND METHODS I-SPY2, a phase II neoadjuvant trial, adaptively randomizes patients with high-risk, early-stage breast cancer to one of several experimental therapies or control based on receptor subtypes as defined by hormone receptor (HR) and HER2 status and MammaPrint risk (MP1, MP2). The primary endpoint is pathologic complete response (pCR). A therapy "graduates" if/when it achieves 85% Bayesian probability of success in a phase III trial within a given subtype. Patients received weekly paclitaxel (plus trastuzumab if HER2-positive) without (control) or with weekly intravenous trebananib, followed by doxorubicin/cyclophosphamide and surgery. Pathway-specific biomarkers were assessed for response prediction. RESULTS There were 134 participants randomized to trebananib and 133 to control. Although trebananib did not graduate in any signature [phase III probabilities: Hazard ratio (HR)-negative (78%), HR-negative/HER2-positive (74%), HR-negative/HER2-negative (77%), and MP2 (79%)], it demonstrated high probability of superior pCR rates over control (92%-99%) among these subtypes. Trebananib improved 3-year event-free survival (HR 0.67), with no significant increase in adverse events. Activation levels of the Tie2 receptor and downstream signaling partners predicted trebananib response in HER2-positive disease; high expression of a CD8 T-cell gene signature predicted response in HR-negative/HER2-negative disease. CONCLUSIONS The angiopoietin (Ang)/Tie2 axis inhibitor trebananib combined with standard neoadjuvant therapy increased estimated pCR rates across HR-negative and MP2 subtypes, with probabilities of superiority >90%. Further study of Ang/Tie2 receptor axis inhibitors in validated, biomarker-predicted sensitive subtypes is warranted.
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Affiliation(s)
- Kathy S. Albain
- Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | - Christina Yau
- University of California San Francisco, San Francisco, CA
| | | | - Denise M. Wolf
- University of California San Francisco, San Francisco, CA
| | | | - A. Jo Chien
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Debu Tripathy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Janice Lu
- University of Southern California, Los Angeles, CA
| | | | | | | | | | - Gregor Krings
- University of California San Francisco, San Francisco, CA
| | - Yunn Yi Chen
- University of California San Francisco, San Francisco, CA
| | | | | | - Sarah Blair
- University of California San Diego, La Jolla, CA
| | - Smita M. Asare
- Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - Amy Wilson
- Quantum Leap Healthcare Collaborative, San Francisco, CA
| | | | - Ruby Singhrao
- University of California San Francisco, San Francisco, CA
| | | | | | | | | | - Adam L. Asare
- Quantum Leap Healthcare Collaborative, San Francisco, CA
| | | | | | - Nola M. Hylton
- University of California San Francisco, San Francisco, CA
| | | | | | - Hope S. Rugo
- University of California San Francisco, San Francisco, CA
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Bhardwaj V, Zhang X, Pandey V, Garg M. Neo-vascularization-based therapeutic perspectives in advanced ovarian cancer. Biochim Biophys Acta Rev Cancer 2023; 1878:188888. [PMID: 37001618 DOI: 10.1016/j.bbcan.2023.188888] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
The process of angiogenesis is well described for its potential role in the development of normal ovaries, and physiological functions as well as in the initiation, progression, and metastasis of ovarian cancer (OC). In advanced stages of OC, cancer cells spread outside the ovary to the pelvic, abdomen, lung, or multiple secondary sites. This seriously limits the efficacy of therapeutic options contributing to fatal clinical outcomes. Notably, a variety of angiogenic effectors are produced by the tumor cells to initiate angiogenic processes leading to the development of new blood vessels, which provide essential resources for tumor survival, dissemination, and dormant micro-metastasis of tumor cells. Multiple proangiogenic effectors and their signaling axis have been discovered and functionally characterized for potential clinical utility in OC. In this review, we have provided the current updates on classical and emerging proangiogenic effectors, their signaling axis, and the immune microenvironment contributing to the pathogenesis of OC. Moreover, we have comprehensively reviewed and discussed the significance of the preclinical strategies, drug repurposing, and clinical trials targeting the angiogenic processes that hold promising perspectives for the better management of patients with OC.
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Affiliation(s)
- Vipul Bhardwaj
- Tsinghua Berkeley Shenzhen Institute, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, PR China; Institute of Biopharmaceutical and Bioengineering, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, PR China
| | - Xi Zhang
- Shenzhen Bay Laboratory, Shenzhen 518055, PR China
| | - Vijay Pandey
- Tsinghua Berkeley Shenzhen Institute, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, PR China; Institute of Biopharmaceutical and Bioengineering, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, PR China.
| | - Manoj Garg
- Amity Institute of Molecular Medicine and Stem Cell Research, Amity University Uttar Pradesh, Sector-125, Noida 201301, India.
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Gaitskell K, Rogozińska E, Platt S, Chen Y, Abd El Aziz M, Tattersall A, Morrison J. Angiogenesis inhibitors for the treatment of epithelial ovarian cancer. Cochrane Database Syst Rev 2023; 4:CD007930. [PMID: 37185961 PMCID: PMC10111509 DOI: 10.1002/14651858.cd007930.pub3] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND Many women, and other females, with epithelial ovarian cancer (EOC) develop resistance to conventional chemotherapy drugs. Drugs that inhibit angiogenesis (development of new blood vessels), essential for tumour growth, control cancer growth by denying blood supply to tumour nodules. OBJECTIVES To compare the effectiveness and toxicities of angiogenesis inhibitors for treatment of epithelial ovarian cancer (EOC). SEARCH METHODS We identified randomised controlled trials (RCTs) by searching CENTRAL, MEDLINE and Embase (from 1990 to 30 September 2022). We searched clinical trials registers and contacted investigators of completed and ongoing trials for further information. SELECTION CRITERIA RCTs comparing angiogenesis inhibitors with standard chemotherapy, other types of anti-cancer treatment, other angiogenesis inhibitors with or without other treatments, or placebo/no treatment in a maintenance setting, in women with EOC. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our outcomes were overall survival (OS), progression-free survival (PFS), quality of life (QoL), adverse events (grade 3 and above) and hypertension (grade 2 and above). MAIN RESULTS We identified 50 studies (14,836 participants) for inclusion (including five studies from the previous version of this review): 13 solely in females with newly-diagnosed EOC and 37 in females with recurrent EOC (nine studies in platinum-sensitive EOC; 19 in platinum-resistant EOC; nine with studies with mixed or unclear platinum sensitivity). The main results are presented below. Newly-diagnosed EOC Bevacizumab, a monoclonal antibody that binds vascular endothelial growth factor (VEGF), given with chemotherapy and continued as maintenance, likely results in little to no difference in OS compared to chemotherapy alone (hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.88 to 1.07; 2 studies, 2776 participants; moderate-certainty evidence). Evidence is very uncertain for PFS (HR 0.82, 95% CI 0.64 to 1.05; 2 studies, 2746 participants; very low-certainty evidence), although the combination results in a slight reduction in global QoL (mean difference (MD) -6.4, 95% CI -8.86 to -3.94; 1 study, 890 participants; high-certainty evidence). The combination likely increases any adverse event (grade ≥ 3) (risk ratio (RR) 1.16, 95% CI 1.07 to 1.26; 1 study, 1485 participants; moderate-certainty evidence) and may result in a large increase in hypertension (grade ≥ 2) (RR 4.27, 95% CI 3.25 to 5.60; 2 studies, 2707 participants; low-certainty evidence). Tyrosine kinase inhibitors (TKIs) to block VEGF receptors (VEGF-R), given with chemotherapy and continued as maintenance, likely result in little to no difference in OS (HR 0.99, 95% CI 0.84 to 1.17; 2 studies, 1451 participants; moderate-certainty evidence) and likely increase PFS slightly (HR 0.88, 95% CI 0.77 to 1.00; 2 studies, 2466 participants; moderate-certainty evidence). The combination likely reduces QoL slightly (MD -1.86, 95% CI -3.46 to -0.26; 1 study, 1340 participants; moderate-certainty evidence), but it increases any adverse event (grade ≥ 3) slightly (RR 1.31, 95% CI 1.11 to 1.55; 1 study, 188 participants; moderate-certainty evidence) and may result in a large increase in hypertension (grade ≥ 3) (RR 6.49, 95% CI 2.02 to 20.87; 1 study, 1352 participants; low-certainty evidence). Recurrent EOC (platinum-sensitive) Moderate-certainty evidence from three studies (with 1564 participants) indicates that bevacizumab with chemotherapy, and continued as maintenance, likely results in little to no difference in OS (HR 0.90, 95% CI 0.79 to 1.02), but likely improves PFS (HR 0.56, 95% CI 0.50 to 0.63) compared to chemotherapy alone. The combination may result in little to no difference in QoL (MD 0.8, 95% CI -2.11 to 3.71; 1 study, 486 participants; low-certainty evidence), but it increases the rate of any adverse event (grade ≥ 3) slightly (RR 1.11, 1.07 to 1.16; 3 studies, 1538 participants; high-certainty evidence). Hypertension (grade ≥ 3) was more common in arms with bevacizumab (RR 5.82, 95% CI 3.84 to 8.83; 3 studies, 1538 participants). TKIs with chemotherapy may result in little to no difference in OS (HR 0.86, 95% CI 0.67 to 1.11; 1 study, 282 participants; low-certainty evidence), likely increase PFS (HR 0.56, 95% CI 0.44 to 0.72; 1 study, 282 participants; moderate-certainty evidence), and may have little to no effect on QoL (MD 6.1, 95% CI -0.96 to 13.16; 1 study, 146 participants; low-certainty evidence). Hypertension (grade ≥ 3) was more common with TKIs (RR 3.32, 95% CI 1.21 to 9.10). Recurrent EOC (platinum-resistant) Bevacizumab with chemotherapy and continued as maintenance increases OS (HR 0.73, 95% CI 0.61 to 0.88; 5 studies, 778 participants; high-certainty evidence) and likely results in a large increase in PFS (HR 0.49, 95% CI 0.42 to 0.58; 5 studies, 778 participants; moderate-certainty evidence). The combination may result in a large increase in hypertension (grade ≥ 2) (RR 3.11, 95% CI 1.83 to 5.27; 2 studies, 436 participants; low-certainty evidence). The rate of bowel fistula/perforation (grade ≥ 2) may be slightly higher with bevacizumab (RR 6.89, 95% CI 0.86 to 55.09; 2 studies, 436 participants). Evidence from eight studies suggest TKIs with chemotherapy likely result in little to no difference in OS (HR 0.85, 95% CI 0.68 to 1.08; 940 participants; moderate-certainty evidence), with low-certainty evidence that it may increase PFS (HR 0.70, 95% CI 0.55 to 0.89; 940 participants), and may result in little to no meaningful difference in QoL (MD ranged from -0.19 at 6 weeks to -3.40 at 4 months). The combination increases any adverse event (grade ≥ 3) slightly (RR 1.23, 95% CI 1.02 to 1.49; 3 studies, 402 participants; high-certainty evidence). The effect on bowel fistula/perforation rates is uncertain (RR 2.74, 95% CI 0.77 to 9.75; 5 studies, 557 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Bevacizumab likely improves both OS and PFS in platinum-resistant relapsed EOC. In platinum-sensitive relapsed disease, bevacizumab and TKIs probably improve PFS, but may or may not improve OS. The results for TKIs in platinum-resistant relapsed EOC are similar. The effects on OS or PFS in newly-diagnosed EOC are less certain, with a decrease in QoL and increase in adverse events. Overall adverse events and QoL data were more variably reported than were PFS data. There appears to be a role for anti-angiogenesis treatment, but given the additional treatment burden and economic costs of maintenance treatments, benefits and risks of anti-angiogenesis treatments should be carefully considered.
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Affiliation(s)
- Kezia Gaitskell
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Sarah Platt
- Obstetrics and Gynaecology, St Mary's Hospital, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Department of Gynaecological Oncology, St. Michael's Hospital, Bristol, UK
| | - Yifan Chen
- Oxford Medical School, University of Oxford, Oxford, UK
| | | | | | - Jo Morrison
- Department of Gynaecological Oncology, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
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Simion L, Rotaru V, Cirimbei C, Stefan DC, Gherghe M, Ionescu S, Tanase BC, Luca DC, Gales LN, Chitoran E. Analysis of Efficacy-To-Safety Ratio of Angiogenesis-Inhibitors Based Therapies in Ovarian Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13061040. [PMID: 36980348 PMCID: PMC10046967 DOI: 10.3390/diagnostics13061040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Among new anti-angiogenesis agents being developed and ever-changing guidelines indications, the question of the benefits/safety ratio remains unclear. (2) Methods: We performed a systematic review combined with a meta-analysis of 23 randomized controlled trials (12,081 patients), evaluating overall survival (OS), progression free survival (PFS) and toxicity (grade ≥ 3 toxic effects, type, and number of all adverse effects. (3) Results: The analysis showed improvement of pooled-PFS (HR, 0.71; 95% CI, 0.64-0.78; I2 = 77%; p < 0.00001) in first-line (HR, 0.85; 95% CI, 0.78-0.93; p = 0.0003) or recurrent cancer (HR, 0.62; 95% CI, 0.56-0.70; p < 0.00001) and regardless of the type of anti-angiogenesis drug used (Vascular endothelial growth factor (VEGF) inhibitors, VEGF-receptors (VEGF-R) inhibitors or angiopoietin inhibitors). Improved OS was also observed (HR, 0.95; 95% CI, 0.90-0.99; p = 0.03). OS benefits were only observed in recurrent neoplasms, both platinum-sensitive and platinum-resistant neoplasms. Grade ≥ 3 adverse effects were increased across all trials. Anti-angiogenetic therapy increased the risk of hypertension, infection, thromboembolic/hemorrhagic events, and gastro-intestinal perforations but not the risk of wound-related issues, anemia or posterior leukoencephalopathy syndrome. (4) Conclusions: Although angiogenesis inhibitors improve PFS, there are little-to-no OS benefits. Given the high risk of severe adverse reactions, a careful selection of patients is required for obtaining the best results possible.
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Affiliation(s)
- Laurentiu Simion
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
| | - Vlad Rotaru
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
| | - Ciprian Cirimbei
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
| | - Daniela-Cristina Stefan
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mirela Gherghe
- Nuclear Medicine Department, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
| | - Sinziana Ionescu
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
| | - Bogdan Cosmin Tanase
- Thoracic Surgery Department, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
| | - Dan Cristian Luca
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
| | - Laurentia Nicoleta Gales
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Medical Oncology Department, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
| | - Elena Chitoran
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology "Prof. Dr. Al. Trestioreanu", 022328 Bucharest, Romania
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Design, construction and in vivo functional assessment of a hinge truncated sFLT01. Gene Ther 2022; 30:347-361. [PMID: 36114375 DOI: 10.1038/s41434-022-00362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 11/08/2022]
Abstract
Gene therapy for the treatment of ocular neovascularization has reached clinical trial phases. The AAV2-sFLT01 construct was already evaluated in a phase 1 open-label trial administered intravitreally to patients with advanced neovascular age-related macular degeneration. SFLT01 protein functions by binding to VEGF and PlGF molecules and inhibiting their activities simultaneously. It consists of human VEGFR1/Flt-1 (hVEGFR1), a polyglycine linker, and the Fc region of human IgG1. The IgG1 upper hinge region of the sFLT01 molecule makes it vulnerable to radical attacks and prone to causing immune reactions. This study pursued two goals: (i) minimizing the immunogenicity and vulnerability of the molecule by designing a truncated molecule called htsFLT01 (hinge truncated sFLT01) that lacked the IgG1 upper hinge and lacked 2 amino acids from the core hinge region; and (ii) investigating the structural and functional properties of the aforesaid chimeric molecule at different levels (in silico, in vitro, and in vivo). Molecular dynamics simulations and molecular mechanics energies combined with Poisson-Boltzmann and surface area continuum solvation calculations revealed comparable free energy of binding and binding affinity for sFLT01 and htsFLT01 to their cognate ligands. Conditioned media from human retinal pigment epithelial (hRPE) cells that expressed htsFLT01 significantly reduced tube formation in HUVECs. The AAV2-htsFLT01 virus suppressed vascular development in the eyes of newborn mice. The htsFLT01 gene construct is a novel anti-angiogenic tool with promising improvements compared to existing treatments.
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Zhang C, Zhao W. The efficacy and safety of angiogenesis inhibitors for recurrent ovarian cancer: a meta‑analysis. J Ovarian Res 2022; 15:99. [PMID: 35996165 PMCID: PMC9396859 DOI: 10.1186/s13048-022-01028-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 08/03/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of angiogenesis inhibitors in the treatment of recurrent ovarian cancer (OC). METHODS Electronic databases including PubMed, Web of Science, and the Cochrane Library were searched to find eligible studies until August 10, 2021. The data on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) were pooled. Furthermore, grade ≥ 3 adverse events (AEs) were investigated. RESULTS A total of 13 studies with 3953 patients were included. Compared with control group, angiogenesis inhibitors resulted in significant improvement in PFS (hazard ratio (HR) = 0.61, 95%CI, 0.54-0.69), OS (HR = 0.88, 95%CI, 0.81-0.95), and ORR (odds ratio (OR) = 2.15, 95% CI, 1.74-2.65). However, angiogenesis inhibitors were associated with a higher risk of grade ≥ 3 AEs (relative risk (RR), 1.20, 95% CI, 1.04-1.38). CONCLUSION Angiogenesis inhibitors can improve ORR, PFS, and OS in patients with recurrent OC, but they can increase the incidence of AEs ≥ 3.
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Affiliation(s)
- Chunmei Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning, 110004, China
| | - Wancheng Zhao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang, Liaoning, 110004, China.
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Hultström M, Fromell K, Larsson A, Persson B, Nilsson B, Quaggin SE, Betsholtz C, Frithiof R, Lipcsey M, Jeansson M. Angiopoietin-2 Inhibition of Thrombomodulin-Mediated Anticoagulation-A Novel Mechanism That May Contribute to Hypercoagulation in Critically Ill COVID-19 Patients. Biomedicines 2022; 10:1333. [PMID: 35740360 PMCID: PMC9220312 DOI: 10.3390/biomedicines10061333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Hypercoagulation and endothelial dysfunction play central roles in severe forms of COVID-19 infections, but the molecular mechanisms involved are unclear. Increased plasma levels of the inflammatory cytokine and TIE2 receptor antagonist Angiopoietin-2 were reported in severely ill COVID-19 patients. In vitro experiments suggest that Angiopoietin-2 bind and inhibits thrombomodulin. Thrombomodulin is expressed on the luminal surface of endothelial cells where it is an important member of the intrinsic anticoagulant pathway through activation of protein C. Using clinical data, mouse models, and in vitro assays, we tested if Angiopoietin-2 plays a causal role in COVID-19-associated hypercoagulation through direct inhibition of thrombin/thrombomodulin-mediated physiological anticoagulation. Angiopoietin-2 was measured in 61 patients at admission, and after 10 days in the 40 patients remaining in the ICU. We found that Angiopoietin-2 levels were increased in COVID-19 patients in correlation with disease severity, hypercoagulation, and mortality. In support of a direct effect of Angiopoietin-2 on coagulation, we found that injected Angiopoietin-2 in mice associated to thrombomodulin and resulted in a shortened tail bleeding time, decreased circulating levels of activated protein C, and increased plasma thrombin/antithrombin complexes. Conversely, bleeding time was increased in endothelial-specific Angiopoietin-2 knockout mice, while knockout of Tie2 had no effect on tail bleeding. Using in vitro assays, we found that Angiopoietin-2 inhibited thrombomodulin-mediated anticoagulation and protein C activation in human donor plasma. Our data suggest a novel in vivo mechanism for Angiopoietin-2 in COVID-19-associated hypercoagulation, implicating that Angiopoietin-2 inhibitors may be effective in the treatment of hypercoagulation in severe COVID-19 infection.
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Affiliation(s)
- Michael Hultström
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden; (M.H.); (R.F.); (M.L.)
- Integrative Physiology, Department of Medical Cell Biology, Uppsala University, 751 23 Uppsala, Sweden
| | - Karin Fromell
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden; (K.F.); (B.P.); (B.N.); (C.B.)
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, 751 85 Uppsala, Sweden;
| | - Barbro Persson
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden; (K.F.); (B.P.); (B.N.); (C.B.)
| | - Bo Nilsson
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden; (K.F.); (B.P.); (B.N.); (C.B.)
| | - Susan E. Quaggin
- Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
- Division of Nephrology and Hypertension, Northwestern University, Chicago, IL 60611, USA
| | - Christer Betsholtz
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden; (K.F.); (B.P.); (B.N.); (C.B.)
- Department of Medicine Huddinge, Karolinska Institutet, 141 52 Huddinge, Sweden
| | - Robert Frithiof
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden; (M.H.); (R.F.); (M.L.)
| | - Miklos Lipcsey
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden; (M.H.); (R.F.); (M.L.)
- Hedenstierna Laboratory, CIRRUS, Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, 751 23 Uppsala, Sweden
| | - Marie Jeansson
- Department of Immunology, Genetics and Pathology, Uppsala University, 751 85 Uppsala, Sweden; (K.F.); (B.P.); (B.N.); (C.B.)
- Department of Medicine Huddinge, Karolinska Institutet, 141 52 Huddinge, Sweden
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Antiangiogenic Strategies in Epithelial Ovarian Cancer: Mechanism, Resistance, and Combination Therapy. JOURNAL OF ONCOLOGY 2022; 2022:4880355. [PMID: 35466318 PMCID: PMC9019437 DOI: 10.1155/2022/4880355] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022]
Abstract
Angiogenesis is one of the hallmarks of cancer and plays a crucial role in carcinogenesis and progression of epithelial ovarian cancer. Antiangiogenic agent is the first approved targeted agent in ovarian cancer. Anti-angiogenic agents mainly include agents target VEGF/VEGFR pathway, such as bevacizumab and agents target receptor tyrosine kinase, and non-VEGF/VEGFR targets of angiogenesis. Antiangiogenic agents demonstrate certain effects in ovarian cancer treatment either as monotherapy or combined with chemotherapy. Unfortunately, antiangiogenic agents, such as bevacizumab, integrated into the ovarian cancer treatment paradigm do not increase cures. Thus, the benefits of anti-angiogenic agents must be carefully weighed against the cost and associated toxicities. Antiangiogenic agents drug resistance and short of predictive biomarkers are main obstacles in ovarian cancer treatment. A combination of poly (ADP-ribose) polymerase inhibitors or immune checkpoint inhibitors might be great strategies to overcome resistance as well as enhance anti-tumor activity of anti-angiogenic drugs. Predictive biomarkers of antiangiogenic agents are in urgent need.
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Parmar D, Apte M. Angiopoietin inhibitors: A review on targeting tumor angiogenesis. Eur J Pharmacol 2021; 899:174021. [PMID: 33741382 DOI: 10.1016/j.ejphar.2021.174021] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 02/24/2021] [Accepted: 03/10/2021] [Indexed: 02/08/2023]
Abstract
Angiogenesis is the process of formation of new blood vessels from existing ones. Vessels serve the purpose of providing oxygen, nutrients and removal of waste from the cells. The physiological angiogenesis is a normal process and is required in the embryonic development, wound healing, menstrual cycle. For homeostasis, balance of pro angiogenic factors and anti angiogenic factors like is important. Their imbalance causes a process known as "angiogenic switch" which leads to various pathological conditions like inflammation, tumor and restenosis. Like normal cells, tumor cells also require oxygen and nutrients to grow which is provided by tumor angiogenesis. Hence angiogenic process can be inhibited to prevent tumor growth. This gives rise to study of anti angiogenic drugs. Currently approved anti angiogenic drugs are mostly VEGF inhibitors, but VEGF inhibitors have certain limitations like toxicity, low progression free survival (PFS), and resistance to anti VEGF therapy. This article focuses on angiopoietins as alternative and potential targets for anti angiogenic therapy. Angiopoietins are ligands of Tie receptor and play a crucial role in angiogenesis, their inhibition can prevent many tumor growths even on later stages of development. We present current clinical and preclinical stages of angiopoietin inhibitors. Drugs studied in the article are selective as well as non-selective inhibitors of angiopoietin 2 like Trebananib (AMG 386), AMG 780, REGN 910, CVX 060, MEDI 3617 and dual inhibitors of angiopoietin 2 and VEGF like Vanucizumab and RG7716. The angiopoietin inhibitors show promising results alone and in combination with VEGF inhibitors in various malignancies.
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Affiliation(s)
- Digna Parmar
- Department of Quality Assurance, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle, Maharashtra, India.
| | - Madhavi Apte
- Department of Quality Assurance, SVKM's Dr. Bhanuben Nanavati College of Pharmacy, Vile Parle, Maharashtra, India.
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11
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Baert T, Ferrero A, Sehouli J, O'Donnell DM, González-Martín A, Joly F, van der Velden J, Blecharz P, Tan DSP, Querleu D, Colombo N, du Bois A, Ledermann JA. The systemic treatment of recurrent ovarian cancer revisited. Ann Oncol 2021; 32:710-725. [PMID: 33675937 DOI: 10.1016/j.annonc.2021.02.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Treatment approaches for relapsed ovarian cancer have evolved over the past decade from a calendar-based decision tree to a patient-oriented biologically driven algorithm. Nowadays, platinum-based chemotherapy should be offered to all patients with a reasonable chance of responding to this therapy. The treatment-free interval for platinum is only one of many factors affecting patients' eligibility for platinum re-treatment. Bevacizumab increases the response to chemotherapy irrespective of the cytotoxic regimen and can be valuable in patients with an urgent need for symptom relief (e.g. pleural effusion, ascites). For patients with recurrent high-grade ovarian cancer, which responds to platinum-based treatment, maintenance therapy with a poly(ADP-ribose) polymerase inhibitor can be offered, regardless of the BRCA mutation status. Here we review contemporary decision-making processes in the systemic treatment of relapsed ovarian cancer.
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Affiliation(s)
- T Baert
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - A Ferrero
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, Mauriziano Hospital, Turin, Italy
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-University hospital Berlin, Berlin, Germany
| | - D M O'Donnell
- Department of Oncology, St. James's Hospital, Dublin, Ireland
| | - A González-Martín
- Medical Oncology Department, Clínica Universidad de Navarra University Hospital, Madrid, Spain
| | - F Joly
- Department of Oncology, Centre Francois Baclesse, Caen, France
| | - J van der Velden
- Department of Medical Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - P Blecharz
- Department of Gynecologic Oncology, Center of Oncology, M. Sklodowska-Curie Institute, Krakow, Poland
| | - D S P Tan
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D Querleu
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - N Colombo
- Department of Medicine and Surgery, European Institute of Oncology IRCCS, Milan, Italy; University of Milan-Bicocca, Milan, Italy
| | - A du Bois
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
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12
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Mooi J, Chionh F, Savas P, Da Gama Duarte J, Chong G, Brown S, Wong R, Price TJ, Wann A, Skrinos E, Mariadason JM, Tebbutt NC. Dual Antiangiogenesis Agents Bevacizumab Plus Trebananib, without Chemotherapy, in First-line Treatment of Metastatic Colorectal Cancer: Results of a Phase II Study. Clin Cancer Res 2021; 27:2159-2167. [PMID: 33514526 DOI: 10.1158/1078-0432.ccr-20-2714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/13/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the efficacy and safety of dual antiangiogenesis agents, bevacizumab plus trebananib, without chemotherapy, in first-line treatment of metastatic colorectal cancer (mCRC). PATIENTS AND METHODS This open-label phase II study enrolled patients with unresectable mCRC with no prior systemic treatment. All patients received bevacizumab 7.5 mg/kg 3-weekly and trebananib 15 mg/kg weekly. The primary endpoint was disease control [stable disease, partial response (PR), or complete response (CR)] at 6 months (DC6m). Secondary endpoints included toxicity, overall response rate (ORR), progression-free survival (PFS), and overall survival (OS). Exploratory biomarkers in plasma angiogenesis-related proteins, tumor gene expression, and plasma antibodies to tumor antigens were examined. RESULTS Forty-five patients were enrolled from four Australian sites. DC6m was 63% [95% confidence interval (CI), 47-77]. ORR was 17% (95% CI, 7-32), comprising of seven PRs. Median duration of response was 20 months (range, 10-48 months). Median PFS was 8.4 months and median OS 31.4 months. Grade 1-2 peripheral edema and joint-related symptoms were common. Overall incidence of grade 3-4 adverse events (AE) of any type was 33% (n = 15). Expected AEs of bevacizumab treatment did not appear to be increased by the addition of trebananib. CONCLUSIONS In a first-line mCRC population, the dual antiangiogenic combination, bevacizumab plus trebananib, without chemotherapy, was efficacious with durable responses. The toxicity profile of the combination was manageable and did not exceed that expected with bevacizumab +/- chemotherapy. Exploratory biomarker results raise the hypothesis that the antiangiogenic combination may enable the antitumor immune response in immunotolerant colorectal cancer.
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Affiliation(s)
- Jennifer Mooi
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Fiona Chionh
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - Peter Savas
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jessica Da Gama Duarte
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia.,La Trobe University, Melbourne, Victoria, Australia
| | - Geoffrey Chong
- University of Melbourne, Melbourne, Victoria, Australia.,Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia
| | - Stephen Brown
- Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia
| | - Rachel Wong
- Eastern Health, Box Hill, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Timothy J Price
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Alysson Wann
- University of Melbourne, Melbourne, Victoria, Australia
| | - Effie Skrinos
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia
| | - John M Mariadason
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia.,La Trobe University, Melbourne, Victoria, Australia
| | - Niall C Tebbutt
- Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia. .,University of Melbourne, Melbourne, Victoria, Australia.,Austin Health, Melbourne, Victoria, Australia
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13
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The efficacy and toxicity of angiogenesis inhibitors for ovarian cancer: a meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2020; 303:285-311. [PMID: 33222040 DOI: 10.1007/s00404-020-05865-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the efficacy and toxicity of angiogenesis inhibitors for the treatment of ovarian cancer patients, we conducted a meta-analysis of the published literature on this subject. METHODS In this meta-analysis, we searched PubMed, EMBASE, Web of Science, and Cochrane Library databases for randomized controlled trials (RCTs). The literature search was performed up to August 12, 2019. The risk of bias of the included studies was evaluated using The Cochrane Collaboration's tool, and the statistical analyses were performed using RevMan 5.3 software. The sensitivity analysis was performed with Stata 12.0 software. RESULTS 22 RCTs with 11,254 patients were included. Our meta-analysis demonstrates that angiogenesis inhibitors therapy can significantly improve progression-free survival (PFS) (hazard ratio [HR] 0.71, 95% CI 0.63-0.79, I2 = 80%, P < 0.00001) and overall survival (OS) (HR 0.95, 95% CI 0.90-0.99, I2 = 0%, P = 0.03) in ovarian cancer patients. The subgroups results suggest differences in the benefit in OS in first-line treatment (HR 1.00, 95% CI 0.93-1.08, I2 = 0%, P = 0.90) compared with treatment at relapse (HR 0.87, 95% CI 0.81-0.95, I2 = 0%, P = 0.0008). The PFS improved both in first-line treatment (HR 0.87, 95% CI 0.79-0.95, I2 = 60%, P = 0.003) and recurrent treatment (HR 0.60, 95% CI 0.53-0.67, I2 = 57% P < 0.0001) patients. The PFS and OS in recurrent group were prolonged both in the platinum-resistant group(PFS: HR 0.50, 95% CI 0.42-0.60, I2 = 0%, P < 0.00001; OS: HR 0.76, 95% CI 0.62-0.93, I2 = 0%, P = 0.007) and the platinum-sensitive group (PFS: HR 0.58, 95% CI 0.49-0.69, I2 = 64%, P < 0.00001; OS: HR 0.88, 95% CI 0.79-0.99, I2 = 0%, P = 0.03). However, this therapy is associated with a higher risk of common adverse events of grade ≥ 3 (risk ratio [RR]: 1.12; 95% CI 1.07-1.17; I2 = 0%, P = 0.68) such as arterial thromboembolic disease, ascites, diarrhea, gastrointestinal perforations, headache, hemorrhagic, hypertension, hypokalemia, leucopenia, pain, proteinuria, thrombocytopenia, and thrombosis or embolism. CONCLUSION This meta-analysis suggests angiogenesis inhibitors may significantly improve PFS and OS of ovarian cancer patients and increase the incidence of common adverse events.
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14
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Gong H, Nie D, Li Z. Targeting Six Hallmarks of Cancer in Ovarian Cancer Therapy. Curr Cancer Drug Targets 2020; 20:853-867. [PMID: 32807056 DOI: 10.2174/1568009620999200816130218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Abstract
Normal cells must overcome multiple protective mechanisms to develop into cancer cells. Their new capabilities include self-sufficiency in growth signals and insensitivity to antigrowth signals, evasion of apoptosis, a limitless replicative potential, sustained angiogenesis, and tissue invasion and metastasis; these are also termed the six hallmarks of cancer. A deep understanding of the genetic and protein alterations involved in these processes has enabled the development of targeted therapeutic strategies and clinical trial design in the search for ovarian cancer treatments. Clinically, significantly longer progression-free survival has been observed in the single use of PARP, MEK, VEGF and Chk1/Chk2 inhibitors. However, the clinical efficacy of the targeted agents is still restricted to specific molecular subtypes and no trials illustrate a benefit in overall survival. Exploring novel drug targets or combining current feasible biological agents hold great promise to further improve outcomes in ovarian cancer. In this review, we intend to provide a comprehensive description of the molecular alterations involved in ovarian cancer carcinogenesis and of emerging biological agents and combined strategies that target aberrant pathways, which might shed light on future ovarian cancer treatment.
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Affiliation(s)
- Han Gong
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Dan Nie
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
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15
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Wang Q, Peng H, Qi X, Wu M, Zhao X. Targeted therapies in gynecological cancers: a comprehensive review of clinical evidence. Signal Transduct Target Ther 2020; 5:137. [PMID: 32728057 PMCID: PMC7391668 DOI: 10.1038/s41392-020-0199-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 12/11/2022] Open
Abstract
Advanced and recurrent gynecological cancers are associated with poor prognosis and lack of effective treatment. The developments of the molecular mechanisms on cancer progression provide insight into novel targeted therapies, which are emerging as groundbreaking and promising cancer treatment strategies. In gynecologic malignancies, potential therapeutic targeted agents include antiangiogenic agents, poly (ADP-ribose) polymerase (PARP) inhibitors, tumor-intrinsic signaling pathway inhibitors, selective estrogen receptor downregulators, and immune checkpoint inhibitors. In this article, we provide a comprehensive review of the clinical evidence of targeted agents in gynecological cancers and discuss the future implication.
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Affiliation(s)
- Qiao Wang
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Hongling Peng
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China
| | - Min Wu
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, 58203, USA
| | - Xia Zhao
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.
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16
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Singh N, Badrun D, Ghatage P. State of the art and up-and-coming angiogenesis inhibitors for ovarian cancer. Expert Opin Pharmacother 2020; 21:1579-1590. [PMID: 32552175 DOI: 10.1080/14656566.2020.1775813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Angiogenesis inhibitors have clearly shown activity in ovarian cancer in various settings; however, preliminary data did not reflect significant survival benefit. Bevacizumab has been extensively studied and is approved for use in ovarian malignancy. However, the efficacy of bevacizumab is modest and most treated patients eventually develop acquired resistance, which highlights the need for new targeted therapies and/or combination strategies. Newer therapies are being evaluated and their role of these newer therapies is upcoming and promising. Recent research focuses on the role of this drug group in frontline, maintenance and recurrent settings. Combination of PARP inhibitors with angiogenesis inhibitors has recently shown to improved survival rates. Potential strategies need to be devised for selecting patients most likely to benefit from such therapy.
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Affiliation(s)
- Nilanchali Singh
- Tom Baker Cancer Centre, Gynecologic Oncology , Calgary, Alberta, Canada
| | - Daniyah Badrun
- Tom Baker Cancer Centre, Gynecologic Oncology , Calgary, Alberta, Canada
| | - Prafull Ghatage
- Tom Baker Cancer Centre, Gynecologic Oncology , Calgary, Alberta, Canada
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17
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Comparison of PARPis with Angiogenesis Inhibitors and Chemotherapy for Maintenance in Ovarian Cancer: A Network Meta-Analysis. Adv Ther 2019; 36:3368-3380. [PMID: 31599396 DOI: 10.1007/s12325-019-01106-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Seventy-five percent of ovarian cancer would relapse within 18-28 months after platinum-base chemotherapy. Evidence suggests that maintenance chemotherapy is effective in prolonging remission. Recent target therapies such as poly(ADP-ribose) polymerase inhibitors (PARPis) and angiogenesis inhibitors (AIs) are known to ease burden and recurrence of ovarian cancer. There is limited data for head-to-head comparison of PARPis, AIs, and chemotherapeutic agents (CTAs) as maintenance treatment. This network meta-analysis thus assessed the effectiveness and toxicity of these three maintenance therapies in patients with ovarian cancer. METHODS We searched relevant sources (PubMed, EMBASE) to identify randomized controlled trials assessing efficacy and safety of maintenance therapy in patients with ovarian cancer. Primary outcome was progression-free survival (PFS) as assessed by blinded review; safety and tolerability were secondary outcomes. A network meta-analysis to compare three drug classes was performed using statistical software R. RESULTS We included 24 trials (11,366 patients) assessing efficacy and safety of PARPis (n = 4), AIs (n = 12), and CTAs (n = 8). PARPis [hazard ratio (HR) 0.64; 95% credible intervals (CrI) 0.55-0.73] and AIs (HR 0.87; 95% CrI 0.81-0.93) showed significant improvement in PFS compared to placebo but not CTA (HR 1.00; 95% CrI 0.86-1.15). PARPis showed significant improvement in PFS compared to AIs (HR 0.73; 95% CrI 0.63-0.86) and CTA (HR 0.64; 95% CrI 0.52-0.78). Adverse events (AEs) leading to treatment discontinuation and dose reduction were lower in PARPis [incidence rate ratio (IRR) 0.60; CrI 0.31-1.18 and IRR 0.73, 95% CrI 0.50-1.06, respectively] compared to AIs, but the differences were not significant. CONCLUSION PARPi as maintenance treatment improved PFS in ovarian cancer and was relatively safer in terms of implications caused by AEs when compared to AIs. This network meta-analysis provides valuable evidence and significant insights into treatment of ovarian cancer.
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18
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Vergote I, Scambia G, O'Malley DM, Van Calster B, Park SY, Del Campo JM, Meier W, Bamias A, Colombo N, Wenham RM, Covens A, Marth C, Raza Mirza M, Kroep JR, Ma H, Pickett CA, Monk BJ. Trebananib or placebo plus carboplatin and paclitaxel as first-line treatment for advanced ovarian cancer (TRINOVA-3/ENGOT-ov2/GOG-3001): a randomised, double-blind, phase 3 trial. Lancet Oncol 2019; 20:862-876. [PMID: 31076365 DOI: 10.1016/s1470-2045(19)30178-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Angiopoietin 1 and 2 regulate angiogenesis and vascular remodelling by interacting with the tyrosine kinase receptor Tie2, and inhibition of angiogenesis has shown promise in the treatment of ovarian cancer. We aimed to assess whether trebananib, a peptibody that inhibits binding of angiopoietin 1 and 2 to Tie2, improved progression-free survival when added to carboplatin and paclitaxel as first-line therapy in advanced epithelial ovarian, primary fallopian tube, or peritoneal cancer in a phase 3 clinical trial. METHODS TRINOVA-3, a multicentre, multinational, phase 3, double-blind study, was done at 206 investigational sites (hospitals and cancer centres) in 14 countries. Eligible patients were aged 18 years or older with biopsy-confirmed International Federation of Gynecology and Obstetrics (FIGO) stage III to IV epithelial ovarian, primary peritoneal, or fallopian tube cancers, and an ECOG performance status of 0 or 1. Eligible patients were randomly assigned (2:1) using a permuted block method (block size of six patients) to receive six cycles of paclitaxel (175 mg/m2) and carboplatin (area under the serum concentration-time curve 5 or 6) every 3 weeks, plus weekly intravenous trebananib 15 mg/kg or placebo. Maintenance therapy with trebananib or placebo continued for up to 18 additional months. The primary endpoint was progression-free survival, as assessed by the investigators, in the intention-to-treat population. Safety analyses included patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT01493505, and is complete. FINDINGS Between Jan 30, 2012, and Feb 25, 2014, 1164 patients were screened and 1015 eligible patients were randomly allocated to treatment (678 to trebananib and 337 to placebo). After a median follow-up of 27·4 months (IQR 17·7-34·2), 626 patients had progression-free survival events (405 [60%] of 678 in the trebananib group and 221 [66%] of 337 in the placebo group). Median progression-free survival did not differ between the trebananib group (15·9 months [15·0-17·6]) and the placebo group (15·0 months [12·6-16·1]) groups (hazard ratio 0·93 [95% CI 0·79-1·09]; p=0·36). 512 (76%) of 675 patients in the trebananib group and 237 (71%) of 336 in the placebo group had grade 3 or worse treatment-emergent adverse events; of which the most common events were neutropenia (trebananib 238 [35%] vs placebo 126 [38%]) anaemia (76 [11%] vs 40 [12%]), and leucopenia (81 [12%] vs 35 [10%]). 269 (40%) patients in the trebananib group and 104 (31%) in the placebo group had serious adverse events. Two fatal adverse events in the trebananib group were considered related to trebananib, paclitaxel, and carboplatin (lung infection and neutropenic colitis); two were considered to be related to paclitaxel and carboplatin (general physical health deterioration and platelet count decreased). No treatment-related fatal adverse events occurred in the placebo group. INTERPRETATION Trebananib plus carboplatin and paclitaxel did not improve progression-free survival as first-line treatment for advanced ovarian cancer. The combination of trebananib plus carboplatin and paclitaxel did not produce new safety signals. These results show that trebananib in combination with carboplatin and paclitaxel is minimally effective in this patient population. FUNDING Amgen.
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Affiliation(s)
- Ignace Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium; European Network of Gynaecological Oncological Trial groups (ENGOT), Divison of Gynecologic Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium.
| | - Giovanni Scambia
- Multicenter Italian Trials in Ovarian Cancer Society (MITO), Rome, Italy; Fondazione Policlinico Universitario A Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica, Rome, Italy
| | - David M O'Malley
- Gynecologic Oncology Group, James Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Ben Van Calster
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Josep M Del Campo
- Grupo Español de Investigación en Cáncer de Ovario (GEICO), Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Werner Meier
- Arbeitsgemeinschaft Gynaekologische Onkologie Study Group (AGO), Department of Gynecology and Obstetrics, AGO-Germany and Evangelic Hospital Düsseldorf, Düsseldorf, Germany
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Alexandra Hospital, National & Kapodistrian University of Athens, Athens, Greece; Hellenic Cooperative Oncology Group (HECOG), Athens, Greece
| | - Nicoletta Colombo
- Mario Negri Gynecologic Oncology Group (MANGO), European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy; Università Milano Bicocca, Milan, Italy
| | - Robert M Wenham
- Gynecologic Oncology Group, Department of Gynecologic Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Al Covens
- Division of Gynecologic Oncology, Toronto Sunnybrook Regional Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Christian Marth
- Arbeitsgemeinschaft Gynaekologische Onkologie Study Group (AGO)-Austria, Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mansoor Raza Mirza
- Nordic Society of Gynaecological Oncology (NSGO), Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Judith R Kroep
- Dutch Gynecological Oncology Group (DCOG), Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - Haijun Ma
- Global Development Oncology, Amgen, Thousand Oaks, CA, USA
| | | | - Bradley J Monk
- Gynecologic Oncology Group, Arizona Oncology (US Oncology Network), University of Arizona, Phoenix, AZ, USA; Creighton University, Phoenix, AZ, USA
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Angiogenesis Inhibitors for the Treatment of Ovarian Cancer: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Gynecol Cancer 2019; 28:903-914. [PMID: 29561301 PMCID: PMC5976222 DOI: 10.1097/igc.0000000000001258] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental digital content is available in the text. Background Angiogenesis inhibitors showed activity in ovarian cancer, but preliminary data could not accurately reflect the survival benefit. We thus did a systematic review and meta-analysis of randomized controlled trials to reassess the efficacy and safety of angiogenesis inhibitors combined with chemotherapy for ovarian cancer. Methods We searched PubMed, EMBASE, Cochrane, and ClinicalTrials.gov for randomized controlled trials comparing angiogenesis inhibitors containing therapy with conventional chemotherapy alone or no further treatment. Our main outcomes were the progression-free survival (PFS), overall survival (OS), and common adverse events. Results Fifteen trials were included (N = 8721 participants). For newly diagnosed ovarian cancer, combination treatment with angiogenesis inhibitors and chemotherapy yielded a lower risk of disease progression (hazard ratio [HR], 0.83; 95% confidence interval (CI), 0.71–0.97) and no improved OS (HR, 0.95; 95% CI, 0.86–1.05). In the high-risk progression subgroup, the addition of bevacizumab significantly improved PFS (HR, 0.72; 95% CI, 0.65–0.81) and OS (HR, 0.84; 95%CI, 0.74–0.96). In recurrent patients, the combined HR was 0.58 (95% CI, 0.52–0.65) for PFS, and for OS, the combined HR was 0.86 (95% CI, 0.79–0.94). We found no significant improvement for either PFS (HR, 0.80; 95% CI, 0.63–1.01) or OS (HR, 1.06; 95% CI, 0.88–1.28) in the pure maintenance therapy. In the overall population, angiogenesis inhibitors increased the incidence of gastrointestinal perforation (risk ratio [RR], 2.57; 95% CI, 1.66–3.97), hypertension (RR, 7.60; 95% CI, 2.79–20.70), arterial thromboembolism (RR, 2.27; 95% CI, 1.34–3.84), proteinuria (RR, 4.31; 95% CI, 2.15–8.64), and complication of wound healing (RR, 1.72, 95% CI, 1.12–2.63). Conclusions Combination treatment with angiogenesis inhibitors and chemotherapy significantly improved PFS and OS in both patients with high-risk of progression and recurrent ovarian cancer, with an increased incidence of common adverse events. Conversely, we detected no statistically significant survival benefit in the pure maintenance setting. The main limitation of the review is clinical heterogeneity across the studies.
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Gillen J, Richardson D, Moore K. Angiopoietin-1 and Angiopoietin-2 Inhibitors: Clinical Development. Curr Oncol Rep 2019; 21:22. [PMID: 30806847 DOI: 10.1007/s11912-019-0771-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the current understanding of the Tie2-angiopoietin system and its role in tumor growth and metastasis. This review also focuses on preclinical and clinical data published to date that have evaluated Tie2-angiopoietin inhibition. RECENT FINDINGS Tie2 inhibition has shown significant promise in preclinical models, notable for decreased tumor burden and fewer sites of metastatic disease across various malignancies. However, data from human clinical trials have shown more mixed results. Trebananib, rebastanib, and MEDI3617 are the three Tie2-angiopoietin inhibitors that have been most widely evaluated in phase I and II trials. Further investigation into these therapies is ongoing. The Tie2-angiopoietin pathway continues to show promise in preclinical and some clinical trials, including studies on recurrent or metastatic breast and renal cell carcinomas. Further evaluation of these therapies, however, is warranted to better understand their optimal clinical utility.
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Affiliation(s)
- Jessica Gillen
- The University of Oklahoma Stephenson Cancer Center, 800 NE 10th Street, Oklahoma City, OK, 73104, USA
| | - Debra Richardson
- The University of Oklahoma Stephenson Cancer Center, 800 NE 10th Street, Oklahoma City, OK, 73104, USA
| | - Kathleen Moore
- The University of Oklahoma Stephenson Cancer Center, 800 NE 10th Street, Oklahoma City, OK, 73104, USA.
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21
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Phage Display Libraries: From Binders to Targeted Drug Delivery and Human Therapeutics. Mol Biotechnol 2019; 61:286-303. [DOI: 10.1007/s12033-019-00156-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Jayson GC, Zhou C, Backen A, Horsley L, Marti-Marti K, Shaw D, Mescallado N, Clamp A, Saunders MP, Valle JW, Mullamitha S, Braun M, Hasan J, McEntee D, Simpson K, Little RA, Watson Y, Cheung S, Roberts C, Ashcroft L, Manoharan P, Scherer SJ, Del Puerto O, Jackson A, O'Connor JPB, Parker GJM, Dive C. Plasma Tie2 is a tumor vascular response biomarker for VEGF inhibitors in metastatic colorectal cancer. Nat Commun 2018; 9:4672. [PMID: 30405103 PMCID: PMC6220185 DOI: 10.1038/s41467-018-07174-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022] Open
Abstract
Oncological use of anti-angiogenic VEGF inhibitors has been limited by the lack of informative biomarkers. Previously we reported circulating Tie2 as a vascular response biomarker for bevacizumab-treated ovarian cancer patients. Using advanced MRI and circulating biomarkers we have extended these findings in metastatic colorectal cancer (n = 70). Bevacizumab (10 mg/kg) was administered to elicit a biomarker response, followed by FOLFOX6-bevacizumab until disease progression. Bevacizumab induced a correlation between Tie2 and the tumor vascular imaging biomarker, Ktrans (R:-0.21 to 0.47) implying that Tie2 originated from the tumor vasculature. Tie2 trajectories were independently associated with pre-treatment tumor vascular characteristics, tumor response, progression free survival (HR for progression = 3.01, p = 0.00014; median PFS 248 vs. 348 days p = 0.0008) and the modeling of progressive disease (p < 0.0001), suggesting that Tie2 should be monitored clinically to optimize VEGF inhibitor use. A vascular response is defined as a 30% reduction in Tie2; vascular progression as a 40% increase in Tie2 above the nadir. Tie2 is the first, validated, tumor vascular response biomarker for VEGFi.
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Affiliation(s)
- Gordon C Jayson
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK.
| | - Cong Zhou
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester, M20 4GJ, UK
| | - Alison Backen
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
| | - Laura Horsley
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Kalena Marti-Marti
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Danielle Shaw
- Clatterbridge Cancer Centre, Liverpool, CH63 4JY, UK
| | - Nerissa Mescallado
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Andrew Clamp
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Mark P Saunders
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Juan W Valle
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Saifee Mullamitha
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Mike Braun
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Jurjees Hasan
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Delyth McEntee
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Kathryn Simpson
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
| | - Ross A Little
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Yvonne Watson
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Susan Cheung
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Caleb Roberts
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Linda Ashcroft
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Prakash Manoharan
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Stefan J Scherer
- Novartis Pharmaceuticals Corporation, One Health Plaza, 337, East Hanover, NJ, 07936-1080, USA
| | - Olivia Del Puerto
- Del Puerto Limited, 23 Porters Wood; Saint Albans, Hertfordshire, AL3 6PQ, UK
| | - Alan Jackson
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - James P B O'Connor
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester, M20 4GJ, UK
| | - Geoff J M Parker
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
- Bioxydyn Ltd, Manchester, M15 6SZ, UK
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
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Phase 1b Study of Trebananib Plus Paclitaxel and Trastuzumab in Patients With HER2-Positive Locally Recurrent or Metastatic Breast Cancer. Clin Breast Cancer 2018; 19:47-57. [PMID: 30420181 DOI: 10.1016/j.clbc.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/21/2018] [Accepted: 09/29/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Trebananib, a peptide-Fc fusion protein, blocks angiogenesis by inhibiting binding of angiopoietin-1/2 to the receptor tyrosine kinase Tie2. Trebananib plus trastuzumab and paclitaxel was evaluated in human epidermal growth factor receptor 2-positive breast cancer in an open-label phase 1b clinical study. PATIENTS AND METHODS Women with human epidermal growth factor receptor 2-positive breast cancer received weekly paclitaxel (80 mg/m2), trastuzumab (8 mg/m2 then 6 mg/kg every 3 weeks), and intravenous trebananib (10 mg/kg or 30 mg/kg weekly) beginning week 2. The primary end point was the incidence of dose-limiting toxicities. Secondary end points included incidence of adverse events (AEs), pharmacokinetics, and tumor response (objective response and duration of response). RESULTS Forty women were enrolled; 2 experienced dose-limiting toxicities (grade 3 ocular transient ischemic attack [10 mg/kg cohort] and grade 3 elevation in γ-glutamyl transferase [30 mg/kg cohort]). The most common treatment-emergent AEs were peripheral edema (n = 28), diarrhea (n = 27), alopecia (n = 26), fatigue (n = 24), and nausea (n = 24). Maximum observed concentration and area under the concentration-time curve increased proportionally with the trebananib dose. Objective response was confirmed in 31 patients. In the 10 mg/kg cohort, 16 patients (80%) experienced partial response, and none experienced complete response. In the 30 mg/kg cohort, 12 patients (71%) experienced partial response and 3 (18%) experienced complete response. Median (95% confidence interval) duration of response in the 10 and 30 mg/kg cohorts was 12.6 (4.3-20.2) and 16.6 (8.2-not estimable) months, respectively. CONCLUSION This phase 1b study showed that trebananib was tolerated with manageable AEs at a dose up to 30 mg/kg weekly. Trebananib demonstrated anticancer activity, as indicated by objective response and duration of response.
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Vergote I, von Moos R, Manso L, Van Nieuwenhuysen E, Concin N, Sessa C. Tumor Treating Fields in combination with paclitaxel in recurrent ovarian carcinoma: Results of the INNOVATE pilot study. Gynecol Oncol 2018; 150:471-477. [DOI: 10.1016/j.ygyno.2018.07.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/18/2018] [Accepted: 07/22/2018] [Indexed: 12/31/2022]
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25
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Rodon J, Curigliano G, Delord JP, Harb W, Azaro A, Han Y, Wilke C, Donnet V, Sellami D, Beck T. A Phase Ib, open-label, dose-finding study of alpelisib in combination with paclitaxel in patients with advanced solid tumors. Oncotarget 2018; 9:31709-31718. [PMID: 30167089 PMCID: PMC6114962 DOI: 10.18632/oncotarget.25854] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/12/2018] [Indexed: 11/25/2022] Open
Abstract
Phosphatidylinositol 3-kinase (PI3K) pathway activation is associated with resistance to paclitaxel in solid tumors. We assessed the safety and activity of alpelisib, an oral, selective PI3K p110α inhibitor, plus paclitaxel in patients with advanced solid tumors. This Phase Ib, multicenter, open-label, dose-finding study, with a planned dose-expansion phase of alpelisib once daily (QD) plus fixed-dose paclitaxel, recruited patients with advanced solid tumors. For the dose-finding phase, the primary objective was determination of maximum tolerated and/or recommended Phase II dose of alpelisib plus paclitaxel, and the secondary objectives included the assessment of safety for this combination. From March 2014 to August 2016, 19 patients with advanced solid tumors were treated with alpelisib QD (300 mg, n=6; 250 mg, n=4; 150 mg, n=9) plus paclitaxel (80 mg/m2, per standard of care). During dose finding, five of 12 (41.7%) evaluable patients for MTD determination experienced dose-limiting toxicities: alpelisib 300 mg, Grade 2 hyperglycemia (n=1); alpelisib 250 mg, Grade 2 hyperglycemia (n=1), Grade 4 hyperglycemia and Grade 3 acute kidney injury (n=1); and alpelisib 150 mg, Grade 2 hyperglycemia (n=1) and Grade 4 leukopenia (n=1). The MTD of alpelisib when administered with paclitaxel was 150 mg QD. Most frequent all-grade AEs were diarrhea (73.7%; Grade 3/4 10.5%) and hyperglycemia (57.9%; Grade 3/4 31.6%). The planned dose-expansion phase was not initiated. Alpelisib plus paclitaxel has a challenging safety profile in patients with advanced solid tumors. This study was closed following the completion of the dose-finding phase. Clinical trial registration: ClinicalTrials.gov NCT02051751.
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Affiliation(s)
- Jordi Rodon
- Molecular Therapeutics Research Unit, Department of Medical Oncology, Vall d'Hebron University Hospital, Centro Cellex, 08035, Barcelona, Spain
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapies, Department of Hematology and Oncology, University of Milano, Istituto Europeo di Oncologia, 20141, Milan, Italy
| | - Jean-Pierre Delord
- Clinical Research Unit, Institut Claudius Regaud, 31052, Toulouse, France
| | - Wael Harb
- Horizon Oncology Center, 47905, Lafayette, IN, USA
| | - Analia Azaro
- Molecular Therapeutics Research Unit, Department of Medical Oncology, Vall d'Hebron University Hospital, Centro Cellex, 08035, Barcelona, Spain
| | - Yu Han
- Novartis Pharmaceuticals Corporation, 07936, East Hanover, NJ, USA
| | - Celine Wilke
- Novartis Pharma AG, Postfach, CH-4002, Basel, Switzerland
| | | | - Dalila Sellami
- Novartis Pharmaceuticals Corporation, 07936, East Hanover, NJ, USA
| | - Thaddeus Beck
- Highlands Oncology Group, 72703, Fayetteville, AR, USA
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26
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Jiang Y, Sun X, Kong B, Jiang J. Antiangiogenesis therapy in ovarian cancer patients: An updated meta-analysis for 15 randomized controlled trials. Medicine (Baltimore) 2018; 97:e11920. [PMID: 30142803 PMCID: PMC6112884 DOI: 10.1097/md.0000000000011920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Antiangiogenesis therapy has been demonstrated to prolong the free survival with tolerable toxicity. However the efficacy of these drugs in overall survival (OS) remains controversial. This study was designed to assess the overall performance of antiangiogenesis therapy in improving the survival of ovary cancer (OC) patients. METHODS Electronic database of PubMed, Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched to identify relevant clinical randomized control trial (RCTs) assessing the therapeutic value of antiangiogenesis therapy in OC patients during 2011 to 2017. Additionally, abstracts of annual meetings were also conducted. Only English articles were considered. Progression free survival (PFS), OS, and objective response rate (ORR) were obtained from eligible RCTs. The HRs for time-to-event variables and ORs for dichotomous outcomes with their 95% CIs were used for this meta-analysis. All the statistical analyses were carried out by Stata 11.0 software using a fixed or random-models according to heterogeneity. RESULTS A total of 15 RCTs including 9359 patients were recruited into this meta-analysis. Addition of antiangiogenic agents improved PFS (HR = 0.71, 95% CI 0.62-0.81, P < .001), OS (HR = 0.92, 95% CI 0.86-0.98, P = .008) and ORR (OR = 1.74, 95% CI 1.27-2.39, P = .001) compared to placebo or chemotherapy alone in overall analysis. Antiangiogenic agents prolonged both PFS (HR = 0.58, 95% CI 0.52-0.65, P = .000) and OS (HR=0.84, 95% CI 0.76-0.92, P = .000) in recurrent settings but only PFS in primary settings (HR = 0.88, 95% CI 0.79-0.98, P = .020), longer PFS and OS in both platinum-sensitive recurrent patients (HR = 0.56, 95% CI 0.48-0.64, P = .000, PFS; HR = 0.86, 95% CI 0.76-0.98, P = .027, OS) as well as platinum-resistant recurrent cases (HR = 0.54, 95% CI 0.41-0.71, P = .000, PFS; HR = 0.84, 95% CI 0.71-0.98, P = .029, OS). Throughout therapy improved PFS (HR = 0.66, 95% CI 0.57-0.76, P < .001) and OS (HR = 0.89, 95% CI 0.83-0.96, P = .001). However the maintenance therapy of antiangiogenic agents was irrelevant to a longer PFS or OS. CONCLUSION Based on the available studies, antiangiogenic agents play an important role in the survival of OC patients. More randomized controlled trials are needed to reach more convinced conclusion.
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Affiliation(s)
- Yanyan Jiang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University
| | - Xiaomei Sun
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University
- Key Laboratory of Gynecologic Oncology of Shandong Province, PR China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University
- Key Laboratory of Gynecologic Oncology of Shandong Province, PR China
| | - Jie Jiang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University
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27
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Evelhoch JL. In vivo MR in the drug pipeline. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 292:117-128. [PMID: 29716831 DOI: 10.1016/j.jmr.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/15/2018] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
The application of in vivo magnetic resonance (MR) in drug development has several requirements that differ significantly from most applications primarily because the biopharmaceutical industry must develop new safe and effective drugs more quickly and at lower cost in a highly regulated environment. In vivo MR is recognized as a useful method to provide biomarkers for target engagement, treatment response, safety and mechanism of action that can be translated between animal and clinical studies. Thus, it has the potential to help identify drugs that are more likely to be safe and effective earlier in the process of drug development, which may help reduce the time and money required to get new drugs to patients with an unmet medical need. A brief introduction of how novel drugs are discovered and developed, what drives the biopharmaceutical industry's interest in using biomarkers and what it takes to use MR as a biomarker to support drug development, including regulatory concerns, provides context for understanding what makes the application of in vivo MR in drug development different from most others. Exploration of three programs (trebananib, ZD6126 and axitinib) using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in the development of antivascular agents provides insight into how in vivo MR biomarkers impact drug discovery and development and the limitations of biomarkers.
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Affiliation(s)
- Jeffrey L Evelhoch
- Merck & Co., Inc., 770 Sumneytown Pike, WP 42-211, West Point, PA 19486, USA.
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28
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WITHDRAWN: Addition of targeted agents to chemotherapy for persistent or recurrent ovarian cancer: a meta-analysis of randomized controlled trials. Crit Rev Oncol Hematol 2018. [DOI: 10.1016/j.critrevonc.2018.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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29
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Huang B, Yin M, Li X, Cao G, Qi J, Lou G, Sheng S, Kou J, Chen K, Yu B. Migration-inducing gene 7 promotes tumorigenesis and angiogenesis and independently predicts poor prognosis of epithelial ovarian cancer. Oncotarget 2018; 7:27552-66. [PMID: 27050277 PMCID: PMC5053671 DOI: 10.18632/oncotarget.8487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/18/2016] [Indexed: 11/25/2022] Open
Abstract
Epithelial ovarian carcinomas (EOC) cause more mortality than any other cancer of the female reproductive system. New therapeutic approaches to reduce EOC mortality have been largely unsuccessful due to the poor understanding of the mechanisms underlying EOC proliferation and metastasis. Progress in EOC treatment is further hampered by a lack of reliable prognostic biomarkers for early risk assessment. In this study, we identify that Migration-Inducting Gene 7 (MIG-7) is specifically induced in human EOC tissues but not normal ovaries or ovarian cyst. Ovarian MIG-7 expression strongly correlated with EOC progression. Elevated MIG-7 level at the time of primary cytoreductive surgery was a strong and independent predictor of poor survival of EOC patients. Cell and murine xenograft models showed that MIG-7 was required for EOC proliferation and invasion, and MIG-7 enhanced EOC-associated angiogenesis by promoting the expression of vascular endothelial growth factor. Inhibiting MIG-7 by RNA interference in grafted EOC cells retarded tumor growth, angiogenesis and improved host survival, and suppressing MIG-7 expression with a small molecule inhibitor D-39 identified from the medicinal plant Liriope muscari mitigated EOC growth and invasion and specifically abrogated the expression of vascular endothelial growth factor. Our data not only reveal a critical function of MIG-7 in EOC growth and metastasis and support MIG-7 as an independent prognostic biomarker for EOC, but also demonstrate that therapeutic targeting of MIG-7 is likely beneficial in the treatment of EOC.
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Affiliation(s)
- Bihui Huang
- Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA.,Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, Michigan, USA
| | - Mingzhu Yin
- State Key Laboratory of Natural Products and Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, Department of Complex Prescription of TCM, China Pharmaceutical University, Nanjing, China.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Xia Li
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Stem Cell Center, Yale University, New Haven, Connecticut, USA
| | - Guosheng Cao
- State Key Laboratory of Natural Products and Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, Department of Complex Prescription of TCM, China Pharmaceutical University, Nanjing, China
| | - Jin Qi
- State Key Laboratory of Natural Products and Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, Department of Complex Prescription of TCM, China Pharmaceutical University, Nanjing, China
| | - Ge Lou
- Department of Gynecologic Oncology, The Affiliated Cancer Hospital of Harbin Medical University, Harbin, China
| | - Shijie Sheng
- Department of Pathology, Wayne State University, Detroit, Michigan, USA.,Tumor Biology and Microenvironment Program, Barbara Ann Karmanos Cancer Center and Department of Oncology, Wayne State University, Detroit, Michigan, USA
| | - Junping Kou
- State Key Laboratory of Natural Products and Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, Department of Complex Prescription of TCM, China Pharmaceutical University, Nanjing, China
| | - Kang Chen
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA.,Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Detroit, Michigan, USA.,Tumor Biology and Microenvironment Program, Barbara Ann Karmanos Cancer Center and Department of Oncology, Wayne State University, Detroit, Michigan, USA.,Department of Immunology and Microbiology, Wayne State University, Detroit, Michigan, USA.,Mucosal Immunology Studies Team, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Boyang Yu
- State Key Laboratory of Natural Products and Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, Department of Complex Prescription of TCM, China Pharmaceutical University, Nanjing, China
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30
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Angiopoietins bind thrombomodulin and inhibit its function as a thrombin cofactor. Sci Rep 2018; 8:505. [PMID: 29323190 PMCID: PMC5765006 DOI: 10.1038/s41598-017-18912-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/14/2017] [Indexed: 02/06/2023] Open
Abstract
Angiopoietin-1 (Ang1) and Angiopoietin-2 (Ang2) are ligands for Tie2, an endothelial-specific receptor tyrosine kinase that is an essential regulator of angiogenesis. Here we report the identification, via expression cloning, of thrombomodulin (TM) as another receptor for Ang1 and Ang2. Thrombomodulin is an endothelial cell surface molecule that plays an essential role as a coagulation inhibitor via its function as a cofactor in the thrombin-mediated activation of protein C, an anticoagulant protein, as well as thrombin-activatable fibrinolysis inhibitor (TAFI). Ang1 and Ang2 inhibited the thrombin/TM-mediated generation of activated protein C and TAFI in cultured endothelial cells, and inhibited the binding of thrombin to TM in vitro. Ang2 appears to bind TM with higher affinity than Ang1 and is a more potent inhibitor of TM function. Consistent with a potential role for angiopoietins in coagulation, administration of thrombin to mice rapidly increased plasma Ang1 levels, presumably reflecting release from activated platelets (previously shown to contain high levels of Ang1). In addition, Ang1 levels were significantly elevated in plasma prepared from wound blood, suggesting that Ang1 is released from activated platelets at sites of vessel injury. Our results imply a previously undescribed role for angiopoietins in the regulation of hemostasis.
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Cortez AJ, Tudrej P, Kujawa KA, Lisowska KM. Advances in ovarian cancer therapy. Cancer Chemother Pharmacol 2018; 81:17-38. [PMID: 29249039 PMCID: PMC5754410 DOI: 10.1007/s00280-017-3501-8] [Citation(s) in RCA: 350] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
Abstract
Epithelial ovarian cancer is typically diagnosed at an advanced stage. Current state-of-the-art surgery and chemotherapy result in the high incidence of complete remissions; however, the recurrence rate is also high. For most patients, the disease eventually becomes a continuum of symptom-free periods and recurrence episodes. Different targeted treatment approaches and biological drugs, currently under development, bring the promise of turning ovarian cancer into a manageable chronic disease. In this review, we discuss the current standard in the therapy for ovarian cancer, major recent studies on the new variants of conventional therapies, and new therapeutic approaches, recently approved and/or in clinical trials. The latter include anti-angiogenic therapies, polyADP-ribose polymerase (PARP) inhibitors, inhibitors of growth factor signaling, or folate receptor inhibitors, as well as several immunotherapeutic approaches. We also discuss cost-effectiveness of some novel therapies and the issue of better selection of patients for personalized treatment.
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Affiliation(s)
- Alexander J Cortez
- Maria Skłodowska-Curie Institute - Oncology Center, Gliwice Branch, Wybrzeże Armii Krajowej 15, Gliwice, 44-100, Poland
| | - Patrycja Tudrej
- Maria Skłodowska-Curie Institute - Oncology Center, Gliwice Branch, Wybrzeże Armii Krajowej 15, Gliwice, 44-100, Poland
| | - Katarzyna A Kujawa
- Maria Skłodowska-Curie Institute - Oncology Center, Gliwice Branch, Wybrzeże Armii Krajowej 15, Gliwice, 44-100, Poland
| | - Katarzyna M Lisowska
- Maria Skłodowska-Curie Institute - Oncology Center, Gliwice Branch, Wybrzeże Armii Krajowej 15, Gliwice, 44-100, Poland.
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Redundant angiogenic signaling and tumor drug resistance. Drug Resist Updat 2018; 36:47-76. [DOI: 10.1016/j.drup.2018.01.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
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Cavaco M, Castanho MARB, Neves V. Peptibodies: An elegant solution for a long-standing problem. Biopolymers 2017; 110. [PMID: 29266205 DOI: 10.1002/bip.23095] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/20/2017] [Accepted: 11/24/2017] [Indexed: 01/09/2023]
Abstract
Chimeric proteins composed of a biologically active peptide and a fragment crystallizable (Fc) domain of immunoglobulin G (IgG) are known as peptibodies. They present an extended half-life due to neonatal Fc receptor (FcRn) salvage pathway, a decreased renal clearance rate owing to its increased size (≈70 kDa) and, depending on the peptide used in the design of the peptibody, an active-targeting moiety. Also, the peptides therapeutic activity is boosted by the number of peptides in the fusion protein (at least two peptides) and to some peptides' alterations. Peptibodies are mainly obtained through recombinant DNA technology. However, to improve peptide properties, "unnatural" changes have been introduced to the original peptides' sequence, for instance, the incorporation of D- or non-natural amino acid residues or even cyclization thus, limiting the application of genetic engineering in the production of peptibodies, since these peptides must be obtained via chemical synthesis. This constrains prompted the development of new methods for conjugation of peptides to Fc domains. Another challenge, subject of intense research, relates to the large-scale production of such peptibodies using these new techniques, which can be minimized by their proved value. To date, two peptibodies, romiplostim and dulaglutide, have been approved and stay as the standard of care in their areas of action. Furthermore, a considerable number of peptibodies are currently in preclinical and clinical development.
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Affiliation(s)
- Marco Cavaco
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa, 1649-028, Portugal
| | - Miguel A R B Castanho
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa, 1649-028, Portugal
| | - Vera Neves
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Av. Prof. Egas Moniz, Lisboa, 1649-028, Portugal
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Francis J, Coakley N, Elit L, Mackay H. Systemic therapy for recurrent epithelial ovarian cancer: a clinical practice guideline. ACTA ACUST UNITED AC 2017; 24:e540-e546. [PMID: 29270064 DOI: 10.3747/co.24.3824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective The purpose of this guideline is to recommend systemic therapy options for women with recurrent epithelial ovarian cancer, including fallopian tube and primary peritoneal cancers. Methods This document updates the recommendations published in the 2011 Optimal Chemotherapy for Recurrent Ovarian Cancer guideline from Cancer Care Ontario. Draft recommendations were formulated based on evidence obtained through a systematic review of phase ii and iii randomized controlled trials (rcts). The draft recommendations underwent internal review by clinical and methodology experts, and external review by clinical practitioners through a survey assessing the clinical relevance and overall quality of the guideline. Feedback from the internal and external reviews was integrated into the clinical practice guideline. Results The primary literature search yielded thirty-six primary research papers representing thirty rcts that met the eligibility criteria. The guideline provides recommendations for patients with serous tumour histologies and with recurrent, platinum-resistant, and platinum-sensitive ovarian cancer. Conclusions The body of evidence from trials that included olaparib and bevacizumab consistently shows a benefit in progression-free survival (pfs) without a corresponding benefit in overall survival (os). The Working Group for this guideline designated pfs, which is associated with symptom control, as a critical outcome. A finding of net benefit can therefore be concluded based on significant differences in pfs. However, that benefit is not without identified harms. Given the identified harms, patient involvement in the decision-making process must take into consideration the side effect profiles of olaparib and bevacizumab within the context of improved pfs but minimal change in os.
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Affiliation(s)
- J Francis
- Department of Obstetrics and Gynecology, Queen's University, Kingston
| | - N Coakley
- Department of Oncology, McMaster University, and Cancer Care Ontario's Program in Evidence-Based Care, Hamilton
| | - L Elit
- Department of Obstetrics and Gynecology, McMaster University, Hamilton; and
| | - H Mackay
- Department of Medical Oncology and Hematology, Sunnybrook Health Sciences Centre, Toronto, ON
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Reardon DA, Lassman AB, Schiff D, Yunus SA, Gerstner ER, Cloughesy TF, Lee EQ, Gaffey SC, Barrs J, Bruno J, Muzikansky A, Duda DG, Jain RK, Wen PY. Phase 2 and biomarker study of trebananib, an angiopoietin-blocking peptibody, with and without bevacizumab for patients with recurrent glioblastoma. Cancer 2017; 124:1438-1448. [PMID: 29266174 DOI: 10.1002/cncr.31172] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/22/2017] [Accepted: 11/02/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Angiopoietins contribute to tumor angiogenesis and may be upregulated as a compensatory factor after vascular endothelial growth factor (VEGF) blockade. The authors performed a phase 2 and biomarker study to evaluate trebananib, an angiopoietin 1 and angiopoietin 2 blocking peptibody, with and without bevacizumab in patients with recurrent glioblastoma. METHODS Forty-eight patients who had bevacizumab-naive, recurrent glioblastoma were treated with trebananib (30 mg/kg weekly) as single agent (n = 11) or combined with bevacizumab (n = 37). The primary endpoint was 6-month progression-free survival rate as determined by investigator review. Circulating biomarker levels were assessed before and after study therapy. RESULTS Trebananib was well tolerated as monotherapy and did not enhance bevacizumab-associated toxicity. Trebananib had no single-agent activity, and all treated patients exhibited progressive disease within 2 months. The 6-month progression-free survival rate for trebananib plus bevacizumab was 24.3% (95% confidence interval [CI], 12.1%-38.8%); whereas the median overall survival was 9.5 months (95% CI, 7.5-4.7 months), and the 12-month overall survival rate was 37.8% (95% CI, 22.6%-53.0%). Baseline and post-treatment changes in circulating vascular VEGF and interleukin-8 levels were correlated with survival among patients who received trebananib plus bevacizumab. CONCLUSIONS Angiopoietin 1 and angiopoietin 2 inhibition with trebananib was ineffective as monotherapy and did not enhance the ability of VEGF blockade with bevacizumab to improve the outcomes of patients with recurrent glioblastoma. Cancer 2018;124:1438-48. © 2017 American Cancer Society.
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Affiliation(s)
- David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrew B Lassman
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - David Schiff
- Department of Neurology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Shakeeb A Yunus
- Hematology/Oncology, University of Massachusetts Memorial Medical Center, Worchester, Massachusetts
| | - Elizabeth R Gerstner
- Department of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy F Cloughesy
- Department of Neurology, University of California, Los Angeles, Los Angeles, California
| | - Eudocia Quant Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah C Gaffey
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jennifer Barrs
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jennifer Bruno
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alona Muzikansky
- Biostatistics, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel G Duda
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rakesh K Jain
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Jiang Y, Fan H, Jiang Y, Song G, Wang F, Li X, Li G. Efficacy and safety of FOLFIRI and biotherapy versus FOLFIRI alone for metastatic colorectal cancer patients: A meta-analysis. Medicine (Baltimore) 2017; 96:e8767. [PMID: 29310351 PMCID: PMC5728752 DOI: 10.1097/md.0000000000008767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Previous randomized controlled trials (RCTs) and meta-analyses have demonstrated the useless of FOLFIRI alone for previously treated patients with metastatic colorectal cancer (mCRC). The role of FOLFIRI regimen combined with biological therapy is unknown. The purpose of this meta-analysis is to evaluate the efficacy and safety of combining biological therapy with chemotherapy in previously treated patients with mCRC. METHODS MEDLINE, EMBASE, Web of Science, Cochrane library, and ClinicalTrials.gov were searched. Eligible studies were RCTs that evaluated the efficacy and safety of the FOLFIRI regimen with or without biological therapy for previously treated patients with mCRC. The hazard ratio (HR) or risk ratio (RR) with 95% confidence interval was estimated. The Chi-squared and I-squared tests were used to assess the statistical heterogeneity. RESULTS The literature search identified 7 RCTs that met the inclusion criteria for the meta-analysis, and 3680 patients with mCRC were included. The meta-analysis showed that combined therapy was associated with a significant improved progression-free survival (PFS) (HR = 0.78, 95% CI = 0.72-0.85, P < .001), overall survival (OS) (HR = 0.84, 95% CI = 0.77-0.92, P < .001), and overall response rate (ORR) (RR = 1.70, 95% CI = 1.25-2.31, P = .001). Sensitivity analysis suggested that combined therapy versus FOLFIRI alone might increase the risk of Grade 3/4 AEs. CONCLUSION The addition of biological therapy to the FOLFIRI regimen improved the PFS, OS, and ORR compared with FOLFIRI alone for previously treated patients with mCRC. Long-term survival outcomes are warranted.
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Affiliation(s)
| | - Hui Fan
- Department of Radiation Oncology
| | - Yongmei Jiang
- Department of Neurological Rehabilitation, the Second Affiliated Hospital of Dalian Medical University
| | - Guirong Song
- School of Public Health, Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Feng Wang
- School of Public Health, Dalian Medical University, Dalian, Liaoning, P.R. China
| | - Xiaofeng Li
- School of Public Health, Dalian Medical University, Dalian, Liaoning, P.R. China
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Leary SES, Park JR, Reid JM, Ralya AT, Baruchel S, Wu B, Roberts TPL, Liu X, Minard CG, Fox E, Weigel B, Blaney S. Pediatric Phase I Trial and Pharmacokinetic Study of Trebananib in Relapsed Solid Tumors, Including Primary Tumors of the Central Nervous System ADVL1115: A Children's Oncology Group Phase I Consortium Report. Clin Cancer Res 2017; 23:6062-6069. [PMID: 28751444 DOI: 10.1158/1078-0432.ccr-16-2882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/03/2017] [Accepted: 07/19/2017] [Indexed: 12/14/2022]
Abstract
Purpose: Trebananib is a first-in-class antiangiogenic peptibody (peptide-Fc fusion protein) that inhibits Angiopoietin 1 and 2. A pediatric phase 1 trial was performed to define trebananib dose-limiting toxicities (DLT), recommended phase 2 dose (RP2D), and pharmacokinetics (PK).Experimental Design: Trebananib was administered by weekly infusion. Three dose levels (10, 15, or 30 mg/kg/dose) were evaluated using a rolling-six design. Part 2 evaluated a cohort of subjects with primary central nervous system (CNS) tumors. Pharmacokinetic sampling and analysis of peripheral blood biomarkers was performed during the first 4 weeks. Response was evaluated after 8 weeks. Correlative studies included angiogenic protein expression and DCE-MRI.Results: Thirty-seven subjects were enrolled (31 evaluable for toxicity) with median age 12 years (range, 2 to 21). Two of 19 evaluable non-CNS subjects developed DLT at the 30 mg/kg dose level, including venous thrombosis and pleural effusion. In the CNS cohort, 3/12 subjects developed DLT, including decreased platelet count, transient ischemic attack, and cerebral edema with headache and hydrocephalus. Other grade 3 or 4 toxicities included lymphopenia (n = 4), anemia, thrombocytopenia, neutropenia, vomiting, and hypertension (n = 1 each). Response included stable disease in 7 subjects, no partial or complete responses. Two subjects continued study treatment with prolonged stable disease for 18 cycles (neuroblastoma) and 26 cycles (anaplastic astrocytoma). Pharmacokinetics appeared linear over 3 dose levels. Correlative studies demonstrated increased PlGF and sVCAM-1, but no change in endoglin or perfusion by DCE-MRI.Conclusions: Trebananib was well tolerated in pediatric patients with recurrent or refractory solid or CNS tumors. RP2D is 30 mg/kg. Clin Cancer Res; 23(20); 6062-9. ©2017 AACR.
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Affiliation(s)
- Sarah E S Leary
- Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Julie R Park
- Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | - Bing Wu
- Hospital for Sick Children, Toronto, Ontario
| | | | - Xiaowei Liu
- Children's Oncology Group, Monrovia, California
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Wu B, Lewis LD, Harvey RD, Rasmussen E, Gamelin E, Sun YN, Friberg G, Koyner JL, Dowlati A, Maitland ML. A Pharmacokinetic and Safety Study of Trebananib, an Fc-Fusion Peptibody, in Patients With Advanced Solid Tumors and Varying Degrees of Renal Dysfunction. Clin Pharmacol Ther 2017; 102:313-320. [PMID: 28074547 DOI: 10.1002/cpt.617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 01/09/2023]
Abstract
Clearance of trebananib (AMG 386), a 64-kD antiangiogenic peptibody, has been associated with estimated glomerular filtration rate (eGFR). We prospectively evaluated trebananib pharmacokinetics and safety/tolerability in advanced solid tumor patients with varying degrees of renal function. Patients were assigned to normal renal function, mild, moderate, or severe renal dysfunction cohorts based on eGFR, received trebananib 15 mg/kg i.v. weekly, and underwent week 1 and week 5 pharmacokinetic and weekly safety assessments. For 28 patients, trebananib clearance decreased from normal renal function (1.52 mL/hr/kg), to mild (1.20 mL/hr/kg), moderate (0.79 mL/hr/kg), and severe (0.53 mL/hr/kg) renal dysfunction (P ≤ 0.001). Treatment-related adverse events showed no association with clearance. Trebananib clearance was proportional to eGFR and unrelated to pretreatment protein excretion. These data confirm a role for renal clearance of a recombinant peptibody with molecular weight <69 kD and support a longer dosing interval for patients with severe renal dysfunction.
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Affiliation(s)
- B Wu
- Amgen Inc, Thousand Oaks, California, USA
| | - L D Lewis
- Department of Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - R D Harvey
- Emory University, Winship Cancer Institute, Atlanta, Georgia, USA
| | | | - E Gamelin
- Amgen Inc, Thousand Oaks, California, USA
| | - Y-N Sun
- Amgen Inc, Thousand Oaks, California, USA
| | - G Friberg
- Amgen Inc, Thousand Oaks, California, USA
| | - J L Koyner
- University of Chicago Medicine, Chicago, Illinois, USA
| | - A Dowlati
- Case Western Reserve University and University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - M L Maitland
- University of Chicago Medicine, Chicago, Illinois, USA.,Inova Schar Cancer Institute and Center for Personalized Health, Falls Church, Virginia, USA
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Saharinen P, Eklund L, Alitalo K. Therapeutic targeting of the angiopoietin-TIE pathway. Nat Rev Drug Discov 2017; 16:635-661. [PMID: 28529319 DOI: 10.1038/nrd.2016.278] [Citation(s) in RCA: 318] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The endothelial angiopoietin (ANG)-TIE growth factor receptor pathway regulates vascular permeability and pathological vascular remodelling during inflammation, tumour angiogenesis and metastasis. Drugs that target the ANG-TIE pathway are in clinical development for oncological and ophthalmological applications. The aim is to complement current vascular endothelial growth factor (VEGF)-based anti-angiogenic therapies in cancer, wet age-related macular degeneration and macular oedema. The unique function of the ANG-TIE pathway in vascular stabilization also renders this pathway an attractive target in sepsis, organ transplantation, atherosclerosis and vascular complications of diabetes. This Review covers key aspects of the function of the ANG-TIE pathway in vascular disease and describes the recent development of novel therapeutics that target this pathway.
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Affiliation(s)
- Pipsa Saharinen
- Wihuri Research Institute and Translational Cancer Biology Program, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, FI-00014 Helsinki, Finland
| | - Lauri Eklund
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, Aapistie 5A, University of Oulu, 90220 Oulu, Finland
| | - Kari Alitalo
- Wihuri Research Institute and Translational Cancer Biology Program, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, FI-00014 Helsinki, Finland
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Siddiqui MK, Tyczynski J, Pahwa A, Fernandes AW. Objective response rate is a possible surrogate endpoint for survival in patients with advanced, recurrent ovarian cancer. Gynecol Oncol 2017; 146:44-51. [PMID: 28395896 DOI: 10.1016/j.ygyno.2017.03.515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Evaluate literature to assess response rate as a surrogate endpoint of survival in ovarian cancer (OC). METHODS Systematic review consistent with PRISMA criteria, identified randomized, controlled trials reporting overall survival (OS), progression-free survival (PFS), and objective response rate (ORR) in recurrent OC. MEDLINE® and Embase® searches (year 2000-March 23, 2015) were augmented by bibliographic screening. Proposed surrogate measures (independent variables) were ORR and disease control rate. True clinical outcomes (dependent variables) were median OS and PFS. Analyses were performed on unweighted and weighted data using correlation analysis, linear regression, and surrogate threshold effect (STE). Smaller STE indicates greater predictive precision with magnitude of STE dependent on variance of prediction. RESULTS Thirty-nine studies were included for review, representing 9223 platinum-sensitive and resistant patients. Objective response rate (r=0.82; P<0.001) was a better predictor than disease control rate (r=0.58; P<0.001) and strongly correlated with PFS (r=0.85; P<0.0001). Weighted-regression analysis demonstrated that for each 10% increase in ORR, PFS increased by 1.20months and OS by 2.83months. Regression analysis of treatment effects (odds ratio of response, hazard ratio of survival) suggests that a 10% increase in odds ratio of ORR would result in 2.5% reduction in the hazard ratio of OS. Based on weighted data, STE indicated that an ORR of ≥1% is needed to achieve nonzero OS benefit. CONCLUSION This systematic review supports ORR as a possible surrogate clinical trial endpoint for OS in recurrent OC with at least second-line therapy.
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Affiliation(s)
| | - Jerzy Tyczynski
- Global Medical Evidence and Outcomes Research, AstraZeneca, Gaithersburg, MD, USA
| | - Ankit Pahwa
- PAREXEL International, Chandigarh, Chandigarh, India
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Gao Y, Shen J, Choy E, Mankin H, Hornicek F, Duan Z. Inhibition of CDK4 sensitizes multidrug resistant ovarian cancer cells to paclitaxel by increasing apoptosiss. Cell Oncol (Dordr) 2017; 40:209-218. [PMID: 28243976 DOI: 10.1007/s13402-017-0316-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Overexpression of cyclin-dependent kinase (CDK) 4 has been observed in a variety of cancers and has been found to contribute to tumor cell growth and proliferation. However, the effect of inhibition of CDK4 in ovarian cancer is unknown. We investigated the therapeutic effect of the CDK4 inhibitor palbociclib in combination with paclitaxel in ovarian cancer cells. METHODS Cell viabilities were determined by MTT assay after exposure to different dosages of palbociclib and/or paclitaxel. Western blot, immunofluorescence, and Calcein AM assays were conducted to determine the mechanisms underlying the cytotoxic effects of palbociclib in combination with paclitaxel. CDK4 siRNA was used to validate the outcome of targeting CDK4 by palbociclib in ovarian cancer cells. RESULTS We found that combinations of palbociclib and paclitaxel significantly enhanced drug sensitivity in both Rb-positive (SKOV3TR) and Rb-negative (OVCAR8TR) ovarian cancer-derived cells. When combined with paclitaxel, palbociclib induced apoptosis in both SKOV3TR and OVCAR8TR cells. We also found that palbociclib inhibited the activity of P-glycoprotein (Pgp), and that siRNA-mediated CDK4 knockdown sensitized multidrug resistant (MDR) SKOV3TR and OVCAR8TR cells to paclitaxel. CONCLUSIONS Inhibition of CDK4 by palbociclib can enhance paclitaxel sensitivity in both Rb-positive and Rb-negative MDR ovarian cancer cells by increasing apoptosis. CDK4 may serve as a promising target in the treatment of ovarian cancer.
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Affiliation(s)
- Yan Gao
- Department of Clinical Laboratory Diagnostics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.,Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom St, Jackson 1115, Boston, MA, 02114, USA
| | - Jacson Shen
- Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom St, Jackson 1115, Boston, MA, 02114, USA
| | - Edwin Choy
- Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom St, Jackson 1115, Boston, MA, 02114, USA
| | - Henry Mankin
- Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom St, Jackson 1115, Boston, MA, 02114, USA
| | - Francis Hornicek
- Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom St, Jackson 1115, Boston, MA, 02114, USA
| | - Zhenfeng Duan
- Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital and Harvard Medical School, 100 Blossom St, Jackson 1115, Boston, MA, 02114, USA.
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Yi S, Zeng L, Kuang Y, Cao Z, Zheng C, Zhang Y, Liao M, Yang L. Antiangiogenic drugs used with chemotherapy for patients with recurrent ovarian cancer: a meta-analysis. Onco Targets Ther 2017; 10:973-984. [PMID: 28255243 PMCID: PMC5322854 DOI: 10.2147/ott.s119879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective The value of antiangiogenic inhibitors for patients with recurrent ovarian cancer has not been completely affirmed. Therefore, we aimed to assess the effectiveness and toxicities of various antiangiogenic drugs for the treatment of recurrent ovarian cancer. Methods In this meta-analysis, we searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials databases for complete randomized controlled trials. The searches were extended to May 15, 2016. The risk of bias of the included studies was evaluated via a Cochrane systematic evaluation, and the statistical analyses were performed using RevMan 5.2 software. Results In total, we included 8 randomized controlled trials involving 3,211 patients and divided them into 3 groups, vascular endothelial growth factor receptor inhibitors (VEGFRIs), vascular endothelial growth factor (VEGF) inhibitors (bevacizumab), and angiopoietin inhibitors (trebananib). The progression-free survival improved significantly in all the groups being given antiangiogenic drugs (hazard ratio [HR]: 0.55, 95% confidence interval [CI]: 0.45–0.67, I2=0%, P<0.00001 for the VEGFRI group; HR: 0.53, 95% CI: 0.45–0.63, I2=51%, P<0.00001 for the VEGF inhibitor group; HR: 0.67, 95% CI: 0.58–0.77, I2=0%, P<0.00001 for the trebananib group). Overall survival was obviously prolonged in the VEGFRI (HR: 0.76, 95% CI: 0.59–0.97, I2=0%, P=0.03), the VEGF inhibitor (HR: 0.87, 95% CI: 0.77–0.99, I2=0%, P=0.03), and trebananib groups (HR: 0.81, 95% CI: 0.67–0.99, I2=0%, P=0.04). The incidence of grade 3/4 side effects was different among the 3 groups, for example, proteinuria, hypertension, gastrointestinal perforation, and arterial thromboembolism were presented in the VEGF inhibitor group. Increased incidences of fatigue, diarrhea, and hypertension were seen in the VEGFRI group, and the trebananib group had a higher incidence of hypokalemia. Conclusion This meta-analysis showed that antiangiogenic drugs improved the progression-free survival. The VEGFRI, bevacizumab, and trebananib groups showed increased overall survival. Adding antiangiogenic drugs to chemotherapy treatment resulted in a higher incidence of grade 3/4 side effects, but these were manageable.
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Affiliation(s)
- SuYi Yi
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - LongJia Zeng
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Yan Kuang
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - ZhiJuan Cao
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - ChengJun Zheng
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Yue Zhang
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Meng Liao
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Lu Yang
- Department of Gynaecology and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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Staropoli N, Ciliberto D, Chiellino S, Caglioti F, Del Giudice T, Gualtieri S, Salvino A, Strangio A, Botta C, Pignata S, Tassone P, Tagliaferri P. Is ovarian cancer a targetable disease? A systematic review and meta-analysis and genomic data investigation. Oncotarget 2016; 7:82741-82756. [PMID: 27764790 PMCID: PMC5347729 DOI: 10.18632/oncotarget.12633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 09/25/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The current gold-standard for the first-line treatment in IIIb/IV stages of epithelial ovarian cancer (EOC) is the combination of carboplatin and paclitaxel plus bevacizumab in some countries. In the era of personalized medicine, there is still uncertainty on the impact of several molecularly targeted agents, which have been investigated for the management of this disease. To shed light on the actual role of targeted therapy in EOC, a systematic review and meta-analysis was performed. METHODS Clinical trials were selected by searching "Pubmed" database and abstracts from major cancer meetings within the time-frame of January 2004-June 2015. The endpoints were survival outcome and response rate (RR). Hazard ratios (HRs) of survival outcomes, with confidence intervals and odds-ratios (ORs) of RR, were extracted from retrieved studies and used for current analysis. Meta-analysis was carried out by random effect model. RESULTS 30 randomized trials for a total of 10,530 patients were selected and included in the final analysis. A benefit in terms of OS (pooled HR 0.915; 95%CI 0.840-0.997; p=0.043), particularly for anti-angiogenetic agents (HR 0.872; 95%CI 0.761-1.000; p=0.049), has been demonstrated for targeted therapy. Moreover, a significant advantage in platinum-resistant subgroup in term of PFS (HR 0.755; 95%CI 0.624-0.912; p=0.004) was found. CONCLUSIONS This systematic review and meta-analysis provide the first evidence that targeted therapy is potentially able to translate into improved survival of EOC patients, with a major role played by anti-angiogenetic drugs. The role of target therapy is underlined in the platinum-resistant setting that represents the "pain in the neck" in EOC management.
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Affiliation(s)
- Nicoletta Staropoli
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Domenico Ciliberto
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Silvia Chiellino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Francesca Caglioti
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Teresa Del Giudice
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Simona Gualtieri
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Angela Salvino
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Alessandra Strangio
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Cirino Botta
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
| | - Sandro Pignata
- Department of Gynecologic and Urologic Oncology, Fondazione Pascale, National Cancer Institute of Naples, Naples, Italy
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University, Catanzaro, Italy
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Marth C, Vergote I, Scambia G, Oberaigner W, Clamp A, Berger R, Kurzeder C, Colombo N, Vuylsteke P, Lorusso D, Hall M, Renard V, Pignata S, Kristeleit R, Altintas S, Rustin G, Wenham RM, Mirza MR, Fong PC, Oza A, Monk BJ, Ma H, Vogl FD, Bach BA. ENGOT-ov-6/TRINOVA-2: Randomised, double-blind, phase 3 study of pegylated liposomal doxorubicin plus trebananib or placebo in women with recurrent partially platinum-sensitive or resistant ovarian cancer. Eur J Cancer 2016; 70:111-121. [PMID: 27914241 DOI: 10.1016/j.ejca.2016.09.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
AIMS Trebananib, a peptide-Fc fusion protein, inhibits angiogenesis by inhibiting binding of angiopoietin-1/2 to the receptor tyrosine kinase Tie2. This randomised, double-blind, placebo-controlled phase 3 study evaluated whether trebananib plus pegylated liposomal doxorubicin (PLD) improved progression-free survival (PFS) in patients with recurrent epithelial ovarian cancer. METHODS Women with recurrent ovarian cancer (platinum-free interval ≤12 months) were randomised to intravenous PLD 50 mg/m2 once every 4 weeks plus weekly intravenous trebananib 15 mg/kg or placebo. PFS was the primary end-point; key secondary end-points were objective response rate (ORR) and duration of response (DOR). Owing to PLD shortages, enrolment was paused for 13 months; the study was subsequently truncated. RESULTS Two hundred twenty-three patients were enrolled. Median PFS was 7.6 months (95% CI, 7.2-9.0) in the trebananib arm and 7.2 months (95% CI, 4.8-8.2) in the placebo arm, with a hazard ratio of 0.92 (95% CI, 0.68-1.24). However, because the proportional hazards assumption was not fulfilled, the standard Cox model did not provide a reliable estimate of the hazard ratio. ORR in the trebananib arm was 46% versus 21% in the placebo arm (odds ratio, 3.43; 95% CI, 1.78-6.64). Median DOR was improved (trebananib, 7.4 months [95% CI, 5.7-7.6]; placebo, 3.9 months [95% CI, 2.3-6.5]). Adverse events with a greater incidence in the trebananib arm included localised oedema (61% versus 32%), ascites (29% versus 9%) and vomiting (45% versus 33%). CONCLUSIONS Trebananib demonstrated anticancer activity in this phase 3 study, indicated by improved ORR and DOR. Median PFS was not improved. No new safety signals were identified. TRIAL REGISTRATION ClinicalTrials.gov, NCT01281254.
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Affiliation(s)
- Christian Marth
- AGO-Austria and Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Ignace Vergote
- BGOG and Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven Cancer Institute, KU Leuven, Belgium
| | - Giovanni Scambia
- MITO and Dipartimento per la Tutela della Salute della Donna e della Vita Nascente del Bambino e Adolescente, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Willi Oberaigner
- AGO-Austria and Department of Clinical Epidemiology of the Tirol Kliniken Ltd., Cancer Registry of Tyrol, Innsbruck, Austria
| | - Andrew Clamp
- Department of Medical Oncology, Institute of Cancer Sciences, University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - Regina Berger
- AGO-Austria and Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kurzeder
- AGO-Study Group and Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte/Evang. Huyssens Stiftung/Knappschaft GmbH, Essen, Germany
| | - Nicoletta Colombo
- MANGO and Istituto Europeo di Oncologia and Università Milano Bicocca, Milano, Italy
| | - Peter Vuylsteke
- BGOG and Department of Medical Oncology, CHU Université Catholique de Louvain, Site Sainte Elisabeth, Namur, Belgium
| | - Domenica Lorusso
- MITO and Unità di Ginecologia Oncologica, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Vincent Renard
- BGOG and Department of Oncology, AZ St. Lucas, Ghent, Belgium
| | - Sandro Pignata
- MITO and Department of Urology and Gynecology, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Rebecca Kristeleit
- Department of Medical Oncology, University College London Cancer Institute, London, UK
| | - Sevilay Altintas
- BGOG and Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Gordon Rustin
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Robert M Wenham
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Peter C Fong
- Medical Oncology Department, Auckland City Hospital, Auckland, New Zealand
| | - Amit Oza
- Department of Medicine, Princess Margaret Hospital, University of Toronto, ON, Canada
| | - Bradley J Monk
- Department of Obstetrics and Gynecology, University of Arizona Cancer Center at Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Haijun Ma
- Global Development Oncology, Amgen Inc., Thousand Oaks, CA, USA
| | - Florian D Vogl
- Global Development Oncology, Amgen Inc., Thousand Oaks, CA, USA
| | - Bruce A Bach
- Global Development Oncology, Amgen Inc., Thousand Oaks, CA, USA
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45
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Liu JF, Ray-Coquard I, Selle F, Poveda AM, Cibula D, Hirte H, Hilpert F, Raspagliesi F, Gladieff L, Harter P, Siena S, Del Campo JM, Tabah-Fisch I, Pearlberg J, Moyo V, Riahi K, Nering R, Kubasek W, Adiwijaya B, Czibere A, Naumann RW, Coleman RL, Vergote I, MacBeath G, Pujade-Lauraine E. Randomized Phase II Trial of Seribantumab in Combination With Paclitaxel in Patients With Advanced Platinum-Resistant or -Refractory Ovarian Cancer. J Clin Oncol 2016; 34:4345-4353. [PMID: 27998236 DOI: 10.1200/jco.2016.67.1891] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Seribantumab is a fully human immunoglobulin G2 monoclonal antibody that binds to human epidermal growth factor receptor (HER) 3 (ErbB3), blocking heregulin (HRG) -mediated ErbB3 signaling and inducing ErbB3 receptor downregulation. This open-label randomized phase II study evaluated progression-free survival (PFS) with seribantumab in combination with once-per-week paclitaxel compared with paclitaxel alone in patients with platinum-resistant or -refractory ovarian cancer. A key secondary objective was to determine if any of five prespecified biomarkers predicted benefit from seribantumab. Patients and Methods Patients with platinum-resistant or -refractory epithelial ovarian, fallopian tube, or primary peritoneal cancer were randomly assigned at a ratio of two to one to receive seribantumab plus paclitaxel or paclitaxel alone. Patients underwent pretreatment core needle biopsy; archival tumor samples were also obtained to support biomarker analyses. Results A total of 223 patients were randomly assigned (seribantumab plus paclitaxel, n = 140; paclitaxel alone, n = 83). Median PFS in the unselected intent-to-treat population was 3.75 months with seribantumab plus paclitaxel compared with 3.68 months with paclitaxel alone (hazard ratio [HR], 1.027; 95% CI, 0.741 to 1.425; P = .864). Among patients whose tumors had detectable HRG mRNA and low HER2 (n = 57 [38%] of 151 with available biomarker data), increased treatment benefit was observed in those receiving seribantumab plus paclitaxel compared with paclitaxel alone (PFS HR, 0.37; 95% CI, 0.18 to 0.76; P = .007). The HR in patients not meeting these criteria was 1.80 (95% CI, 1.08 to 2.98; P = .023). Conclusion The addition of seribantumab to paclitaxel did not result in improved PFS in unselected patients. Exploratory analyses suggest that detectable HRG and low HER2, biomarkers that link directly to the mechanism of action of seribantumab, identified patients who might benefit from this combination. Future clinical trials are needed to validate this finding and should preselect for HRG expression and focus on cancers with low HER2 levels.
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Affiliation(s)
- Joyce F Liu
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Isabelle Ray-Coquard
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Frederic Selle
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Andrés M Poveda
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - David Cibula
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Hal Hirte
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Felix Hilpert
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Francesco Raspagliesi
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Laurence Gladieff
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Philipp Harter
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Salvatore Siena
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Josep Maria Del Campo
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Isabelle Tabah-Fisch
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Joseph Pearlberg
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Victor Moyo
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Kaveh Riahi
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Rachel Nering
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - William Kubasek
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Bambang Adiwijaya
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Akos Czibere
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - R Wendel Naumann
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Robert L Coleman
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Ignace Vergote
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Gavin MacBeath
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
| | - Eric Pujade-Lauraine
- Joyce F. Liu, Dana-Farber Cancer Institute, Boston; Isabelle Tabah-Fisch and Joseph Pearlberg, Sanofi Oncology; Victor Moyo, Kaveh Riahi, Rachel Nering, William Kubasek, Bambang Adiwijaya, Akos Czibere, and Gavin MacBeath, Merrimack Pharmaceuticals, Cambridge, MA; R. Wendel Naumann, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC; Robert L. Coleman, MD Anderson Cancer Center, Houston, TX; Isabelle Ray-Coquard, Centre Léon Bérard, University Claude Bernard, and Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens (GINECO), Lyon; Frederic Selle, Hôpital Tenon and GINECO; Eric Pujade-Lauraine, Hôpital Hotel-Dieu, Université Paris Descartes, and GINECO, Paris; Laurence Gladieff, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, and GINECO, Toulouse, France; Andrés M. Poveda, Instituto Valenciano de Oncologia and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Valencia; Josep Maria del Campo, Hospital Universitari Vall d'Hebron and GEICO, Barcelona, Spain; David Cibula, General University Hospital Prague and Charles University, Prague, Czech Republic; Hal Hirte, Hamilton Health Sciences-Juravinski Cancer Centre, Hamilton, Ontario, Canada; Felix Hilpert, Universitätsklinikum Schleswig-Holstein, Kiel; Philipp Harter, Kliniken Essen Mitte and Arbeitsgemeinschaft Gynäkologische Onkologie, Essen, Germany; Francesco Raspagliesi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori; Salvatore Siena, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Università degli Studi di Milano, Milano, Italy; and Ignace Vergote, University Hospital Katholieke Universiteit Leuven and Leuven Cancer Institute, Leuven, Belgium
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Pecqueux M, Liebetrau I, Werft W, Dienemann H, Muley T, Pfannschmidt J, Müssle B, Rahbari N, Schölch S, Büchler MW, Weitz J, Reissfelder C, Kahlert C. A Comprehensive MicroRNA Expression Profile of Liver and Lung Metastases of Colorectal Cancer with Their Corresponding Host Tissue and Its Prognostic Impact on Survival. Int J Mol Sci 2016; 17:ijms17101755. [PMID: 27775664 PMCID: PMC5085780 DOI: 10.3390/ijms17101755] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/04/2016] [Accepted: 10/12/2016] [Indexed: 12/22/2022] Open
Abstract
MicroRNAs are small non-coding RNAs with a length of 18–25 nucleotides. They can regulate tumor invasion and metastasis by changing the expression and translation of their target mRNAs. Their expression is substantially altered in colorectal cancer cells as well as in the adjacent tumor-associated stroma. Both of these compartments have a mutual influence on tumor progression. In the development of metastases, cancer cells initially interact with the host tissue. Therefore, compartment-specific expression signatures of these three locations—tumor, associated stroma, and host tissue—can provide new insights into the complex tumor biology of colorectal cancer. Frozen tissue samples of colorectal liver (n = 25) and lung metastases (n = 24) were laser microdissected to separate tumor cells and the adjacent tumor-associated stroma cells. Additionally, normal lung and liver tissue was collected from the same patients. We performed a microarray analysis in four randomly selected liver metastases and four randomly selected lung metastases, analyzing a total of 939 human miRNAs. miRNAs with a significant change >2-fold between the tumor, tumor stroma, and host tissue were analyzed in all samples using RT-qPCR (11 miRNAs) and correlated with the clinical data. We found a differential expression of several miRNAs between the tumor, the tumor-associated stroma, and the host tissue compartment. When comparing liver and lung metastases, miR-194 showed a 1.5-fold; miR-125, miR-127, and miR-192 showed a 2.5-fold; miR-19 and miR-215 a 3-fold; miR-145, miR-199-3, and miR-429 a 5-fold; miR-21 a 7-fold; and, finally, miR-199-5 a 12.5-fold downregulation in liver metastases compared to lung metastases. Furthermore miR-19, miR-125, miR-127, miR-192, miR-194, miR-199-5, and miR-215 showed a significant upregulation in the normal liver tissue compared to the normal lung tissue. Univariate analysis identified an association of poor survival with the expression of miR-125 (p = 0.05), miR-127 (p = 0.001), miR-145 (p = 0.005), miR-192 (p = 0.015), miR-194 (0.003), miR-199-5 (p = 0.008), miR-215 (p < 0.001), and miR-429 (p = 0.03) in the host liver tissue of the liver metastases. Colorectal liver and lung metastases have a unique miRNA expression profile. miRNA expression in the host tissue of colorectal liver metastases seems to be able to influence tumor progression and survival. These findings can be used in the development of tailored therapies.
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Affiliation(s)
- Mathieu Pecqueux
- Department of General, Visceral and Thoracic Surgery, University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | | | - Wiebke Werft
- German Cancer Research Center, Division of Biostatistics, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Hendrik Dienemann
- Department of Thoracic Surgery, Thoraxklinik am Universitätsklinikum Heidelberg, Amalienstrasse 5, 69126 Heidelberg, Germany.
| | - Thomas Muley
- Department of Thoracic Surgery, Thoraxklinik am Universitätsklinikum Heidelberg, Amalienstrasse 5, 69126 Heidelberg, Germany.
| | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Helios Clinic Emil von Behring, Walterhöferstraße 11, 14165 Berlin, Germany.
| | - Benjamin Müssle
- Department of General, Visceral and Thoracic Surgery, University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - Nuh Rahbari
- Department of General, Visceral and Thoracic Surgery, University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - Sebastian Schölch
- Department of General, Visceral and Thoracic Surgery, University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - Markus W Büchler
- Department of Surgery at Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Jürgen Weitz
- Department of General, Visceral and Thoracic Surgery, University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - Christoph Reissfelder
- Department of General, Visceral and Thoracic Surgery, University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
| | - Christoph Kahlert
- Department of General, Visceral and Thoracic Surgery, University of Dresden, Fetscherstraße 74, 01307 Dresden, Germany.
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Dowlati A, Vlahovic G, Natale RB, Rasmussen E, Singh I, Hwang YC, Rossi J, Bass MB, Friberg G, Pickett CA. A Phase I, First-in-Human Study of AMG 780, an Angiopoietin-1 and -2 Inhibitor, in Patients with Advanced Solid Tumors. Clin Cancer Res 2016; 22:4574-84. [PMID: 27076631 DOI: 10.1158/1078-0432.ccr-15-2145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the toxicity, pharmacokinetics, tumor vascular response, tumor response, and pharmacodynamics of AMG 780, a mAb designed to inhibit the interaction between angiopoietin-1 and -2 and the Tie2 receptor. EXPERIMENTAL DESIGN This was a phase I dose-escalation study of patients with advanced solid tumors refractory to standard treatment without previous antiangiogenic treatment. AMG 780 was administered by intravenous infusion every 2 weeks in doses from 0.1 to 30 mg/kg. The primary endpoints were incidences of dose-limiting toxicity (DLT) and adverse events (AE), and pharmacokinetics. Secondary endpoints included tumor response, changes in tumor volume and vascularity, and anti-AMG 780 antibody formation. RESULTS Forty-five patients were enrolled across nine dose cohorts. Three patients had DLTs (0.6, 10, and 30 mg/kg), none of which prevented dose escalation. At 30 mg/kg, no MTD was reached. Pharmacokinetics of AMG 780 were dose proportional; median terminal elimination half-life was 8 to 13 days. No anti-AMG 780 antibodies were detected. At week 5, 6 of 16 evaluable patients had a >20% decrease in volume transfer constant (K(trans)), suggesting reduced capillary blood flow/permeability. The most frequent AEs were hypoalbuminemia (33%), peripheral edema (29%), decreased appetite (27%), and fatigue (27%). Among 35 evaluable patients, none had an objective response; 8 achieved stable disease. CONCLUSIONS AMG 780 could be administered at doses up to 30 mg/kg every 2 weeks in patients with advanced solid tumors. AMG 780 treatment resulted in tumor vascular effects in some patients. AEs were in line with toxicity associated with antiangiopoietin treatment. Clin Cancer Res; 22(18); 4574-84. ©2016 AACR.
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Affiliation(s)
- Afshin Dowlati
- Case Western Reserve University and University Hospitals Seidman Cancer Center, Cleveland, Ohio.
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Epirubicin, Cisplatin, and Capecitabine for Primary Platinum-Resistant or Platinum-Refractory Epithelial Ovarian Cancer: Results of a Retrospective, Single-Institution Study. Int J Gynecol Cancer 2016; 25:977-84. [PMID: 25962114 PMCID: PMC4485738 DOI: 10.1097/igc.0000000000000448] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Supplemental digital content is available in the text. Objective Primary platinum-resistant epithelial ovarian cancer (EOC) is an area of unmet medical need. There is limited evidence from small studies that platinum-based combinations can overcome “resistance” in a proportion of patients. We investigated the efficacy and toxicity of platinum-based combination chemotherapy in the platinum-resistant and platinum-refractory setting. Methods Epirubicin, cisplatin, and capecitabine (ECX) combination chemotherapy was used at our institution for the treatment of relapsed EOC. From the institutional database, we identified all patients with primary platinum-refractory or platinum-resistant relapse treated with ECX as second-line therapy between 2001 and 2012. We extracted demographic, clinical, treatment, and toxicity data and outcomes. We used logistic and Cox regression models to identify predictors of response and survival respectively. Results Thirty-four 34 patients (8 refractory, 26 resistant) were treated with ECX. Response Evaluation Criteria In Solid Tumors (RECIST) response rate was 45%, median progression-free survival (PFS) was 6.4 months, and overall survival (OS) was 10.6 months. Platinum-resistant patients had better outcomes than did platinum-refractory patients (response rate, 54% vs 0%, P = 0.047; PFS 7.2 vs 1.8 months, P < 0.0001; OS 14.4 vs 3 months, P < 0.001). In regression models, time to progression after first-line treatment and platinum-refractory status were the strongest predictors of response and PFS or OS, respectively. Patients with time to progression after first-line treatment longer than 3 months showed PFS and OS of 7.9 and 14.7 months, respectively. Toxicity was manageable, with only 13% of cycles administered at reduced doses. Conclusions Epirubicin, cisplatin, and capecitabine seems to be active in platinum-resistant relapsed EOC with manageable toxicity. Further prospective investigation of platinum-anthracycline combinations is warranted in patients who relapse 3 to 6 months after first-line platinum-taxane treatment.
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Evaluation of Angiopoietin-2 as a biomarker in gastric cancer: results from the randomised phase III AVAGAST trial. Br J Cancer 2016; 114:855-62. [PMID: 27031850 PMCID: PMC4984795 DOI: 10.1038/bjc.2016.30] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/29/2015] [Accepted: 01/20/2016] [Indexed: 01/01/2023] Open
Abstract
Background: In the phase III AVAGAST trial, the addition of bevacizumab to chemotherapy improved progression-free survival (PFS) but not overall survival (OS) in patients with advanced gastric cancer. We studied the role of Angiopoietin-2 (Ang-2), a key driver of tumour angiogenesis, metastasis and resistance to antiangiogenic treatment, as a biomarker. Methods: Previously untreated, advanced gastric cancer patients were randomly assigned to receive bevacizumab (n=387) or placebo (n=387) in combination with chemotherapy. Plasma collected at baseline and at progression was analysed by ELISA. The role of Ang-2 as a prognostic and a predictive biomarker of bevacizumab efficacy was studied using a Cox proportional hazards model. Logistic regression analysis was applied for correlations with metastasis. Results: Median baseline plasma Ang-2 levels were lower in Asian (2143 pg ml−1) vs non-Asian patients (3193 pg ml−1), P<0.0001. Baseline plasma Ang-2 was identified as an independent prognostic marker for OS but did not predict bevacizumab efficacy alone or in combination with baseline VEGF. Baseline plasma Ang-2 correlated with the frequency of liver metastasis (LM) at any time: Odds ratio per 1000 pg ml−1 increase: 1.19; 95% CI 1.10–1.29; P<0.0001 (non-Asians) and 1.37; 95% CI 1.13–1.64; P=0.0010 (Asians). Conclusions: Baseline plasma Ang-2 is a novel prognostic biomarker for OS in advanced gastric cancer strongly associated with LM. Differences in Ang-2 mediated vascular response may, in part, account for outcome differences between Asian and non-Asian patients; however, data have to be further validated. Ang-2 is a promising drug target in gastric cancer.
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Al Wadi K, Ghatage P. Efficacy of trebananib (AMG 386) in treating epithelial ovarian cancer. Expert Opin Pharmacother 2016; 17:853-60. [PMID: 26933765 DOI: 10.1517/14656566.2016.1161027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Epithelial ovarian cancer (EOC) is the leading cause of death among gynecologic cancers. The majority of women are diagnosed with advanced stage disease. It is considered a chemosensitive cancer with a high initial response rate to first-line platinum and taxane-based chemotherapy. However, most patients with advanced EOC will relapse with subsequent resistance to conventional chemotherapy and ultimately succumb to their disease. Therefore, new therapeutic agents and strategies are desperately needed to improve the outcomes in patients with advanced EOC. AREAS COVERED This review focuses on the use of Trebananib (a non-VEGF-dependent angiogenesis pathway inhibitor) in EOC. Angiogenesis has been recognized as an important process promoting EOC growth and metastasis. Targeting angiogenesis in EOC have been developed and studied with demonstrated clinical efficacy. Bevacizumab, a humanized monoclonal antibody, that targets vascular endothelial growth factor A (VEGF-A), has been the most well evaluated molecular targeted therapy in the treatment of advanced and recurrent EOC with proven clinical efficacy. However, VEGF-dependent angiogenesis pathway inhibitors are often associated with serious toxicities and drug resistance ultimately develops. Hence, new therapeutic approach targeting the angiopoietin-Tie-2 complex pathway (a non-VEGF-dependent angiogenesis pathway) has gained interest over the past few years as an alternative strategy to overcome VEGF-dependent anti-angiogenesis-related toxicity and resistance. EXPERT OPINION Targeting angiopoietin-Tie-2 pathway represents a promising alternative approach to tumor anti-angiogenesis with a distinct toxicity profile from the VEGF-dependent pathway inhibitors. However, there are still many questions to be answered regarding the optimal treatment schedules, maintenance regimens, duration of maintenance therapy, and the best combination strategy. Currently there is no reliable surrogate molecular, cellular, or genetic marker that would definitively predict response to anti-angiogenic therapy. Identification of certain relevant and predictive biomarkers in the future may optimize treatment's efficacy by distinguishing the subset group of patients with EOC that would derive the most benefit from existing antiangiogenic treatment regimens.
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Affiliation(s)
- Khalid Al Wadi
- a Division of Gynecologic Oncology , Tom Baker Cancer Centre , Calgary , AB , Canada.,b Women's Specialized Hospital, King Fahad Medical City , Riyadh , Saudi Arabia
| | - Prafull Ghatage
- a Division of Gynecologic Oncology , Tom Baker Cancer Centre , Calgary , AB , Canada
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