1
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Allahyari A, Ehsanpour A, Ansarinejad N, Mehrzad V, Kalantari B, Raafat J, Ghadiany M, Shahi F, Gharib B, Moazed V, Khosravi A, Mirpour MH, Salari S, Mortazavizadeh S, Nekoyi A, Khani M, Sadeghi A, Gharib S, Bary A, Mirzania M, Haghighat S, Razavi SM, Emami SAH, Hosseinzadeh M, Mirbolouk M, Sadighi S, Shahrasbi A, Esfahani A, Gity M, Anjidani N, Kafi H, Najafi S. Comparing efficacy and safety of P013, a proposed pertuzumab biosimilar, with the reference product in HER2-positive breast cancer patients: a randomized, phase III, equivalency clinical trial. BMC Cancer 2022; 22:960. [PMID: 36071409 PMCID: PMC9450379 DOI: 10.1186/s12885-022-09895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer is the most frequently diagnosed cancer and the leading reason for cancer-related death among women. Neoadjuvant treatment with dual-HER2 (human epidermal growth factor receptor 2) blockade has shown promising effects in this regard. The present study aimed to compare the efficacy and safety of a proposed pertuzumab biosimilar with the reference pertuzumab. METHODS This randomized, phase III, multicenter, equivalency clinical trial was conducted on chemotherapy-naive women with HER2-positive breast cancer. Patients were randomly assigned (1:1) to receive six cycles of either P013 (CinnaGen, Iran) or the originator product (Perjeta, Roche, Switzerland) along with trastuzumab, carboplatin, and docetaxel every 3 weeks. Patients were stratified by cancer type (operable, locally advanced, inflammatory) and hormone receptor status. The primary endpoint was breast pathologic complete response (bpCR). Secondary endpoints included comparisons of total pCR, overall response rate (ORR), breast-conserving surgery (BCS), safety, and immunogenicity. RESULTS Two hundred fourteen patients were randomized to treatment groups. bpCR rate in the per-protocol population was 67.62% in the P013 and 71.57% in the reference drug groups. Based on bpCR, P013 was equivalent to the reference pertuzumab with a mean difference of - 0.04 (95% CI: - 0.16, 0.09). Secondary endpoints were also comparable between the two groups. CONCLUSIONS The proposed biosimilar P013 was equivalent to the reference product in terms of efficacy. The safety of both medications was also comparable.
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Affiliation(s)
- Abolghasem Allahyari
- grid.411583.a0000 0001 2198 6209Hematology Oncology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Ehsanpour
- grid.411230.50000 0000 9296 6873Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nafiseh Ansarinejad
- grid.411746.10000 0004 4911 7066Department of Hematology & Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - Valiollah Mehrzad
- Hematology and Oncology Department, Isfahan Medical School, Isfahan, Iran
| | - Behjat Kalantari
- grid.412105.30000 0001 2092 9755Hematology & Oncology, Department of Internal Medicine, School of Medicine, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Mojtaba Ghadiany
- grid.411600.2Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Shahi
- grid.414574.70000 0004 0369 3463Department of Hematology and Medical Oncology, Breast Disease Research Center, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, TUMS, Tehran, Iran
| | - Behrooz Gharib
- Department of Medical Oncology & Hematology, Naft Hospital, Tehran, Iran
| | - Vahid Moazed
- grid.412105.30000 0001 2092 9755Hematology & Oncology Kerman University of Medical Sciences, Kerman, Iran
| | - Adnan Khosravi
- grid.411600.2Hematology & Oncology, Department of Adult Hematology & Oncology, School of Medicine, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Dr. Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mir Hossein Mirpour
- grid.415733.7Medical Oncology Guilan University of Medical Sciences, Razi Hospital, Fuman, Iran
| | - Sina Salari
- grid.411600.2Medical Oncology, Hematology Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amirabbas Nekoyi
- grid.411036.10000 0001 1498 685XDepartment of Hematology and Medical Oncology, Seyyed-al-shohada Hospital, Esfahan University of Medical Sciences, Tehran, Iran
| | | | - Alireza Sadeghi
- grid.411036.10000 0001 1498 685XDepartment of Hematology-Oncology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sirus Gharib
- grid.411874.f0000 0004 0571 1549Hematology, Oncology Department of Internal Medicine, Guilan University of Medical Sciences, Guilan, Iran
| | - Alireza Bary
- grid.415529.eDepartment of Hematology & Oncology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrzad Mirzania
- grid.414574.70000 0004 0369 3463Department of Hematology and Medical Oncology, Cancer Research Center, Cancer Institute of Iran, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Haghighat
- grid.412571.40000 0000 8819 4698Hematology Research Center, Hematology and Medical Oncology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Seyed Amir Hossein Emami
- grid.411705.60000 0001 0166 0922Medical Oncology, Cancer Institute, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Hosseinzadeh
- grid.411230.50000 0000 9296 6873Hematology, Oncology Department of Internal Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Sanambar Sadighi
- grid.411705.60000 0001 0166 0922Internal Medicine Group TUMS Faculty of Cancer Institute of Iran, Tehran, Iran
| | - Abdolali Shahrasbi
- grid.411463.50000 0001 0706 2472Bouali Hospital, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ali Esfahani
- grid.412888.f0000 0001 2174 8913Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Gity
- grid.411705.60000 0001 0166 0922Advanced Diagnostic and Interventional Radiology Research Center, Breast Disease Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hamidreza Kafi
- Medical Department, Orchid Pharmed Company, Tehran, Iran
| | - Safa Najafi
- grid.417689.5Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
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2
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Lorenzi E, Simonelli M, Persico P, Dipasquale A, Santoro A. Risks of molecular targeted therapies to fertility and safety during pregnancy: a review of current knowledge and future needs. Expert Opin Drug Saf 2021; 20:503-521. [PMID: 33600273 DOI: 10.1080/14740338.2021.1893299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION As the population of young cancer survivors is increasing and a trend toward postponing pregnancy later in life is reported, more efforts are focused toward understanding treatment-induced sequelae, in particular, the effects of cancer and/or treatment on fertility. AREA COVERED Whereas the fertility risk of cytotoxic agents for both men and women is well recognized, the impact of molecular-targeted therapy (MTT) on fertility parameters, their teratogenic potential and pregnancy outcome/management in case of an accidental exposure are not established. We update available clinical data on the impact of new MTTs on fertility in both sexes, their potential teratogenic effects and the outcome of pregnancy during accidental exposure. Agents are categorized by class and the potential relevance of their target signaling pathways to gonadal maturation. EXPERT OPINION The majority of MTTs have worrying preclinical data discouraging their use during pregnancy and reinforcing the idea that they can induce impairment in gonadal function. However, it does not mean that all MTTs result in permanent infertility and that they should be completely avoided during pregnancy. The current review provides a critical evaluation on the most commonly used MTTs, offering a possible guide for clinicians.
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Affiliation(s)
- Elena Lorenzi
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Matteo Simonelli
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Pasquale Persico
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Angelo Dipasquale
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
| | - Armando Santoro
- Department of Oncology, IRCCS Humanitas Cancer Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy
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3
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Yang Z, Chen H, Shu M, Zhang Y, Xue L, Lin Y. DLC2 operates as a tumor suppressor gene in breast cancer via the RhoGTPase pathway. Oncol Lett 2018; 17:2107-2116. [PMID: 30719106 PMCID: PMC6350186 DOI: 10.3892/ol.2018.9874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 09/21/2018] [Indexed: 12/21/2022] Open
Abstract
Deleted in liver cancer 2 (DLC2) is a tumor suppressor, associated with various types of cancer. The aim of the present study was to analyze the expression of DLC2 in breast cancer, its clinical significance and its effect on breast cancer cell behavior. The expression of DLC2 was evaluated by immunohistochemistry in 131 cases of breast cancer. Associations among DLC2 expression and clinicopathological features were analyzed, and its effects on proliferation, motility, migration and invasion in DLC2-knockdown breast cancer cell lines were observed. The results indicated that DLC2 was expressed in 42.75% of breast cancer cases (56/131) and in 79.39% of adjacent normal tissues (104/131). Lower expression of DLC2 in breast cancer was associated with tumor differentiation (P<0.001), lymph node metastasis (P<0.001) and poor prognosis (P<0.001). The silencing of the DLC2 gene in human breast cancer cell indicated an increased number of cells entering S phase, and increased abilities of clone formation, cell migration and invasion. Downregulated expression of DLC2 was associated with activated Ras homolog family member A and decreased Rac family small GTPase 1, cell division cycle 42 and Rho-associated protein kinase-2 expression levels, indicating that DLC2 may serve a regulatory function in breast cancer cell proliferation and invasion via the RhoGTPase pathway. The results of the present study suggested that DLC2 serves as a suppressor gene in the development of breast cancer and may be a prognostic marker for patients with breast cancer.
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Affiliation(s)
- Zheng Yang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Hanrui Chen
- Department of Oncology, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, P.R. China
| | - Man Shu
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yunjian Zhang
- Department of Thyroid, Breast Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Ling Xue
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yuan Lin
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, P.R. China
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4
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Mollen EWJ, Ient J, Tjan-Heijnen VCG, Boersma LJ, Miele L, Smidt ML, Vooijs MAGG. Moving Breast Cancer Therapy up a Notch. Front Oncol 2018; 8:518. [PMID: 30515368 PMCID: PMC6256059 DOI: 10.3389/fonc.2018.00518] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
Breast cancer is the second most common malignancy, worldwide. Treatment decisions are based on tumor stage, histological subtype, and receptor expression and include combinations of surgery, radiotherapy, and systemic treatment. These, together with earlier diagnosis, have resulted in increased survival. However, initial treatment efficacy cannot be guaranteed upfront, and these treatments may come with (long-term) serious adverse effects, negatively affecting a patient's quality of life. Gene expression-based tests can accurately estimate the risk of recurrence in early stage breast cancers. Disease recurrence correlates with treatment resistance, creating a major need to resensitize tumors to treatment. Notch signaling is frequently deregulated in cancer and is involved in treatment resistance. Preclinical research has already identified many combinatory therapeutic options where Notch involvement enhances the effectiveness of radiotherapy, chemotherapy or targeted therapies for breast cancer. However, the benefit of targeting Notch has remained clinically inconclusive. In this review, we summarize the current knowledge on targeting the Notch pathway to enhance current treatments for breast cancer and to combat treatment resistance. Furthermore, we propose mechanisms to further exploit Notch-based therapeutics in the treatment of breast cancer.
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Affiliation(s)
- Erik W J Mollen
- Department of Radiotherapy, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.,Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre+, Maastricht, Netherlands.,Division of Medical Oncology, Department of Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Jonathan Ient
- Department of Radiotherapy, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Radiotherapy, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Liesbeth J Boersma
- Department of Radiotherapy, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.,Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Lucio Miele
- Department of Genetics, Louisiana State University Health Sciences Center, New Orleans, LA, United States.,Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Marjolein L Smidt
- Department of Radiotherapy, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.,Division of Medical Oncology, Department of Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Marc A G G Vooijs
- Department of Radiotherapy, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.,Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre+, Maastricht, Netherlands
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5
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Esin E, Oksuzoglu B, Bilici A, Cicin I, Kostek O, Kaplan MA, Aksoy S, Aktas BY, Ozdemir O, Alacacioglu A, Cabuk D, Sumbul AT, Sakin A, Paydas S, Yetisir E, Er O, Korkmaz T, Yildirim N, Sakalar T, Demir H, Artac M, Karaagac M, Harputluoglu H, Bilen E, Erdur E, Degirmencioglu S, Aliyev A, Cil T, Olgun P, Basaran G, Gumusay O, Demir A, Tanrikulu E, Yumuk PF, Imamoglu I, Oyan B, Cetin B, Haksoyler V, Karadurmus N, Erturk I, Evrensel T, Yilmaz H, Beypinar I, Kocer M, Pilanci KN, Seker M, Urun Y, Yildirim N, Eren T, Demirci U. Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes. Cancer Chemother Pharmacol 2018; 83:131-143. [PMID: 30377778 DOI: 10.1007/s00280-018-3712-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/25/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients. METHODS This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers. RESULTS Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure. CONCLUSIONS Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Lobular/drug therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/secondary
- Docetaxel/administration & dosage
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Metastasis
- Paclitaxel/administration & dosage
- Practice Patterns, Physicians'
- Prognosis
- Retrospective Studies
- Survival Rate
- Trastuzumab/administration & dosage
- Young Adult
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Affiliation(s)
- Ece Esin
- Department of Medical Oncology, Dr. A. Y. Ankara Oncology Education and Research Hospital, University of Health Sciences, Yenimahalle, Ankara, Turkey.
| | - B Oksuzoglu
- Department of Medical Oncology, Dr. A. Y. Ankara Oncology Education and Research Hospital, University of Health Sciences, Yenimahalle, Ankara, Turkey
| | - A Bilici
- Departmant of Medical Oncology, Medipol University International Health Center, Istanbul, Turkey
| | - I Cicin
- Department of Medical Oncology, Trakya University, Edirne, Turkey
| | - O Kostek
- Department of Medical Oncology, Trakya University, Edirne, Turkey
| | - M A Kaplan
- Department of Medical Oncology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - S Aksoy
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - B Y Aktas
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - O Ozdemir
- Department of Medical Oncology, Ataturk Education and Research Hospital, İzmir K.C. University, Izmir, Turkey
| | - A Alacacioglu
- Department of Medical Oncology, Ataturk Education and Research Hospital, İzmir K.C. University, Izmir, Turkey
| | - D Cabuk
- Department of Medical Oncology, Faculty of Medicine, Kocaeli University, Izmit, Turkey
| | - A T Sumbul
- Department of Medical Oncology, Baskent University Adana Hospital, Adana, Turkey
| | - A Sakin
- Department of Medical Oncology, Istanbul Okmeydani Education and Research Hospital, Istanbul, Turkey
| | - S Paydas
- Department of Medical Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - E Yetisir
- Department of Medical Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - O Er
- Department of Medical Oncology, Acibadem Maslak Hospital, Acibadem MAA University, Istanbul, Turkey
| | - T Korkmaz
- Department of Medical Oncology, Acibadem Altunizade Hospital, Acibadem MAA University, Istanbul, Turkey
| | - N Yildirim
- Department of Medical Oncology, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - T Sakalar
- Department of Medical Oncology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - H Demir
- Department of Medical Oncology, Kayseri Education and Research Hospital, University of Health Sciences, Kayseri, Turkey
| | - M Artac
- Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - M Karaagac
- Department of Medical Oncology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - H Harputluoglu
- Department of Medical Oncology, Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
| | - E Bilen
- Department of Medical Oncology, Turgut Ozal Medical Center, Inonu University, Malatya, Turkey
| | - E Erdur
- Department of Medical Oncology, Dr. A. Y. Ankara Oncology Education and Research Hospital, University of Health Sciences, Yenimahalle, Ankara, Turkey
| | - S Degirmencioglu
- Department of Medical Oncology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - A Aliyev
- Department of Medical Oncology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - T Cil
- Department of Medical Oncology, Adana City Hospital, University of Health Sciences, Adana, Turkey
| | - P Olgun
- Department of Medical Oncology, Adana City Hospital, University of Health Sciences, Adana, Turkey
| | - G Basaran
- Department of Medical Oncology, Acibadem Maslak Hospital, Acibadem MAA University, Istanbul, Turkey
| | - O Gumusay
- Department of Medical Oncology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - A Demir
- Department of Medical Oncology, Istanbul Okmeydani Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - E Tanrikulu
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - P F Yumuk
- Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Inanc Imamoglu
- Department of Medical Oncology, Ankara Diskapi Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - B Oyan
- Department of Medical Oncology, Acibadem Altunizade Hospital, Acibadem MAA University, Istanbul, Turkey
| | - B Cetin
- Department of Medical Oncology, Faculty of Medicine, RTE University, Rize, Turkey
| | - V Haksoyler
- Department of Medical Oncology, Diyarbakir G.Y. Education and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
| | - N Karadurmus
- Department of Medical Oncology, Gulhane Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - I Erturk
- Department of Medical Oncology, Gulhane Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - T Evrensel
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - H Yilmaz
- Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - I Beypinar
- Department of Medical Oncology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - M Kocer
- Department of Medical Oncology, Faculty of Medicine, Isparta S.D University, Isparta, Turkey
| | - K N Pilanci
- Department of Medical Oncology, Haseki Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - M Seker
- Department of Medical Oncology, Ankara Bayindir Hospital, Ankara, Turkey
| | - Y Urun
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - N Yildirim
- Department of Medical Oncology, Numune Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - T Eren
- Department of Medical Oncology, Numune Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - U Demirci
- Department of Medical Oncology, Dr. A. Y. Ankara Oncology Education and Research Hospital, University of Health Sciences, Yenimahalle, Ankara, Turkey
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6
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Hichert V, Scholl C, Steffens M, Paul T, Schumann C, Rüdiger S, Boeck S, Heinemann V, Kächele V, Seufferlein T, Stingl J. Predictive blood plasma biomarkers for EGFR inhibitor-induced skin rash. Oncotarget 2018; 8:35193-35204. [PMID: 28456787 PMCID: PMC5471046 DOI: 10.18632/oncotarget.17060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/22/2017] [Indexed: 01/26/2023] Open
Abstract
Epidermal growth factor receptor overexpression in human cancer can be effectively targeted by drugs acting as specific inhibitors of the receptor, like erlotinib, gefitinib, cetuximab and panitumumab. A common adverse effect is a typical papulopustular acneiform rash, whose occurrence and severity are positively correlated with overall survival in several cancer types. We studied molecules involved in epidermal growth factor receptor signaling which are quantifiable in plasma, with the aim of identifying biomarkers for the severity of rash. With a predictive value for the rash these biomarkers may also have a prognostic value for survival and disease outcome. The concentrations of amphiregulin, hepatocyte growth factor (HGF) and calcidiol were determined by specific enzyme-linked immunosorbent assays in plasma samples from 211 patients. We observed a significant inverse correlation between the plasma concentration of HGF and overall survival in patients with an inhibitor-induced rash (p-value = 0.0075; mean overall survival low HGF: 299 days, high HGF: 240 days) but not in patients without rash. The concentration of HGF was also significantly inversely correlated with severity of rash (p-value = 0.00124). High levels of HGF lead to increased signaling via its receptor MET, which can activate numerous pathways which are normally also activated by epidermal growth factor receptor. Increased HGF/MET signaling might compensate the inhibitory effect of epidermal growth factor receptor inhibitors in skin as well as tumor cells, leading to less severe skin rash and decreased efficacy of the anti-tumor therapy, rendering the plasma concentration of HGF a candidate for predictive biomarkers.
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Affiliation(s)
- Vivien Hichert
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Centre for Translational Medicine, University Bonn Medical Faculty, Bonn, Germany
| | - Catharina Scholl
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Centre for Translational Medicine, University Bonn Medical Faculty, Bonn, Germany
| | - Michael Steffens
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Centre for Translational Medicine, University Bonn Medical Faculty, Bonn, Germany
| | - Tanusree Paul
- Institute of Pharmacology of Natural Products and Clinical Pharmacology, University of Ulm, Ulm, Germany
| | - Christian Schumann
- Department of Internal Medicine II, University of Ulm, Ulm, Germany.,Pneumology, Thoracic Oncology, Sleep and Respiratory Critical Care Medicine, Clinics Kempten-Oberallgäu, Kempten, Germany
| | - Stefan Rüdiger
- Department of Internal Medicine II, University of Ulm, Ulm, Germany
| | - Stefan Boeck
- Department of Internal Medicine III and Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany.,DKTK, German Cancer Consortium, German Cancer Research Center, (DKFZ), Heidelberg, Germany
| | - Volker Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany.,DKTK, German Cancer Consortium, German Cancer Research Center, (DKFZ), Heidelberg, Germany
| | - Volker Kächele
- Department of Internal Medicine I, University of Ulm, Ulm, Germany
| | | | - Julia Stingl
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Centre for Translational Medicine, University Bonn Medical Faculty, Bonn, Germany
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7
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The incidence and management of cutaneous adverse events of the epidermal growth factor receptor inhibitors. Postepy Dermatol Alergol 2017; 34:418-428. [PMID: 29507555 PMCID: PMC5831275 DOI: 10.5114/ada.2017.71106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/27/2016] [Indexed: 01/04/2023] Open
Abstract
Overexpression of the epidermal growth factor receptor (EGFR) is found in many cancers, including those of the head and neck area, non-small-cell lung cancer, and colorectal, cervical, prostate, breast, ovary, stomach, and pancreatic cancer. The EGFR inhibitors are used at present in the treatment of such cancers. Skin lesions that develop during and after cancer treatment may be due to specific cytostatics, molecular-targeted drugs, radiation therapy, complementary therapy, or the cancer itself, and hence knowledge is essential to distinguish between them. The mechanism through which skin toxicity arises during treatment with EGFR inhibitors is not well known, but seems to be due to the modification of the RAS/RAF/MEK/ERK signal path associated with its activation, which results in the similarity between the adverse effects of EGFR inhibitors and the treatment of melanoma with BRAF and MEK inhibitors. The most common side effects are pruritus, xerosis, papulopustular rash, hand-foot skin reaction, alopecia and dystrophy of the hair, and paronychia. This work presents options for prevention and suggestions for managing these adverse events, which are of importance in the care of patients undergoing oncological treatment.
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8
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Improving Pertuzumab production by gene optimization and proper signal peptide selection. Protein Expr Purif 2017; 135:24-32. [DOI: 10.1016/j.pep.2017.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/12/2017] [Accepted: 04/24/2017] [Indexed: 12/23/2022]
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9
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Abstract
Cancer is the most challenging disease of our time with increasing numbers of new cases each year, worldwide. Great achievements have been reached in cancer research through deep sequencing which helped define druggable targets. However, the still-evolving targeted therapy suffers resistance suggesting that DNA mutations considered as drivers may not have a role in tumor initiation. The present work discusses the role of DNA mutations as drivers and passengers in cancer initiation and development. First, it is important to discern the role of these DNA mutations as initiating events causing cancer or as contributors crucial for the development of a tumor once it has initiated. Second, breast cancer shown here illustrates how identification of DNA mutations in cancerous cells has influenced our approach for anti-cancer drug design. The cancer trilogy we have reached and described as: initial drug; resistance/recurrence; drug/treatment combinations, calls for a paradigm shift. To design more effective cancer drugs with durable and positive outcome, future cancer research needs to move beyond the sequencing era and explore changes which are taking place in cancer cells at levels other than the DNA. Evolutionary constraints may be acting as a barrier to preserve the human species from being transformed and, for that matter, all multi-cellular species which can incur cancer. Furthermore, mutations in the DNA do occur and for a multitude of reasons but without necessarily causing cancer. New directions will draw themselves when more focus is given to the event responsible for the switch of a cell from normalcy to malignancy. Until then, targeted therapy will certainly continue to improve the outcome of patients; however, it is unlikely to eradicate breast cancer depicted here.
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10
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Abstract
BACKGROUND The development of targeted therapies benefits patients with certain markers in the treatment of breast cancer. Pertuzumab is a novel humanized monoclonal antibody that blocks human epidermal growth factor receptor 2 (HER2) dimerization. The Food and Drug Administration has approved pertuzumab in combination with trastuzumab and docetaxel for the treatment of patients with HER2-positive metastatic breast cancer. METHODS To assess the safety and efficacy profile of pertuzumab, we searched PubMed and Embase (articles from January 1966 to January 2015) using the keyword "pertuzumab". RESULTS Fourteen eligible studies were included in our final analysis. From the results of our analysis, diarrhea (56.9%, 95% confidence interval [CI] 49.6%-63.9%), nausea (34.0%, 95% CI 27.7%-40.8%), and rash (25.6%, 95% CI 20.8%-31.0%) were the most common adverse effects in pertuzumab alone and pertuzumab-based therapies. Based on randomized controlled clinical trials, diarrhea (odds ratio [OR] 2.310, 95% CI 1.818-2.936), rash (OR 1.848, 95% CI 1.094-3.122), and febrile neutropenia (OR 1.672, 95% CI 1.130-2.474) were of statistical significance, which meant that pertuzumab played a prominent role in the incidence of diarrhea. Meanwhile, pertuzumab showed its effective role in cancer control and lifetime prolongation. CONCLUSION In conclusion, considering that the common adverse effects for pertuzumab are gastrointestinal and skin toxicities, which are easier to handle than other toxicities, pertuzumab is a safe and effective drug for patients with solid tumors.
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Affiliation(s)
- Chenjing Zhu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy
| | - Wenwu Ling
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Zhang
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hui Gao
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kai Shen
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy
| | - Xuelei Ma
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy
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11
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Singer CF, Tan YY, Fitzal F, Steger GG, Egle D, Reiner A, Rudas M, Moinfar F, Gruber C, Petru E, Bartsch R, Tendl KA, Fuchs D, Seifert M, Exner R, Balic M, Bago-Horvath Z, Filipits M, Gnant M. Pathological Complete Response to Neoadjuvant Trastuzumab Is Dependent on HER2/CEP17 Ratio in HER2-Amplified Early Breast Cancer. Clin Cancer Res 2017; 23:3676-3683. [PMID: 28143867 DOI: 10.1158/1078-0432.ccr-16-2373] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate whether pathologic complete response (pCR) to neoadjuvant trastuzumab is dependent on the level of HER2 amplification.Experimental Design: 114 HER2-overexpressing early breast cancer patients who had received neoadjuvant trastuzumab were included in this study. Absolute HER2 and chromosome 17 centromere (CEP17) were measured by in situ hybridization analysis, and associations were examined between HER2/CEP17 ratio and tumor pCR status (commonly defined by ypT0 ypN0, ypT0/is ypN0, and ypT0/is).Results: In trastuzumab-treated patients, ypT0 ypN0 was achieved in 69.0% of patients with high-level amplification (HER2/CEP17 ratio > 6), but only in 30.4% of tumors with low-level amplification (ratio ≤ 6; P = 0.001). When pCR was defined by ypT0/is ypN0 or ypTis, 75.9% and 82.8% of tumors with high-level amplification had a complete response, whereas only 39.1%, and 38.3% with low-level amplification achieved pCR (P = 0.002 and P < 0.001, respectively). Logistic regression revealed that tumors with high-level amplification had a significantly higher probability achieving ypT0 ypN0 (OR, 5.08; 95% confidence interval, 1.86-13.90; P = 0.002) than tumors with low-level amplification, whereas no other clinicopathologic parameters were predictive of pCR. The association between high-level HER2 amplification and pCR was almost exclusively confined to hormone receptor (HR)-positive tumors (ypT0 ypN0: 62.5% vs. 24.0%, P = 0.014; ypT0/is ypN0: 75.0% vs. 28.0%, P = 0.005; and ypT0/is: 87.5% vs. 28.0%, P < 0.001), and was largely absent in HR-negative tumors.Conclusions: An HER2/CEP17 ratio of >6 in the pretherapeutic tumor biopsy is associated with a significantly higher pCR rate, particularly in HER2/HR copositive tumors, and can be used as a biomarker to predict response before neoadjuvant trastuzumab is initiated. Clin Cancer Res; 23(14); 3676-83. ©2017 AACR.
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Affiliation(s)
- Christian F Singer
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria.
| | - Yen Y Tan
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Guenther G Steger
- Department of Internal Medicine 1, Division of Oncology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Daniel Egle
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Angelika Reiner
- Institute of Pathology, Sozialmedizinisches Zentrum Ost, Vienna, Austria
| | - Margaretha Rudas
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Farid Moinfar
- Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria
| | - Christine Gruber
- Institute for Clinical Pathology, Barmherzige Schwestern Hospital, Linz, Austria
| | - Edgar Petru
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Rupert Bartsch
- Department of Internal Medicine 1, Division of Oncology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Kristina A Tendl
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - David Fuchs
- Department of Internal Medicine 3-Hematology and Oncology, Kepler University Hospital, Linz, Austria
| | - Michael Seifert
- Department of Obstetrics and Gynecology, Cancer Comprehensive Center, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marija Balic
- Department of Internal Medicine, Division of Oncology, Medical University of Graz, Graz, Austria
| | | | - Martin Filipits
- Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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12
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Georgakopoulou E, Scully C. Biological agents: what they are, how they affect oral health and how they can modulate oral healthcare. Br Dent J 2017; 218:671-7. [PMID: 26114697 DOI: 10.1038/sj.bdj.2015.439] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/17/2022]
Abstract
Biological agents - biologics, biologicals or biopharmaceuticals - are any medicinal product manufactured in, or extracted from, a biological source. They are often generated by DNA recombinant biotechnology and several dozen therapeutic monoclonal antibodies (mAbs) are now marketed for a variety of indications, increasingly in the management of inflammatory immune-mediated disorders, transplantation rejection and cancer treatments. Immunomodulatory mAbs are expensive, must be given by injection or infusion and can have adverse effects but are increasingly used and can be highly effective agents. This paper reviews these agents and their increasing relevance to oral science and healthcare.
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Affiliation(s)
- E Georgakopoulou
- Department of Histology and Embryology, School of Medicine, University of Athens, Greece
| | - C Scully
- 1] WHO Collaborating Centre for Oral Health-General Health Co-Director London [2] Royal College of Surgeons of Edinburgh King James IV Professor London [3] UCL Emeritus Professor, London
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13
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van Ramshorst MS, van Werkhoven E, Honkoop AH, Dezentjé VO, Oving IM, Mandjes IA, Kemper I, Smorenburg CH, Stouthard JM, Linn SC, Sonke GS. Toxicity of dual HER2-blockade with pertuzumab added to anthracycline versus non-anthracycline containing chemotherapy as neoadjuvant treatment in HER2-positive breast cancer: The TRAIN-2 study. Breast 2016; 29:153-9. [DOI: 10.1016/j.breast.2016.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022] Open
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14
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Tóth G, Szöőr Á, Simon L, Yarden Y, Szöllősi J, Vereb G. The combination of trastuzumab and pertuzumab administered at approved doses may delay development of trastuzumab resistance by additively enhancing antibody-dependent cell-mediated cytotoxicity. MAbs 2016; 8:1361-1370. [PMID: 27380003 PMCID: PMC5058622 DOI: 10.1080/19420862.2016.1204503] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Although the recently concluded CLEOPATRA trial showed clinical benefits of combining trastuzumab and pertuzumab for treating HER2-positive metastatic breast cancer, trastuzumab monotherapy is still the mainstay in adjuvant settings. Since trastuzumab resistance occurs in over half of these cancers, we examined the mechanisms by which treatment of intrinsically trastuzumab-resistant and -sensitive tumors can benefit from the combination of these antibodies. F(ab′)2 of both trastuzumab and pertuzumab were generated and validated in order to separately analyze antibody-dependent cell-mediated cytotoxicity (ADCC)-based and direct biological effects of the antibodies. Compared to monotherapy, combination of the two antibodies at clinically permitted doses enhanced the recruitment of natural killer cells responsible for ADCC, and significantly delayed the outgrowth of xenografts from intrinsically trastuzumab-resistant JIMT-1 cells. Antibody dose-response curves of in vitro ADCC showed that antibody-mediated killing can be saturated, and the two antibodies exert an additive effect at sub-saturation doses. Thus, the additive effect in vivo indicates that therapeutic tissue levels likely do not saturate ADCC. Additionally, isobole studies with the in vitro trastuzumab-sensitive BT-474 cells showed that the direct biological effect of combined treatment is additive, and surpasses the maximum effect of either monotherapy. Our results suggest the combined therapy is expected to give results that are superior to monotherapy, whatever the type of HER2-positive tumor may be. The combination of both antibodies at maximum clinically approved doses should thus be administered to patients to recruit maximum ADCC and cause maximum direct biological growth inhibition.
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Affiliation(s)
- Gábor Tóth
- a Department of Biophysics and Cell Biology , Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Árpád Szöőr
- a Department of Biophysics and Cell Biology , Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - László Simon
- a Department of Biophysics and Cell Biology , Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Yosef Yarden
- b Department of Biological Regulation , The Weizmann Institute of Science , Rehovot , Israel
| | - János Szöllősi
- a Department of Biophysics and Cell Biology , Faculty of Medicine, University of Debrecen , Debrecen , Hungary.,c MTA-DE Cell Biology and Signaling Research Group, Faculty of Medicine
| | - György Vereb
- a Department of Biophysics and Cell Biology , Faculty of Medicine, University of Debrecen , Debrecen , Hungary.,c MTA-DE Cell Biology and Signaling Research Group, Faculty of Medicine.,d Faculty of Pharmacy, University of Debrecen , Debrecen , Hungary
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15
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The use of combinations of monoclonal antibodies in clinical oncology. Cancer Treat Rev 2015; 41:859-67. [PMID: 26547132 DOI: 10.1016/j.ctrv.2015.10.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 01/18/2023]
Abstract
Treatment with monoclonal antibodies is becoming increasingly important in clinical oncology. These antibodies specifically inhibit signaling pathways in tumor growth and/or induce immunological responses against tumor cells. By combining monoclonal antibodies several pathways may be targeted simultaneously, potentially leading to additive or synergistic effects. Theoretically, antibodies are very suitable for use in combination therapy, because of limited overlapping toxicity and lack of pharmacokinetic interactions. In this article an overview is given of preclinical and clinical data on twenty-five different combinations of antibodies in oncology. Some of these combinations have proven clinical benefit, for example the combination of trastuzumab and pertuzumab in HER2-positive breast cancer, which exemplifies an additive or synergistic effect on antitumor activity in clinical studies and the combination of nivolumab and ipilimumab, which results in significant increases in progression-free and overall survival in patients with advanced melanoma. However, other combinations may lead to unfavorable results, such as bevacizumab with cetuximab or panitumumab in advanced colorectal cancer. These combinations result in shorter progression-free survival and increased toxicity compared to therapy with a single antibody. In summary, the different published studies showed widely varying results, depending on the combination of antibodies, indication and patient population. More preclinical and clinical studies are necessary to unravel the mechanisms behind synergistic or antagonistic effects of combining monoclonal antibodies. Most research on combination therapies is still in an early stage, but it is expected that for several tumor types the use of combination therapy of antibodies will become standard of care in the near future.
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16
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Yao Y, Yu L, Su X, Wang Y, Li W, Wu Y, Cheng X, Zhang H, Wei X, Chen H, Zhang R, Gou L, Chen X, Xie Y, Zhang B, Zhang Y, Yang J, Wei Y. Synthesis, characterization and targeting chemotherapy for ovarian cancer of trastuzumab-SN-38 conjugates. J Control Release 2015; 220:5-17. [PMID: 26439663 DOI: 10.1016/j.jconrel.2015.09.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/20/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023]
Abstract
Antibody-drug conjugates (ADCs), combining monoclonal antibody with high cytotoxicity chemotherapeutic drug (warhead), have been successfully applied for clinical cancer therapy. Linker technology to select and design linker connecting warhead with antibody, is critical to the success of therapeutic ADCs. In this study, three kinds of linkers were designed to connect SN-38, the bioactive metabolite of the anticancer drug irinotecan (CPT-11), which is 100-1000 times more potent than CPT-11, with the anti-HER2 antibody trastuzumab to prepare three different ADC conjugates (T-SN38 A, B and C). Meanwhile, we compared the anti-ovarian cancer effect of these three T-SN38 conjugates with trastuzumab in vitro and in vivo. Our in vitro results showed that T-SN38 A, B and C (drug-to-antibody ratio, DAR=3.7, 3.2, 3.4) were 2 to 3 times as cytotoxic as SN-38, and the IC50 for these three conjugates on SKOV-3 cell line at 72 h were 5.2 ± 0.3, 4.4 ± 0.7, and 5.1 ± 0.4 nM respectively. In our in vivo studies, T-SN38 conjugates had well targeting ability for tumor tissue and all three of them had much higher anti-ovarian cancer potency than trastuzumab. Among of them, T-SN38 B, which coupled SN-38 with trastuzumab by a carbonate bond, has the best anti-ovarian cancer potency. In conclusion, the novel HER2-targeting ADCs T-SN38 have great potential for HER2-positive ovarian cancer. Moreover, the SN-38-Linkers designed in this study can also be used to connect with other antibodies for the therapy of other cancers.
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Key Words
- 10-hydroxycamptothecin (PubChem CID: 97,226)
- 4-dimethylaminopyridine (PubChem CID:14,284)
- 7-ethyl-10-hydroxycamptothecin (PubChem CID:104,842)
- Antibody-drug conjugates (ADCs)
- Bi-function linker
- N-hydroxysuccinimide (PubChem CID:80,170)
- Ovarian cancer
- PEG4 (PubChem CID:21,896,924)
- SN-38
- Targeting chemotherapy
- Trastuzumab
- dicyclohexylcarbodiimide (PubChem CID:10,868)
- dithiothreitol (PubChem CID:19,001)
- ethyldiisopropylamine (PubChem CID:81,531)
- mercaptoacetic acid (PubChem CID:1133)
- triphosgene (PubChem CID:94,429)
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Affiliation(s)
- Yuqin Yao
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China; Research Center for Public Health and Preventive Medicine, West China School of Public Health/No.4 West China Teaching Hospital, Sichuan University, PR China; Guangdong Zhongsheng Pharmaceutical Co., Ltd., PR China
| | - Lin Yu
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xiaolan Su
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Yuxi Wang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Wenting Li
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Yangpin Wu
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xiangzheng Cheng
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Hang Zhang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xian Wei
- Guangdong Zhongsheng Pharmaceutical Co., Ltd., PR China
| | - Hao Chen
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Rundong Zhang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Lantu Gou
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xiaoxin Chen
- Guangdong Zhongsheng Pharmaceutical Co., Ltd., PR China
| | - Yongmei Xie
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hostpital, Sichuan University, PR China
| | - Yonghui Zhang
- Pharmacology & Pharmaceutical Sciences School of Medicine/ Collaborative Innovation Center for Biotherapy, Tsinghua University, Beijing, PR China
| | - Jinliang Yang
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China.
| | - Yuquan Wei
- State Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, PR China
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Schroeder RL, Stevens CL, Sridhar J. Small molecule tyrosine kinase inhibitors of ErbB2/HER2/Neu in the treatment of aggressive breast cancer. Molecules 2014; 19:15196-212. [PMID: 25251190 PMCID: PMC6270702 DOI: 10.3390/molecules190915196] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 12/12/2022] Open
Abstract
The human epidermal growth factor receptor 2 (HER2) is a member of the erbB class of tyrosine kinase receptors. These proteins are normally expressed at the surface of healthy cells and play critical roles in the signal transduction cascade in a myriad of biochemical pathways responsible for cell growth and differentiation. However, it is widely known that amplification and subsequent overexpression of the HER2 encoding oncogene results in unregulated cell proliferation in an aggressive form of breast cancer known as HER2-positive breast cancer. Existing therapies such as trastuzumab (Herceptin®) and lapatinib (Tyverb/Tykerb®), a monoclonal antibody inhibitor and a dual EGFR/HER2 kinase inhibitor, respectively, are currently used in the treatment of HER2-positive cancers, although issues with high recurrence and acquired resistance still remain. Small molecule tyrosine kinase inhibitors provide attractive therapeutic targets, as they are able to block cell signaling associated with many of the proposed mechanisms for HER2 resistance. In this regard we aim to present a review on the available HER2 tyrosine kinase inhibitors, as well as those currently in development. The use of tyrosine kinase inhibitors as sequential or combinatorial therapeutic strategies with other HER family inhibitors is also discussed.
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Affiliation(s)
- Richard L Schroeder
- Department of Chemistry, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA.
| | - Cheryl L Stevens
- Ogden College of Science and Engineering, Western Kentucky University, 1906 College Heights Boulevard #11075, Bowling Green, KY 42101, USA.
| | - Jayalakshmi Sridhar
- Department of Chemistry, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA.
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