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Spanakis M, Patelarou AE, Patelarou E. Nursing Personnel in the Era of Personalized Healthcare in Clinical Practice. J Pers Med 2020; 10:E56. [PMID: 32610469 PMCID: PMC7565499 DOI: 10.3390/jpm10030056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/27/2022] Open
Abstract
Personalized, stratified, or precision medicine (PM) introduces a new era in healthcare that tries to identify and predict optimum treatment outcomes for a patient or a cohort. It also introduces new scientific terminologies regarding therapeutic approaches and the need of their adoption from healthcare providers. Till today, evidence-based practice (EBP) was focusing on population averages and their variances among cohorts for clinical values that are essential for optimizing healthcare outcome. It can be stated that EBP and PM are complementary approaches for a modern healthcare system. Healthcare providers through EBP often see the forest (population averages) but miss the trees (individual patients), whereas utilization of PM may not see the forest for the trees. Nursing personnel (NP) play an important role in modern healthcare since they are consulting, educating, and providing care to patients whose needs often needs to be individualized (personalized nursing care, PNC). Based on the clinical issues earlier addressed from clinical pharmacology, EBP, and now encompassed in PM, this review tries to describe the challenges that NP have to face in order to meet the requisites of the new era in healthcare. It presents the demands that should be met for upgrading the provided education and expertise of NP toward an updated role in a modern healthcare system.
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Affiliation(s)
- Marios Spanakis
- Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology—Hellas (FORTH), Heraklion, GR-70013 Crete, Greece
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Heraklion, GR-71004 Crete, Greece; (A.E.P.); (E.P.)
| | - Athina E. Patelarou
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Heraklion, GR-71004 Crete, Greece; (A.E.P.); (E.P.)
| | - Evridiki Patelarou
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, Heraklion, GR-71004 Crete, Greece; (A.E.P.); (E.P.)
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2
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Xu ZY, Li JL. Comparative review of drug-drug interactions with epidermal growth factor receptor tyrosine kinase inhibitors for the treatment of non-small-cell lung cancer. Onco Targets Ther 2019; 12:5467-5484. [PMID: 31371986 PMCID: PMC6636179 DOI: 10.2147/ott.s194870] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
The development of small-molecule tyrosine kinase inhibitors (TKIs) that target the epidermal growth factor receptor (EGFR) has revolutionized the management of non-small-cell lung cancer (NSCLC). Because these drugs are commonly used in combination with other types of medication, the risk of clinically significant drug–drug interactions (DDIs) is an important consideration, especially for patients using multiple drugs for coexisting medical conditions. Clinicians need to be aware of the potential for clinically important DDIs when considering therapeutic options for individual patients. In this article, we describe the main mechanisms underlying DDIs with the EGFR-TKIs that are currently approved for the treatment of NSCLC, and, specifically, the potential for interactions mediated via effects on gastrointestinal pH, cytochrome P450-dependent metabolism, uridine diphosphate-glucuronosyltransferase, and transporter proteins. We review evidence of such DDIs with the currently approved EGFR-TKIs (gefitinib, erlotinib, afatinib, osimertinib, and icotinib) and discuss several information sources that are available online to aid clinical decision-making. We conclude by summarizing the most clinically relevant DDIs with these EFGR-TKIs and provide recommendations for managing, minimizing, or avoiding DDIs with the different agents.
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Affiliation(s)
- Zi-Yi Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jun-Ling Li
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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3
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Zebrafish Xenograft Model of Human Lung Cancer for Evaluating Osimertinib Resistance. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3129748. [PMID: 31346515 PMCID: PMC6620834 DOI: 10.1155/2019/3129748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
Abstract
About half of NSCLC patients with EGFR mutation had secondary mutation T790M after treatment with a first-generation tyrosine kinase inhibitor (TKI), Gefitinib. The third-generation of EGFR-TKI Osimertinib is suitable for patients with EGFR mutation and T790M mutation. However, drug screening for NSCLC patients after the emergence of acquired resistance has become a difficult problem for clinicians. In this study, we established drug-resistant cell lines of Gefitinib and Osimertinib to evaluate cell proliferation in vitro. And we investigated the inhibitory effect of different drug concentration gradients on cancer cells. Zebrafish with high homology to human genes were selected as xenotransplantation models to compare the effects of different concentrations of Osimertinib on the proliferation and angiogenesis of zebrafish tumors after transplantation of different lung cancer cell lines. It was confirmed that Osimertinib could inhibit the proliferation of tumor cells with EGFR mutation and T790M resistance mutation in zebrafish, which was consistent with the clinical research conclusion.
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4
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Abdallah SMB, Hirsh V. Irreversible tyrosine kinase inhibition of epidermal growth factor receptor with afatinib in EGFR activating mutation-positive advanced non-small-cell lung cancer. ACTA ACUST UNITED AC 2018; 25:S9-S17. [PMID: 29910643 DOI: 10.3747/co.25.3732] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite recent advances in the systemic therapy of non-small-cell lung cancer (nsclc), the prognosis for stage iv disease remains poor. The discovery of targetable mutations has led to new treatment options. The most common mutations, the EGFR activating mutations, are present in about 50% of Asian patients and up to 15% of white patients. First-generation reversible epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) have led to improved survival in patients positive for EGFR activating mutations, but resistance eventually leads to disease progression. The irreversible egfr tki afatinib was developed to counter such resistance. The clinical efficacy of afatinib has been shown in first-line studies comparing it with both cytotoxic chemotherapy and first-generation egfr tkis. Afatinib has also shown continued benefit beyond progression while a patient is taking an egfr inhibitor. Furthermore, its toxicity profile is both predictable and manageable. The results of the principal clinical trials assessing afatinib are reviewed here.
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Affiliation(s)
| | - V Hirsh
- Department of Oncology, McGill University Health Centre, Montreal, QC
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5
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Abdallah SM, Wong A. Brain metastases in non-small-cell lung cancer: are tyrosine kinase inhibitors and checkpoint inhibitors now viable options? Curr Oncol 2018; 25:S103-S114. [PMID: 29910653 PMCID: PMC6001769 DOI: 10.3747/co.25.3733] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Significant progress has been made in the treatment of stage iv non-small-cell lung cancer (nsclc); however, the prognosis of patients with brain metastases remains poor. Resection and radiation therapy remain standard options. This issue is an important one because 10% of patients with nsclc have brain metastases at diagnosis, and 25%-40% develop brain metastases during their disease. Standard chemotherapy does not cross the blood-brain barrier. However, there is new hope that tyrosine kinase inhibitors (tkis) used in patients with identified targetable mutations such as mutations of EGFR and rearrangements of ALK could have activity in the central nervous system (cns). Furthermore, immunotherapy is increasingly becoming a standard option for patients with nsclc, and interest about the intracranial activity of those agents is growing. This review presents current data about the cns activity of the available major tkis and immunotherapy agents.
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Affiliation(s)
| | - A. Wong
- Medical Oncology, McGill University Health Centre, Montreal, and
- Medical Oncology, Hôpital du Suroît, Valleyfield, QC
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6
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Xu Y, Zhang F, Pan X, Wang G, Zhu L, Zhang J, Wen D, Lu S. Xenograft tumors derived from malignant pleural effusion of the patients with non-small-cell lung cancer as models to explore drug resistance. Cancer Commun (Lond) 2018; 38:19. [PMID: 29764505 PMCID: PMC5993147 DOI: 10.1186/s40880-018-0284-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/08/2018] [Indexed: 12/25/2022] Open
Abstract
Background Non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) fusions show dramatic responses to specific tyrosine kinase inhibitors (TKIs); however, after 10–12 months, secondary mutations arise that confer resistance. We generated a murine xenograft model using patient-derived NSCLC cells isolated from the pleural fluid of two patients with NSCLC to investigate the mechanisms of resistance against the ALK- and EGFR-targeted TKIs crizotinib and osimertinib, respectively. Methods Genotypes of patient biopsies and xenograft tumors were determined by whole exome sequencing (WES), and patients and xenograft-bearing mice received targeted treatment (crizotinib or osimertinib) accordingly. Xenograft mice were also treated for prolonged periods to identify whether the development of drug resistance and/or treatment responses were associated with tumor size. Finally, the pathology of patients biopsies and xenograft tumors were compared histologically. Results The histological characteristics and chemotherapy responses of xenograft tumors were similar to the actual patients. WES showed that the genotypes of the xenograft and patient tumors were similar (an echinoderm microtubule-associated protein-like 4-ALK (EML4–ALK) gene fusion (patient/xenograft: CTC15035EML4–ALK) and EGFR L858R and T790M mutations (patient/xenograft: CTC15063EGFR L858R, T790M)). After continuous crizotinib or osimertinib treatment, WES data suggested that acquired ALK E1210K mutation conferred crizotinib resistance in the CTC15035EML4–ALK xenograft, while decreased frequencies of EGFR L858R and T790M mutations plus the appearance of v-RAF murine sarcoma viral oncogene homolog B (BRAF) G7V mutations and phosphatidylinositol-4-phosphate 3-kinase catalytic subunit type 2 alpha (PIK3C2A) A86fs frame shift mutations led to osimertinib resistance in the CTC15063EGFR L858R, T790M xenografts. Conclusions We successfully developed a new method of generating drug resistance xenograft models from liquid biopsies using microfluidic technology, which might be a useful tool to investigate the mechanisms of drug resistance in NSCLC. Electronic supplementary material The online version of this article (10.1186/s40880-018-0284-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yunhua Xu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Shanghai, 200030, China
| | - Feifei Zhang
- Shanghai LIDE Biotech Co., Ltd, 887 Zuchongzhi Rd, Pudong, Shanghai, 201203, China
| | - Xiaoqing Pan
- Shanghai LIDE Biotech Co., Ltd, 887 Zuchongzhi Rd, Pudong, Shanghai, 201203, China
| | - Guan Wang
- GenomiCare Biotechnology (Shanghai) Co., Ltd., Shanghai, 200233, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jie Zhang
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Danyi Wen
- Shanghai LIDE Biotech Co., Ltd, 887 Zuchongzhi Rd, Pudong, Shanghai, 201203, China.
| | - Shun Lu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Shanghai, 200030, China.
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7
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Wang A, Yan XE, Wu H, Wang W, Hu C, Chen C, Zhao Z, Zhao P, Li X, Wang L, Wang B, Ye Z, Wang J, Wang C, Zhang W, Gray NS, Weisberg EL, Chen L, Liu J, Yun CH, Liu Q. Ibrutinib targets mutant-EGFR kinase with a distinct binding conformation. Oncotarget 2018; 7:69760-69769. [PMID: 27626175 PMCID: PMC5342513 DOI: 10.18632/oncotarget.11951] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/05/2016] [Indexed: 12/20/2022] Open
Abstract
Ibrutinib, a clinically approved irreversible BTK kinase inhibitor for Mantle Cell Lymphoma (MCL) and Chronic Lymphocytic Leukemia (CLL) etc, has been reported to be potent against EGFR mutant kinase and currently being evaluated in clinic for Non Small Cell Lung Cancer (NSCLC). Through EGFR wt/mutant engineered isogenic BaF3 cell lines we confirmed the irreversible binding mode of Ibrutinib with EGFR wt/mutant kinase via Cys797. However, comparing to typical irreversible EGFR inhibitor, such as WZ4002, the washing-out experiments revealed a much less efficient covalent binding for Ibrutinib. The biochemical binding affinity examination in the EGFR L858R/T790M kinase revealed that, comparing to more efficient irreversible inhibitor WZ4002 (Kd: 0.074 μM), Ibrutinib exhibited less efficient binding (Kd: 0.18 μM). An X-ray crystal structure of EGFR (T790M) in complex with Ibrutinib exhibited a unique DFG-in/c-Helix-out inactive binding conformation, which partially explained the less efficiency of covalent binding and provided insight for further development of highly efficient irreversible binding inhibitor for the EGFR mutant kinase. These results also imply that, unlike the canonical irreversible inhibitor, sustained effective concentration might be required for Ibrutinib in order to achieve the maximal efficacy in the clinic application against EGFR driven NSCLC.
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Affiliation(s)
- Aoli Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,University of Science and Technology of China, Anhui, Hefei 230036, P. R. China
| | - Xiao-E Yan
- Institute of Systems Biomedicine, Department of Biophysics, Beijing Key Laboratory of Tumor Systems Biology and Center for Molecular and Translational Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P. R. China
| | - Hong Wu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,University of Science and Technology of China, Anhui, Hefei 230036, P. R. China
| | - Wenchao Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,Hefei Science Center, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China
| | - Chen Hu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,University of Science and Technology of China, Anhui, Hefei 230036, P. R. China
| | - Cheng Chen
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,University of Science and Technology of China, Anhui, Hefei 230036, P. R. China
| | - Zheng Zhao
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,Hefei Science Center, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China
| | - Peng Zhao
- Institute of Systems Biomedicine, Department of Biophysics, Beijing Key Laboratory of Tumor Systems Biology and Center for Molecular and Translational Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P. R. China
| | - Xixiang Li
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China
| | - Li Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,University of Science and Technology of China, Anhui, Hefei 230036, P. R. China
| | - Beilei Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,University of Science and Technology of China, Anhui, Hefei 230036, P. R. China
| | - Zi Ye
- Synthetic and Functional Biomolecules Center, Beijing National Laboratory for Molecular Sciences, Key Laboratory of Bioorganic Chemistry and Molecular Engineering of Ministry of Education, College of Chemistry and Molecular Engineering, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, P. R. China
| | - Jinhua Wang
- Department of Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Chu Wang
- Synthetic and Functional Biomolecules Center, Beijing National Laboratory for Molecular Sciences, Key Laboratory of Bioorganic Chemistry and Molecular Engineering of Ministry of Education, College of Chemistry and Molecular Engineering, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, P. R. China
| | - Wei Zhang
- Collaborative Innovation Center of Cancer Medicine, National Institute of Biological Sciences, Beijing 102206, P. R. China
| | - Nathanael S Gray
- Department of Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.,Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Ellen L Weisberg
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Liang Chen
- Collaborative Innovation Center of Cancer Medicine, National Institute of Biological Sciences, Beijing 102206, P. R. China
| | - Jing Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,Hefei Science Center, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China
| | - Cai-Hong Yun
- Institute of Systems Biomedicine, Department of Biophysics, Beijing Key Laboratory of Tumor Systems Biology and Center for Molecular and Translational Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P. R. China
| | - Qingsong Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China.,University of Science and Technology of China, Anhui, Hefei 230036, P. R. China.,Hefei Science Center, Chinese Academy of Sciences, Anhui, Hefei 230031, P. R. China
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8
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Veldore VH, Choughule A, Routhu T, Mandloi N, Noronha V, Joshi A, Dutt A, Gupta R, Vedam R, Prabhash K. Validation of liquid biopsy: plasma cell-free DNA testing in clinical management of advanced non-small cell lung cancer. LUNG CANCER (AUCKLAND, N.Z.) 2018; 9:1-11. [PMID: 29379323 PMCID: PMC5757203 DOI: 10.2147/lctt.s147841] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Plasma cell-free tumor DNA, or circulating tumor DNA (ctDNA), from liquid biopsy is a potential source of tumor genetic material, in the absence of tissue biopsy, for EGFR testing. Our validation study reiterates the clinical utility of ctDNA next generation sequencing (NGS) for EGFR mutation testing in non-small cell lung cancer (NSCLC). A total of 163 NSCLC cases were included in the validation, of which 132 patients had paired tissue biopsy and ctDNA. We chose to validate ctDNA using deep sequencing with custom designed bioinformatics methods that could detect somatic mutations at allele frequencies as low as 0.01%. Benchmarking allele specific real time PCR as one of the standard methods for tissue-based EGFR mutation testing, the ctDNA NGS test was validated on all the plasma derived cell-free DNA samples. We observed a high concordance (96.96%) between tissue biopsy and ctDNA for oncogenic driver mutations in Exon 19 and Exon 21 of the EGFR gene. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the assay were 91.1%, 100% 100%, 95.6%, and 97%, respectively. A false negative rate of 3% was observed. A subset of mutations was also verified on droplet digital PCR. Sixteen percent EGFR mutation positivity was observed in patients where only liquid biopsy was available, thus creating options for targeted therapy. This is the first and largest study from India, demonstrating successful validation of circulating cell-free DNA as a clinically useful material for molecular testing in NSCLC.
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Affiliation(s)
| | | | | | | | | | - Amit Joshi
- Tata Memorial Centre, Parel, Mumbai, India
| | - Amit Dutt
- The Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Center, Kharghar, Navi Mumbai, Maharashtra, India
| | - Ravi Gupta
- MedGenome Labs Private Ltd,, Bangalore, India
| | - Ramprasad Vedam
- MedGenome Labs Private Ltd,, Bangalore, India
- Ramprasad Vedam, MedGenome Labs Private Ltd., 3 Floor, Narayana Netralaya Building, NH City, 258/A, Bommasandra Industrial Area, Bommasandra, Bangalore 560099, India, Email
| | - Kumar Prabhash
- Tata Memorial Centre, Parel, Mumbai, India
- Correspondence: Kumar Prabhash, Department of Medical Oncology, Tata Memorial Hospital, Dr E Borges Road, Parel, Mumbai 400 012, India, Email
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9
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Hu C, Wang A, Wu H, Qi Z, Li X, Yan XE, Chen C, Yu K, Zou F, Wang W, Wang W, Wu J, Liu J, Wang B, Wang L, Ren T, Zhang S, Yun CH, Liu J, Liu Q. Discovery and characterization of a novel irreversible EGFR mutants selective and potent kinase inhibitor CHMFL-EGFR-26 with a distinct binding mode. Oncotarget 2017; 8:18359-18372. [PMID: 28407693 PMCID: PMC5392334 DOI: 10.18632/oncotarget.15443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/23/2017] [Indexed: 12/18/2022] Open
Abstract
EGFR T790M mutation accounts for about 40-55% drug resistance for the first generation EGFR kinase inhibitors in the NSCLC. Starting from ibrutinib, a highly potent irreversible BTK kinase inhibitor, which was also found to be moderately active to EGFR T790M mutant, we discovered a highly potent irreversible EGFR inhibitor CHMFL-EGFR-26, which is selectively potent against EGFR mutants including L858R, del19, and L858R/T790M. It displayed proper selectivity window between the EGFR mutants and the wide-type. CHMFL-EGFR-26 exhibited good selectivity profile among 468 kinases/mutants tested (S score (1)=0.02). In addition, X-ray crystallography revealed a distinct “DFG-in” and “cHelix-out” inactive binding mode between CHMFL-EGFR-26 and EGFR T790M protein. The compound showed highly potent anti-proliferative efficacy against EGFR mutant but not wide-type NSCLC cell lines through effective inhibition of the EGFR mediated signaling pathway, induction of apoptosis and arresting of cell cycle progression. CHMFL-EGFR-26 bore acceptable pharmacokinetic properties and demonstrated dose-dependent tumor growth suppression in the H1975 (EGFR L858R/T790M) and PC-9 (EGFR del19) inoculated xenograft mouse models. Currently CHMFL-EGFR-26 is undergoing extensive pre-clinical evaluation for the clinical trial purpose.
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Affiliation(s)
- Chen Hu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China
| | - Aoli Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China
| | - Hong Wu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China
| | - Ziping Qi
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China
| | - Xixiang Li
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China
| | - Xiao-E Yan
- Institute of Systems Biomedicine, Department of Biophysics, Beijing Key Laboratory of Tumor Systems Biology and Center for Molecular and Translational Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Cheng Chen
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China
| | - Kailin Yu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China
| | - Fengming Zou
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China
| | - Wenchao Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China
| | - Wei Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China
| | - Jiaxin Wu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China
| | - Juan Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China
| | - Beilei Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China
| | - Li Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China
| | - Tao Ren
- Precision Targeted Therapy Discovery Center, Institute of Technology Innovation, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, Anhui 230088, P. R. China
| | - Shanchun Zhang
- CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China.,Hefei Cosource Medicine Technology Co. LTD., Hefei, Anhui 230031, P. R. China
| | - Cai-Hong Yun
- Institute of Systems Biomedicine, Department of Biophysics, Beijing Key Laboratory of Tumor Systems Biology and Center for Molecular and Translational Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Jing Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China
| | - Qingsong Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui 230031, P. R. China.,University of Science and Technology of China, Hefei, Anhui 230036, P. R. China.,CHMFL-HCMTC Target Therapy Joint Laboratory, Hefei, Anhui 230031, P. R. China.,Precision Targeted Therapy Discovery Center, Institute of Technology Innovation, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, Anhui 230088, P. R. China
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10
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Gaut D, Sim MS, Yue Y, Wolf BR, Abarca PA, Carroll JM, Goldman JW, Garon EB. Clinical Implications of the T790M Mutation in Disease Characteristics and Treatment Response in Patients With Epidermal Growth Factor Receptor (EGFR)-Mutated Non-Small-Cell Lung Cancer (NSCLC). Clin Lung Cancer 2017; 19:e19-e28. [PMID: 28712979 DOI: 10.1016/j.cllc.2017.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The secondary T790M mutation accounts for more than 50% of acquired tyrosine kinase inhibitor (TKI) resistance in patients with EGFR-mutated non-small-cell lung cancer (NSCLC). Recent reports suggest this resistance mutation may be more common among patients with longer progression-free survival (PFS) on first-line TKI therapy, but much is still unknown. MATERIALS AND METHODS Our group collected medical records from patients who underwent a biopsy for T790M mutation testing while screening for clinical trials involving the drug rociletinib (CO-1686), a T790M mutation-specific TKI. Medical records were retrospectively analyzed for demographic data, PFS, and best response to previous therapies. RESULTS Our patient cohort included 69 T790M+ patients and 28 T790M- patients. Patients who later developed a T790M mutation had a longer PFS on first-line TKI therapy (12.0 vs. 9.0 months, P = .021), but overall response rate (ORR) was the same (75.0% vs. 81.0%, P = .76). There was no difference in PFS on TKI rechallenge (4.0 vs. 3.0 months, P = .94), although there was a trend toward higher ORR in T790M+ patients (22.2% vs. 0%, P = .12). T790M+ patients had a longer PFS on initial chemotherapy treatment (5.0 vs. 4.0 months, P = .025) and a trend toward higher ORR (40.0% vs. 21.4%, P = .31). CONCLUSION Our study confirms that tumors expressing T790M have a more indolent progression of disease compared with their T790M- counterparts when treated with both first-line TKI and cytotoxic chemotherapy.
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Affiliation(s)
- Daria Gaut
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
| | - Myung Shin Sim
- Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Yuguang Yue
- Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Brian R Wolf
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Phillip A Abarca
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - James M Carroll
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jonathan W Goldman
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Edward B Garon
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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11
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Morin-Ben Abdallah S, Hirsh V. Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Treatment of Metastatic Non-Small Cell Lung Cancer, with a Focus on Afatinib. Front Oncol 2017; 7:97. [PMID: 28560182 PMCID: PMC5432609 DOI: 10.3389/fonc.2017.00097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/27/2017] [Indexed: 11/27/2022] Open
Abstract
Somatic epidermal growth factor receptor (EGFR) mutations are present in around 50% of Asian patients and in 10–15% of Caucasian patients with metastatic non-small cell lung cancer (NSCLC) of adenocarcinoma histology. The first-generation EGFR-tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib have demonstrated improved progression-free survival (PFS) and response rates but not overall survival (OS) benefit in randomized phase III trials when compared with platinum-doublet chemotherapy. All patients treated with EGFR-TKIs will eventually develop acquired resistance to these agents. Afatinib, an irreversible ErbB family blocker, has shown in two randomly controlled trials in patients with EGFR-activating mutations, a significant improvement in PFS and health-related quality of life when compared to platinum-based chemotherapy. Afatinib improved OS in patients with Del19 mutations. In patients having progressed on first-generation EGFR-TKIs, afatinib did lead to a clinical benefit. A randomly controlled trial showed that PFS was significantly superior with afatinib vs. erlotinib in patients with squamous NSCLC in the second-line setting. A phase IIb trial comparing afatinib and gefitinib in first-line EGFR positive NSCLC showed significantly improved PFS with afatinib but OS was not significantly improved.
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Affiliation(s)
| | - Vera Hirsh
- Department of Oncology, McGill University Health Centre, Montreal, QC, Canada
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12
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Liu TC, Jin X, Wang Y, Wang K. Role of epidermal growth factor receptor in lung cancer and targeted therapies. Am J Cancer Res 2017; 7:187-202. [PMID: 28337370 PMCID: PMC5336495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023] Open
Abstract
Lung cancer is the foremost cause of cancer-related deaths world-wide. Both, the major forms of lung cancer, Non-small cell lung cancer (NSCLC) and Small cell lung cancers (SCLC), have responded effectively to chemo-, radiation and adjuvant-therapies. Tumor removal through surgery also appeared as a good therapeutic strategy. However, these therapies demonstrated unfavourable side-effects, and hence novel drugs targeting lung cancer emerged essential. Activation of epidermal growth factor receptor (EGFR)-tyrosine kinases is a key reason for lung cancer progression. Two important strategies that have attenuated lung cancers were through treatments with EGFR-tyrosine kinase-inhibitors, erlotinib and gefitinib, or EGFR-neutralizing antibodies, cetuximab and bevacizumab. A major advantage with erlotinib and gefitinib was their role in second and third-line treatments following chemotherapies. Phase II/III clinical trials showed that combinatorial treatment of tyrosine kinase (TK)-inhibitors with chemotherapeutics, such as docetaxel and pemetrexed, caused significant improvements in progression-free survival and overall survival.Phase I and II clinical studies also revealed that combination of tyrosine kinase-inhibitors with the EGFR-targeted antibodies was an effective approach for treating lung cancer. However, patients having T790M-mutations within EGFR gene were resistant to erlotinib and gefitinib. Alternatively, another second-generation EGFR-tyrosine kinase-inhibitor, afatinib, that could circumvent the problem of drug resistance has been developed as lung cancer therapy. The current review focuses on the role of EGFR in lung cancer progression and apprises about the EGFR-targeted therapies. The review also informs on the adverse side-effects of these therapies and enlightens the need for safer therapeutic regimens to eradicate this dreaded disease.
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Affiliation(s)
- Tie-Cheng Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Jilin UniversityChangchun, China
| | - Xin Jin
- Department of Respiratory Medicine, The Second Affiliated Hospital of Jilin UniversityChangchun, China
| | - Yan Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Jilin UniversityChangchun, China
| | - Ke Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Jilin UniversityChangchun, China
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13
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Wu YL, Sequist LV, Hu CP, Feng J, Lu S, Huang Y, Li W, Hou M, Schuler M, Mok T, Yamamoto N, O'Byrne K, Hirsh V, Gibson N, Massey D, Kim M, Yang JCH. EGFR mutation detection in circulating cell-free DNA of lung adenocarcinoma patients: analysis of LUX-Lung 3 and 6. Br J Cancer 2016; 116:175-185. [PMID: 28006816 PMCID: PMC5243999 DOI: 10.1038/bjc.2016.420] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/17/2016] [Accepted: 11/16/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In the Phase III LUX-Lung 3/6 (LL3/LL6) trials in epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma patients, we evaluated feasibility of EGFR mutation detection using circulating cell-free DNA (cfDNA) and prognostic and predictive utility of cfDNA positivity (cfDNA+). METHODS Paired tumour and blood samples were prospectively collected from randomised patients. Mutations were detected using cfDNA from serum (LL3) or plasma (LL6) by a validated allele-specific quantitative real-time PCR kit. RESULTS EGFR mutation detection rates in cfDNA were 28.6% (serum) and 60.5% (plasma). Mutation detection in blood was associated with advanced disease characteristics, including higher performance score, number of metastatic sites and bone/liver metastases, and poorer prognosis. In patients with common EGFR mutations, afatinib improved progression-free survival vs chemotherapy in cfDNA+ (LL3: HR, 0.35; P=0.0009; LL6: HR, 0.25; P<0.0001) and cfDNA- (LL3: HR, 0.46; P<0.0001; LL6: HR, 0.12; P<0.0001) cohorts. A trend towards overall survival benefit with afatinib was observed in cfDNA+ patients. CONCLUSIONS Plasma cfDNA is a promising alternative to biopsy for EGFR testing. Detectable mutation in blood was associated with more advanced disease and poorer prognosis. Afatinib improved outcomes in EGFR mutation-positive patients regardless of blood mutation status.
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Affiliation(s)
- Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Lecia V Sequist
- Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Cheng-Ping Hu
- Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410018, China
| | - Jifeng Feng
- Jiangsu Provincial Tumor Hospital, 42 Baiziting, Xuanwu, Nanjing, Jiangsu 210009, China
| | - Shun Lu
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui, Shanghai 200030, China
| | - Yunchao Huang
- Yunnan Tumor Hospital (The Third Affiliated Hospital of Kunming Medical University), Xingjie Alley, Xishan, Kunming, Yunnan, China
| | - Wei Li
- Cancer Center, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, China
| | - Mei Hou
- West China Hospital, Sichuan University, 24 South Section 1, Yihuan Road, Chengdu, 610065, China
| | - Martin Schuler
- West German Cancer Center, University Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen 45147, Germany
| | - Tony Mok
- The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China
| | - Nobuyuki Yamamoto
- Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama Prefecture 641-8509, Japan
| | - Kenneth O'Byrne
- Princess Alexandra Hospital and Queensland University of Technology, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Vera Hirsh
- McGill University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada
| | - Neil Gibson
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Street 65, Biberach 88400, Germany
| | - Dan Massey
- Boehringer Ingelheim Ltd UK, Ellesfield Avenue, Bracknell, Berkshire RG12 8YS, UK
| | - Miyoung Kim
- Boehringer Ingelheim GmbH, Binger Street 173, Ingelheim 55216, Germany
| | - James Chih-Hsin Yang
- National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan
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14
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Wu H, Wang A, Zhang W, Wang B, Chen C, Wang W, Hu C, Ye Z, Zhao Z, Wang L, Li X, Yu K, Liu J, Wu J, Yan XE, Zhao P, Wang J, Wang C, Weisberg EL, Gray NS, Yun CH, Liu J, Chen L, Liu Q. Ibrutinib selectively and irreversibly targets EGFR (L858R, Del19) mutant but is moderately resistant to EGFR (T790M) mutant NSCLC Cells. Oncotarget 2016; 6:31313-22. [PMID: 26375053 PMCID: PMC4741607 DOI: 10.18632/oncotarget.5182] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/24/2015] [Indexed: 12/18/2022] Open
Abstract
Through comprehensive comparison study, we found that ibrutinib, a clinically approved covalent BTK kinase inhibitor, was highly active against EGFR (L858R, del19) mutant driven NSCLC cells, but moderately active to the T790M 'gatekeeper' mutant cells and not active to wild-type EGFR NSCLC cells. Ibrutinib strongly affected EGFR mediated signaling pathways and induced apoptosis and cell cycle arrest (G0/G1) in mutant EGFR but not wt EGFR cells. However, ibrutinib only slowed down tumor progression in PC-9 and H1975 xenograft models. MEK kinase inhibitor, GSK1120212, could potentiate ibrutinib's effect against the EGFR (L858R/T790M) mutation in vitro but not in vivo. These results suggest that special drug administration might be required to achieve best clinical response in the ongoing phase I/II clinical trial with ibrutinib for NSCLC.
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Affiliation(s)
- Hong Wu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China.,University of Science and Technology of China, Hefei 230036, Anhui, P. R. China
| | - Aoli Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China.,University of Science and Technology of China, Hefei 230036, Anhui, P. R. China
| | - Wei Zhang
- Collaborative Innovation Center of Cancer Medicine, National Institute of Biological Sciences, Beijing, Beijing 102206, P.R. China
| | - Beilei Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Cheng Chen
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Wenchao Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Chen Hu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Zi Ye
- Synthetic and Functional Biomolecules Center, Beijing National Laboratory for Molecular Sciences, Key Laboratory of Bioorganic Chemistry and Molecular Engineering of Ministry of Education, College of Chemistry and Molecular Engineering, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, P.R. China
| | - Zheng Zhao
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Li Wang
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Xixiang Li
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Kailin Yu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Juan Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Jiaxin Wu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China.,University of Science and Technology of China, Hefei 230036, Anhui, P. R. China
| | - Xiao-E Yan
- Institute of Systems Biomedicine, Department of Biophysics, Beijing Key Laboratory of Tumor Systems Biology and Center for Molecular and Translational Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Peng Zhao
- Institute of Systems Biomedicine, Department of Biophysics, Beijing Key Laboratory of Tumor Systems Biology and Center for Molecular and Translational Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Jinhua Wang
- Department of Cancer Biology, Dana-Farber Cancer Institute, and Department of Biological Chemistry & Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Chu Wang
- Synthetic and Functional Biomolecules Center, Beijing National Laboratory for Molecular Sciences, Key Laboratory of Bioorganic Chemistry and Molecular Engineering of Ministry of Education, College of Chemistry and Molecular Engineering, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, P.R. China
| | - Ellen L Weisberg
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Nathanael S Gray
- Department of Cancer Biology, Dana-Farber Cancer Institute, and Department of Biological Chemistry & Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Cai-Hong Yun
- Institute of Systems Biomedicine, Department of Biophysics, Beijing Key Laboratory of Tumor Systems Biology and Center for Molecular and Translational Medicine, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Jing Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
| | - Liang Chen
- Collaborative Innovation Center of Cancer Medicine, National Institute of Biological Sciences, Beijing, Beijing 102206, P.R. China
| | - Qingsong Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China.,University of Science and Technology of China, Hefei 230036, Anhui, P. R. China.,Hefei Science Center, Chinese Academy of Sciences, Hefei 230031, Anhui, P. R. China
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15
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Ott GR, Cheng M, Learn KS, Wagner J, Gingrich DE, Lisko JG, Curry M, Mesaros EF, Ghose AK, Quail MR, Wan W, Lu L, Dobrzanski P, Albom MS, Angeles TS, Wells-Knecht K, Huang Z, Aimone LD, Bruckheimer E, Anderson N, Friedman J, Fernandez SV, Ator MA, Ruggeri BA, Dorsey BD. Discovery of Clinical Candidate CEP-37440, a Selective Inhibitor of Focal Adhesion Kinase (FAK) and Anaplastic Lymphoma Kinase (ALK). J Med Chem 2016; 59:7478-96. [PMID: 27527804 DOI: 10.1021/acs.jmedchem.6b00487] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Analogues structurally related to anaplastic lymphoma kinase (ALK) inhibitor 1 were optimized for metabolic stability. The results from this endeavor not only led to improved metabolic stability, pharmacokinetic parameters, and in vitro activity against clinically derived resistance mutations but also led to the incorporation of activity for focal adhesion kinase (FAK). FAK activation, via amplification and/or overexpression, is characteristic of multiple invasive solid tumors and metastasis. The discovery of the clinical stage, dual FAK/ALK inhibitor 27b, including details surrounding SAR, in vitro/in vivo pharmacology, and pharmacokinetics, is reported herein.
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Affiliation(s)
- Gregory R Ott
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Mangeng Cheng
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Keith S Learn
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Jason Wagner
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Diane E Gingrich
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Joseph G Lisko
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Matthew Curry
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Eugen F Mesaros
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Arup K Ghose
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Matthew R Quail
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Weihua Wan
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Lihui Lu
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Pawel Dobrzanski
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Mark S Albom
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Thelma S Angeles
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Kevin Wells-Knecht
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Zeqi Huang
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Lisa D Aimone
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Elizabeth Bruckheimer
- Champions Oncology, Inc. , One University Plaza, Suite 307, Hackensack, New Jersey 07601, United States
| | - Nathan Anderson
- Champions Oncology, Inc. , One University Plaza, Suite 307, Hackensack, New Jersey 07601, United States
| | - Jay Friedman
- Champions Oncology, Inc. , One University Plaza, Suite 307, Hackensack, New Jersey 07601, United States
| | - Sandra V Fernandez
- Thomas Jefferson University , 233 South 10th Street, 1002 BLSB, Philadelphia, Pennsylvania 19107, United States
| | - Mark A Ator
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Bruce A Ruggeri
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Bruce D Dorsey
- Teva Branded Pharmaceutical Products R&D , 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
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16
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Xu Y, Ding VW, Zhang H, Zhang X, Jablons D, He B. Spotlight on afatinib and its potential in the treatment of squamous cell lung cancer: the evidence so far. Ther Clin Risk Manag 2016; 12:807-16. [PMID: 27307741 PMCID: PMC4888861 DOI: 10.2147/tcrm.s92996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Compared to adenocarcinoma, fewer effective treatment options are available for advanced or metastatic squamous cell carcinoma (SCC) of the lung. Afatinib is an orally administered, irreversible EGFR antagonist. As a second-generation tyrosine kinase inhibitor, it has been applied in the treatment of patients with EGFR-mutant non-small-cell lung cancer. Recently, several clinical trials have shown that afatinib leads to a significant improvement in progression-free survival and overall survival of patients with SCC. Moving forward, afatinib should be one of the options among tyrosine kinase inhibitors, monoclonal antibodies, and cytotoxicity chemotherapy drugs for SCC.
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Affiliation(s)
- Yijun Xu
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA; Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Vivianne W Ding
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Hong Zhang
- Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Xun Zhang
- Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - David Jablons
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Biao He
- Thoracic Oncology Program, Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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17
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Abstract
First-generation, reversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), erlotinib and gefitinib, represented an important addition to the treatment armamentarium for non-small-cell lung cancer (NSCLC) patients with activating EGFR mutations. However, all patients inevitably develop acquired resistance to these agents, primarily due to secondary EGFR mutations, molecular aberrations affecting other signaling pathways, or transformation to small-cell histology. It was hypothesized that development of second-generation TKIs with broader inhibitory profiles could confer longer-lasting clinical activity and overcome acquired resistance to first-generation inhibitors. Here, we review the development of afatinib, an irreversible ErbB family blocker that potently inhibits signaling of all homodimers and heterodimers formed by the EGFR, human epidermal growth factor receptor (HER)-2, HER3, and HER4 receptors. In two phase III trials in patients with EGFR mutation-positive NSCLC, first-line afatinib significantly improved progression-free survival (PFS) and health-related quality of life versus standard-of-care chemotherapy. Moreover, in preplanned sub-analyses, afatinib significantly improved overall survival in patients harboring EGFR Del19 mutations. Afatinib has also demonstrated clinical activity in NSCLC patients who had progressed on erlotinib/gefitinib, particularly when combined with cetuximab, and offers ‘treatment beyond progression’ benefit when combined with paclitaxel versus chemotherapy alone. Furthermore, a recent phase III study demonstrated that PFS was significantly improved with afatinib versus erlotinib for the second-line treatment of patients with squamous cell carcinoma of the lung. The activity of afatinib in both first-line and relapsed/refractory settings may reflect its ability to irreversibly inhibit all ErbB family members. Afatinib has a well-defined safety profile with characteristic gastrointestinal (diarrhea, stomatitis) and cutaneous (rash/acne) adverse events.
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Affiliation(s)
- Vera Hirsh
- McGill Department of Oncology, Royal Victoria Hospital, 687 Pine Avenue W., Montreal, QC, H3A 1A1, Canada,
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18
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Orechia J, Pathak A, Shi Y, Nawani A, Belozerov A, Fontes C, Lakhiani C, Jawale C, Patel C, Quinn D, Botvinnik D, Mei E, Cotter E, Byleckie J, Ullman-Cullere M, Chhetri P, Chalasani P, Karnam P, Beaudoin R, Sahu S, Belozerova Y, Mathew JP. OncDRS: An integrative clinical and genomic data platform for enabling translational research and precision medicine. Appl Transl Genom 2015; 6:18-25. [PMID: 27054074 PMCID: PMC4803771 DOI: 10.1016/j.atg.2015.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/05/2015] [Indexed: 02/01/2023]
Abstract
We live in the genomic era of medicine, where a patient's genomic/molecular data is becoming increasingly important for disease diagnosis, identification of targeted therapy, and risk assessment for adverse reactions. However, decoding the genomic test results and integrating it with clinical data for retrospective studies and cohort identification for prospective clinical trials is still a challenging task. In order to overcome these barriers, we developed an overarching enterprise informatics framework for translational research and personalized medicine called Synergistic Patient and Research Knowledge Systems (SPARKS) and a suite of tools called Oncology Data Retrieval Systems (OncDRS). OncDRS enables seamless data integration, secure and self-navigated query and extraction of clinical and genomic data from heterogeneous sources. Within a year of release, the system has facilitated more than 1500 research queries and has delivered data for more than 50 research studies.
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Affiliation(s)
- John Orechia
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Ameet Pathak
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Yunling Shi
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Aniket Nawani
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Andrey Belozerov
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Caitlin Fontes
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Camille Lakhiani
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Chetan Jawale
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Chetansharan Patel
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Daniel Quinn
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Dmitry Botvinnik
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Eddie Mei
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Elizabeth Cotter
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - James Byleckie
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | | | - Padam Chhetri
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Poornima Chalasani
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Purushotham Karnam
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Ronald Beaudoin
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Sandeep Sahu
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Yelena Belozerova
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
| | - Jomol P Mathew
- Dana-Faber Cancer Institute, 450 Brookline Ave., Boston, MA-02215, United States
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19
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He M, Xia J, Shehab M, Wang X. The development of precision medicine in clinical practice. Clin Transl Med 2015; 4:69. [PMID: 26302883 PMCID: PMC4547974 DOI: 10.1186/s40169-015-0069-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 12/04/2022] Open
Abstract
Precision medicine allows a dramatic expansion of biological data, while there is still an urgent need to understand and insight the exact meaning of those data to human health and disease. This has led to an increasing wealth of data unanalyzed. The concept of precision medicine is about the customization of healthcare, with decisions and practices tailored to an individual patient based on their intrinsic biology in addition to clinical “signs and symptoms”. Construction of a standardized model for the integration of data from various platforms is the central mission of the ‘New Disease Management Model’. The model is helpful for the development of new taxonomy of diseases and subtypes, to personalize therapy based on patient genetic profiles. A rapid progression of precision therapy has been made recently. Clinical trials have shown the therapeutic efficacy of discovered and developed therapeutic agents has improved. However, next-generation drugs would be designed for disease subtypes with more specificity, efficacy and lower toxicity.
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Affiliation(s)
- Mingyan He
- Zhongshan Hospital, Minhang Hospital, Zhongshan Hospital Biomedical Research Center, Fudan University Medical School, Fudan University Center for Clinical Bioinformatics, Shanghai Institute of Clinical Bioinformatics, Shanghai, China,
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20
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Mennel RG. Precision medicine: hype or hoax? Proc (Bayl Univ Med Cent) 2015; 28:397-400. [PMID: 26130901 PMCID: PMC4462234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Robert G Mennel
- Charles A. Sammons Cancer Center and Baylor University Medical Center at Dallas, Dallas, Texas
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21
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Francis G, Stein S. Circulating Cell-Free Tumour DNA in the Management of Cancer. Int J Mol Sci 2015; 16:14122-42. [PMID: 26101870 PMCID: PMC4490543 DOI: 10.3390/ijms160614122] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 04/23/2015] [Accepted: 05/26/2015] [Indexed: 12/22/2022] Open
Abstract
With the development of new sensitive molecular techniques, circulating cell-free tumour DNA containing mutations can be identified in the plasma of cancer patients. The applications of this technology may result in significant changes to the care and management of cancer patients. Whilst, currently, these "liquid biopsies" are used to supplement the histological diagnosis of cancer and metastatic disease, in the future these assays may replace the need for invasive procedures. Applications include the monitoring of tumour burden, the monitoring of minimal residual disease, monitoring of tumour heterogeneity, monitoring of molecular resistance and early diagnosis of tumours and metastatic disease.
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Affiliation(s)
- Glenn Francis
- Director Pathology, Genomics for Life, Herston 4006, Australia.
- School of Medicine, Griffith University, Gold Coast 4215, Australia.
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia 4067, Australia.
| | - Sandra Stein
- Laboratory Director, Genomics for Life, Herston 4006, Australia.
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22
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Joshi M, Rizvi SM, Belani CP. Afatinib for the treatment of metastatic non-small cell lung cancer. Cancer Manag Res 2015; 7:75-82. [PMID: 25733926 PMCID: PMC4340466 DOI: 10.2147/cmar.s51808] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Targeting the epidermal growth factor receptor (EGFR) in patients with non-small cell lung cancer (NSCLC) harboring sensitizing mutations in the tyrosine kinase (TKI) domain has led to a significant change in the management of this disease. The classic or sensitizing mutations are G719X mutation in exon 18, in-frame deletions or insertion of exon 19, L858R or L861Q mutation in exon 21. Approximately 90% of these mutations are exon 19 deletion or exon 21 L858R point mutation. Gefitinib and erlotinib are reversible first-generation inhibitors of mutant EGFR, and treatment with these agents in the first-line setting has demonstrated a progression-free survival of 9.5-13.7 months. However, the majority of these patients ultimately develop resistance to these drugs. Afatinib is an irreversible pan-ErbB inhibitor that was developed to circumvent the problem of resistance to first-generation TKIs. The LUX-Lung studies have evaluated the efficacy and toxicities of afatinib in treatment-naïve and refractory NSCLC patients. The promising results of some of these trials led to approval of afatinib by the US Food and Drug Administration for patients with advanced NSCLC and EGFR exon 19 deletions or exon 21 (L858R) substitution mutations. Afatinib causes toxicities similar to those of the first-generation EGFR TKIs, such as diarrhea, rash, acne, and stomatitis, and overall is well tolerated. This article focuses on the clinical studies of afatinib in patients with NSCLC.
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Affiliation(s)
- Monika Joshi
- Penn State Milton S Hershey Medical Center, Department of Medicine, Division of Hematology-Oncology, Hershey, PA, USA
| | - Syed M Rizvi
- Penn State Milton S Hershey Medical Center, Department of Medicine, Division of Hematology-Oncology, Hershey, PA, USA
| | - Chandra P Belani
- Penn State Milton S Hershey Medical Center, Department of Medicine, Division of Hematology-Oncology, Hershey, PA, USA
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23
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Hojjat-Farsangi M. Novel and emerging targeted-based cancer therapy agents and methods. Tumour Biol 2015; 36:543-56. [PMID: 25663495 DOI: 10.1007/s13277-015-3184-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/27/2015] [Indexed: 02/06/2023] Open
Abstract
After several decades of uncovering the cancer features and following the improvement of therapeutic agents, however cancer remains as one of the major reasons of mortality. Chemotherapy is one of the main treatment options and has significantly improved the overall survival of cancer patients, but chemotherapeutic agents are highly toxic for normal cells. Therefore, there is a great unmet medical need to develop new therapeutic principles and agents. Targeted-based cancer therapy (TBCT) agents and methods have revolutionized the cancer treatment efficacy. Monoclonal antibodies (mAbs) and small molecule inhibitors (SMIs) are among the most effective agents of TBCT. These drugs have improved the prognosis and survival of cancer patients; however, the therapeutic resistance has subdued the effects. Several mechanisms lead to drug resistance such as mutations in the drug targets, activation of compensatory pathways, and intrinsic or acquired resistance of cancer stem cells. Therefore, new modalities, improving current generation of inhibitors and mAbs, and optimizing the combinational therapy regimens are necessary to decrease the current obstacles in front of TBCT. Moreover, the success of new TBCT agents such as mAbs, SMIs, and immunomodulatory agents has sparked further therapeutic modalities with novel targets to inhibit. Due to the lack of cumulative information describing different agents and methods of TBCT, this review focuses on the most important agents and methods of TBCT that are currently under investigation.
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Affiliation(s)
- Mohammad Hojjat-Farsangi
- Department of Oncology-Pathology, Immune and Gene therapy Lab, Cancer Center Karolinska (CCK), Karolinska University Hospital Solna and Karolinska Institute, SE-171 76, Stockholm, Sweden,
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