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Han H, Zhang Y, Tang H, Zhou T, Khan A. A Review of the Use of Native and Engineered Probiotics for Colorectal Cancer Therapy. Int J Mol Sci 2024; 25:3896. [PMID: 38612706 PMCID: PMC11011422 DOI: 10.3390/ijms25073896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer (CRC) is a serious global health concern, and researchers have been investigating different strategies to prevent, treat, or support conventional therapies for CRC. This review article comprehensively covers CRC therapy involving wild-type bacteria, including probiotics and oncolytic bacteria as well as genetically modified bacteria. Given the close relationship between CRC and the gut microbiota, it is crucial to compile and present a comprehensive overview of bacterial therapies used in the context of colorectal cancer. It is evident that the use of native and engineered probiotics for colorectal cancer therapy necessitates research focused on enhancing the therapeutic properties of probiotic strains.. Genetically engineered probiotics might be designed to produce particular molecules or to target cancer cells more effectively and cure CRC patients.
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Affiliation(s)
- Huawen Han
- State Key Laboratory of Grassland Agro-Ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - Yifan Zhang
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Haibo Tang
- Ministry of Education Key Laboratory of Cell Activities and Stress Adaptations, School of Life Science, Lanzhou University, Lanzhou 730000, China; (H.T.); (T.Z.)
| | - Tuoyu Zhou
- Ministry of Education Key Laboratory of Cell Activities and Stress Adaptations, School of Life Science, Lanzhou University, Lanzhou 730000, China; (H.T.); (T.Z.)
| | - Aman Khan
- College of Life Sciences, Northeast Forestry University, Harbin 150040, China
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Kuboki Y, Fakih M, Strickler J, Yaeger R, Masuishi T, Kim EJ, Bestvina CM, Kopetz S, Falchook GS, Langer C, Krauss J, Puri S, Cardona P, Chan E, Varrieur T, Mukundan L, Anderson A, Tran Q, Hong DS. Sotorasib with panitumumab in chemotherapy-refractory KRAS G12C-mutated colorectal cancer: a phase 1b trial. Nat Med 2024; 30:265-270. [PMID: 38177853 PMCID: PMC11135132 DOI: 10.1038/s41591-023-02717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/14/2023] [Indexed: 01/06/2024]
Abstract
The current third-line (and beyond) treatment options for RAS-mutant metastatic colorectal cancer have yielded limited efficacy. At the time of study start, the combination of sotorasib, a KRAS (Kirsten rat sarcoma viral oncogene homolog)-G12C inhibitor, and panitumumab, an epidermal growth factor receptor (EGFR) inhibitor, was hypothesized to overcome treatment-induced resistance. This phase 1b substudy of the CodeBreaK 101 master protocol evaluated sotorasib plus panitumumab in patients with chemotherapy-refractory KRASG12C-mutated metastatic colorectal cancer. Here, we report the results in a dose-exploration cohort and a dose-expansion cohort. Patients received sotorasib (960 mg, once daily) plus panitumumab (6 mg kg-1, once every 2 weeks). The primary endpoints were safety and tolerability. Secondary endpoints included efficacy and pharmacokinetics. Exploratory biomarkers at baseline were assessed. Forty-eight patients (dose-exploration cohort, n = 8; dose-expansion cohort, n = 40) were treated. Treatment-related adverse events of any grade and grade ≥3 occurred in 45 (94%) and 13 (27%) patients, respectively. In the dose-expansion cohort, the confirmed objective response rate was 30.0% (95% confidence interval (CI) 16.6%, 46.5%). Median progression-free survival was 5.7 months (95% CI 4.2, 7.7 months). Median overall survival was 15.2 months (95% CI 12.5 months, not estimable). Prevalent genomic coalterations included APC (84%), TP53 (74%), SMAD4 (33%), PIK3CA (28%) and EGFR (26%). Sotorasib-panitumumab demonstrated acceptable safety with promising efficacy in chemotherapy-refractory KRASG12C-mutated metastatic colorectal cancer. ClinicalTrials.gov identifier: NCT04185883 .
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Affiliation(s)
| | - Marwan Fakih
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Rona Yaeger
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Edward J Kim
- UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | | | - Scott Kopetz
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Corey Langer
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sonam Puri
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | | | | | | | | | - Qui Tran
- Amgen Inc., Thousand Oaks, CA, USA
| | - David S Hong
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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3
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Fakih MG, Salvatore L, Esaki T, Modest DP, Lopez-Bravo DP, Taieb J, Karamouzis MV, Ruiz-Garcia E, Kim TW, Kuboki Y, Meriggi F, Cunningham D, Yeh KH, Chan E, Chao J, Saportas Y, Tran Q, Cremolini C, Pietrantonio F. Sotorasib plus Panitumumab in Refractory Colorectal Cancer with Mutated KRAS G12C. N Engl J Med 2023; 389:2125-2139. [PMID: 37870968 DOI: 10.1056/nejmoa2308795] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND KRAS G12C is a mutation that occurs in approximately 3 to 4% of patients with metastatic colorectal cancer. Monotherapy with KRAS G12C inhibitors has yielded only modest efficacy. Combining the KRAS G12C inhibitor sotorasib with panitumumab, an epidermal growth factor receptor (EGFR) inhibitor, may be an effective strategy. METHODS In this phase 3, multicenter, open-label, randomized trial, we assigned patients with chemorefractory metastatic colorectal cancer with mutated KRAS G12C who had not received previous treatment with a KRAS G12C inhibitor to receive sotorasib at a dose of 960 mg once daily plus panitumumab (53 patients), sotorasib at a dose of 240 mg once daily plus panitumumab (53 patients), or the investigator's choice of trifluridine-tipiracil or regorafenib (standard care; 54 patients). The primary end point was progression-free survival as assessed by blinded independent central review according to the Response Evaluation Criteria in Solid Tumors, version 1.1. Key secondary end points were overall survival and objective response. RESULTS After a median follow-up of 7.8 months (range, 0.1 to 13.9), the median progression-free survival was 5.6 months (95% confidence interval [CI], 4.2 to 6.3) and 3.9 months (95% CI, 3.7 to 5.8) in the 960-mg sotorasib-panitumumab and 240-mg sotorasib-panitumumab groups, respectively, as compared with 2.2 months (95% CI, 1.9 to 3.9) in the standard-care group. The hazard ratio for disease progression or death in the 960-mg sotorasib-panitumumab group as compared with the standard-care group was 0.49 (95% CI, 0.30 to 0.80; P = 0.006), and the hazard ratio in the 240-mg sotorasib-panitumumab group was 0.58 (95% CI, 0.36 to 0.93; P = 0.03). Overall survival data are maturing. The objective response was 26.4% (95% CI, 15.3 to 40.3), 5.7% (95% CI, 1.2 to 15.7), and 0% (95% CI, 0.0 to 6.6) in the 960-mg sotorasib-panitumumab, 240-mg sotorasib-panitumumab, and standard-care groups, respectively. Treatment-related adverse events of grade 3 or higher occurred in 35.8%, 30.2%, and 43.1% of patients, respectively. Skin-related toxic effects and hypomagnesemia were the most common adverse events observed with sotorasib-panitumumab. CONCLUSIONS In this phase 3 trial of a KRAS G12C inhibitor plus an EGFR inhibitor in patients with chemorefractory metastatic colorectal cancer, both doses of sotorasib in combination with panitumumab resulted in longer progression-free survival than standard treatment. Toxic effects were as expected for either agent alone and resulted in few discontinuations of treatment. (Funded by Amgen; CodeBreaK 300 ClinicalTrials.gov number, NCT05198934.).
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Affiliation(s)
- Marwan G Fakih
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Lisa Salvatore
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Taito Esaki
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Dominik P Modest
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - David P Lopez-Bravo
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Julien Taieb
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Michalis V Karamouzis
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Erika Ruiz-Garcia
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Tae-Won Kim
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Yasutoshi Kuboki
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Fausto Meriggi
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - David Cunningham
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Kun-Huei Yeh
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Emily Chan
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Joseph Chao
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Yaneth Saportas
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Qui Tran
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Chiara Cremolini
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
| | - Filippo Pietrantonio
- From Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte (M.G.F.), and Amgen, Thousand Oaks (E.C., J.C., Y.S., Q.T.) - both in California; Oncologia Medica, Università Cattolica del Sacro Cuore, and Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome (L.S.), the Oncology Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia (F.M.), the Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa (C.C.), and the Medical Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan (F.P.) - all in Italy; the Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka (T.E.), and the Experimental Therapeutics and GI Oncology Department, National Cancer Center Hospital East, Kashiwa (Y.K.) - both in Japan; the Medicine Department of Hematology, Oncology, and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin (D.P.M.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (D.P.L.-B.); Université Paris Cité, Site de Recherche Intégrée sur le Cancer, Cancer Research for Personalized Medicine Comprehensive Cancer Center, Department of Gastroenterology and Digestive Oncology, Hôpital Européen Georges-Pompidou, Paris (J.T.); the Department of Biological Chemistry, National and Kapodistrian University of Athens-School of Medicine, Athens (M.V.K.); Gastrointestinal Oncology Department and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City (E.R.-G.); the Oncology Department, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (T.W.K.); the Medicine Department, Royal Marsden Hospital, London (D.C.); and the Department of Oncology, National Taiwan University Hospital, and the Graduate Institute of Oncology, National Taiwan University College of Medicine - both in Taipei (K.H.Y.)
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4
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Leung BW, Fay CJ, Said JT, Sheets AR, Lian CG, Brown JR, Castillo JJ, Sarosiek S, Flynn C, LeBoeuf NR. Localized upper extremity edema secondary to Bruton's tyrosine kinase inhibition. Leuk Lymphoma 2023; 64:2047-2050. [PMID: 37671695 DOI: 10.1080/10428194.2023.2245091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/01/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Bonnie W Leung
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Christopher J Fay
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jordan T Said
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anthony R Sheets
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer R Brown
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | | | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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5
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Das S, Bhattacharya K, Blaker JJ, Singha NK, Mandal M. Beyond traditional therapy: Mucoadhesive polymers as a new frontier in oral cancer management. Biopolymers 2023; 114:e23556. [PMID: 37341448 DOI: 10.1002/bip.23556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
In recent times mucoadhesive drug delivery systems are gaining popularity in oral cancer. It is a malignancy with high global prevalence. Despite significant advances in cancer therapeutics, improving the prognosis of late-stage oral cancer remains challenging. Targeted therapy using mucoadhesive polymers can improve oral cancer patients' overall outcome by offering enhanced oral mucosa bioavailability, better drug distribution and tissue targeting, and minimizing systemic side effects. Mucoadhesive polymers can also be delivered via different formulations such as tablets, films, patches, gels, and nanoparticles. These polymers can deliver an array of medicines, making them an adaptable drug delivery approach. Drug delivery techniques based on these mucoadhesive polymers are gaining traction and have immense potential as a prospective treatment for late-stage oral cancer. This review examines leading research in mucoadhesive polymers and discusses their potential applications in treating oral cancer.
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Affiliation(s)
- Subhayan Das
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Koushik Bhattacharya
- Rubber Technology Centre, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Jonny J Blaker
- Bio-Active Materials Group, Department of Materials and Henry Royce Institute, The University of Manchester, Manchester, UK
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Nikhil K Singha
- Rubber Technology Centre, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Mahitosh Mandal
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
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6
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Tezcan S, Tanır Gİ, Yılmaz H, Memiş S, Yumuk PF, Apikoğlu Ş. Assessment of chemotherapy-related educational needs of colorectal cancer patients. J Oncol Pharm Pract 2023; 29:1387-1391. [PMID: 36000285 DOI: 10.1177/10781552221122782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Aim of our study was to evaluate cancer patients' knowledge about their chemotherapy regimens in order to assess educational needs of patients. METHODS Study was conducted on 58 colorectal carcinoma patients who were treated in an outpatient chemotherapy unit. These patients had received a 2-page information pamphlet about their chemotherapy treatments before the commencement of treatment. During the first interview with patients, pharmacist collected demographic data and evaluated patients' knowledge about their medications using a standardized questionnaire. FINDINGS Mean age of the patients was 59.6 ± 1.3 years; 65.5% were male. Majority (77.6%) of patients were graduates of primary school. Sixty-four percent of these had at least one comorbid disease. Median number of chemotherapy courses already received by patients was 4 (1-9). Fifty-nine percent reported that they did not receive any patient education and 43.1% reported that they did not receive any informative document. Twenty-nine percent of patients did not know what actions to take in case of nausea-vomiting; while 53.4% did not know how to react if their body temperature exceeded 38 °C and 25.9% had no idea about dietary necessities. About one-third of patients did not pay attention to oral care. CONCLUSION Our study showed that patients did not understand (or remember) the basic points about their chemotherapy sufficiently, but remembered the adverse effects they experienced occasionally. Pharmacists will have the chance to increase the level of knowledge of the patients receiving chemotherapy by providing patient education and follow-up.
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Affiliation(s)
- Songul Tezcan
- Marmara University Faculty of Pharmacy, Clinical Pharmacy Department, Istanbul, Turkey
| | - Gökçen İlke Tanır
- Marmara University Faculty of Pharmacy, Clinical Pharmacy Department, Istanbul, Turkey
| | - Hayriye Yılmaz
- Marmara University Faculty of Pharmacy, Clinical Pharmacy Department, Istanbul, Turkey
| | - Semra Memiş
- Marmara University Faculty of Pharmacy, Clinical Pharmacy Department, Istanbul, Turkey
| | | | - Şule Apikoğlu
- Marmara University Faculty of Pharmacy, Clinical Pharmacy Department, Istanbul, Turkey
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7
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Chang YT, Chen CC, Chang SC, Chang YY, Lin BW, Chen HH, Hsieh YY, Hsu HC, Hsieh MC, Kuan FC, Wu CC, Lu WC, Su YL, Liang YH, Chen JB, Huang SY, Huang CW, Wang JY. Efficacy and Safety of a Parenteral Nutrition Program for Patients with RAS Wild-Type Metastatic Colorectal Cancer Administered First-Line Cetuximab Plus Chemotherapy: A Propensity Score Matching Study. Nutrients 2023; 15:2971. [PMID: 37447297 DOI: 10.3390/nu15132971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Malnutrition is a common problem in patients with metastatic colorectal cancer (mCRC) receiving targeted therapy plus chemotherapy, resulting in severe toxicity and decreased survival rates. This retrospective study employing propensity score matching (PSM) examined the efficacy and safety of a supplemental home parenteral nutrition (HPN) program for patients with RAS wild-type mCRC receiving cetuximab plus chemotherapy. This retrospective nationwide registry study included data from 14 medical centers/hospitals across Taiwan, and the data period ranged from November 2016 to December 2020. Patients with RAS wild-type mCRC receiving cetuximab plus chemotherapy as their first-line therapy were included and divided into HPN and non-HPN program groups. HPN was initiated based on patient-specific factors, such as baseline nutritional status, treatment-related toxicities, and comorbidities. Clinical outcomes were evaluated using response to therapy, duration of response (DoR), progression-free survival (PFS), and overall survival (OS). This study recruited 758 patients, of whom 110 and 648 were included in the HPN and non-HPN program groups, respectively. After 1:3 PSM, the data of 109 and 327 patients from the HPN and non-HPN program groups were analyzed, respectively. The HPN program group had a higher metastasectomy rate (33.9% vs. 20.2%, p = 0.005), and longer duration of treatment and DoR than the non-HPN program group (13.6 vs. 10.3 and 13.6 vs. 9.9 months, p = 0.001 and < 0.001, respectively). The HPN program group tended to have a longer median PFS (18.2 vs. 13.9 months, p = 0.102). Moreover, we noted a significant improvement in the median OS in the same group (53.4 vs. 34.6 months, p = 0.002). Supplemental HPN programs may be recommended for select patients with mCRC receiving targeted therapy plus chemotherapy to improve oncological outcomes.
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Affiliation(s)
- Yu-Tang Chang
- Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chou-Chen Chen
- Department of Surgery, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Shih-Ching Chang
- Division of Colon and Rectal Surgery, Department of Surgery, Veterans General Hospital, Taipei 11217, Taiwan
| | - Yu-Yao Chang
- Department of Colorectal Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Bo-Wen Lin
- Department of Surgery, National Cheng Kung University Hospital, Tainan 70457, Taiwan
| | - Hong-Hwa Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
| | - Yao-Yu Hsieh
- Division of Hematology and Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Hung-Chih Hsu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Meng-Che Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung 84001, Taiwan
| | - Feng-Che Kuan
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Chih-Chien Wu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan
| | - Wei-Chen Lu
- Department of Oncology, National Taiwan University Hospital Yunlin Branch, Yunlin 64041, Taiwan
| | - Yu-Li Su
- Division of Hematology and Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung 33305, Taiwan
| | - Yi-Hsin Liang
- Department of Oncology, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Joe-Bin Chen
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Shuan-Yuan Huang
- Department of Colorectal Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Ching-Wen Huang
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Jaw-Yuan Wang
- Department of Surgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Pingtung Hospital, Ministry of Health and Welfare, Pingtung 90054, Taiwan
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8
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Manzi J, Hoff CO, Ferreira R, Pimentel A, Datta J, Livingstone AS, Vianna R, Abreu P. Targeted Therapies in Colorectal Cancer: Recent Advances in Biomarkers, Landmark Trials, and Future Perspectives. Cancers (Basel) 2023; 15:cancers15113023. [PMID: 37296986 DOI: 10.3390/cancers15113023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
In 2022, approximately 600,000 cancer deaths were expected; more than 50,000 of those deaths would be from colorectal cancer (CRC). The CRC mortality rate in the US has decreased in recent decades, with a 51% drop between 1976 and 2014. This drop is attributed, in part, to the tremendous therapeutic improvements, especially after the 2000s, in addition to increased social awareness regarding risk factors and diagnostic improvement. Five-fluorouracil, irinotecan, capecitabine, and later oxaliplatin were the mainstays of mCRC treatment from the 1960s to 2002. Since then, more than a dozen drugs have been approved for the disease, betting on a new chapter in medicine, precision oncology, which uses patient and tumor characteristics to guide the therapeutic choice. Thus, this review will summarize the current literature on targeted therapies, highlighting the molecular biomarkers involved and their pathways.
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Affiliation(s)
- Joao Manzi
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA
| | - Camilla O Hoff
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA
| | - Raphaella Ferreira
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA
| | - Agustin Pimentel
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA
| | - Jashodeep Datta
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA
| | - Rodrigo Vianna
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA
| | - Phillipe Abreu
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL 33136, USA
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9
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Sutton SR, Taniguchi AN, Nguyen SA, Albergotti WG, Kaczmar JM, Kejner AE, Newman JG. The Inconsistent Assessment of Quality of Life in Patients Treated for Head and Neck Cancer with Anti-EGFR Inhibitors: A Systematic Scoping Review. Cancers (Basel) 2023; 15:cancers15092475. [PMID: 37173942 PMCID: PMC10177329 DOI: 10.3390/cancers15092475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
In patients receiving treatment for head and neck cancer (HNC), there is a correlation between quality of life (QoL) scores and treatment outcomes. Higher QoL scores have been associated with improved survival. Despite this, the assessment of QoL in clinical trials varies considerably. Three databases (Scopus, PubMed, and Cinahl) were queried for articles published in English between 2006 and 2022. Two reviewers (SRS and ANT) performed study screening, data extraction, and risk of bias assessment. The authors identified 21 articles that met the inclusion criteria. A total of 5961 patients were evaluated. QoL was reported as average scores for specific variables across five different surveys in 12 included articles. Supplemental QoL data were available in 10 included studies. Critical appraisal of studies indicated a high risk of bias due to the inclusion of trials. There is no standard method for reporting QoL data in clinical trials for HNC patients undergoing treatment with anti-EGFR inhibitors. Future clinical trials should standardize their method for assessing and reporting quality-of-life data to increase patient-centered care and refine treatment choices to optimize survival.
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Affiliation(s)
- Sarah R Sutton
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
- School of Medicine, University of Nevada, Reno, NV 89557, USA
| | - April N Taniguchi
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - William G Albergotti
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - John M Kaczmar
- Division of Hematology and Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jason G Newman
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
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10
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Hettie KS, Chin FT. NIRDye 812: A molecular platform tailored for multimodal bioimaging applications of targeted fluorescence- and photoacoustic-guided surgery. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2023; 242:112683. [PMID: 36934549 DOI: 10.1016/j.jphotobiol.2023.112683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
The primary treatment for malignant tumors remains to be surgical removal of the diseased tissue. The presence or absence of residual diseased tissue at the tumor margin is the strongest predictor of postoperative prognosis and recurrence. Accordingly, reliance on the ability of surgeons to visually distinguish diseased tissue from healthy tissue unambiguously in real time is crucial. Near infrared-I (NIRI) fluorescence-emitting targeting biomolecular constructs such as anticancer antibody-fluorophore conjugates, namely cetuximab-IRDye® 800CW (CTB-IRDye® 800CW), are FDA-approved for clinical trial usage in the fluorescence-guided resection of diseased tissue due to affording improved direct visualization of tumor tissue when compared to the use of either the unaided eye under standard white light illumination (WLI) surgical techniques or non-targeting fluorophores. Unfortunately, though helpful, CTB-IRDye® 800CW affords limited (i) identification of diseased tissue and (ii) tumor margin delineation, because the immunoconjugate generates suboptimal tumor-to-background ratios (TBRs) as a result of its spectral/photophysical profiles poorly aligning with the fixed optical windows of pre-/clinical setups. As such, CTB-IRDye® 800CW is more prone to affording incomplete resection compared to if TBRs were higher due to otherwise. To aid in accurately identifying deep-seated diseased tissue, photoacoustic (PA) tomography has been implemented alongside CTB-IRDye® 800CW to achieve PA signals that could result in higher TBRs. However, in clinical trial practice, using IRDye® 800CW for PA imaging also yields subpar TBRs due to it affording low PA signals. To overcome such limitations, we developed NIRDye 812, a structurally-modified topological equivalent of IRDye® 800CW, to confer it the capability to yield both higher TBRs and superior PA signal than that of the equivalent CTB-conjugate and fluorophore IRDye® 800CW itself, respectively. To do so, we substituted the oxygen atom at its meso-position with a sulfur atom. CTB-NIRDye 812 demonstrated a red-shifted absorption wavelength at 796 nm and a peak NIR-I fluorescence emission wavelength at 820 nm, which better dovetails with the fixed windows of preinstalled fixed emission filters within commercial pre-/clinical NIR-I fluorescence imaging instruments. Overall, CTB-NIRDye 812 provided a ∼ 2-fold increase in TBRs compared to those of CTB-IRDye® 800CW in vivo. Also, NIRDye 812 displayed an ∼60% higher PA signal than that of IRDye® 800CW. Collectively, we achieved our goal of improving upon the spectral/photophysical and PA properties of IRDye® 800CW via introducing a subtle modification to its electronic core such that its CTB immunoconjugate could potentially allow for fast track or breakthrough designation by the FDA due to its near-identical structure displaying considerably improved efficacy.
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Affiliation(s)
- Kenneth S Hettie
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305, USA; Department of Otolaryngology - Head & Neck Surgery, Stanford University, Stanford, CA 94305, USA.
| | - Frederick T Chin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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11
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Bian Y, Wang Y, Chen X, Zhang Y, Xiong S, Su D. Image‐guided diagnosis and treatment of glioblastoma. VIEW 2023. [DOI: 10.1002/viw.20220069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yongning Bian
- Center of Excellence for Environmental Safety and Biological Effects Beijing Key Laboratory for Green Catalysis and Separation Department of Chemistry Beijing University of Technology Beijing P. R. China
| | - Yaling Wang
- Center of Excellence for Environmental Safety and Biological Effects Beijing Key Laboratory for Green Catalysis and Separation Department of Chemistry Beijing University of Technology Beijing P. R. China
| | - Xueqian Chen
- Center of Excellence for Environmental Safety and Biological Effects Beijing Key Laboratory for Green Catalysis and Separation Department of Chemistry Beijing University of Technology Beijing P. R. China
| | - Yong Zhang
- Center of Excellence for Environmental Safety and Biological Effects Beijing Key Laboratory for Green Catalysis and Separation Department of Chemistry Beijing University of Technology Beijing P. R. China
| | - Shaoqing Xiong
- Center of Excellence for Environmental Safety and Biological Effects Beijing Key Laboratory for Green Catalysis and Separation Department of Chemistry Beijing University of Technology Beijing P. R. China
| | - Dongdong Su
- Center of Excellence for Environmental Safety and Biological Effects Beijing Key Laboratory for Green Catalysis and Separation Department of Chemistry Beijing University of Technology Beijing P. R. China
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12
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Current Targeted Therapy for Metastatic Colorectal Cancer. Int J Mol Sci 2023; 24:ijms24021702. [PMID: 36675216 PMCID: PMC9864602 DOI: 10.3390/ijms24021702] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/07/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer deaths worldwide. Surgery or surgery plus radiotherapy and/or chemotherapy for patients with metastatic CRC (mCRC) were accepted as the main therapeutic strategies until the early 2000s, when targeted drugs, like cetuximab and bevacizumab, were developed. The use of targeted drugs in clinical practice has significantly increased patients' overall survival. To date, the emergence of several types of targeted drugs has opened new possibilities and revealed new prospects for mCRC treatment. Therapeutic strategies are continually being updated to select the most suitable targeted drugs based on the results of clinical trials that are currently underway. This review discusses the up-to date molecular evidence of targeted therapy for mCRC and summarizes the Food and Drug Administration-approved targeted drugs including the results of clinical trials. We also explain their mechanisms of action and how these affect the choice of a suitable targeted therapy.
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13
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Al-Hujaily EM, Al-Sowayan BS, Alyousef Z, Uddin S, Alammari F. Recruiting Immunity for the Fight against Colorectal Cancer: Current Status and Challenges. Int J Mol Sci 2022; 23:ijms232213696. [PMID: 36430176 PMCID: PMC9697544 DOI: 10.3390/ijms232213696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Cancer immunotherapies have changed the landscape of cancer management and improved the standard treatment protocols used in multiple tumors. This has led to significant improvements in progression-free survival and overall survival rates. In this review article, we provide an insight into the major immunotherapeutic methods that are currently under investigation for colorectal cancer (CRC) and their clinical implementations. We emphasize therapies that are based on monoclonal antibodies (mAbs) and adoptive cell therapy, their mechanisms of action, their advantages, and their potential in combination therapy. We also highlight the clinical trials that have demonstrated both the therapeutic efficacy and the toxicities associated with each method. In addition, we summarize emerging targets that are now being evaluated as potential interventions for CRC. Finally, we discuss current challenges and future direction for the cancer immunotherapy field.
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Affiliation(s)
- Ensaf M. Al-Hujaily
- Department of Blood and Cancer Research, King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Batla S. Al-Sowayan
- Department of Blood and Cancer Research, King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
| | - Zeyad Alyousef
- Department of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh 14611, Saudi Arabia
| | - Shahab Uddin
- Translational Research Institute and Dermatology Institute, Academic Health System, Hamad Medical Corporation, Doha 3050, Qatar
| | - Farah Alammari
- Department of Blood and Cancer Research, King Abdullah International Medical Research Center, Riyadh 11481, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- Correspondence:
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14
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Safety Assessment on Serious Adverse Events of Targeted Therapeutic Agents Prescribed for RAS Wild-Type Metastatic Colorectal Cancer: Systematic Review and Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159196. [PMID: 35954563 PMCID: PMC9368240 DOI: 10.3390/ijerph19159196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023]
Abstract
Despite substantially elevated risk of serious adverse events (SAEs) from targeted therapy in combination with chemotherapy, comprehensive pharmacovigilance research is limited. This study aims to systematically assess SAE risks of commonly prescribed targeted agents (bevacizumab, cetuximab, and panitumumab) in patients with rat sarcoma viral oncogene homolog (RAS) wild-type metastatic colon cancer. Keyword searches of Cochrane Library, Clinical Key and MEDLINE were conducted per PRISMA-NMA guidelines. Frequentist network meta-analysis was performed with eight randomized controlled trials to compare relative risk (RR) of 21 SAE profiles. The risks of hematological, gastrointestinal, neurological SAE were insignificant among targeted agents (p > 0.05). The risk of serious hypertension was substantially elevated in bevacizumab-based chemotherapy (p < 0.05), whereas panitumumab-based chemotherapy had markedly elevated risk of serious thromboembolism (RR 3.65; 95% CI 1.30−10.26). Although both cetuximab and panitumumab demonstrated increased risk of serious dermatological and renal toxicities, panitumumab-based chemotherapy has relatively higher risk of skin toxicity (RR 15.22; 95% CI 7.17−32.35), mucositis (RR 3.18; 95% CI 1.52−6.65), hypomagnesemia (RR 20.10; 95% CI 5.92−68.21), and dehydration (RR 2.81; 95% CI 1.03−7.67) than cetuximab-based chemotherapy. Thus, further studies on risk stratification and SAE management are warranted for safe administration of targeted agents.
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15
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Bhat AA, Nisar S, Singh M, Ashraf B, Masoodi T, Prasad CP, Sharma A, Maacha S, Karedath T, Hashem S, Yasin SB, Bagga P, Reddy R, Frennaux MP, Uddin S, Dhawan P, Haris M, Macha MA. Cytokine‐ and chemokine‐induced inflammatory colorectal tumor microenvironment: Emerging avenue for targeted therapy. Cancer Commun (Lond) 2022; 42:689-715. [PMID: 35791509 PMCID: PMC9395317 DOI: 10.1002/cac2.12295] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/28/2022] [Accepted: 04/24/2022] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer (CRC) is a predominant life‐threatening cancer, with liver and peritoneal metastases as the primary causes of death. Intestinal inflammation, a known CRC risk factor, nurtures a local inflammatory environment enriched with tumor cells, endothelial cells, immune cells, cancer‐associated fibroblasts, immunosuppressive cells, and secretory growth factors. The complex interactions of aberrantly expressed cytokines, chemokines, growth factors, and matrix‐remodeling enzymes promote CRC pathogenesis and evoke systemic responses that affect disease outcomes. Mounting evidence suggests that these cytokines and chemokines play a role in the progression of CRC through immunosuppression and modulation of the tumor microenvironment, which is partly achieved by the recruitment of immunosuppressive cells. These cells impart features such as cancer stem cell‐like properties, drug resistance, invasion, and formation of the premetastatic niche in distant organs, promoting metastasis and aggressive CRC growth. A deeper understanding of the cytokine‐ and chemokine‐mediated signaling networks that link tumor progression and metastasis will provide insights into the mechanistic details of disease aggressiveness and facilitate the development of novel therapeutics for CRC. Here, we summarized the current knowledge of cytokine‐ and chemokine‐mediated crosstalk in the inflammatory tumor microenvironment, which drives immunosuppression, resistance to therapeutics, and metastasis during CRC progression. We also outlined the potential of this crosstalk as a novel therapeutic target for CRC. The major cytokine/chemokine pathways involved in cancer immunotherapy are also discussed in this review.
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Affiliation(s)
- Ajaz A. Bhat
- Laboratory of Molecular and Metabolic Imaging Cancer Research Department Sidra Medicine Doha 26999 Qatar
| | - Sabah Nisar
- Laboratory of Molecular and Metabolic Imaging Cancer Research Department Sidra Medicine Doha 26999 Qatar
| | - Mayank Singh
- Department of Medical Oncology Dr. B. R. Ambedkar Institute Rotary Cancer Hospital All India Institute of Medical Sciences (AIIMS) New Delhi 110029 India
| | - Bazella Ashraf
- Department of Biotechnology School of Life Sciences Central University of Kashmir Ganderbal Jammu & Kashmir 191201 India
| | - Tariq Masoodi
- Laboratory of Molecular and Metabolic Imaging Cancer Research Department Sidra Medicine Doha 26999 Qatar
| | - Chandra P. Prasad
- Department of Medical Oncology Dr. B. R. Ambedkar Institute Rotary Cancer Hospital All India Institute of Medical Sciences (AIIMS) New Delhi 110029 India
| | - Atul Sharma
- Department of Medical Oncology Dr. B. R. Ambedkar Institute Rotary Cancer Hospital All India Institute of Medical Sciences (AIIMS) New Delhi 110029 India
| | - Selma Maacha
- Division of Translational Medicine Research Branch Sidra Medicine Doha 26999 Qatar
| | - Thasni Karedath
- Genomics Core Facility, QBRI Qatar Foundation Doha 34110 Qatar
| | - Sheema Hashem
- Laboratory of Molecular and Metabolic Imaging Cancer Research Department Sidra Medicine Doha 26999 Qatar
| | - Syed Besina Yasin
- Department of Pathology Sher‐I‐Kashmir Institute of Medical Sciences Srinagar Jammu & Kashmir 190011 India
| | - Puneet Bagga
- Department of Diagnostic Imaging St. Jude Children's Research Hospital Memphis TN 38105 USA
| | - Ravinder Reddy
- Center for Advanced Metabolic Imaging in Precision Medicine Department of Radiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA 19104 USA
| | | | - Shahab Uddin
- Translational Research Institute Hamad Medical Corporation Doha 3050 Qatar
| | - Punita Dhawan
- Department of Biochemistry and Molecular Biology University of Nebraska Medical Center Omaha NE 68198 USA
| | - Mohammad Haris
- Laboratory of Molecular and Metabolic Imaging Cancer Research Department Sidra Medicine Doha 26999 Qatar
- Laboratory Animal Research Center Qatar University Doha 2713 Qatar
| | - Muzafar A. Macha
- Watson‐Crick Centre for Molecular Medicine Islamic University of Science and Technology Awantipora Jammu & Kashmir 192122 India
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16
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Harwardt J, Bogen JP, Carrara SC, Ulitzka M, Grzeschik J, Hock B, Kolmar H. A Generic Strategy to Generate Bifunctional Two-in-One Antibodies by Chicken Immunization. Front Immunol 2022; 13:888838. [PMID: 35479092 PMCID: PMC9036444 DOI: 10.3389/fimmu.2022.888838] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 12/21/2022] Open
Abstract
Various formats of bispecific antibodies exist, among them Two-in-One antibodies in which each Fab arm can bind to two different antigens. Their IgG-like architecture accounts for low immunogenicity and also circumvents laborious engineering and purification steps to facilitate correct chain pairing. Here we report for the first time the identification of a Two‐in‐One antibody by yeast surface display (YSD) screening of chicken-derived immune libraries. The resulting antibody simultaneously targets the epidermal growth factor receptor (EGFR) and programmed death‐ligand 1 (PD-L1) at the same Fv fragment with two non-overlapping paratopes. The dual action Fab is capable of inhibiting EGFR signaling by binding to dimerization domain II as well as blocking the PD-1/PD-L1 interaction. Furthermore, the Two-in-One antibody demonstrates specific cellular binding properties on EGFR/PD-L1 double positive tumor cells. The presented strategy relies solely on screening of combinational immune-libraries and obviates the need for any additional CDR engineering as described in previous reports. Therefore, this study paves the way for further development of therapeutic antibodies derived from avian immunization with novel and tailor-made binding properties.
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Affiliation(s)
- Julia Harwardt
- Institute for Organic Chemistry and Biochemistry, Technical University of Darmstadt, Darmstadt, Germany
| | - Jan P. Bogen
- Institute for Organic Chemistry and Biochemistry, Technical University of Darmstadt, Darmstadt, Germany
- Ferring Darmstadt Laboratory, Biologics Technology and Development, Darmstadt, Germany
| | - Stefania C. Carrara
- Institute for Organic Chemistry and Biochemistry, Technical University of Darmstadt, Darmstadt, Germany
- Ferring Darmstadt Laboratory, Biologics Technology and Development, Darmstadt, Germany
| | - Michael Ulitzka
- Institute for Organic Chemistry and Biochemistry, Technical University of Darmstadt, Darmstadt, Germany
- Ferring Darmstadt Laboratory, Biologics Technology and Development, Darmstadt, Germany
| | - Julius Grzeschik
- Ferring Biologics Innovation Centre, Biologics Technology and Development, Epalinges, Switzerland
| | - Björn Hock
- Ferring Biologics Innovation Centre, Biologics Technology and Development, Epalinges, Switzerland
| | - Harald Kolmar
- Institute for Organic Chemistry and Biochemistry, Technical University of Darmstadt, Darmstadt, Germany
- Centre for Synthtic Biology, Technical University of Darmstadt, Darmstadt, Germany
- *Correspondence: Harald Kolmar,
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17
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Youssef ASED, Abdel-Fattah MA, Lotfy MM, Nassar A, Abouelhoda M, Touny AO, Hassan ZK, Mohey Eldin M, Bahnassy AA, Khaled H, Zekri ARN. Multigene Panel Sequencing Reveals Cancer-Specific and Common Somatic Mutations in Colorectal Cancer Patients: An Egyptian Experience. Curr Issues Mol Biol 2022; 44:1332-1352. [PMID: 35723313 PMCID: PMC8947625 DOI: 10.3390/cimb44030090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022] Open
Abstract
This study aims at identifying common pathogenic somatic mutations at different stages of colorectal carcinogenesis in Egyptian patients. Our cohort included colonoscopic biopsies collected from 120 patients: 20 biopsies from patients with inflammatory bowel disease, 38 from colonic polyp patients, and 62 from patients with colorectal cancer. On top of this, the cohort included 20 biopsies from patients with non-specific mild to moderated colitis. Targeted DNA sequencing using a customized gene panel of 96 colorectal related genes running on the Ion Torrent NGS technology was used to process the samples. Our results revealed that 69% of all cases harbored at least one somatic mutation. Fifty-seven genes were found to carry 232 somatic non-synonymous variants. The most frequently pathogenic somatic mutations were localized in TP53, APC, KRAS, and PIK3CA. In total, 16 somatic mutations were detected in the CRC group and in either the IBD or CP group. In addition, our data showed that 51% of total somatic variants were CRC-specific variants. The average number of CRC-specific variants per sample is 2.4. The top genes carrying CRC-specific mutations are APC, TP53, PIK3CA, FBXW7, ATM, and SMAD4. It seems obvious that TP53 and APC genes were the most affected genes with somatic mutations in all groups. Of interest, 85% and 28% of the APC and TP53 deleterious somatic mutations were located in Exon 14 and Exon 3, respectively. Besides, 37% and 28% of the total somatic mutations identified in APC and TP53 were CRC-specific variants, respectively. Moreover, we identified that, in 29 somatic mutations in 21 genes, their association with CRC patients was unprecedented. Ten detected variants were likely to be novel: six in PIK3CA and four variants in FBXW7. The detected P53, Wnt/βcatenin, Angiogenesis, EGFR, TGF-β and Interleukin signaling pathways were the most altered pathways in 22%, 16%, 12%, 10%, 9% and 9% of the CRC patients, respectively. These results would contribute to a better understanding of the colorectal cancer and in introducing personalized therapies for Egyptian CRC patients.
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Affiliation(s)
- Amira Salah El-Din Youssef
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt; (M.M.L.); (A.N.); (Z.K.H.)
| | | | - Mai M. Lotfy
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt; (M.M.L.); (A.N.); (Z.K.H.)
| | - Auhood Nassar
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt; (M.M.L.); (A.N.); (Z.K.H.)
| | | | - Ahmed O. Touny
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt;
| | - Zeinab K. Hassan
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt; (M.M.L.); (A.N.); (Z.K.H.)
| | - Mohammed Mohey Eldin
- Tropical Medicine Department, El Kasr Al-Aini, Cairo University, Cairo 11562, Egypt;
| | - Abeer A. Bahnassy
- Molecular Pathology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt;
| | - Hussein Khaled
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt;
| | - Abdel Rahman N. Zekri
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt; (M.M.L.); (A.N.); (Z.K.H.)
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18
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Immunotherapy for Colorectal Cancer: Mechanisms and Predictive Biomarkers. Cancers (Basel) 2022; 14:cancers14041028. [PMID: 35205776 PMCID: PMC8869923 DOI: 10.3390/cancers14041028] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Late-stage colorectal cancer treatment often involves chemotherapy and radiation that can cause dose-limiting toxicity, and therefore there is great interest in developing targeted therapies for this disease. Immunotherapy is a targeted therapy that uses peptides, cells, antibodies, viruses, or small molecules to engage or train the immune system to kill cancer. Here, we discuss the preclinical and clinical development of immunotherapy for treatment of colorectal cancer and provide an overview of predictive biomarkers for such treatments. We also consider open questions including optimal combination treatments and sensitization of colorectal cancer patients with proficient mismatch repair enzymes. Abstract Though early-stage colorectal cancer has a high 5 year survival rate of 65–92% depending on the specific stage, this probability drops to 13% after the cancer metastasizes. Frontline treatments for colorectal cancer such as chemotherapy and radiation often produce dose-limiting toxicities in patients and acquired resistance in cancer cells. Additional targeted treatments are needed to improve patient outcomes and quality of life. Immunotherapy involves treatment with peptides, cells, antibodies, viruses, or small molecules to engage or train the immune system to kill cancer cells. Preclinical and clinical investigations of immunotherapy for treatment of colorectal cancer including immune checkpoint blockade, adoptive cell therapy, monoclonal antibodies, oncolytic viruses, anti-cancer vaccines, and immune system modulators have been promising, but demonstrate limitations for patients with proficient mismatch repair enzymes. In this review, we discuss preclinical and clinical studies investigating immunotherapy for treatment of colorectal cancer and predictive biomarkers for response to these treatments. We also consider open questions including optimal combination treatments to maximize efficacy, minimize toxicity, and prevent acquired resistance and approaches to sensitize mismatch repair-proficient patients to immunotherapy.
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19
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Han YN, Choi YJ, Rhie SJ. Tolerability on Serious Adverse Events of First-Line Bevacizumab and Cetuximab for RAS Wild-Type Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10020217. [PMID: 35206832 PMCID: PMC8871808 DOI: 10.3390/healthcare10020217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/07/2023] Open
Abstract
Proper medication management is crucial in metastatic colorectal cancer because of its substantially low survival rate. There has been advancing evidence on the efficacy of the two most prescribed targeted agents (bevacizumab and cetuximab); however, comprehensive analyses on their safety are limited. This study aims to comprehensively assess the clinical safety of first-line bevacizumab and cetuximab-based chemotherapy in unresectable RAS wild-type metastatic colorectal cancer patients and to provide guidance on the selection of appropriate targeted therapeutic agents. Keyword searches of MEDLINE, Cochrane Library, and ClinicalKey were conducted per PRISMA guidelines. We performed pooled analysis on safety outcomes from six studies which administered FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) or FOLFIRI (5-fluorouracil, leucovorin, irinotecan) as backbone chemotherapy. Thirty different adverse events from six categories were compared. First-line bevacizumab-based chemotherapy substantially lowered the risks of adverse events related to the dermatological (RR 0.24, 95% CI: 0.11–0.53, p < 0.00001) and renal systems (RR 0.57, 95% CI: 0.37–0.86, p = 0.007), while significantly increasing the incidence of cardiovascular adverse events (RR 4.65, 95% CI: 1.83–11.78, p = 0.001). Thus, first-line cetuximab-based chemotherapy increases patient susceptibility to dermatological and renal adverse events, especially with rash and electrolyte disorders, whereas bevacizumab-based chemotherapy increases cardiovascular risks such as hypertension and arrhythmia.
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Affiliation(s)
- Yu Na Han
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul 03760, Korea;
| | - Yeo Jin Choi
- Graduate School of Clinical Pharmacy, CHA University, Seongnam 13488, Korea;
| | - Sandy Jeong Rhie
- Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul 03760, Korea;
- College of Pharmacy, Graduated School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Korea
- Correspondence: ; Tel.: +82-2-3277-3023
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20
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Pekar L, Klewinghaus D, Arras P, Carrara SC, Harwardt J, Krah S, Yanakieva D, Toleikis L, Smider VV, Kolmar H, Zielonka S. Milking the Cow: Cattle-Derived Chimeric Ultralong CDR-H3 Antibodies and Their Engineered CDR-H3-Only Knobbody Counterparts Targeting Epidermal Growth Factor Receptor Elicit Potent NK Cell-Mediated Cytotoxicity. Front Immunol 2021; 12:742418. [PMID: 34759924 PMCID: PMC8573386 DOI: 10.3389/fimmu.2021.742418] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/04/2021] [Indexed: 01/11/2023] Open
Abstract
In this work, we have generated epidermal growth factor receptor (EGFR)-specific cattle-derived ultralong CDR-H3 antibodies by combining cattle immunization with yeast surface display. After immunization, ultralong CDR-H3 regions were specifically amplified and grafted onto an IGHV1-7 scaffold by homologous recombination to facilitate Fab display. Antigen-specific clones were readily obtained by fluorescence-activated cell sorting (FACS) and reformatted as chimeric antibodies. Binning experiments revealed epitope targeting of domains I, II, and IV of EGFR with none of the generated binders competing with Cetuximab, Matuzumab, or EGF for binding to EGFR. Cattle-derived chimeric antibodies were potent in inducing antibody-dependent cell-mediated cytotoxicity (ADCC) against EGFR-overexpressing tumor cells with potencies (EC50 killing) in the picomolar range. Moreover, most of the antibodies were able to significantly inhibit EGFR-mediated downstream signaling. Furthermore, we demonstrate that a minor fraction of CDR-H3 knobs derived from generated antibodies was capable of independently functioning as a paratope facilitating EGFR binding when grafted onto the Fc part of human IgG1. Besides slightly to moderately diminished capacities, these engineered Knobbodies largely retained main properties of their parental antibodies such as cellular binding and triggering of ADCC. Hence, Knobbodies might emerge as promising tools for biotechnological applications upon further optimization.
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Affiliation(s)
- Lukas Pekar
- Protein Engineering and Antibody Technologies, Merck Healthcare KGaA, Darmstadt, Germany
| | - Daniel Klewinghaus
- Protein Engineering and Antibody Technologies, Merck Healthcare KGaA, Darmstadt, Germany
| | - Paul Arras
- Protein Engineering and Antibody Technologies, Merck Healthcare KGaA, Darmstadt, Germany
| | - Stefania C. Carrara
- Institute for Organic Chemistry and Biochemistry, Technische Universität Darmstadt, Darmstadt, Germany
| | - Julia Harwardt
- Institute for Organic Chemistry and Biochemistry, Technische Universität Darmstadt, Darmstadt, Germany
| | - Simon Krah
- Protein Engineering and Antibody Technologies, Merck Healthcare KGaA, Darmstadt, Germany
| | - Desislava Yanakieva
- Protein Engineering and Antibody Technologies, Merck Healthcare KGaA, Darmstadt, Germany
- Institute for Organic Chemistry and Biochemistry, Technische Universität Darmstadt, Darmstadt, Germany
| | - Lars Toleikis
- Protein Engineering and Antibody Technologies, Merck Healthcare KGaA, Darmstadt, Germany
| | - Vaughn V. Smider
- The Applied Biomedical Science Institute, San Diego, CA, United States
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, United States
| | - Harald Kolmar
- Institute for Organic Chemistry and Biochemistry, Technische Universität Darmstadt, Darmstadt, Germany
| | - Stefan Zielonka
- Protein Engineering and Antibody Technologies, Merck Healthcare KGaA, Darmstadt, Germany
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21
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Singh D, Dheer D, Samykutty A, Shankar R. Antibody drug conjugates in gastrointestinal cancer: From lab to clinical development. J Control Release 2021; 340:1-34. [PMID: 34673122 DOI: 10.1016/j.jconrel.2021.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/15/2022]
Abstract
The antibody-drug conjugates (ADCs) are one the fastest growing biotherapeutics in oncology and are still in their infancy in gastrointestinal (GI) cancer for clinical applications to improve patient survival. The ADC based approach is developed with tumor specific antigen, antibody carrying cytotoxic agents to precisely target and deliver chemotherapeutics at the tumor site. To date, 11 ADCs have been approved by US-FDA, and more than 80 are in the clinical development phase for different oncological indications. However, The ADCs based therapies in GI cancers are still far from having high-efficient clinical outcomes. The limited success of these ADCs and lessons learned from the past are now being used to develop a newer generation of ADC against GI cancers. In this review, we did a comprehensive assessment of the key components of ADCs, including tumor marker, antibody, cytotoxic payload, and linkage strategy, with a focus on technical improvement and some future trends in the pipeline for clinical translation. The various preclinical and clinical ADCs used in gastrointestinal malignancies, their target, composition and bioconjugation, along with preclinical and clinical outcomes, are discussed. The emphasis is also given to new generation ADCs employing novel mAb, payload, linker, and bioconjugation methods are also included.
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Affiliation(s)
- Davinder Singh
- Natural Products and Medicinal Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180001, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Divya Dheer
- Natural Products and Medicinal Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180001, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Abhilash Samykutty
- Stephenson Comprehensive Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA.
| | - Ravi Shankar
- Natural Products and Medicinal Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180001, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
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22
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Hameduh T, Mokry M, Miller AD, Adam V, Heger Z, Haddad Y. A rotamer relay information system in the epidermal growth factor receptor-drug complexes reveals clues to new paradigm in protein conformational change. Comput Struct Biotechnol J 2021; 19:5443-5454. [PMID: 34667537 PMCID: PMC8511715 DOI: 10.1016/j.csbj.2021.09.026] [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: 03/02/2021] [Revised: 09/13/2021] [Accepted: 09/24/2021] [Indexed: 11/04/2022] Open
Abstract
Cancer cells can escape the effects of chemotherapy through mutations and upregulation of a tyrosine kinase protein called the epidermal growth factor receptor (EGFR). In the past two decades, four generations of tyrosine kinase inhibitors targeting EGFR have been developed. Using comparative structure analysis of 116 EGFR-drug complex crystal structures, cluster analysis produces two clans of 73 and 43 structures, respectively. The first clan of 73 structures is larger and is comprised mostly of the C-helix-IN conformation while the second clan of 43 structures correlates with the C-helix-OUT conformation. A deep rotamer analysis identifies 43 residues (18%) of the total of 237 residues spanning the kinase structures under investigation with significant rotamer variations between the C-helix-IN and C-helix-OUT clans. The locations of these rotamer variations take on the appearance of side chain conformational relays extending out from points of EGFR mutation to different regions of the EGFR kinase. Accordingly, we propose that key EGFR mutations act singly or together to induce drug resistant conformational changes in EGFR that are communicated via these side chain conformational relays. Accordingly, these side chain conformational relays appear to play a significant role in the development of tumour resistance. This phenomenon also suggests a new paradigm in protein conformational change that is mediated by supportive relays of rotamers on the protein surface, rather than through conventional backbone movements.
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Affiliation(s)
- Tareq Hameduh
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00 Brno, Czech Republic
| | - Michal Mokry
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00 Brno, Czech Republic
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 612 00 Brno, Czech Republic
| | - Andrew D. Miller
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00 Brno, Czech Republic
- Veterinary Research Institute, Hudcova 70, CZ-62100 Brno, Czech Republic
- KP Therapeutics (Europe) s.r.o., Purkyňova 649/127, Brno CZ-61200, Czech Republic
| | - Vojtech Adam
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00 Brno, Czech Republic
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 612 00 Brno, Czech Republic
| | - Zbynek Heger
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00 Brno, Czech Republic
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 612 00 Brno, Czech Republic
| | - Yazan Haddad
- Department of Chemistry and Biochemistry, Mendel University in Brno, Zemedelska 1, CZ-613 00 Brno, Czech Republic
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 612 00 Brno, Czech Republic
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23
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Secombe KR, Van Sebille YZA, Mayo BJ, Coller JK, Gibson RJ, Bowen JM. Diarrhea Induced by Small Molecule Tyrosine Kinase Inhibitors Compared With Chemotherapy: Potential Role of the Microbiome. Integr Cancer Ther 2021; 19:1534735420928493. [PMID: 32493068 PMCID: PMC7273583 DOI: 10.1177/1534735420928493] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Small molecule receptor tyrosine kinase inhibitors (SM-TKIs) are among a group of
targeted cancer therapies, intended to be more specific to cancer cells compared
with treatments, such as chemotherapy, hence reducing adverse events.
Unfortunately, many patients report high levels of diarrhea, the pathogenesis of
which remains under investigation. In this article, we compare the current state
of knowledge of the pathogenesis of chemotherapy-induced diarrhea (CID) in
comparison to SM-TKI–induced diarrhea, and investigate how a similar research
approach in both areas may be beneficial. To this end, we review evidence that
both treatment modalities may interact with the gut microbiome, and as such the
microbiome should be investigated for its ability to reduce the risk of
diarrhea.
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Affiliation(s)
- Kate R Secombe
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Ysabella Z A Van Sebille
- UniSA Online, Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Bronwen J Mayo
- Division of Health Sciences, University of South Australia, South Australia, Australia
| | - Janet K Coller
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel J Gibson
- School of Allied Health Science and Practice, University of Adelaide, South Australia, Australia
| | - Joanne M Bowen
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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24
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Mihai MM, Ion A, Giurcăneanu C, Nițipir C, Popa AM, Chifiriuc MC, Popa MI, Říčař J, Popa LG, Sârbu I, Lazăr V. The Impact of Long-Term Antibiotic Therapy of Cutaneous Adverse Reactions to EGFR Inhibitors in Colorectal Cancer Patients. J Clin Med 2021; 10:jcm10153219. [PMID: 34362003 PMCID: PMC8347035 DOI: 10.3390/jcm10153219] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is an important public health issue, in terms of incidence and mortality, with approximately 1.8 million new cases reported worldwide in 2018. Advancements in understanding pathophysiological key steps in CRC tumorigenesis have led to the development of new targeted therapies such as those based on epidermal growth factor receptor inhibitors (EGFR inhibitors). The cutaneous adverse reactions induced by EGFR inhibitors, particularly papulopustular rash, often require long-term antibiotic treatment with tetracycline agents (mostly minocycline and doxycycline). However, this raises several issues of concern: possible occurrence of gut dysbiosis in already vulnerable CRC patients, selection of highly antibiotic resistant and/or virulent clones, development of adverse reactions related to tetracyclines, interference of antibiotics with the response to oncologic therapy, with a negative impact on disease prognosis etc. In the context of scarce information regarding these issues and controversial opinions regarding the role of tetracyclines in patients under EGFR inhibitors, our aim was to perform a thorough literature review and discuss the main challenges raised by long-term use of tetracyclines in advanced CRC patients receiving this targeted therapy.
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Affiliation(s)
- Mara Mădălina Mihai
- Department of Oncologic Dermatology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.G.); (L.G.P.)
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
- Department of Microbiology, Faculty of Biology, ICUB—Research Institute of the University of Bucharest, 050657 Bucharest, Romania; (M.-C.C.); (V.L.)
- Correspondence: (M.M.M.); (A.I.); Tel.: +40-74-336-4164 (M.M.M.)
| | - Ana Ion
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
- Correspondence: (M.M.M.); (A.I.); Tel.: +40-74-336-4164 (M.M.M.)
| | - Călin Giurcăneanu
- Department of Oncologic Dermatology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.G.); (L.G.P.)
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
| | - Cornelia Nițipir
- Department of Oncology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (A.-M.P.)
| | - Ana-Maria Popa
- Department of Oncology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.N.); (A.-M.P.)
| | - Mariana-Carmen Chifiriuc
- Department of Microbiology, Faculty of Biology, ICUB—Research Institute of the University of Bucharest, 050657 Bucharest, Romania; (M.-C.C.); (V.L.)
| | - Mircea Ioan Popa
- Department of Microbiology, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Jan Říčař
- Department of Dermatology and Venereology, Charles University, Medical School and Teaching Hospital Pilsen, 30599 Pilsen, Czech Republic;
| | - Liliana Gabriela Popa
- Department of Oncologic Dermatology, ‘Elias’ Emergency University Hospital, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.G.); (L.G.P.)
- Department of Dermatology, ‘Elias’ Emergency University Hospital, 011461 Bucharest, Romania
| | - Ionela Sârbu
- Department of Genetics, Faculty of Biology, ICUB—Research Institute of the University of Bucharest, 050657 Bucharest, Romania;
| | - Veronica Lazăr
- Department of Microbiology, Faculty of Biology, ICUB—Research Institute of the University of Bucharest, 050657 Bucharest, Romania; (M.-C.C.); (V.L.)
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25
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Huang BC, Lu YC, Liao JM, Liu HJ, Hong ST, Hsieh YC, Chuang CH, Chen HJ, Liao TY, Ho KW, Wang YT, Cheng TL. Development of a structure-based computational simulation to optimize the blocking efficacy of pro-antibodies. Chem Sci 2021; 12:9759-9769. [PMID: 34349949 PMCID: PMC8293997 DOI: 10.1039/d1sc01748a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/20/2021] [Accepted: 06/13/2021] [Indexed: 11/21/2022] Open
Abstract
The on-target toxicity of monoclonal antibodies (Abs) is mainly due to the fact that Abs cannot distinguish target antigens (Ags) expressed in disease regions from those in normal tissues during systemic administration. In order to overcome this issue, we “copied” an autologous Ab hinge as an “Ab lock” and “pasted” it on the binding site of the Ab by connecting a protease substrate and linker in between to generate a pro-Ab, which can be specifically activated in the disease region to enhance Ab selectivity and reduce side effects. Previously, we reported that 70% of pro-Abs can achieve more than 100-fold blocking ability compared to the parental Abs. However, 30% of pro-Abs do not have such efficient blocking ability. This is because the same Ab lock linker cannot be applied to every Ab due to the differences in the complementarity-determining region (CDR) loops. Here we designed a method which uses structure-based computational simulation (MSCS) to optimize the blocking ability of the Ab lock for all Ab drugs. MSCS can precisely adjust the amino acid composition of the linker between the Ab lock and Ab drug with the assistance of molecular simulation. We selected αPD-1, αIL-1β, αCTLA-4 and αTNFα Ab as models and attached the Ab lock with various linkers (L1 to L7) to form pro-Abs by MSCS, respectively. The resulting cover rates of the Ab lock with various linkers compared to the Ab drug were in the range 28.33–42.33%. The recombinant pro-Abs were generated by MSCS prediction in order to verify the application of molecular simulation for pro-Ab development. The binding kinetics effective concentrations (EC-50) for αPD-1 (200-250-fold), αIL-1β (152-186-fold), αCTLA-4 (68-150-fold) and αTNFα Ab (20-123-fold) were presented as the blocking ability of pro-Ab compared to the Ab drug. Further, there was a positive correlation between cover rate and blocking ability of all pro-Ab candidates. The results suggested that MSCS was able to predict the Ab lock linker most suitable for application to αPD-1, αIL-1β, αCTLA-4 and αTNFα Ab to form pro-Abs efficiently. The success of MSCS in optimizing the pro-Ab can aid the development of next-generation pro-Ab drugs to significantly improve Ab-based therapies and thus patients' quality of life. The pro-Ab blocks the Ag binding site using an Ab lock. We designed a method which uses structure-based computational simulation (MSCS) to predict the cover rate of Ab locks with various linkers and select the suitable linker for each Ab.![]()
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Affiliation(s)
- Bo-Cheng Huang
- Institute of Biomedical Sciences, National Sun Yat-Sen University Kaohsiung Taiwan
| | - Yun-Chi Lu
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University Kaohsiung Taiwan.,Drug Development and Value Creation Research Center, Kaohsiung Medical University Kaohsiung Taiwan
| | - Jun-Min Liao
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University Kaohsiung Taiwan.,Drug Development and Value Creation Research Center, Kaohsiung Medical University Kaohsiung Taiwan
| | - Hui-Ju Liu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung Taiwan
| | - Shih-Ting Hong
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung Taiwan
| | - Yuan-Chin Hsieh
- School of Medicine for International Students, I-Shou University Kaohsiung Taiwan
| | - Chih-Hung Chuang
- Drug Development and Value Creation Research Center, Kaohsiung Medical University Kaohsiung Taiwan.,Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University Kaohsiung Taiwan
| | - Huei-Jen Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung Taiwan
| | - Tzu-Yi Liao
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung Taiwan
| | - Kai-Wen Ho
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung Taiwan
| | - Yeng-Tseng Wang
- Department of Biochemistry, Kaohsiung Medical University Kaohsiung Taiwan
| | - Tian-Lu Cheng
- Institute of Biomedical Sciences, National Sun Yat-Sen University Kaohsiung Taiwan .,Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University Kaohsiung Taiwan.,Drug Development and Value Creation Research Center, Kaohsiung Medical University Kaohsiung Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital Kaohsiung Taiwan
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26
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Yokoyama D, Mukai M, Uda S, Kishima K, Koike T, Hasegawa S, Izumi H, Yamamoto S, Tajima T, Nomura E, Makuuchi H. Efficacy of modified bevacizumab-XELOX therapy in Japanese patients with stage IV recurrent or non-resectable colorectal cancer. J Gastrointest Oncol 2021; 12:527-534. [PMID: 34012646 DOI: 10.21037/jgo-20-350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) has been conducted for patients with non-resectable colorectal cancer; however, few reports of a systematic approach to NAC exist. At our hospital, bevacizumab with capecitabine and oxaliplatin (B-mab XELOX) has been used as chemotherapy for Stage IV colorectal cancer since 2014. We aimed to evaluate the efficacy and safety of NAC with a molecular-targeting agent for Stage IV colorectal cancer. Methods A retrospective, single-institute analysis was performed including 27 patients with advanced recurrent cancer following primary tumor resection and 43 patients with non-resectable tumors and remote metastasis. At the time of resection, 17 were receiving chemotherapy. All 70 patients received at least 3 cycles of B-mab XELOX (total: 920 cycles). We determined the 1-year progression-free survival (1Y-PFS), 1-year overall survival (1Y-OS), 3Y-PFS, 3Y-OS, and number of treatment cycles. The objective response rate, clinical benefit rate, and adverse events were assessed. The number of chemotherapy cycles, survival time, and R0 surgery rate were determined for patients who underwent RO conversion surgery. Results The 1Y-PFS was 28.5% [median survival time (MST): 7.4 months], 1Y-OS was 76.6% (MST not reached), 3Y-PFS was 5.5% (MST: 7.4 months), and 3Y-OS was 26.4% (MST: 25.2 months). The mean and median number of cycles of B-mab XELOX was 13.1 and 10.5, respectively. The objective response rate was 28.6%, and the clinical benefit rate was 58.6%. Grade 1 or Grade 2 adverse events occurred in 60 patients (85.7%); however, they all resolved without intervention. A single Grade 4 event (perforation of the primary tumor) occurred in 1 patient (1.4%). RO conversion surgery was performed in 7 patients (10.0%; primary + liver in 2 patients, primary + lung in 1 patient, liver in 3 patients, and primary in 1 patient). These patients received 3 to 10 cycles preoperatively (mean: 7.3; median: 6.5). R0 surgery was achieved in 5 of the 7 patients (71.4%). Postoperative survival ranged from 1 to 26 months (MST: 8 months). Conclusions This modified regimen was safe and effective in Japanese patients, and a high quality of life/quality-adjusted life-year was achieved. To further evaluate PFS and OS, more patients are being investigated.
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Affiliation(s)
- Daiki Yokoyama
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Masaya Mukai
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Shuji Uda
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Kyouko Kishima
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Takuya Koike
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Sayuri Hasegawa
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Hideki Izumi
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Souichirou Yamamoto
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Takayuki Tajima
- Department of Surgery, Tokai University Tokyo Hospital, Shibuya, Tokyo, Japan
| | - Eiji Nomura
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Hiroyasu Makuuchi
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
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Jones GD, Caso R, Tan KS, Mastrogiacomo B, Sanchez-Vega F, Liu Y, Connolly JG, Murciano-Goroff YR, Bott MJ, Adusumilli PS, Molena D, Rocco G, Rusch VW, Sihag S, Misale S, Yaeger R, Drilon A, Arbour KC, Riely GJ, Rosen N, Lito P, Zhang H, Lyden DC, Rudin CM, Jones DR, Li BT, Isbell JM. KRAS G12C Mutation Is Associated with Increased Risk of Recurrence in Surgically Resected Lung Adenocarcinoma. Clin Cancer Res 2021; 27:2604-2612. [PMID: 33593884 DOI: 10.1158/1078-0432.ccr-20-4772] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE KRAS G12C is the most common KRAS mutation in primary lung adenocarcinoma. Phase I clinical trials have demonstrated encouraging clinical activity of KRAS G12C inhibitors in the metastatic setting. We investigated disease-free survival (DFS) and tumor genomic features in patients with surgically resected KRAS G12C-mutant lung adenocarcinoma. EXPERIMENTAL DESIGN Patients who underwent resection of stage I-III lung adenocarcinoma and next-generation sequencing (NGS) were evaluated. Exclusion criteria were receipt of induction therapy, incomplete resection, and low-quality NGS. Mutations were classified as KRAS wild-type (KRAS wt), G12C (KRAS G12C), or non-G12C (KRAS other). DFS was compared between groups using the log-rank test; factors associated with DFS were assessed using Cox regression. Mutual exclusivity and cooccurrence, tumor clonality, and mutational signatures were assessed. RESULTS In total, 604 patients were included: 374 KRAS wt (62%), 95 KRAS G12C (16%), and 135 KRAS other (22%). Three-year DFS was not different between KRAS-mutant and KRAS wt tumors. However, 3-year DFS was worse in patients with KRAS G12C than KRAS other tumors (log-rank P = 0.029). KRAS G12C tumors had more lymphovascular invasion (51% vs. 37%; P = 0.032) and higher tumor mutation burden [median (interquartile range), 7.0 (5.3-10.8) vs. 6.1 (3.5-9.7); P = 0.021], compared with KRAS other tumors. KRAS G12C mutation was independently associated with worse DFS on multivariable analysis. Our DFS findings were externally validated in an independent The Cancer Genome Atlas cohort. CONCLUSIONS KRAS G12C mutations are associated with worse DFS after complete resection of stage I-III lung adenocarcinoma. These tumors harbor more aggressive clinicopathologic and genomic features than other KRAS-mutant tumors. We identified a high-risk group for whom KRAS G12C inhibitors may be investigated to improve survival.
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Affiliation(s)
- Gregory D Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raul Caso
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brooke Mastrogiacomo
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Francisco Sanchez-Vega
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuan Liu
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James G Connolly
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Matthew J Bott
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gaetano Rocco
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sandra Misale
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alexander Drilon
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn C Arbour
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory J Riely
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medicine, New York, New York
| | - Neal Rosen
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York.,Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Piro Lito
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Haiying Zhang
- Department of Pediatrics, Weill Cornell School of Medicine, New York, New York
| | - David C Lyden
- Department of Pediatrics, Weill Cornell School of Medicine, New York, New York
| | - Charles M Rudin
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bob T Li
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medicine, New York, New York
| | - James M Isbell
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York
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28
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Hettie KS, Teraphongphom NT, Ertsey RD, Rosenthal EL, Chin FT. Targeting intracranial patient-derived glioblastoma (GBM) with a NIR-I fluorescent immunoconjugate for facilitating its image-guided resection. RSC Adv 2020; 10:42413-42422. [PMID: 33391732 PMCID: PMC7747479 DOI: 10.1039/d0ra07245a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most aggressive form of primary brain tumor type and is associated with a high mortality rate borne out of such affording a survival rate of only 15 months. GBM aggressiveness is associated with the overexpression of epidermal growth factor receptor (EGFR) and its mutants. Targeting GBM with therapeutics is challenging because the blood-brain barrier (BBB) permits primarily select small-molecule entities across its semipermeable blockade. However, recent preclinical data suggest that large biomolecules, such as the anti-EGFR antibody therapeutic, cetuximab, could be capable of bypassing the BBB despite the relative enormity of its size. As such, we set forth to establish the feasibility of utilizing an EGFR-targeting near-infrared-I (NIR-I) fluorescent construct in the form of an immunoconjugate (cetuxmimab-IRDye800) to achieve visual differentiation between diseased brain tissue arising from a low-passage patient-derived GBM cell line (GBM39) and healthy brain tissue via utilizing orthotopic intracranial murine GBM39 tumor models for in vivo and ex vivo evaluation such that by doing so would establish proof of concept for ultimately facilitating its in vivo fluorescence-guided resection and ex vivo surgical back-table pathological confirmation in the clinic. As anticipated, we were not capable of distinguishing between malignant tumor tissue and healthy tissue in resected intact and slices of whole brain ex vivo under white-light illumination (WLI) due to both the diseased tissue and healthy tissue appearing virtually identical to the unaided eye. However, we readily observed over an average 6-fold enhancement in the fluorescence emission in the resected intact whole brain ex vivo when performing NIR-I fluorescence imaging (FLI) on the cohort of GBM39 tumor models that were administered the immunoconjugate compared to controls. In all, we laid the initial groundwork for establishing that NIR-I fluorescent immunoconjugates (theranostics) such as cetuximab–IRDye800 can bypass the BBB to visually afford GBM39 tumor tissue differentiation for its image-guided surgical removal. Fluorescent immunoconjugate cetuximab-IRDye800 bypasses the blood-brain-barrier to afford visualization of patient-derived GBM39 brain tumor tissue for facilitating its fluorescence-guided resection.![]()
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Affiliation(s)
- Kenneth S Hettie
- Department of Radiology, Stanford University School of Medicine, 1201 Welch Rd, Stanford, CA 94305, USA. ; Tel: +1-650-725-8172.,Department of Otolaryngology - Head & Neck Surgery, Stanford University, 1201 Welch Rd, Stanford, CA 94305, USA
| | - Nutte Tarn Teraphongphom
- Department of Otolaryngology - Head & Neck Surgery, Stanford University, 1201 Welch Rd, Stanford, CA 94305, USA
| | - Robert D Ertsey
- Department of Otolaryngology - Head & Neck Surgery, Stanford University, 1201 Welch Rd, Stanford, CA 94305, USA
| | - Eben L Rosenthal
- Department of Otolaryngology - Head & Neck Surgery, Stanford University, 1201 Welch Rd, Stanford, CA 94305, USA
| | - Frederick T Chin
- Department of Radiology, Stanford University School of Medicine, 1201 Welch Rd, Stanford, CA 94305, USA. ; Tel: +1-650-725-8172
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CH7233163 Overcomes Osimertinib-Resistant EGFR-Del19/T790M/C797S Mutation. Mol Cancer Ther 2020; 19:2288-2297. [DOI: 10.1158/1535-7163.mct-20-0229] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/17/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022]
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30
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Chuang SC, Huang CW, Chen YT, Ma CJ, Tsai HL, Chang TK, Su WC, Hsu WH, Kuo CH, Wang JY. Effect of KRAS and NRAS mutations on the prognosis of patients with synchronous metastatic colorectal cancer presenting with liver-only and lung-only metastases. Oncol Lett 2020; 20:2119-2130. [PMID: 32782529 PMCID: PMC7400335 DOI: 10.3892/ol.2020.11795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
It has been reported that 20–25% of patients with colorectal cancer (CRC) have metastases at the time of diagnosis. Liver and lung are the most common metastatic sites. The aim of the present study was to investigate the association of KRAS and NRAS mutations with clinicopathological features and prognosis of patients with initial liver-metastasis only (LiM-only) or lung-metastasis only (LuM-only) metastatic CRC (mCRC). Overall, 166 patients with CRC with initial LiM-only (n=124) and LuM-only (n=42) were retrospectively analyzed from January 2014 to December 2017. The median follow-up time was 19.2 months (1.0–57.1 months). Patient characteristics at diagnosis were collected. Genomic DNA was isolated from frozen primary CRC tissues for targeting KRAS and NRAS. Patients with LuM-only were significantly older compared with those with LiM-only (65.5 vs. 61.5 years; P=0.05). There was no significant differences between the LiM-only and LuM-only groups in terms of sex, location of the primary tumor, serum carcinoembryonic antigen level, histological grade and RAS mutation status. KRAS mutations were detected in 43 (41.0%) patients with LiM-only and 13 (35.1%) patients with LuM-only. The overall survival time (OS) of LuM-only was more favorable compared with that of patients with LiM-only (44.5 vs. 24.7 months); however, there was no significant difference (P=0.095). The progression-free survival (PFS) and OS in the RAS wild-type group were significantly improved compared with the RAS mutant cohorts (P=0.004 and P=0.031, respectively) in the LiM-only group. In patients with stage IV CRC, those with synchronous LiM-only mCRC had a higher incidence of metastasis but a less favorable PFS and OS compared with patients with LuM-only. RAS mutation status exhibited a significant association with the survival outcome in patients with LiM-only mCRC.
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Affiliation(s)
- Shih-Chang Chuang
- Division of General and Digestive Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C.,Department of Surgery, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Ching-Wen Huang
- Department of Surgery, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Yi-Ting Chen
- Department of Pathology; Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C.,Department of Pathology, Faculty of Medicine, College of Medicine, Kaohsiung 807, Taiwan, R.O.C.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Cheng-Jen Ma
- Division of General and Digestive Surgery, Department of Surgery; Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan, R.O.C
| | - Hsiang-Lin Tsai
- Department of Surgery, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
| | - Jaw-Yuan Wang
- Department of Surgery, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.,Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung 807, Taiwan, R.O.C.,Cohort Research Center, College of Medicine, Kaohsiung 807, Taiwan, R.O.C.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan, R.O.C
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31
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Targeting strategies for superparamagnetic iron oxide nanoparticles in cancer therapy. Acta Biomater 2020; 102:13-34. [PMID: 31759124 DOI: 10.1016/j.actbio.2019.11.027] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/01/2019] [Accepted: 11/12/2019] [Indexed: 12/12/2022]
Abstract
Among various nanoparticles, superparamagnetic iron oxide nanoparticles (SPIONs) have been increasingly studied for their excellent superparamagnetism, magnetic heating properties, and enhanced magnetic resonance imaging (MRI). The conjugation of SPIONs with drugs to obtain delivery nanosystems has several advantages including magnetic targeted functionalization, in vivo imaging, magnetic thermotherapy, and combined delivery of anticancer agents. To further increase the targeting efficiency of drugs through a delivery nanosystem based on SPIONs, additional targeting moieties including transferrin, antibodies, aptamers, hyaluronic acid, folate, and targeting peptides are coated onto the surface of SPIONs. Therefore, this review summarizes the latest progresses in the conjugation of targeting molecules and drug delivery nanosystems based on SPIONs, especially focusing on their performances to develop efficient targeted drug delivery systems for tumor therapy. STATEMENT OF SIGNIFICANCE: Some magnetic nanoparticle-based nanocarriers loaded with drugs were evaluated in patients and did not produce convincing results, leading to termination of clinical development in phase II/III. An alternative strategy for drug delivery systems based on SPIONs is the conjugation of these systems with targeting segments such as transferrin, antibodies, aptamers, hyaluronic acid, folate, and targeting peptides. These targeting moieties can be recognized by specific integrin/receptors that are overexpressed specifically on the tumor cell surface, resulting in minimizing dosage and reducing off-target effects. This review focuses on magnetic nanoparticle-based nonviral drug delivery systems with targeting moieties to deliver anticancer drugs, with an aim to provide suggestions on the development of SPIONs through discussion.
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32
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Overcoming Intrinsic and Acquired Cetuximab Resistance in RAS Wild-Type Colorectal Cancer: An In Vitro Study on the Expression of HER Receptors and the Potential of Afatinib. Cancers (Basel) 2019; 11:cancers11010098. [PMID: 30650638 PMCID: PMC6357064 DOI: 10.3390/cancers11010098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 12/16/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) is an important therapeutic target in colorectal cancer (CRC). After the initial promising results of EGFR-targeted therapies such as cetuximab, therapeutic resistance poses a challenging problem and limits the success of effective anti-EGFR cancer therapies in the clinic. In order to overcome resistance to these EGFR-targeted therapies, new treatment options are necessary. The objective of this study was to investigate the expression of human epidermal growth factor (HER) receptors and the efficacy of afatinib, a second-generation irreversible EGFR-tyrosine kinase inhibitor, in RAS wild-type CRC cell lines with different cetuximab sensitivities. CRC cell lines with different sensitivities to cetuximab showed rather low EGFR expression but high HER2 and HER3 expression. These results were in line with the The Cancer Genome Atlas (TCGA) data from CRC patients, where higher mRNA levels of HER2 and HER3 were also detected compared to EGFR. Therefore, the targets of afatinib were indeed expressed on the CRC cell lines used in this study and in CRC patients. Furthermore, cetuximab resistance had no significant influence on the expression levels of HER receptors in CRC cell lines (p ≥ 0.652). This study also demonstrated that afatinib was able to induce a concentration-dependent cytotoxic effect in RAS wild-type CRC cell lines with different cetuximab sensitivities. Neither cetuximab resistance (p = 0.233) nor hypoxia (p = 0.157) significantly influenced afatinib’s cytotoxic effect. In conclusion, our preclinical data support the hypothesis that treatment with afatinib might be a promising novel therapeutic strategy for CRC patients experiencing intrinsic and acquired cetuximab resistance.
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33
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Shin W, Lee SK, Hwang JH, Park JC, Cho YH, Ro EJ, Song Y, Seo HR, Choi KY. Identification of Ras-degrading small molecules that inhibit the transformation of colorectal cancer cells independent of β-catenin signaling. Exp Mol Med 2018; 50:1-10. [PMID: 29884842 PMCID: PMC5994827 DOI: 10.1038/s12276-018-0102-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/06/2018] [Indexed: 12/17/2022] Open
Abstract
Although the development of drugs that control Ras is an emerging topic in cancer therapy, no clinically applicable drug is currently available. We have previously utilized knowledge of the Wnt/β-catenin signaling-dependent mechanism of Ras protein stability regulation to identify small molecules that inhibit the proliferation and transformation of various colorectal cancer (CRC) cells via degradation of both β-catenin and Ras. Due to the absence of Ras degradation in cells expressing a nondegradable mutant form of β-catenin and the need to determine an alternative mechanism of Ras degradation, we designed a cell-based system to screen compounds that degrade Ras independent of the Wnt/β-catenin signaling pathway. A cell-based high-content screening (HCS) system that monitors the levels of EGFP-K-RasG12V was established using HCT-116 cells harboring a nondegradable mutant CTNNB1 (ΔS45). Through HCS of a chemical library composed of 10,000 compounds and subsequent characterization of hits, we identified several compounds that degrade Ras without affecting the β-catenin levels. KY7749, one of the most effective compounds, inhibited the proliferation and transformation of CRC cells, especially KRAS-mutant cells that are resistant to the EGFR monoclonal antibody cetuximab. Small molecules that degrade Ras independent of β-catenin may able to be used in treatments for cancers caused by aberrant EGFR and Ras. Mutations in KRAS, a gene regulating cell proliferation, occur in 40–50% of colorectal cancer (CRC) patients. These cancers are usually insensitive to antibody drugs targeting the epidermal growth factor receptor (EGFR) on cancer cells. Kang-Yell Choi at Yonsei University, Seoul, South Korea and co-workers had previously identified small molecules that inhibited CRC by degrading the signaling proteins β-catenin and Ras. However, CRC cells with β-catenin mutations are resistant to Ras-degrading compounds. In this study, they screened 10,000 small molecules that could degrade Ras in CRC cells expressing nondegradable mutant β-catenin. They identified small molecules that inhibited growth of CRC cells resistant to EGFR-mediated antibody therapy. Further investigation of these molecules may help develop new drugs for treating CRC.
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Affiliation(s)
- Wookjin Shin
- Translational Research Center for Protein Function Control, Yonsei University, Seoul, Republic of Korea.,Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Sang-Kyu Lee
- Translational Research Center for Protein Function Control, Yonsei University, Seoul, Republic of Korea.,Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Jeong-Ha Hwang
- Translational Research Center for Protein Function Control, Yonsei University, Seoul, Republic of Korea.,Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Jong-Chan Park
- Translational Research Center for Protein Function Control, Yonsei University, Seoul, Republic of Korea.,Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Yong-Hee Cho
- Translational Research Center for Protein Function Control, Yonsei University, Seoul, Republic of Korea.,Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Eun Ji Ro
- Translational Research Center for Protein Function Control, Yonsei University, Seoul, Republic of Korea.,Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea
| | - Yeonhwa Song
- Cancer Biology Research Laboratory, Institut Pasteur Korea, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Haeng Ran Seo
- Cancer Biology Research Laboratory, Institut Pasteur Korea, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kang-Yell Choi
- Translational Research Center for Protein Function Control, Yonsei University, Seoul, Republic of Korea. .,Department of Biotechnology, College of Life Science and Biotechnology, Yonsei University, Seoul, Republic of Korea.
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A phase II trial of 1st-line modified-FOLFOXIRI plus bevacizumab treatment for metastatic colorectal cancer harboring RAS mutation: JACCRO CC-11. Oncotarget 2018; 9:18811-18820. [PMID: 29721163 PMCID: PMC5922357 DOI: 10.18632/oncotarget.24702] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/06/2018] [Indexed: 12/22/2022] Open
Abstract
FOLFOXIRI plus bevacizumab is considered a standard initial therapy for metastatic colorectal cancer (mCRC). However, few prospective trials have evaluated triplet therapy plus bevacizumab in patients with RAS mutant mCRC. Patients with an age of 20 to 75 years, and unresectable, measurable tumors harboring RAS mutation were given first-line treatment with bevacizumab (5 mg/kg on day 1) plus modified-FOLFOXIRI (irinotecan 150 mg/m2, oxaliplatin 85 mg/m2, levofolinate 200 mg/m2, and fluorouracil 2400 mg/m2 as a 46-h continuous infusion on day 1, repeated every 2 weeks). The primary endpoint was the objective response rate (ORR) as evaluated by an external review board. Progression-free survival (PFS), overall survival, early tumor shrinkage (ETS), depth of response (DpR), and safety were secondary endpoints. Among 64 patients who were enrolled between October 2014 and August 2016, 62 were evaluable for efficacy (right-sided tumors in 27%). ORR and disease control rate were 75.8% (95% confidence interval [CI] 65.1-86.5) and 96.8%, respectively. ETS was 73.8%, and median DpR was 49.2%. Median PFS was 11.5 (95% CI 9.5-14.0) months as of the cut-off date of September 2017. Adverse events of grade 3 or 4 were neutropenia (54%), hypertension (32%), diarrhea (13%), anorexia (11%), peripheral neuropathy (2%), and febrile neutropenia (5%). In conclusion, this prospective trial demonstrated for the first time that FOLFOXIRI plus bevacizumab is an active first-line treatment for patients with RAS mutant mCRC. Modified-FOLFOXIRI plus bevacizumab might become an alternative regimen of triplet chemotherapy for mCRC in Japan.
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35
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Nittoli T, Kelly MP, Delfino F, Rudge J, Kunz A, Markotan T, Spink J, Chen Z, Shan J, Navarro E, Tait M, Provoncha K, Giurleo J, Zhao F, Jiang X, Hylton D, Makonnen S, Hickey C, Kirshner JR, Thurston G, Papadopoulos N. Antibody drug conjugates of cleavable amino-alkyl and aryl maytansinoids. Bioorg Med Chem 2018; 26:2271-2279. [PMID: 29605304 DOI: 10.1016/j.bmc.2018.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/09/2018] [Accepted: 02/15/2018] [Indexed: 10/18/2022]
Abstract
Natural products have been used for many medicinal purposes for centuries. Antibody drug conjugates (ADCs) have utilized this rich source of small molecule therapeutics to produce several clinically useful treatments. ADCs based on the natural product maytansine have been successful clinically. The authors further the utility of the anti-cancer natural product maytansine by developing efficacious payloads and linker-payloads for conjugating to antibodies. The success of our approach was realized in the EGFRvIII targeting ADC EGFRvIII-16. The ADC was able to regress tumors in 2 tumor models (U251/EGFRvIII and MMT/EGFRvIII). When compared to a positive control ADC, the efficacy observed was similar or improved while the isotype control ADCs had no effect.
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Affiliation(s)
- Thomas Nittoli
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States.
| | - Marcus P Kelly
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Frank Delfino
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - John Rudge
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Arthur Kunz
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Thomas Markotan
- Abzena, 360 George Patterson Blvd, Bristol, PA 19007, United States
| | - Jan Spink
- Abzena, 360 George Patterson Blvd, Bristol, PA 19007, United States
| | - Zhaoyuan Chen
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Jing Shan
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Elizabeth Navarro
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Michele Tait
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Kathleen Provoncha
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Jason Giurleo
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Feng Zhao
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Xiaobo Jiang
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Donna Hylton
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Sosina Makonnen
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Carlos Hickey
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Jessica R Kirshner
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Gavin Thurston
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
| | - Nicholas Papadopoulos
- Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY 10591, United States
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Bhullar KS, Lagarón NO, McGowan EM, Parmar I, Jha A, Hubbard BP, Rupasinghe HPV. Kinase-targeted cancer therapies: progress, challenges and future directions. Mol Cancer 2018; 17:48. [PMID: 29455673 PMCID: PMC5817855 DOI: 10.1186/s12943-018-0804-2] [Citation(s) in RCA: 705] [Impact Index Per Article: 117.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/01/2018] [Indexed: 02/06/2023] Open
Abstract
The human genome encodes 538 protein kinases that transfer a γ-phosphate group from ATP to serine, threonine, or tyrosine residues. Many of these kinases are associated with human cancer initiation and progression. The recent development of small-molecule kinase inhibitors for the treatment of diverse types of cancer has proven successful in clinical therapy. Significantly, protein kinases are the second most targeted group of drug targets, after the G-protein-coupled receptors. Since the development of the first protein kinase inhibitor, in the early 1980s, 37 kinase inhibitors have received FDA approval for treatment of malignancies such as breast and lung cancer. Furthermore, about 150 kinase-targeted drugs are in clinical phase trials, and many kinase-specific inhibitors are in the preclinical stage of drug development. Nevertheless, many factors confound the clinical efficacy of these molecules. Specific tumor genetics, tumor microenvironment, drug resistance, and pharmacogenomics determine how useful a compound will be in the treatment of a given cancer. This review provides an overview of kinase-targeted drug discovery and development in relation to oncology and highlights the challenges and future potential for kinase-targeted cancer therapies.
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Affiliation(s)
- Khushwant S Bhullar
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Naiara Orrego Lagarón
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Eileen M McGowan
- Chronic Disease Solutions Team, School of Life Science, University of Technology, New South Wales, Australia
| | - Indu Parmar
- Division of Product Development, Radient Technologies, Edmonton, AB, Canada
| | - Amitabh Jha
- Department of Chemistry, Acadia University, Wolfville, NS, Canada
| | - Basil P Hubbard
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - H P Vasantha Rupasinghe
- Department of Plant, Food, and Environmental Sciences, Faculty of Agriculture, Dalhousie University, Truro, NS, Canada.
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
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Aguilar-Company J, Fernández-Ruiz M, García-Campelo R, Garrido-Castro AC, Ruiz-Camps I. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Cell surface receptors and associated signaling pathways). Clin Microbiol Infect 2018; 24 Suppl 2:S41-S52. [PMID: 29426804 DOI: 10.1016/j.cmi.2017.12.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/18/2017] [Accepted: 12/30/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The present review is part of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Compromised Hosts (ESGICH) consensus document on the safety of targeted and biologic therapies. AIMS To review, from an infectious diseases perspective, the safety profile of therapies targeting cell surface receptors and associated signaling pathways among cancer patients and to suggest preventive recommendations. SOURCES Computer-based Medline searches with MeSH terms pertaining to each agent or therapeutic family. CONTENT Vascular endothelial growth factor (VEGF)-targeted agents (bevacizumab and aflibercept) are associated with a meaningful increase in the risk of infection, likely due to drug-induced neutropaenia, although no clear benefit is expected from the universal use of anti-infective prophylaxis. VEGF tyrosine kinase inhibitors (i.e. sorafenib or sunitinib) do not seem to significantly affect host's susceptibility to infection, and universal anti-infective prophylaxis is not recommended either. Anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (cetuximab or panitumumab) induce neutropaenia and secondary skin and soft tissue infection in cases of severe papulopustular rash. Systemic antibiotics (doxycycline or minocycline) should be administered to prevent the latter complication, whereas no recommendation can be established on the benefit from antiviral, antifungal or anti-Pneumocystis prophylaxis. A lower risk of infection is reported for anti-ErbB2/HER2 monoclonal antibodies (trastuzumab and pertuzumab) and ErbB receptor tyrosine kinase inhibitors (including dual-EGFR/ErbB2 inhibitors such as lapatinib or neratinib) compared to conventional chemotherapy, presumably as a result of the decreased occurrence of drug-induced neutropaenia. IMPLICATIONS With the exception of VEGF-targeted agents, the overall risk of infection associated with the reviewed therapies seems to be low.
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Affiliation(s)
- J Aguilar-Company
- Departments of Infectious Diseases and Oncology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Hospital '12 de Octubre' (i + 12), School of Medicine, Universidad Complutense, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - R García-Campelo
- Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - A C Garrido-Castro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - I Ruiz-Camps
- Department of Infectious Diseases, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
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Tsuji A, Sunakawa Y, Ichikawa W, Nakamura M, Kochi M, Denda T, Yamaguchi T, Shimada K, Takagane A, Tani S, Kotaka M, Kuramochi H, Furushima K, Koike J, Yonemura Y, Takeuchi M, Fujii M, Nakajima T. Early Tumor Shrinkage and Depth of Response as Predictors of Favorable Treatment Outcomes in Patients with Metastatic Colorectal Cancer Treated with FOLFOX Plus Cetuximab (JACCRO CC-05). Target Oncol 2017; 11:799-806. [PMID: 27306648 DOI: 10.1007/s11523-016-0445-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Retrospective studies have found that early tumor shrinkage (ETS) and depth of response (DpR) are associated with favorable outcomes in patients with metastatic colorectal cancer (mCRC); however, few prospective studies have evaluated ETS and DpR. PATIENTS AND METHODS We performed a phase II study of FOLFOX plus cetuximab as first-line treatment in Japanese patients with KRAS wild-type mCRC. The primary endpoint was response rate (RR), and secondary endpoints included progression-free survival (PFS), overall survival (OS), chronological tumor shrinkage (evaluated every 8 weeks), and safety. The association of ETS and DpR with survival time was analyzed using Spearman's rank correlation coefficient. RESULTS In 54 participants, the RR, median PFS, and OS were 66.7 % (95 % CI, 53.4-77.8 %), 11.1 months, and 33.9 months, respectively. There was no unexpected toxicity. Forty (80 %) of 50 assessable patients had ETS, which was associated with prolonged PFS and OS (11.3 vs. 3.7 months, HR 0.26, p = 0.0003; 42.8 vs. 9.0 months, HR 0.40, p = 0.0279, respectively). Median DpR was 56.3 %. The DpR correlated with OS (r s = 0.314, p = 0.027) as well as post-progression survival (PPS) (r s = 0.366, p = 0.017). Interestingly, DpR was moderately associated with OS and PPS (r s = 0.587, r s = 0.570, respectively) in patients harboring tumors with larger target lesions, but was not associated with OS or PPS in patients with smaller target lesions. FOLFOX plus cetuximab was active as a first-line treatment for Japanese mCRC patients, with no unexpected toxicities. CONCLUSIONS Our prospective evaluation of chronological tumor shrinkage showed that ETS and DpR correlate with outcomes in patients with KRAS wild-type mCRC who receive cetuximab-based chemotherapy (UMIN000004197).
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Affiliation(s)
- Akihito Tsuji
- Department of Clinical Oncology, Kagawa University Faculty of Medicine Cancer Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yu Sunakawa
- Division of Medical Oncology, Department of Internal Medicine, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa, 224-8503, Japan
| | - Wataru Ichikawa
- Division of Medical Oncology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
| | - Masato Nakamura
- Aizawa Comprehensive Cancer Center, Aizawa Hospital, 2-5-1, Honjyo, Matsumoto, Nagano, 390-8510, Japan
| | - Mitsugu Kochi
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Tadamichi Denda
- Division of Gastroenterology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Tatsuro Yamaguchi
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Ken Shimada
- Division of Medical Oncology, Department of Internal Medicine, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Koto-ku, Tokyo, 135-8577, Japan
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryokaku-machi, Hakodate, Hokkaido, 040-8611, Japan
| | - Satoshi Tani
- Department of Internal Medicine, Konan Hospital, 1-5-16, Kamokogahara, Higashinada-ku, Kobe, Hyogo, 658-0064, Japan
| | - Masahito Kotaka
- Gastrointestinal Cancer Center, Sano Hospital, 2-5-1, Shimizugaoka, Tarumi-ku, Kobe, Hyogo, 655-0031, Japan
| | - Hidekazu Kuramochi
- Department of gastroenterological Surgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96, Owadashinden, Yachiyo, Chiba, 276-8524, Japan
| | - Kaoru Furushima
- Department of Surgery, NTT Medical Center, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Junichi Koike
- Department of Digestive Surgery, Toho University School of Medicine, 6-11-1, Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Yutaka Yonemura
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamoricho, Kishiwada, Osaka, 596-0042, Japan
| | - Masahiro Takeuchi
- Department of Clinical Medicine (Biostatistics), Kitasato University School of Pharmacy, 5-9-1, Shirokane, Minato-ku, Tokyo, 108-8641, Japan
| | - Masashi Fujii
- Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Toshifusa Nakajima
- Japan Clinical Cancer Research Organization, 7F Ginza Wing Bldg. 1-14-5, Ginza, Chuo-ku, Tokyo, 104-0061, Japan
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Abstract
Epidermal growth factor receptor (EGFR) is overexpressed in many malignancies, including colorectal cancer (CRC), making EGFR an attractive treatment option. Panitumumab and cetuximab, monoclonal antibodies (mAbs) directed at EGFR, are both currently utilized in the management of metastatic CRC (mCRC). Through the development of these agents in mCRC, key issues surrounding each mAbs use have been revealed. These key issues include negative patient outcome avoidance when determining use, the economic burden with high-cost medication, predictive biomarkers, tumor location, patient geographic location, patient quality of life, and the prevention of debilitating adverse effects. CRC remains a common malignancy, with many of these patients expected to receive targeted therapy, including EGFR mAb therapy. Oncologists must recognize these EGFR mAb factors in order to improve outcomes. This review aims to provide a chronological timeline on the development of panitumumab, clinical pearls, and guidance on the current use of panitumumab in mCRC.
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Affiliation(s)
- Jane E Rogers
- Pharmacy Clinical Programs, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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40
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Enhanced tumor-targeting selectivity by modulating bispecific antibody binding affinity and format valence. Sci Rep 2017; 7:40098. [PMID: 28067257 PMCID: PMC5220356 DOI: 10.1038/srep40098] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/30/2016] [Indexed: 01/07/2023] Open
Abstract
Bispecific antibodies are considered attractive bio-therapeutic agents owing to their ability to target two distinct disease mediators. Cross-arm avidity targeting of antigen double-positive cancer cells over single-positive normal tissue is believed to enhance the therapeutic efficacy, restrict major escape mechanisms and increase tumor-targeting selectivity, leading to reduced systemic toxicity and improved therapeutic index. However, the interplay of factors regulating target selectivity is not well understood and often overlooked when developing clinically relevant bispecific therapeutics. We show in vivo that dual targeting alone is not sufficient to endow selective tumor-targeting, and report the pivotal roles played by the affinity of the individual arms, overall avidity and format valence. Specifically, a series of monovalent and bivalent bispecific IgGs composed of the anti-HER2 trastuzumab moiety paired with affinity-modulated VH and VL regions of the anti-EGFR GA201 mAb were tested for selective targeting and eradication of double-positive human NCI-H358 non-small cell lung cancer target tumors over single-positive, non-target NCI-H358-HER2 CRISPR knock out tumors in nude mice bearing dual-flank tumor xenografts. Affinity-reduced monovalent bispecific variants, but not their bivalent bispecific counterparts, mediated a greater degree of tumor targeting selectivity, while the overall efficacy against the targeted tumor was not substantially affected.
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Abramson VG, Supko JG, Ballinger T, Cleary JM, Hilton JF, Tolaney SM, Chau NG, Cho DC, Pearlberg J, Lager J, Shapiro GI, Arteaga CL. Phase Ib Study of Safety and Pharmacokinetics of the PI3K Inhibitor SAR245408 with the HER3-Neutralizing Human Antibody SAR256212 in Patients with Solid Tumors. Clin Cancer Res 2016; 23:3520-3528. [PMID: 28031425 DOI: 10.1158/1078-0432.ccr-16-1764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/05/2016] [Accepted: 12/14/2016] [Indexed: 11/16/2022]
Abstract
Purpose: This phase Ib study was designed to determine the MTD, safety, preliminary efficacy, and pharmacokinetics of the HER3 (ErbB3) mAb SAR256212 in combination with the oral PI3K inhibitor SAR245408 for patients with metastatic or locally advanced solid tumors.Experimental Design: Patients received the combination of intravenous SAR256212 and oral SAR245408 in a 3 + 3 dose-escalation design until occurrence of disease progression or dose-limiting toxicity. Objective response rate, pharmacokinetics, pharmacodynamics, and PIK3CA mutational status were also evaluated.Results: Twenty-seven patients were enrolled. Thirteen of 20 patients tested (65%) had a hotspot-activating mutation in PIK3CA in their tumor. The MTD was determined to be SAR256212 at 40 mg/kg loading dose followed by 20 mg/kg weekly, plus SAR245408 200 mg daily. Dose-limiting toxicities included rash and hypotension; the most frequent treatment-related side effect was diarrhea (66.7%). Twenty-three patients were evaluable for efficacy, of which 12 patients (52.2%) had stable disease and 11 patients (47.8%) had progression of disease as best response. In this study with a limited sample size, there was no difference in best response between patients with PI3KCA-mutant versus PIK3CA wild-type tumors (P = 0.07). The concurrent administration of SAR245408 and SAR256212 did not appear to have an effect on the pharmacokinetics of either drug.Conclusions: The combination of SAR256212 and SAR245408 resulted in stable disease as the best response. Side effects seen in combination were similar to the profiles of each individual drug. Patient outcome was the same regardless of tumor PI3KCA mutation status. Clin Cancer Res; 23(14); 3520-8. ©2016 AACR.
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Affiliation(s)
- Vandana G Abramson
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey G Supko
- Clinical Pharmacology Laboratory, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Tarah Ballinger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James M Cleary
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John F Hilton
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sara M Tolaney
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Breast Oncology Program, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicole G Chau
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel C Cho
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | | | | - Geoffrey I Shapiro
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. .,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carlos L Arteaga
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee. .,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Prognostic and Predictive Value of RAS Gene Mutations in Colorectal Cancer: Moving Beyond KRAS Exon 2. Drugs 2016; 75:1739-56. [PMID: 26347132 DOI: 10.1007/s40265-015-0459-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The advent of anti-EGFR (epidermal growth factor receptor) therapy resulted in significant progress in the treatment of metastatic colorectal cancer patients. However, many patients do not respond to this therapy or develop acquired resistance within a few months after the start of treatment. Since 2008, anti-EGFR therapy is restricted to KRAS wild-type patients as it has been shown that KRAS exon 2-mutated patients do not respond to this therapy. Still, up to 60 % of KRAS exon 2 wild-type patients show primary resistance to this treatment. Recently, several studies investigating the predictive and prognostic role of RAS mutations other than in KRAS exon 2 demonstrated that patients with these mutations are not responding to therapy. However, the role of these mutations has long been questioned as The National Comprehensive Cancer Network Guidelines in Oncology and the European Medicines Agency indications had already been changed in order to restrict anti-EGFR therapy to all RAS wild-type colorectal cancer patients, while the Food and Drug Administration guidelines remained unchanged. Recently, the Food and Drug Administration guidelines have also been changed, which implies the importance of RAS mutations beyond KRAS exon 2 in colorectal cancer. In this review, we discuss the most important studies regarding the predictive and prognostic role of RAS mutations other than in KRAS exon 2 in order to demonstrate the importance of these RAS mutations in patients with metastatic colorectal cancer treated with anti-EGFR therapy.
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43
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De Pauw I, Wouters A, Van den Bossche J, Peeters M, Pauwels P, Deschoolmeester V, Vermorken JB, Lardon F. Preclinical and clinical studies on afatinib in monotherapy and in combination regimens: Potential impact in colorectal cancer. Pharmacol Ther 2016; 166:71-83. [PMID: 27373506 DOI: 10.1016/j.pharmthera.2016.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 12/15/2022]
Abstract
Targeting the epidermal growth factor receptor (EGFR) with monoclonal antibodies (mAbs) or tyrosine kinase inhibitors (TKI) has been an interesting therapeutic strategy because aberrant activation of this receptor plays an important role in the tumorgenesis of many cancer types, including colorectal cancer (CRC). After the initial promising results of EGFR-targeted therapies, therapeutic resistance is a major clinical problem. In order to overcome resistance to these EGFR-targeted therapies, new treatment options are necessary. In contrast to first generation EGFR inhibitors, afatinib (BIBW2992) is a second-generation irreversible ErbB family blocker that inhibits EGFR as well as HER2 and HER4. Consequently, treatment with afatinib may result in a distinct and more pronounced therapeutic benefit. Preclinical studies have reported promising results for afatinib in monotherapy as well as in combination with other drugs in CRC model systems. Furthermore, clinical studies examining afatinib as single agent and in combination therapy demonstrated manageable safety profile. Nevertheless, only limited antitumor activity has been observed in CRC patients. Although several combination treatments with afatinib have already been investigated, no optimal combination has been identified for CRC patients yet. As molecular tumor characteristics have gained increased importance in the choice of treatment, additional studies with biomarker-driven patient recruitment are required to further explore afatinib efficacy in CRC.
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Affiliation(s)
- I De Pauw
- Center for Oncological Research (CORE), University of Antwerp, Belgium.
| | - A Wouters
- Center for Oncological Research (CORE), University of Antwerp, Belgium
| | - J Van den Bossche
- Center for Oncological Research (CORE), University of Antwerp, Belgium
| | - M Peeters
- Center for Oncological Research (CORE), University of Antwerp, Belgium; Department of Oncology, Antwerp University Hospital, Belgium
| | - P Pauwels
- Center for Oncological Research (CORE), University of Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Belgium
| | - V Deschoolmeester
- Center for Oncological Research (CORE), University of Antwerp, Belgium; Department of Pathology, Antwerp University Hospital, Belgium
| | - J B Vermorken
- Center for Oncological Research (CORE), University of Antwerp, Belgium; Department of Oncology, Antwerp University Hospital, Belgium
| | - F Lardon
- Center for Oncological Research (CORE), University of Antwerp, Belgium
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Kapogiannatos G, Margaritis D, Alevizou R, Gogoulou I, Nomicos A, Digalakis M. Immunohistochemical expression of EGFR in colorectal adenocarcinoma and its correlation with the presence of lymph node metastases. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13126-015-0242-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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45
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Holcmann M, Sibilia M. Mechanisms underlying skin disorders induced by EGFR inhibitors. Mol Cell Oncol 2015; 2:e1004969. [PMID: 27308503 PMCID: PMC4905346 DOI: 10.1080/23723556.2015.1004969] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/31/2014] [Accepted: 01/03/2015] [Indexed: 12/21/2022]
Abstract
The epidermal growth factor receptor (EGFR) is a receptor tyrosine kinase that is frequently mutated or overexpressed in a large number of tumors such as carcinomas or glioblastoma. Inhibitors of EGFR activation have been successfully established for the therapy of some cancers and are more and more frequently being used as first or later line therapies. Although the side effects induced by inhibitors of EGFR are less severe than those observed with classic cytotoxic chemotherapy and can usually be handled by out-patient care, they may still be a cause for dose reduction or discontinuation of treatment that can reduce the effectiveness of antitumor therapy. The mechanisms underlying these cutaneous side effects are only partly understood. Important questions, such as the reasons for the correlation between the intensity of the side effects and the efficiency of treatment with EGFR inhibitors, remain to be answered. Optimized adjuvant strategies to accompany anti-EGFR therapy need to be found for optimal therapeutic application and improved quality of life of patients. Here, we summarize current literature on the molecular and cellular mechanisms underlying the cutaneous side effects induced by EGFR inhibitors and provide evidence that keratinocytes are probably the optimal targets for adjuvant therapy aimed at alleviating skin toxicities.
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Affiliation(s)
- Martin Holcmann
- Institute of Cancer Research; Department of Medicine I; Medical University of Vienna; Comprehensive Cancer Center ; Vienna, Austria
| | - Maria Sibilia
- Institute of Cancer Research; Department of Medicine I; Medical University of Vienna; Comprehensive Cancer Center ; Vienna, Austria
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46
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Grech G, Zhan X, Yoo BC, Bubnov R, Hagan S, Danesi R, Vittadini G, Desiderio DM. EPMA position paper in cancer: current overview and future perspectives. EPMA J 2015; 6:9. [PMID: 25908947 PMCID: PMC4407842 DOI: 10.1186/s13167-015-0030-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 02/26/2015] [Indexed: 12/31/2022]
Abstract
At present, a radical shift in cancer treatment is occurring in terms of predictive, preventive, and personalized medicine (PPPM). Individual patients will participate in more aspects of their healthcare. During the development of PPPM, many rapid, specific, and sensitive new methods for earlier detection of cancer will result in more efficient management of the patient and hence a better quality of life. Coordination of the various activities among different healthcare professionals in primary, secondary, and tertiary care requires well-defined competencies, implementation of training and educational programs, sharing of data, and harmonized guidelines. In this position paper, the current knowledge to understand cancer predisposition and risk factors, the cellular biology of cancer, predictive markers and treatment outcome, the improvement in technologies in screening and diagnosis, and provision of better drug development solutions are discussed in the context of a better implementation of personalized medicine. Recognition of the major risk factors for cancer initiation is the key for preventive strategies (EPMA J. 4(1):6, 2013). Of interest, cancer predisposing syndromes in particular the monogenic subtypes that lead to cancer progression are well defined and one should focus on implementation strategies to identify individuals at risk to allow preventive measures and early screening/diagnosis. Implementation of such measures is disturbed by improper use of the data, with breach of data protection as one of the risks to be heavily controlled. Population screening requires in depth cost-benefit analysis to justify healthcare costs, and the parameters screened should provide information that allow an actionable and deliverable solution, for better healthcare provision.
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Affiliation(s)
- Godfrey Grech
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Xianquan Zhan
- Key Laboratory of Cancer Proteomics of Chinese Ministry of Health, Xiangya Hospital, Central South University, Changsha, China
| | - Byong Chul Yoo
- Colorectal Cancer Branch, Division of Translational and Clinical Research I, Research Institute, National Cancer Center, Gyeonggi, 410-769 Republic of Korea
| | - Rostyslav Bubnov
- Clinical Hospital 'Pheophania' of State Management of Affairs Department, Kyiv, Ukraine ; Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Suzanne Hagan
- Dept of Life Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Dominic M Desiderio
- Department of Neurology, University of Tennessee Center for Health Science, Memphis, USA
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Sousa V, Bastos B, Silva M, Alarcão AM, Carvalho L. Bronchial-pulmonary adenocarcinoma subtyping relates with different molecular pathways. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:259-70. [PMID: 25926247 DOI: 10.1016/j.rppnen.2014.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 05/30/2014] [Indexed: 01/30/2023] Open
Abstract
Lung cancer is one of the most common cancers in the world with a high mortality rate. We analyzed 45 surgical samples of the adenocarcinoma, 13 with lymph node metastasis. APC, BCL2, chromogranin A, CK 5/6/18 (LP34), CK20, CK7, cyclin D1, EGFR, ERCC1, HER2, Ki67, LRP, MRP, P53, RB and TTF1 expressions were evaluated by immunohistochemistry (IHC). Higher Ki67, APC, ERCC1 expressions and lower TTF1 expression were identified in advanced stages (IIA and IIIA) of adenocarcinomas, which reflect a more aggressive, less differentiated, possibly a non-TRU adenocarcinoma. Acinar, micropapillary and BA/lepidic adenocarcinoma patterns were the most similar patterns and papillary was the most different pattern followed by solid pattern, according to expression of these markers. Different adenocarcinoma patterns are engaged with different molecular pathways for carcinogenesis, based on the differences of expression. Acinar, BA/lepidic and micropapillary showed higher TTF1 expression (type TRU), and papillary and solid patterns revealed less TTF1 expression, exhibiting a non-TRU/bronchial phenotype. Solid pattern revealed lower HER2 and higher EGFR and ERCC1 (this compared to papillary) expression; papillary higher HER2 and lower ERCC1 expressions; micropapillary higher RB expression; and acinar lower ERCC1 and higher EGFR expressions. Ciclin D1 seems to have more importance in acinar and BA/lepidic patterns than in micropapillary. ERCC1 protein expression in micropapillary, solid and BA/lepidic patterns may indicate DNA repair activation. Inhibition of apoptosis could be explained by BCL2 overexpression, present in all adenocarcinoma patterns. MRP-1 and LRP were overexpressed in all patterns, which may have implications for drug resistance. Further studies are needed to interpret these data regarding to therapy response in advanced staged bronchial-pulmonary carcinomas.
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Affiliation(s)
- Vítor Sousa
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pathology Institute, Coimbra University Hospital (HUC-CHUC), Coimbra, Portugal.
| | - Bruno Bastos
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria Silva
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Maria Alarcão
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lina Carvalho
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pathology Institute, Coimbra University Hospital (HUC-CHUC), Coimbra, Portugal
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48
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Sousa V, Bastos B, Silva M, Alarcão AM, Carvalho L. WITHDRAWN: Bronchial-pulmonary adenocarcinoma subtyping relates with different molecular pathways. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014:S0873-2159(14)00099-3. [PMID: 25131502 DOI: 10.1016/j.rppneu.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 05/20/2014] [Accepted: 05/30/2014] [Indexed: 10/24/2022] Open
Abstract
This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.05.006. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Vítor Sousa
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pathology Institute, Coimbra University Hospital (HUC-CHUC), Coimbra, Portugal.
| | - Bruno Bastos
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria Silva
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Ana Maria Alarcão
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Lina Carvalho
- IAP-FMUC-Institute of Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Pathology Institute, Coimbra University Hospital (HUC-CHUC), Coimbra, Portugal
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49
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Hocking CM, Townsend AR, Price TJ. Panitumumab in metastatic colorectal cancer. Expert Rev Anticancer Ther 2014; 13:781-93. [DOI: 10.1586/14737140.2013.811064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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50
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Hocking CM, Price TJ. Panitumumab in the management of patients with KRAS wild-type metastatic colorectal cancer. Therap Adv Gastroenterol 2014; 7:20-37. [PMID: 24381645 PMCID: PMC3871277 DOI: 10.1177/1756283x13498660] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The past 15 years has seen a marked increase in available therapeutic options for patients with metastatic colorectal cancer resulting in improvements in median survival from 12 to 24 months. One of these new options is panitumumab, which is a fully humanized monoclonal antibody that binds to the epidermal growth factor receptor of tumor cells and inhibits downstream cell signaling with antitumor effects of inhibition of tumor growth, induction of apoptosis and inhibition of angiogenesis. Large randomized clinical trials have demonstrated significant improvements in tumor response rates and progression-free survival when panitumumab is combined with chemotherapy and as monotherapy in chemorefractory metastatic colorectal cancer. Clinical benefit with panitumumab is limited to patients with nonmutated KRAS tumors. Rash is a common toxicity of panitumumab treatment but can potentially be ameliorated with the use of prophylactic strategies. The role of panitumumab in the overall treatment of metastatic colorectal cancer is evolving and future clinical trials will focus on improved patient selection through use of novel predictive biomarkers, and the optimal timing of treatment.
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Affiliation(s)
- Christopher M Hocking
- Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA, Australia
| | - Timothy J Price
- Department of Medical Oncology, TQEH, Woodville, Woodville Road, Woodville, SA 5011, Australia
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