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Pirosa MC, Stathis A, Zucca E. Tafasitamab for the treatment of patients with diffuse large B-cell lymphoma. Hum Vaccin Immunother 2024; 20:2309701. [PMID: 38299612 PMCID: PMC10841029 DOI: 10.1080/21645515.2024.2309701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/21/2024] [Indexed: 02/02/2024] Open
Abstract
Patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) require additional treatments, especially those not eligible or not responding to high dose cytotoxic chemotherapy and stem cell transplantation. Over the last few years, several new treatments have been developed and approved for these patients, among them of particular relevance are those targeting CD19. Tafasitamab is a humanized monoclonal antibody targeting CD19, composed of a modified fragment crystallizable (Fc) region engineered with higher affinity for Fc gamma receptors (FcγR) receptors, leading to increased cytotoxicity through natural killer cells and macrophages (antibody-dependent cellular cytotoxicity and antibody-dependent cell-mediated phagocytosis). In this product review, we will discuss its mechanism of action, safety profile and efficacy results from clinical trials that led to its approval in combination with lenalidomide for patients with R/R DLBCL ineligible for high-dose chemotherapy and autologous transplantation.
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Affiliation(s)
- Maria Cristina Pirosa
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
- Faculty of Biomedical Science, Universita’ della Svizzera italiana, Lugano, Switzerland
| | - Anastasios Stathis
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Science, Universita’ della Svizzera italiana, Lugano, Switzerland
| | - Emanuele Zucca
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
- Faculty of Biomedical Science, Universita’ della Svizzera italiana, Lugano, Switzerland
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2
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Caimi PF, Ai WZ, Alderuccio JP, Ardeshna KM, Hamadani M, Hess B, Kahl BS, Radford J, Solh M, Stathis A, Zinzani PL, Wang Y, Qin Y, Wang L, Xu ZC, Carlo-Stella C. Loncastuximab tesirine in relapsed/refractory diffuse large B-cell lymphoma: long-term efficacy and safety from the phase II LOTIS-2 study. Haematologica 2024; 109:1184-1193. [PMID: 37646659 PMCID: PMC10985439 DOI: 10.3324/haematol.2023.283459] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
Therapies that demonstrate durable, long-term responses with manageable safety and tolerability are needed for patients with relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL). Loncastuximab tesirine (loncastuximab tesirine-lpyl [Lonca]), an anti-CD19 antibody conjugated to a potent pyrrolobenzodiazepine dimer, demonstrated single-agent antitumor activity in the pivotal phase II LOTIS-2 study in heavily pretreated patients with R/R DLBCL. Here we present updated efficacy and safety analyses from LOTIS-2, performed for all patients and in subsets of patients with a complete response (CR), including patients with CR who were event-free (no progressive disease or death) for ≥1 year and ≥2 years from cycle 1, day 1 of treatment. Lonca was administered every 3 weeks (0.15 mg/kg for 2 cycles; 0.075 mg/kg for subsequent cycles). As of the final data cutoff (September 15, 2022; median follow-up: 7.8 months [range, 0.3-42.6]), 70 of 145 (48.3%) patients achieved an overall response. Thirty-six (24.8%) patients achieved CR, of which 16 (44%) and 11 (31%) were event-free for ≥1 year and ≥2 years, respectively. In the all-treated population, the median overall survival was 9.5 months; the median progression-free survival was 4.9 months. Among patients with CR, median overall survival and progression-free survival were not reached, with 24-month overall and progression-free survival rates of 68.2% (95% CI: 50.0-81.0) and 72.5% (95% CI: 48.2-86.8), respectively. No new safety concerns were detected. With additional follow-up, Lonca continued to demonstrate durable, long-term responses with manageable safety and tolerability in patients with CR (clinicaltrials gov. Identifier: NCT03589469).
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Affiliation(s)
- Paolo F Caimi
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH.
| | - Weiyun Z Ai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Juan Pablo Alderuccio
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Kirit M Ardeshna
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Brian Hess
- Medical University of South Carolina, Charleston, SC
| | | | - John Radford
- NIHR Clinical Research Facility, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Melhem Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli," Bologna, Italy; Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna
| | - Ying Wang
- ADC Therapeutics America, Inc., Murray Hill, NJ
| | - Yajuan Qin
- ADC Therapeutics America, Inc., Murray Hill, NJ
| | | | | | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, and Department of Oncology and Hematology, Humanitas Research Hospital-IRCCS, Milano
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3
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Colombo I, Koster KL, Holer L, Haefliger S, Rabaglio M, Bastian S, Schwitter M, Eckhardt K, Hayoz S, Mc Laughlin AM, Kloft C, Klose M, Halbherr S, Baumgartner C, Sessa C, Stathis A, Hess D, Joerger M. TLD-1, a novel liposomal doxorubicin, in patients with advanced solid tumors: Dose escalation and expansion part of a multicenter open-label phase I trial (SAKK 65/16). Eur J Cancer 2024; 201:113588. [PMID: 38377773 DOI: 10.1016/j.ejca.2024.113588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND TLD-1 is a novel liposomal doxorubicin that compared favorably to conventional doxorubicin liposomal formulations in preclinical models. This phase I first-in-human study aimed to define the maximum tolerated dose (MTD), recommended phase 2 dose (RP2D), safety and preliminary activity of TLD-1 in patients with advanced solid tumors. PATIENTS AND METHODS We recruited patients with advanced solid tumors who failed standard therapy and received up to 3 prior lines of palliative systemic chemotherapy. TLD-1 was administered intravenously every 3 weeks up to a maximum of 9 cycles (6 for patients with prior anthracyclines) from a starting dose of 10 mg/m2, according to an accelerated titration design followed by a modified continual reassessment method. RESULTS 30 patients were enrolled between November 2018 and May 2021. No dose-limiting toxicities (DLT) were observed. Maximum administered dose of TLD-1 was 45 mg/m2, RP2D was defined at 40 mg/m2. Most frequent treatment-related adverse events (TRAE) of any grade included palmar-plantar erythrodysesthesia (PPE) (50% of patients), oral mucositis (50%), fatigue (30%) and skin rash (26.7%). Most common G3 TRAE included PPE in 4 patients (13.3%) and oral mucositis in 2 (6.7%). Overall objective response rate was 10% in the whole population and 23.1% among 13 patients with breast cancer; median time-to-treatment failure was 2.7 months. TLD-1 exhibit linear pharmacokinetics, with a median terminal half-life of 95 h. CONCLUSIONS The new liposomal doxorubicin formulation TLD-1 showed a favourable safety profile and antitumor activity, particularly in breast cancer. RP2D was defined at 40 mg/m2 administered every 3 weeks. (NCT03387917).
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Affiliation(s)
- Ilaria Colombo
- Oncology Institute of Southern Switzerland, EOC, 6500 Bellinzona, Switzerland
| | - Kira-Lee Koster
- Department of Medical Oncology and Hematology, Cantonal Hospital, 9007 St.Gallen, Switzerland
| | - Lisa Holer
- Competence Center of SAKK, 3008 Bern, Switzerland
| | - Simon Haefliger
- Department of Medical Oncology, Inselspital, 3010 Bern, Switzerland
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, 3010 Bern, Switzerland
| | - Sara Bastian
- Department of Medical Oncology and Hematology, Cantonal Hospital, 7000 Chur, Switzerland
| | - Michael Schwitter
- Department of Medical Oncology and Hematology, Cantonal Hospital, 7000 Chur, Switzerland
| | | | | | - Anna M Mc Laughlin
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie aet Berlin, 12169 Berlin, Germany; PharMetrX Graduate Research Training Program, Berlin/Postdam, Germany
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie aet Berlin, 12169 Berlin, Germany
| | - Marian Klose
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie aet Berlin, 12169 Berlin, Germany; PharMetrX Graduate Research Training Program, Berlin/Postdam, Germany
| | | | | | - Cristiana Sessa
- Oncology Institute of Southern Switzerland, EOC, 6500 Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, 6500 Bellinzona, Switzerland
| | - Dagmar Hess
- Department of Medical Oncology and Hematology, Cantonal Hospital, 9007 St.Gallen, Switzerland
| | - Markus Joerger
- Department of Medical Oncology and Hematology, Cantonal Hospital, 9007 St.Gallen, Switzerland; Medical faculty, University of Basel, 4056 Basel, Switzerland.
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4
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Conconi A, Chiappella A, Ferreri AJM, Stathis A, Botto B, Sassone M, Gaidano G, Balzarotti M, Merli F, Tucci A, Vanazzi A, Tani M, Bruna R, Orsucci L, Cabras MG, Celli M, Annibali O, Liberati AM, Zanni M, Ghiggi C, Pisani F, Pinotti G, Dore F, Esposito F, Pirosa MC, Cesaretti M, Bonomini L, Vitolo U, Zucca E. IELSG30 phase 2 trial: intravenous and intrathecal CNS prophylaxis in primary testicular diffuse large B-cell lymphoma. Blood Adv 2024; 8:1541-1549. [PMID: 38181782 DOI: 10.1182/bloodadvances.2023011251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/07/2024] Open
Abstract
ABSTRACT Primary testicular diffuse large B-cell lymphoma (PTL) is characterized by high risk of contralateral testis and central nervous system (CNS) relapse. Chemoimmunotherapy with intrathecal (IT) CNS prophylaxis and contralateral testis irradiation eliminates contralateral recurrences and reduces CNS relapses. The IELSG30 phase 2 study investigated feasibility and activity of an intensified IT and IV CNS prophylaxis. Patients with stage I/II PTL who had not received treatment received 2 cycles of IV high-dose methotrexate (MTX) (1.5 g/m2) after 6 cycles of the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, every 21 days). IT liposomal cytarabine was administered on day 0 of cycles 2 to 5 of 21-day R-CHOP regimen. Contralateral testis radiotherapy (25-30 Gy) was recommended. Fifty-four patients (median age: 66 years) with stage I (n = 32) or II (n = 22) disease were treated with R-CHOP, 53 received at least 3 doses of IT cytarabine, 48 received at least 1 dose of IV MTX, and 50 received prophylactic radiotherapy. No unexpected toxicity occurred. At a median follow-up of 6 years, there was no CNS relapse; 7 patients progressed, and 8 died, with 5-year progression-free and overall survival rates of 91% (95% confidence interval [CI], 79-96) and 92% (95% CI, 81-97), respectively. Extranodal recurrence was documented in 6 patients (in 2 without nodal involvement). In 4 cases, the relapse occurred >6 years after treatment. Causes of death were lymphoma (n = 4), second primary malignancy (n = 1), cerebral vasculopathy (n = 1), unknown (n = 2). Intensive prophylaxis was feasible and effective in preventing CNS relapses. Late relapses, mainly at extranodal sites, represented the most relevant pattern of failure. This trial was registered at www.clinicaltrials.gov as #NCT00945724.
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Affiliation(s)
| | - Annalisa Chiappella
- Haematology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Barbara Botto
- SC Ematologia, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marianna Sassone
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Gaidano
- SCDU Ematologia, Department of Translational Medicine, University of Eastern Piedmont and AOU Maggiore della Carità, Novara, Italy
| | - Monica Balzarotti
- UO Ematologia, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Merli
- Hematology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Tucci
- Division of Hematology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Anna Vanazzi
- Division of Clinical Haemato-Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Monica Tani
- UO Ematologia, Dipartimento Oncologia ed Ematologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Riccardo Bruna
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Lorella Orsucci
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Melania Celli
- Ospedale degli Infermi, Hematology Unit, Rimini, Italy
| | - Ombretta Annibali
- Area Ematologia Medicina Trasfusionale e Terapia cellulare Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Anna Marina Liberati
- SC Oncoematologia, Azienda Ospedaliera Santa Maria, Università degli studi di Perugia, Terni, Italy
| | - Manuela Zanni
- Antonio e Biagio e Cesare Arrigo Hospital, Hematology Unit, Alessandria, Italy
| | - Chiara Ghiggi
- IRCCS Ospedale Policlinico San Martino UO Ematologia e Terapie Cellulari, Genoa, Italy
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, IRCCS Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | | | - Fabiana Esposito
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Maria Cristina Pirosa
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
| | | | | | - Umberto Vitolo
- Medical Oncology, Candiolo Cancer Institute, Fondazione del Piemonte per l'Oncologia-IRCCS, Candiolo, Turin, Italy
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
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5
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Arribas AJ, Napoli S, Cascione L, Barnabei L, Sartori G, Cannas E, Gaudio E, Tarantelli C, Mensah AA, Spriano F, Zucchetto A, Rossi FM, Rinaldi A, Castro de Moura M, Jovic S, Bordone Pittau R, Stathis A, Stussi G, Gattei V, Brown JR, Esteller M, Zucca E, Rossi D, Bertoni F. ERBB4-Mediated Signaling Is a Mediator of Resistance to PI3K and BTK Inhibitors in B-cell Lymphoid Neoplasms. Mol Cancer Ther 2024; 23:368-380. [PMID: 38052765 DOI: 10.1158/1535-7163.mct-23-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/28/2023] [Accepted: 10/11/2023] [Indexed: 12/07/2023]
Abstract
BTK and PI3K inhibitors are among the drugs approved for the treatment of patients with lymphoid neoplasms. Although active, their ability to lead to long-lasting complete remission is rather limited, especially in the lymphoma setting. This indicates that tumor cells often develop resistance to the drugs. We started from a marginal zone lymphoma cell line, Karpas-1718, kept under prolonged exposure to the PI3Kδ inhibitor idelalisib until acquisition of resistance, or with no drug. Cells underwent transcriptome, miRNA and methylation profiling, whole-exome sequencing, and pharmacologic screening, which led to the identification of the overexpression of ERBB4 and its ligands HBEGF and NRG2 in the resistant cells. Cellular and genetic experiments demonstrated the involvement of this axis in blocking the antitumor activity of various BTK/PI3K inhibitors, currently used in the clinical setting. Addition of recombinant HBEGF induced resistance to BTK/PI3K inhibitors in parental cells and in additional lymphoma models. Combination with the ERBB inhibitor lapatinib was beneficial in resistant cells and in other lymphoma models already expressing the identified resistance factors. An epigenetic reprogramming sustained the expression of the resistance-related factors, and pretreatment with demethylating agents or EZH2 inhibitors overcame the resistance. Resistance factors were also shown to be expressed in clinical specimens. In conclusion, we showed that the overexpression of ERBB4 and its ligands represents a novel mechanism of resistance for lymphoma cells to bypass the antitumor activity of BTK and PI3K inhibitors and that targeted pharmacologic interventions can restore sensitivity to the small molecules.
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Affiliation(s)
- Alberto J Arribas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Sara Napoli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Laura Barnabei
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Giulio Sartori
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Eleonora Cannas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Eugenio Gaudio
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Chiara Tarantelli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Afua A Mensah
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Filippo Spriano
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | | | | | - Andrea Rinaldi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Manuel Castro de Moura
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
| | - Sandra Jovic
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona, Switzerland
| | | | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Georg Stussi
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Valter Gattei
- Centro di Riferimento Oncologico di Aviano - CRO, Aviano, Italy
| | - Jennifer R Brown
- Chronic Lymphocytic Leukemia Center, Division of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
- Centro de Investigacion Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
- Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Emanuele Zucca
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Davide Rossi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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6
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Stathis A, Pirosa MC, Orsucci L, Feugier P, Tani M, Ghesquières H, Musuraca G, Rossi FG, Merli F, Guièze R, Gyan E, Gini G, Marino D, Gressin R, Morschhauser F, Cavallo F, Palombi F, Conconi A, Tessoulin B, Tilly H, Zanni M, Cabras MG, Capochiani E, Califano C, Celli M, Pulsoni A, Angrilli F, Occhini U, Casasnovas RO, Cartron G, Devizzi L, Haioun C, Liberati AM, Houot R, Merli M, Pietrantuono G, Re F, Spina M, Landi F, Cavalli F, Bertoni F, Rossi D, Ielmini N, Borgo E, Luminari S, Zucca E, Thieblemont C. IELSG38: phase II trial of front-line chlorambucil plus subcutaneous rituximab induction and maintenance in mucosa-associated lymphoid tissue lymphoma. Haematologica 2024. [PMID: 38385243 DOI: 10.3324/haematol.2023.283918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Indexed: 02/23/2024] Open
Abstract
The IELSG38 trial was conducted to investigate the effects of subcutaneous (SC) rituximab on the complete remission (CR) rate and the benefits of SC maintenance in patients with extranodal marginal zone lymphoma (MZL) who received frontline treatment with chlorambucil plus rituximab. Study treatment comprised an induction phase with chlorambucil 6 mg/m2/day orally on weeks 1-6, 9-10, 13-14, 17-18, and 21-22, and rituximab 375 mg/m2 intravenously on day 1 of weeks 1-4, and 1400 mg SC on weeks 9, 13, 17, and 21. Then, a maintenance phase followed with rituximab administered at 1400 mg SC every two months for two years. Of the 112 patients enrolled, 109 were evaluated for efficacy. The CR rates increased from 52% at the end of the induction phase to 70% upon completion of the maintenance phase. With a median follow-up of 5.8 years, the 5-year event-free, progression-free, and overall survival rates were 87% (95% CI, 78-92), 84% (95% CI, 75-89), and 93% (95% CI, 86-96), respectively. The most common grade ≥3 toxicities were neutropenia (33%) and lymphocytopenia (16%). Six patients experienced treatment-related serious adverse events, including fever of unknown origin, sepsis, pneumonia, respiratory failure, severe cerebellar ataxia, and fatal acute myeloid leukemia. The trial showed that subcutaneous rituximab did not improve the complete remission rate at the conclusion of the induction phase, which was the main endpoint. Nevertheless, SC maintenance might have facilitated long-term disease control, potentially contributing to enhanced event-free and progression-free survival.
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Affiliation(s)
- Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano.
| | - Maria Cristina Pirosa
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Institute of Oncology Research, Bellinzona
| | - Lorella Orsucci
- S.C. Ematologia, AOU Città della Salute e della Scienza di Torino, Turin
| | - Pierre Feugier
- Department of Clinical Hematology, Nancy University Hospital, INSERM 1256, Nancy
| | - Monica Tani
- U.O. Ematologia, Dipartimento Oncologia e Ematologia, Ospedale Santa Maria delle Croci, Ravenna
| | - Hervé Ghesquières
- Hematology Department, Hospices Civils de Lyon, CHU Lyon-Sud, Pierre-Bénite
| | - Gerardo Musuraca
- Hematology Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - Francesca Gaia Rossi
- Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano
| | | | - Romain Guièze
- Service d'Hématologie Clinique et de Thérapie Cellulaire, CHU Estaing, Clermont- Ferrand
| | - Emmanuel Gyan
- Hématologie et thérapie cellulaire, CIC Inserm U1415, Centre Hospitalier Universitaire de Tours, Tours
| | - Guido Gini
- Hematology, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona
| | - Dario Marino
- Oncology 1 Unit, Istituto Oncologico Veneto IOV-IRCCS, Padova
| | - Remy Gressin
- Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309/Grenoble Alpes University, Grenoble
| | | | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU Città della Salute e della Scienza di Torino, Turin
| | - Francesca Palombi
- Hematology and Stem Cell Transplant Unit, IRCCS. National Cancer Institute, Istituto Regina Elena, Rome Italy
| | | | - Benoît Tessoulin
- Hématologie Clinique, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes
| | - Hervé Tilly
- Department of Hematology and U1245, Centre Henri Becquerel, Rouen
| | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria
| | | | - Enrico Capochiani
- Hematology Unit, Azienda USL Toscana NordOvest, Center for Translational Medicine, Livorno
| | | | | | - Alessandro Pulsoni
- Department of Translational and Precision Medicine, Sapienza University, Rome
| | - Francesco Angrilli
- Unità Operativa Semplice Dipartimentale Centro Diagnosi e Terapia Linfomi, Presidio Ospedaliero, Pescara
| | - Ubaldo Occhini
- Unità Operativa di Ematologia, Ospedale San Donato, AUSL Toscana Sud-Est, Arezzo
| | | | | | - Liliana Devizzi
- Hematology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil
| | - Anna Marina Liberati
- SC Oncoematologia, Azienda Ospedaliera Santa Maria, Università degli studi di Perugia, Terni
| | - Roch Houot
- Department of Clinical Hematology, University Hospital of Rennes, Rennes
| | - Michele Merli
- Division of Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi ASST Sette Laghi, University of Insubria, Varese
| | - Giuseppe Pietrantuono
- Hematology Unit, Centro di Riferimento Oncologico della Basilicata IRCCS Rionero in Vulture
| | - Francesca Re
- Hematology and BMT Center, Azienda Ospedaliera Universitaria, Parma
| | - Michele Spina
- Division of Medical Oncology, Centro di Riferimento Oncologico IRCCS, Aviano
| | | | | | - Francesco Bertoni
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland; Institute of Oncology Research, Bellinzona
| | - Davide Rossi
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland; Institute of Oncology Research, Bellinzona
| | | | - Elena Borgo
- FIL, Fondazione Italiana Linfomi ONLUS, Alessandria
| | - Stefano Luminari
- AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy; CHIMOMO Department, University of Modena and Reggio Emilia, Reggio Emilia
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland; Università della Svizzera Italiana, Faculty of Biomedical Sciences, Lugano, Switzerland; Institute of Oncology Research, Bellinzona, Switzerland; Medical Oncology, University Hospital and University of Bern
| | - Catherine Thieblemont
- APHP - Service d'Hématologie-Oncologie, Hôpital Saint Louis, Université de Paris - Diderot, Paris
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Hamadani M, Spira A, Zhou X, Liao L, Chen L, Radford J, Ai W, Solh M, Ardeshna KM, Hess B, Caimi PF, Stathis A, Carlo-Stella C, Alderuccio JP, Kahl B, Wang Y, Qin Y, Xu ZC, Zinzani PL. Clinical outcomes of older and younger patients treated with loncastuximab tesirine in the LOTIS-2 clinical trial. Blood Adv 2024; 8:93-98. [PMID: 37871303 PMCID: PMC10787240 DOI: 10.1182/bloodadvances.2023010636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Affiliation(s)
- Mehdi Hamadani
- Division of Hematology and Oncology, BMT & Cellular Therapy Program, Medical College of Wisconsin, Milwaukee, WI
| | | | - Xiaolei Zhou
- RTI Health Solutions, Research Triangle Park, NC
| | - Laura Liao
- ADC Therapeutics America Inc, Murray Hill, NJ
| | - Lei Chen
- ADC Therapeutics America Inc, Murray Hill, NJ
| | - John Radford
- NIHR Clinical Research Facility, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Weiyun Ai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Melhem Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | - Kirit M. Ardeshna
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Brian Hess
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Paolo F. Caimi
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Oncology and Hematology, Humanitas Research Hospital−IRCCS, Milan, Italy
| | - Juan Pablo Alderuccio
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Brad Kahl
- Division of Oncology, Washington University, St. Louis, MO
| | - Ying Wang
- ADC Therapeutics America Inc, Murray Hill, NJ
| | - Yajuan Qin
- ADC Therapeutics America Inc, Murray Hill, NJ
| | | | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
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8
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Alderuccio JP, Reis IM, Hamadani M, Nachiappan M, Leslom S, Kahl BS, Ai WZ, Radford J, Solh M, Ardeshna KM, Hess BT, Lunning MA, Zinzani PL, Stathis A, Carlo-Stella C, Lossos IS, Caimi PF, Han S, Yang F, Kuker RA, Moskowitz CH. PET/CT Biomarkers Enable Risk Stratification of Patients with Relapsed/Refractory Diffuse Large B-cell Lymphoma Enrolled in the LOTIS-2 Clinical Trial. Clin Cancer Res 2024; 30:139-149. [PMID: 37855688 PMCID: PMC10872617 DOI: 10.1158/1078-0432.ccr-23-1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/11/2023] [Accepted: 10/17/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Significant progress has occurred in developing quantitative PET/CT biomarkers in diffuse large B-cell lymphoma (DLBCL). Total metabolic tumor volume (MTV) is the most extensively studied, enabling assessment of FDG-avid tumor burden associated with outcomes. However, prior studies evaluated the outcome of cytotoxic chemotherapy or chimeric antigen receptor T-cell therapy without data on recently approved FDA agents. Therefore, we aimed to assess the prognosis of PET/CT biomarkers in patients treated with loncastuximab tesirine. EXPERIMENTAL DESIGN We centrally reviewed screening PET/CT scans of patients with relapsed/refractory DLBCL enrolled in the LOTIS-2 (NCT03589469) study. MTV was obtained by computing individual volumes using the SUV ≥4.0 threshold. Other PET/CT metrics, clinical factors, and the International Metabolic Prognostic Index (IMPI) were evaluated. Logistic regression was used to assess the association between biomarkers and treatment response. Cox regression was used to determine the effect of biomarkers on time-to-event outcomes. We estimated biomarker prediction as continuous and binary variables defined by cutoff points. RESULTS Across 138 patients included in this study, MTV with a cutoff point of 96 mL was the biomarker associated with the highest predictive performance in univariable and multivariable models to predict failure to achieve complete metabolic response (OR, 5.42; P = 0.002), progression-free survival (HR, 2.68; P = 0.002), and overall survival (HR, 3.09; P < 0.0001). IMPI demonstrated an appropriate performance, however, not better than MTV alone. CONCLUSIONS Pretreatment MTV demonstrated robust risk stratification, with those patients demonstrating high MTV achieving lower responses and survival to loncastuximab tesirine in relapsed/refractory DLBCL.
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Affiliation(s)
- Juan Pablo Alderuccio
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Isildinha M. Reis
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mehdi Hamadani
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Muthiah Nachiappan
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Salman Leslom
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Brad S. Kahl
- Washington University, St. Louis, MO, United States
| | - Weiyun Z. Ai
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, United States
| | - John Radford
- NIHR Clinical Research Facility, University of Manchester and the Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Melhem Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, United States
| | - Kirit M. Ardeshna
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Brian T. Hess
- Medical University of South Carolina, Charleston, SC, United States
| | - Matthew A. Lunning
- University of Nebraska Medical Center- Fred and Pamela Buffett Cancer Center, Omaha, NE, United States
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”; Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, and Department of Oncology and Hematology, Humanitas Research Hospital–IRCCS, Milano, Italy
| | - Izidore S. Lossos
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Paolo F. Caimi
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH, United States
| | - Sunwoo Han
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Fei Yang
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Russ A. Kuker
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Craig H. Moskowitz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
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9
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Sartori G, Tarantelli C, Spriano F, Gaudio E, Cascione L, Mascia M, Barreca M, Arribas AJ, Licenziato L, Golino G, Ferragamo A, Pileri S, Damia G, Zucca E, Stathis A, Politz O, Wengner AM, Bertoni F. The ATR inhibitor elimusertib exhibits anti-lymphoma activity and synergizes with the PI3K inhibitor copanlisib. Br J Haematol 2024; 204:191-205. [PMID: 38011941 DOI: 10.1111/bjh.19218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
The DNA damage response (DDR) is the cellular process of preserving an intact genome and is often deregulated in lymphoma cells. The ataxia telangiectasia and Rad3-related (ATR) kinase is a crucial factor of DDR in the response to DNA single-strand breaks. ATR inhibitors are agents that have shown considerable clinical potential in this context. We characterized the activity of the ATR inhibitor elimusertib (BAY 1895344) in a large panel of lymphoma cell lines. Furthermore, we evaluated its activity combined with the clinically approved PI3K inhibitor copanlisib in vitro and in vivo. Elimusertib exhibits potent anti-tumour activity across various lymphoma subtypes, which is associated with the expression of genes related to replication stress, cell cycle regulation and, as also sustained by CRISPR Cas9 experiments, CDKN2A loss. In several tumour models, elimusertib demonstrated widespread anti-tumour activity stronger than ceralasertib, another ATR inhibitor. This activity is present in both DDR-proficient and DDR-deficient lymphoma models. Furthermore, a combination of ATR and PI3K inhibition by treatment with elimusertib and copanlisib has in vitro and in vivo anti-tumour activity, providing a potential new treatment option for lymphoma patients.
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Affiliation(s)
- Giulio Sartori
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Chiara Tarantelli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Filippo Spriano
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Eugenio Gaudio
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Michele Mascia
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Marilia Barreca
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Palermo, Italy
| | - Alberto J Arribas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Luca Licenziato
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Department of Veterinary Sciences, University of Turin, Turin, Italy
| | - Gaetanina Golino
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Adele Ferragamo
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Stefano Pileri
- Division of Diagnostic Haematopathology, European Institute of Oncology, Milan, Italy
| | - Giovanna Damia
- Laboratory of Molecular Pharmacology, Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Emanuele Zucca
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Oliver Politz
- Bayer AG, Pharmaceuticals, Research & Development, Berlin, Germany
| | - Antje M Wengner
- Bayer AG, Pharmaceuticals, Research & Development, Berlin, Germany
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
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10
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de Ramon Ortiz C, Wang S, Stathis A, Bertoni F, Zenz T, Novak U, Simonetta F. How to integrate CD19 specific chimeric antigen receptor T cells with other CD19 targeting agents in diffuse large B-cell lymphoma? Hematol Oncol 2024; 42:e3237. [PMID: 37937474 DOI: 10.1002/hon.3237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023]
Abstract
About one third of patients with diffuse large B-cell lymphoma (DLBCL) have a relapsing/refractory (R/R) disease after first line chemo-immunotherapy, with particularly poor outcomes observed in patients with primary refractory disease and early relapse. CD19 specific chimeric antigen receptor (CAR) T cell therapy is a game changer that results in durable and complete response rates in almost half of the patients with R/R DLBCL. Other emerging CD19-targeting therapies include monoclonal antibodies, bispecific antibodies and targeting antibody-drug conjugates, which also show encouraging results. However, the timing and sequencing of different anti-CD19-targeting agents and how they might interfere with subsequent CAR T cell treatment is still unclear. In this review, we summarize the results of the pivotal clinical trials as well as evidence from real-world series of the use of different CD19-targeting approved agents. We discuss the effect of various therapies on CD19 expression and its implications for treatment sequencing.
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Affiliation(s)
- Carmen de Ramon Ortiz
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Sisi Wang
- Translational Research Center for Oncohematology, Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Francesco Bertoni
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Thorsten Zenz
- Department of Medical Oncology and Hematology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Federico Simonetta
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
- Translational Research Center for Oncohematology, Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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11
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Arribas AJ, Gaudio E, Napoli S, Yvon Herbaux CJ, Tarantelli C, Bordone RP, Cascione L, Munz N, Aresu L, Sgrignani J, Rinaldi A, Kwee I, Rossi D, Cavalli A, Zucca E, Stussi G, Stathis A, Sloss C, Davids MS, Bertoni F. PI3Kδ activation, IL6 over-expression, and CD37 loss cause resistance to the targeting of CD37-positive lymphomas with the antibody-drug conjugate naratuximab emtansine. bioRxiv 2023:2023.11.14.566994. [PMID: 38014209 PMCID: PMC10680772 DOI: 10.1101/2023.11.14.566994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Purpose The transmembrane protein CD37 is expressed almost exclusively in lymphoid tissues, with the highest abundance in mature B cells. CD37-directed antibody- and, more recently, cellular-based approaches have shown preclinical and promising early clinical activity. Naratuximab emtansine (Debio 1562, IMGN529) is an antibodydrug conjugate (ADC) that incorporates an anti-CD37 monoclonal antibody conjugated to the maytansinoid DM1 as payload. Naratuximab emtansine has shown activity as a single agent and in combination with the anti-CD20 monoclonal antibody rituximab in B cell lymphoma patients. Experimental Design We assessed the activity of naratuximab emtansine using in vitro models of lymphomas, correlated its activity with CD37 expression levels, characterized two resistance mechanisms to the ADC, and identified combination partners providing synergy. Results The anti-tumor activity of naratuximab emtansine was tested in 54 lymphoma cell lines alongside its free payload. The median IC 50 of naratuximab emtansine was 780 pM, and the activity, primarily cytotoxic, was more potent in B than in T cell lymphoma cell lines. In the subgroup of cell lines derived from B cell lymphoma, there was some correlation between sensitivity to DM1 and sensitivity to naratuximab emtansine (r=0.28, P = 0.06). After prolonged exposure to the ADC, one diffuse large B cell lymphoma (DLBCL) cell line developed resistance to the ADC due to the biallelic loss of the CD37 gene. After CD37 loss, we also observed upregulation of IL6 (IL-6) and other transcripts from MYD88/IL6-signaling. Recombinant IL6 led to resistance to naratuximab emtansine, while the anti-IL6 antibody tocilizumab improved the cytotoxic activity of the ADC in CD37-positive cells. In a second model, resistance was sustained by an activating mutation in the PIK3CD gene, associated with increased sensitivity to PI3K δ inhibition and a switch from functional dependence on the anti-apoptotic protein MCL1 to reliance on BCL2. The addition of idelalisib or venetoclax to naratuximab emtansine overcame resistance to the ADC in the resistant derivative while also improving the cytotoxic activity of the ADC in the parental cells. Conclusions Targeting B cell lymphoma with the CD37 targeting ADC naratuximab emtansine showed vigorous anti-tumor activity as a single agent, which was also observed in models bearing genetic lesions associated with inferior outcomes, such as MYC translocations and TP53 inactivation or resistance to R-CHOP. Resistance DLBCL models identified active combinations of naratuximab emtansine with drugs targeting IL6, PI3K δ , and BCL2. Despite notable progress in recent decades, we still face challenges in achieving a cure for a substantial number of lymphoma patients (1,2). A pertinent example is diffuse large B cell lymphoma (DLBCL), the most prevalent type of lymphoma (3). More than half of DLBCL patients can achieve remission, but around 40% of them experience refractory disease or relapse following an initial positive response (3). Regrettably, the prognosis for many of these cases remains unsatisfactory despite introducing the most recent antibody-based or cellular therapies (3,4), underscoring the importance of innovating new therapeutic strategies and gaining insights into the mechanisms of therapy resistance. CD37 is a transmembrane glycoprotein belonging to the tetraspanin family, primarily expressed on the surface of immune cells, principally in mature B cells but also, at lower levels, in T cells, macrophages/monocytes, granulocytes and dendritic cells (5) (6-8). CD37 plays a crucial role in various immune functions, including B cell activation, proliferation, and signaling, although its precise role still needs to be fully elucidated. CD37 interacts with multiple molecules, including SYK, LYN, CD19, CD22, PI3K δ , PI3K γ , and different integrins, among others (6-8). In mice, the lack of CD37 is paired with reduced T cell-dependent antibody-secreting cells and memory B cells, apparently due to the loss of CD37-mediated clustering of α 4 β 1 integrins (VLA-4) on germinal center B cells and decreased downstream activation of PI3K/AKT signaling and cell survival (5). Reflecting the expression pattern observed in normal lymphocytes, CD37 exhibits elevated expression in all mature B-cell lymphoid neoplasms, including most lymphoma subtypes, and absence in early progenitor cells or terminally differentiated plasma cells (6,8-14). In DLBCL, CD37 expression has been reported between 40% and 90% of cases across multiple studies performed using different antibodies (10,14-16). CD37-directed antibody- and, more recently, cellular-based approaches have shown preclinical (7,10-14,17-23) and early promising clinical activity (24-32). Among the CD37-targeting agents, naratuximab emtansine (Debio 1562, IMGN529) is an antibody-drug conjugate (ADC) that incorporates the anti-CD37 humanized IgG1 monoclonal antibody K7153A conjugated to the maytansinoid DM1, as payload, via the thioether linker, N-succinimidyl-4-(N-maleimidomethyl)cyclohexane-1-carboxylate (SMCC) (10). Based on the initial in vitro and in vivo evidence of anti-tumor activity in lymphoma and chronic lymphocytic leukemia (CLL) (7,10), naratuximab emtansine entered the clinical evaluation as a single agent. The phase 1 study exploring naratuximab emtansine enrolled 39 patients with relapsed/refractory B cell lymphoma (27). The overall response rate (ORR) was 13% across all patients and 22% in DLBCL patients, including the only observed complete remission (CR) (27). In preliminary results of a phase 2 trial exploring the combination of naratuximab emtansine with the anti-CD20 monoclonal antibody rituximab (18), based on positive preclinical data (18), the ORR was 45% in 76 patients with DLBCL with 24 CRs (32%), 57% in 14 patients with follicular lymphoma (five CR), 50% in four MCL patients (2 CR) (31). Here, we studied the pattern of activity of naratuximab emtansine across a large panel of cell lines derived from DLBCL and other lymphoma subtypes and characterized two resistance mechanisms to the ADC.
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12
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Guo C, Sharp A, Gurel B, Crespo M, Figueiredo I, Jain S, Vogl U, Rekowski J, Rouhifard M, Gallagher L, Yuan W, Carreira S, Chandran K, Paschalis A, Colombo I, Stathis A, Bertan C, Seed G, Goodall J, Raynaud F, Ruddle R, Swales KE, Malia J, Bogdan D, Tiu C, Caldwell R, Aversa C, Ferreira A, Neeb A, Tunariu N, Westaby D, Carmichael J, Fenor de la Maza MD, Yap C, Matthews R, Badham H, Prout T, Turner A, Parmar M, Tovey H, Riisnaes R, Flohr P, Gil J, Waugh D, Decordova S, Schlag A, Calì B, Alimonti A, de Bono JS. Targeting myeloid chemotaxis to reverse prostate cancer therapy resistance. Nature 2023; 623:1053-1061. [PMID: 37844613 PMCID: PMC10686834 DOI: 10.1038/s41586-023-06696-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
Inflammation is a hallmark of cancer1. In patients with cancer, peripheral blood myeloid expansion, indicated by a high neutrophil-to-lymphocyte ratio, associates with shorter survival and treatment resistance across malignancies and therapeutic modalities2-5. Whether myeloid inflammation drives progression of prostate cancer in humans remain unclear. Here we show that inhibition of myeloid chemotaxis can reduce tumour-elicited myeloid inflammation and reverse therapy resistance in a subset of patients with metastatic castration-resistant prostate cancer (CRPC). We show that a higher blood neutrophil-to-lymphocyte ratio reflects tumour myeloid infiltration and tumour expression of senescence-associated mRNA species, including those that encode myeloid-chemoattracting CXCR2 ligands. To determine whether myeloid cells fuel resistance to androgen receptor signalling inhibitors, and whether inhibiting CXCR2 to block myeloid chemotaxis reverses this, we conducted an investigator-initiated, proof-of-concept clinical trial of a CXCR2 inhibitor (AZD5069) plus enzalutamide in patients with metastatic CRPC that is resistant to androgen receptor signalling inhibitors. This combination was well tolerated without dose-limiting toxicity and it decreased circulating neutrophil levels, reduced intratumour CD11b+HLA-DRloCD15+CD14- myeloid cell infiltration and imparted durable clinical benefit with biochemical and radiological responses in a subset of patients with metastatic CRPC. This study provides clinical evidence that senescence-associated myeloid inflammation can fuel metastatic CRPC progression and resistance to androgen receptor blockade. Targeting myeloid chemotaxis merits broader evaluation in other cancers.
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Affiliation(s)
- Christina Guo
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Adam Sharp
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Bora Gurel
- The Institute of Cancer Research, London, UK
| | | | | | - Suneil Jain
- Northern Ireland Cancer Centre, Belfast, UK
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Ursula Vogl
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | | | | | | | - Wei Yuan
- The Institute of Cancer Research, London, UK
| | | | - Khobe Chandran
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Alec Paschalis
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Ilaria Colombo
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | | | - George Seed
- The Institute of Cancer Research, London, UK
| | | | | | - Ruth Ruddle
- The Institute of Cancer Research, London, UK
| | | | - Jason Malia
- The Institute of Cancer Research, London, UK
| | | | - Crescens Tiu
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Antje Neeb
- The Institute of Cancer Research, London, UK
| | - Nina Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Westaby
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Juliet Carmichael
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | | | - Toby Prout
- The Institute of Cancer Research, London, UK
| | | | - Mona Parmar
- The Institute of Cancer Research, London, UK
| | - Holly Tovey
- The Institute of Cancer Research, London, UK
| | | | - Penny Flohr
- The Institute of Cancer Research, London, UK
| | - Jesus Gil
- MRC London Institute of Medical Sciences (LMS), London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | - David Waugh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Centre for Cancer Biology, University of South Australia, Adelaide, South Australia, Australia
| | | | - Anna Schlag
- The Institute of Cancer Research, London, UK
| | - Bianca Calì
- Institute of Oncology Research, Bellinzona, Switzerland
| | - Andrea Alimonti
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
- Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich (ETH), Zurich, Switzerland
- Department of Medicine, Veneto Institute of Molecular Medicine, University of Padova, Padua, Italy
| | - Johann S de Bono
- The Institute of Cancer Research, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
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Hanna GJ, Stathis A, Lopez-Miranda E, Racca F, Quon D, Leyvraz S, Hess D, Keam B, Rodon J, Ahn MJ, Kim HR, Schneeweiss A, Ribera JM, DeAngelo D, Perez Garcia JM, Cortes J, Schönborn-Kellenberger O, Weber D, Pisa P, Bauer M, Beni L, Bobadilla M, Lehal R, Vigolo M, Vogl FD, Garralda E. A Phase I Study of the Pan-Notch Inhibitor CB-103 for Patients with Advanced Adenoid Cystic Carcinoma and Other Tumors. Cancer Res Commun 2023; 3:1853-1861. [PMID: 37712875 PMCID: PMC10501326 DOI: 10.1158/2767-9764.crc-23-0333] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE CB-103 selectively inhibits the CSL-NICD (Notch intracellular domain) interaction leading to transcriptional downregulation of oncogenic Notch pathway activation. This dose-escalation/expansion study aimed to determine safety, pharmacokinetics, and preliminary antitumor activity. EXPERIMENTAL DESIGN Patients ≥18 years of age with selected advanced solid tumors [namely, adenoid cystic carcinoma (ACC)] and hematologic malignancies were eligible. CB-103 was dosed orally in cycles of 28 days at escalating doses until disease progression. Notch-activating mutations were required in a dose confirmatory cohort. Endpoints included dose-limiting toxicities (DLT), safety, tumor response, pharmacokinetics, and pharmacodynamics. Exploratory analyses focused on correlates of Notch and target gene expression. RESULTS Seventy-nine patients (64, 12 dose-escalation cohorts; 15, confirmatory cohort) enrolled with 54% receiving two or more lines of prior therapy. ACC was the dominant tumor type (40, 51%). Two DLTs were observed [elevated gamma-glutamyl transferase (GGT), visual change]; recommended phase II dose was declared as 500 mg twice daily (5 days on, 2 days off weekly). Grade 3-4 treatment-related adverse events occurred in 15 patients (19%), including elevated liver function tests (LFTs), anemia, and visual changes. Five (6%) discontinued drug for toxicity; with no drug-related deaths. There were no objective responses, but 37 (49%) had stable disease; including 23 of 40 (58%) patients with ACC. In the ACC cohort, median progression-free survival was 2.5 months [95% confidence interval (CI), 1.5-3.7] and median overall survival was 18.4 months (95% CI, 6.3-not reached). CONCLUSIONS CB-103 had a manageable safety profile and biological activity but limited clinical antitumor activity as monotherapy in this first-in-human study. SIGNIFICANCE CB-103 is a novel oral pan-Notch inhibitor that selectively blocks the CSL-NICD interaction leading to transcriptional downregulation of oncogenic Notch pathway activation. This first-in-human dose-escalation and -confirmation study aimed to determine the safety, pharmacokinetics, and preliminary antitumor efficacy of CB-103. We observed a favorable safety profile with good tolerability and biological activity but limited clinical single-agent antitumor activity. Some disease stabilization was observed among an aggressive NOTCH-mutant ACC type-I subgroup where prognosis is poor and therapies are critically needed. Peripheral downregulation of select Notch target gene levels was observed with escalating doses. Future studies exploring CB-103 should enrich for patients with NOTCH-mutant ACC and investigate rational combinatorial approaches in tumors where there is limited success with investigational or approved drugs.
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Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | | | - Fabricio Racca
- IOB – Institute of Oncology Barcelona and Madrid, Hospital Quironsalud-Barcelona, Barcelona, Spain
| | - Doris Quon
- Sarcoma Oncology Research Center, Santa Monica, California
| | - Serge Leyvraz
- Charité Comprehensive Cancer Center, Charité Campus Benjamin Franklin, Berlin, Germany
| | - Dagmar Hess
- Department of Medical Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of South Korea
| | - Jordi Rodon
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Myung-Ju Ahn
- Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Republic of South Korea
| | - Hye Ryun Kim
- Severance Hospital – Yonsei Cancer Center, Seoul, Republic of South Korea
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Josep-Maria Ribera
- Institut Català d'Oncologia (Catalan Institute of Oncology [ICO]), Josep Carreras Research Institute, Barcelona, Spain
| | - Daniel DeAngelo
- Division of Leukemia, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jose Manuel Perez Garcia
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quiron Hospital, Barcelona, Spain
- Medica Scientia Innovation Research, Barcelona, Spain
- Medica Scientia Innovation Research, Ridgewood, New Jersey
| | - Javier Cortes
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quiron Hospital, Barcelona, Spain
- Medica Scientia Innovation Research, Barcelona, Spain
- Medica Scientia Innovation Research, Ridgewood, New Jersey
| | | | - Dirk Weber
- Cellestia Biotech AG, Basel, Switzerland
| | - Pavel Pisa
- piMedConsulting Ltd, Gersau, Switzerland
| | | | - Laura Beni
- Cellestia Biotech AG, Basel, Switzerland
| | | | - Raj Lehal
- Cellestia Biotech AG, Basel, Switzerland
| | | | | | - Elena Garralda
- Early Drug Development Unit, Clinical Research Program, Vall d'Hebron University Hospital and Institute of Oncology (VHIO) and Medical Oncology, Vall d'Hebron University Hospital (HUVH), Barcelona, Spain
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14
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Cekani E, Martorell C, Martucci F, Patella M, Cafarotti S, Valenti A, Freguia S, Molinari F, Froesch P, Frattini M, Stathis A, Wannesson L. Prognostic implication of PD-L1 in early-stage non-small cell lung cancer: a retrospective single-centre study. Swiss Med Wkly 2023; 153:40110. [PMID: 37769653 DOI: 10.57187/smw.2023.40110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The prognostic role of programmed death-ligand 1 (PD-L1) expression in patients with localised and locally advanced non-small cell lung cancer has not been fully elucidated. This information could help to better interpret recent and upcoming results of phase III adjuvant or neoadjuvant anti-PD-1/PD-L1 immunotherapy studies. METHODS In a cohort of 146 patients with early or locally advanced non-small cell lung cancer treated with curative intent (by surgery or radiotherapy), we investigated the prognostic value of PD-L1 expression and its correlation with other biological and clinical features. PD-L1 expression was stratified by quartiles. Primary endpoints were overall and disease-free survival. We also analysed the prognostic impact of the presence of actionable mutations, implemented treatment modality and completion of the treatment plan. Neither type of patient received neoadjuvant or adjuvant immunotherapy or target therapy. RESULTS Of the 146 selected patients, 32 (21.9%) presented disease progression and 15 died (10.3%) at a median follow-up of 20 months. In a univariable analysis, PD-L1 expression ≥25% was associated with significantly lower disease-free survival (hazard ratio [HR]) 1.9, 95% confidence interval [CI] 1.0-3.9, p = 0.049). PD-L1 expression ≥50% did not lead to disease-free survival or overall survival benefits (HR 1.2 and 1.1, respectively; 95% CI 0.6-2.6 and 0.3-3.4, respectively; pnot significant). In a multivariate analysis, a stage >I (HR 2.7, 95% CI 1.2-6, p = 0.012) and having an inoperable tumour (HR 3.2, 95% CI 1.4-7.4, p = 0.005) were associated with lower disease-free survival. CONCLUSION The population of patients with early-stage non-small cell lung cancer and PD-L1 expression ≥25% who were treated with curative intent during the pre-immunotherapy era exhibited a worse prognosis. This finding provides justification for the utilisation of adjuvant immunotherapy in this subgroup of patients, based on the current evidence derived from disease-free survival outcomes. However, for patients with PD-L1 expression <25%, opting to wait for the availability of the overall survival results may be a prudent choice.
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Affiliation(s)
- Elona Cekani
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Carolina Martorell
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Francesco Martucci
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Miriam Patella
- Thoracic Surgery Department, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Stefano Cafarotti
- Thoracic Surgery Department, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Antonio Valenti
- Pneumology Department, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | | | | | - Patrizia Froesch
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | | | - Anastasios Stathis
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Luciano Wannesson
- Istituto Oncologico della Svizzera Italiana (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
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15
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Stathis A, Tolcher AW, Wang JS, Renouf DJ, Chen LC, Suttner LH, Freshwater T, Webber AL, Nayak T, Siu LL. Results of an open-label phase 1b study of the ERK inhibitor MK-8353 plus the MEK inhibitor selumetinib in patients with advanced or metastatic solid tumors. Invest New Drugs 2023:10.1007/s10637-022-01326-3. [PMID: 37040046 DOI: 10.1007/s10637-022-01326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 04/12/2023]
Abstract
AIM We evaluated MK-8353 (small molecule inhibitor of extracellular signal-regulated kinase 1/2) plus selumetinib (mitogen-activated extracellular signal-regulated kinase 1/2 inhibitor) in patients with advanced solid tumors. METHODS This phase 1b, open-label, dose-escalation study (NCT03745989) enrolled adults with histologically/cytologically documented, locally advanced/metastatic solid tumors. MK-8353/selumetinib dose combinations were intended to be investigated in sequence: 50/25, 100/50, 150/75, 200/75, 200/100, and 250/100. Each agent was administered orally BID 4 days on/3 days off in repeating cycles every 21 days. Primary objectives were safety and tolerability and to establish preliminary recommended phase 2 doses for combination therapy. RESULTS Thirty patients were enrolled. Median (range) age was 61.5 (26-78) years and 93% had received previous cancer therapy. Among 28 patients in the dose-limiting toxicities [DLT]-evaluable population, 8 experienced DLTs: 1/11 (9%) in the MK-8353/selumetinib 100/50-mg dose level experienced a grade 3 DLT (urticaria), and 7/14 (50%) in the 150/75-mg dose level experienced grade 2/3 DLTs (n = 2 each of blurred vision, retinal detachment, vomiting; n = 1 each of diarrhea, macular edema, nausea, retinopathy). The DLT rate in the latter dose level exceeded the prespecified target DLT rate (~30%). Twenty-six patients (87%) experienced treatment-related adverse events (grade 3, 30%; no grade 4/5), most commonly diarrhea (67%), nausea (37%), and acneiform dermatitis (33%). Three patients (10%) experienced treatment-related adverse events leading to treatment discontinuation. Best response was stable disease in 14 patients (n = 10 with MK-8353/selumetinib 150/75 mg). CONCLUSION MK-8353/selumetinib 50/25 mg and 100/50 mg had acceptable safety and tolerability, whereas 150/75 mg was not tolerable. No responses were observed.
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Affiliation(s)
- Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, via A. Gallino 12, Bellinzona 6500, Switzerland.
| | | | - Judy S Wang
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL, USA
| | | | | | | | | | | | | | - Lillian L Siu
- Princess Margaret Cancer Centre, Toronto, ON, Canada
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16
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Arribas AJ, Napoli S, Cascione L, Barnabei L, Sartori G, Cannas E, Gaudio E, Tarantelli C, Mensah AA, Spriano F, Zucchetto A, Rossi FM, Rinaldi A, de Moura MC, Stathis A, Stussi G, Gattei V, Brown JR, Esteller M, Zucca E, Rossi D, Bertoni F. Abstract 394: ERBB4-mediated signaling is a mediator of resistance to BTK and PI3K inhibitors in B cell lymphoid neoplasms. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Abstract
Background: Marginal zone lymphoma (MZL) is an indolent yet incurable B cell malignancy. Two BTK inhibitors, ibrutinib and zanubrutinib, are FDA approved for relapsed/refractory MZL patients. PI3K inhibitors have also shown clinical activity. The identification of the mechanisms of resistance can provide useful information to optimize the use of the agents. We previously reported an IL6 driven MZL model of PI3K inhibitors resistance developed by prolonged exposure to the PI3Kδ inhibitor idelalisib (Arribas, Haematologica 2022). Here, we present the detailed characterization of a second model with resistance to both BTK and PI3K inhibitors.
Methods: MTT assay. RNA-Seq, whole exome sequencing, miRNA and methylation profiling. FACS and ELISA analyses.
Results: Resistant cells, developed by continuous exposure of the cell line Karpas1718 to idelalisib, showed resistance to various inhibitors of BTK (ibrutinib, zanubrutinib, acalabrutinib and pirtobrutinib) and PI3K (idelalisib, duvelisib, copanlisib and umbralisib). No mutations affecting BTK, PLCG2 or CXCR4 were identified in resistant cells, which had higher expression of genes involved in ERBB signaling (HBEGF, NRG2, ERBB4), cell proliferation (PBK, MKI67, TCL1A) and DNA recombination (RAG1, RAG2) than parental cells. We confirmed cell surface ERBB4 up-regulation, and the cytoplasmatic expression and secretion of its ligand HBEGF in resistant cells, which led to increased levels of p-AKT and p-ERK. The miRNAs miR-29c and let-7c, known negative regulators of the HBEGF-ERBB axis, were fully methylated and down-regulated in resistant compared to parental cells. ERBB4 genetic silencing improved sensitivity to PI3Kδ inhibitor, and exposure to let-7c or miR-29c mimics decreased secreted HBEGF and recovered sensitivity to PI3K inhibitors in resistant cells. Addition of recombinant HBEGF (rHBEGF) induced resistance to BTK and to PI3K inhibitors in parental cells and in other lymphoma models including mantle cell lymphomas and diffuse large B cell lymphomas (DLBCL). The rHBEGF induced resistance was reverted adding the ERBB inhibitor lapatinib. To extend our findings to the clinical context, using two MZL and one DLBCL expression datasets, we showed HBEGF and ERBB4 expression in clinical specimens. Finally, HBEGF levels appeared elevated in the serum of CLL patients with primary or acquired resistance to PI3Kδ or to BTK inhibitors, compared to patients responding to the drugs and paired for similar clinical features.
Conclusions: We characterized a novel B cell lymphoma model of secondary resistance to BTK and PI3K inhibitors. Our results indicate that epigenetic plasticity led to the activation of HBEGF-ERBB signaling sustaining resistance to BTK/PI3K inhibitors, which can be overcome using epigenetic agents and ERBB inhibitors. These therapeutics approaches could be tested in novel clinical trials. AJA, SN: equally contributed.
Citation Format: Alberto J. Arribas, Sara Napoli, Luciano Cascione, Laura Barnabei, Giulio Sartori, Eleonora Cannas, Eugenio Gaudio, Chiara Tarantelli, Afua A. Mensah, Filippo Spriano, Antonella Zucchetto, Francesca M. Rossi, Andrea Rinaldi, Manuel Castro de Moura, Anastasios Stathis, Georg Stussi, Valter Gattei, Jennifer R. Brown, Manel Esteller, Emanuele Zucca, Davide Rossi, Francesco Bertoni. ERBB4-mediated signaling is a mediator of resistance to BTK and PI3K inhibitors in B cell lymphoid neoplasms [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 394.
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Affiliation(s)
| | - Sara Napoli
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Laura Barnabei
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | - Giulio Sartori
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Eugenio Gaudio
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Afua A. Mensah
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | | | | | - Andrea Rinaldi
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | | | | | - Georg Stussi
- 4Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Valter Gattei
- 2Centro di Riferimento Oncologico di Aviano – CRO, Aviano, Italy
| | - Jennifer R. Brown
- 5Chronic Lymphocytic Leukemia Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Manel Esteller
- 3Josep Carreras Leukaemia Research Institute, Barcelona, Spain
| | - Emanuele Zucca
- 1Institute of Oncology Research, Bellinzona, Switzerland
| | - Davide Rossi
- 1Institute of Oncology Research, Bellinzona, Switzerland
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17
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Spriano F, Tarantelli C, Arribas AJ, Gaudio E, Cascione L, Aresu L, Rinaldi A, Zucca E, Rossi D, Stathis A, Murone M, Radtke F, Lehal R, Bertoni F. In vitro anti-lymphoma activity of the first-in-class pan-NOTCH transcription inhibitor CB-103. Br J Haematol 2023; 200:669-672. [PMID: 36484636 DOI: 10.1111/bjh.18576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Filippo Spriano
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland
| | - Chiara Tarantelli
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland
| | - Alberto J Arribas
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Eugenio Gaudio
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland
| | - Luciano Cascione
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Luca Aresu
- Department of Veterinary Science, University of Turin, Grugliasco, Turin, Italy
| | - Andrea Rinaldi
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland
| | - Emanuele Zucca
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland.,Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Davide Rossi
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland.,Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | | | - Freddy Radtke
- Swiss Institute for Experimental Cancer Research, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Francesco Bertoni
- Faculty of Biomedical Sciences, Institute of Oncology Research, USI, Bellinzona, Switzerland.,Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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18
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Joerger M, Hundsberger T, Haefliger S, von Moos R, Hottinger AF, Kaindl T, Engelhardt M, Marszewska M, Lane H, Roth P, Stathis A. Safety and anti-tumor activity of lisavanbulin administered as 48-hour infusion in patients with ovarian cancer or recurrent glioblastoma: a phase 2a study. Invest New Drugs 2023; 41:267-275. [PMID: 36792805 PMCID: PMC10140113 DOI: 10.1007/s10637-023-01336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Lisavanbulin (BAL101553) is the prodrug of avanbulin (BAL27862), a microtubule-destabilizing agent. The goal of this study (NCT02895360) was to characterize the safety, tolerability and antitumor activity of lisavanbulin administered as a 48-hour intravenous (IV) infusion at the recommended Phase 2 dose (RP2D) of 70 mg/m2. Results from the Phase 1 dose-escalation portion of the study identifying the RP2D have been previously reported. Here, we present the findings from the Phase 2a portion of this study. Methods. This multi-center, open-label study included patients with ovarian, fallopian-tube, or primary peritoneal cancer that was either platinum-resistant or refractory (11 patients), or with first recurrence of glioblastoma (12 patients). Lisavanbulin was administered as a 48-hour IV infusion on Days 1, 8, and 15 of a 28-day cycle. Results. Lisavanbulin was well tolerated in both patient cohorts. Thirteen patients (56.5%) developed 49 adverse events assessed as related to study treatment. The majority were mild or moderate; four were grade 3/4. Sixteen SAEs were reported in nine patients (39.1%), with none considered related to study treatment. No AEs led to permanent treatment discontinuation. Three patients in the ovarian cancer cohort had stable disease with lesion size reductions after two cycles of treatment; in the glioblastoma cohort, one patient showed partial response with a > 90% glioblastoma area reduction as best response, and one patient had stable disease after eight cycles of treatment. Conclusion. This study demonstrated a favorable safety and tolerability profile of 48-hour continuous IV infusion of lisavanbulin in patients with solid extracranial tumors or glioblastoma. Clinicaltrials.gov registration: NCT02895360.
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Affiliation(s)
- Markus Joerger
- Department of Hematology/Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Thomas Hundsberger
- Department of Hematology/Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Simon Haefliger
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger von Moos
- Department of Medical Oncology/Hematology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Andreas F Hottinger
- Lundin Family Brain Tumor Research Center, Departments of Oncology & Clinical Neurosciences, Lausanne University Hospital & University of Lausanne, Lausanne, Switzerland
| | - Thomas Kaindl
- Basilea Pharmaceutica International Ltd, Hegenheimermattweg 167b, Allschwil, 4123, Switzerland.
| | - Marc Engelhardt
- Basilea Pharmaceutica International Ltd, Hegenheimermattweg 167b, Allschwil, 4123, Switzerland
| | - Michalina Marszewska
- Basilea Pharmaceutica International Ltd, Hegenheimermattweg 167b, Allschwil, 4123, Switzerland
| | - Heidi Lane
- Basilea Pharmaceutica International Ltd, Hegenheimermattweg 167b, Allschwil, 4123, Switzerland
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
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19
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Bertoni F, Tarantelli C, Spriano F, Cascione L, Civanelli E, Cannas E, Mensah A, Arribas A, Napoli S, Rinaldi A, Stathis A, Niewola K, Di Conza G, Lahn M, Santoro A, Carlo-Stella C. 53P Characterization of the non-ATP competitive PI3Kdelta inhibitor IOA-244 in lymphoma models: From single agent to combination screen and clinical investigation. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
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20
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Arribas AJ, Napoli S, Cascione L, Barnabei L, Sartori G, Cannas E, Gaudio E, Tarantelli C, Mensah AA, Spriano F, Zucchetto A, Rossi FM, Rinaldi A, de Moura MC, Jovic S, Pittau RB, Stathis A, Stussi G, Gattei V, Brown JR, Esteller M, Zucca E, Rossi D, Bertoni F. ERBB4-mediated signaling is a mediator of resistance to BTK and PI3K inhibitors in B cell lymphoid neoplasms. bioRxiv 2023:2023.01.01.522017. [PMID: 36711490 PMCID: PMC9881865 DOI: 10.1101/2023.01.01.522017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BTK and PI3K inhibitors are among the drugs approved for the treatment of patients with lymphoid neoplasms. Although active, their ability to lead as single agents to long-lasting complete remission is rather limited especially in the lymphoma setting. This indicates that tumor cells often develop resistance to the drugs. Here, we show that the overexpression of ERBB4 and its ligands represents a modality for B cell neoplastic cells to bypass the anti-tumor activity of BTK and PI3K inhibitors and that targeted pharmacological interventions can restore sensitivity to the small molecules. We started from a marginal zone lymphoma (MZL) cell line, Karpas-1718, kept under prolonged exposure to the PI3Kδ inhibitor idelalisib until acquisition of resistance, or with no drug. Cells underwent transcriptome, miRNA and methylation profiling, whole exome sequencing, and pharmacological screening which led to the identification of the overexpression of ERBB4 and its ligands HBEGF and NRG2 in the resistant cells. Cellular and genetic experiments demonstrated the involvement of this axis in blocking the anti-tumor activity of various BTK and PI3K inhibitors, currently used in the clinical setting. Addition of recombinant HBEGF induced resistance to BTK and PI3K inhibitors in parental cells but also in additional lymphoma models. Combination with the ERBB inhibitor lapatinib was beneficial in resistant cells and in other lymphoma models already expressing the identified resistance factors. Multi-omics analysis underlined that an epigenetic reprogramming affected the expression of the resistance-related factors, and pretreatment with demethylating agents or EZH2 inhibitors overcame the resistance. Resistance factors were shown to be expressed in clinical samples, further extending the findings of the study. In conclusions, we identified a novel ERBB4-driven mechanism of resistance to BTK and PI3K inhibitors and treatments that appear to overcome it. Key points A mechanism of secondary resistance to the PI3Kδ and BTK inhibitors in B cell neoplasms driven by secreted factors.Resistance can be reverted by targeting ERBB signaling.
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21
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Araujo D, Greystoke A, Bates S, Bayle A, Calvo E, Castelo-Branco L, de Bono J, Drilon A, Garralda E, Ivy P, Kholmanskikh O, Melero I, Pentheroudakis G, Petrie J, Plummer R, Ponce S, Postel-Vinay S, Siu L, Spreafico A, Stathis A, Steeghs N, Yap C, Yap TA, Ratain M, Seymour L. Oncology phase I trial design and conduct: time for a change - MDICT Guidelines 2022. Ann Oncol 2023; 34:48-60. [PMID: 36182023 DOI: 10.1016/j.annonc.2022.09.158] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/18/2022] [Indexed: 02/03/2023] Open
Abstract
In 2021, the Food and Drug Administration Oncology Center of Excellence announced Project Optimus focusing on dose optimization for oncology drugs. The Methodology for the Development of Innovative Cancer Therapies (MDICT) Taskforce met to review and discuss the optimization of dosage for oncology trials and to develop a practical guide for oncology phase I trials. Defining a single recommended phase II dose based on toxicity may define doses that are neither the most effective nor the best tolerated. MDICT recommendations address the need for robust non-clinical data which are needed to inform trial design, as well as an expert team including statisticians and pharmacologists. The protocol must be flexible and adaptive, with clear definition of all endpoints. Health authorities should be consulted early and regularly. Strategies such as randomization, intrapatient dose escalation, and real-world eligibility criteria are encouraged whereas serial tumor sampling is discouraged in the absence of a strong rationale and appropriately validated assay. Endpoints should include consideration of all longitudinal toxicity. The phase I dose escalation trial should define the recommended dose range for later testing in randomized phase II trials, rather than a single recommended phase II dose, and consider scenarios where different populations may require different dosages. The adoption of these recommendations will improve dosage selection in early clinical trials of new anticancer treatments and ultimately, outcomes for patients.
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Affiliation(s)
- D Araujo
- Hospital de Base, Sao Jose do Rio Preto, Brazil
| | - A Greystoke
- Northern Centre for Cancer Care, Newcastle, UK
| | - S Bates
- Division of Hematology and Oncology, Department of Medicine, Columbia University, New York, USA
| | - A Bayle
- Institut Gustave Roussy, Paris, France
| | - E Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - L Castelo-Branco
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - J de Bono
- Institute of Cancer Research, University of London, London; The Royal Marsden Hospital, London, UK
| | - A Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, USA
| | - E Garralda
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - P Ivy
- National Cancer Institute, USA Cancer Therapy Evaluation Program Investigational Drug Branch (NCI/CTEP/IDB), Bethesda, USA
| | - O Kholmanskikh
- European Medicines Agency, Amsterdam, Netherlands; Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - I Melero
- CUN and CIMA, University of Navarra, Pamplona, Spain
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - J Petrie
- Canadian Cancer Trials Group, Queen's University, Kingston
| | - R Plummer
- Northern Centre for Cancer Care, Newcastle, UK
| | - S Ponce
- Institut Gustave Roussy, Paris, France
| | | | - L Siu
- Princess Margaret Cancer Centre, Toronto, Canada
| | - A Spreafico
- Princess Margaret Cancer Centre, Toronto, Canada
| | - A Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - N Steeghs
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Yap
- Institute of Cancer Research, University of London, London
| | - T A Yap
- Department of Investigational Cancer Therapeutics, University of Texas, MD Anderson Cancer Center, Houston
| | - M Ratain
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, USA
| | - L Seymour
- Canadian Cancer Trials Group, Queen's University, Kingston.
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Tarantelli C, Spriano F, Cascione L, Civanelli E, Cannas E, Mensah A, Arribas A, Rinaldi A, Stathis A, Di Conza G, Niewola-Staszkowska K, Lahn M, Bertoni F. Non-ATP competitive inhibition of PI3Kδ with IOA-244 shows anti-lymphoma activity. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Tarantelli C, Civanelli E, Gaudio E, Stathis A, Merlino G, Binaschi M, Bertoni F. The anti-CD205 antibody drug conjugate MEN1309/OBT076 shows synergistic activity in combination with the monoclonal antibody rituximab in diffuse large B cell lymphomas. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Pagel JM, Soumerai JD, Reddy N, Jagadeesh D, Stathis A, Asch A, Salman H, Kenkre VP, Iasonos A, Llorin-Sangalang J, Li J, Zelenetz AD. Zandelisib with continuous or intermittent dosing as monotherapy or in combination with rituximab in patients with relapsed or refractory B-cell malignancy: a multicentre, first-in-patient, dose-escalation and dose-expansion, phase 1b trial. Lancet Oncol 2022; 23:1021-1030. [PMID: 35835137 DOI: 10.1016/s1470-2045(22)00333-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Phosphatidylinositol 3-kinase p110δ (PI3Kδ) inhibitors are efficacious in B-cell malignancies. Immune-related adverse events might be mitigated with intermittent dosing. We aimed to evaluate the safety and antitumour activity of zandelisib, a potent novel PI3Kδ inhibitor, with continuous or intermittent dosing as monotherapy or in combination with rituximab, in patients with relapsed or refractory B-cell malignancy. METHODS We conducted a first-in-patient, dose-escalation and dose-expansion, phase 1b trial at ten treatment centres across Switzerland and the USA. Eligible patients were aged 18 years or older with relapsed or refractory B-cell malignancy (limited to follicular lymphoma or chronic lymphocytic leukaemia during dose escalation) and an Eastern Cooperative Oncology Group performance status of 0-2, and had received at least one previous line of therapy and no previous PI3Kδ inhibitor treatment. In the dose-escalation study, participants received oral zandelisib once daily (60 mg, 120 mg, or 180 mg; we did not evaluate four additional planned dose levels). The 60 mg dose was further evaluated as monotherapy or with intravenous rituximab 375 mg/m2 on days 1, 8, 15, and 22 of cycle 1 and day 1 of cycles 3-6, using a continuous daily schedule or intermittent dosing therapy (days 1-28 of cycles 1-2 and days 1-7 of subsequent cycles) in 28-day cycles. Treatment was continued until evidence of disease progression, intolerance, or withdrawal of consent by the patient. Primary endpoints were safety (dose-limiting toxicities and maximum tolerated dose), minimum biologically effective dose, and a composite endpoint to assess the activity of each dose level, and were analysed by intention to treat. The zandelisib monotherapy and zandelisib-rituximab combination cohorts have completed accrual, but accrual to a cohort evaluating zandelisib with zanubrutinib is ongoing. This study is registered with ClinicalTrials.gov, NCT02914938. FINDINGS Between Nov 17, 2016, and June 2, 2020, 100 patients were assessed for eligibility and 97 were enrolled and received zandelisib monotherapy (n=56) or zandelisib plus rituximab (n=41), with zandelisib administered on either a continuous schedule (n=38) or with intermittent dosing (n=59). No dose-limiting toxicities were observed, the objective of determining the maximum tolerated dose was abandoned, and antitumour activity was similar across the evaluated doses activity (objective responses in 11 [92%; 95% CI 61·5-99·8] of 12 patients at both 60 mg and 120 mg doses, and in five [83%; 95% CI 35·9-99·6] of six patients at 180 mg). With a median duration of exposure of 15·2 months (IQR 3·7-21·7), the most common grade 3-4 adverse events were neutrophil count decrease (ten [17%] of 59 patients in the intermittent dosing group and four [11%] of 38 in the continuous dosing group), diarrhoea (three [5%] and eight [21%]), pneumonia (one [2%] and six [16%]), alanine aminotransferase increase (three [5%] and two [5%]), and colitis (two [3%] and one [3%]). 26 (44%) of 59 patients in the intermittent dosing group and 29 (76%) of 38 patients in the continuous dosing group had grade 3-4 adverse events. Treatment-related serious adverse events occurred in eight (21%) patients in the continuous dosing group and five (8%) patients in the intermittent dosing group. There were no treatment-related deaths. INTERPRETATION Zandelisib 60 mg once daily on an intermittent dosing schedule was safe, with low frequency of grade 3 or worse adverse events, warranting the ongoing global phase 2 and phase 3 trials. FUNDING MEI Pharma.
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Affiliation(s)
| | | | - Nishitha Reddy
- Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, Nashville, TN, USA
| | | | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, Switzerland
| | - Adam Asch
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Huda Salman
- Stony Brook University Hospital, Stony Brook, NY, USA
| | | | - Alexia Iasonos
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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25
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Spriano F, Sartori G, Tarantelli C, Barreca M, Golino G, Rinaldi A, Napoli S, Mascia M, Scalise L, Arribas AJ, Cascione L, Zucca E, Stathis A, Gaudio E, Bertoni F. Pharmacologic screen identifies active combinations with BET inhibitors and LRRK2 as a novel putative target in lymphoma. eJHaem 2022; 3:764-774. [PMID: 36051080 PMCID: PMC9422027 DOI: 10.1002/jha2.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
Inhibitors of the Bromo‐ and Extra‐Terminal domain (BET) family proteins have strong preclinical antitumor activity in multiple tumor models, including lymphomas. Limited single‐agent activity has been reported in the clinical setting. Here, we have performed a pharmacological screening to identify compounds that can increase the antitumor activity of BET inhibitors in lymphomas. The germinal center B‐cell like diffuse large B‐cell lymphoma (DLBCL) cell lines OCI‐LY‐19 and WSU‐DLCL2 were exposed to 348 compounds given as single agents at two different concentrations and in combination with the BET inhibitor birabresib. The combination partners included small molecules targeting important biologic pathways such as PI3K/AKT/MAPK signaling and apoptosis, approved anticancer agents, kinase inhibitors, epigenetic compounds. The screening identified a series of compounds leading to a stronger antiproliferative activity when given in combination than as single agents: the histone deacetylase (HDAC) inhibitors panobinostat and dacinostat, the mTOR (mechanistic target of rapamycin) inhibitor everolimus, the ABL/SRC (ABL proto‐oncogene/SRC proto oncogene) inhibitor dasatinib, the AKT1/2/3 inhibitor MK‐2206, the JAK2 inhibitor TG101209. The novel finding was the benefit given by the addition of the LRRK2 inhibitor LRRK2‐IN‐1, which was validated in vitro and in vivo. Genetic silencing demonstrated that LRRK2 sustains the proliferation of lymphoma cells, a finding paired with the association between high expression levels and inferior outcome in DLBCL patients. We identified combinations that can improve the response to BET inhibitors in lymphomas, and LRRK2 as a gene essential for lymphomas and as putative novel target for this type of tumors.
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Affiliation(s)
- Filippo Spriano
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Giulio Sartori
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Chiara Tarantelli
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Marilia Barreca
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
- Department of Biological Chemical and Pharmaceutical Sciences and Technologies (STEBICEF) University of Palermo Palermo Italy
| | - Gaetanina Golino
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Andrea Rinaldi
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Sara Napoli
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Michele Mascia
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Lorenzo Scalise
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Alberto J. Arribas
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
- SIB Swiss Institute of Bioinformatics Lausanne Switzerland
| | - Luciano Cascione
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
- SIB Swiss Institute of Bioinformatics Lausanne Switzerland
| | - Emanuele Zucca
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
- Department of Oncology Oncology Institute of Southern Switzerland Ente Ospedaliero Cantonale Bellinzona Switzerland
| | - Anastasios Stathis
- Department of Oncology Oncology Institute of Southern Switzerland Ente Ospedaliero Cantonale Bellinzona Switzerland
- Faculty of Biomedical Sciences Università della Svizzera Italiana Lugano Switzerland
| | - Eugenio Gaudio
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
| | - Francesco Bertoni
- Institute of Oncology Research Faculty of Biomedical Sciences Università della Svizzera Italiana Bellinzona Switzerland
- Department of Oncology Oncology Institute of Southern Switzerland Ente Ospedaliero Cantonale Bellinzona Switzerland
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26
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Perale G, Gaudio E, Casalini T, Aresu L, De Corso AR, Spriano F, Tarantelli C, Stathis A, Castrovinci A, Bertoni F. Abstract 1879: A novel implantable device to in vivo assess anti-cancer agents. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The high variability in clinical responses observed in cancer patients highlights the need of a tailored therapeutic approach. A possible modality is to assess drugs sensitivity directly in the patients, by introducing small drug delivering devices in tumor sites for a very short period and then looking at the local anti-tumor effect. Here, we present the design of an innovative drug eluting device and its test with the BTK inhibitor ibrutinib as an example of small molecules.
Methods: Mathematical models considered factors related to drug (MW), physical properties, desired concentrations in surrounding tissue, polymers and tissue physical features to identify the optimal polymers and the drug loading for the desired release profile over 24h. In vitro proliferation was measured with the MTT assay, in vivo experiments done in NOD-SCID mice (license TI05/2021), and immunohistochemistry on FFPE xenograft sections stained for Ki67 and cleaved caspase 3 (CASP-3).
Results: Device was designed as an arrow-shaped cylinder, with flat end and flatter sections to be filled with the drug-eluting polymers. Prototypes were built in nylon6,6, a biocompatible but stable polymer. Ibrutinib was incorporated in low MW polyester poly-ε-caprolactone (PCL) as biopolymer by solvent casting. Polymeric coating onto devices was done with a dedicated automatic device.Devices loaded with biopolymer and different concentrations of ibrutinib or “empty” biopolymers were first in vitro tested using diffuse large B cell lymphoma (DLBCL) cell lines. Over 72h, devices with drug inhibited proliferation of the ibrutinib-sensitive TMD8 and OCI-Ly10 cell lines, but not of the ibrutinib-resistant SU-DHL-2 and U2932. No effect was seen with devices with ibrutinib-free biopolymers. Devices, empty or loaded with ibrutinib (5μg), were then inserted in xenografts of ibrutinib-sensitive cell line OCI-Ly10 and ibrutinib resistant U2932. After 24h, mice were sacrificed and xenografts analyzed. By Ki67 and CASP-3 a reduced cell proliferation and an increased apoptosis in the region surrounding the device was observed in the ibrutinib-sensitive xenografts, conversely nor reduced cell proliferation nor apoptosis induction were identified in the ibrutinib-resistant xenografts.
Conclusions: We have created a prototype of a device that can locally release drugs allowing the evaluation of anti-tumor activity, optimizing cures tailored to single patient. The system can be further developed to include multiple drugs, including e.g. antibodies.
Citation Format: Giuseppe Perale, Eugenio Gaudio, Tommaso Casalini, Luca Aresu, Anna Rita De Corso, Filippo Spriano, Chiara Tarantelli, Anastasios Stathis, Andrea Castrovinci, Francesco Bertoni. A novel implantable device to in vivo assess anti-cancer agents [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1879.
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Affiliation(s)
| | - Eugenio Gaudio
- 2Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Tommaso Casalini
- 3University of Applied Sciences of Southern Switzerland, Viganello, Switzerland
| | - Luca Aresu
- 4Department of Veterinary Science, University of Turin, Grugliasco, Italy
| | - Anna Rita De Corso
- 3University of Applied Sciences of Southern Switzerland, Viganello, Switzerland
| | - Filippo Spriano
- 2Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Chiara Tarantelli
- 2Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
| | - Anastasios Stathis
- 5Oncology Institute of Southern Switzerland, Ente Ospedaliere Cantonale, Bellinzona, Switzerland
| | - Andrea Castrovinci
- 3University of Applied Sciences of Southern Switzerland, Viganello, Switzerland
| | - Francesco Bertoni
- 2Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland
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Yap TA, Tan DS, Stathis A, Shapiro GI, Iwasa S, Joerger M, Zhang J, Plummer R, Sawyer M, Tan AC, Castonguay V, Gabrail N, Matsubara N, Wilkinson G, Ludwig M, Zhou Y, Merz C, Hreiki J, Sharma N, deBono J. Abstract CT006: Phase Ib expansion trial of the safety and efficacy of the oral ataxia telangiectasia and Rad3-related (ATR) inhibitor elimusertib in advanced solid tumors with DNA damage response (DDR) defects. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: ATR kinase is a critical component of DDR machinery and is activated by DNA damage or replication stress. Elimusertib is a selective ATR inhibitor with promising antitumor activity in pts with advanced solid tumors with ataxia telangiectasia mutated (ATM) protein loss and/or ATM putative deleterious alterations (Yap et al. Cancer Discov 2021). We report here the safety and efficacy of elimusertib in expansion cohorts of pts with a range of cancer types and DDR deficiencies and/or ATM loss. We also explored an alternative dose schedule in pts with ATM aberrations.
Methods: Pts with advanced solid tumors resistant or refractory to standard treatment were screened for pathogenic DDR defects by next-generation sequencing or ATM protein loss by immunohistochemistry (IHC) analysis of baseline tumor tissue. Pts were assigned to cohorts: colorectal cancer (CRC); castration-resistant prostate cancer (CRPC); HER2− breast cancer (BC); gynecologic (GYN, mainly ovarian and endometrial); and advanced cancers with ATM IHC loss. Pts were treated with elimusertib 40 mg twice daily (BID) 3 days on/4 days off (3 on/4 off). A schedule of 3 on/11 off was also explored by dose escalation in pts with ATM loss or inactivating mutation.
Results: 143 pts received ≥1 dose of elimusertib 40 mg BID 3 on/4 off, including 24 CRC, 19 CRPC, 19 BC, 45 GYN, and 36 ATM loss. 56% of pts had ≥4 prior therapy lines. Drug-related grade 3 and 4 treatment-emergent adverse events (TEAEs) were observed in 69% and 15% of pts, respectively, mainly anemia, leukopenia/neutropenia, and thrombocytopenia leading to dose modification but not withdrawal. 32 pts were treated 3 on/11 off with doses from 60 to 120 mg BID. Compared with 3 on/4 off, drug-related grade ≥3 hematologic TEAEs and dose modifications improved at lower doses, with 80 mg 3 on/11 off determined as the recommended dose. In pts receiving elimusertib 3 on/4 off, 5 RECIST partial responses were observed: 1 in ovarian (BRCA1 heterozygous mutation), 1 in BC (BRCA2 mutation), and 3 in ATM IHC loss: 2 CRPC pts both with ATM mutations (1 heterozygous, 1 homozygous), including 1 with FANCA mutation; 1 esophageal with ATM mutation. In pts with ATM IHC loss, objective response rate (ORR) was 9% and disease control rate (DCR) was 65%. A similar ORR was seen on 3 on/11 off in pts with ATM aberrations. In GYN pts, ORR was 2.3% and DCR was 73%.
Conclusions: Elimusertib monotherapy demonstrated clinical activity in pts with DDR defects. Overall safety was manageable and hematologic toxicity improved on the 3 on/11 off schedule. Further biomarker analysis is underway to identify potential gene signatures associated with response. Clinical development of elimusertib in combination with checkpoint inhibitors and chemotherapy is ongoing (NCT04095273, NCT04514497).
Citation Format: Timothy A. Yap, David S. Tan, Anastasios Stathis, Geoffrey I. Shapiro, Satoru Iwasa, Markus Joerger, Jingsong Zhang, Ruth Plummer, Michael Sawyer, Aaron C. Tan, Vincent Castonguay, Nashat Gabrail, Nobuaki Matsubara, Gary Wilkinson, Matthias Ludwig, Yinghui Zhou, Claudia Merz, Joseph Hreiki, Neelesh Sharma, Johan deBono. Phase Ib expansion trial of the safety and efficacy of the oral ataxia telangiectasia and Rad3-related (ATR) inhibitor elimusertib in advanced solid tumors with DNA damage response (DDR) defects [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT006.
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Affiliation(s)
- Timothy A. Yap
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - David S. Tan
- 2National University Hospital, Singapore, Singapore
| | | | | | | | | | - Jingsong Zhang
- 7H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Ruth Plummer
- 8Northern Centre for Cancer Care, Newcastle Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | | | | | | | | | | | | | | | - Yinghui Zhou
- 16Bayer HealthCare Pharmaceuticals, Inc., Cambridge, MA
| | | | - Joseph Hreiki
- 14Bayer HealthCare Pharmaceuticals, Inc., Whippany, NJ
| | | | - Johan deBono
- 17Royal Marsden NHS Trust (Surrey), Sutton, United Kingdom
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28
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French CA, Cheng ML, Hanna GJ, DuBois SG, Chau NG, Hann CL, Storck S, Salgia R, Trucco M, Tseng J, Stathis A, Piekarz R, Lauer UM, Massard C, Bennett K, Coker S, Tontsch-Grunt U, Sos ML, Liao S, Wu CJ, Polyak K, Piha-Paul SA, Shapiro GI. Report of the First International Symposium on NUT Carcinoma. Clin Cancer Res 2022; 28:2493-2505. [PMID: 35417004 PMCID: PMC9197941 DOI: 10.1158/1078-0432.ccr-22-0591] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022]
Abstract
NUT carcinoma is a rare, aggressive cancer defined by rearrangements of the NUTM1 gene. No routinely effective treatments of NUT carcinoma exist, despite harboring a targetable oncoprotein, most commonly BRD4-NUT. The vast majority of cases are fatal. Poor awareness of the disease is a major obstacle to progress in the treatment of NUT carcinoma. While the incidence likely exceeds that of Ewing sarcoma, and BRD4-NUT heralded the bromodomain and extra-terminal domain (BET) inhibitor class of selective epigenetic modulators, NUT carcinoma is incorrectly perceived as "impossibly rare," and therefore receives comparatively little private or governmental funding or prioritization by pharma. To raise awareness, propagate scientific knowledge, and initiate a consensus on standard and targeted treatment of NUT carcinoma, we held the First International Symposium on NUT Carcinoma on March 3, 2021. This virtual event had more than eighty attendees from the Americas, Europe, Asia, and Australia. Patients with NUT carcinoma and family members were represented and shared perspectives. Broadly, the four areas discussed by experts in the field included (1) the biology of NUT carcinoma; (2) standard approaches to the treatment of NUT carcinoma; (3) results of clinical trials using BET inhibitors; and (4) future directions, including novel BET bromodomain inhibitors, combinatorial approaches, and immunotherapy. It was concluded that standard chemotherapeutic approaches and first-generation BET bromodomain inhibitors, the latter complicated by a narrow therapeutic window, are only modestly effective in a minority of cases. Nonetheless, emerging second-generation targeted inhibitors, novel rational synergistic combinations, and the incorporation of immuno-oncology approaches hold promise to improve the prognosis of this disease.
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Affiliation(s)
| | | | | | - Steven G. DuBois
- Dana-Farber Cancer Institute, Boston, MA, USA,Boston Children’s Hospital, Boston, MA, USA
| | - Nicole G. Chau
- British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada
| | | | - Simone Storck
- Swabian Children’s Cancer Center, Paediatric and Adolescent Medicine, University Medical Center Augsburg, Augsburg, Germany
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | | | | | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland and Faculty of Biomedical Sciences, Universita della Svizzera Italiana, Lugano, Switzerland
| | - Richard Piekarz
- Investigational Drug Branch, Cancer Therapy Evaluation Program (CTEP), Bethesda, MD
| | | | - Christophe Massard
- Gustave Roussy-Molecular Radiotherapy INSERM U1030, Faculty of Medicine Kremlin-Bicêtre and Paris-Saclay University , France
| | | | - Shodeinde Coker
- Bristol-Myers Squibb Company, Lawrenceville, New Jersey, USA
| | | | - Martin L. Sos
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Pathology, Molecular Pathology University of Cologne, Cologne, Germany and Department of Translational Genomics and Center for Molecular Medicine Cologne, Cologne, Germany
| | - Sida Liao
- TScan Therapeutics, Waltham, MA, USA
| | | | | | - Sarina A. Piha-Paul
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Hess D, Colombo I, Haefliger S, Rabaglio M, Bastian S, Schwitter M, Eckhardt K, Garzon JG, Hayoz S, Kopp C, Holer L, Mc Laughlin A, Kloft C, Sessa C, Stathis A, Halbherr S, Baumgartner C, Joerger M. TLD-1, a novel liposomal doxorubicin, in patients (pts) with advanced solid tumors: Dose escalation and expansion part of a multicenter open-label phase I trial (SAKK 65/16). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3027 Background: TLD-1 is a novel liposomal doxorubicin that compared favorably to conventional liposomal formulations of doxorubicin in preclinical in vivo mouse breast cancer models. This phase I first-in-human trial is aiming to determine the recommended phase II dose (RP2D), toxicity profile, pharmacokinetics and preliminary activity. Methods: Patients with a maximum of 3 prior lines of systemic chemotherapy and preferably anthracycline-sensitive disease were eligible. TLD-1 was administered on day 1 iv over 60-90 minutes (depending on individual dose) q 21 days, for up to 6 or 9 cycles (according to prior anthracycline-exposure) with premedication of 8mg dexamethasone. Dose escalation with dose levels (DL) 1-7 of 10, 16, 23, 30, 35, 40 and 45mg/m2 started with an accelerated titration design, treating one pt at each DL up to DL6 (40mg/m2) followed by a modified continual reassessment method at DL7 due to observed toxicity. Results: 30 pts (F:M = 24:6) have been treated, one each at DLs 1-6, 15 pts at DL7 and an additional 9 pts at DL6. Most frequent tumor types included breast (n = 13), ovarian (n = 6), cervical cancer (n = 2) and cholangiocarcinoma (n = 2). Median age was 67.5 years (range:38-83), 13 pts were exposed to prior anthracyclines. The median number of cycles was 4 (range:1-9). No dose-limiting toxicities (DLT) occurred during cycle 1. At DLs 1 to 5, no treatment-related G3 AEs (TRAE) were observed. At DL6, there was one case of mucositis G3, one of palmar-plantar-erythrodysesthesia (PPE) G3 and one of anemia and neutropenia G3 each. One patient with pre-existing valvular cardiopathy developed symptoms of heart-failure G3 after 8 cycles. Echocardiography showed severe mitral regurgitation with normal LV-EF. In addition one case of urinary-tract infection G3 was seen. Dose-modifications or -delays due to AEs occurred in 7/50 cycles. At DL7, one case of mucositis G3, 3 events of PPE G3 and one case of fatigue G3 were reported. In addition, one case of infection with shingles occurred. Dose-modifications or -delays due to AEs occurred in 12/61 cycles. Shingles and heart failure were reported as SAEs. All toxicities listed above were categorized as TRAE. 29/30 pts were evaluable for response. Three breast cancer pts had a partial response, 2 at DL7 and 1 at DL6, 14 pts had stable disease. Conclusions: No DLT was observed up to DL7. RP2D was defined at 40mg/m2 due to cumulative PPE G3 at DL7. The trial is ongoing with a comparative PK-part evaluating the two iv liposomal formulations of doxorubicin TLD-1 and Caelyx. Clinical trial information: NCT03387917.
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Affiliation(s)
- Dagmar Hess
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Ilaria Colombo
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | | | | | | | | | | | | | - Stefanie Hayoz
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Christoph Kopp
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Lisa Holer
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Anna Mc Laughlin
- Freie Universität Berlin, Institute of Pharmacy, Berlin, Germany
| | - Charlotte Kloft
- Freie Universität Berlin, Institut für Pharmazie, Berlin, Germany
| | - Cristiana Sessa
- IOSI-Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Anastasios Stathis
- IOSI-Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | | | - Markus Joerger
- Department of Oncology/Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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30
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Papadopoulos KP, Sharma M, Dummer R, Rodrigo Imedio E, Yge ML, Micallef S, Bellon A, Stathis A. A phase 1 dose-finding and dose-expansion study evaluating the safety, tolerability, pharmacokinetics, and efficacy of a highly selective WEE1 inhibitor (Debio 0123) in adult patients with advanced solid tumors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps2702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2702 Background: Debio 0123 is an oral, highly selective inhibitor of the tyrosine kinase WEE1. WEE1 is a key regulator of cell cycle progression that modulates the activity of CDK1 (CDC2), influencing entry into mitosis. WEE1 inhibition results in G2 checkpoint abrogation, triggering mitosis with unrepaired DNA leading to cell death. In vitro and in vivo tumor models have shown Debio 0123 antitumor activity. Continuous exposure seems to be needed to maximize monotherapy efficacy in preclinical models. Preliminary data from an ongoing phase 1 study of intermittent Debio 0123 combined with carboplatin, showed a manageable safety profile, and signals of antitumor activity in patients (pts) with advanced solid tumors. We present the design of a phase 1 study (NCT05109975) of continuous Debio 0123 administered as a single agent in pts with advanced solid tumors. Methods: The study comprises a dose escalation part and a dose expansion part. The primary objective of the dose escalation part of the study is to determine the maximum tolerated dose (MTD) and/or the recommended phase 2 dose (RP2D) of continuous Debio 0123 monotherapy in adults with previously treated advanced solid tumors. Key secondary objectives include characterization of safety and tolerability, pharmacokinetics (PK), and preliminary antitumor activity (overall response rate [ORR]). Key inclusion criteria are histologically or cytologically confirmed locally advanced or metastatic solid tumors, and ECOG-PS 0 or 1. Key exclusion criteria are asymptomatic or unstable brain metastases, history of cardiac disorders, inability to swallow oral medication or abnormalities affecting drug absorption. Approximately 30 dose-limiting toxicity (DLT)-evaluable pts are anticipated to be enrolled based on an escalation with overdose control (EWOC) approach for 21-day treatment cycles. When the pts of each cohort become evaluable, a safety monitoring committee will review safety and tolerability and based on EWOC recommendations will decide the next dose level or will declare the MTD and/or RP2D. Pharmacodynamic biomarkers will be correlated with tumor response and/or PK. The dose-expansion part may start after MTD and/or RP2D determination. The primary objective of this part will be to characterize the safety and tolerability (e.g. percentage of pts with DLTs, serious adverse events or discontinuations) of Debio 0123 monotherapy at the MTD/RP2D, and to evaluate the anti-tumor activity (ORR) in pts with selected recurrent/progressive solid tumors. Key inclusion criteria are measurable disease per RECIST 1.1 and specific tumor types. Based on a Simon 2-stage design, up to 34 pts per tumor type cohort may be enrolled. Currently accrual to the dose escalation is ongoing in the United States and Switzerland. Clinical trial information: NCT05109975.
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Affiliation(s)
| | | | - Reinhard Dummer
- Universitätsspital Zurich, Dermatologische Klinik, Zurich, Switzerland
| | | | | | | | - Anne Bellon
- Debiopharm International SA, Lausanne, Switzerland
| | - Anastasios Stathis
- IOSI-Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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31
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Arribas AJ, Napoli S, Cascione L, Sartori G, Barnabei L, Gaudio E, Tarantelli C, Mensah AA, Spriano F, Zucchetto A, Rossi FM, Rinaldi A, De Moura MC, Jovic S, Bordone-Pittau R, Di Veroli A, Stathis A, Cruciani G, Stussi G, Gattei V, Brown JR, Esteller M, Zucca E, Rossi D, Bertoni F. Resistance to PI3κδ inhibitors in marginal zone lymphoma can be reverted by targeting the IL-6/PDGFRA axis. Haematologica 2022; 107:2685-2697. [PMID: 35484662 PMCID: PMC9614536 DOI: 10.3324/haematol.2021.279957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
PI3Kδ inhibitors are active in patients with lymphoid neoplasms and a first series of them have been approved for the treatment of multiple types of B-cell lymphoid tumors, including marginal zone lymphoma (MZL). The identification of the mechanisms underlying either primary or secondary resistance is fundamental to optimize the use of novel drugs. Here we present a model of secondary resistance to PI3Kδ inhibitors obtained by prolonged exposure of a splenic MZL cell line to idelalisib. The VL51 cell line was kept under continuous exposure to idelalisib. The study included detailed characterization of the model, pharmacological screens, silencing experiments, and validation experiments on multiple cell lines and on clinical specimens. VL51 developed resistance to idelalisib, copanlisib, duvelisib, and umbralisib. An integrative analysis of transcriptome and methylation data highlighted an enrichment of upregulated transcripts and low-methylated promoters in resistant cells, including IL-6/STAT3- and PDGFRA-related genes and surface CD19 expression, alongside the repression of the let-7 family of miRNA, and miR-125, miR-130, miR-193 and miR-20. The IL-6R blocking antibody to-cilizumab, the STAT3 inhibitor stattic, the LIN28 inhibitor LIN1632, the PDGFR inhibitor masitinib and the anti-CD19 antibody drug conjugate loncastuximab tesirine were active compounds in the resistant cells as single agents and/or in combination with PI3Kδ inhibition. Findings were validated on additional in vitro lymphoma models and on clinical specimens. A novel model of resistance obtained from splenic MZL allowed the identification of therapeutic approaches able to improve the antitumor activity of PI3Kδ inhibitors in B-cell lymphoid tumors.
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Affiliation(s)
- Alberto J Arribas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne.
| | - Sara Napoli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne
| | - Giulio Sartori
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | - Laura Barnabei
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | - Eugenio Gaudio
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | - Chiara Tarantelli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | | | - Filippo Spriano
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | | | | | - Andrea Rinaldi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona
| | | | - Sandra Jovic
- Institute for Research in Biomedicine, Università della Svizzera italiana, Bellinzona
| | | | - Alessandra Di Veroli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Faculty of Biomedical Sciences, USI, Bellinzona
| | - Gabriele Cruciani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia
| | - Georg Stussi
- Oncology Institute of Southern Switzerland, Bellinzona
| | - Valter Gattei
- Centro di Riferimento Oncologico di Aviano - CRO, Aviano
| | - Jennifer R Brown
- Chronic Lymphocytic Leukemia Center, Division of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain; Centro de Investigacion Biomedica en Red Cancer (CIBERONC), Madrid, Spain; Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain; Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Catalonia
| | - Emanuele Zucca
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona
| | - Davide Rossi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland; Oncology Institute of Southern Switzerland, Bellinzona.
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32
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Joerger M, Metaxas Y, Zaman K, Michielin O, Mach N, Bettini A, Schmitt AM, Cantoni N, Caspar CB, Stettler S, Malval R, Pless M, Britschgi C, Renner C, Koeberle D, Schulz JD, Kopp C, Hayoz S, Stathis A, von Moos R. Outcome and Prognostic Factors of COVID-19 Infection in Swiss Cancer Patients: Final Results of SAKK 80/20 (CaSA). Cancers (Basel) 2022; 14:2191. [PMID: 35565320 PMCID: PMC9104745 DOI: 10.3390/cancers14092191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: These are the final results of a national registry on cancer patients with COVID-19 in Switzerland. Methods: We collected data on symptomatic COVID-19-infected cancer patients from 23 Swiss sites over a one-year period starting on 1 March 2020. The main objective was to assess the outcome (i.e., mortality, rate of hospitalization, ICU admission) of COVID-19 infection in cancer patients; the main secondary objective was to define prognostic factors. Results: From 455 patients included, 205 patients (45%) had non-curative disease, 241 patients (53%) were hospitalized for COVID-19, 213 (47%) required oxygen, 43 (9%) invasive ventilation and 62 (14%) were admitted to the ICU. Death from COVID-19 infection occurred in 98 patients, resulting in a mortality rate of 21.5%. Age ≥65 years versus <65 years (OR 3.14, p = 0.003), non-curative versus curative disease (OR 2.42, p = 0.012), ICU admission (OR 4.45, p < 0.001) and oxygen requirement (OR 20.28, p < 0.001) were independently associated with increased mortality. Conclusions: We confirmed high COVID-19 severity and mortality in real-world cancer patients during the first and second wave of the pandemic in a country with a decentralized, high-quality, universal-access health care system. COVID-19-associated mortality was particularly high for those of older age in a non-curative disease setting, requiring oxygen or ICU care.
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Affiliation(s)
- Markus Joerger
- Department of Oncology, Cantonal Hospital, 9007 St. Gallen, Switzerland
| | - Yannis Metaxas
- Department of Medical Oncology, Cantonal Hospital, 8596 Muensterlingen, Switzerland;
| | - Khalil Zaman
- Breast Center, Department of Medical Oncology, University Hospital, 1011 Lausanne, Switzerland;
| | - Olivier Michielin
- Department of Medical Oncology, University Hospital, 1011 Lausanne, Switzerland;
| | - Nicolas Mach
- Department of Medical Oncology, University Hospital, 1205 Geneva, Switzerland;
| | - Adrienne Bettini
- Department of Medical Oncology, HFR Fribourg-Hôpital Cantonal, 1752 Fribourg, Switzerland;
| | - Andreas M. Schmitt
- Department of Medical Oncology, University Hospital, 4031 Basel, Switzerland;
| | - Nathan Cantoni
- Oncology, Hematology and Transfusion Medicine, Cantonal Hospital, 5001 Aarau, Switzerland;
| | - Clemens B. Caspar
- Division of Hematology and Oncology, Cantonal Hospital, 5404 Baden, Switzerland;
| | - Sonja Stettler
- Division of Medical Oncology, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland;
| | | | - Miklos Pless
- Division of Medical Oncology and Hematology, Cantonal Hospital, 8400 Winterthur, Switzerland;
| | - Christian Britschgi
- Department of Medical Oncology and Hematology, University Hospital, 8091 Zurich, Switzerland;
| | - Christoph Renner
- Department of Medical Oncology, Oncological Center Zurich, 8038 Zurich, Switzerland;
| | - Dieter Koeberle
- Department of Oncology, Claraspital, 4058 Basel, Switzerland;
| | - Jessica D. Schulz
- SAKK Coordinating Center, 3008 Bern, Switzerland; (J.D.S.); (C.K.); (S.H.)
| | - Christoph Kopp
- SAKK Coordinating Center, 3008 Bern, Switzerland; (J.D.S.); (C.K.); (S.H.)
| | - Stefanie Hayoz
- SAKK Coordinating Center, 3008 Bern, Switzerland; (J.D.S.); (C.K.); (S.H.)
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland;
| | - Roger von Moos
- Department of Medical Oncology/Hematology, Cantonal Hospital Graubuenden, 7000 Chur, Switzerland;
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33
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Bonfiglio F, Bruscaggin A, Guidetti F, Terzi di Bergamo L, Faderl M, Spina V, Condoluci A, Bonomini L, Forestieri G, Koch R, Piffaretti D, Pini K, Pirosa MC, Cittone MG, Arribas A, Lucioni M, Ghilardi G, Wu W, Arcaini L, Baptista MJ, Bastidas G, Bea S, Boldorini R, Broccoli A, Buehler MM, Canzonieri V, Cascione L, Ceriani L, Cogliatti S, Corradini P, Derenzini E, Devizzi L, Dietrich S, Elia AR, Facchetti F, Gaidano G, Garcia JF, Gerber B, Ghia P, Gomes da Silva M, Gritti G, Guidetti A, Hitz F, Inghirami G, Ladetto M, Lopez-Guillermo A, Lucchini E, Maiorana A, Marasca R, Matutes E, Meignin V, Merli M, Moccia A, Mollejo M, Montalban C, Novak U, Oscier DG, Passamonti F, Piazza F, Pizzolitto S, Rambaldi A, Sabattini E, Salles G, Santambrogio E, Scarfò L, Stathis A, Stüssi G, Geyer JT, Tapia G, Tarella C, Thieblemont C, Tousseyn T, Tucci A, Vanini G, Visco C, Vitolo U, Walewska R, Zaja F, Zenz T, Zinzani PL, Khiabanian H, Calcinotto A, Bertoni F, Bhagat G, Campo E, De Leval L, Dirnhofer S, Pileri SA, Piris MA, Traverse-Glehen A, Tzankov A, Paulli M, Ponzoni M, Mazzucchelli L, Cavalli F, Zucca E, Rossi D. Genetic and phenotypic attributes of splenic marginal zone lymphoma. Blood 2022; 139:732-747. [PMID: 34653238 DOI: 10.1182/blood.2021012386] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/14/2021] [Indexed: 11/20/2022] Open
Abstract
Splenic marginal zone B-cell lymphoma (SMZL) is a heterogeneous clinico-biological entity. The clinical course is variable, multiple genes are mutated with no unifying mechanism, and essential regulatory pathways and surrounding microenvironments are diverse. We sought to clarify the heterogeneity of SMZL by resolving different subgroups and their underlying genomic abnormalities, pathway signatures, and microenvironment compositions to uncover biomarkers and therapeutic vulnerabilities. We studied 303 SMZL spleen samples collected through the IELSG46 multicenter international study (NCT02945319) by using a multiplatform approach. We carried out genetic and phenotypic analyses, defined self-organized signatures, validated the findings in independent primary tumor metadata and in genetically modified mouse models, and determined correlations with outcome data. We identified 2 prominent genetic clusters in SMZL, termed NNK (58% of cases, harboring NF-κB, NOTCH, and KLF2 modules) and DMT (32% of cases, with DNA-damage response, MAPK, and TLR modules). Genetic aberrations in multiple genes as well as cytogenetic and immunogenetic features distinguished NNK- from DMT-SMZLs. These genetic clusters not only have distinct underpinning biology, as judged by differences in gene-expression signatures, but also different outcomes, with inferior survival in NNK-SMZLs. Digital cytometry and in situ profiling segregated 2 basic types of SMZL immune microenvironments termed immune-suppressive SMZL (50% of cases, associated with inflammatory cells and immune checkpoint activation) and immune-silent SMZL (50% of cases, associated with an immune-excluded phenotype) with distinct mutational and clinical connotations. In summary, we propose a nosology of SMZL that can implement its classification and also aid in the development of rationally targeted treatments.
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Affiliation(s)
- Ferdinando Bonfiglio
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Alessio Bruscaggin
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Francesca Guidetti
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Martin Faderl
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Valeria Spina
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Adalgisa Condoluci
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luisella Bonomini
- International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
| | - Gabriela Forestieri
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Ricardo Koch
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Deborah Piffaretti
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Katia Pini
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Maria Cristina Pirosa
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Micol Giulia Cittone
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Alberto Arribas
- Lymphoma Genomics, Institute of Oncology Research, Bellinzona, Switzerland
| | - Marco Lucioni
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and Università degli Studi di Pavia, Pavia, Italy
| | - Guido Ghilardi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Wei Wu
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Maria Joao Baptista
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Gabriela Bastidas
- Division of Hematology, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - Silvia Bea
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) 28029, Madrid, Spain
- Pathology Department, Hospital Clínic, Barcelona University, Barcelona, Spain
| | - Renzo Boldorini
- Division of Pathology, University of Eastern Piedmont, Novara, Italy
| | - Alessandro Broccoli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy
| | - Marco Matteo Buehler
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Vincenzo Canzonieri
- Pathology Unit, CRO Aviano National Cancer Institute, Aviano, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luciano Cascione
- Lymphoma Genomics, Institute of Oncology Research, Bellinzona, Switzerland
| | - Luca Ceriani
- Clinic of Nuclear Medicine and PET-CT Centre, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Sergio Cogliatti
- Institute of Pathology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Paolo Corradini
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Enrico Derenzini
- Onco-hematology Division, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Liliana Devizzi
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Sascha Dietrich
- Division of Hematology, University Hospital Heidelberg, Heidelberg, Germany
| | - Angela Rita Elia
- Cancer Immunotherapy, Institute of Oncology Research, Bellinzona, Switzerland
| | - Fabio Facchetti
- Department of Molecular and Translational Medicine, Pathology Unit, Spedali Civili, Brescia, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | | | - Bernhard Gerber
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Hematology and Oncology, University of Zurich, Zurich, Switzerland
| | - Paolo Ghia
- Strategic Research Program on Chronic Lymphocytic Leukemia (CLL), IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Maria Gomes da Silva
- Division of Hematology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Giuseppe Gritti
- Division of Hematology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Guidetti
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Felicitas Hitz
- Division of Hematology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Marco Ladetto
- Division of Hematology, Azienda Ospedaliera SS Antonio e Biagio, Alessandria, Italy
- Dipartimento di Medicina Traslazionale, University of Eastern Piedmont, Alessandria, Italy
| | | | - Elisa Lucchini
- Division of Hematology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Antonino Maiorana
- Division of Pathology, Universitá degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Marasca
- Hematology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Estella Matutes
- Haematopathology Unit, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | - Michele Merli
- Division of Hematology, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Alden Moccia
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Manuela Mollejo
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) 28029, Madrid, Spain
- Division of Pathology, Hospital Virgen de la Salud, Toledo, Spain
| | - Carlos Montalban
- Division of Hematology, MD Anderson Cancer Center, Madrid, Spain
| | - Urban Novak
- Department of Medical Oncology and University Cancer Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Graham Oscier
- Division of Hematology, University Hospitals Dorset, Bournemouth, United Kingdom
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Francesco Piazza
- Division of Hematology, Ospedale Universitario di Padova, Padova, Italy
| | - Stefano Pizzolitto
- Division of Pathology, General Hospital S Maria della Misericordia, Udine, Italy
| | - Alessandro Rambaldi
- Division of Hematology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Elena Sabattini
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Gilles Salles
- Faculté de Médecine et de Maïeutique Lyon Sud, Université de Lyon, Lyon, France
| | | | - Lydia Scarfò
- Strategic Research Program on Chronic Lymphocytic Leukemia (CLL), IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Anastasios Stathis
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Georg Stüssi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Julia T Geyer
- Division of Anatomic Pathology and Clinical Pathology, Weill Cornell Medical College, New York, NY
| | - Gustavo Tapia
- Division of Pathology, Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Corrado Tarella
- Onco-hematology Division, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Catherine Thieblemont
- Assistance Publique-Hôpitaux de Paris, Hopital Saint-Louis, Hemato-Oncology Unit; Université de Paris, Paris, France
| | - Thomas Tousseyn
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | | | - Giorgio Vanini
- Department of Medical Oncology and University Cancer Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Italy
| | - Umberto Vitolo
- Candiolo Cancer Institute (FPO-IRCCS), Candiolo, Turin, Italy
| | - Renata Walewska
- Division of Hematology, University Hospitals Dorset, Bournemouth, United Kingdom
| | - Francesco Zaja
- Division of Hematology, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Thorsten Zenz
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia Seràgnoli, Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Bologna, Italy
| | - Hossein Khiabanian
- Center for Systems and Computational Biology, Rutgers University, New Brunswick, NJ
| | - Arianna Calcinotto
- Cancer Immunotherapy, Institute of Oncology Research, Bellinzona, Switzerland
| | - Francesco Bertoni
- Lymphoma Genomics, Institute of Oncology Research, Bellinzona, Switzerland
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University, New York, NY
| | - Elias Campo
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS)
- Pathology Department, Hospital Clínic, Barcelona University, Barcelona, Spain
| | - Laurence De Leval
- Division of Pathology, Institut Universitaire de Pathologie, Lausanne, Switzerland
| | - Stefan Dirnhofer
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland
| | - Stefano A Pileri
- Haematopathology Division, European Institute of Oncology IRCCS, Milan, Italy
| | - Miguel A Piris
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC) 28029, Madrid, Spain
- Pathology Service, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Alexander Tzankov
- Institute of Pathology and Medical Genetics, University Hospital Basel, Basel, Switzerland
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, Fondazione IRCCS Policlinico San Matteo and Università degli Studi di Pavia, Pavia, Italy
| | - Maurilio Ponzoni
- Ateneo Vita-Salute San Raffaele University and Pathology Unit San Raffaele Scientific Institute, Milan, Italy
| | - Luca Mazzucchelli
- Division of Pathology, Cantonal Institute of Pathology, Locarno, Switzerland
| | - Franco Cavalli
- Institute of Oncology Research, Bellinzona, Switzerland; and
| | - Emanuele Zucca
- International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
- Clinic of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Department of Medical Oncology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Davide Rossi
- Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Panayiotidis P, Tumyan G, Thieblemont C, Ptushkin VV, Marin-Niebla A, García-Sanz R, Le Gouill S, Stathis A, Bottos A, Hamidi H, Katz P, Perretti T, Willis JC, Buske C. A phase-II study of atezolizumab in combination with obinutuzumab or rituximab for relapsed or refractory mantle cell or marginal zone lymphoma or Waldenström's macroglobulinemia. Leuk Lymphoma 2022; 63:1058-1069. [PMID: 35045765 DOI: 10.1080/10428194.2021.2015765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We report efficacy, safety and biomarker data from a phase-II study evaluating atezolizumab (eight 21-day cycle as induction therapy) in combination with obinutuzumab in patients with relapsed/refractory mantle cell lymphoma (MCL, n = 30) or Waldenström's macroglobulinemia (WM, n = 4), and in combination with rituximab in patients with marginal zone lymphoma (MZL, n = 21). All patients received atezolizumab monotherapy as maintenance for ≤10 cycles. Objective response rates at end of induction were 16.7% (MCL) and 42.9% (MZL), with no responses in WM. Median duration of response was 6.8 months (range 5.7-not estimable) for MCL and not reached for MZL. Treatment-emergent adverse events (TEAEs) occurred in 93.3%, 95.2% and 100% of MCL, MZL and WM patients, respectively. One fatal TEAE (pneumonia) occurred in each of the MCL and MZL groups. Biomarker analysis highlighted the importance of characterizing the immune environment to optimize efficacy of immunotherapy regimens.Trial registration details: EudraCT: 2016-003579-22.
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Affiliation(s)
| | - Gayane Tumyan
- N.N. Blokhin Russian Cancer Research Centre, Moscow, Russian Federation
| | | | - Vadim V Ptushkin
- City Clinical Hospital Named After S.P. Botkin, Moscow, Russian Federation
| | | | - Ramon García-Sanz
- Hospital Universitario de Salamanca (HUSA/IBSAL/CIBERONC), Salamanca, Spain
| | - Steven Le Gouill
- Service d'Hématologie Clinique du CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland, and Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | | | | | - Pablo Katz
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | | | - Christian Buske
- CCC Ulm, Institute of Experimental Cancer Research, University Hospital Ulm, Ulm, Germany
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35
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Calvo E, Sessa C, Harada G, de Miguel M, Kahatt C, Luepke-Estefan XE, Siguero M, Fernandez-Teruel C, Cullell-Young M, Stathis A, Drilon A. Phase I study of lurbinectedin in combination with weekly paclitaxel with or without bevacizumab in patients with advanced solid tumors. Invest New Drugs 2022; 40:1263-1273. [PMID: 35947247 PMCID: PMC9652263 DOI: 10.1007/s10637-022-01281-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/03/2022] [Indexed: 01/12/2023]
Abstract
Lurbinectedin and paclitaxel showed synergism in preclinical studies and have non-completely overlapping toxicity profiles. This phase I trial evaluated a combination of paclitaxel and lurbinectedin with/without bevacizumab in advanced tumors. This trial was divided into Group A, which evaluated weekly paclitaxel (60 or 80 mg) plus lurbinectedin (3.0-5.0 mg flat dose [FD] or 2.2 mg/m2) every 3 weeks in advanced solid tumors; and Group B, which evaluated bevacizumab (BEV, 15 mg/kg) added to the recommended dose (RD) defined in Group A in advanced epithelial ovarian or non-small cell lung cancer (NSCLC). 67 patients (A, n = 55; B, n = 12) were treated. The RD was paclitaxel 80 mg/m2 on Day (D)1,D8 plus lurbinectedin 2.2 mg/m2 on D1. At this RD, myelotoxicity was reversible and manageable, and most non-hematological toxicities were mild/moderate. Adding BEV did not notably change tolerability. Twenty-five confirmed responses were observed: 20/51 evaluable patients in Group A (overall response rate [ORR] = 39% at all dose levels and at the RD), and 5/10 evaluable patients in Group B (ORR = 50%). Most responders had breast (n = 7/12 patients), small cell lung (SCLC) (n = 5/7), epithelial ovarian (n = 3/9) and endometrial cancer (n = 3/11) in Group A, and epithelial ovarian (n = 3/4) and NSCLC (n = 2/6) in Group B. Clinical benefit rate was 61% in Group A (58% at the RD), and 90% in Group B. No major pharmacokinetic drug-drug interactions were observed. Paclitaxel/lurbinectedin and paclitaxel/lurbinectedin/BEV are feasible combinations. Further development is warranted of paclitaxel/lurbinectedin in SCLC, breast, and endometrial cancer, and of paclitaxel/lurbinectedin/BEV in epithelial ovarian cancer.
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Affiliation(s)
- Emiliano Calvo
- START Madrid - HM CIOCC, Hospital Madrid Norte Sanchinarro, Madrid, Spain
| | - Cristiana Sessa
- Oncology Institute of Southern Switzerland, EOC, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Guilherme Harada
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY USA
| | - Maria de Miguel
- START Madrid - HM CIOCC, Hospital Madrid Norte Sanchinarro, Madrid, Spain
| | | | | | | | | | | | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, EOC, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY USA
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Tarantelli C, Cannas E, Ekeh H, Moscatello C, Gaudio E, Cascione L, Napoli S, Rech C, Testa A, Maniaci C, Rinaldi A, Zucca E, Stathis A, Ciulli A, Bertoni F. The bromodomain and extra-terminal domain degrader MZ1 exhibits preclinical anti-tumoral activity in diffuse large B-cell lymphoma of the activated B cell-like type. Explor Target Antitumor Ther 2021; 2:586-601. [PMID: 36046113 PMCID: PMC9400774 DOI: 10.37349/etat.2021.00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/30/2021] [Indexed: 01/03/2023] Open
Abstract
Aim Bromodomain and extra-terminal domain (BET) proteins are epigenetic readers that play a fundamental role in transcription regulation. Preclinical and early clinical evidence sustain BET targeting as an anti-cancer approach. BET degraders are chimeric compounds comprising of a BET inhibitor, which allows the binding to BET bromodomains, linked to a small molecule, binder for an E3 ubiquitin ligase complex, triggering BET proteins degradation via the proteasome. These degraders, called proteolysis-targeting chimeras (PROTACs), can exhibit greater target specificity compared to BET inhibitors and overcome some of their limitations, such as the upregulation of the BET proteins themselves. Here are presented data on the anti-tumor activity and the mechanism of action of the BET degrader MZ1 in diffuse large B cell lymphoma (DLBCL) of the activated B-cell like (ABC, ABC DLBCL), using a BET inhibitor as a comparison. Methods Established lymphoma cell lines were exposed for 72 h to increasing doses of the compounds. Cell proliferation was evaluated by using an 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazoliumbromide (MTT) assay. Fluorescent-Activated Cell Sorter (FACS) analysis was performed to measure apoptotic activation and RNA sequencing (RNA-Seq) to study the transcriptional changes induced by the compounds. Results MZ1, and not its negative control epimer cisMZ1, was very active with a median half maximal inhibitory concentration (IC50) of 49 nmol/L. MZ1 was more in vitro active than the BET inhibitor birabresib (OTX015). Importantly, MZ1 induced cell death in all the ABC DLBCL cell lines, while the BET inhibitor was cytotoxic only in a fraction of them. BET degrader and inhibitor shared partially similar changes at transcriptome level but the MZ1 effect was stronger and overlapped with that caused cyclin-dependent kinase 9 (CDK9) inhibition. Conclusions The BET degrader MZ1 had strong cytotoxic activity in all the ABC DLBCL cell lines that were tested, and, at least in vitro, it elicited more profound effects than BET inhibitors, and encourages further investigations.
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Affiliation(s)
- Chiara Tarantelli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
| | - Eleonora Cannas
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
| | - Hillarie Ekeh
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
| | - Carmelo Moscatello
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, I-66100 Chieti, Italy
| | - Eugenio Gaudio
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
| | - Luciano Cascione
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
- SIB Swiss Institute of Bioinformatics, 1000 Lausanne, Switzerland
| | - Sara Napoli
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
| | - Cesare Rech
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
| | - Andrea Testa
- Division of Biological Chemistry and Drug Discovery, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, Scotland, UK
| | - Chiara Maniaci
- Division of Biological Chemistry and Drug Discovery, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, Scotland, UK
| | - Andrea Rinaldi
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
| | - Emanuele Zucca
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, USI, 6900 Lugano, Switzerland
| | - Alessio Ciulli
- Division of Biological Chemistry and Drug Discovery, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, Scotland, UK
| | - Francesco Bertoni
- Institute of Oncology Research, Faculty of Biomedical Sciences, USI, 6500 Bellinzona, Switzerland
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
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Hess B, Townsend W, Ai W, Stathis A, Solh M, Alderuccio JP, Ungar D, Liao S, Liao L, Khouri L, Zhang X, Boni J. Efficacy and Safety Exposure-Response Analysis of Loncastuximab Tesirine in Patients with B cell non-Hodgkin Lymphoma. AAPS J 2021; 24:11. [PMID: 34893942 DOI: 10.1208/s12248-021-00660-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/15/2021] [Indexed: 12/27/2022] Open
Abstract
We developed an integrated population pharmacokinetic model to investigate loncastuximab tesirine pharmacokinetics (PK) and exposure-response relationships for relapsed/refractory B cell non-Hodgkin lymphoma, including diffuse large B cell lymphoma (DLBCL). The model, based on the recommended dosing schedule (150 µg/kg every 3 weeks [Q3W] for 2 cycles; 75 µg/kg Q3W thereafter) and drug concentrations in phase 1 and 2 studies (DLBCL [n = 284], non-DLBCL [n = 44]), was used to characterize loncastuximab tesirine PK and evaluate exposure covariates. Relationships between exposure (pyrrolobenzodiazepine-conjugated antibody [cAb] cycle 1 average concentration) and (1) efficacy (including overall response rate [ORR; primary endpoint] and overall survival [OS]) and (2) grade ≥ 2 treatment-emergent adverse events were explored. Statistical analyses included univariate and multivariate logistic regression, Kaplan-Meier analysis, and Cox proportional hazard regression. cAb and total Ab were best described by a two-compartment linear model with time-dependent clearance. The cAb steady-state half-life increased to 20.6 days by ~ 15 weeks. cAb exposure was lower for low albumin, mild/moderate hepatic impairment, non-DLBCL subtypes, and Eastern Cooperative Oncology Group scores > 1. Significant positive associations were reported between exposure and ORR (p = 3.21E-6), OS (p = 0.0016), grade ≥ 2 increased gamma-glutamyltransferase, liver function test abnormalities, pain, and skin/nail reactions (p < 0.05). Low albumin, bulky disease, and mild/moderate hepatic impairment had a significant negative effect on OS (p < 0.01). Modeling supports the recommended loncastuximab tesirine dosing schedule. Although reduced exposure and efficacy were predicted for specific covariates (e.g., low albumin, mild/moderate hepatic impairment), dose increases are not recommended. Trial registration: NCT02669017 and NCT03589469.
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Affiliation(s)
- Brian Hess
- Hollings Cancer Center, Charleston, South Carolina, USA
| | - William Townsend
- University College London Hospitals NHS Foundation Trust and UCLH National Institute for Health Research Clinical Research Facility, London, UK
| | - Weiyun Ai
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Melhem Solh
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, Georgia, USA
| | | | - David Ungar
- ADC Therapeutics Inc, Murray Hill, New Jersy, USA
| | - Sam Liao
- Pharmax Research Inc, Irvine, California, USA
| | - Lori Liao
- Pharmax Research Inc, Irvine, California, USA
| | - Lisa Khouri
- Pharmax Research Inc, Irvine, California, USA
| | | | - Joseph Boni
- ADC Therapeutics Inc, Murray Hill, New Jersy, USA.
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Martorana F, Colombo I, Treglia G, Gillessen S, Stathis A. A systematic review of phase II trials exploring anti-PD-1/PD-L1 combinations in patients with solid tumors. Cancer Treat Rev 2021; 101:102300. [PMID: 34688105 DOI: 10.1016/j.ctrv.2021.102300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND A high number of combinations of PD-1/PD-L1 inhibitors with other anti-cancer therapies are in clinical development. The usefulness of phase II trials in evaluating their efficacy and safety is unclear. MATERIALS AND METHODS We performed a systematic search on PubMed and Cochrane Library for phase II trials of PD-1/PD-L1 inhibitors in combination with other anti-cancer therapies (systemic therapy and/or radiotherapy) published between January 1st 2018 and December 31st 2020. Study design, primary endpoint and main outcomes were registered for each paper. RESULTS 119 articles reporting on 65 regimens were included in our analysis. Backbone agents were more frequently PD-1 inhibitors (pembrolizumab = 47, nivolumab = 41, camrelizumab = 3) followed by anti-PD-L1 (durvalumab = 19, atezolizumab = 6, avelumab = 3). Therapeutic partners were other immunotherapeutic agents (n = 46), targeted therapies (n = 40), chemotherapy (n = 22) or radiotherapy (n = 11). The majority of articles reported on single-arm trials (n = 87, 73%) and response rate was the most frequent primary endpoint (n = 69, 58%). Objective responses, registered in 109 (92%) articles, ranged between 0% and 91%. The incidence of grade 3 or higher treatment-related adverse events, clearly reported in 97 (82%) articles, spanned from 0 to 100%. Five combinations received regulatory approval by Food and Drug Administration or European Medicine Agency for 9 different indications, based on the results of a phase II trial (n = 3) or on a confirmatory phase III trial (n = 6). CONCLUSIONS The landscape of phase II trials evaluating PD-1/PD-L1 inhibitors with other anticancer therapies is heterogeneous. Combinations of two immunotherapeutic agents have been the most investigated. Only a minority of indications (8%) granted regulatory approval.
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Affiliation(s)
- F Martorana
- Department of Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - I Colombo
- Department of Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - G Treglia
- Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - S Gillessen
- Department of Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - A Stathis
- Department of Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland.
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Arribas A, Napoli S, Cascione L, Sartori G, Gaudio E, Tarantelli C, Mensah A, Spriano F, Zucchetto A, Rossi F, Rinaldi A, Jovic S, Stathis A, Stussi G, Gattei V, Brown J, Esteller M, Zucca E, Rossi D, Bertoni F. 842P Secreted factors determine resistance to idelalisib in splenic marginal zone lymphoma (MZL) models. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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40
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Metaxas Y, Kahatt C, Alfaro V, Fudio S, Zeaiter A, Plummer R, Sessa C, Von Moos R, Forster M, Stathis A. A phase I trial of lurbinectedin in combination with cisplatin in patients with advanced solid tumors. Invest New Drugs 2021; 40:91-98. [PMID: 34453241 DOI: 10.1007/s10637-021-01142-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Background In vitro/in vivo data showed synergism of cisplatin and lurbinectedin in ovarian cancer cells and grafts. This phase I trial investigated the recommended phase II dose (RD) of cisplatin and lurbinectedin combination, with (Group A) or without aprepitant (Group B), in patients with advanced solid tumors. Patients and Methods All patients received 60 mg/m2 cisplatin 90-min intravenous (i.v.) infusion followed by lurbinectedin 60-min i.v. infusion at escalating doses on Day 1 every 3 weeks (q3wk). Patients in Group A additionally received orally 125 mg aprepitant one hour before cisplatin on Day 1 and 80 mg on Days 2 and 3. Toxicity was graded according to the NCI-CTCAE v.4. Results RD for Group A was cisplatin 60 mg/m2 plus lurbinectedin 1.1 mg/m2. RD for Group B was cisplatin 60 mg/m2 plus lurbinectedin 1.4 mg/m2. The most frequent grade ≥ 3 adverse events were hematological [neutropenia (41%), lymphopenia (35%), leukopenia (24%), thrombocytopenia (18%)] and fatigue (35%) in Group A (n = 17), and neutropenia (50%), leukopenia (42%), lymphopenia (29%), and fatigue (13%) and nausea (8%) in Group B (n = 24). Four patients (2 in each group) had a partial response. Disease stabilization for ≥ 4 months was observed in 4 and 10 patients, respectively. Conclusion The combination of lurbinectedin with cisplatin was not possible in meaningful therapeutic dosage due to toxicity. The addition of aprepitant in combination with cisplatin did not allow increasing the dose due to hematological toxicity, whereas omitting aprepitant increased the incidence of nausea and vomiting. Modest clinical activity was observed in general.Clinical trial registration www.ClinicalTrials.gov code: NCT01980667. Date of registration: 11 November 2013.
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Affiliation(s)
- Yannis Metaxas
- Oncology/Hematology Kantonsspital Graubünden, Hematology Kantonsspital Münsterlingen, Oncology, Chur / Münsterlingen, Switzerland.
| | | | | | | | - Ali Zeaiter
- Pharma Mar, Colmenar Viejo, Madrid, S.A, Spain
| | - Ruth Plummer
- Newcastle University and Northern Centre for Cancer Care, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Cristiana Sessa
- Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Roger Von Moos
- Oncology/Hematology Kantonsspital Graubünden, Chur, Switzerland
| | - Martin Forster
- UCL Cancer Institute, University College of London Hospitals, NHS Foundation Trust, London, UK
| | - Anastasios Stathis
- Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
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Pirosa MC, Zhang L, Hitz F, Novak U, Hess D, Terrot T, Pascale M, Mazzucchelli L, Bertoni F, Cavalli F, Zucca E, Stathis A. A phase I trial of inotuzumab ozogamicin in combination with temsirolimus in patients with relapsed or refractory CD22-positive B-cell non-Hodgkin lymphomas. Leuk Lymphoma 2021; 63:117-123. [PMID: 34407735 DOI: 10.1080/10428194.2021.1966780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This phase I trial evaluated the safety, tolerability, and preliminary activity of inotuzumab ozogamicin in combination with temsirolimus in patients with relapsed/refractory CD22 positive B-cell non-Hodgkin lymphomas. Nineteen patients received at least one dose of both study drugs. Dose-limiting toxicities consisted of thrombocytopenia, hypertriglyceridemia, oral mucositis, clinical deterioration, and the inability to receive at least three doses of temsirolimus during cycle 1. The most common grade ≥3 treatment-related adverse events were thrombocytopenia (n = 8), neutropenia (n = 5), and two patients each hyperphosphatemia, lymphopenia, and hypertriglyceridemia. The recommended phase II dose was inotuzumab ozogamicin 0.8 mg/m2 on day 1 in combination with temsirolimus 10 mg on days 8, 15, and 22 every 28 days. Among 18 patients evaluable, seven (39%) with follicular lymphoma had a partial remission. This drug combination is not possible within a therapeutically useful range of doses due to toxicities. Antitumor activity was observed in heavily pretreated patients (ClinicalTrials.gov, Identifier NCT01535989).
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Affiliation(s)
- Maria C Pirosa
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Lu Zhang
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Felicitas Hitz
- Department of Oncology and Hematology, Cantonal Hospital, St. Gallen, Switzerland
| | - Urban Novak
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dagmar Hess
- Department of Oncology and Hematology, Cantonal Hospital, St. Gallen, Switzerland
| | - Tatiana Terrot
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Mariarosa Pascale
- Clinical Trial Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Francesco Bertoni
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Oncology Research, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Franco Cavalli
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Oncology Research, Bellinzona, Switzerland
| | - Emanuele Zucca
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Oncology Research, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
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Colombo I, Genta S, Martorana F, Guidi M, Frattini M, Samartzis EP, Brandt S, Gaggetta S, Moser L, Pascale M, Terrot T, Sessa C, Stathis A. Phase I Dose-Escalation Study of the Dual PI3K-mTORC1/2 Inhibitor Gedatolisib in Combination with Paclitaxel and Carboplatin in Patients with Advanced Solid Tumors. Clin Cancer Res 2021; 27:5012-5019. [PMID: 34266890 DOI: 10.1158/1078-0432.ccr-21-1402] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/22/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE This phase I study evaluated safety, tolerability, pharmacokinetics, and preliminary activity of the PI3K/mTORC1/2 dual inhibitor gedatolisib combined with carboplatin and paclitaxel. PATIENTS AND METHODS Patients with advanced solid tumors treated with ≤ 2 prior chemotherapies received intravenous gedatolisib on days 1, 8, 15, and 22 (95, 110, or 130 mg according to dose level); carboplatin (AUC5) on day 8 (day 1 following protocol amendment); and paclitaxel at 80 mg/m2 on days 8, 15, and 22 (1, 8, and 15 after amendment), every 28 days. Patients without progressive disease after cycle 6 received maintenance gedatolisib until progression. RESULTS Seventeen patients were enrolled [11 ovarian (10 clear cell ovarian cancer, CCOC), 4 endometrial, 2 lung cancers]. Median number of prior chemotherapies was 1 (range, 0-2). Median number of administered cycles was 6 (range, 2-16). Dose-limiting toxicities occurred in 4 patients: 2 (cycle 2 delay due to G2-G3 neutropenia) at 110 mg leading to a change in the treatment schedule, 2 at 130 mg (G2 mucositis causing failure to deliver ≥ 75% of gedatolisib at cycle 1). The recommended phase II dose is gedatolisib 110 mg on days 1, 8, 15, and 22 with carboplatin AUC5 on day 1 and paclitaxel 80 mg/m2 on days 1, 8, and 15. The most frequent ≥G3 treatment-related adverse events were neutropenia (35%), anemia (18%), and mucositis (12%). The overall response rate was 65% (80% in CCOC). Pharmacokinetic parameters of gedatolisib were consistent with single-agent results. CONCLUSIONS Gedatolisib combined with carboplatin and paclitaxel is tolerable, and preliminary efficacy was observed especially in CCOC.
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Affiliation(s)
- Ilaria Colombo
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Sofia Genta
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Federica Martorana
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Monia Guidi
- Service of Clinical Pharmacology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Milo Frattini
- Molecular Pathology Laboratory, Cantonal Institute of Pathology, Locarno, Switzerland
| | | | - Simone Brandt
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Sheila Gaggetta
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Laura Moser
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Mariarosa Pascale
- Clinical Trial Unit, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Tatiana Terrot
- Clinical Trial Unit, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Cristiana Sessa
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Anastasios Stathis
- Service of Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland. .,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Abstract
Radiomics is an emerging field of research that aims to find associations between quantitative information extracted from imaging examinations and clinical data to support the best clinical decision. In the last few years, some papers have been evaluating the role of radiomics in gynecological malignancies, mainly focusing on ovarian cancer. Nonetheless, cervical cancer is the most frequent gynecological malignancy in developing countries and endometrial cancer is the most common in western countries. The purpose of this narrative review is to give an overview of the latest published papers evaluating the role of radiomics in cervical and endometrial cancer, mostly evaluating association with tumor prognostic factors, with response to therapy and with prediction of recurrence and distant metastasis.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences; University of Rome Sapienza (IT), Rome, Italy
| | - Gabriele Maria Nicolino
- Post-graduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences; University of Rome Sapienza (IT), Rome, Italy
| | - Federica Martorana
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland.,Facoltà di Scienze biomediche, Università della Svizzera italiana (USI), Via Buffi 13, 6900, Lugano (CH), Switzerland
| | - Ilaria Colombo
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland
| | - Stefania Rizzo
- Facoltà di Scienze biomediche, Università della Svizzera italiana (USI), Via Buffi 13, 6900, Lugano (CH), Switzerland.,Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, Lugano (CH), Switzerland
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Solh M, Alderuccio JP, Stathis A, Ungar D, Liao S, Khouri L, Zhang X, Boni J. Abstract 1366: Integrated population modeling of loncastuximab tesirine (Lonca) exposure in B-cell non-Hodgkin lymphoma (B-NHL). Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Lonca is an antibody (Ab) drug conjugate comprising a humanized monoclonal Ab directed against B-cell antigen CD19, conjugated with a potent pyrrolobenzodiazepine (PBD) dimer toxin. In a Phase 1 (NCT02669017) study in relapsed or refractory (R/R) B-NHL, a recommended Phase 2 dosing regimen for Lonca of 150 µg/kg once every 3 weeks (Q3W) for two doses, followed by 75 µg/kg Q3W was identified then evaluated in a Phase 2 (NCT03589469) study in R/R diffuse large B-cell lymphoma (DLBCL). A population pharmacokinetic (PPK) model was developed to characterize the pharmacokinetics (PK) of the Lonca dosing regimen and evaluate exposure covariates.
The integrated PPK model was used to describe drug concentrations for Lonca PBD-conjugated Ab (5,301 samples), total Ab (5,241 samples), and unconjugated warhead SG3199 (239 samples) in serum from 328 patients. Samples were taken pre-dose, at end of infusion and at pre-determined timepoints post-infusion throughout the trials. Analysis was performed using non-linear mixed-effects modeling (NONMEM, v7.4 [ICON Solutions]). Subgroup analyses were conducted on model-predicted exposure metrics derived from simulation of Lonca PK profiles based on empirical Bayesian estimates of individual PK parameters.
Concentration-time data of Lonca PBD-conjugated Ab and total Ab were best characterized by a two-compartment model with parallel linear clearance (0.218 L/day), and a time-dependent clearance component which approached zero by ~15 weeks. The estimated volume of distribution of central compartment was 3.86 L and the estimated typical half-life at steady state of Lonca is ~3 weeks. The effect of body weight, age, sex, race, renal impairment, drug formulation, anti-drug Ab, ECOG, and concomitant P-gp inhibitors did not show clinically important influence on exposure (< ±30% change relative to reference). Based on model-predicted Cycle 1 average concentration (Cavg) patients with low albumin (<35 g/L, n=49) had 52% lower Cavg than patients with normal albumin levels (≥35 g/L, n=279). Patients with non-DLBCL (n=44) had 61% lower Cavg than patients with DLBCL (n=284). Trends of lower exposures with baseline mild/moderate hepatic impairment and ECOG status >1 were noted but did not appear to be of clinical relevance.
In conclusion, Lonca exposure was well described by a two-compartment model with linear and time-dependent clearance; the latter is thought to reflect reduction of tumor cells. Lonca exposure was lower in non-DLBCL patients, and lower in patients with hypoalbuminemia secondary to enhanced protein clearance in patients with critical illness. Overall, modeling demonstrates rapid attainment of steady-state exposure for Lonca given 150 µg/kg Q3W for two doses, and a sustaining profile for Lonca given 75 µg/kg Q3W thereafter for patients with DLBCL.
Citation Format: Melhem Solh, Juan Pablo Alderuccio, Anastasios Stathis, David Ungar, Sam Liao, Lisa Khouri, Xiaoyan Zhang, Joseph Boni. Integrated population modeling of loncastuximab tesirine (Lonca) exposure in B-cell non-Hodgkin lymphoma (B-NHL) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1366.
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Affiliation(s)
- Melhem Solh
- 1Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA
| | | | | | | | - Sam Liao
- 5Pharmax Research Inc, Irvine, CA
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Pagel J, Reddy N, Jagadeesh D, Stathis A, Asch AS, Salman H, Kenkre VP, Soumerai JD, Llorin‐Sangalang J, Gorbatchevsky I, Li J, Zelenetz AD. ZANDELISIB, A PI3Kδ INHIBITOR ON INTERMITTENT SCHEDULE (IS) IN FOLLICULAR LYMPHOMA PATIENTS WHO PROGRESSED WITHIN 24 MONTHS OF FIRST‐LINE CHEMOIMUNOTHERAPY (POD24). Hematol Oncol 2021. [DOI: 10.1002/hon.25_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J. Pagel
- Swedish Cancer Institute Hematology and Oncology Seattle Washington USA
| | - N. Reddy
- Vanderbilt University Medical Center Hematology and Oncology Nashville USA
| | - D. Jagadeesh
- Cleveland Clinic, Hematology and Medical Oncology Cleveland USA
| | - A. Stathis
- IOSI‐Oncology Institute of Southern Switzerland Ospedale Regionale Di Bellinzona E Valli, Oncology Bellinzona Switzerland
| | - A. S. Asch
- University of Oklahoma Health Sciences Center‐ Stephenson Cancer Center Hematology and Oncology Oklahoma City USA
| | - H. Salman
- Stony Brook Medical Center Hematology and Oncology Stony Brook USA
| | - V. P. Kenkre
- Carbone Cancer Center Hematology and Oncology Madison USA
| | - J. D. Soumerai
- Massachusetts General Hospital Hematology and Oncology Boston USA
| | | | | | - J. Li
- MEI Pharma, Inc Biometrics San Diego USA
| | - A. D. Zelenetz
- Memorial Sloan Kettering Cancer Center Hematology and Oncology New York City USA
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Zinzani PL, Caimi PF, Carlo‐Stella C, Ai W, Alderuccio JP, Ardeshna KM, Hess B, Kahl BS, Radford J, Solh M, Stathis A, Feingold J, Ungar D, Qin Y, He S, Hamadani M. LOTIS 2 FOLLOW‐UP ANALYSIS: UPDATED RESULTS FROM A PHASE 2 STUDY OF LONCASTUXIMAB TESIRINE IN RELAPSED OR REFRACTORY DIFFUSE LARGE B‐CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.89_2880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P. L. Zinzani
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna Istituto di Ematologia "Seràgnoli" and Diagnostica e Sperimentale Università di Bologna Dipartimento di Medicina Specialistica Bologna Italy
| | - P. F. Caimi
- Case Western Reserve University University Hospitals Cleveland Medical Center Cleveland USA
| | - C. Carlo‐Stella
- Humanitas Clinical and Research Center – IRCCS, and Humanitas University Department of Oncology and Hematology Rozzano Milan Italy
| | - W. Ai
- University of California Division of Hematology and Oncology Department of Medicine San Francisco USA
| | - J. P. Alderuccio
- University of Miami Sylvester Comprehensive Cancer Center Miami USA
| | - K. M. Ardeshna
- University College London Hospitals NHS Foundation Trust Department of Haematology London UK
| | - B. Hess
- Medical University of South Carolina Division of Hematology and Medical Oncology Department of Medicine Charleston USA
| | - B. S. Kahl
- Washington University Department of Medicine Oncology Division St Louis USA
| | - J. Radford
- Christie NHS Foundation Trust and the University of Manchester NIHR Clinical Research Facility Manchester UK
| | - M. Solh
- Northside Hospital Blood and Marrow Transplant Program AtlantaGeorgia USA
| | - A. Stathis
- Oncology Institute of Southern Switzerland Division of Medical Oncology Bellinzona Switzerland
| | - J. Feingold
- ADC Therapeutics America, Inc Clinical Development Murray Hill USA
| | - D. Ungar
- ADC Therapeutics America, Inc Clinical Development Murray Hill USA
| | - Y. Qin
- ADC Therapeutics America, Inc Clinical Development Murray Hill USA
| | - S. He
- ADC Therapeutics America, Inc Clinical Development Murray Hill USA
| | - M. Hamadani
- Medical College of Wisconsin Division of Hematology and Oncology Milwaukee USA
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Stathis A. New drugs and pharmacological interactions in real life. Hematol Oncol 2021; 39 Suppl 1:78-82. [PMID: 34105810 DOI: 10.1002/hon.2859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A high number of new drugs have entered clinical development and many of them have recently been approved for patients with lymphoid malignancies. The availability of new drugs offers additional treatment options, but it also requires particular attention for the emergence of adverse events. In addition, new drugs may also have interactions with other drugs, which could further increase the risk of toxicities or result in decreased efficacy. Here we review potential drug interactions for nonchemotherapy new drugs approved for patients with lymphoid malignancies.
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Affiliation(s)
- Anastasios Stathis
- New Drugs Development Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Bonfiglio F, Bruscaggin A, Guidetti F, Terzi di Bergamo L, Faderl M, Spina V, Condoluci A, Bonomini L, Forestieri G, Koch R, Piffaretti D, Pini K, Pirosa MC, Cittone MG, Arribas A, Lucioni M, Ghilardi G, Wu W, Arcaini L, Baptista MJ, Bastidas G, Bea S, Boldorini R, Broccoli A, Canzonieri V, Cascione L, Ceriani L, Cogliatti S, Derenzini E, Devizzi L, Dietrich S, Elia AR, Facchetti F, Gaidano G, Garcia JF, Gerber B, Ghia P, Silva MG, Gritti G, Guidetti A, Hitz F, Inghirami G, Ladetto M, Lopez‐Guillermo A, Lucchini E, Maiorana A, Marasca R, Matutes E, Meignin V, Merli M, Moccia A, Mollejo M, Montalban C, Novak U, Oscier DG, Passamonti F, Piazza F, Pizzolitto S, Sabattini E, Salles G, Santambrogio E, Scarfó L, Stathis A, Stüssi G, Geyer JT, Tapia G, Thieblemont C, Tousseyn T, Tucci A, Visco C, Vitolo U, Zenz T, Zinzani PL, Khiabanian H, Calcinotto A, Bertoni F, Bhagat G, Campo E, Leval L, Dirnhofer S, Pileri SA, Piris MÁ, Traverse‐Glehen A, Tzankov A, Paulli M, Ponzoni M, Mazzucchelli L, Cavalli F, Zucca E, Rossi D. GENETIC AND PHENOTYPIC ATTRIBUTES OF SPLENIC MARGINAL ZONE LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.43_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Spina V, Pirosa MC, Bruscaggin A, Condoluci A, Pini K, Forestieri G, Zangrilli I, di Trani M, Kurlapski M, Moccia A, Moia R, Bulian P, Annunziata S, Borsatti E, Rodari M, Romanowicz G, Sacchetti GM, Faderl M, Koch R, Piffaretti D, Terzi di Bergamo L, Stasia A, Cittone M, Chauvie S, Stüssi G, Gerber B, Stathis A, Sommer SG, Cavalli F, Zucca E, Gattei V, Zaucha JM, Pinto A, Gaidano G, Carlo‐Stella C, Hohaus S, Ceriani L, Rossi D. CIRCULATING TUMOR DNA IS A PROGNOSTIC BIOMARKER IN CLASSIC HODGKIN LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.70_2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rizzo S, Del Grande M, Espeli V, Stathis A, Nicolino GM, Del Grande F. Do oncologists prefer subspecialty radiology reports? A quality care study. Insights Imaging 2021; 12:64. [PMID: 34037872 PMCID: PMC8155173 DOI: 10.1186/s13244-021-01007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background The main objective was to assess whether CT reports of radiologists subspecialized in oncologic imaging respond better to oncological referrals than reports from general radiologists. The secondary objective was to assess differences in ratings between a senior and junior oncologist. Two hundred radiological reports pertaining to oncological patients were retrospectively selected of which 100 each were written by subspecialized radiologists and general radiologists, respectively. The senior and junior oncologists each rated all CT reports using a Likert scale from 1 to 5 (1 = very poor, 5 = excellent) for the following information: anatomical details; interpretation of findings; need for further explanations; appropriateness of conclusions; overall satisfaction. Comparisons between ratings assigned to reports from generalist radiologists and subspecialty radiologists were performed using the Mann–Whitney U test. Agreement between both oncologists was assessed through Gwet's coefficient. Results For all but two of the five items obtained from the senior oncologist, oncologists' ratings were significantly higher for subspecialty radiologists' reports (p < 0.01); mean values from both oncologists were generally higher for subspecialty reports (p < 0.001). Agreement between the senior and junior oncologist in the rating of reports from general and subspecialty radiologists was either moderate to substantial (0.5986–0.6788) or substantial to almost perfect (0.6958–0.8358). Conclusions According to a senior and junior oncologist, CT reports performed by subspecialized radiologists in oncologic imaging are clearer, more accurate, and more appropriate in the interpretation and conclusions compared to reports written by general radiologists. Likewise, the overall satisfaction of the oncologist from a subspecialized radiologist report is higher. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01007-4.
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Affiliation(s)
- Stefania Rizzo
- Istituto Di Imaging Della Svizzera Italiana (IIMSI), Clinica Di Radiologia EOC, Via Tesserete 46, 6900, Lugano, Switzerland. .,Facoltà Di Scienze Biomediche, Università della Svizzera italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland.
| | - Maria Del Grande
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Vittoria Espeli
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500, Bellinzona, Switzerland
| | - Gabriele Maria Nicolino
- Post-Graduate School in Radiodiagnostics, Università Degli Studi Di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Filippo Del Grande
- Istituto Di Imaging Della Svizzera Italiana (IIMSI), Clinica Di Radiologia EOC, Via Tesserete 46, 6900, Lugano, Switzerland.,Facoltà Di Scienze Biomediche, Università della Svizzera italiana (USI), Via G. Buffi 13, 6904, Lugano, Switzerland
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