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Nelson BE, Roszik J, Janku F, Hong DS, Kato S, Naing A, Piha-Paul S, Fu S, Tsimberidou A, Cabanillas M, Busaidy NL, Javle M, Byers LA, Heymach JV, Meric-Bernstam F, Subbiah V. BRAF v600E-mutant cancers treated with vemurafenib alone or in combination with everolimus, sorafenib, or crizotinib or with paclitaxel and carboplatin (VEM-PLUS) study. NPJ Precis Oncol 2023; 7:19. [PMID: 36801912 PMCID: PMC9938883 DOI: 10.1038/s41698-022-00341-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/14/2022] [Indexed: 02/20/2023] Open
Abstract
Combined BRAF + MEK inhibition is FDA approved for BRAF V600E-mutant solid tumors except for colorectal cancer. However, beyond MAPK mediated resistance several other mechanisms of resistance such as activation of CRAF, ARAF, MET, P13K/AKT/mTOR pathway exist among other complex pathways. In the VEM-PLUS study, we performed a pooled analysis of four phase one studies evaluating the safety and efficacy of vemurafenib monotherapy and vemurafenib combined with targeted therapies (sorafenib, crizotinib, or everolimus) or carboplatin plus paclitaxel in advanced solid tumors harboring BRAF V600 mutations. When vemurafenib monotherapy was compared with the combination regimens, no significant differences in OS or PFS durations were noted, except for inferior OS in the vemurafenib and paclitaxel and carboplatin trial (P = 0.011; HR, 2.4; 95% CI, 1.22-4.7) and in crossover patients (P = 0.0025; HR, 2.089; 95% CI, 1.2-3.4). Patients naïve to prior BRAF inhibitors had statistically significantly improved OS at 12.6 months compared to 10.4 months in the BRAF therapy refractory group (P = 0.024; HR, 1.69; 95% CI 1.07-2.68). The median PFS was statistically significant between both groups, with 7 months in the BRAF therapy naïve group compared to 4.7 months in the BRAF therapy refractory group (P = 0.016; HR, 1.80; 95% CI 1.11-2.91). The confirmed ORR in the vemurafenib monotherapy trial (28%) was higher than that in the combination trials. Our findings suggest that, compared with vemurafenib monotherapy, combinations of vemurafenib with cytotoxic chemotherapy or with RAF- or mTOR-targeting agents do not significantly extend the OS or PFS of patients who have solid tumors with BRAF V600E mutations. Gaining a better understanding of the molecular mechanisms of BRAF inhibitor resistance, balancing toxicity and efficacy with novel trial designs are warranted.
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Affiliation(s)
- Blessie Elizabeth Nelson
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Jason Roszik
- grid.240145.60000 0001 2291 4776Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Filip Janku
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David S. Hong
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Shumei Kato
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Aung Naing
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Sarina Piha-Paul
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Siqing Fu
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Apostolia Tsimberidou
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Maria Cabanillas
- grid.240145.60000 0001 2291 4776Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Naifa Lamki Busaidy
- grid.240145.60000 0001 2291 4776Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Milind Javle
- grid.240145.60000 0001 2291 4776Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lauren Averett Byers
- grid.240145.60000 0001 2291 4776Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - John V. Heymach
- grid.240145.60000 0001 2291 4776Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Funda Meric-Bernstam
- grid.240145.60000 0001 2291 4776Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Vivek Subbiah
- Departments of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Westin SN, Fu S, Tsimberidou A, Piha-Paul S, Akhmedzhanov F, Yilmaz B, McQuinn L, Brink AL, Gong J, Leung CH, Lin H, Hong DS, Pant S, Carter B, Jazaeri A, Gershenson D, Sood AK, Coleman RL, Shah J, Meric-Bernstam F, Naing A. Selinexor in combination with weekly paclitaxel in patients with metastatic solid tumors: Results of an open label, single-center, multi-arm phase 1b study with expansion phase in ovarian cancer. Gynecol Oncol 2023; 168:76-82. [PMID: 36423446 PMCID: PMC9797438 DOI: 10.1016/j.ygyno.2022.11.004] [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: 05/24/2022] [Revised: 10/29/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Selinexor is a first-in-class, oral selective inhibitor of nuclear export (SINE) compound which blocks Exportin-1 (XPO1). Our objective was to determine maximum tolerated dose (MTD) and recommended phase II dose (RP2D) of selinexor and weekly paclitaxel. METHODS This was an open label, single-center, multi-arm phase 1b study utilizing a "3 + 3" design and a "basket-type" expansion in recurrent solid tumors. Selinexor (60 mg or 80 mg twice weekly orally) and weekly paclitaxel (80 mg IV 2 week on, 1 week off) were one of 13 parallel arms. Efficacy was evaluated using RECIST version 1.1. RESULTS All 35 patients treated were evaluable for toxicity and 31 (88%) were evaluable for response. Patient diagnoses included platinum-resistant/refractory ovarian (n = 28), breast (n = 4), prostate (n = 2), and cervical (n = 1) cancer. Patients had a median of four prior therapies (range 1-10), and 47% had a prior taxane in the recurrent setting. There were no DLTs and 60 mg was chosen as the RP2D due to long-term tolerability. Ninety-seven percent of patients had at least one treatment-emergent adverse event (TEAE), and the most common grade ≥ 3 TEAE were neutropenia (46%), anemia (31%), and nausea (21%). Among 24 evaluable patients with ovarian cancer, response rate was 17%, CBR was 58%, and median PFS was 6.8 months (95% CI 3.7, not reached (NR)). CONCLUSIONS Oral selinexor in combination with weekly paclitaxel demonstrated promising clinical activity with manageable toxicity. This combination should be considered for further exploration in a randomized study, especially in ovarian malignancies.
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Affiliation(s)
- Shannon N Westin
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fechukwu Akhmedzhanov
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bulent Yilmaz
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lacey McQuinn
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda L Brink
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cheuk Hong Leung
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shubham Pant
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett Carter
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amir Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Gershenson
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jatin Shah
- Karyopharm Therapeutics, Inc, Newton, MA, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Robinson P, Hamana L, Beretta L, Kasembeli M, Bharadwaj U, Chun YS, Wang Y, Wang X, Reyes L, Solis L, Rashid A, Maru D, Vila E, Tsimberidou A, Kaseb A, Kopetz S, Tweardy D. Abstract IA004: Targeting STAT3 with TTI-101, an oral small molecule, to prevent colorectal and hepatocellular cancer. Cancer Prev Res (Phila) 2022. [DOI: 10.1158/1940-6215.tacpad22-ia004] [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: 12/03/2022]
Abstract
Abstract
Persistent STAT3 activation contributes to 10 of 14 hallmarks of cancer, including inflammation; successful targeting of STAT3 has the potential to prevent and/or treat cancer. However, no small molecule that directly targets STAT3 has been FDA approved. The Tweardy lab used computer-based docking of drug-like compounds into the SH2 domain of STAT3, along with hit-to-lead optimization and medicinal chemistry, to identify TTI-101; TTI-101 treatment was safe, hit its target in tumor cells, and resulted in clinical benefit in a Phase I trial of patients with advanced solid tumors.
The incidence of colorectal cancer (CRC) is increased 20-30 fold in patients with inflammatory bowel disease (IBD), while 90% of hepatocellular carcinomas (HCC) arise in the setting of chronic inflammation. To assess the contribution of STAT3 to CRC secondary to IBD and to HCC, we performed immunohistochemistry (IHC) staining and computer-based scoring for activated STAT3 (phosphorylated on Y705, pY-STAT3) of epithelial and stromal cells within colonic endoscopic biopsies and surgically resected CRC from IBD patients, as well as of tumor cells and hepatocytes within surgically resected HCC tumors. Compared to epithelium of normal tissue, levels of pY-STAT3 were increased 1.9-fold in dysplastic epithelium (p=0.05) and 1.8-fold in the stroma of normal tissue (p<0.0001). In surgically resected HCC tumors, lower pY-STAT3 scores in tumor cells, but not hepatocytes, correlated with longer recurrence free survival (RFS; p=0.003).
TTI-101 administration in three AOM-DSS mouse models of IBD resulted in a dose-dependent reduction in polyps, adenomas, and/or adenocarcinomas. TTI-101 administration to the HepPten- mouse model of NASH-induced HCC resulted in a dose-dependent reduction in liver pY-STAT3 levels. Thus, STAT3 may be a valid target for chemoprevention using TTI-101 in CRC arising from IBD and in HCC.
We thank Tvardi Therapeutics for providing TTI-101 for these studies.
Citation Format: Prema Robinson, Leticia Hamana, Laura Beretta, Moses Kasembeli, Uddalak Bharadwaj, Yun Shin Chun, Yinghong Wang, Xeumei Wang, Laura Reyes, Luisa Solis, Asif Rashid, Dipen Maru, Eduardo Vila, Apostolia Tsimberidou, Ahmed Kaseb, Scott Kopetz, David Tweardy. Targeting STAT3 with TTI-101, an oral small molecule, to prevent colorectal and hepatocellular cancer [abstract]. In: Proceedings of the Second Biennial NCI Meeting: Translational Advances in Cancer Prevention Agent Development (TACPAD); 2022 Sep 7-9. Philadelphia (PA): AACR; Can Prev Res 2022;15(12 Suppl_2): Abstract nr IA004.
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Affiliation(s)
- Prema Robinson
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Leticia Hamana
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura Beretta
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Yun Shin Chun
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yinghong Wang
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xeumei Wang
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura Reyes
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Luisa Solis
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Asif Rashid
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dipen Maru
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Vila
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ahmed Kaseb
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scott Kopetz
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Tweardy
- 1University of Texas MD Anderson Cancer Center, Houston, TX
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4
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Nelson BE, Roszik J, Janku F, Hong D, Kato S, Naing A, Piha-Paul S, Fu S, Tsimberidou A, Cabanillas M, Busaidy N, Javle M, Byers L, Heymach J, Meric-Bernstam F, Subbiah V. Abstract 5237: B-Raf V600E harboring non-melanoma cancers treated with Vemurafenib monotherapy and in combination with Everolimus/Sorafenib/Crizotinib/Paclitaxel+ Carboplatin: A pooled analysis of five phase 1/2 studies. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5237] [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: BRAF V600 mutations are driver oncogenes in multiple human cancers. Given complex resistance mechanisms beyond combined MEK inhibition, limited data exists to evaluate combinations with CRAF/ARAF/MET/mTOR inhibitors and cytotoxic chemotherapy in sustaining response and overcoming resistance. We explore patient outcomes comparing vemurafenib monotherapy with the above combination therapies in this analysis.
METHODS: A pooled analysis of 5 phase 1/2 clinical trials containing vemurafenib was conducted between January 2012 and October 2020 in BRAF V600E mutant advanced or metastatic tumors. Overall survival (OS) and Progression free survival (PFS) in vemurafenib monotherapy (V) arm compared with vemurafenib + crizotinib (VC), vemurafenib + sorafenib (VS), vemurafenib + everolimus (VE) and vemurafenib + paclitaxel + carboplatin (VPC) arms were assessed. Objective Response Rate (ORR) and Clinical Benefit Rate (CBR=CR+PR+SD≥6 months) and safety profile of combination arms were also explored.
RESULTS: 99 patients were enrolled across 5 studies. Median age was 57 years with 78% of ECOG 1 and M:F ratio at 1:1. Tumor types included NSCLC (13%), Thyroid cancer (12%), Low and High-grade Gliomas (7%), Colorectal cancer (6%), Cholangiocarcinoma (5%) and ECD (3%). V arm derived greatest clinical benefit with median OS at 21 months while addition of PC arm dropped median OS to 2 months. Inferior OS was seen in VPC arm when compared to V arm (p=0.00616). Median PFS peaked at 11 months in VC arm versus 3 months for the VPC arm. Of 85 evaluable patients, 2 complete responses were noted in the V (n=25) and VPC (n=14) arms and 8 Partial Responses (PR) were noted with 5 (18%) patients with NSCLC in V arm followed by 4 PRs in the VC (n=12) arm. PR rates were equally seen in the other arms. ORR (36%) and CBR (40%) rates were the highest for the V arm. G3/G4 treatment related adverse events with neutropenia (63%), thrombocytopenia (50%) and fatigue (63%) were highest in VPC. 1 patient died from G4 thrombocytopenia with intracranial hemorrhage in the VPC arm.
CONCLUSIONS: No significant added clinical benefit was noted when vemurafenib was combined with other targeted agents or cytotoxic therapy. Combinations resulted in poor tolerance and need for dose reductions compromising clinical efficacy. Prospective studies to analyze resistance mechanisms to BRAF inhibitor therapy in BRAF+ tumors and in real time tailoring therapy based on co-occuring alterations is warranted.
Citation Format: Blessie Elizabeth Nelson, Jason Roszik, Filip Janku, David Hong, Shumei Kato, Aung Naing, Sarina Piha-Paul, Siqing Fu, Apostolia Tsimberidou, Maria Cabanillas, Naifa Busaidy, Milind Javle, Lauren Byers, John Heymach, Funda Meric-Bernstam, Vivek Subbiah. B-Raf V600E harboring non-melanoma cancers treated with Vemurafenib monotherapy and in combination with Everolimus/Sorafenib/Crizotinib/Paclitaxel+ Carboplatin: A pooled analysis of five phase 1/2 studies [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 5237.
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Affiliation(s)
| | | | | | - David Hong
- 1U.T. MD Anderson Cancer Center, Houston, TX
| | - Shumei Kato
- 3University of California San Diego, San Diego, CA
| | - Aung Naing
- 1U.T. MD Anderson Cancer Center, Houston, TX
| | | | - Siqing Fu
- 1U.T. MD Anderson Cancer Center, Houston, TX
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Bullock A, Grossman J, Fakih M, Lenz H, Gordon M, Margolin K, Wilky B, Mahadevan D, Trent J, Bockorny B, Moser J, Balmanoukian A, Schlechter B, Ortuzar Feliu W, Rosenthal K, Bullock B, Stebbing J, Godwin J, O'Day S, Tsimberidou A, El-Khoueiry A. LBA O-9 Botensilimab, a novel innate/adaptive immune activator, plus balstilimab (anti-PD-1) for metastatic heavily pretreated microsatellite stable colorectal cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.453] [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: 11/01/2022] Open
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6
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Thein KZ, Piha-Paul SA, Tsimberidou A, Karp DD, Janku F, Fu S, Subbiah V, Hong DS, Yap TA, Shah J, Milton DR, McQuinn L, Gong J, Tran Y, Carter BW, Colen R, Meric-Bernstam F, Naing A. Selinexor in combination with standard chemotherapy in patients with advanced or metastatic solid tumors. Exp Hematol Oncol 2021; 10:59. [PMID: 34965890 PMCID: PMC8715578 DOI: 10.1186/s40164-021-00251-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/18/2021] [Indexed: 11/16/2022] Open
Abstract
Selinexor, an oral selective inhibitor of nuclear export (SINE), was demonstrated to hinder the DNA damage repair (DDR) system by reducing DDR proteins while enhancing the killing of cancer cells by DDR-based therapeutics in vivo studies. In this single-center, multi-arm phase 1b study, selinexor with carboplatin, doxorubicin and cyclophosphamide (DC), irinotecan with fluorouracil and folinic acid (FOLFIRI), irinotecan, and capecitabine and oxaliplatin (XELOX), were employed as separate parallel arms. Eligible patients have relapsed/ metastatic refractory solid tumors following standard therapy or addition of selinexor to systemic therapy was appropriate. Nineteen patients were treated in the 5 arms. Tumor types included were colorectal (n = 3), breast (n = 3), neuroendocrine (n = 2), ovarian (n = 2), and pancreas cancers (n = 2). All patients developed one treatment-related adverse events (TRAE). The most prevalent TRAE were thrombocytopenia (84%), nausea (68%), leukopenia (68%), neutropenia (63%), and fatigue (58%). The common grade 3/4 TRAE were neutropenia (42%), leukopenia (26%), and hyponatremia (21%). Three patients had dose-limiting toxicities (DLT) in 3 separate arms. Fourteen patients were evaluable for response. Although no patients achieved complete or partial response (CR or PR), seven patients attained stable disease (SD). Disease control rate (DCR) was 14%. The combination of oral selinexor with different standard chemotherapies showed limited clinical activity despite toxicity and DLT prevented further dose escalation. Optimizing supportive care, the utility of growth factors, and aggressive measures on antiemetics strategies remain tangible. Trial registration ClinicalTrials.gov Identifier: NCT02419495. Registered 14 April 2015, https://clinicaltrials.gov/ct2/show/NCT02419495). Sponsor(s): Karyopharm Therapeutics
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Affiliation(s)
- Kyaw Z Thein
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Division of Hematology and Medical Oncology, Oregon Health and Science University/Knight Cancer Institute, 3181 SW Sam Jackson Park Rd, Mail Code: OC14HO, Portland, OR, 97239, USA.
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy A Yap
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jatin Shah
- Karyopharm Therapeutics, Newton, MA, USA
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lacey McQuinn
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yanyan Tran
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett W Carter
- Department of Thoracic Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka Colen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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7
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Thein KZ, Karp DD, Tsimberidou A, Gong J, Sulovic S, Shah J, Milton DR, Hong DS, Janku F, McQuinn L, Stephen BA, Colen R, Carter BW, Yap TA, Piha-Paul SA, Fu S, Meric-Bernstam F, Naing A. Correction to: Selinexor in combination with carboplatin and paclitaxel in patients with advanced solid tumors: results of a single‑center, multi‑arm phase Ib study. Invest New Drugs 2021; 40:463. [PMID: 34731355 PMCID: PMC8993707 DOI: 10.1007/s10637-021-01194-3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kyaw Z Thein
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Division of Hematology and Medical Oncology, Oregon Health and Science University/ Knight Cancer Institute, Portland, OR, USA.
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Selma Sulovic
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jatin Shah
- , Karyopharm Therapeutics, Newton, MA, USA
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lacey McQuinn
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bettzy A Stephen
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka Colen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett W Carter
- Department of Thoracic Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy A Yap
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Thoracic Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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8
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El-Khoueiry A, Bullock A, Tsimberidou A, Mahadevan D, Wilky B, Twardowski P, Bockorny B, Moser J, Feliu WO, Grossman J, Rosenthal K, O’Day S, Gordon M. 479 AGEN1181, an Fc-enhanced anti-CTLA-4 antibody, alone and in combination with balstilimab (anti-PD-1) in patients with advanced solid tumors: Initial phase I results. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundAGEN1181 is a novel anti-CTLA-4 antibody with enhanced FcyR-dependent functionality, engineered to bind high and low binding alleles of FcyRIIIA, promoting superior T cell priming, memory responses, and depletion of intratumoral T regulatory cells. Further, AGEN1181 avoids complement recruitment, predictive of better tolerability. Here we report initial safety and efficacy findings from a phase I/Ib study of AGEN1181 as monotherapy and in combination with balstilimab (BAL; anti-PD-1).MethodsEligible patients (pts) had advanced solid tumors refractory to standard therapies. AGEN1181 was dosed Q3W (0.1–3 mg/kg) or Q6W (1–2 mg/kg) as monotherapy, or Q6W (0.1–2 mg/kg) in combination with BAL Q2W (3 mg/kg).ResultsAs of July 16th 2021, 102 pts received AGEN1181 (43 monotherapy, 59 combination). Median age, 63 years (29–83); 50.5% with ≥3 prior lines of therapy. MTD not yet reached with AGEN1181 dosing up to 3 mg/kg Q3W as monotherapy and 2 mg/kg in combination with BAL. The most common treatment-related adverse events (TRAEs) of any grade were fatigue (34.3%), diarrhea (32.4%), and nausea (19.6%) with grade ≥3 events in 21.6% (diarrhea/colitis, 11.8%, fatigue, 2.9%). Notably, no immune-related hypophysitis or pneumonitis has been observed. Discontinuation from AGEN1181 due to TRAEs occurred in 15% of pts. Grade 5 TRAEs occurred in two pts (colitis [chronic], intestinal perforation). The disease control rate in evaluable pts (completed ≥1 on-treatment scan) defined as best overall response of CR, PR, or SD ≥6 weeks was 48.1% for AGEN1181 monotherapy ≥1 mg/kg (1 CR, 3 PR, 9 SD) and 70% for combination (3 PR, 6 unconfirmed PR [uPR], 19 SD). Monotherapy responders include individual pts with MSS endometrial cancer (CR), PD-1-relapsed/refractory cervical cancer (PR), PD-1-relapsed/refractory melanoma (PR), and pancreatic cancer (PR). Enrollment is continuing in several disease expansion cohorts with combination therapy. For MSS CRC, 2 PR, 2 uPR, and 7 SD have been seen in 17 evaluable ≥1 mg/kg patients to date. In the ovarian cohort (n=6), 2 PRs and 3 SD are noted. Additional combination responders include one PR and uPR in MSS endometrial cancer, two uPRs in visceral angiosarcoma (uPRs) and one uPR in PD-1-relapsed/refractory NSCLC (uPR); the majority of the responses are recent and ongoing.ConclusionsAGEN1181 alone and in combination with BAL demonstrates favorable tolerability and compelling clinical activity, notably in poorly immunogenic tumor types and PD-1-refractory pts. These results underscore the significant potential of AGEN1181 to expand benefit of anti-CTLA-4 therapy to a broader patient population.Trial RegistrationNCT03860272Ethics ApprovalThe study obtained ethics approval at each participating center (UT Health Sciences Center at San Antonio, University of Colorado Cancer Center, St John’s Cancer Institute, and HonorHealth under WIRB Study number 1256391; USC Norris Comprehensive Cancer Center, Beth Israel Deaconess Medical Center, and MD Anderson Cancer Center, approval numbers HS19-00277, 19–132, and 140346, respectively). All patients provided written informed consent in accordance with federal, local, and institutional guidelines.
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Thein KZ, Piha-Paul SA, Tsimberidou A, Karp DD, Janku F, Zarifa A, Shah J, Milton DR, Bean S, McQuinn L, Gong J, Colen R, Carter BW, Subbiah V, Ogbonna DC, Pant S, Meric-Bernstam F, Naing A. Selinexor in combination with topotecan in patients with advanced or metastatic solid tumors: Results of an open-label, single-center, multi-arm phase Ib study. Invest New Drugs 2021; 39:1357-1365. [PMID: 33909232 PMCID: PMC8542012 DOI: 10.1007/s10637-021-01119-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
Background Selinexor, a first-in-class, oral selective inhibitor of nuclear export (SINE) compound inhibits Exportin-1(XPO1), had demonstrated synergistic activity with many chemotherapies and conferred in vivo antitumor efficacy in hematologic as well as solid tumors. Methods This open-label, single-center, multi-arm phase 1b study used a standard 3 + 3 design and a "basket type" expansion. Selinexor with intravenous topotecan was given in one of the 13 parallel arms. Patients with advanced or metastatic relapsed/refractory solid tumors following prior systemic therapy, or in whom the addition of selinexor to standard chemotherapy deemed appropriate, were eligible. Results Fourteen patients with the median age of 61 years (range, 22-68years) were treated, and the most common cancer types were gynecological cancers; ovarian (n = 5), endometrial (n = 2), and 1 each with fallopian tube and vaginal cancers. Of the 14 patients treated, 12 (86 %) had at least one treatment-related adverse event (TRAE). The most common TRAEs were anemia (71 %), thrombocytopenia (57 %), hyponatremia (57 %), vomiting (57 %), fatigue (50 %), nausea (50 %), and neutropenia (36 %). Two patients had dose limiting toxicities. One patient dosed at selinexor 80 mg had grade 3 nausea and vomiting and one patient dosed at selinexor 60 mg experienced grade 4 neutropenia and thrombocytopenia. Of the 13 efficacy evaluable patients, one (8 %) with endometrial cancer achieved unconfirmed partial response (uPR) and the time-to-treatment failure (TTF) was 48 weeks, whereas 6 of the 13 (46 %) patients had stable disease (SD) contributing to the clinical benefit rate of 46 %. The median TTF for all patients was 9 weeks (range, 2-48weeks). Conclusions Once weekly selinexor in combination with topotecan was viable and showed some preliminary tumor efficacy. The recommend phase 2 dose of selinexor was 60 mg once weekly in combination with IV topotecan.Trial registration: NCT02419495. Registered 14 April 2015, https://clinicaltrials.gov/ct2/show/NCT02419495.
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Affiliation(s)
- Kyaw Zin Thein
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
- Division of Hematology and Medical Oncology, Oregon Health and Science University/ Knight Cancer Institute, Portland, OR, USA.
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Abdulrazzak Zarifa
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jatin Shah
- Karyopharm Therapeutics, Newton, MA, USA
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stacie Bean
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lacey McQuinn
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Rivka Colen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett W Carter
- Department of Thoracic Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Deby C Ogbonna
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Shubham Pant
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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10
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Thein KZ, Karp DD, Tsimberidou A, Gong J, Sulovic S, Shah J, Milton DR, Hong DS, Janku F, McQuinn L, Stephen BA, Colen R, Carter BW, Yap TA, Piha-Paul SA, Fu S, Meric-Bernstam F, Naing A. Selinexor in combination with carboplatin and paclitaxel in patients with advanced solid tumors: Results of a single-center, multi-arm phase Ib study. Invest New Drugs 2021; 40:290-299. [PMID: 34562230 PMCID: PMC8993773 DOI: 10.1007/s10637-021-01188-1] [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: 07/08/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Background. Carboplatin and paclitaxel (CT) is one of the standard chemotherapy regimens used in various tumor types. Preclinical models have suggested that selinexor, a first-in-class oral potent selective inhibitor of nuclear export Exportin-1, and CT exerts antitumor activity in multiple malignancies. Methods. This was a single-center, multi-arm phase Ib study utilizing a “basket type” expansion. CT and selinexor was employed as one of the 13 parallel arms. Advanced relapsed/refractory solid tumors following standard therapy or where the addition of selinexor to standard regimens deemed appropriate, were eligible. Results. Of 13 patients treated, 12 patients were evaluable for response. The most common cancers were breast (n = 4), esophageal (n = 2), ovarian (n = 2) and non-small cell lung cancers (n = 2). All 13 patients had at least one treatment-related adverse events (TRAEs) and the most common were neutropenia (85%), leukopenia (85%), thrombocytopenia (85%), anemia (69%), nausea (54%), vomiting (46%), and fatigue (46%). One patient at 60 mg QW experienced DLT with grade 3 nausea and vomiting lasting 3 days. Unconfirmed partial response (uPR) was observed in 3 patients; one patient each with esophageal, breast, and ovarian cancer. One patient with esophageal adenocarcinoma had confirmed PR, however, was discontinued from the study due to clinical progression. Five patients achieved stable disease (SD). Disease control rate was 8%. Majority of patients (77%), including two patients who had uPR, had prior exposure to carboplatin and/or paclitaxel. Time-to-treatment failure (TTF) ranged from 1 to 153 weeks. Conclusion. The RP2D of selinexor was 60 mg QW in combination with CT. The combination conferred viable clinical activity with durable objective responses which should further be explored in tumor types for which CT is used as standard of care. Trial information. ClinicalTrials.gov Identifier: NCT02419495. Sponsor(s): Karyopharm Therapeutics. (Trial registration: NCT02419495. Registered 14 April 2015, https://clinicaltrials.gov/ct2/show/NCT02419495).
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Affiliation(s)
- Kyaw Z Thein
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. .,Division of Hematology and Medical Oncology, Oregon Health and Science University/ Knight Cancer Institute, Portland, OR, USA.
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Selma Sulovic
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jatin Shah
- , Karyopharm Therapeutics, Newton, MA, USA
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lacey McQuinn
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bettzy A Stephen
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka Colen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brett W Carter
- Department of Thoracic Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy A Yap
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Piha-Paul S, Tsimberidou A, Janku F, Raghav K, Wolff R, Huey R, Peng P, Levin W, Ngo B, Wang H, Sun C, Ru Q, Wu F, Javle M. P-261 Phase I study of multiple kinase inhibitor, TT-00420, in advanced, refractory cholangiocarcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.315] [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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Rodon J, Soria JC, Berger R, Miller WH, Rubin E, Kugel A, Tsimberidou A, Saintigny P, Ackerstein A, Braña I, Loriot Y, Afshar M, Miller V, Wunder F, Bresson C, Martini JF, Raynaud J, Mendelsohn J, Batist G, Onn A, Tabernero J, Schilsky RL, Lazar V, Lee JJ, Kurzrock R. Genomic and transcriptomic profiling expands precision cancer medicine: the WINTHER trial. Nat Med 2019; 25:751-758. [PMID: 31011205 DOI: 10.1038/s41591-019-0424-4] [Citation(s) in RCA: 289] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/14/2019] [Indexed: 12/21/2022]
Abstract
Precision medicine focuses on DNA abnormalities, but not all tumors have tractable genomic alterations. The WINTHER trial ( NCT01856296 ) navigated patients to therapy on the basis of fresh biopsy-derived DNA sequencing (arm A; 236 gene panel) or RNA expression (arm B; comparing tumor to normal). The clinical management committee (investigators from five countries) recommended therapies, prioritizing genomic matches; physicians determined the therapy given. Matching scores were calculated post-hoc for each patient, according to drugs received: for DNA, the number of alterations matched divided by the total alteration number; for RNA, expression-matched drug ranks. Overall, 303 patients consented; 107 (35%; 69 in arm A and 38 in arm B) were evaluable for therapy. The median number of previous therapies was three. The most common diagnoses were colon, head and neck, and lung cancers. Among the 107 patients, the rate of stable disease ≥6 months and partial or complete response was 26.2% (arm A: 23.2%; arm B: 31.6% (P = 0.37)). The patient proportion with WINTHER versus previous therapy progression-free survival ratio of >1.5 was 22.4%, which did not meet the pre-specified primary end point. Fewer previous therapies, better performance status and higher matching score correlated with longer progression-free survival (all P < 0.05, multivariate). Our study shows that genomic and transcriptomic profiling are both useful for improving therapy recommendations and patient outcome, and expands personalized cancer treatment.
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Affiliation(s)
- Jordi Rodon
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Wilson H Miller
- Segal Cancer Centre, Jewish General Hospital, QCROC-Quebec Cancer Consortium and Rossy Cancer Network, McGill University, Montreal, Québec, Canada
| | - Eitan Rubin
- Ben-Gurion University of the Negev, Beersheva, Israel
| | | | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Irene Braña
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Fanny Wunder
- Worldwide Innovative Network (WIN) Association-WIN Consortium, Villejuif, France
| | - Catherine Bresson
- Worldwide Innovative Network (WIN) Association-WIN Consortium, Villejuif, France
| | | | | | - John Mendelsohn
- Worldwide Innovative Network (WIN) Association-WIN Consortium, Villejuif, France.,Sheikh Khalifa Bin Zayad Al Nahyan Institute for Personalized Cancer Therapy (IPCT), The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, QCROC-Quebec Cancer Consortium and Rossy Cancer Network, McGill University, Montreal, Québec, Canada
| | - Amir Onn
- Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Josep Tabernero
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Richard L Schilsky
- Worldwide Innovative Network (WIN) Association-WIN Consortium, Villejuif, France.,American Society of Clinical Oncology (ASCO), Alexandria, VA, USA
| | - Vladimir Lazar
- Worldwide Innovative Network (WIN) Association-WIN Consortium, Villejuif, France
| | - J Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Razelle Kurzrock
- Worldwide Innovative Network (WIN) Association-WIN Consortium, Villejuif, France. .,University of California San Diego, Moores Cancer Center, San Diego, CA, USA.
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13
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Fujii T, Colen RR, Bilen MA, Hess KR, Hajjar J, Suarez-Almazor ME, Alshawa A, Hong DS, Tsimberidou A, Janku F, Gong J, Stephen B, Subbiah V, Piha-Paul SA, Fu S, Sharma P, Mendoza T, Patel A, Thirumurthi S, Sheshadri A, Meric-Bernstam F, Naing A. Incidence of immune-related adverse events and its association with treatment outcomes: the MD Anderson Cancer Center experience. Invest New Drugs 2018; 36:638-646. [PMID: 29159766 PMCID: PMC5962379 DOI: 10.1007/s10637-017-0534-0] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [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: 10/12/2017] [Accepted: 10/26/2017] [Indexed: 12/13/2022]
Abstract
Background Immunotherapy is emerging as the cornerstone for treatment of patients with advanced cancer, but significant toxicity (immune-related adverse events [irAEs]) associated with unbridled T cell activity remains a concern. Patients and methods A retrospective review of the electronic medical records of 290 patients with advanced cancer treated on an immunotherapy-based clinical trial in the Department of Investigational Cancer Therapeutics at The University of Texas MD Anderson Cancer Center between February 2010 and September 2015 was performed. Clinical and laboratory parameters were collected to determine the incidence of irAEs, risk factors, and their association with treatment outcomes. Results Ninety eight of 290 patients (34%) experienced any grade irAEs. Among the 15 (5.2%) patients with grade ≥ 3 irAEs, the most common irAEs were dermatitis and enterocolitis. Although 80% of the patients with grade ≥ 3 irAEs required systemic corticosteroids, all the 15 patients recovered from the irAEs. On re-challenge, 4 of the 5 patients who had received systemic corticosteroids for irAE continued to respond. There were no irAE-related deaths. Importantly, patients with grade ≥ 3 irAEs had improved overall response rate (25 vs. 6%; p = 0.039) and longer median time to progression (30 weeks vs. 10 weeks; p = 0.0040) when compared to those without grade ≥ 3 irAEs. Conclusion Incidence of irAEs with immunotherapeutic agents indicates an active immune status, suggestive of potential clinical benefit to the patient. Further validation of this association in a large prospective study is warranted.
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Affiliation(s)
- Takeo Fujii
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Rivka R Colen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Asim Bilen
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joud Hajjar
- Department of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anas Alshawa
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Bettzy Stephen
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Padmanee Sharma
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anisha Patel
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Selvi Thirumurthi
- Department of Gastroenterology Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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Sen S, Hess K, Hong DS, Naing A, Piha-Paul S, Janku F, Fu S, Subbiah IM, Liu H, Khanji R, Huang L, Moorthy S, Karp DD, Tsimberidou A, Meric-Bernstam F, Subbiah V. Development of a prognostic scoring system for patients with advanced cancer enrolled in immune checkpoint inhibitor phase 1 clinical trials. Br J Cancer 2018; 118:763-769. [PMID: 29462132 PMCID: PMC5886120 DOI: 10.1038/bjc.2017.480] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 07/04/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/19/2022] Open
Abstract
Background: We sought to develop a prognostic scoring system to aid in patient selection for immune checkpoint inhibitor (ICI) phase 1 clinical trials. Methods: Clinical data from patients treated in phase 1 ICI clinical trials at MD Anderson (MDA) Center were analysed. Seventeen clinical factors were studied. Recursive partitioning analysis, a tree-based model, was used to develop a regression tree and identify optimal cut-points based on differences in survival for each clinical factor. A Cox proportional hazards regression model was then used to identify factors independently affecting overall survival. A prognostic scoring system was subsequently developed. Results: A total of 172 patients (105 CTLA4- and 67 PD1-based) were analysed. Seven factors were independently associated with worse overall survival (OS): age>52 years (hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.1–2.4), Eastern Cooperative Oncology Group performance status>1 (HR 2.81, 95%CI 1.3–6.3), lactate dehydrogenase >466 (which is 0.75 × the upper limit of normal at our institution) (HR 2.1, 95% CI 1.4–3.2), platelet count >300 × 103μL−1 (HR 1.8, 95% CI 1.2–2.8), absolute neutrophil count >4.9 × 103μL−1 (HR 2.3, 95% CI 1.5–3.5), absolute lymphocyte count <1.8 × 103μL−1 (HR 3.3, 95% CI 1.9–5.7), and liver metastases (HR 1.8, 95% CI 1.2–2.6). An index was created by dividing the cohort into risk groups based on the number of factors present: 0–2, 3, 4, or 5–6. Median OS was 24.2 months, 11.6 months, 8.0 months, and 3.8 months for patients with 0–2, 3, 4, or 5–6 risk factors, respectively; log-rank test, P<0.0001. The Harrell c-index of this scoring system was 0.72, indicating better predictability than the Royal Marsden Hospital score (c-index 0.67) and MDA score (c-index 0.61). Conclusions: We have developed a novel ‘MDA-ICI’ prognostic scoring system for patients treated in phase 1 ICI clinical trials. Prospective evaluation and external validation is warranted and may help aid patient selection for future clinical trials.
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Affiliation(s)
- Shiraj Sen
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kenneth Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ishwaria M Subbiah
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Holly Liu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Rahil Khanji
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Le Huang
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shhyam Moorthy
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ileana Dumbrava E, Balaji K, Raghav K, Javle M, Blum-Murphy M, Sajan B, Kopetz S, Broaddus R, Routbort M, Pant S, Tsimberidou A, Subbiah V, Hong DS, Rodon Ahnert J, Shaw K, Piha-Paul S, Meric-Bernstam F. Abstract A167: Targeting HER2 (ERBB2) amplification identified by next-generation sequencing (NGS) in patients with advanced or metastatic solid tumors. Mol Cancer Ther 2018. [DOI: 10.1158/1535-7163.targ-17-a167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: Personalized cancer treatment is becoming more tumor agnostic by choosing a treatment based on the tumor genomics rather than the tumor type. HER2 is an effective therapeutic target with FDA-approved treatments in breast and gastric/gastroesophageal junction (GEJ) cancers; however, less is known about the efficacy of HER2-targeted treatment in other tumor types. Methods: Next-generation sequencing (NGS) was performed in 2221 patients (pts) with advanced solid tumors in CLIA-certified laboratories using multiple platforms for personalized cancer therapy. HER2 amplification (amp) was assessed by NGS platforms that report copy-number variations as per their respective algorithm. We assessed clinical characteristics and coalterations with HER2 amp. We evaluated the clinical benefit of HER2-targeted therapy, by measuring the progression-free survival (PFS) on HER2-matched targeted therapy (PFS2) compared to the PFS on prior therapy (PFS1). We also evaluated the response rate and overall survival (OS) of pts who received vs pts who did not receive HER2-targeted therapy. Results: A total of 122 pts (5.5%) were found to have HER2 amp. The most frequent tumor types were colorectal, biliary/gallbladder, gastric/gastroesophageal, esophageal, endometrial, head and neck squamous cell and salivary gland, non-small cell lung, and bladder cancers. Coalterations included mutations in TP53, APC, PIK3CA, LRP1B, NF1, KRAS, mutations and deletions in CDKN2A, and amp in MYC and CCNE1. Frequent amp in CDK12, RARA, and TOP2A amp (all within chromosome 17q) were also found in our pts. Concurrent mutations in HER2 were found in 16 pts (13%). Forty pts with HER2 amp on NGS also underwent HER2 IHC testing: 30 pts (75%) had overexpression (3+), 4 pts (10%) had equivocal expression (2+), 2 pts (5%) had low expression (1+), and 4 pts (10%) had no HER2 expression. FISH analysis was performed in 14 patients, out of which 12 patients were positive for amplification. Forty-four of 115 pts received at least 1 line of HER2-targeted therapy (range 1-4) with 42 pts receiving trastuzumab in combination with other drugs, including 11 (92%) of 12 pts with gastric, GEJ cancers with HER2 amp having received trastuzumab with chemotherapy (8 pts in the first line). Median OS of pts who received HER2-targeted therapy was 42 months vs 23 months for pts who did not receive HER2-targeted therapy (Hazard Ratio [HR] 0.6, 95% CI 0.38-0.97, p=0.0384). For 32 evaluable pts, PFS2/PFS1 ratio was ≥1.3 in 17 pts (53%) and ≥2 in 11 pts (34%) with median PFS2 of 23 weeks vs PFS1 of 11 weeks (p=0.0089). After exclusion of pts with gastric or GEJ cancers, pts receiving HER2-targeted therapy still had an improved OS (53 vs 23 months) (HR 0.56, 95% CI 0.33-0.93, p=0.0307) and the PFS2/PFS1 ratio was ≥1.3 in 15 (52%) of 29 pts with a median PFS2 of 23 weeks vs PFS1 of 12 weeks (p=0.0174). Conclusion: NGS reveals HER2 amp in a clinically relevant proportion of tumors and in a variety of tumor types. HER2-targeted therapy may confer clinical benefit in tumor types beyond those for which HER2 inhibitors are approved. The association of HER2 amp with genomic alterations in other oncogenic drivers provides rationale for novel therapeutic combinations.
Citation Format: Ecaterina Ileana Dumbrava, Kavitha Balaji, Kanwal Raghav, Milind Javle, Mariela Blum-Murphy, Blessy Sajan, Scott Kopetz, Russell Broaddus, Mark Routbort, Shubham Pant, Apostolia Tsimberidou, Vivek Subbiah, David S. Hong, Jordi Rodon Ahnert, Kenna Shaw, Sarina Piha-Paul, Funda Meric-Bernstam. Targeting HER2 (ERBB2) amplification identified by next-generation sequencing (NGS) in patients with advanced or metastatic solid tumors [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A167.
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Sen S, Hess K, Hong D, Naing A, Piha-Paul S, Janku F, Fu S, Liu H, Jiang Y, Khanji R, Karp D, Tsimberidou A, Tannir N, Meric-Bernstam F, Subbiah V. Abstract 3291: Development of a novel prognostic scoring system for patient selection in immune checkpoint inhibitor phase 1 clinical trials. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3291] [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
Purpose: To develop a prognostic scoring system for selecting patients for immune checkpoint inhibitor (ICI) phase 1 clinical trials.
Background: The Royal Marsden Hospital (RMH) and MD Anderson (MDA) prognostic scoring systems have been validated for patients in phase 1 clinical trials treated with cytotoxic chemotherapy and targeted therapy, but no such scoring system has been validated to help select patients entering ICI clinical trials.
Methods: We analyzed clinical data from patients treated in phase 1 ICI clinical trials (with anti-CTLA4 and anti-PD1 antibody therapy) at the MD Anderson Center for Targeted Therapy. Sixteen clinical factors were studied. Recursive partitioning analysis identified cut-points for each clinical factor and a Cox proportional hazards regression model was used to identify factors independently affecting overall survival.
Results: Among 172 patients treated with ICI therapy (105 CTLA4-based and 67 PD1-based) between January 2013 and November 2015, the median age was 60 years (range: 19-86 years) and 87 (51%) were male. The most common tumor types treated included renal cell carcinoma (n = 25; 15%), non-small cell lung cancer (n = 21; 12%), melanoma (n = 17; 10%), sarcoma (n = 14; 8%), gastrointestinal stromal tumors (n = 10; 6%), prostate cancer (n = 6; 3%), and colorectal cancer (n = 6; 3%). Seven factors were independently associated with significantly worse overall survival: age >52 years (hazard ratio [HR] 1.59, 95% confidence interval [CI] 1.1-2.4), Eastern Cooperative Oncology Group performance status >1 (HR 2.81, 95% CI 1.3-6.3), lactate dehydrogenase >466 U/L (HR 2.1, 95% CI 1.4-3.2), platelet count >300 × 109/L (HR 1.8, 95% CI 1.2-2.8), absolute neutrophil count >4.9 × 109/L (HR 2.3, 95% CI 1.5-3.5), absolute lymphocyte count <1.8 × 109/L (HR 3.3, 95% CI 1.9-5.7), and liver metastases (HR 1.8, 95% CI 1.2-2.6). An index was created whereby the cohort was divided into four risk groups based on the number of factors present: 0-2, 3, 4, or 5-6. Median overall survival was 24.2 months (0-2), 11.6 months (3), 8.0 months (4), and 3.8 months (5-6); log rank test, p < 0.0001. The Harrell c-index of this scoring system was 0.72, indicating significant predictability.
Conclusion: We have developed a novel “MDA ICI” prognostic scoring system incorporating seven clinical parameters with prognostic significance for patients in phase 1 clinical trials treated with immune checkpoint inhibitors. Unlike in the RMH and MDA prognostic scoring systems, albumin level and number of metastatic sites did not independently correlate with overall survival. Prospective evaluation and external validation of our novel prognostic scoring system is warranted and may help better select patients for future clinical trials of checkpoint inhibitors.
Citation Format: Shiraj Sen, Kenneth Hess, David Hong, Aung Naing, Sarina Piha-Paul, Filip Janku, Siqing Fu, Holly Liu, Yunfang Jiang, Rahil Khanji, Daniel Karp, Apostolia Tsimberidou, Nizar Tannir, Funda Meric-Bernstam, Vivek Subbiah. Development of a novel prognostic scoring system for patient selection in immune checkpoint inhibitor phase 1 clinical trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3291. doi:10.1158/1538-7445.AM2017-3291
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Affiliation(s)
- Shiraj Sen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kenneth Hess
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - David Hong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aung Naing
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Filip Janku
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Siqing Fu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Holly Liu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yunfang Jiang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rahil Khanji
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel Karp
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Nizar Tannir
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Vivek Subbiah
- University of Texas MD Anderson Cancer Center, Houston, TX
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Subbiah IM, Tsimberidou A, Subbiah V, Janku F, Roy-Chowdhuri S, Hong DS. Next generation sequencing of carcinoma of unknown primary reveals novel combinatorial strategies in a heterogeneous mutational landscape. Oncoscience 2017; 4:47-56. [PMID: 28781987 PMCID: PMC5538848 DOI: 10.18632/oncoscience.352] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 03/24/2017] [Accepted: 05/02/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Advanced carcinoma of unknown primary (CUP) has limited effective therapeutic options given the phenotypic and genotypic diversity. To identify future novel therapeutic strategies we conducted an exploratory analysis of next-generation sequencing (NGS) of relapsed, refractory CUP. METHODS We identified patients in our phase I clinic where archival tissue was available for a targeted NGS CLIA-certified assay. RESULTS Of 17 patients tested, 15 (88%) demonstrated genomic alterations (median 2 aberrations; range 0-8, total 59 alterations). Nine (53%) patients had altered cell signaling including the PI3K/AKT/MTOR (n=5, 29%) and MAPK pathways (n=3,18%); 7 (41%) patients demonstrated ≥1 alterations in tumor suppressor genes (TP53 in 5 patients), 8 (47%) had impaired epigenetic regulation and DNA methylation, 8 (47%) had aberrant cell cycle regulation, commonly in the cyclin dependent kinases. Ten (59%) patients had alterations in transcriptional regulators. Concurrent mutations affecting cell cycle regulation were noted to occur with aberrant epigenetic regulation (n=6, 35%) and MAPK/PI3K pathway (n=5, 29%). CONCLUSION Every patient had a unique molecular profile with no two patients demonstrating an identical panel of mutations. We identify two emerging novel combinatorial strategies targeting impaired cell cycle arrest, first with epigenetic modifiers and, second, with MAPK/PI3K pathway inhibition.
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Affiliation(s)
- Ishwaria M Subbiah
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, all at the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Reilley MJ, Bailey A, Subbiah V, Janku F, Naing A, Falchook G, Karp D, Piha-Paul S, Tsimberidou A, Fu S, Lim J, Bean S, Bass A, Montez S, Vence L, Sharma P, Allison J, Meric-Bernstam F, Hong DS. Phase I clinical trial of combination imatinib and ipilimumab in patients with advanced malignancies. J Immunother Cancer 2017; 5:35. [PMID: 28428884 PMCID: PMC5394629 DOI: 10.1186/s40425-017-0238-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 11/18/2016] [Accepted: 03/29/2017] [Indexed: 02/07/2023] Open
Abstract
Background Imatinib mesylate can induce rapid tumor regression, increase tumor antigen presentation, and inhibit tumor immunosuppressive mechanisms. CTLA-4 blockade and imatinib synergize in mouse models to reduce tumor volume via intratumoral accumulation of CD8+ T cells. We hypothesized that imatinib combined with ipilimumab would be tolerable and may synergize in patients with advanced cancer. Methods Primary objective of the dose-escalation study (3 + 3 design) was to establish the maximum tolerated dose (MTD) and recommended phase II dose. Secondary objectives included evaluation of antitumor activity of the combination based on KIT mutation status and the capacity of tumor-associated immune biomarkers to predict response. Results The primary objective to establish the maximum tolerated dose (MTD) was achieved, and the recommended phase II doses are ipilimumab at 3 mg/kg every 3 weeks and imatinib 400 mg twice daily. Of the 35 patients treated in the escalation and GIST expansion, none experienced dose-limiting toxicities. The most common grade 1/2–related adverse events (AEs) were fatigue (66%), nausea (57%), anorexia, vomiting (each 31%), edema (29%), and anemia, diarrhea, and rash (each 23%). Grade 3 AEs occurred in 6 patients (17%) and included fatigue, anemia, fever, rash, and vomiting. There were no grade 4 AEs. In general, the combination was well tolerated. Among all patients, 2 responses were seen: 1 partial response (GIST) and 1 partial response (melanoma). Stable disease was seen in 6 patients lasting an average of 6 months. The melanoma responder was KIT mutated and the GIST responder was wild-type. Conclusions Our findings suggest that this combination of a targeted agent with checkpoint blockade is safe across multiple tumor types. Low activity with no clear signal for synergy was observed in escalation or GIST expansion cohorts. Assessment of antitumor activity of this combination in the KIT-mutant melanoma population is being evaluated. Trial registration Clinicaltrials.gov NCT01738139, registered 28 November 2012. Electronic supplementary material The online version of this article (doi:10.1186/s40425-017-0238-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew J Reilley
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Ann Bailey
- Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Gerald Falchook
- Sarah Cannon Research Institute at HealthOne, 1800 Williams Street, Suite 300, Denver, CO 80218 USA
| | - Daniel Karp
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - JoAnn Lim
- Pharamacy Clinical Programs, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Stacie Bean
- Pharamacy Clinical Programs, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Allison Bass
- Pharamacy Clinical Programs, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Sandra Montez
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Luis Vence
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Padmanee Sharma
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - James Allison
- Department of Immunology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 USA.,Department of Cancer Medicine, John Mendelsohn Faculty Center (FC8.3050), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0455, Houston, TX 77030 USA
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Mahalingam D, Patel M, Sachdev J, Hart L, Halama N, Ramanathan R, Sarantopoulos J, Liu X, Yazji S, Jäger D, Yoon M, Manzur G, Adib D, Kerschbaumer R, Tsimberidou A. Anti-oxidized macrophage migration inhibitory factor (oxMIF) antibody imalumab (BAX69) in advanced solid tumors: Final results of first-in-human phase 1 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw368.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khawaja MR, Khatua S, Karp D, Janku F, Hong D, Munoz J, Tsimberidou A, Zaky W, Sherman SI, Hwu P, Meric-Bernstam F, Subbiah V. Abstract CT052: A phase I dose escalation trial of vemurafenib in combination with the mTOR inhibitor everolimus for melanoma and non-melanoma cancers with a BRAF aberration. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-ct052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: Vemurafenib (Vem) is approved by the US Food and Drug Administration for the treatment of BRAF V600-mutant melanoma. Vem also has demonstrated activity in BRAF V600-mutant non-melanoma cancers. However, with monotherapy, all patients eventually experience disease progression, and more effective treatments are needed. On the basis of preclinical studies showing that combined inhibition of the BRAF and PI3K/mTOR pathways may overcome the primary or innate resistance mechanisms in BRAF-mutant malignancies, we conducted a phase I trial combining Vem with the mTOR inhibitor everolimus (Eve).
Objectives: Primary objectives of this open-label phase I trial were to evaluate safety and tolerability, and to determine the maximum tolerated dose (MTD) of the Vem and Eve combination in patients with BRAF-mutant advanced cancers; the secondary objective was to assess efficacy.
Methods: Escalating doses of Vem twice daily (BID) and Eve once daily (QD) were combined using the standard 3 + 3 design, and then an expansion cohort was enrolled and treated at the MTD. Treatment was administered in 28-day cycles. MTD was defined as the highest dose studied in which incidence of dose-limiting toxicity (DLT) was less than 33%. Younger patients were enrolled at the accruing dose level, with body surface area-based dose adjustments for smaller children.
Results: Twenty patients (14 male, 6 female) with BRAF-mutant (18 V600E, 1 V600K, 1 G469A) melanoma (n = 7) or central nervous system (n = 5), thyroid (n = 4), non-small cell lung (n = 1), colorectal (n = 1), appendiceal (n = 1), or unknown primary (n = 1) cancer were enrolled. The median age of the 18 adult patients was 64 years (range 16-85 years); the 2 pediatric patients were aged 10 and 13 years. Prior therapies included surgery (n = 18, 90%), radiation (n = 11, 55%), cytotoxic chemotherapy (n = 14, 70%), and a prior phase I trial (n = 10, 50%). Ten patients (50%) had prior treatment with BRAF/MEK inhibitor(s). Ten patients had received 2 or more lines of systemic therapies. No dose-limiting toxicity was observed at dose level 1 (Vem 720 mg BID, Eve 5 mg QD). Two DLTs (rash, fatigue) were observed at dose level 2 (Vem 720 mg BID, Eve 10 mg QD). Dose level 1 was determined to be the MTD. Grade >3 toxic effects included rash (n = 4), fatigue (n = 4), photosensitivity (n = 1), anemia (n = 1), hyperglycemia (n = 1), and hypertriglyceridemia (n = 1). After excluding 1 patient who withdrew consent before restaging, we found that 5 patients (26%) had a partial response (melanoma = 1, non-melanoma = 4), 9 (47%) had stable disease, and 5 (26%) had progression as the best response. Among 9 evaluable patients with a history of prior treatment with BRAF/MEK inhibitors, 2 had a partial response and 5 had stable disease. Two patients are continuing the treatment after 5 and 16 cycles.
Conclusion: The combination of Vem (720 mg BID) and Eve (5 mg QD) is safe, well-tolerated, and has activity in patients with BRAF-mutant advanced cancers, including those previously treated with a BRAF/MEK inhibitor.
Citation Format: Muhammad Rizwan Khawaja, Soumen Khatua, Daniel Karp, Filip Janku, David Hong, Javier Munoz, Apostolia Tsimberidou, Wafik Zaky, Steven I. Sherman, Patrick Hwu, Funda Meric-Bernstam, Vivek Subbiah. A phase I dose escalation trial of vemurafenib in combination with the mTOR inhibitor everolimus for melanoma and non-melanoma cancers with a BRAF aberration. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT052.
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Khawaja MR, Madhusudanannair V, Ng C, Nick A, Janku F, Piha-Paul S, Coleman R, Soliman P, Fu S, Hong D, Karp D, Subbiah V, Tsimberidou A, Meric-Bernstam F, Lu K, Naing A. Abstract C44: Phase I dose escalation study of temsirolimus in combination with metformin in patients with advanced cancers. Mol Cancer Ther 2015. [DOI: 10.1158/1535-7163.targ-15-c44] [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 mTOR inhibitors may result in upregulation of Akt, leading to undesirable cell proliferation. Metformin inhibits mTOR through different mechanisms and may enhance antitumor activity of Temsirolimus.
Objectives: Primary objectives of this open-label phase 1 trial were to evaluate safety and tolerability, and to determine the maximum tolerated dose (MTD) of Temsirolimus plus Metformin combination in patients with advanced cancers refractory to standard therapies. Secondary objective was to assess clinical tumor response with this combination.
Methods: A fixed dose of intravenous (IV) Temsirolimus 25mg weekly was combined with an escalating dose of oral Metformin (level-1: 500mg daily, level-2: 1000mg daily, level-3: 1500mg daily, level-4: 2000g daily) by utilizing a standard 3 + 3 design. Treatment was administered in 28-day cycles following an initial 2 weeks of Metformin titration during the first cycle. MTD was defined as the highest dose studied in which the incidence of dose-limiting toxicity (DLT) was less than 33%.
Results: Twenty-one patients (male/female: 7/14) with sarcoma (n = 8), colorectal cancer (n = 3), endometrial cancer (n = 4), uterine carcinosarcoma (n = 2), ovarian cancer (n = 2) and other cancers (n = 2) were enrolled. Median age of patients was 56 (range 18-81) years. Patients had received median of 4 (range 2-11) lines of prior systemic treatments. Three DLTs were observed including one grade 3 mucositis in a patient with dose level-1, one grade 2 pneumonitis in level-2 and one grade 3 renal failure in level-4; all 3 patients who experienced DLT were able to continue treatment after dose modification. No grade 4 or 5 toxicities were observed. Patients continued treatment for a median of 11 (range 1-99; interquartile range 8-25) weeks.
Conclusion: Combination of Temsirolimus and Metformin is feasible and well tolerated. We recommend a dose of Temsirolimus 25mg IV weekly and Metformin 2000mg orally daily administered in 28-day cycles for phase 2 study. The combination showed modestly promising effectiveness among this cohort of heavily pretreated patients. Further expansion is being conducted among patients with metastatic endometrial cancer.
Citation Format: Muhammad Rizwan Khawaja, Vinu Madhusudanannair, Chaan Ng, Alpa Nick, Filip Janku, Sarina Piha-Paul, Robert Coleman, Pamela Soliman, Siqing Fu, David Hong, Daniel Karp, Vivek Subbiah, Apostolia Tsimberidou, Funda Meric-Bernstam, Karen Lu, Aung Naing. Phase I dose escalation study of temsirolimus in combination with metformin in patients with advanced cancers. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr C44.
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Affiliation(s)
| | | | - Chaan Ng
- 1MD Anderson Cancer Center, Houston, TX
| | - Alpa Nick
- 1MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Siqing Fu
- 1MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - Karen Lu
- 1MD Anderson Cancer Center, Houston, TX
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Fu S, Shi N, Wheler J, Naing A, Janku F, Piha-Paul S, Gong J, Hong D, Tsimberidou A, Zinner R, Subbiah V, Hou MM, Ramirez P, Ramondetta L, Lu K, Meric-Bernstam F. Characteristics and outcomes for patients with advanced vaginal or vulvar cancer referred to a phase I clinical trials program: the MD Anderson cancer center experience. Gynecol Oncol Res Pract 2015; 2:10. [PMID: 27231570 PMCID: PMC4880813 DOI: 10.1186/s40661-015-0018-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/03/2015] [Indexed: 11/16/2022]
Abstract
Background Early-stage vaginal and vulvar cancer can be cured. But outcomes of patients with metastatic disease are poor. Thus, new therapeutic strategies are urgently required. Methods In this retrospective study, we analyzed the clinical outcomes of consecutive patients with metastatic vaginal or vulvar cancer who were referred to a phase I trial clinic between January 2006 and December 2013. Demographic and clinical data were obtained from patients’ electronic medical records. Results Patients with metastatic vaginal (n = 16) and vulvar (n = 20) cancer who were referred for phase I trial therapy had median overall survival durations of 6.2 and 4.6 months, respectively. Among those who underwent therapy (n = 27), one experienced a partial response and three experienced stable disease for at least 6 months. Patients with a body mass index ≥30 had a significantly longer median overall survival duration than did those with a body mass index <30 (13.2 months versus 4.4 months, p = 0.04). Preliminary data revealed differences in molecular profiling between patients with advanced vaginal cancer and those with advanced vaginal cancer. Conclusions Metastatic vaginal and vulvar cancers remain to be difficult-to-treat diseases with poor clinical outcomes. The currently available phase I trial agents provided little meaningful clinical benefits. Understanding these tumors’ molecular mechanisms may allow us to develop more effective therapeutic strategies than are currently available regimens.
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Affiliation(s)
- Siqing Fu
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Naiyi Shi
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Jennifer Wheler
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Sarina Piha-Paul
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Jing Gong
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - David Hong
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Ralph Zinner
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Ming-Mo Hou
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
| | - Pedro Ramirez
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Lois Ramondetta
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Karen Lu
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030 USA
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Tang C, Naing A, de Groot P, Chang J, Massarelli E, Parkhurst K, Erdman D, Barrientes S, Fok J, Subbiah V, Fu S, Tsimberidou A, Karp D, Gomez D, Heymach J, Hahn S, Komaki R, Hong D, Welsh J. Phase 1 Study of Ipilimumab and Stereotactic Radiation Targeting Liver or Lung Lesions in Patients With Advanced Malignancies. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hou MM, Liu X, Wheler J, Naing A, Hong D, Coleman RL, Tsimberidou A, Janku F, Zinner R, Lu K, Kurzrock R, Fu S. Targeted PI3K/AKT/mTOR therapy for metastatic carcinomas of the cervix: A phase I clinical experience. Oncotarget 2015; 5:11168-79. [PMID: 25426553 PMCID: PMC4294378 DOI: 10.18632/oncotarget.2584] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 07/21/2014] [Accepted: 10/09/2014] [Indexed: 11/25/2022] Open
Abstract
Background Activated PI3K/AKT/mTOR pathway frequently occurs in metastatic or recurrent cervical carcinomas. However, the clinical benefits of matched therapy, a therapeutic approach targeting a specific mutational abnormality, have not yet been established. Methods We analyzed the outcomes of patients with metastatic or recurrent cervical carcinomas who had a test for PIK3CA mutation and/or PTEN loss/mutation, and received ≥1 phase I therapeutic regimen between January 2006 and June 2013. Results Patients with adenocarcinoma had fewer PIK3CA mutations (14%), and survived longer (median, 14.2 months) than those with squamous cell carcinoma (48% and 7.2 months; p = 0.016, and 0.001, respectively). Matched therapy targeting the activated PI3K/AKT/mTOR pathway led to a favorable rate of SD ≥ 6 months/CR/PR (53%) and significantly longer progression-free survival (median, 6.0 months) than non-matched therapy (11% and 1.5 months; p = 0.08 and 0.026; respectively). In patients with squamous cell carcinoma of the cervix, the presence of PIK3CA mutations was associated with a significantly longer overall survival (median, 9.4 months) than the absence of PIK3CA mutations (median, 4.2 months; p = 0.019). Conclusions Matched therapy targeting the activated PI3K/AKT/mTOR pathway provided meaningful clinical benefits. Thus, further evaluation of PI3K/AKT/mTOR pathway targeted therapy is warranted, especially in metastatic or recurrent squamous cell carcinoma.
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Affiliation(s)
- Ming-Mo Hou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas. Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Xiaochun Liu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer Wheler
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert L Coleman
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ralph Zinner
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen Lu
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Rodon J, Soria JC, Berger R, Batist G, Tsimberidou A, Bresson C, Lee JJ, Rubin E, Onn A, Schilsky RL, Miller WH, Eggermont AM, Mendelsohn J, Lazar V, Kurzrock R. Challenges in initiating and conducting personalized cancer therapy trials: perspectives from WINTHER, a Worldwide Innovative Network (WIN) Consortium trial. Ann Oncol 2015; 26:1791-8. [PMID: 25908602 DOI: 10.1093/annonc/mdv191] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [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: 01/06/2015] [Accepted: 04/13/2015] [Indexed: 12/11/2022] Open
Abstract
Advances in 'omics' technology and targeted therapeutic molecules are together driving the incorporation of molecular-based diagnostics into the care of patients with cancer. There is an urgent need to assess the efficacy of therapy determined by molecular matching of patients with particular targeted therapies. WINTHER is a clinical trial that uses cutting edge genomic and transcriptomic assays to guide treatment decisions. Through the lens of this ambitious multinational trial (five countries, six sites) coordinated by the Worldwide Innovative Networking Consortium for personalized cancer therapy, we discovered key challenges in initiation and conduct of a prospective, omically driven study. To date, the time from study concept to activation has varied between 19 months at Gustave Roussy Cancer Campus in France to 30 months at the Segal Cancer Center, McGill University (Canada). It took 3+ years to be able to activate US sites due to national regulatory hurdles. Access to medications proposed by the molecular analysis remains a major challenge, since their availability through active clinical trials is highly variable over time within sites and across the network. Rules regarding the off-label use of drugs, or drugs not yet approved at all in some countries, pose a further challenge, and many biopharmaceutical companies lack a simple internal mechanism to supply the drugs even if they wish to do so. These various obstacles should be addressed to test and then implement precision medicine in cancer.
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Affiliation(s)
- J Rodon
- Vall D'Hebron Institute of Oncology and Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J C Soria
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - R Berger
- Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - G Batist
- Segal Cancer Center, Jewish General Hospital Mcgill University, Montreal Quebec Consortium de Recherche en Oncologie Clinique, Quebec, Canada
| | - A Tsimberidou
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - J J Lee
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E Rubin
- The National Institute of Biotechnology in the Negev, Ben Gurion University, Beer-Sheva, Israel
| | - A Onn
- Oncology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - R L Schilsky
- American Society of Clinical Oncology (ASCO), Alexandria
| | - W H Miller
- Segal Cancer Center, Jewish General Hospital Mcgill University, Montreal Quebec Consortium de Recherche en Oncologie Clinique, Quebec, Canada
| | - A M Eggermont
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - J Mendelsohn
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - V Lazar
- Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - R Kurzrock
- Center for Personalized Cancer Therapy, UC San Diego-Moores Cancer Center, La Jolla, USA
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Fu S, Hou MM, Naing A, Janku F, Hess K, Zinner R, Subbiah V, Hong D, Wheler J, Piha-Paul S, Tsimberidou A, Karp D, Araujo D, Kee B, Hwu P, Wolff R, Kurzrock R, Meric-Bernstam F. Phase I study of pazopanib and vorinostat: a therapeutic approach for inhibiting mutant p53-mediated angiogenesis and facilitating mutant p53 degradation. Ann Oncol 2015; 26:1012-1018. [PMID: 25669829 DOI: 10.1093/annonc/mdv066] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 12/23/2014] [Accepted: 01/29/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We carried out a phase I trial of the vascular endothelial growth factor inhibitor pazopanib and the histone deacetylase inhibitor vorinostat to determine the safety and efficacy. Because these agents are known to target factors activated by TP53 mutation and facilitate mutant p53 degradation, a subgroup analysis may be interesting in patients with TP53 mutant malignancies. PATIENTS AND METHODS Patients with advanced solid tumors (n = 78) were enrolled following a 3 + 3 design, with dose expansion for those with responsive tumors. Hotspot TP53 mutations were tested when tumor specimens were available. RESULTS Adverse events of ≥grade 3 included thrombocytopenia, neutropenia, fatigue, hypertension, diarrhea and vomiting. Overall, the treatment produced stable disease for at least 6 months or partial response (SD ≥6 months/PR) in 19% of the patients, median progression-free survival (PFS) of 2.2 months, and median overall survival (OS) of 8.9 months. In patients with detected hotspot TP53 mutant advanced solid tumors (n = 11), the treatment led to a 45% rate of SD ≥6 months/PR (1 PR and 3 SD ≥6 months), median PFS of 3.5 months, and median OS of 12.7 months, compared favorably with the results for patients with undetected hotspot TP53 mutations (n = 25): 16% (1 PR and 3 SD ≥6 months, P = 0.096), 2.0 months (P = 0.042), and 7.4 months (P = 0.1), respectively. CONCLUSION The recommended phase II dosage was oral pazopanib at 600 mg daily plus oral vorinostat at 300 mg daily. The preliminary evidence supports further evaluation of the combination in cancer patients with mutated TP53, especially in those with metastatic sarcoma or metastatic colorectal cancer. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT01339871.
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Affiliation(s)
- S Fu
- Departments of Investigational Cancer Therapeutics.
| | - M M Hou
- Departments of Investigational Cancer Therapeutics; Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - A Naing
- Departments of Investigational Cancer Therapeutics
| | - F Janku
- Departments of Investigational Cancer Therapeutics
| | | | - R Zinner
- Departments of Investigational Cancer Therapeutics
| | - V Subbiah
- Departments of Investigational Cancer Therapeutics
| | - D Hong
- Departments of Investigational Cancer Therapeutics
| | - J Wheler
- Departments of Investigational Cancer Therapeutics
| | - S Piha-Paul
- Departments of Investigational Cancer Therapeutics
| | | | - D Karp
- Departments of Investigational Cancer Therapeutics
| | | | - B Kee
- GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | | | - R Wolff
- GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - R Kurzrock
- University of California San Diego, Moores Cancer Center, La Jolla, USA
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Gonzalez-Angulo AM, Krop I, Piha-Paul S, Li Y, Culotta KS, Moulder-Thompson S, Tsimberidou A, Velez-Bravo VM, Madden TL, Norberg LM, Doyle A, Winder EP, Mills GB, Meric-Bernstam F, Kurzrock R. Abstract LB-231: Phase Ib dose escalation and biomarker study of MK2206 in combination with standard doses of weekly paclitaxel in patients with locally advanced or metastatic solid tumors with expansion in advanced breast cancer. Clin Trials 2014. [DOI: 10.1158/1538-7445.am2012-lb-231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tang C, Jardim D, Gagliato D, Falchook G, Hess K, Fu S, Wheler J, Zinner R, Naing A, Tsimberidou A, Meric-Bernstam F, Hong D. Abstract 4424: Analysis of 1115 patients tested for MET amplification and therapy response in the MD Anderson phase I clinic. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-4424] [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: Increased c-Met activity has been implicated in numerous oncologic processes. However, its prevalence among different cancers, association with demographics and genetic aberrations, and implication in therapy resistance has not been fully described.
Patients and Methods: Between May 2010 to November 2012, 3607 patients were referred to the investigational cancer therapeutics department at MD Anderson Cancer Center for consideration of a phase I protocol. Among these patients, 1115 underwent MET amplification testing via fluorescence in-situ hybridization and were included in this analysis. Copy numbers are expressed as a ratio to the centromeric gene CEP7 with amplification defined as MET/CEP7 ≥2 or >20 gene copies in >10% of nuclei. Patient demographic, histologic, and molecular characteristics were stratified based on MET amplification status. Among patients with MET amplification, 20 were treated on a phase I protocol and evaluated for therapy response. Responses were categorized by RECIST criteria with objective responses defined as stable disease lasting ≥6 months or any observed partial responses. Categorical variables were compared via Chi-Squared and Fisher Exact Tests, while continuous variables were compared via Student's T-Test. Overall survival from the date of first consultation at our phase I clinic were compared via the Log-Rank test.
Results: Twenty-nine (2.6%) patients exhibited MET amplification (median 3.48; range 2.05-16.14). Of these, 2 exhibited MET/CEP7 ratios 20 MET copies among >10% of nuclei. The highest prevalence was in tumors of adrenal (2 of 13; 15%) and renal (4 of 28; 14%) origins. Stratifying by MET amplification status, no differences were observed in demographic characteristics including age, ethnicity, or gender (all P>0.10). Amplified patients exhibited more organ systems involved with metastatic disease (median 3 vs. 4, P=0.0005). MET amplification was correlated with higher incidence of BRAF mutation, high-grade histology, and PTEN loss (all P<0.01). There were no differences in overall survival when stratifying by amplification status. Of the 20 patients with MET amplification treated and evaluated on a phase I protocol, 6 (30%) achieved objective responses on any phase I protocol. No patients treated with a c-Met inhibitor (0 of 6) achieved an objective response. Considering only the best response on a phase I protocol, the highest response rate was observed with agents targeting VEGFR (4 of 7, 57%).
Conclusions: Although caution must be stressed when interpreting these results, MET amplification exhibits an association with higher metastatic burden, specific molecular characteristics (BRAF mutation, PTEN loss), and high grade histology. Patients with MET amplification in this cohort exhibited a high response rate to VEGFR inhibitors while c-Met targeted agents showed little activity.
Citation Format: Chad Tang, Denis Jardim, Debora Gagliato, Gerald Falchook, Kenneth Hess, Siqing Fu, Jennifer Wheler, Ralph Zinner, Aung Naing, Apostolia Tsimberidou, Funda Meric-Bernstam, David Hong. Analysis of 1115 patients tested for MET amplification and therapy response in the MD Anderson phase I clinic. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4424. doi:10.1158/1538-7445.AM2014-4424
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Affiliation(s)
- Chad Tang
- MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Siqing Fu
- MD Anderson Cancer Center, Houston, TX
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Liu X, Hou M, Wheler J, Naing A, Hong D, Tsimberidou A, Piha-Paul S, Falchook G, Zinner R, Janku F, Lois R, Schmeler K, Lu K, Kurzrock R, Fu S. Abstract 2838: Differential effects of PIK3CA mutations and PTEN loss in patients with advanced endometrial cancers on matched therapy. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2838] [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
Purpose: To evaluate whether PIK3CA mutations and/or PTEN loss predict better clinical outcomes to phase I trials of PI3K/AKT/mTOR inhibition-based therapies in patients with metastatic, recurrent or refractory endometrial cancers.
Methods: Outcome analyses were conducted on 73 patients with advanced endometrial cancers who were seen in a designated Phase I clinic at MD Anderson Cancer Center from 1/1/2006 to 4/30/2013, and tested for PIK3CA mutations and/or PTEN loss (an immunoreactive score of 3 or less) in a CLIA-certified molecular diagnostic laboratory, in accordance with the IRB guidelines. All data were obtained from patients' electronic medical records.
Results: All patients (n=73) had received at least one systemic therapy before the referral (median = 2). Approximately 24% of tested patients (n=13/55) harbored PIK3CA mutations. Of the 13 patients with PIK3CA mutations, 12 (92%) were treated in clinical trials including a PI3K/AKT/mTOR pathway inhibitor with or without chemotherapy (matched therapy). Matched therapy led to a total of 54% PR/SD≥6months (23% PR and 31% SD≥6months) and a median PFS of 7.9 months. The response rate and PFS are much lower in the 17 patients who did not have PIK3CA and PTEN tested; 17.6% SD≥6months and median PFS of 1.9 months (p=0.037and p=0.013, respectively). Of those who had PTEN tested (n=41), 21 patients (51%) had PTEN loss. All 21 patients with PTEN loss received matched therapies, which led to a total of 38% PR/SD≥6months (14% PR and 24% SD≥6months) and a median PFS of 5 months. That is not significantly different from therapy in patients who do not have PIK3CA and PTEN tested (p=0.167and p=0.076, respectively). Of 30 patients with PIK3CA mutations and/or PTEN loss (n=30), matched therapy led to a significantly longer median PFS of 4.8 months (p=0.03) but similar response rate (15% PR and 25% SD≥6months) to those in patients without PIK3CA and PTEN tests (p=0.114). Patients with unknown PIK3CA and PTEN status received significantly fewer regimens targeting at PIK3CA pathway compared to those with known status (p<0.001).
Conclusions: Matched therapy using PI3K/AKT/mTOR pathway inhibitor -based regimens led to higher clinical response rate including CR/PR/SD ≥ 6months and PFS in patients with PI3Kinase mutation but not PTEN loss, indicating that different biological mechanisms are involved in these molecular aberrations. Further evaluation in patients with advanced endometrial cancers may require dissect individual molecular aberration for personalized cancer therapy.
Citation Format: Xiaochun Liu, Mingmou Hou, Jennifer Wheler, Aung Naing, David Hong, Apostolia Tsimberidou, Sarina Piha-Paul, Gerald Falchook, Ralph Zinner, Filip Janku, Ramondetta Lois, Kathleen Schmeler, Karen Lu, Razelle Kurzrock, Siqing Fu. Differential effects of PIK3CA mutations and PTEN loss in patients with advanced endometrial cancers on matched therapy. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2838. doi:10.1158/1538-7445.AM2014-2838
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Affiliation(s)
| | | | | | - Aung Naing
- 1UT MD Anderson Cancer Center, Houston, TX
| | - David Hong
- 1UT MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Karen Lu
- 1UT MD Anderson Cancer Center, Houston, TX
| | | | - Siqing Fu
- 1UT MD Anderson Cancer Center, Houston, TX
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Hong DS, Henary H, Falchook GS, Naing A, Fu S, Moulder S, Wheler JJ, Tsimberidou A, Durand JB, Khan R, Yang P, Johansen M, Newman RA, Kurzrock R. First-in-human study of pbi-05204, an oleander-derived inhibitor of akt, fgf-2, nf-κΒ and p70s6k, in patients with advanced solid tumors. Invest New Drugs 2014; 32:1204-12. [PMID: 24919855 DOI: 10.1007/s10637-014-0127-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND PBI-05204, a Nerium oleander extract (NOE) containing the cardiac glycoside oleandrin, inhibits the α-3 subunit of Na-K ATPase, as well as FGF-2 export, Akt and p70S6K, hence attenuating mTOR activity. This first-in-human study determined the safety, pharmacokinetics (PK) and pharmacodynamics (PD) of PBI-05204 in patients with advanced cancer. Methods Forty-six patients received PBI-05204 by mouth for 21 of 28 days (3 + 3 trial design). Dose was escalated 100% using an accelerated titration design until grade 2 toxicity was observed. Plasma PK and mTOR effector (p70S6K and pS6) protein expressions were evaluated. Results Dose-limiting toxicities (grade 3 proteinuria, fatigue) were observed at dose level 8 (0.3383 mg/kg/day). Common possible drug-related adverse were fatigue (26 patients, 56.5%), nausea (19 patients, 41.3%) and diarrhea (15 patients, 32.6 %). Electrocardiogram monitoring revealed grade 1 atrioventricular block (N = 10 patients) and grade 2 supraventricular tachycardia (N = 1). The MTD was DL7 (0.2255 mg/kg) where no toxicity of grade ≥ 3 was observed in seven patients treated. Seven patients (15%) had stable disease > 4 months. Mean peak oleandrin concentrations up to 2 ng/mL were achieved, with area under the curves 6.6 to 25.5 μg/L*hr and a half-life range of 5-13 h. There was an average 10% and 35% reduction in the phosphorylation of Akt and pS6 in PBMC samples in 36 and 32 patients, respectively, tested between predose and 21 days of treatment. Conclusions PBI-05204 was well tolerated in heavily pretreated patients with advanced solid tumors. The recommended Phase II dose is 0.2255 mg/kg/day.
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Affiliation(s)
- D S Hong
- Department of Investigational Cancer Therapeutics (Phase I Program), University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 455, Houston, TX, 77030, USA,
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Fu S, Hou MM, Wheler J, Hong D, Naing A, Tsimberidou A, Janku F, Zinner R, Piha-Paul S, Falchook G, Kuo MT, Kurzrock R. Exploratory study of carboplatin plus the copper-lowering agent trientine in patients with advanced malignancies. Invest New Drugs 2013; 32:465-72. [PMID: 24306314 DOI: 10.1007/s10637-013-0051-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 01/03/2023]
Abstract
PURPOSE Preclinical data showed that trientine, a copper-lowering agent, re-sensitized cancer cells to carboplatin through enhanced human copper transporter 1 (hCtr1) -mediated platinum uptake. EXPERIMENTAL DESIGN We studied carboplatin and trientine in patients (n = 55; 45 who had failed platinum) with advanced malignancies (Phase I, modified 3 + 3 design). RESULTS The most common cancers were head and neck (n = 13), non-small cell lung (n = 10) and epithelial ovarian (n = 8). The median number of prior regimens was four. No dose-limiting toxicity or treatment-related deaths were observed at doses up to carboplatin AUC 6 given with trientine. Eight patients achieved stable disease (SD) ≥ 6 months (six platinum failures) and one patient with platinum-resistant ovarian cancer, partial response (PR) (total SD ≥ 6 months/PR = 9, 16.4 %). The mean nadir serum copper level in the nine patients with SD ≥ 6 months/PR was 0.55 μg/mL (95 % CI, 0.34-0.75) versus 1.22 μg/mL (95 % CI, 1.02-1.42) (p < 0.001) in 38 tested patients with progression. In patients who maintained their ceruloplasmin (major copper-carrying protein) levels at 5-15 mg/dL (n = 9), the median progression-free and overall survivals were 9.2 and 15.2 months versus 1.9 (p = 0.001) and 5.7 months (p = 0.033) in patients who did not (n = 38), respectively. CONCLUSIONS The combination of a copper-lowering agent with carboplatin was well tolerated and associated with antitumor activity, especially in patients in whom copper and/or ceruloplasmin levels were lowered. Further investigation of this strategy for reversing platinum resistance is warranted.
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Affiliation(s)
- Siqing Fu
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA,
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Fu S, McQuinn L, Naing A, Wheler JJ, Janku F, Falchook GS, Piha-Paul SA, Tu D, Howard A, Tsimberidou A, Zinner R, Hong DS, Kurzrock R. Barriers to study enrollment in patients with advanced cancer referred to a phase I clinical trials unit. Oncologist 2013; 18:1315-20. [PMID: 24153239 DOI: 10.1634/theoncologist.2013-0202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED We conducted this retrospective study to identify reasons that patients referred to a phase I clinical trial failed to enroll or delayed enrollment onto the trial. MATERIALS AND METHODS Outcome analyses were conducted independently on data collected from electronic medical records of two sets of consecutive patients referred to a phase I clinical trial facility at MD Anderson Cancer Center. Data from the first set of 300 patients were used to determine relevant variables affecting enrollment; data from the second set of 957 patients were then analyzed for these variables. RESULTS Results from the two sets of patients were similar. Approximately 55% of patients were enrolled in a phase I trial. Patients referred from within MD Anderson were more likely to be enrolled than patients seen originally outside the institution (p = .006); black patients were more likely than white patients to enroll (69% vs. 43%; p = .04). The median interval from the initial visit to initiation of treatments was 19 days. Major reasons for failure to enroll included failure to return to the clinic (36%), opting for treatment in another clinic (17%), hospice referral (11%), early death (10%), and lack of financial clearance (5%). Treatment was delayed for three weeks or more in 250 patients; in 85 patients (34%), the delay was caused by financial and insurance issues. CONCLUSION Failure to return to the clinic, pursuit of other therapy, and rapid deterioration were the major reasons for failure to enroll; lengthy financial clearance was the most common reason for delayed enrollment onto a phase I trial.
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Affiliation(s)
- Siqing Fu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Henary H, Hong DS, Falchook GS, Tsimberidou A, George GC, Wen S, Wheler J, Fu S, Naing A, Piha-Paul S, Janku F, Kim KB, Hwu P, Kurzrock R. Melanoma patients in a phase I clinic: molecular aberrations, targeted therapy and outcomes. Ann Oncol 2013; 24:2158-65. [PMID: 23576709 DOI: 10.1093/annonc/mdt115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 02/06/2023] Open
Abstract
BACKGROUND The purpose of the study was to assess the outcome of patients with advanced melanoma treated with matched molecularly targeted therapy. PATIENTS AND METHODS We reviewed 160 consecutive patients with metastatic melanoma treated in the phase I program (N = 35 protocols). Treatment was considered to be 'matched' (N = 84) if at least one drug in the regimen was known to inhibit the functional activity of at least one of the patient's mutations. RESULTS Of 160 patients, 134 (83.7%) had adequate tissue for molecular analysis; 69% (110 of 160) had ≥1 mutation: 61.2% (82 of 134), BRAF; 20.7% (23 of 111), NRAS; 2.6% (2 of 77), KIT; 2.3% (1 of 44), KRAS; 20% (1 of 5), GNAQ; 11.1% (1 of 9), P53 and 2.6% (1 of 39), coexisting mutations in BRAF and PIK3CA. Eighty-four patients (52.4%) were treated with matched-targeted agents, most of whom had BRAF mutations (N = 74). Twenty-six percent of patients (41 of 160) achieved a complete or partial remission (CR/PR) [40% (34 of 84)) on a matched phase I protocol versus 9.2% (7 of 76) for those on a non-matched study (P ≤ 0.0001)]. The median progression-free survival (PFS) (95% CI) was longer for patients treated on a matched phase I trial than on their prior first standard treatment [5.27 (4.10, 6.44) versus 3.10 (1.92, 4.28) months, P = 0.023], but not on non-matched phase I treatment. Multivariable analysis showed that matched therapy was an independent predictor of higher CR/PR rates, prolonged PFS and survival. CONCLUSIONS For melanoma patients, especially those with BRAF mutations, administering molecularly matched agents can be associated with better outcomes, including longer PFS compared with their first-line systemic therapy.
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Affiliation(s)
- H Henary
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77230, USA
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Chen DS, Feltquate DM, Smothers F, Hoos A, Langermann S, Marshall S, May R, Fleming M, Hodi FS, Senderowicz A, Wiman KG, de Dosso S, Fiedler W, Gianni L, Cresta S, Schulze-Bergkamen HB, Gurrieri L, Salzberg M, Dietrich B, Danielczyk A, Baumeister H, Goletz S, Sessa C, Strumberg D, Schultheis B, Santel A, Gebhardt F, Meyer-Sabellek W, Keil O, Giese K, Kaufmann J, Maio M, Choy G, Covre A, Parisi G, Nicolay H, Fratta E, Fonsatti E, Sigalotti L, Coral S, Taverna P, Azab M, Deutsch E, Lepechoux C, Pignon JP, Tao YT, Rivera S, Bourgier BC, Angokai M, Bahleda R, Slimane K, Angevin E, Besse BB, Soria JC, Dragnev K, Beumer JH, Anyang B, Ma T, Galimberti F, Erkmen CP, Nugent W, Rigas J, Abraham K, Johnstone D, Memoli V, Dmitrovsky E, Voest EE, Siu L, Janku F, Soria JC, Tsimberidou A, Kurzrock R, Tabernero J, Rodon J, Berger R, Onn A, Batist G, Bresson C, Lazar V, Molenaar JJ, Koster J, Ebus M, Zwijnenburg DA, van Sluis P, Lamers F, Schild L, van der Ploeg I, Caron HN, Versteeg R, Pouyssegur J, Marchiq I, Chiche J, Roux D, Le Floch R, Critchlow SE, Wooster RF, Agresta S, Yen KE, Janne PA, Plummer ER, Trinchieri G, Ellis L, Chan SL, Yeo W, Chan AT, Mouliere F, El Messaoudi S, Gongora C, Lamy PJ, del Rio M, Lopez-Crapez E, Gillet B, Mathonnet M, Pezet D, Ychou M, Thierry AR, Ribrag V, Vainchenker W, Constantinescu S, Keilhack H, Umelo IA, Noeparast A, Chen G, Renard M, Geers C, Vansteenkiste J, Teugels E, de Greve J, Rixe O, Qi X, Chu Z, Celerier J, Leconte L, Minet N, Pakradouni J, Kaur B, Cuttitta F, Wagner AJ, Zhang YX, Sicinska E, Czaplinski JT, Remillard SP, Demetri GD, Weng S, Debussche L, Agoni L, Reddy EP, Guha C, Silence K, Thibault A, de Haard H, Dreier T, Ulrichts P, Moshir M, Gabriels S, Luo J, Carter C, Rajan A, Khozin S, Thomas A, Lopez-Chavez A, Brzezniak C, Doyle L, Keen C, Manu M, Raffeld M, Giaccone G, Lutzker S, Melief JM, Eckhardt SG, Trusolino L, Migliardi G, Zanella ER, Cottino F, Galimi F, Sassi F, Marsoni S, Comoglio PM, Bertotti A, Hidalgo M, Weroha SJ, Haluska P, Becker MA, Harrington SC, Goodman KM, Gonzalez SE, al Hilli M, Butler KA, Kalli KR, Oberg AL, Huijbers IJ, Bin Ali R, Pritchard C, Cozijnsen M, Proost N, Song JY, Krimpenfort P, Michalak E, Jonkers J, Berns A, Banerji U, Stewart A, Thavasu P, Banerjee S, Kaye SB. Lectures. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt042] [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: 11/12/2022] Open
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Soria J, Tsimberidou A, Kurzrock R, Tabernero J, Rodon J, Berger R, Onn A, Batist G, Bresson C, Lazar V. Winther: A Study to Select Rational Therapeutics Based On the Analysis of Tumor and Matched Normal Tissue Biopsies in Subjects with Advanced Malignancies. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt042.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moulder S, Wheler J, Albarracin C, Gilcrease M, Falchook G, Naing A, Hong D, Fu S, Piha-Paul S, Tsimberidou A, Janku F, Kurzrock R. Abstract P5-20-09: Tumor mutational analysis and therapy outcomes for patients (pts) with metastatic/unresectable locally advanced myoepithelial/metaplastic breast cancer treated with PI3K targeted therapy. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-20-09] [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: Metaplastic breast cancers are considered a chemorefractory subset of triple negative breast cancers. Molecular profiling has demonstrated that metaplastic tumors are enriched for epithelial-to-mesenchymal transition (EMT), frequently express myoepithelial differentiation, make up a component of the ‘claudin-low’ subtype, and harbor relatively high rates of mutations/activation of the PI3kinase pathway (Hennessy, Cancer Research, 2009; Prat, Breast Cancer Res, 2010).
Methods: Data from pts with myoepithelial/metaplastic breast cancer treated within the Center for Targeted Therapy using regimens with known inhibitors of the PI3K pathway were evaluated to determine response to therapy. Mutational analyses were performed in archived tumor samples when available.
Results: 23 pts have been treated using 6 different therapy regimens and one pt was treated on two separate clinical trials for a total of 24 analyzable outcomes. Patients were treated with liposomal doxorubicin, bevacizumab and the mTOR inhibitor, temsirolimus (DAT, n=17); liposomal doxorubicin and temsirolimus (DT, n=1); paclitaxel, bevacizumab and temsirolimus (TAT, n=3); paclitaxel and temsirolimus (TT, n=1), paclitaxel in combination with an experimental PI3K inhibitor (TEx, n=1), or temsirolimus alone (tem, n=1). Response was measured every two cycles using RECIST criteria. Most pts had received prior chemotherapy, median of 2 prior regimens (range 0–7). Three patients were not evaluated for response, one who died of pneumonia during cycle 2 (DAT) and two who have not yet completed 2 cycles of therapy (DAT, TEx). Response rate (CR+PR) was 35% (CR = 2, PR=4, SD≥6 months=2, SD<6 months=2, PD/death=7) with the anthracycline based regimens, DAT and DT; whereas, stable disease was the best response seen thus far with the paclitaxel based regimens or temsirolimus alone: TAT (SD<6months=2, PD=1), TT (SD<6months=1), tem (SD<6months=1). 8 of 9 tumors tested (89%) were found to have mutations that would lead to activation of the PI3K pathway: PIK3CA=5 (62%), PTEN=2 (25%) and NF2=1(13%). The two patients with CR from DAT had mutations in NF2 and PIK3CA, respectively. Both patients remain in CR (2+ years and 1+ year respectively) after discontinuing protocol therapy, and both continue maintenance everolimus.
Conclusion: Activating mutations in the PI3K pathway are common in metaplastic breast cancers, a tumor subtype that shares molecular features with claudin-low and mesenchymal/mesenchymal-stem cell like triple negative breast cancers. DAT has demonstrated activity in myoepithelial/metaplastic breast cancer including two durable CRs to therapy. This regimen should be explored in larger, randomized trials to test superiority to chemotherapy alone.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-20-09.
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Affiliation(s)
- S Moulder
- University of Texas, MD Anderson Cancer Center
| | - J Wheler
- University of Texas, MD Anderson Cancer Center
| | | | - M Gilcrease
- University of Texas, MD Anderson Cancer Center
| | - G Falchook
- University of Texas, MD Anderson Cancer Center
| | - A Naing
- University of Texas, MD Anderson Cancer Center
| | - D Hong
- University of Texas, MD Anderson Cancer Center
| | - S Fu
- University of Texas, MD Anderson Cancer Center
| | - S Piha-Paul
- University of Texas, MD Anderson Cancer Center
| | | | - F Janku
- University of Texas, MD Anderson Cancer Center
| | - R Kurzrock
- University of Texas, MD Anderson Cancer Center
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Fu S, Barber FD, Naing A, Wheler J, Hong D, Falchook G, Piha-Paul S, Tsimberidou A, Howard A, Kurzrock R. Advance care planning in patients with cancer referred to a phase I clinical trials program: the MD Anderson Cancer Center experience. J Clin Oncol 2012; 30:2891-6. [PMID: 22778314 DOI: 10.1200/jco.2011.38.0758] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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
PURPOSE Patients with advanced malignancies referred for early clinical trials have a short life expectancy. We designed this survey to ascertain the status of advance care planning in this population. PATIENTS AND METHODS Patients who were seen in a phase I clinic were asked to anonymously complete an investigator-designed survey. RESULTS Of 435 individuals approached, 215 (49%) returned completed or partially completed surveys, whereas many others stated that they wanted to avoid the topic, because they had come to the phase I clinic for cancer therapy. Most patients (n = 149; 69%) were still hopeful about their future. Approximately 42% of patients (n = 90) reported having a living will, 46% had a medical power of attorney (n = 98), and 19% had a do-not-resuscitate (DNR) order (n = 40). Approximately 20% of participants (n = 43) had not discussed advance care planning. Fifty-nine percent of patients wanted to discuss advance care planning with their physician. Having a DNR order in place was significantly more common in individuals who had a living will and/or a medical power of attorney. CONCLUSION Although most patients referred to a phase I clinic remained optimistic, many had discussed a living will, medical power of attorney, and/or DNR order with their physician, family, and/or attorney. However, a significant minority had not addressed this issue with anyone, and many refused to take a survey on the topic. More than half of the patients wanted to discuss these matters with their physician. These observations suggest that extra effort to address advance care planning is needed for these patients.
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Affiliation(s)
- Siqing Fu
- Department of Investigational Cancer Therapeutics, Unit 0455, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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El-Osta H, Falchook G, Tsimberidou A, Hong D, Naing A, Kim K, Wen S, Janku F, Kurzrock R. BRAF mutations in advanced cancers: clinical characteristics and outcomes. PLoS One 2011; 6:e25806. [PMID: 22039425 PMCID: PMC3198456 DOI: 10.1371/journal.pone.0025806] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 09/12/2011] [Indexed: 01/12/2023] Open
Abstract
Background Oncogenic BRAF mutations have been found in diverse malignancies and activate RAF/MEK/ERK signaling, a critical pathway of tumorigenesis. We examined the clinical characteristics and outcomes of patients with mutant (mut) BRAF advanced cancer referred to phase 1 clinic. Methods We reviewed the records of 80 consecutive patients with mutBRAF advanced malignancies and 149 with wild-type (wt) BRAF (matched by tumor type) referred to the Clinical Center for Targeted Therapy and analyzed their outcome. Results Of 80 patients with mutBRAF advanced cancer, 56 had melanoma, 10 colorectal, 11 papillary thyroid, 2 ovarian and 1 esophageal cancer. Mutations in codon 600 were found in 77 patients (62, V600E; 13, V600K; 1, V600R; 1, unreported). Multivariate analysis showed less soft tissue (Odds ratio (OR) = 0.39, 95%CI: 0.20–0.77, P = 0.007), lung (OR = 0.38, 95%CI: 0.19–0.73, p = 0.004) and retroperitoneal metastases (OR = 0.34, 95%CI: 0.13–0.86, p = 0.024) and more brain metastases (OR = 2.05, 95%CI: 1.02–4.11, P = 0.043) in patients with mutBRAF versus wtBRAF. Comparing to the corresponding wtBRAF, mutBRAF melanoma patients had insignificant trend to longer median survival from diagnosis (131 vs. 78 months, p = 0.14), while mutBRAF colorectal cancer patients had an insignificant trend to shorter median survival from diagnosis (48 vs. 53 months, p = 0.22). In melanoma, V600K mutations in comparison to other BRAF mutations were associated with more frequent brain (75% vs. 36.3%, p = 0.02) and lung metastases (91.6% vs. 47.7%, p = 0.007), and shorter time from diagnosis to metastasis and to death (19 vs. 53 months, p = 0.046 and 78 vs. 322 months, p = 0.024 respectively). Treatment with RAF/MEK targeting agents (Hazard ratio (HR) = 0.16, 95%CI: 0.03–0.89, p = 0.037) and any decrease in tumor size after referral (HR = 0.07, 95%CI: 0.015–0.35, p = 0.001) correlated with longer survival in mutBRAF patients. Conclusions BRAF appears to be a druggable mutation that also defines subgroups of patients with phenotypic overlap, albeit with differences that correlate with histology or site of mutation.
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Affiliation(s)
- Hazem El-Osta
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Gerald Falchook
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Apostolia Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - David Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Aung Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Kevin Kim
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Sijin Wen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Razelle Kurzrock
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
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Garrido-Laguna I, Janku F, Falchook GS, Fu S, Naing A, Wheler J, Tsimberidou A, Hong DS, Kurzrock R. Abstract 2264: K-ras mutations in colorectal cancer may predict a pattern of organ-specific metastasis. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-2264] [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: Activating mutations of the K-ras oncogene in colorectal cancer (CRC) are associated with resistance to EGFR antibodies and poor prognosis. We systematically analyzed clinical and pathological characteristics associated with K-ras mutations. Methods: Patients with CRC referred to the phase I program for targeted therapy were analyzed for K-ras mutations using PCR-based DNA sequencing. Patients with mutant K-ras were matched with wild-type (wt) K-ras controls. Multiple clinical and pathological characteristics were analyzed to determine, whether there is a phenotype associated with K-ras mutations. Results: A total of 151 patients with CRC were identified; 61 with K-ras mutations; 80 with wt K-ras and 10 with unknown K-ras status. Patients with K-ras mutations compared with wt K-ras had more frequently lung metastases (80% vs. 63%, p = 0.03). Patients whose tumors had K-ras mutations had higher number of metastatic sites of disease (3.18 vs. 2.65; p = 0.013). There were no associations between K-ras mutations and gender, age at diagnosis, liver metastases, peritoneal metastases, lymphatic involvement or Duke stage at diagnose. Patients with K-ras wt had a trend for longer median survival (283 vs. 222 weeks, p=0.09). There was no difference in the median survival from diagnosis in patients with different types of K-ras mutations (codon 12, codon 13, and codon 61). Dukes staging was the only statistically significant prognostic factor on multivariate analysis (p < 0.05). Conclusions: K-ras mutations in CRC in comparison with wt K-ras were associated with more frequent lung metastases and shorter survival.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2264. doi:10.1158/1538-7445.AM2011-2264
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Affiliation(s)
| | | | | | - Siqing Fu
- 1UT M.D. Anderson Cancer Ctr., Houston, TX
| | - Aung Naing
- 1UT M.D. Anderson Cancer Ctr., Houston, TX
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Garrido-Laguna I, Janku F, Tsimberidou A, Wheler J, Falchook GS, Fu S, Hong D, Naing A, Piha-Paul S, Kurzrock R. Phosphatase and tensin homologue (PTEN) loss and response to phase I trials targeting PI3K/AKT/mTOR pathway in patients with advanced cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e13018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wheler JJ, Tsimberidou A, Moulder S, Cristofanill M, Hong D, Naing A, Pathak R, Liu S, Feng L, Kurzrock R. Clinical outcomes of patients with breast cancer in a phase I clinic: The M. D. Anderson Cancer Center experience. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1054] [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
1054 Background: Patients with metastatic breast cancer refractory to standard therapy are eligible for phase I trials. We assessed prognostic factors and clinical outcomes for patients with breast cancer in a phase I clinic focused on targeted agents. Methods: We reviewed the medical records of sequential patients with metastatic breast cancer who presented to our phase I clinic from September 2004 to May 2008. We assessed the relationship between overall survival and patients’ demographic and clinical characteristics using both univariate and multivariate (Cox proportional hazard model) analyses. Results: Ninety-two patients were identified with median age of 53 years (range 28 to 83 years). The median number of prior therapies was 5 (range 1 to 16). The median follow-up of surviving patients is 7.4 months. The median overall survival is 6.7 (95% CI: 5.2, 9.7) months. In univariate analysis, factors predicting shorter survival were elevated Ca-125 (p = 0.001) (Ca27.29 was not significant), albumin < 3.5 g/dL (p = 0.002), worsening ECOG performance status (p = 0.004), absolute neutrophil count < 7.3 x 109/L (p = 0.004), ≥ 10 prior treatment regimens (p = 0.008), ≥ 5 prior chemotherapy-only regimens (p = 0.008), body mass index (BMI) < 25 (p = 0.018), and elevated platelet counts (p = 0.007). In multivariate analysis, independent factors predicting shorter survival were ≥10 prior treatments (vs. <10 prior treatments) (HR = 3.27; 95% CI 1.37, 7.81; p = 0.0077), ECOG performance status 2–3 (vs. 0–1) (HR = 2.92; 95% CI 1.28, 6.66; p = 0.01), and albumin < 3.5 g/dL (vs. > 3.5g/dL) (hazard ratio [HR] = 2.88; 95% CI; 1.41, 5.89; p = 0.004). Of 78 patients treated on a first phase I trial, 14 (18%) demonstrated stable disease (SD), with a median duration of 18 weeks (range 10–25). Of those 19 patients treated on a second phase I trial, 6 (32%) had SD with a median duration of 12 weeks (range 8–17). Two of 4 (50%) patients treated on a third phase I trial had SD with a median duration of 20 weeks (range 16–24). Conclusions: Patients with metastatic breast cancer referred for our phase I studies had a median survival of 6.6 months. In this preliminary analysis, independent factors predicting shorter survival were ≥ 10 prior treatments, worsening ECOG performance status and low albumin levels. No significant financial relationships to disclose.
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Affiliation(s)
- J. J. Wheler
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - A. Tsimberidou
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - S. Moulder
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - M. Cristofanill
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - D. Hong
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - A. Naing
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - R. Pathak
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - S. Liu
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - L. Feng
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - R. Kurzrock
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Wierda W, Tsimberidou A, O’Brien S, Ferrajoli A, Faderl S, Ravandi F, Cortes J, Kantarjian H, Plunkett W, Keating M. The combination of oxaliplatin, fludarabine (FLU), cytarabine (Ara-c), and rituximab (R) (OFAR) in patients with Richter’s Transformation and FLU-refractory CLL. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
6608 Background: Patients with (FLU-ref) CLL and Richter’s transformation (RT) have a very poor prognosis. Oxaliplatin (OX), a platinum analog with a 1,2-diaminocyclohexamine carrier ligand, has a different activity and side effect profile from cisplatin. OX covalently binds DNA, inducing DNA intra- and inter-strand cross-links. FLU and Ara-c act synergistically to inhibit excision-repair of DNA cross-links, thereby providing the rationale for combining OX, FLU, Ara-c, and R (OFAR). Methods: The phase I portion of a phase I/II study of the OFAR regimen had increasing doses of OX. The OFAR regimen consists of OX 17.5, 20, or 25mg/m2, d1–4; fludarabine 30mg/m2, d2,3; Ara-c 1gm/m2, d2,3; and rituximab 375mg/m2, d3. Courses were given every 4 wks; patients received Neulasta 6mg each course and prophylaxis for tumor lysis, DNA virus’, and PCP. Results: 19 patients enrolled in phase I; 1 received no treatment, 8 had RT, and 10 had FLU-ref CLL. Patients received OX 17.5mg/m2 (3), 20mg/m2 (8), or 25mg/m2 (7). Patients receiving at least 1 course were evaluable for toxicity and could receive up to 6 courses. There were no dose-limiting toxicities, defined as any ≥ G3, non-hematologic, treatment-related toxicity. The major toxicity was hematologic and appeared OX-dose dependent. Neutropenia (G3–4) was experienced by 1/3, 6/8, and 7/7 patients treated at 17.5, 20, and 25mg/m2 OX levels, respectively. Thrombocytopenia (G3–4) was experienced by 2/3, 8/8, and 7/7 of patients treated at 17.5, 20, and 25mg/m2m OX levels, respectively. There were no treatment-related deaths. Five patients continue treatment on the phase I portion, and results will be evaluable, with 3 responders, including 2 complete, in the 7 evaluable patients with RT. Among the 10 FLU-ref patients, there are 5 PRs; treatment continues for 3 of them. Pharmacodynamic analyses demonstrate enhanced killing by OX in the presence of FLU and Ara-c. Conclusions: The OFAR regimen is safe and active for treating patients with RT and FLU-ref CLL. This trial continues to accrue patients to confirm efficacy. No significant financial relationships to disclose.
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Affiliation(s)
- W. Wierda
- UT M. D. Anderson Cancer Center, Houston, TX
| | | | - S. O’Brien
- UT M. D. Anderson Cancer Center, Houston, TX
| | | | - S. Faderl
- UT M. D. Anderson Cancer Center, Houston, TX
| | - F. Ravandi
- UT M. D. Anderson Cancer Center, Houston, TX
| | - J. Cortes
- UT M. D. Anderson Cancer Center, Houston, TX
| | | | - W. Plunkett
- UT M. D. Anderson Cancer Center, Houston, TX
| | - M. Keating
- UT M. D. Anderson Cancer Center, Houston, TX
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Tsimberidou A, Cortes J, Thomas D, Garcia-Manero G, Verstovsek S, Faderl S, Albitar M, Kantarjian H, Estey E, Giles FJ. Gemtuzumab ozogamicin, fludarabine, cytarabine and cyclosporine combination regimen in patients with CD33+ primary resistant or relapsed acute myeloid leukemia. Leuk Res 2003; 27:893-7. [PMID: 12860008 DOI: 10.1016/s0145-2126(03)00022-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [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: 10/27/2022]
Abstract
Clinical resistance to gemtuzumab ozogamicin (Mylotarg) in acute myeloid leukemia (AML) is associated with blast multidrug resistance (MDR) phenotype. A Phase II study of Mylotarg, fludarabine, ara-C and the MDR-modifier, cyclosporine (CSA) (MFAC) was conducted in 32 patients with primary resistant (11, 34%) or relapsed (21, 66%) AML. Nine (28%) patients obtained complete remission (CR), two (6%) CR with incomplete platelet recovery. Overall median survival was 5.3 months, 12-month survival rate 19%. Fourteen patients (44%) developed grade 3/4 hyperbilirubinemia; six (18%) grade 3/4 hepatic transaminitis; three (9%) hepatic veno-occlusive disease (VOD). CSA inclusion in gemtuzumab ozogamicin-based regimens is feasible. MFAC is an effective regimen for refractory AML.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Aminoglycosides
- Anti-Bacterial Agents/administration & dosage
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antigens, CD
- Antigens, Differentiation, Myelomonocytic
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/toxicity
- Cyclosporine/administration & dosage
- Cytarabine/administration & dosage
- Drug Resistance, Neoplasm
- Female
- Gemtuzumab
- Humans
- Leukemia, Myeloid/complications
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/mortality
- Male
- Middle Aged
- Platelet Count
- Recurrence
- Remission Induction
- Sialic Acid Binding Ig-like Lectin 3
- Survival Rate
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- Apostolia Tsimberidou
- Department of Leukemia, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 428, Houston, TX 77030, USA
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44
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Apostolidou E, Cortes J, Tsimberidou A, Estey E, Kantarjian H, Giles FJ. Pilot study of gemtuzumab ozogamicin, liposomal daunorubicin, cytarabine and cyclosporine regimen in patients with refractory acute myelogenous leukemia. Leuk Res 2003; 27:887-91. [PMID: 12860007 DOI: 10.1016/s0145-2126(03)00021-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [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: 11/21/2022]
Abstract
Multi-drug resistance (MDR) protein expression is associated with reduced gemtuzumab ozogamicin (Mylotarg) activity. Both cyclosporine-A (CSA) and liposome-encapsulated daunorubicin, DaunoXome (DNX) may reduce the negative impact of MDR. A gemtuzumab ozogamicin, DNX, cytarabine (ara-C) and CSA (MDAC) regimen was piloted in patients with refractory acute myelogenous leukemia (AML) (relapsed 10, primary refractory 1) (median age 37 years (16-67)). One (9%) patient achieved a transient CR, one CRp. Grade 3/4 toxicities included sepsis (seven patients; 63%); hyperbilirubinemia (six patients; 54%), with transaminitis in one patient; mucositis (three patients; 27%). The inclusion of CSA in a gemtuzumab ozogamicin-containing regimen is feasible. The MDAC regimen was associated with significant toxicity in a cohort of patients with very advanced AML.
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Affiliation(s)
- Efrosyni Apostolidou
- Department of Leukemia, M.D. Anderson Cancer Center, University of Texas, Box 428, 1515 Holcombe Blvd., Houston, TX 77030, USA
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45
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Apostolidou E, Estey E, Cortes J, Garcia-Manero G, Faderl S, Thomas D, Tsimberidou A, Kantarjian H, Giles FJ. Mitoxantrone and prolonged infusion gemcitabine as salvage therapy in patients with acute myelogenous leukemia. Leuk Res 2003; 27:301-4. [PMID: 12531220 DOI: 10.1016/s0145-2126(02)00171-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/29/2022]
Abstract
In a recent phase I study, a combination of gemcitabine at 10 mg/(m(2)min) for 12 h and mitoxantrone 12 mg/m(2) daily for 3 days, achieved a complete remission (CR) in 3 of 12 (25%) patients with refractory leukemia. A pilot assessment of this regimen was conducted to determine its tolerability in patients with refractory acute myeloid leukemia (AML). In a cohort of 18 patients with very refractory disease (6 primary refractory, 12 relapsed, mean initial CR duration 3.5 months), one patient achieved a CR, a second CR with incomplete platelet recovery (CRp). Sepsis and mucositis were significant extramedullary toxicities. The gemcitabine and mitoxantrone regimen was feasible to administer even in heavily pre-treated patients. It was not active in patients who had failed a prior salvage regimen. It may warrant further study in patients with primary resistant AML.
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Affiliation(s)
- Efrosyni Apostolidou
- Department of Leukemia, M.D. Anderson Cancer Center, University of Texas, P.O. Box 428, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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46
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Tsimberidou A, Estey E, Cortes J, Thomas D, Faderl S, Verstovsek S, Garcia-Manero G, Keating M, Albitar M, O'Brien S, Kantarjian H, Giles F. Gemtuzumab, fludarabine, cytarabine, and cyclosporine in patients with newly diagnosed acute myelogenous leukemia or high-risk myelodysplastic syndromes. Cancer 2003; 97:1481-7. [PMID: 12627513 DOI: 10.1002/cncr.11239] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [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: 11/11/2022]
Abstract
BACKGROUND Gemtuzumab is used to treat patients with previously untreated or recurrent acute myelogenous leukemia (AML). The fludarabine and cytarabine (ara-C) regimen is active in these patients. Resistance to gemtuzumab is associated with blast multidrug resistance (MDR). The objectives of this study were to evaluate the efficacy and toxicity of a combination regimen of gemtuzumab, fludarabine, ara-C, and the MDR modifier (cyclosporine [CyA]) in patients with previously untreated AML, refractory anemia with excess blasts (RAEB), or RAEB in transformation (RAEBT). METHODS The MFAC regimen was comprised of gemtuzumab (Mylotarg trade mark ) (6 mg/m(2) intravenously [i.v.] on Day 1); fludarabine and ara-C (15 mg/m(2) and 0.5 g/m(2), respectively, twice daily on Days 2-6); and CSA (6 mg/kg loading dose before gemtuzumab, followed by 16 mg/kg continuous i.v. infusion on Days 1 and 2). RESULTS Fifty-nine evaluable patients were treated: 39 patients (66%) had AML and 20 patients (34%) had RAEB/RAEBT. Their median age was 57 years (range, 27-76 years). The MFAC regimen induced complete remission (CR) in 27 patients (46%) and CR with incomplete platelet recovery (CRp) in 1 patient (2%). The median survival period is 8 months. At 12 months, the survival rate is 38% and the event-free survival rate in patients with CR/CRp is 27%. Infections complicated 38% of the courses of chemotherapy. Grade 3/4 toxicity included hyperbilirubinemia in 31% and transaminitis in 7% of the patients. Four patients (7%) developed hepatic venoocclusive disease (VOD). CONCLUSIONS The MFAC regimen may merit further study in patients with AML if measures to avoid and/or treat VOD can be incorporated into the regimen.
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MESH Headings
- Adult
- Aged
- Alanine Transaminase/analysis
- Aminoglycosides
- Anemia, Refractory, with Excess of Blasts/drug therapy
- Anemia, Refractory, with Excess of Blasts/pathology
- Anti-Bacterial Agents/administration & dosage
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Aspartate Aminotransferases/analysis
- Cyclosporine/administration & dosage
- Cytarabine/administration & dosage
- Female
- Gemtuzumab
- Humans
- Hyperbilirubinemia/chemically induced
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/pathology
- Male
- Middle Aged
- Survival
- Treatment Outcome
- Vidarabine/administration & dosage
- Vidarabine/analogs & derivatives
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Affiliation(s)
- Apostolia Tsimberidou
- Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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47
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Alvarado Y, Tsimberidou A, Kantarjian H, Cortes J, Garcia-Manero G, Faderl S, Thomas D, Estey E, Giles FJ. Pilot study of Mylotarg, idarubicin and cytarabine combination regimen in patients with primary resistant or relapsed acute myeloid leukemia. Cancer Chemother Pharmacol 2003; 51:87-90. [PMID: 12497211 DOI: 10.1007/s00280-002-0546-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [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: 08/10/2002] [Accepted: 09/25/2000] [Indexed: 11/29/2022]
Abstract
PURPOSE Mylotarg has moderate activity as a single agent in patients with CD33-positive refractory or relapsed acute myelogenous leukemia (AML). A combination of an anthracycline and cytarabine (ara-C) is the core of most AML induction regimens. We conducted a pilot study of Mylotarg combined with idarubicin and ara-C in patients with refractory or relapsed AML. METHODS Mylotarg was administered at 6 mg/m(2) intravenously on days 1 and 15, idarubicin 12 mg/m(2) daily on days 2 through 4, and ara-C at 1.5 g/m(2) daily on days 2 through 5 (MIA) RESULTS: Of 14 patients were treated, 4 (29%) had primary resistant AML, and 10 (71%) relapsed AML. The median age of the patients was 61 years (range 34-74 years). MIA induced complete remission (CR) in three patients (21%) and CR with incomplete platelet recovery (CRp) in three patients (21%). The median survival was 8 weeks (range 2-64 weeks), and the median failure-free survival of CR patients was 27 weeks (range 11-64 weeks). All patients developed grade 3/4 myelosuppression - severe sepsis occurred in ten patients (71%). Other grade 3/4 nonhematologic toxicities included hepatic transaminitis, oral mucositis, and diarrhea. Two patients (14%) developed hepatic venoocclusive disease (VOD). CONCLUSIONS The addition of Mylotarg to idarubicin and ara-C is feasible. MIA has significant activity in patients with refractory AML. Hepatotoxicity and VOD are significant toxicities of Mylotarg-based combinations.
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Affiliation(s)
- Yesid Alvarado
- Department of Leukemia, The University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, 77030, USA
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48
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Meletis J, Samarkos M, Mesogitis S, Meletis C, Mougiou A, Terpos E, Tsimberidou A, Andreopoulos A, Konstantopoulos K, Loukopoulos D. Severe aplastic anaemia relapsing during a pregnancy; spontaneous remission following termination. Haematologia (Budap) 1998; 29:147-51. [PMID: 9728807] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The case of a 29-year-old woman with aplastic anaemia in remission who relapsed during pregnancy is reported here. Following successful Caesarean delivery, spontaneous remission was obtained and the patient remains well thereafter. Pathogenetic and therapeutic aspects of this rare complication of pregnancy are discussed.
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Affiliation(s)
- J Meletis
- First Department of Internal Medicine, Athens University Medical School, Laikon General Hospital, Greece.
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49
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Meletis J, Michali E, Samarkos M, Konstantopoulos K, Meletis C, Terpos E, Tsimberidou A, Chandrinou E, Viniou N, Rombos Y, Pangalis GA, Yataganas X, Loukopoulos D. Detection of "PNH red cell" populations in hematological disorders using the Sephacryl Gel Test micro typing system. Leuk Lymphoma 1997; 28:177-82. [PMID: 9498717 DOI: 10.3109/10428199709058344] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 02/06/2023]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder characterised by an unusual sensitivity of abnormal red cell population(s) to complement lysis, due to a complete or incomplete defect of various surface molecules, including CD55 and CD59. PNH has been associated with various hematological disorders. Using a newly introduced method, the Sephacryl gel test microtyping system, we investigated the presence of CD55 or CD59 defective red cell populations in several hematological disorders. It was also found that a large proportion of such patients possess CD55 deficient populations, while a smaller but still significant proportion possess CD59 deficient populations. Defective red cell populations were detected in normal subjects as well. These findings need further investigation. Nevertheless the Sephacryl Gel Test microtyping system although non specific, seems to be useful in screening for the PNH and/or "PNH-like" red cell defect in several hematological disorders.
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Affiliation(s)
- J Meletis
- First Department of Internal Medicine, University of Athens School of Medicine, Laikon General Hospital, Greece
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