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Yap TA, Tolcher AW, Plummer R, Mukker JK, Enderlin M, Hicking C, Grombacher T, Locatelli G, Szucs Z, Gounaris I, de Bono JS. First-in-Human Study of the Ataxia Telangiectasia and Rad3-related (ATR) Inhibitor Tuvusertib (M1774) as Monotherapy in Patients with Solid Tumors. Clin Cancer Res 2024:734921. [PMID: 38407317 DOI: 10.1158/1078-0432.ccr-23-2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/26/2023] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE Tuvusertib (M1774) is a potent, selective, orally administered ATR protein kinase inhibitor. This first-in-human study (NCT04170153) evaluated safety, tolerability, maximum tolerated dose (MTD), recommended dose for expansion (RDE), pharmacokinetics (PK), pharmacodynamics (PD), and preliminary efficacy of tuvusertib monotherapy. PATIENTS AND METHODS Ascending tuvusertib doses were evaluated in 55 patients with metastatic or locally advanced unresectable solid tumors. A safety monitoring committee determined dose escalation based on PK, PD, and safety data guided by a Bayesian 2‑parameter logistic regression model. Molecular responses (MRs) were assessed in circulating tumor DNA samples. RESULTS Most common Grade ≥3 treatment-emergent adverse events were anemia (36%), neutropenia and lymphopenia (both 7%). Eleven patients experienced dose-limiting toxicities, most commonly Grade 2 (n=2) or Grade 3 (n=8) anemia. No persistent effects on blood immune cell populations were observed. The RDE was 180mg tuvusertib QD, 2 weeks on/1 week off, which was better tolerated than the MTD (180mg QD continuously). Tuvusertib median time to peak plasma concentration ranged from 0.5-3.5h and mean elimination half-life from 1.2-5.6h. Exposure-related PD analysis suggested maximum target engagement at ≥130mg tuvusertib QD. Tuvusertib induced frequent MRs in the predicted efficacious dose range, MRs were enriched in patients with radiological disease stabilization and complete MRs were detected for mutations in ARID1A, ATRX and DAXX. One patient with platinum- and PARP inhibitor‑resistant BRCA wild-type ovarian cancer achieved an unconfirmed RECIST v1.1 partial response. CONCLUSIONS Tuvusertib demonstrated manageable safety and exposure-related target engagement. Further clinical evaluation of tuvusertib is ongoing.
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Affiliation(s)
- Timothy A Yap
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anthony W Tolcher
- South Texas Accelerated Research Therapeutics, San Antonio, TX, United States
| | - Ruth Plummer
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | | | - Marta Enderlin
- the healthcare business of Merck KGaA, Darmstadt, Germany
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Spira A, Awada A, Isambert N, Lorente D, Penel N, Zhang Y, Ojalvo LS, Hicking C, Rolfe PA, Ihling C, Dussault I, Locke G, Borel C. Identification of HMGA2 as a predictive biomarker of response to bintrafusp alfa in a phase 1 trial in patients with advanced triple-negative breast cancer. Front Oncol 2022; 12:981940. [PMID: 36568239 PMCID: PMC9773992 DOI: 10.3389/fonc.2022.981940] [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: 07/06/2022] [Accepted: 10/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background We report the clinical activity, safety, and identification of a predictive biomarker for bintrafusp alfa, a first-in-class bifunctional fusion protein composed of the extracellular domain of TGFβRII (a TGF-β "trap") fused to a human IgG1 mAb blocking PD-L1, in patients with advanced triple-negative breast cancer (TNBC). Methods In this expansion cohort of a global phase 1 study, patients with pretreated, advanced TNBC received bintrafusp alfa 1200 mg every 2 weeks intravenously until disease progression, unacceptable toxicity, or withdrawal. The primary objective was confirmed best overall response by RECIST 1.1 assessed per independent review committee (IRC). Results As of May 15, 2020, a total of 33 patients had received bintrafusp alfa, for a median of 6.0 (range, 2.0-48.1) weeks. The objective response rate was 9.1% (95% CI, 1.9%-24.3%) by IRC and investigator assessment. The median progression-free survival per IRC was 1.3 (95% CI, 1.2-1.4) months, and median overall survival was 7.7 (95% CI, 2.1-10.9) months. Twenty-five patients (75.8%) experienced treatment-related adverse events (TRAEs). Grade 3 TRAEs occurred in 5 patients (15.2%); no patients had a grade 4 TRAE. There was 1 treatment-related death (dyspnea, hemolysis, and thrombocytopenia in a patient with extensive disease at trial entry). Responses occurred independently of PD-L1 expression, and tumor RNAseq data identified HMGA2 as a potential biomarker of response. Conclusions Bintrafusp alfa showed clinical activity and manageable safety in patients with heavily pretreated advanced TNBC. HMGA2 was identified as a potential predictive biomarker of response. ClinicalTrialsgov identifier NCT02517398.
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Affiliation(s)
- Alexander Spira
- Department of Medical Oncology, Virginia Cancer Specialists, Fairfax, VA, United States,US Oncology Research, The Woodlands, TX, United States,*Correspondence: Alexander Spira,
| | - Ahmad Awada
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - David Lorente
- Department of Medical Oncology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France,Department of Medical Oncology, Université de Lille, Lille, France
| | - Yue Zhang
- EMD Serono Research & Development Institute, Inc, an Affiliate of Merck KGaA, Billerica, MA, United States
| | - Laureen S. Ojalvo
- EMD Serono Research & Development Institute, Inc, an Affiliate of Merck KGaA, Billerica, MA, United States
| | | | - P. Alexander Rolfe
- EMD Serono Research & Development Institute, Inc, an Affiliate of Merck KGaA, Billerica, MA, United States
| | | | - Isabelle Dussault
- EMD Serono Research & Development Institute, Inc, an Affiliate of Merck KGaA, Billerica, MA, United States
| | - George Locke
- EMD Serono Research & Development Institute, Inc, an Affiliate of Merck KGaA, Billerica, MA, United States
| | - Christian Borel
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
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Yap T, Tolcher A, Plummer R, Mukker J, Enderlin M, Hicking C, Locatelli G, Szucs Z, Gounaris I, de Bono J. 457MO A phase I study of ATR inhibitor M1774 in patients with solid tumours (DDRiver Solid Tumours 301): Part A1 results. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.586] [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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Georges S, Shah PK, Shapiro I, Hicking C, Lu L, Hennessy M, D'Angelo SP, Cai T. Integrative molecular analysis of metastatic Merkel cell carcinoma to identify predictive biomarkers of response to avelumab. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9569] [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: 11/20/2022] Open
Abstract
9569 Background: Avelumab, an FDA-approved human anti–PD-L1 IgG1 monoclonal antibody for patients (pts) with metastatic Merkel cell carcinoma, showed an objective response rate (ORR; by RECIST v1.1) of 31.8% in a second-line phase 2 trial (NCT02155647). We assessed the association of tumor mutational burden (TMB; nonsynonymous somatic variants/megabase), PD-L1 expression, Merkel cell polyomavirus (MCPyV) status, and CD8+ tumor-infiltrating T-cell density with ORR and survival. Molecular profiles (RNAseq and WEX) also were analyzed. Methods: Baseline tumors (n = 36) were profiled using RNAseq and WEX sequencing. PD-L1 expression (≥1% cutoff), MCPyV status, and CD8+ T-cell density at the tumor invasive margin were evaluated by IHC. MHC locus expression was measured with OptiType and loss of heterozygosity (LOH) with LOHHLA. Results: Of 36 pts profiled, 12 had a response, 27 were PD-L1+, and 23 were MCPyV+. The TMB upper tertile and quartile values were 1.34 and 3.16, respectively. Consistent with literature, MCPyV− pts had a higher median TMB (2.72) than MCPyV+ pts (0.49). PD-L1+ tumors trended toward a higher TMB. An empirical cohort-specific TMB cutoff of ≥2 was chosen to include sufficient pts per subgroup. Pts with TMB ≥2 vs TMB < 2 had higher ORR (5 of 11 [45.5%] vs 7 of 25 [28.0%]) and 6-mo PFS rates (60% vs 38%). Among pts with TMB ≥2, the highest ORRs were reported in MCPyV− (4 of 7 pts), PD-L1+ (5 of 9 pts), and CD8+ T-cell density higher than median (5 of 6 pts) subgroups. MHC expression trended with ORR and survival. Higher mean MHC expression was found in pts with CD8+ T-cell density higher than median (p < 0.05). Mutations in antigen presentation genes were detected: LOH at the HLA locus in 9 of 30 pts (28%), including 4 with a response; an NK cell activation signature was also associated with response. These data may suggest that ADCC contributes to response. Factorial analysis of gene signature scores identified signatures (eg, IFNγ, TP53 pathway) associated with MCPyV status and response. Conclusions: Responses in this data set were not attributed to any specific biomarker alone. Future analysis is focused on validating these results and identifying rational drug combinations with avelumab. Clinical trial information: NCT02155647.
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Affiliation(s)
- Sara Georges
- Global Development, EMD Serono Research & Development Inc., Billerica, MA
| | - Parantu K. Shah
- Global Development, EMD Serono Research & Development Inc., Billerica, MA
| | - Irina Shapiro
- Global Development, EMD Serono Research & Development Inc., Billerica, MA
| | - Christine Hicking
- Global Development, EMD Serono Research & Development Inc., Billerica, MA
| | - Lei Lu
- Global Development, EMD Serono Research & Development Inc., Billerica, MA
| | - Meliessa Hennessy
- Global Development, EMD Serono Research & Development Inc., Billerica, MA
| | | | - Ti Cai
- Global Development, EMD Serono Research & Development Inc., Billerica, MA
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Comi G, Cook S, Giovannoni G, Rieckmann P, Sørensen PS, Vermersch P, Galazka A, Nolting A, Hicking C, Dangond F. Effect of cladribine tablets on lymphocyte reduction and repopulation dynamics in patients with relapsing multiple sclerosis. Mult Scler Relat Disord 2019; 29:168-174. [PMID: 30885375 DOI: 10.1016/j.msard.2019.01.038] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immune reconstitution therapies (IRT) for patients with multiple sclerosis are used for short, intermittent treatment periods to induce immune resetting and allow subsequent treatment-free periods. Cladribine tablets are postulated to be an IRT that causes selective and transient reductions in CD19+ B cells and T cells, followed by reconstitution of adaptive immune function. OBJECTIVE To characterize long-term lymphocyte count changes in pooled data from the 2-year CLARITY and subsequent 2-year CLARITY Extension studies, and the PREMIERE registry (Long-term CLARITY cohort). METHODS Data from patients randomized to placebo (n = 435) or cladribine tablets 10 mg (MAVENCLAD®; 3.5 mg/kg cumulative dose over 2 years, referred to as cladribine tablets 3.5 mg/kg; n = 685) in CLARITY or CLARITY Extension, including time spent in the PREMIERE registry were pooled to provide long-term follow-up data. The study investigated absolute lymphocyte counts (ALC) up to 312 weeks and B and T cell subsets up to 240 weeks after the first dose, in patients receiving placebo or cladribine tablets 3.5 mg/kg administered as two short (4 or 5 days) weekly treatments at the start of months 1 and 2 in each treatment year, followed by no further active treatment. RESULTS Treatment with cladribine tablets 3.5 mg/kg resulted in selective reductions in B and T lymphocytes. Lymphocyte recovery began soon after treatment in each of years 1 and 2. Median ALC recovered to the normal range and CD19+ B cells recovered to threshold values by week 84, approximately 30 weeks after the last dose of cladribine tablets in year 2. Median CD4+ T cell counts recovered to threshold values by week 96 (approximately 43 weeks after the last dose of cladribine tablets in year 2). Median CD8+ cell counts never dropped below the threshold value. CONCLUSION These results show the dynamics of lymphocyte count changes following treatment with cladribine tablets 3.5 mg/kg. The immune cell repopulation results provide further evidence that cladribine tablets may represent a form of IRT.
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Affiliation(s)
- Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology, Università Vita-Salute San Raffaele, Ospedale San Raffaele, Milan, Italy
| | - Stuart Cook
- Rutgers, The State University of New Jersey, New Jersey Medical School, Department of Neurology & Neurosciences, Medical Science Building, 185 South Orange Avenue, MSB, H506, Newark, NJ 07101-1709, United States.
| | - Gavin Giovannoni
- Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Peter Rieckmann
- Department of Neurology, Medical Park Loipl and University of Erlangen, Erlangen, Germany
| | - Per Soelberg Sørensen
- Danish MS Center, Department of Neurology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Patrick Vermersch
- University of Lille, CHU Lille, LIRIC-INSERM U995, FHU Imminent, Lille, France
| | | | | | | | - Fernando Dangond
- EMD Serono Research & Development Institute Inc., Billerica, MA, United States
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Cook S, Leist T, Comi G, Montalban X, Giovannoni G, Nolting A, Hicking C, Galazka A, Sylvester E. Safety of cladribine tablets in the treatment of patients with multiple sclerosis: An integrated analysis. Mult Scler Relat Disord 2018; 29:157-167. [PMID: 30885374 DOI: 10.1016/j.msard.2018.11.021] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Treating patients with relapsing multiple sclerosis (MS) with cladribine tablets (two times 4 or 5 days of treatment each year for 2 years) results in long-lasting efficacy, with continued stability in many patients for 4 or more years. Safety and tolerability outcomes from individual clinical studies with cladribine tablets have been reported previously. OBJECTIVE Report safety data from an integrated analysis of clinical trials and follow-up in patients with MS to further characterize the safety profile of cladribine tablets. METHODS Data for patients treated with cladribine tablets 10 mg (MAVENCLAD®; 3.5 mg/kg cumulative dose over 2 years, referred to as cladribine tablets 3.5 mg/kg) as monotherapy (n = 923) or placebo (n = 641) in Phase III clinical trials (CLARITY, CLARITY Extension and ORACLE-MS) and followed up in the PREMIERE registry were aggregated (Monotherapy Oral cohort). To better characterize rare events, additional data from earlier studies which involved the use of parenteral cladribine in patients with MS, and the ONWARD study, in which patients were given cladribine tablets in addition to interferon (IFN)-β or placebo plus IFN-β were included in an All Exposed cohort (cladribine, n = 1926; placebo, n = 802). Adjusted adverse events incidences per 100 patient-years (Adj-AE per 100 PY) were calculated for the integrated analyses. RESULTS The incidence rate of treatment-emergent adverse events (TEAEs) in the Monotherapy Oral cohort was 103.29 vs. 94.26 Adj-AEs per 100 PY for placebo. TEAEs that occurred more frequently with cladribine tablets were mainly driven by the TEAEs of lymphopenia (Adj-AE per 100 PY 7.94 vs. 1.06 for placebo) and lymphocyte count decreased (Adj-AE per 100 PY 0.78 vs. 0.10 for placebo) as anticipated due to the mode of action of cladribine. An increase in TEAE incidence rate was also observed in the cladribine tablets 3.5 mg/kg group vs. placebo for herpes zoster (Adj-AE per 100 PY 0.83 vs. 0.20, respectively). There were no cases of systemic, serious disseminated herpes zoster attributed to treatment with cladribine tablets. In general there was no increase in the risk of infections including opportunistic infections with cladribine tablets versus placebo, except for herpes zoster. Periods of severe lymphopenia (< 0.5 × 109 cells/L) were associated with an increased frequency of infections, but the nature of these was not different to that observed in the overall patient group treated with cladribine tablets 3.5 mg/kg. Within the constraints of a limited sample size, malignancy rates in the overall clinical program for cladribine in MS did not show evidence of an increase compared to placebo-treated patients and there was no increase in the incidence of malignancies over time in cladribine-treated patients. CONCLUSION The AE profile for cladribine tablets 3.5 mg/kg as a monotherapy has been well-characterized in a pooled population of patients from early to more advanced relapsing MS. There was no increased risk for infections in general except for a higher incidence of herpes zoster. Lymphopenia was amongst the most frequently observed TEAEs that occurred at a higher incidence with cladribine relative to placebo. There was also no increase in malignancy rates for cladribine relative to placebo.
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Affiliation(s)
- Stuart Cook
- Rutgers, The State University of New Jersey, New Jersey Medical School, Department of Neurology & Neurosciences, 185 South Orange Avenue, Newark, NJ 07101-1709, United States.
| | - Thomas Leist
- Division of Clinical Neuroimmunology, Jefferson University, Comprehensive MS Center, 900 Walnut Street, Philadelphia, PA 19107, United States
| | - Giancarlo Comi
- Department of Neurology and Institute of Experimental Neurology, Università Vita-Salute San Raffaele, Ospedale San Raffaele, Via Olgettina 48, Milan 20132, Italy
| | - Xavier Montalban
- Division of Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada; Department of Neurology-Neuroimmunology, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Passeif de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Gavin Giovannoni
- Queen Mary University of London, Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK
| | - Axel Nolting
- Merck KGaA, Frankfurter Str. 250, 64293 Darmstadt, Germany
| | | | - Andrew Galazka
- Merck, Zone Industrielle de L'Ouriettaz, Aubonne, 1170, Switzerland, a division of Merck KGaA, Darmstadt, Germany
| | - Elke Sylvester
- Merck KGaA, Frankfurter Str. 250, 64293 Darmstadt, Germany
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Galazka A, Nolting A, Cook S, Leist T, Comi G, Montalban X, Hicking C, Dangond F. Pregnancy Outcomes During the Clinical Development of Cladribine in Multiple Sclerosis: An Integrated Analysis of Safety. Mult Scler Relat Disord 2018. [DOI: 10.1016/j.msard.2018.10.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Giovannoni G, Rammohan K, Cook S, Comi G, Rieckmann P, Soelberg-Sorensen P, Vermersch P, Dangond F, Hicking C. WED 184 Cladribine tablets in clarity patients with high disease activity ms. J Neurol Psychiatry 2018. [DOI: 10.1136/jnnp-2018-abn.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with high disease activity (HDA) relapsing-remitting MS are less likely to attain no evidence of disease activity (NEDA; no relapses, MRI activity or progression).ObjectivePost-hoc analysis to compare the proportion of patients with NEDA with cladribine tablets 3.5 mg/kg (CT3.5) vs placebo.MethodsPatients from CLARITY were retrospectively stratified using 2 definitions of HDA based on relapse history, prior treatment, and MRI characteristics: HRA (n=261) and HRA plus disease activity on treatment (HRA+DAT) [n=289]). Data for patients treated with CT3.5 or placebo who fulfilled these criteria and achieved NEDA status were compared over the 2 years using odds ratios (OR) and 95% CI.ResultsHRA subgroup: 76% of CT3.5-treated patients were relapse-free and 84% were T1 Gd+ lesion free vs 49% and 31%, respectively, for placebo. HRA+DAT subgroup: 77% of CT3.5-treated were relapse-free and 85% were T1 Gd+ lesion free vs 50% and 32%, respectively, for placebo. In the HRA and HRA+DAT subgroups, 43.2% and 43.7%, respectively, of CT3.5-treated patients were disease activity free compared with 8.7%, (OR: 8.02; 95% CI: 3.93 to 16.35; p<0.0001) and 9.0% (OR: 7.82; 95% CI: 4.03 to 15.19; p<0.0001) respectively, for placebo. In the overall population, composite NEDA score favored CT over placebo (OR: 4.46; 95% CI: 3.18 to 6.26; p<0.0001).ConclusionsTreatment with CT3.5 significantly increased the proportion of HDA patients with NEDA vs placebo.Disclaimerhttp://medpub-poster.merckgroup.com/ABN2018DISC_NEDA.pdf
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Soelberg-Sorensen P, Dangond F, Hicking C, Giovannoni G. WED 182 Cladribine tablets effects on lymphocytes in ms patients. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-abn.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLymphopenia is expected from the mechanism of action of cladribine tablets 3.5 mg/kg (CT3.5)ObjectiveInvestigate absolute lymphocyte counts (ALC; 312 weeks) and subsets (240 weeks) in RRMS patients receiving 2 annual courses of CT3.5.MethodsPooled data from patients randomised to CT3.5 over 2 years in CLARITY/CLARITY-Extension inclusive of the PREMIERE registry (n=685).ResultsBaseline: median ALC=1.86 × 109/L. Year-1: ALC reached nadir at 9 weeks post-treatment with CT3.5 (1.00 × 109/L). Year-2: ALC reached nadir at Week-55 (0.81 × 109/L), then recovered to the normal range (≥1.00 × 109/L; Week-96). ALC was in normal range in 75% of patients by Week-144. Baseline median CD4+ were 851 cells/µL. Nadirs occurred at Week-16 (385 cells/µL) in Year-1 and at Week-60 (292 cells/µL) in Year-2; values increased after nadirs and regained threshold (350 cells/µL, ~Week-120). Baseline median CD8+ were 378 cells/µL. Nadirs occurred at Week-16 (239 cells/µL; Year 1) and Week-72 (232 cells/µL; Year 2). CD8+ recovered quickly after treatment and remained above 200 cells/µL at all times. Baseline median CD19+ were 205 cells/µL. Nadirs occurred at Week-9 (18 cells/µL; Year-1) and Week-52 (31 cells/µL; Year-2). CD19+ then reached threshold of 100 cells/µL by the end of Year-2.ConclusionLymphocyte recovery begins soon after CT3.5. ALC, CD19+ B and CD4+ T cells; reached threshold by 7.5, 12 and 18 months. CD8+ cells remained above threshold.Disclaimerhttp://medpub-poster.merckgroup.com/ABN2018DISC_LongLymph.pdf
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Cook S, Comi G, Giovannoni G, Rieckmann P, Soelberg-Sorensen P, Vermersch P, Dangond F, Hicking C. THUR 192 Yearly lymphopenia rates in cladribine tablets-treated rms patients. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-abn.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCladribine tablets 3.5 mg/kg (CT3.5) demonstrated efficacy in RMS patients in CLARITY/CLARITY-Extension. Lymphopenia was common (CT3.5: mechanism of action).ObjectiveEvaluate whether lymphopenia persists following treatment/re-treatment with CT3.5 in CLARITY/CLARITY- Extension.MethodsLymphopenia by grade for patients randomised to CT3.5 throughout CLARITY/CLARITY-Extension (7 mg/kg cumulative 4 year dose; n=186) are reported. Patients with Grade 0 (G0) lymphopenia (≥1.0 × 109 cells/L) before the first course of CT and G0/1 (≥0.8 × 109 cells/L) before subsequent treatment in Years 2 (Y2), 3 and 4 were analysed.Results176 patients were G0 at the start of CLARITY (167 were G0/1; CLARITY-Extension). G3 lymphopenia was observed in 1% patients (Week-13, Y1), and in 7%, 11% and 12% patients at Week-12 in Y2, 3 and 4. In each year, G3 lymphopenia was observed in 1%, 4%, 4% and 4% patients (Week-24), in 1%, 2%, 2% and 2% patients (Week-36), and in 1% patients (Week-48) in Y2 only. G3 lymphopenia was reported in <18% patients at any time-point. No patients had G4 lymphopenia at the end of each treatment year.ConclusionsIn patients meeting treatment/re-treatment guidelines, no G4 lymphopenia occurred at the end of any treatment year; G3 lymphopenia was uncommon. Lymphocyte-based re-treatment criteria minimised the incidence of severe, sustained lymphopenia during 4 years’ treatment with CT.Disclaimerhttp://medpub-poster.merckgroup.com/ABN2018DISC_Year1-4.pdf
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Giovannoni G, Rammohan K, Cook S, Comi G, Rieckmann P, Soelberg-Sorensen P, Vermersch P, Dangond F, Hicking C. WED 185 Clarity: mri outcomes in high disease activity relapsing ms. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-abn.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe CLARITY study demonstrated the benefit of cladribine tablets 3.5 mg/kg (CT3.5) for patients with relapsing MS (RMS). Patients with high disease activity (HDA) RMS are at risk of clinical activity and disability progression.ObjectivePost-hoc analysis of MRI outcomes in CLARITY for CT3.5 vs placebo.MethodsRetrospective analysis using HDA definitions based on relapse history, prior treatment, and MRI characteristics: high relapse activity (HRA) and HRA plus disease activity on treatment (HRA+DAT).ResultsFor cumulative new T1 Gd+ lesions, relative risk ratios (RRR) for both subgroups (HRA: 0.087; 95% CI: 0.052 to 0.144; p<0.0001) (HRA+DAT: 0.077; 95% CI: 0.046 to 0.128; p<0.0001) were lower for CT3.5 vs placebo. Risk reductions (RR) (91% and 92%, respectively) were similar to the 90% reduction in the overall CLARITY population (0.097; 95% CI: 0.070 to 0.134; p<0.0001). Cumulative active T2 lesions RRR favoured CT3.5 vs placebo for both subgroups (HRA: 0.263; 95% CI: 0.180 to 0.383, p<0.0001) (HRA+DAT: 0.254; 95% CI: 0.178 to 0.363; p<0.0001): RRs of 74% and 75%, reflecting the 73% overall population reduction (0.272; 95% CI: 0.221 to 0.335; p<0.0001). Cumulative combined unique lesions RRR favoured CT3.5 vs placebo for HRA (0.212; 95% CI: 0.145 to 0.311; p<0.0001) and HRA+DAT (0.203; 95% CI: 0.141 to 0.291; p<0.0001): RRs were 79% and 80%, reflecting the 77% overall population reduction (0.234; 95% CI: 0.190 to 0.290; p<0.0001). There were no significant interactions between HDA and non-HDA subgroups.ConclusionsThe treatment benefit of CT3.5 on MRI outcomes was similar in HDA RMS subgroups and the overall CLARITY study population.Disclaimerhttp://medpub-poster.merckgroup.com/ABN2018DISC_HDAMRI.pdf
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Cook S, Leist T, Comi G, Montalban X, Sylvester E, Hicking C, Dangond F. THUR 178 Infections during grade 3/4 lymphopenia with cladribine tablets. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-abn.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn CLARITY, cladribine tablets 3.5 mg/kg (CT3.5) demonstrated efficacy in relapsing MS patients. The most common AE was lymphopenia, reflecting cladribine’s mode of action. Integrated safety analysis showed infection incidence was not higher in patients receiving CT3.5 vs placebo, bar a small increase of herpes zoster (HZV).ObjectivePost-hoc analysis examined infectious AEs occurring concurrently with Grade 3/4 lymphopenia (G3/4) in CT3.5 treated patients.MethodsThe AE profile for CT3.5 during the periods of G3/4 was analysed. Adjusted-AE incidences per 100 patient years (Adj-AE/100PY) were calculated in a cohort of patients receiving CT3.5 monotherapy in clinical trials.ResultsData are presented as Adj-AE/100PY: G3/4 vs without G3/4. Adj-AE/100PY for any infections/infestations was 57.53 vs 24.50. Infections were similar between periods. ≥50% cases with G3/4 were easily-treatable upper- respiratory-tract infections (nasopharyngitis: 13.48 vs 5.24; upper-respiratory-tract infection: 9.67 vs 3.41; pharyngitis: 4.51 vs 0.73). HZV occurred in 4 patients with G3/4 (4.50 vs 0.73); cases were dermatomal and mild-to- moderate in severity. Single occurrences were reported for most infectious AEs. Opportunistic infections were single occurrences, not severe, serious or difficult-to-treat.ConclusionsG3/4 increased frequency of infections but did not affect the type of infectious AEs in CT3.5 treated patients. HZV profile was uncomplicated, consistent with findings of previous analyses.Disclaimerhttp://medpub-poster.merckgroup.com/ABN2018DISC_Grade34.pdf
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Terranova N, Hicking C, Dangond F, Munafo A. Effects of Postponing Treatment in the Second Year of Cladribine Administration: Clinical Trial Simulation Analysis of Absolute Lymphocyte Counts and Relapse Rate in Patients with Relapsing-Remitting Multiple Sclerosis. Clin Pharmacokinet 2018; 58:325-333. [PMID: 29992396 PMCID: PMC6373385 DOI: 10.1007/s40262-018-0693-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cladribine Tablets (MAVENCLAD®) selectively reduce absolute lymphocyte counts (ALCs) in patients with multiple sclerosis. The recommended cumulative dose of Cladribine Tablets is 3.5 mg/kg over 4-5 days in months 1 and 2 of treatment years 1 and 2, followed by prolonged efficacy with no additional treatment. After the cladribine-induced reduction, ALCs recover to normal within each treatment year in most patients. Those patients with slow ALC recovery can develop Grade 3-4 lymphopenia, especially those patients with Grade ≥ 2 lymphopenia at the start of year 2. Guidelines allowing treatment postponements during year 2 have been proposed for patients with a low ALC, subsequent to CLARITY, the pivotal clinical trial. METHODS A virtual population was generated using characteristics from CLARITY patients. A clinical trial simulation was performed to determine the impact of alternative treatment scenarios on ALC and relapse rate, by postponing treatment in year 2 to allow for longer ALC recovery time in patients who required it. Should a patient not recover to normal ALC (Grade 0) or Grade 1 lymphopenia within the period defined in the treatment algorithm, treatment in year 2 was suspended. RESULTS Results were similar across considered scenarios, which implemented different postponement durations. Specifically, ~ 92% of virtual subjects did not require treatment postponement and < 1% discontinued due to Grade 2-4 lymphopenia at the end of the maximally permitted postponement. Less severe lymphopenia was observed during year 2 when a treatment algorithm was applied. The effect on relapse rate over 2 years was negligible. CONCLUSIONS Results support treatment guidelines to decrease the risk of severe lymphopenia following treatment with Cladribine Tablets, while preserving efficacy. TRIAL REGISTRATION CLARITY; ClinicalTrials.gov: NCT00213135.
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Affiliation(s)
- Nadia Terranova
- Quantitative Pharmacology, Merck Institute for Pharmacometrics, Merck Serono S.A., EPFL Innovation Park - Building I, CH-1015, Lausanne, Switzerland.
| | | | - Fernando Dangond
- Global Clinical Development - Neurology, EMD Serono Inc., Billerica, MA, USA
| | - Alain Munafo
- Quantitative Pharmacology, Merck Institute for Pharmacometrics, Merck Serono S.A., EPFL Innovation Park - Building I, CH-1015, Lausanne, Switzerland
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Montalban X, Leist TP, Cohen BA, Moses H, Campbell J, Hicking C, Dangond F. Cladribine tablets added to IFN-β in active relapsing MS: The ONWARD study. Neurol Neuroimmunol Neuroinflamm 2018; 5:e477. [PMID: 30027104 PMCID: PMC6047834 DOI: 10.1212/nxi.0000000000000477] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/23/2018] [Indexed: 01/07/2023]
Abstract
Objective To evaluate the safety and efficacy of cladribine tablets in patients still experiencing active relapsing MS despite interferon (IFN)-β treatment. Methods A 96-week phase II study, randomizing patients treated with IFN-β to cladribine tablets 3.5 mg/kg/IFN-β or placebo/IFN-β. Patients were to receive cladribine tablets 3.5 mg/kg/IFN-β or placebo/IFN-β in a 2:1 ratio (n = 172) with safety and exploratory efficacy outcomes being assessed. Results Adverse events (AEs) and serious AEs were similar across treatment groups, except lymphopenia. Fifty of 124 (40.3%) cladribine/IFN-β recipients vs 0% of placebo/IFN-β recipients reported lymphopenia as an AE, with grade 3/4 lymphopenia (laboratory lymphocyte count < 500 cells/mm3) experienced by 79/124 (63.7%) vs 1 (2.1%), respectively. Patients treated with cladribine tablets 3.5 mg/kg/IFN-β were 63% less likely to have a qualifying relapse than placebo/IFN-β recipients, and cladribine tablets 3.5 mg/kg/IFN-β reduced most MRI measures of disease activity. Conclusions In patients with active relapsing MS despite IFN-β treatment, cladribine tablets 3.5 mg/kg/IFN-β reduced relapses and MRI lesion activity over 96 weeks compared with placebo/IFN-β but led to an increased incidence of lymphopenia. Classification of evidence This study provides Class I evidence that for patients with active relapsing MS despite IFN-β treatment, cladribine tablets added to IFN-β reduced relapses and MRI lesion activity over 96 weeks and increased the incidence of lymphopenia. Clinical trial registration NCT00436826.
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Affiliation(s)
- Xavier Montalban
- Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Ontario, Canada; Division of Clinical Neuroimmunology (T.P.L.), Jefferson University, Comprehensive MS Center, Philadelphia, PA; Department of Neurology (B.A.C.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.M.), Vanderbilt University Medical Center, Nashville, TN; inScience Communications (J.C.), Springer Healthcare, Chester, United Kingdom; Research and Development Global BioStatistics (C.H.), Merck KGaA, Darmstadt, Germany; and Global Clinical Development Center (F.D.), EMD Serono Inc., Billerica, MA
| | - Thomas P Leist
- Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Ontario, Canada; Division of Clinical Neuroimmunology (T.P.L.), Jefferson University, Comprehensive MS Center, Philadelphia, PA; Department of Neurology (B.A.C.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.M.), Vanderbilt University Medical Center, Nashville, TN; inScience Communications (J.C.), Springer Healthcare, Chester, United Kingdom; Research and Development Global BioStatistics (C.H.), Merck KGaA, Darmstadt, Germany; and Global Clinical Development Center (F.D.), EMD Serono Inc., Billerica, MA
| | - Bruce A Cohen
- Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Ontario, Canada; Division of Clinical Neuroimmunology (T.P.L.), Jefferson University, Comprehensive MS Center, Philadelphia, PA; Department of Neurology (B.A.C.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.M.), Vanderbilt University Medical Center, Nashville, TN; inScience Communications (J.C.), Springer Healthcare, Chester, United Kingdom; Research and Development Global BioStatistics (C.H.), Merck KGaA, Darmstadt, Germany; and Global Clinical Development Center (F.D.), EMD Serono Inc., Billerica, MA
| | - Harold Moses
- Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Ontario, Canada; Division of Clinical Neuroimmunology (T.P.L.), Jefferson University, Comprehensive MS Center, Philadelphia, PA; Department of Neurology (B.A.C.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.M.), Vanderbilt University Medical Center, Nashville, TN; inScience Communications (J.C.), Springer Healthcare, Chester, United Kingdom; Research and Development Global BioStatistics (C.H.), Merck KGaA, Darmstadt, Germany; and Global Clinical Development Center (F.D.), EMD Serono Inc., Billerica, MA
| | - Jackie Campbell
- Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Ontario, Canada; Division of Clinical Neuroimmunology (T.P.L.), Jefferson University, Comprehensive MS Center, Philadelphia, PA; Department of Neurology (B.A.C.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.M.), Vanderbilt University Medical Center, Nashville, TN; inScience Communications (J.C.), Springer Healthcare, Chester, United Kingdom; Research and Development Global BioStatistics (C.H.), Merck KGaA, Darmstadt, Germany; and Global Clinical Development Center (F.D.), EMD Serono Inc., Billerica, MA
| | - Christine Hicking
- Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Ontario, Canada; Division of Clinical Neuroimmunology (T.P.L.), Jefferson University, Comprehensive MS Center, Philadelphia, PA; Department of Neurology (B.A.C.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.M.), Vanderbilt University Medical Center, Nashville, TN; inScience Communications (J.C.), Springer Healthcare, Chester, United Kingdom; Research and Development Global BioStatistics (C.H.), Merck KGaA, Darmstadt, Germany; and Global Clinical Development Center (F.D.), EMD Serono Inc., Billerica, MA
| | - Fernando Dangond
- Department of Neurology-Neuroimmunology (X.M.), Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Ontario, Canada; Division of Clinical Neuroimmunology (T.P.L.), Jefferson University, Comprehensive MS Center, Philadelphia, PA; Department of Neurology (B.A.C.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.M.), Vanderbilt University Medical Center, Nashville, TN; inScience Communications (J.C.), Springer Healthcare, Chester, United Kingdom; Research and Development Global BioStatistics (C.H.), Merck KGaA, Darmstadt, Germany; and Global Clinical Development Center (F.D.), EMD Serono Inc., Billerica, MA
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Galazka A, Nolting A, Cook S, Leist T, Comi G, Montalban X, Hicking C, King J, Dangond F. 040 An analysis of malignancy risk in the clinical development programme of cladribine tablets in patients with relapsing multiple sclerosis. J Neurol Neurosurg Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IntroductionAn independent meta-analysis; Pakpoor et al. Neurol Neuroimmunol Neuroinflamm 2015;2:e158) in Phase III trials (with a 2 year duration) of disease modifying drugs (DMDs) in patients with relapsing multiple sclerosis found no increased rate of malignancy with cladribine tablets (CT) versus other DMD treatments. Data from additional trials involving CT 3.5 mg/kg (CT3.5) and a safety registry (up to 8 years’ follow-up) allow further insights into malignancy risk. Objective is to assess malignancy risk with CT3.5 monotherapy and placebo (PBO) in data from 3 Phase III trials and a registry, and compare the incidence rate with a global database.MethodsThe CT 3.5 population comprised 923 patients (3433 patient-years’ [PY] total exposure time) and the PBO group comprised 641 patients (2026 PY). Individual case reports of malignancies were reviewed by independent, blinded adjudication committee. Standardised incidence ratios (SIR) were calculated using the GLOBOCAN reference population (excluding non-melanoma skin cancers [NMSCs]) and a Danish reference population for NMSC rates.ResultsThe incidence per 100 PY of confirmed malignancy was CT3.5 0.293 (95%CI 0.158–0.544) and PBO 0.148 (95%CI 0.048–0.460); the risk difference 95% CI included 0 (−0.166–0.414). The CT 3.5 malignancy SIR was almost identical (0.97, 95% CI 0.44–1.85) to the GLOBOCAN matched reference population. The PBO group SIR was numerically lower (0.48, 95% CI 0.14–1.53). There were no cases of haematological, lymphoproliferative or virus-induced cancers. There was no clustering of specific tumour types, and the incidence of skin cancer was not increased after treatment with CT3.5 versus PBO. The incidence of malignancies with CT3.5 was constant and did not increase over time.ConclusionAnalysis of malignancy rates in a cohort that includes patients with up to 8 years’ follow-up confirms the Conclusion of the earlier meta-analysis; the incidence of malignancies with CT3.5 is similar to a matched reference population.
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Cook S, Comi G, Giovannoni G, Rieckmann P, Sorensen PS, Vermersch P, Dangond F, King J, Hicking C. 039 Rates of lymphopenia in years 1–4 in patients with relapsing multiple sclerosis treated annually with cladribine tablets. J Neurol Psychiatry 2018. [DOI: 10.1136/jnnp-2018-anzan.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionThe CLARITY and CLARITY Extension studies demonstrated the efficacy of cladribine tablets in patients with relapsing multiple sclerosis. The most common adverse event was lymphopenia, consistent with the mechanism of action of cladribine tablets. Objective was to evaluate whether lymphopenia persists following annual treatment with cladribine tablets.MethodsLymphopenia by grade (NCI CTCAE v3.0) for patients randomised to cladribine tablets 3.5 mg/kg in CLARITY and re-randomised to cladribine tablets 3.5 mg/kg in CLARITY Extension (7 mg/kg cumulative dose over 4 years; n=186) are reported. Patients with Grade 0 lymphopenia (≥1.0×109 cells/L) before the first course of cladribine tablets and Grade 0/1 (≥0.8×109 cells/L) prior to administration in Years 2, 3 and 4 were included in the analysis.Results176 patients were Grade 0 at CLARITY baseline and 167 were Grade 0/1 at CLARITY Extension baseline. Grade 3 lymphopenia was observed in 1% of patients at Week 13 in Year 1, and in 7%, 11% and 12% at Week 12 in Years 2, 3 and 4, respectively. By Week 24 in Years 1, 2, 3 and 4, Grade 3 lymphopenia was observed in 1%, 4%, 4% and 4% of patients, respectively. By Week 36 in Years 1, 2, 3 and 4, Grade 3 lymphopenia was observed in 1%, 2%, 2% and 2% of patients, respectively. Grade 3 lymphopenia was only observed in Week 48 of Year 2 (1% of patients). Grade 3 lymphopenia was reported in <18% of patients at any time point. No patients had Grade 4 lymphopenia at the end of any years.ConclusionNo patients included in this analysis experienced Grade 4 lymphopenia at the end of any treatment year. Grade 3 lymphopenia was uncommon. This study demonstrates the effectiveness of lymphocyte-based treatment criteria in minimising the incidence of severe, sustained lymphopenia during treatment with cladribine tablets.
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Nghiem P, Bhatia S, Brohl AS, Hamid O, Mehnert JM, Terheyden P, Shih KC, Brownell I, Lebbé C, Lewis KD, Linette GP, Milella M, Hennessy M, Bajars M, Hicking C, D'Angelo SP. Two-year efficacy and safety update from JAVELIN Merkel 200 part A: A registrational study of avelumab in metastatic Merkel cell carcinoma progressed on chemotherapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9507] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paul Nghiem
- University of Washington Medical Center at South Lake Union, Seattle, WA
| | | | | | - Omid Hamid
- The Angeles Clinic and Research Institute, Los Angeles, CA
| | | | | | - Kent C. Shih
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | - Celeste Lebbé
- APHP CIC and Dermatology Departments University Paris Diderot, Paris, France
| | - Karl D. Lewis
- University of Colorado Denver School of Medicine, Aurora, CO
| | | | | | | | | | | | - Sandra P. D'Angelo
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Tsimberidou AM, Verschraegen CF, Weise AM, Sarantopoulos J, Lopes G, Nemunaitis JJ, Hicking C, Shaw J, Kaleta R, Kurzrock R. Precision oncology: Results of a phase I study of M2698, a p70S6K/AKT targeted agent in patients with advanced cancer and tumor PI3K/AKT/mTOR (PAM) pathway abnormalities. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Claire F. Verschraegen
- Division of Medical Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - John Sarantopoulos
- Institute for Drug Development, Mays Cancer Center at University of Texas Health San Antonio, San Antonio, TX
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, FL
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Giovannoni G, Soelberg Sorensen P, Cook S, Rammohan KW, Rieckmann P, Comi G, Dangond F, Hicking C, Vermersch P. Efficacy of Cladribine Tablets in high disease activity subgroups of patients with relapsing multiple sclerosis: A post hoc analysis of the CLARITY study. Mult Scler 2018; 25:819-827. [PMID: 29716436 PMCID: PMC6460686 DOI: 10.1177/1352458518771875] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Indexed: 02/06/2023]
Abstract
Background: In the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study, Cladribine Tablets significantly improved clinical and magnetic resonance imaging (MRI) outcomes (vs placebo) in patients with relapsing-remitting multiple sclerosis. Objective: Describe two clinically relevant definitions for patients with high disease activity (HDA) at baseline of the CLARITY study (utility verified in patients receiving placebo) and assess the treatment effects of Cladribine Tablets 3.5 mg/kg compared with the overall study population. Methods: Outcomes of patients randomised to Cladribine Tablets 3.5 mg/kg or placebo were analysed for subgroups using HDA definitions based on high relapse activity (HRA; patients with ⩾2 relapses during the year prior to study entry, whether on DMD treatment or not) or HRA plus disease activity on treatment (HRA + DAT; patients with ⩾2 relapses during the year prior to study entry, whether on DMD treatment or not, PLUS patients with ⩾1 relapse during the year prior to study entry while on therapy with other DMDs and ⩾1 T1 Gd+ or ⩾9 T2 lesions). Results: In the overall population, Cladribine Tablets 3.5 mg/kg reduced the risk of 6-month-confirmed Expanded Disability Status Scale (EDSS) worsening by 47% vs placebo. A risk reduction of 82% vs placebo was seen in both the HRA and HRA + DAT subgroups (vs 19% for non-HRA and 18% for non-HRA + DAT), indicating greater responsiveness to Cladribine Tablets 3.5 mg/kg in patients with HDA. There were consistent results for other efficacy endpoints. The safety profile in HDA patients was consistent with the overall CLARITY population. Conclusion: Patients with HDA showed clinical and MRI responses to Cladribine Tablets 3.5 mg/kg that were generally better than, or at least comparable with, the outcomes seen in the overall CLARITY population.
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Affiliation(s)
- Gavin Giovannoni
- Department of Neurology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Per Soelberg Sorensen
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stuart Cook
- Department of Neurology & Neurosciences, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Kottil W Rammohan
- MS Research Center, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Peter Rieckmann
- Department of Neurology, Hospital for Nervous Diseases, Medical Park Loipl, Bischofswiesen, Germany/University of Erlangen-Nürnberg, Erlangen, Germany
| | - Giancarlo Comi
- Department of Neurology, Università Vita-Salute San Raffaele and Institute of Experimental Neurology, Ospedale San Raffaele, Milan, Italy
| | | | | | - Patrick Vermersch
- University of Lille, CHU Lille, LIRIC-INSERM U995, FHU Imminent, Lille, France
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Cook S, Vermersch P, Dangond F, Hicking C. Taux de lymphopénie année par année chez des patients atteints d’une forme récurrente de la sclérose en plaques traités et retraités par cladribine comprimés à la dose de 3,5 mg/kg. Rev Neurol (Paris) 2018. [DOI: 10.1016/j.neurol.2018.01.209] [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: 10/17/2022]
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Soelberg-Sorensen P, Dangond F, Hicking C, Giovannoni G. Numération des cellules immunitaires innées chez les patients atteints de sclérose en plaques récurrente-rémittente (SEP-RR) traités par cladribine comprimés à la dose de 3,5 mg/kg dans les études CLARITY/CLARITY Extension. Rev Neurol (Paris) 2018. [DOI: 10.1016/j.neurol.2018.01.217] [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: 10/17/2022]
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Weller M, Nabors LB, Gorlia T, Leske H, Rushing E, Bady P, Hicking C, Perry J, Hong YK, Roth P, Wick W, Goodman SL, Hegi ME, Picard M, Moch H, Straub J, Stupp R. Cilengitide in newly diagnosed glioblastoma: biomarker expression and outcome. Oncotarget 2017; 7:15018-32. [PMID: 26918452 PMCID: PMC4924768 DOI: 10.18632/oncotarget.7588] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 01/03/2016] [Accepted: 01/29/2016] [Indexed: 11/25/2022] Open
Abstract
Integrins αvβ3 and αvβ5 regulate angiogenesis and invasiveness in cancer, potentially by modulating activation of the transforming growth factor (TGF)-β pathway. The randomized phase III CENTRIC and phase II CORE trials explored the integrin inhibitor cilengitide in patients with newly diagnosed glioblastoma with versus without O6-methylguanine DNA methyltransferase (MGMT) promoter methylation. These trials failed to meet their primary endpoints. Immunohistochemistry was used to assess the levels of the target integrins of cilengitide, αvβ3 and αvβ5 integrins, of αvβ8 and of their putative target, phosphorylation of SMAD2, in tumor tissues from CENTRIC (n=274) and CORE (n=224). αvβ3 and αvβ5 expression correlated well in tumor and endothelial cells, but showed little association with αvβ8 or pSMAD2 levels. In CENTRIC, there was no interaction between the biomarkers and treatment for prediction of outcome. In CORE, higher αvβ3 levels in tumor cells were associated with improved progression-free survival by central review and with improved overall survival in patients treated with cilengitide. Integrins αvβ3, αvβ5 and αvβ8 are differentially expressed in glioblastoma. Integrin levels do not correlate with the activation level of the canonical TGF-β pathway. αvβ3 integrin expression may predict benefit from integrin inhibition in patients with glioblastoma lacking MGMT promoter methylation.
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Affiliation(s)
- Michael Weller
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Henning Leske
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Elisabeth Rushing
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Pierre Bady
- Department of Education and Research, University of Lausanne, Lausanne, Switzerland.,SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Christine Hicking
- Department of Translational and Biomarkers Research, Oncology, Merck KGaA, Darmstadt, Germany
| | - James Perry
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yong-Kil Hong
- The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit (CCU) Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon L Goodman
- Department of Translational and Biomarkers Research, Oncology, Merck KGaA, Darmstadt, Germany
| | - Monika E Hegi
- Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Martin Picard
- Department of Translational and Biomarkers Research, Oncology, Merck KGaA, Darmstadt, Germany
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Josef Straub
- Department of Translational and Biomarkers Research, Oncology, Merck KGaA, Darmstadt, Germany
| | - Roger Stupp
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
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Giovannoni G, Comi G, Cook S, Rammohan K, Rieckmann P, Soelberg-Sorensen P, Vermersch P, Hicking C, Adeniji A, Dangond F. PO136 Durable efficacy of cladribine tablets: clarity+extension. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Soelberg-Sorensen P, Dangond F, Hicking C, Giovannoni G. PO135 Cladribine tablets in rrms: lymphocyte counts. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Giovannoni G, Rammohan K, Cook S, Comi G, Rieckmann P, Soelberg-Sorensen P, Vermersch P, Dangond F, Hicking C. PO137 Efficacy of cladribine tablets in high disease activity rms. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Giovannoni G, Rammohan K, Cook S, Comi G, Rieckmann P, Soelberg-Sorensen P, Vermersch P, Dangond F, Hicking C. PO138 High disease activity in relapsing multiple sclerosis (rms). J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.168] [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: 11/04/2022]
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Cook S, Leist T, Comi G, Montalban X, Sylvester E, Hicking C, Dangond F. PO139 Integrated safety analysis; cladribine in multiple sclerosis (ms). J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.169] [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: 11/04/2022]
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De Stefano N, Giorgio A, Battaglini M, De Leucio A, Hicking C, Dangond F, Giovannoni G, Sormani MP. Reduced brain atrophy rates are associated with lower risk of disability progression in patients with relapsing multiple sclerosis treated with cladribine tablets. Mult Scler 2017; 24:222-226. [PMID: 28140753 PMCID: PMC5818021 DOI: 10.1177/1352458517690269] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Neuroimaging studies have used magnetic resonance imaging-derived methods to assess brain volume loss in multiple sclerosis (MS) as a reliable measure of diffuse tissue damage. METHODS In the CLARITY study ( ClinicalTrials.gov NCT00213135), the effect of 2 years' treatment with cladribine tablets on annualized percentage brain volume change (PBVC/y) was evaluated in patients with relapsing MS (RMS). RESULTS Compared with placebo (-0.70% ± 0.79), PBVC/y was reduced in patients treated with cladribine tablets 3.5 mg/kg (-0.56% ± 0.68, p = 0.010) and 5.25 mg/kg (-0.57% ± 0.72, p = 0.019). After adjusting for treatment group, PBVC/y showed a significant correlation with the cumulative probability of disability progression (HR = 0.67, 95% CI = 0.571, 0.787; p < 0.001), with patients with lower PBVC/y showing the highest probability of remaining free from disability progression at 2 years and vice versa. CONCLUSIONS Cladribine tablets given annually for 2 years in short-duration courses in patients with RMS in the CLARITY study significantly reduced brain atrophy in comparison with placebo treatment, with residual rates in treated patients being close to the physiological rates.
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Affiliation(s)
- Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alessandro De Leucio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Fernando Dangond
- Global Clinical Development, EMD Serono, Inc., Billerica, MA, USA
| | - Gavin Giovannoni
- Department of Neurology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
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Vansteenkiste J, Barlesi F, Waller CF, Bennouna J, Gridelli C, Goekkurt E, Verhoeven D, Szczesna A, Feurer M, Milanowski J, Germonpre P, Lena H, Atanackovic D, Krzakowski M, Hicking C, Straub J, Picard M, Schuette W, O'Byrne K. Cilengitide combined with cetuximab and platinum-based chemotherapy as first-line treatment in advanced non-small-cell lung cancer (NSCLC) patients: results of an open-label, randomized, controlled phase II study (CERTO). Ann Oncol 2015; 26:1734-40. [PMID: 25939894 DOI: 10.1093/annonc/mdv219] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 01/16/2015] [Accepted: 04/28/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This multicentre, open-label, randomized, controlled phase II study evaluated cilengitide in combination with cetuximab and platinum-based chemotherapy, compared with cetuximab and chemotherapy alone, as first-line treatment of patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Patients were randomized 1:1:1 to receive cetuximab plus platinum-based chemotherapy alone (control), or combined with cilengitide 2000 mg 1×/week i.v. (CIL-once) or 2×/week i.v. (CIL-twice). A protocol amendment limited enrolment to patients with epidermal growth factor receptor (EGFR) histoscore ≥200 and closed the CIL-twice arm for practical feasibility issues. Primary end point was progression-free survival (PFS; independent read); secondary end points included overall survival (OS), safety, and biomarker analyses. A comparison between the CIL-once and control arms is reported, both for the total cohorts, as well as for patients with EGFR histoscore ≥200. RESULTS There were 85 patients in the CIL-once group and 84 in the control group. The PFS (independent read) was 6.2 versus 5.0 months for CIL-once versus control [hazard ratio (HR) 0.72; P = 0.085]; for patients with EGFR histoscore ≥200, PFS was 6.8 versus 5.6 months, respectively (HR 0.57; P = 0.0446). Median OS was 13.6 for CIL-once versus 9.7 months for control (HR 0.81; P = 0.265). In patients with EGFR ≥200, OS was 13.2 versus 11.8 months, respectively (HR 0.95; P = 0.855). No major differences in adverse events between CIL-once and control were reported; nausea (59% versus 56%, respectively) and neutropenia (54% versus 46%, respectively) were the most frequent. There was no increased incidence of thromboembolic events or haemorrhage in cilengitide-treated patients. αvβ3 and αvβ5 expression was neither a predictive nor a prognostic indicator. CONCLUSIONS The addition of cilengitide to cetuximab/chemotherapy indicated potential clinical activity, with a trend for PFS difference in the independent-read analysis. However, the observed inconsistencies across end points suggest additional investigations are required to substantiate a potential role of other integrin inhibitors in NSCLC treatment. CLINICAL TRIAL REGISTRATION ID NUMBER NCT00842712.
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Affiliation(s)
- J Vansteenkiste
- Respiratory Oncology Unit, Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - F Barlesi
- Multidisciplinary Oncology and Therapeutic Innovations, Aix Marseille University-Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - C F Waller
- Haematology, Oncology and Stem Cell Transplantation, University Hospital of Freiburg, Freiburg, Germany
| | - J Bennouna
- Département d'Oncologie Médicale, Centre Rene Gauducheau, Saint-Herblain Cedex, France
| | - C Gridelli
- Division of Medical Oncology, Azienda Ospedaliera 'S.G. Moscati', Avellino, Italy
| | - E Goekkurt
- Department of Oncology, Hematology, Stem Cell Transplantation and Hemostaseology, University Hospital Aachen, Aachen, Germany
| | - D Verhoeven
- Iridium Cancer Network, Medical Oncology, AZ Klina, Antwerp, Belgium
| | - A Szczesna
- Mazowieckie Centrum Leczenia Chorób Pluc i Gruźlicy, Otwock, Poland
| | - M Feurer
- Lungenpraxis Munich, Munich, Germany
| | - J Milanowski
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - P Germonpre
- Pulmonary Medicine, AZ Maria Middelares, Ghent, Belgium
| | - H Lena
- Pneumology, CHU Rennes, Rennes, France
| | - D Atanackovic
- Oncology/Hematology/Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Krzakowski
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Lung and Thoracic Tumours, Warsaw, Poland
| | | | | | | | - W Schuette
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle, Germany
| | - K O'Byrne
- Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
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30
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Nabors LB, Fink KL, Mikkelsen T, Grujicic D, Tarnawski R, Nam DH, Mazurkiewicz M, Salacz M, Ashby L, Zagonel V, Depenni R, Perry JR, Hicking C, Picard M, Hegi ME, Lhermitte B, Reardon DA. Two cilengitide regimens in combination with standard treatment for patients with newly diagnosed glioblastoma and unmethylated MGMT gene promoter: results of the open-label, controlled, randomized phase II CORE study. Neuro Oncol 2015; 17:708-17. [PMID: 25762461 DOI: 10.1093/neuonc/nou356] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [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: 09/30/2014] [Accepted: 12/12/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Survival outcomes for patients with glioblastoma remain poor, particularly for patients with unmethylated O(6)-methylguanine-DNA methyltransferase (MGMT) gene promoter. This phase II, randomized, open-label, multicenter trial investigated the efficacy and safety of 2 dose regimens of the selective integrin inhibitor cilengitide combined with standard chemoradiotherapy in patients with newly diagnosed glioblastoma and an unmethylated MGMT promoter. METHODS Overall, 265 patients were randomized (1:1:1) to standard cilengitide (2000 mg 2×/wk; n = 88), intensive cilengitide (2000 mg 5×/wk during wk 1-6, thereafter 2×/wk; n = 88), or a control arm (chemoradiotherapy alone; n = 89). Cilengitide was administered intravenously in combination with daily temozolomide (TMZ) and concomitant radiotherapy (RT; wk 1-6), followed by TMZ maintenance therapy (TMZ/RT→TMZ). The primary endpoint was overall survival; secondary endpoints included progression-free survival, pharmacokinetics, and safety and tolerability. RESULTS Median overall survival was 16.3 months in the standard cilengitide arm (hazard ratio [HR], 0.686; 95% CI: 0.484, 0.972; P = .032) and 14.5 months in the intensive cilengitide arm (HR, 0.858; 95% CI: 0.612, 1.204; P = .3771) versus 13.4 months in the control arm. Median progression-free survival assessed per independent review committee was 5.6 months (HR, 0.822; 95% CI: 0.595, 1.134) and 5.9 months (HR, 0.794; 95% CI: 0.575, 1.096) in the standard and intensive cilengitide arms, respectively, versus 4.1 months in the control arm. Cilengitide was well tolerated. CONCLUSIONS Standard and intensive cilengitide dose regimens were well tolerated in combination with TMZ/RT→TMZ. Inconsistent overall survival and progression-free survival outcomes and a limited sample size did not allow firm conclusions regarding clinical efficacy in this exploratory phase II study.
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Affiliation(s)
- L Burt Nabors
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Karen L Fink
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Tom Mikkelsen
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Danica Grujicic
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Rafal Tarnawski
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Do Hyun Nam
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Maria Mazurkiewicz
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Michael Salacz
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Lynn Ashby
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Vittorina Zagonel
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Roberta Depenni
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - James R Perry
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Christine Hicking
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Martin Picard
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Monika E Hegi
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - Benoit Lhermitte
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
| | - David A Reardon
- University of Alabama at Birmingham, Birmingham, Alabama (L.B.N.); Baylor University Medical Center, Dallas, Texas (K.L.F.); Henry Ford Hospital, Detroit, Michigan (T.M.); Clinic for Neurosurgery, Clinical Center of Serbia, Medical Faculty University of Belgrade, Belgrade, Serbia (D.G.); Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland (R.T.); Samsung Medical Center, Seoul, South Korea (D.H.N.); Centrum Onkologii Ziemi Lubelskiej, Lublin, Poland (M.M.); St. Luke's Brain Tumor Center, St. Luke's Hospital, Kansas City, Missouri (M.S.); Barrow Neurological Institute, Phoenix, Arizona (L.A.); Medical Oncology Unit 1, IOV, IRCCS, Padova, Italy (V.Z.); Policlinico di Modena, Modena, Italy (R.D.); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.R.P.); Merck KGaA, Darmstadt, Germany (C.H., M.P.); Department of Clinical Neurosciences, University Hospital Lausanne, Lausanne, Switzerland (M.E.H.); Institute of Pathology, University Hospital Lausanne, Lausanne, Switzerland (B.L.); Dana-Farber Cancer Institute, Boston, Massachusetts (D.A.R.)
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Stupp R, Hegi ME, Gorlia T, Erridge SC, Perry J, Hong YK, Aldape KD, Lhermitte B, Pietsch T, Grujicic D, Steinbach JP, Wick W, Tarnawski R, Nam DH, Hau P, Weyerbrock A, Taphoorn MJB, Shen CC, Rao N, Thurzo L, Herrlinger U, Gupta T, Kortmann RD, Adamska K, McBain C, Brandes AA, Tonn JC, Schnell O, Wiegel T, Kim CY, Nabors LB, Reardon DA, van den Bent MJ, Hicking C, Markivskyy A, Picard M, Weller M. Cilengitide combined with standard treatment for patients with newly diagnosed glioblastoma with methylated MGMT promoter (CENTRIC EORTC 26071-22072 study): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol 2014; 15:1100-8. [PMID: 25163906 DOI: 10.1016/s1470-2045(14)70379-1] [Citation(s) in RCA: 700] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Cilengitide is a selective αvβ3 and αvβ5 integrin inhibitor. Data from phase 2 trials suggest that it has antitumour activity as a single agent in recurrent glioblastoma and in combination with standard temozolomide chemoradiotherapy in newly diagnosed glioblastoma (particularly in tumours with methylated MGMT promoter). We aimed to assess cilengitide combined with temozolomide chemoradiotherapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter. METHODS In this multicentre, open-label, phase 3 study, we investigated the efficacy of cilengitide in patients from 146 study sites in 25 countries. Eligible patients (newly diagnosed, histologically proven supratentorial glioblastoma, methylated MGMT promoter, and age ≥18 years) were stratified for prognostic Radiation Therapy Oncology Group recursive partitioning analysis class and geographic region and centrally randomised in a 1:1 ratio with interactive voice response system to receive temozolomide chemoradiotherapy with cilengitide 2000 mg intravenously twice weekly (cilengitide group) or temozolomide chemoradiotherapy alone (control group). Patients and investigators were unmasked to treatment allocation. Maintenance temozolomide was given for up to six cycles, and cilengitide was given for up to 18 months or until disease progression or unacceptable toxic effects. The primary endpoint was overall survival. We analysed survival outcomes by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00689221. FINDINGS Overall, 3471 patients were screened. Of these patients, 3060 had tumour MGMT status tested; 926 patients had a methylated MGMT promoter, and 545 were randomly assigned to the cilengitide (n=272) or control groups (n=273) between Oct 31, 2008, and May 12, 2011. Median overall survival was 26·3 months (95% CI 23·8-28·8) in the cilengitide group and 26·3 months (23·9-34·7) in the control group (hazard ratio 1·02, 95% CI 0·81-1·29, p=0·86). None of the predefined clinical subgroups showed a benefit from cilengitide. We noted no overall additional toxic effects with cilengitide treatment. The most commonly reported adverse events of grade 3 or worse in the safety population were lymphopenia (31 [12%] in the cilengitide group vs 26 [10%] in the control group), thrombocytopenia (28 [11%] vs 46 [18%]), neutropenia (19 [7%] vs 24 [9%]), leucopenia (18 [7%] vs 20 [8%]), and convulsion (14 [5%] vs 15 [6%]). INTERPRETATION The addition of cilengitide to temozolomide chemoradiotherapy did not improve outcomes; cilengitide will not be further developed as an anticancer drug. Nevertheless, integrins remain a potential treatment target for glioblastoma. FUNDING Merck KGaA, Darmstadt, Germany.
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Affiliation(s)
- Roger Stupp
- UniversitätsSpital Zürich, Zurich, Switzerland; Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
| | - Monika E Hegi
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | - Sara C Erridge
- Edinburgh Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - James Perry
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yong-Kil Hong
- The Catholic University of Korea, Seoul St Mary's Hospital, Seoul, South Korea
| | - Kenneth D Aldape
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benoit Lhermitte
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Torsten Pietsch
- Department of Neuropathology, Universität Bonn, Bonn, Germany
| | - Danica Grujicic
- Clinic for Neurosurgery, Clinical Center Serbia and Medical Faculty University of Belgrade, Belgrade, Serbia
| | | | - Wolfgang Wick
- Heidelberg University Medical Center & German Cancer Research Center, Heidelberg, Germany
| | - Rafał Tarnawski
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Do-Hyun Nam
- Samsung Medical Center, Sungkyunkwan Univ School of Medicine, Seoul, South Korea
| | - Peter Hau
- Universitätsklinikum Regensburg, Regensburg, Germany
| | | | | | | | - Nalini Rao
- Bangalore Institute of Oncology, Bangalore, India
| | | | | | | | | | | | | | - Alba A Brandes
- Bellaria-Maggiore Hospital, AUSL-IRCCS Institute of Neurological Sciences-Bologna, Italy
| | | | | | | | - Chae-Yong Kim
- Seoul National University Bundang Hospital, SNU College of Medicine, Seoul, South Korea
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Vansteenkiste J, Barlesi F, Waller C, Bennouna J, Gridelli C, Goekkurt E, Verhoeven D, Szczesna A, Feurer M, Milanowski J, Germonpre P, Lena H, Atanackovic D, Krzakowski M, Hicking C, Straub J, Picard M, Schuette W, Byrne KO. Cilengitide (Cil) Combined with Cetuximab and Platinum-Based Chemotherapy As First-Line Treatment in Advanced Non-Small Cell Lung Cancer (Nsclc) Patients (Pts): Phase Ii Randomised Certo Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.14] [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: 11/13/2022] Open
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Vermorken JB, Peyrade F, Krauss J, Mesía R, Remenar E, Gauler TC, Keilholz U, Delord JP, Schafhausen P, Erfán J, Brümmendorf TH, Iglesias L, Bethe U, Hicking C, Clement PM. Cisplatin, 5-fluorouracil, and cetuximab (PFE) with or without cilengitide in recurrent/metastatic squamous cell carcinoma of the head and neck: results of the randomized phase I/II ADVANTAGE trial (phase II part). Ann Oncol 2014; 25:682-688. [PMID: 24567516 PMCID: PMC3933250 DOI: 10.1093/annonc/mdu003] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 12/23/2013] [Accepted: 12/31/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recurrent and/or metastatic squamous cell carcinoma of the head and neck (R/M-SCCHN) overexpresses αvβ5 integrin. Cilengitide selectively inhibits αvβ3 and αvβ5 integrins and is investigated as a treatment strategy. PATIENTS AND METHODS The phase I/II study ADVANTAGE evaluated cilengitide combined with cisplatin, 5-fluorouracil, and cetuximab (PFE) in R/M-SCCHN. The phase II part reported here was an open-label, randomized, controlled trial investigating progression-free survival (PFS). Patients received up to six cycles of PFE alone or combined with cilengitide 2000 mg once (CIL1W) or twice (CIL2W) weekly. Thereafter, patients received maintenance therapy (cilengitide arms: cilengitide plus cetuximab; PFE-alone arm: cetuximab only) until disease progression or unacceptable toxicity. RESULTS One hundred and eighty-two patients were treated. Median PFS per investigator read was similar for CIL1W + PFE, CIL2W + PFE, and PFE alone (6.4, 5.6, and 5.7 months, respectively). Accordingly, median overall survival and objective response rates were not improved with cilengitide (12.4 months/47%, 10.6 months/27%, and 11.6 months/36%, respectively). No clinically meaningful safety differences were observed between groups. None of the tested biomarkers (expression of integrins, CD31, Ki-67, vascular endothelial growth factor receptor 2, vascular endothelial-cadherin, type IV collagen, epidermal growth factor receptor, or p16 for human papillomavirus) were predictive of outcome. CONCLUSION Neither of the cilengitide-containing regimens demonstrated a PFS benefit over PFE alone in R/M-SCCHN patients.
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Affiliation(s)
- J B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium.
| | - F Peyrade
- Medical Oncology Service, Center Antoine Lacassagne, Nice, France
| | - J Krauss
- Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - R Mesía
- Medical Oncology Service, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Remenar
- Head and Neck Surgery, National Oncology Institute, Budapest, Hungary
| | - T C Gauler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen
| | - U Keilholz
- Department of Hematology and Medical Oncology, Charité Campus Benjamin Franklin, Berlin, Germany
| | - J P Delord
- Clinical Research Unit, Institute Claudius Regaud, Toulouse, France
| | - P Schafhausen
- II Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Erfán
- Onco-radiology, Jósa András Teaching Hospital, Nyíregyháza, Hungary
| | - T H Brümmendorf
- Department of Hematology and Oncology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - L Iglesias
- Lung and Head and Neck Cancer Unit, Hospital 12 de Octubre, Madrid, Spain
| | - U Bethe
- Merck KGaA, Darmstadt, Germany
| | | | - P M Clement
- Department of Oncology, KU Leuven, Leuven, Belgium
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Stupp R, Hegi ME, Gorlia T, Erridge S, Grujicic D, Steinbach JP, Wick W, Tarnawski R, Nam DH, Weyerbrock A, Hau P, Taphoorn MJB, Nabors LB, Reardon DA, Van Den Bent MJ, Perry JR, Hong YK, Hicking C, Picard M, Weller M. Cilengitide combined with standard treatment for patients with newly diagnosed glioblastoma and methylated O6-methylguanine-DNA methyltransferase (MGMT) gene promoter: Key results of the multicenter, randomized, open-label, controlled, phase III CENTRIC study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.18_suppl.lba2009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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
LBA2009 Background: Cilengitide (CIL) is a selective αvβ3 and αvβ5 integrin inhibitor. In a phase II study in patients with newly diagnosed glioblastoma, CIL added to standard temozolomide (TMZ) and radiotherapy (RT) was well tolerated and appeared to confer improved survival in patients with glioblastoma and methylated MGMT gene promoter (Stupp et al. J Clin Oncol. 2010;28:2712-8). Methods: This multicenter, randomized, controlled, open-label, phase III study randomized (1:1) patients (≥ 18 years) with newly diagnosed, histologically proven supratentorial glioblastoma (WHO Grade IV) and centrally determined MGMT gene promoter methylation. Treatment consisted of CIL 2000 mg twice weekly i.v. plus standard TMZ/RT→TMZ (concomitant and adjuvant temozolomide and radiotherapy; Stupp et al. N Engl J Med. 2005;352:987-96) or standard TMZ/RT→TMZ alone. CIL was to be administered for ≥ 18 months, or until disease progression or unacceptable toxicity. Primary endpoint was overall survival (OS); secondary endpoints included progression-free survival (PFS) per investigator read and safety. Results: 272 patients received CIL plus TMZ/RT→TMZ, and 273 were treated with TMZ/RT→TMZ alone (intention-to-treat population). 54% and 52% of patients were male, and 42% and 44% had ECOG-PS ≥ 1, respectively. 75% of patients of both arms were ≥ 50 years old. Overall, baseline characteristics were well balanced across treatment arms. Median OS was 26.3 months in both arms (Hazard Ratio [HR] = 1.02 [95%CI: 0.81-1.29], p = 0.86). Median PFS per investigator read was 13.5 months in the CIL arm and 10.7 months in the control arm (HR = 0.93 [95%CI: 0.76-1.14], p = 0.48). Treatment was generally well tolerated and the known safety profile of CIL was confirmed. Conclusions: CIL failed to prolong PFS or OS in patients with newly diagnosed glioblastoma and methylated MGMT gene promoter. The previously reported safety profile of CIL in addition to standard therapy was confirmed. Clinical trial information: NCT00689221.
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Affiliation(s)
- Roger Stupp
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Monika E. Hegi
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Sara Erridge
- Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - Danica Grujicic
- Institute for Neurosurgery, Clinical Center Serbia, Belgrade, Serbia
| | - Joachim Peter Steinbach
- Klinikum der J.W. Goethe Universität Frankfurt, Dr. Senkenbergisches Institut für Neuroonkologie, Frankfurt, Germany
| | - Wolfgang Wick
- Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Rafal Tarnawski
- Maria Sklodowska-Curie Memorial Cancer-Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland
| | | | - Astrid Weyerbrock
- Universitätsklinikum Freiburg, Allgemeine Neurochirurgie, Freiburg, Germany
| | - Peter Hau
- Universitätsklinikum Regensburg, Neurologie und Wilhelm Sander-Therapieeinheit NeuroOnkologie, Regensburg, Germany
| | | | | | | | | | | | - Yong Kil Hong
- Catholic University of Korea, Seoul St Marys Hospital, Seoul, South Korea
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Stupp R, Hegi ME, Gorlia T, Erridge S, Grujicic D, Steinbach JP, Wick W, Tarnawski R, Nam DH, Weyerbrock A, Hau P, Taphoorn MJB, Nabors LB, Reardon DA, Van Den Bent MJ, Perry JR, Hong YK, Hicking C, Picard M, Weller M. Cilengitide combined with standard treatment for patients with newly diagnosed glioblastoma with O6-methylguanine-DNA methyltransferase ( MGMT) promoter methylation: Final results of the multicenter, randomized, open-label, controlled, phase III CENTRIC study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.lba2009] [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
LBA2009 The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Sunday, June, 2, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Sunday edition of ASCO Daily News.
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Affiliation(s)
- Roger Stupp
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Monika E. Hegi
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Sara Erridge
- Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - Danica Grujicic
- Institute for Neurosurgery, Clinical Center Serbia, Belgrade, Serbia
| | - Joachim Peter Steinbach
- Klinikum der J.W. Goethe Universität Frankfurt, Dr. Senkenbergisches Institut für Neuroonkologie, Frankfurt, Germany
| | - Wolfgang Wick
- Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Rafal Tarnawski
- Maria Sklodowska-Curie Memorial Cancer-Center and Institute of Oncology Gliwice Branch, Radiotherapy and Chemotherapy Clinic, Gliwice, Poland
| | | | - Astrid Weyerbrock
- Universitätsklinikum Freiburg, Allgemeine Neurochirurgie, Freiburg, Germany
| | - Peter Hau
- Universitätsklinikum Regensburg, Neurologie und Wilhelm Sander-Therapieeinheit NeuroOnkologie, Regensburg, Germany
| | | | | | | | | | | | - Yong Kil Hong
- Catholic University of Korea, Seoul St Marys Hospital, Seoul, South Korea
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Clarke JL, Ennis MM, Lamborn KR, Prados MD, Puduvalli VK, Penas-Prado M, Gilbert MR, Groves MD, Hess KR, Levin VA, de Groot J, Colman H, Conrad CA, Loghin ME, Hunter K, Yung WK, Chen C, Damek D, Liu A, Gaspar LE, Waziri A, Lillehei K, Kavanagh B, Finlay JL, Haley K, Dhall G, Gardner S, Allen J, Cornelius A, Olshefski R, Garvin J, Pradhan K, Etzl M, Goldman S, Atlas M, Thompson S, Hirt A, Hukin J, Comito M, Bertolone S, Torkildson J, Joyce M, Moertel C, Letterio J, Kennedy G, Walter A, Ji L, Sposto R, Dorris K, Wagner L, Hummel T, Drissi R, Miles L, Leach J, Chow L, Turner R, Gragert MN, Pruitt D, Sutton M, Breneman J, Crone K, Fouladi M, Friday BB, Buckner J, Anderson SK, Giannini C, Kugler J, Mazurczac M, Flynn P, Gross H, Pajon E, Jaeckle K, Galanis E, Badruddoja MA, Pazzi MA, Stea B, Lefferts P, Contreras N, Bishop M, Seeger J, Carmody R, Rance N, Marsella M, Schroeder K, Sanan A, Swinnen LJ, Rankin C, Rushing EJ, Hutchins LF, Damek DM, Barger GR, Norden AD, Lesser G, Hammond SN, Drappatz J, Fadul CE, Batchelor TT, Quant EC, Beroukhim R, Ciampa A, Doherty L, LaFrankie D, Ruland S, Bochacki C, Phan P, Faroh E, McNamara B, David K, Rosenfeld MR, Wen PY, Hammond SN, Norden AD, Drappatz J, Phuphanich S, Reardon D, Wong ET, Plotkin SR, Lesser G, Mintz A, Raizer JJ, Batchelor TT, Quant EC, Beroukhim R, Kaley TJ, Ciampa A, Doherty L, LaFrankie D, Ruland S, Smith KH, Wen PY, Chamberlain MC, Graham C, Mrugala M, Johnston S, Kreisl TN, Smith P, Iwamoto F, Sul J, Butman JA, Fine HA, Westphal M, Heese O, Warmuth-Metz M, Pietsch T, Schlegel U, Tonn JC, Schramm J, Schackert G, Melms A, Mehdorn HM, Seifert V, Geletneky K, Reuter D, Bach F, Khasraw M, Abrey LE, Lassman AB, Hormigo A, Nolan C, Gavrilovic IT, Mellinghoff IK, Reiner AS, DeAngelis L, Omuro AM, Burzynski SR, Weaver RA, Janicki TJ, Burzynski GS, Szymkowski B, Acelar SS, Mechtler LL, O'Connor PC, Kroon HA, Vora T, Kurkure P, Arora B, Gupta T, Dhamankar V, Banavali S, Moiyadi A, Epari S, Merchant N, Jalali R, Moller S, Grunnet K, Hansen S, Schultz H, Holmberg M, Sorensen MM, Poulsen HS, Lassen U, Reardon DA, Vredenburgh JJ, Desjardins A, Janney DE, Peters K, Sampson J, Gururangan S, Friedman HS, Jeyapalan S, Constantinou M, Evans D, Elinzano H, O'Connor B, Puthawala MY, Goldman M, Oyelese A, Cielo D, Dipetrillo T, Safran H, Anan M, Seyed Sadr M, Alshami J, Sabau C, Seyed Sadr E, Siu V, Guiot MC, Samani A, Del Maestro R, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine VE, Parfenov VE, Poverennova IE, Hau P, Jachimczak P, Heinrichs H, Schlingensiepen KH, Shibui S, Kayama T, Wakabayashi T, Nishikawa R, de Groot M, Aronica E, Vecht CJ, Toering ST, Heimans JJ, Reijneveld JC, Batchelor T, Mulholland P, Neyns B, Nabors LB, Campone M, Wick A, Mason W, Mikkelsen T, Phuphanich S, Ashby LS, DeGroot JF, Gattamaneni HR, Cher LM, Rosenthal MA, Payer F, Xu J, Liu Q, van den Bent M, Nabors B, Fink K, Mikkelsen T, Chan M, Trusheim J, Raval S, Hicking C, Henslee-Downey J, Picard M, Reardon D, Kaley TJ, Wen PY, Schiff D, Karimi S, DeAngelis LM, Nolan CP, Omuro A, Gavrilovic I, Norden A, Drappatz J, Purow BW, Lieberman FS, Hariharan S, Abrey LE, Lassman AB, Perez-Larraya JG, Honnorat J, Chinot O, Catry-Thomas I, Taillandier L, Guillamo JS, Campello C, Monjour A, Tanguy ML, Delattre JY, Franz DN, Krueger DA, Care MM, Holland-Bouley K, Agricola K, Tudor C, Mangeshkar P, Byars AW, Sahmoud T, Alonso-Basanta M, Lustig RA, Dorsey JF, Lai RK, Recht LD, Reardon DA, Paleologos N, Groves M, Rosenfeld MR, Meech S, Davis T, Pavlov D, Marshall MA, Sampson J, Slot M, Peerdeman SM, Beauchesne PD, Faure G, Noel G, Schmitt T, Kerr C, Jadaud E, Martin L, Taillandier L, Carnin C, Desjardins A, Reardon DA, Peters KB, Herndon JE, Kirkpatrick JP, Friedman HS, Vredenburgh JJ, Nayak L, Panageas KS, Deangelis LM, Abrey LE, Lassman AB. Ongoing Clinical Trials. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s9] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Stupp R, Hegi ME, Neyns B, Goldbrunner R, Schlegel U, Clement PM, Grabenbauer GG, Ochsenbein AF, Simon M, Dietrich PY, Pietsch T, Hicking C, Tonn JC, Diserens AC, Pica A, Hermisson M, Krueger S, Picard M, Weller M. Phase I/IIa Study of Cilengitide and Temozolomide With Concomitant Radiotherapy Followed by Cilengitide and Temozolomide Maintenance Therapy in Patients With Newly Diagnosed Glioblastoma. J Clin Oncol 2010; 28:2712-8. [DOI: 10.1200/jco.2009.26.6650] [Citation(s) in RCA: 338] [Impact Index Per Article: 24.1] [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
Purpose Invasion and migration are key processes of glioblastoma and are tightly linked to tumor recurrence. Integrin inhibition using cilengitide has shown synergy with chemotherapy and radiotherapy in vitro and promising activity in recurrent glioblastoma. This multicenter, phase I/IIa study investigated the efficacy and safety of cilengitide in combination with standard chemoradiotherapy in newly diagnosed glioblastoma. Patients and Methods Patients (age ≥ 18 to ≤ 70 years) were treated with cilengitide (500 mg) administered twice weekly intravenously in addition to standard radiotherapy with concomitant and adjuvant temozolomide. Treatment was continued until disease progression or for up to 35 weeks. The primary end point was progression-free survival (PFS) at 6 months. Results Fifty-two patients (median age, 57 years; 62% male) were included. Six- and 12-month PFS rates were 69% (95% CI, 54% to 80%) and 33% (95% CI, 21% to 46%). Median PFS was 8 months (95% CI, 6.0 to 10.7 months). Twelve- and 24-month overall survival (OS) rates were 68% (95% CI, 53% to 79%) and 35% (95% CI, 22% to 48%). Median OS was 16.1 months (95% CI, 13.1 to 23.2 months). PFS and OS were longer in patients with tumors with O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation (13.4 and 23.2 months) versus those without MGMT promoter methylation (3.4 and 13.1 months). The combination of cilengitide with temozolomide and radiotherapy was well tolerated, with no additional toxicity. No pharmacokinetic interactions between temozolomide and cilengitide were identified. Conclusion Compared with historical controls, the addition of concomitant and adjuvant cilengitide to standard chemoradiotherapy demonstrated promising activity in patients with glioblastoma with MGMT promoter methylation.
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Affiliation(s)
- Roger Stupp
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Monika E. Hegi
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Bart Neyns
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Roland Goldbrunner
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Uwe Schlegel
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Paul M.J. Clement
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Gerhard G. Grabenbauer
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Adrian F. Ochsenbein
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Matthias Simon
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Pierre-Yves Dietrich
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Torsten Pietsch
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Christine Hicking
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Joerg-Christian Tonn
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Annie-Claire Diserens
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Alessia Pica
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Mirjam Hermisson
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Stefan Krueger
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Martin Picard
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
| | - Michael Weller
- From the Centre Pluridisciplinaire d'Oncologie, Department of Neurosurgery, Service de Radio-Oncologie, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne; Institute of Medical Oncology, University of Bern, Bern; Division d'Oncologie, Hôpitaux Universitaires de Genève, Geneva; Department of Neurology, University Hospital, Zurich, Switzerland; Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels; Department of Clinical Oncology, Katholieke Universiteit
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Nabors LB, Fink K, Reardon DA, Lesser GJ, Trusheim J, Raval SN, Hicking C, Picard M, Mikkelsen T. Cilengitide in patients with newly diagnosed glioblastoma multiforme and unmethylated MGMT gene promoter: Protocol of a multicenter, randomized, open-label, controlled phase II study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps151] [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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Fink K, Mikkelsen T, Nabors LB, Ravin P, Plotkin SR, Schiff D, Hicking C, Picard M, Reardon DA. Long-term effects of cilengitide, a novel integrin inhibitor, in recurrent glioblastoma: A randomized phase IIa study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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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Goetz CG, Laska E, Hicking C, Damier P, Müller T, Nutt J, Warren Olanow C, Rascol O, Russ H. Placebo influences on dyskinesia in Parkinson's disease. Mov Disord 2008; 23:700-7. [PMID: 18175337 DOI: 10.1002/mds.21897] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Clinical features that are prognostic indicators of placebo response among dyskinetic Parkinson's disease patients were determined. Placebo-associated improvements occur in Parkinsonism, but responses in dyskinesia have not been studied. Placebo data from two multicenter studies with identical design comparing sarizotan to placebo for treating dyskinesia were accessed. Sarizotan (2 mg/day) failed to improve dyskinesia compared with placebo, but both treatments improved dyskinesia compared with baseline. Stepwise regression identified baseline characteristics that influenced dyskinesia response to placebo, and these factors were entered into a logistic regression model to quantify their influence on placebo-related dyskinesia improvements and worsening. Because placebo-associated improvements in Parkinsonism have been attributed to heightened dopaminergic activity, we also examined the association between changes in Parkinsonism and dyskinesia. Four hundred eighty-four subjects received placebo treatment; 178 met criteria for placebo-associated dyskinesia improvement and 37 for dyskinesia worsening. Older age, lower baseline Parkinsonism score, and lower total daily levodopa doses were associated with placebo-associated improvement, whereas lower baseline dyskinesia score was associated with placebo-associated worsening. Placebo-associated dyskinesia changes were not correlated with Parkinsonism changes, and all effects in the sarizotan group were statistically explained by the placebo-effect regression model. Dyskinesias are affected by placebo treatment. The absence of correlation between placebo-induced changes in dyskinesia and Parkinsonism argues against a dopaminergic activation mechanism to explain placebo-associated improvements in dyskinesia. The magnitude and variance of placebo-related changes and the factors that influence them can be helpful in the design of future clinical trials of antidyskinetic agents.
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Goetz CG, Damier P, Hicking C, Laska E, Müller T, Olanow CW, Rascol O, Russ H. Sarizotan as a treatment for dyskinesias in Parkinson's disease: A double-blind placebo-controlled trial. Mov Disord 2007; 22:179-86. [PMID: 17094088 DOI: 10.1002/mds.21226] [Citation(s) in RCA: 211] [Impact Index Per Article: 12.4] [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: 11/07/2022] Open
Abstract
The objective of this study is to conduct a dose-finding study of sarizotan in Parkinson's disease (PD) patients with dyskinesia to identify a safe dose and to identify a sensitive dyskinesia rating measure. Sarizotan is a novel compound with full 5-HT(1A) agonist properties and additional high affinity for D(3) and D(4) receptors. An open label study documented improvements in PD patients with levodopa-induced dyskinesia. There is no precedent for study designs or outcome measures in pivotal trials of antidyskinesia therapies. The approach used here was a multicenter, randomized, placebo-controlled, double-blind, parallel study. Included were PD patients optimized to levodopa and dopaminergic drugs with moderately disabling dyskinesias present greater than or equal to 25% of the waking day. Interventions included sarizotan 2, 4, or 10 mg/day or matching placebo, given in two doses. There were two outcome measures: the primary measure was change from baseline in diary-based on time without dyskinesia; the secondary measures were change from baseline in scores on the Abnormal Involuntary Movement Scale (AIMS), the composite score of Unified Parkinson's Disease Rating Scale (UPDRS) Items 32+33 (dyskinesia duration and disability) and total UPDRS. A total of 398 subjects were randomized, with 381 included in the intention-to-treat population. No significant changes occurred on sarizotan compared to placebo on any diary-based measure of dyskinesia or the AIMS score. The composite score of UPDRS Items 32+33 was significantly improved with 2 mg/day sarizotan, with a trend at 10 mg/day. Adverse events were not significantly different in sarizotan- and placebo-treated patients, but off time significantly increased with sarizotan 10 mg/day. Sarizotan 2 mg/day is a safe agent in PD patients with dyskinesia. To test its role in abating dyskinesia, future studies should focus on this dose and will use the composite score of UPDRS Items 32+33 as the primary outcome.
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