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Makker V, Perez-Fidalgo JA, Bergamini A, Spitz DL, Van Gorp T, Sehouli J, Klat J, Perri T, Oza AM, Hogdall EVS, Konner JA, Guerra EM, Raspagliesi F, Henry S, Monk BJ, Martinez Garcia J, Slomovitz BM, Shacham S, Mirza MR, Vergote I. Randomized phase III study of maintenance selinexor versus placebo in endometrial cancer (ENGOT-EN5/GOG-3055/SIENDO): Impact of subgroup analysis and molecular classification. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5511 Background: Endometrial cancers (ECs) are stratified into four molecular categories: wild type TP53 with non-specific molecular profile typically with microsatellite stability (NSMP, p53wt/MSS), DNA polymerase ε exonuclease domain-mutated (POLEmut), microsatellite instability high (MSI) and TP53 abnormal (p53abn). These are associated with specific prognoses. Selinexor (SEL) is a specific XPO1 inhibitor that leads to the nuclear retention and activation of tumor suppressor proteins (TSP) including p53. SEL showed improved progression-free survival (PFS) over placebo (PLB) in the stratification adjusted results of the ENGOT-EN5/GOG-3055/SIENDO study (NCT03555422; ESMO 2022). Methods: The SIENDO study is a prospective, multicenter, double-blind, placebo-controlled, phase 3 study of SEL (80 mg once weekly) vs. PLB (2:1 randomization) as maintenance therapy in 263 patients (pts) with advanced or recurrent EC after one line of taxane-platinum therapy with partial or complete remission. TP53 mutations and MSI were assessed by centralized targeted sequencing and local immunohistochemistry. Classification was based on sequencing 648 genes on tumor samples from 172 pts (107 on SEL), assigned first by POLEmut, then MSI, then p53abn or p53wt (NSMP). Preliminary exploratory analyses based on molecular classification were prespecified in the trial. Results: The SIENDO study resulted in a median progression-free survival (PFS) of 5.7 months (SEL) vs. 3.8 months (PLB), with a stratification adjusted (eCRF) hazard ratio (HR) of 0.70 (p =.024; and a stratification non-adjusted (IRT) HR of 0.76 (p=0.063). Among the 172 patients who underwent molecular classification, those on SEL (107 pts) were classified as follows: 37 (35%) NSMP, 2 (2%) POLEmut, 18 (17%) MSI, and 50 (46%) p53abn. A similar distribution was seen in those on PLB (65 pts): 20 (31%) NSMP; 4 (6%) POLEmut; 8 (12%) MSI; 33 (51%) p53abn. Subgroup analysis of pts with TP53wt showed a PFS of 13.7 mo with SEL vs. 3.7 mo with PLB (HR 0.375; 95% CI, 0.210-0.670; nominal p =.0003) and pts with MSS/pMMR disease had a PFS of 6.9 mo with SEL vs. 5.4 with PLB (HR 0.593; 95% CI, 0.388-0.905, nominal p =.007). An analysis of patients with NSMP (p53wt, MSS) showed a substantial difference in PFS for SEL vs. PLB: medians NR and 3.71 months, respectively (HR 0.163; 95% CI, 0.060-0.444; nominal p <.0001). Analyses of the other 3 molecular categories did not show significant differences in PFS between SEL and PLB. Additional biomarker identification studies assessing tumor genetics and epigenetics are ongoing. Conclusions: SEL showed improved PFS over PLB in the SIENDO study based on the stratification adjusted analysis. As an indirect p53 activator, preliminary exploratory subgroup analyses of SEL showed improvement over PLB amongst the patients with TP53wt, MSS, and the NSMP EC comprising approximately 50% of patients with advanced/recurrent EC. Clinical trial information: NCT03555422.
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Affiliation(s)
- Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alice Bergamini
- MITO and Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milan, Italy
| | - Daniel Lewis Spitz
- Florida Cancer Specialists, Sarah Cannon Research Institute, Wellington, FL
| | - Toon Van Gorp
- Belgium and Luxembourg Gynaecological Oncology Group (BCOG), Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jalid Sehouli
- North-Eastern German Society of Gynaecological Oncology (NOGGO) and Department of Gynecology with Center for Oncological Surgery, Charité-University Medicine of Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Jaroslav Klat
- CEEGOG and University Hospital Ostrava, Ostrava Poruba, Czech Republic
| | - Tamar Perri
- ISGO and Sheba Medical Center, Ramat Gan, Israel
| | - Amit M. Oza
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Francesco Raspagliesi
- MITO and Fondazione IRCCS Istituto Nazionale dei Tumori– Milano, S.C. Ginecologia Oncologica, Milan, Italy
| | - Stephanie Henry
- BGOG and Université Catholique de Louvain, CHU UCL Namur Site Ste Elisabeth, Service d’Onco-hématologie (SORMN), Namur, Belgium
| | - Bradley J. Monk
- GOG Foundation, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
| | | | - Brian M. Slomovitz
- Division of Gynecologic Oncology, Mount Sinai Medical Center, Miami Beach, FL
| | | | | | - Ignace Vergote
- Belgium and Luxembourg Gynaecological Oncology Group (BGOG), Leuven Cancer Institute, and University Hospital Leuven, Leuven, Belgium
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Moore KN, Chambers SK, Hamilton EP, Chen LM, Oza AM, Ghamande SA, Konecny GE, Plaxe SC, Spitz DL, Geenen JJ, Troso-Sandoval TA, Cragun JM, Rodrigo Imedio E, Kumar S, Mugundu GM, Lai Z, Chmielecki J, Jones SF, Spigel DR, Cadoo KA. Adavosertib with chemotherapy (CT) in patients (pts) with platinum-resistant ovarian cancer (PPROC): An open label, four-arm, phase II study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5513] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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
5513 Background: Adavosertib (AZD1775; A), a highly selective WEE1 inhibitor, demonstrated activity and tolerability in combination with carboplatin (C) in primary PROC. This study (NCT02272790) assessed the objective response rate (ORR) and safety of A in PROC. Methods: Pts with recurrent RECIST v1.1 measurable PROC received A with C, gemcitabine (G), weekly paclitaxel (P), or pegylated liposomal doxorubicin (PLD) in 3- (C) or 4-week (G, P, PLD) cycles (Table). Tumor assessments were performed every 2 cycles until disease progression. Primary objective: ORR; other objectives: disease control rate (DCR), progression-free survival (PFS) and safety. Results: In the 94 pts treated (median treatment duration 3 months; range 0–16 months), outcomes were greatest with A (weeks [W]1–3) + C (Table), with ORR of 67% and median PFS (mPFS) of 10.1 months for this cohort. Most common grade ≥3 treatment-emergent adverse events (TEAEs) are shown in the Table, with hematologic toxicity most notable with A (W1–3) + C. TEAEs led to A dose interruptions, reductions and discontinuations in 63%, 30% and 13% of the whole cohort, respectively. A possible positive relationship between CCNE1 amplification and response warrants further investigation. Conclusions: A shows preliminary efficacy when combined with CT. Pts receiving A (W1–3) + C showed greatest benefit. The increased but not unexpected hematologic toxicity is a challenge and could be further studied to optimize the dose schedule and supportive medications. Clinical trial information: NCT02272790. [Table: see text]
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Affiliation(s)
- Kathleen N. Moore
- Stephenson Cancer Center at the University of Oklahoma HSC and Sarah Cannon Research Institute, Oklahoma City, OK
| | | | | | - Lee-may Chen
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Amit M. Oza
- Bras Drug Development Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | - Ganesh M. Mugundu
- Quantitative Clinical Pharmacology, ECD, IMED Biotech Unit, AstraZeneca, Boston, MA
| | | | | | | | - David R. Spigel
- Tennessee Oncology, PLLC and Sarah Cannon Research Institute, Nashville, TN
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Piha-Paul SA, Knost JA, Braiteh FS, Beck JT, Spitz DL, Papish SW, Hellerstedt BA, Nikolinakos P, Taylor MH, Chawla SP, Schwartzberg LS, Smith DA, Szpakowski S, Zhang L, White T, Lebedinsky C. Genomic mutation profiling (GMP) and clinical outcome of patients treated with buparlisib (PI3K inhibitor) in the “Signature” program. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.2516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Sarina Anne Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase 1 Program), The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Fadi S. Braiteh
- Comprehensive Cancer Centers of Nevada, University of Nevada School of Medicine, Las Vegas, NV
| | | | | | | | - Beth A. Hellerstedt
- US Oncology Research, LLC, McKesson Specialty Health, and Texas Oncology, Central Austin Cancer Center, Austin, TX
| | | | | | | | | | | | | | | | - Theresa White
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Overton LC, Corless CL, Agrawal M, Assikis VJ, Beegle NL, Blau S, Chernoff M, Divers SG, Henry DH, Nikolinakos P, Oliver C, Schaefer ES, Schnell FM, Slater D, Spitz DL, Tosher V, Green RJ. Impact of next-generation sequencing (NGS) on treatment decisions in the community oncology setting. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.11028] [Citation(s) in RCA: 2] [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)
| | | | | | | | | | - Sibel Blau
- Northwest Medical Specialties, Tacoma and Puyallup, WA
| | - Marc Chernoff
- Abington Hematology Oncology Associates, Willow Grove, PA
| | | | | | | | | | | | | | - Dennis Slater
- Eastern Connecticut Hematology & Oncology Associates, Norwich, CT
| | | | - Vicki Tosher
- Cancer Clinics of Excellence, Greenwood Village, CO
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Abstract
The sensitivity of chronic lymphocytic leukemia (CLL) lymphocytes to attack by natural killer (NK) cells has remained questionable. To clarify this issue, freshly isolated lymphocytes of 37 patients with B-CLL, five with WDLL and two with HCL, were tested with a standard cytotoxicity assay with NK cells from normal donors. All these targets were resistant to cytolysis by the effectors. Freeze-fracture analysis of CLL cell plasma membranes revealed that they have a larger number of intramembranous particles (IMP) associated with the external leaflet (E-face) than have normal lymphocytes. Unlike other neoplastic cells, exposure of CLL lymphocytes to phorbol esters or treatment with neuraminidase did not render them vulnerable to attack by NK cells, nor did 5 days of culture have an effect. Incubation of CLL lymphocytes with anti-Ig-mu (24-72 hr) or with 0.1% pepsin (15 min) resulted in 15% and 27% cytolysis, respectively. B-lymphocytes from the blood of healthy donors were not killed when treated similarly: These data establish that freshly isolated B-CLL lymphocytes are resistant to NK cytolysis but that in contrast to normal B-cells, they possess cryptic NK-recognition structures, which may be uncovered by surface modulation.
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Affiliation(s)
- D L Spitz
- Department of Medicine, New York University Medical Center, New York 10016
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