1
|
Hogarty MD, Ziegler DS, Franson A, Chi YY, Tsao-Wei D, Liu K, Vemu R, Gerner EW, Bruckheimer E, Shamirian A, Hasenauer B, Balis FM, Groshen S, Norris MD, Haber M, Park JR, Matthay KK, Marachelian A. Phase 1 study of high-dose DFMO, celecoxib, cyclophosphamide and topotecan for patients with relapsed neuroblastoma: a New Approaches to Neuroblastoma Therapy trial. Br J Cancer 2024; 130:788-797. [PMID: 38200233 PMCID: PMC10912730 DOI: 10.1038/s41416-023-02525-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND MYC genes regulate ornithine decarboxylase (Odc) to increase intratumoral polyamines. We conducted a Phase I trial [NCT02030964] to determine the maximum tolerated dose (MTD) of DFMO, an Odc inhibitor, with celecoxib, cyclophosphamide and topotecan. METHODS Patients 2-30 years of age with relapsed/refractory high-risk neuroblastoma received oral DFMO at doses up to 9000 mg/m2/day, with celecoxib (500 mg/m2 daily), cyclophosphamide (250 mg/m2/day) and topotecan (0.75 mg/m2/day) IV for 5 days, for up to one year with G-CSF support. RESULTS Twenty-four patients (median age, 6.8 years) received 136 courses. Slow platelet recovery with 21-day courses (dose-levels 1 and 2) led to subsequent dose-levels using 28-day courses (dose-levels 2a-4a). There were three course-1 dose-limiting toxicities (DLTs; hematologic; anorexia; transaminases), and 23 serious adverse events (78% fever-related). Five patients (21%) completed 1-year of therapy. Nine stopped for PD, 2 for DLT, 8 by choice. Best overall response included two PR and four MR. Median time-to-progression was 19.8 months, and 3 patients remained progression-free at >4 years without receiving additional therapy. The MTD of DFMO with this regimen was 6750 mg/m2/day. CONCLUSION High-dose DFMO is tolerable when added to chemotherapy in heavily pre-treated patients. A randomized Phase 2 trial of DFMO added to chemoimmunotherapy is ongoing [NCT03794349].
Collapse
Affiliation(s)
- Michael D Hogarty
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - David S Ziegler
- Children's Cancer Institute, Lowy Cancer Research Centre, Randwick, NSW, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Andrea Franson
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Yueh-Yun Chi
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Denice Tsao-Wei
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kangning Liu
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rohan Vemu
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Anasheh Shamirian
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Beth Hasenauer
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Frank M Balis
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Groshen
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Murray D Norris
- Children's Cancer Institute, Lowy Cancer Research Centre, Randwick, NSW, Australia
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Centre, Randwick, NSW, Australia
| | - Julie R Park
- St. Jude Children's Research Hospital, University of Tennessee, Memphis, TN, USA
| | - Katherine K Matthay
- UCSF Benioff Children's Hospital, UCSF School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Araz Marachelian
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
2
|
Nawrocki ST, Olea J, Villa Celi C, Dadrastoussi H, Wu K, Tsao-Wei D, Colombo A, Coffey M, Fernandez Hernandez E, Chen X, Nuovo GJ, Carew JS, Mohrbacher AF, Fields P, Kuhn P, Siddiqi I, Merchant A, Kelly KR. Comprehensive Single-Cell Immune Profiling Defines the Patient Multiple Myeloma Microenvironment Following Oncolytic Virus Therapy in a Phase Ib Trial. Clin Cancer Res 2023; 29:5087-5103. [PMID: 37812476 PMCID: PMC10722139 DOI: 10.1158/1078-0432.ccr-23-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/26/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Our preclinical studies showed that the oncolytic reovirus formulation pelareorep (PELA) has significant immunomodulatory anti-myeloma activity. We conducted an investigator-initiated clinical trial to evaluate PELA in combination with dexamethasone (Dex) and bortezomib (BZ) and define the tumor immune microenvironment (TiME) in patients with multiple myeloma treated with this regimen. PATIENTS AND METHODS Patients with relapsed/refractory multiple myeloma (n = 14) were enrolled in a phase Ib clinical trial (ClinicalTrials.gov: NCT02514382) of three escalating PELA doses administered on Days 1, 2, 8, 9, 15, and 16. Patients received 40 mg Dex and 1.5 mg/m2 BZ on Days 1, 8, and 15. Cycles were repeated every 28 days. Pre- and posttreatment bone marrow specimens (IHC, n = 9; imaging mass cytometry, n = 6) and peripheral blood samples were collected for analysis (flow cytometry, n = 5; T-cell receptor clonality, n = 7; cytokine assay, n = 7). RESULTS PELA/BZ/Dex was well-tolerated in all patients. Treatment-emergent toxicities were transient, and no dose-limiting toxicities occurred. Six (55%) of 11 response-evaluable patients showed decreased paraprotein. Treatment increased T and natural killer cell activation, inflammatory cytokine release, and programmed death-ligand 1 expression in bone marrow. Compared with nonresponders, responders had higher reovirus protein levels, increased cytotoxic T-cell infiltration posttreatment, cytotoxic T cells in significantly closer proximity to multiple myeloma cells, and larger populations of a novel immune-primed multiple myeloma phenotype (CD138+ IDO1+HLA-ABCHigh), indicating immunomodulation. CONCLUSIONS PELA/BZ/Dex is well-tolerated and associated with anti-multiple myeloma activity in a subset of responding patients, characterized by immune reprogramming and TiME changes, warranting further investigation of PELA as an immunomodulator.
Collapse
Affiliation(s)
- Steffan T. Nawrocki
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, Arizona
| | - Julian Olea
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Claudia Villa Celi
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Homa Dadrastoussi
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Kaijin Wu
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Denice Tsao-Wei
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anthony Colombo
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Matt Coffey
- Oncolytics Biotech, Inc, Calgary, Alberta, Canada
| | | | - Xuelian Chen
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Gerard J. Nuovo
- The Ohio State University Comprehensive Cancer Center Columbus, Columbus, Ohio
| | - Jennifer S. Carew
- Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, Arizona
| | - Ann F. Mohrbacher
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| | - Paul Fields
- Formerly, Adaptive Biotechnologies, Seattle, Washington; currently, Tempus Labs, Seattle, Washington
| | - Peter Kuhn
- USC Michelson Center for Convergent Biosciences and Department of Biological Sciences, University of Southern California, Los Angeles
| | - Imran Siddiqi
- Department of Pathology, University of Southern California, Los Angeles, California
| | - Akil Merchant
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kevin R. Kelly
- Division of Hematology, Health Sciences Campus, University of Southern California, Los Angeles, California
| |
Collapse
|
3
|
Sadeghi S, Quinn D, Dorff T, Pal S, Groshen S, Tsao-Wei D, Parikh R, Devitt M, Parikh M, Jackovich A, Ruel N, Vogelzang N, Burgess E, Siddiqi I, Gill IS, Lara PN, Dreicer R, Gill PS. EphrinB2 Inhibition and Pembrolizumab in Metastatic Urothelial Carcinoma. J Clin Oncol 2023; 41:640-650. [PMID: 35984996 DOI: 10.1200/jco.21.02923] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Patients with metastatic urothelial carcinoma have poor prognosis after failure of standard first-line chemotherapy. Immune check point programmed death 1-programmed death ligand 1 antibodies have low response rates and thus there exists a major unmet need. MATERIALS AND METHODS In this phase II trial, patients with metastatic urothelial carcinoma that recurred or progressed after platinum-based chemotherapy received soluble EphB4-human serum albumin (sEphB4-HSA) in combination with pembrolizumab. The primary end points were tolerability and overall survival (OS). The secondary end points were progression-free survival (PFS), objective response rate (ORR), duration of response, and toxicity. The expression of sEphB4-HSA target EphrinB2 was correlated with outcomes. RESULTS Seventy patients were enrolled. The median follow up was 22.9 months (range, 1.3-54.7). The regimen had acceptable toxicity. In the intent-to-treat analysis (N = 70), the median OS was 14.6 months (95% CI, 9.2 to 21.5). Twenty-six (37%) patients had an objective response (95% CI, 26 to 48). The median PFS was 4.1 (95% CI, 1.5 to 5.7) months. Forty-six (66%) patients expressed EphrinB2, and among them, the median OS was 21.5 months (95% CI, 12.4 to not reached), the ORR was 52% (95% CI, 37 to 67), including a complete response rate of 24% (11 of 46; 95% CI, 12 to 36). The median PFS was 5.7 (95% CI, 2.7 to 27.9) months. Response was maintained at 6, 12, and 24 months in 88%, 74%, and 69% of the patients, respectively. CONCLUSION The combination of sEphB4-HSA and pembrolizumab appears synergistic with improved OS and ORR compared with historical data for programmed death 1/programmed death ligand 1 monotherapy.
Collapse
Affiliation(s)
| | - David Quinn
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Susan Groshen
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Michael Devitt
- University of Virginia Cancer Center, Charlottesville, VA
| | - Mamta Parikh
- University of California Davis, Comprehensive Cancer Center, Sacramento, CA
| | | | - Nora Ruel
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | - Imran Siddiqi
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | - Primo N Lara
- University of California Davis, Comprehensive Cancer Center, Sacramento, CA
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA
| | | |
Collapse
|
4
|
O’Connell CL, Baer MR, Ørskov AD, Saini SK, Duong VH, Kropf P, Hansen JW, Tsao-Wei D, Jang HS, Emadi A, Holmberg-Thyden S, Cowland J, Brinker BT, Horwood K, Burgos R, Hostetter G, Youngblood BA, Hadrup SR, Issa JP, Jones P, Baylin SB, Siddiqi I, Grønbaek K. Safety, Outcomes, and T-Cell Characteristics in Patients with Relapsed or Refractory MDS or CMML Treated with Atezolizumab in Combination with Guadecitabine. Clin Cancer Res 2022; 28:5306-5316. [PMID: 36222848 PMCID: PMC9772102 DOI: 10.1158/1078-0432.ccr-22-1810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/17/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE We hypothesized that resistance to hypomethylating agents (HMA) among patients with myelodysplastic syndrome (MDS) and chronic myelomonocytic leukemia (CMML) would be overcome by combining a programmed death-ligand 1 antibody with an HMA. PATIENTS AND METHODS We conducted a Phase I/II, multicenter clinical trial for patients with MDS not achieving an International Working Group response after at least 4 cycles of an HMA ("refractory") or progressing after a response ("relapsed") with 3+ or higher risk MDS by the revised International Prognostic Scoring System (IPSS-R) and CMML-1 or -2. Phase I consisted of a 3+3 dose-escalation design beginning with guadecitabine at 30 mg/m2 and escalating to 60 mg/m2 Days 1 to 5 with fixed-dose atezolizumab: 840 mg intravenously Days 8 and 22 of a 28-day cycle. Primary endpoints were safety and tolerability; secondary endpoints were overall response rate (ORR) and survival. RESULTS Thirty-three patients, median age 73 (range 54-85), were treated. Thirty patients had MDS and 3 had CMML, with 30% relapsed and 70% refractory. No dose-limiting toxicities were observed in Phase I. There were 3 (9%) deaths in ≤ 30 days. Five patients (16%) came off study for drug-related toxicity. Immune-related adverse events (IRAE) occurred in 12 (36%) patients (4 grade 3, 3 grade 2, and 5 grade1). ORR was 33% [95% confidence interval (CI), 19%-52%] with 2 complete remission (CR), 3 hematologic improvement, 5 marrow CR, and 1 partial remission. Median overall survival was 15.1 (95% CI, 8.5-25.3) months. CONCLUSIONS Guadecitabine with atezolizumab has modest efficacy with manageable IRAEs and typical cytopenia-related safety concerns for patients with relapsed or refractory MDS and CMML.
Collapse
Affiliation(s)
- Casey L O’Connell
- Jane Anne Nohl Division of Hematology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Maria R Baer
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Andreas Due Ørskov
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark,Biotech Research and Innovation Centre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,The Danish Stem Cell Center (Danstem), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sunil Kumar Saini
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Vu H. Duong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - Jakob Werner Hansen
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark,Biotech Research and Innovation Centre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,The Danish Stem Cell Center (Danstem), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Denice Tsao-Wei
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hyo Sik Jang
- Department of Epigenetics, Van Andel Institute, Grand Rapids, MI, USA
| | - Ashkan Emadi
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA,University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Staffan Holmberg-Thyden
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jack Cowland
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Brett T. Brinker
- Medical Oncology, Cancer and Hematology Centers of West Michigan, Grand Rapids, MI, USA
| | - Kristin Horwood
- Jane Anne Nohl Division of Hematology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan Burgos
- Department of Epigenetics, Van Andel Institute, Grand Rapids, MI, USA
| | - Galen Hostetter
- Department of Epigenetics, Van Andel Institute, Grand Rapids, MI, USA
| | | | - Sine Reker Hadrup
- Department of Health Technology, Section of Experimental and Translational Immunology, Technical University of Denmark, Kongens Lyngby, Denmark
| | | | - Peter Jones
- Department of Epigenetics, Van Andel Institute, Grand Rapids, MI, USA
| | - Stephen B Baylin
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Imran Siddiqi
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kirsten Grønbaek
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark,Biotech Research and Innovation Centre, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,The Danish Stem Cell Center (Danstem), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Barzi A, Azad NS, Yang Y, Tsao-Wei D, Rehman R, Fakih M, Iqbal S, El-Khoueiry AB, Millstein J, Jayachandran P, Zhang W, Lenz HJ. Phase I/II study of regorafenib (rego) and pembrolizumab (pembro) in refractory microsatellite stable colorectal cancer (MSSCRC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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
15 Background: Immune check point inhibitors (ICI) are ineffective in MSSCRC. Combination of ICI with targeted agents has the potential to alter the tumor microenvironment and render these tumors vulnerable to ICI. We report the results of the multicenter study of rego and pembro in a diverse patient population with advanced MSSCRC. Methods: This was an investigator-initiated study and enrolled patients (pts) who had failed/were intolerant of chemotherapy at 3 sites. A 3+3 design was used for phase I to evaluate escalating doses of rego (80,120,160, days 1-14/21) in combination with pembro (200m/q3weeks). The primary endpoint was dose limiting toxicities during the first cycle. For phase II, pts received rego at the recommended phase II dose (RP2D) with pembro. The primary endpoint was progression free survival (PFS). Secondary endpoints were overall survival (OS) and objective response rate (ORR). The study was powered to show an improvement in PFS from 1.9 months (CORRECT data) to 2.85 months. Estimated sample size for phase II was 63 pts. Results: Study started in 7/2019 and accrual completed in 7/2021. Of 73 pts, 10 enrolled in phase I and 63 in phase II. RP2D of rego was 80 mg, days 1-14/21, and 70 pts treated at that dose. As of Sep 14, 11 pts remain on treatment. At baseline, median age was 54 years (23-81), 51% female, 53% white, 19% Asian, 12% black, and 11% Hispanic, median prior lines of therapy 2 (1-5), primary tumor location rectosigmoid/rectal 13%, KRAS mutated 68%, BRAF mutated 5%. Liver metastases was present in 78% of the pts. There was no grade 4 toxicity. The most common grade 3 toxicities were rash (20%), followed by hand-foot syndrome and HTN (7%). Dose modification was required in 14%. The most common reason for discontinuation was disease progression (85%), followed by withdrawal of consent (12%). With a median follow up of 5.3 (range:0.6-24.4) months, median PFS was 2.0 (1.8 -3.5) months, and median OS was 10.9 (5.3-NR) months. In 16 pts (23%), with non-liver metastatic disease PFS was 4.3 (1.9-8.4) months. No objective response was observed. Stable disease was observed in 49% of pts, median duration of stable disease was 2 (0.2-18.8) months. Conclusions: This is the largest trial of combination of ICI + rego in MSSCRC reported to date. The trial didn’t meet its primary endpoint, though the median OS is provocative. Analysis of biomarkers for identification of pts with longer duration of benefit is ongoing. Clinical trial information: NCT03657641.
Collapse
Affiliation(s)
- Afsaneh Barzi
- City of Hope Comprehensive Cancer Center/AccessHope, Duarte, CA
| | - Nilofer Saba Azad
- Department of Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | - Yan Yang
- University of Southern California, Los Angeles, CA
| | | | - Rabia Rehman
- Norris Comprehensive Cancer Center, USC Keck School of Medicine, Los Angeles, CA
| | - Marwan Fakih
- City of Hope National Medical Center, Duarte, CA
| | - Syma Iqbal
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | - Joshua Millstein
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA
| | | | - Wu Zhang
- USC Keck School of Medicine, Los Angeles, CA
| | - Heinz-Josef Lenz
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| |
Collapse
|
6
|
DuBois SG, Granger MM, Groshen S, Tsao-Wei D, Ji L, Shamirian A, Czarnecki S, Goodarzian F, Berkovich R, Shimada H, Villablanca JG, Vo KT, Pinto N, Mosse YP, Maris JM, Shusterman S, Cohn SL, Goldsmith KC, Weiss B, Yanik GA, Twist CJ, Irwin MS, Haas-Kogan DA, Park JR, Marachelian A, Matthay KK. Randomized Phase II Trial of MIBG Versus MIBG, Vincristine, and Irinotecan Versus MIBG and Vorinostat for Patients With Relapsed or Refractory Neuroblastoma: A Report From NANT Consortium. J Clin Oncol 2021; 39:3506-3514. [PMID: 34270348 PMCID: PMC8547934 DOI: 10.1200/jco.21.00703] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/02/2021] [Accepted: 06/23/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE 131I-metaiodobenzylguanidine (MIBG) is an active radiotherapeutic for neuroblastoma. The primary aim of this trial was to identify which of three MIBG regimens was likely associated with the highest true response rate. PATIENTS AND METHODS Patients 1-30 years were eligible if they had relapsed or refractory neuroblastoma, at least one MIBG-avid site, and adequate autologous stem cells. Patients received MIBG 18 mCi/kg on day 1 and autologous stem cell on day 15. Patients randomly assigned to arm A received only MIBG; patients randomly assigned to arm B received intravenous vincristine on day 0 and irinotecan daily on days 0-4; patients randomly assigned to arm C received vorinostat (180 mg/m2/dose) orally once daily on days 1 to 12. The primary end point was response after one course by New Approaches to Neuroblastoma Therapy criteria. The trial was designed with 105 patients to ensure an 80% chance that the arm with highest response rate was selected. RESULTS One hundred fourteen patients were enrolled, with three ineligible and six unevaluable, leaving 105 eligible and evaluable patients (36 in arm A, 35 in arm B, and 34 in arm C; 55 boys; and median age 6.5 years). After one course, the response rates (partial response or better) on arms A, B, and C were 14% (95% CI, 5 to 30), 14% (5 to 31), and 32% (18 to 51). An additional five, five, and four patients met New Approaches to Neuroblastoma Therapy Minor Response criteria on arms A, B, and C, respectively. On arms A, B, and C, rates of any grade 3+ nonhematologic toxicity after first course were 19%, 49%, and 35%. CONCLUSION Vorinostat and MIBG is likely the arm with the highest true response rate, with manageable toxicity. Vincristine and irinotecan do not appear to improve the response rate to MIBG and are associated with increased toxicity.
Collapse
Affiliation(s)
- Steven G. DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | | | - Susan Groshen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Denice Tsao-Wei
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Lingyun Ji
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anasheh Shamirian
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Scarlett Czarnecki
- Department of Pediatrics, Loma Linda University Medical Center, Loma Linda, CA
| | - Fariba Goodarzian
- Department of Radiology, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Rachel Berkovich
- Department of Radiology, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Hiroyuki Shimada
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA
| | - Judith G. Villablanca
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Kieuhoa T. Vo
- Department of Pediatrics, UCSF Benioff Children's Hospital and UCSF School of Medicine, San Francisco, CA
| | - Navin Pinto
- Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
| | - Yael P. Mosse
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John M. Maris
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Suzanne Shusterman
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Susan L. Cohn
- Department of Pediatrics, Comer Children's Hospital and University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Kelly C. Goldsmith
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, GA
| | - Brian Weiss
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gregory A. Yanik
- Department of Pediatrics, CS Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI
| | - Clare J. Twist
- Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Meredith S. Irwin
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Julie R. Park
- Department of Pediatrics, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
| | - Araz Marachelian
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Katherine K. Matthay
- Department of Pediatrics, UCSF Benioff Children's Hospital and UCSF School of Medicine, San Francisco, CA
| |
Collapse
|
7
|
Garcia-Sayre J, Lin Y, Matsuo K, Tsao-Wei D, Mhawech-Fauceglia P, Louie S, Dong T, Ciccone M, Brunette L, Pham H, Yessaian A, Groshen S, Facio G, Aldana M, Muderspach L, Garcia A, Roman L. Phase II trial of eribulin in advanced/recurrent cervical cancer. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00773-3] [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: 11/29/2022]
|
8
|
Jackovich A, Gitlitz BJ, Tiu-lim JWW, Duddalwar V, King KG, El-Khoueiry AB, Thomas JS, Tsao-Wei D, Quinn DI, Gill PS, Nieva JJ. Phase II trial of soluble EphB4-albumin in combination with PD-1 antibody (pembrolizumab) in relapsed/refractory head neck squamous cell carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6016 Background: EphB4 receptor tyrosine kinase and its ligand EphrinB2 are highly induced in head neck squamous cell carcinoma (HN SCC) tumor cells and vessels, particularly in HPV negative tumors. Each are predictors for poor survival with worse prognosis when both are induced. EphB4 provides tumor cell survival and EphrinB2 inhibits immune cell invasion. Soluble EphB4-Alb blocks bidirectional signaling, enhances immune cell recruitment alone and when combined with PD-1 antibody. Methods: A phase II trial of sEphB4-Alb combined with pembrolizumab accrued HN SCC patients after failure of one or more prior regimens. IHC positivity for p16 was used as a surrogate for HPV infection. Treatment regimen was sEphB4-Alb 10 mg/kg weekly IV infusion with pembrolizumab 200 mg IV infusion every three weeks. Study endpoints were toxicity, overall response rates (ORR) and overall survival (OS). Response to therapy was based on RECIST 1.1 criteria. Patient tumor samples were collected at baseline with a 2nd biopsy at week 8 on therapy, for tissue analysis of PD-L1, EphrinB2 and other biomarkers. Results: Twenty-four patients were accrued to the phase II trial combination of sEphB4-Alb and pembrolizumab. Age, sex, prior treatment, HPV status, and response data are summarized in the table below. The most common toxicity was hypertension with 8 patients experiencing grade 3 HTN. No grade 4 or above toxicities were observed. Among HPV negative cases, partial and complete responses were observed in 6 of 14 patients (43%) with complete response (CR) observed in 3 of 6 responders. Additionally, rapid response was observed in 3 of 14 HPV negative patients. Response was associated with increase in immune markers on 2nd biopsy. Median overall and progression-free survival in all patients was 12.6 months and 8.6 months, respectively. Conclusions: 1. sEphB4-Alb was well tolerated in combination with PD-1 antibody. 2. sEphB4-Alb was associated with increased immune response to tumor, when combined with PD-1 antibody. 3. sEphB4-Alb appears to have substantial activity (including complete remission) when combined with PD-1 antibody in relapsed/refractory HPV negative HN SCC. Clinical trial information: NCT03049618. [Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jacob Stephen Thomas
- Division of Oncology, USC Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | | |
Collapse
|
9
|
Thomas JS, Habib D, Hanna DL, Kang I, Iqbal S, Nieva JJ, Tsao-Wei D, Acosta F, Hsieh M, Zhang Y, El-Khoueiry AB. A phase 1 trial of FID-007, a novel nanoparticle paclitaxel formulation, in patients with solid tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3021] [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
3021 Background: FID-007 (FID) consists of paclitaxel encapsulated in a polyethyloxazoline (PEOX) polymer excipient designed to enhance PK, biodistribution, and tolerability. In addition to allowing the drug to remain in solution until it can enter a cancer cell, the PEOX nanoparticle preferentially delivers paclitaxel to the tumor through the leaky hyperpermeable vasculature. In xenograft studies, FID reduced or limited tumor growth in multiple tumor types including lung, gastric, breast, pancreatic, and ovarian cancer. FID was more effective at lower or comparable taxane doses with fewer side effects. We present the first-in-human trial of FID. Methods: The study is evaluating the safety, PK, and efficacy of FID in pts with advanced solid tumors. The primary objective is to determine the MTD and RP2D. Pts received FID in doses between 15mg/m2 and 125mg/m2 using a standard 3+3 dose escalation design. FID was given IV on Days 1, 8, and 15 of a 28-day cycle. Eligibility included ECOG 0-2, adequate organ function, and no more than 3 prior lines of cytotoxic therapy for advanced disease. Results: Twenty-five pts were treated across 6 dose levels. Median age was 62 (44-76). ECOG PS was 2 in 1 pt and 1 in 64%. Median number of cycles was 2 (1-16). There were 2 DLTs of grade 3 rash at 100 mg/m2. Given the transient nature of the rash and response to topical therapy, DLT definition was modified to exclude grade 3 rash that lasts ≤ 7 days and additional patients were treated at 100 mg/m2 which was deemed tolerable. There was 1 DLT of grade 3 neutropenia at 125 mg/m2. All grade treatment related adverse events (TRAEs) in ≥ 25% of pts were rash (64%), alopecia (52%), pruritus (44%), anemia (44%) leukopenia, fatigue (40% each), dysgeusia, anorexia, nausea (32% each), and neutropenia (28%). Grade 3/4 TRAEs occurring in > 1 pt were anemia (20%), neutropenia, leukopenia, and maculopapular rash (16%). There were no treatment discontinuations due to toxicity. Twenty-two pts were evaluable for response by RECIST 1.1 with a PR rate of 14% (PR in pancreatic, biliary tract and NSCLC) and disease control rate of 59%. PK is linear and dose proportional. There is no paclitaxel accumulation after weekly dosing, and the t1/2 is between 18-26 hours. Conclusions: FID has a manageable safety profile with MTD not reached. Accrual is continuing at 125 mg/m2. PK is linear, dose proportional and comparable to that of nab-paclitaxel. There is preliminary evidence of anti-tumor activity in heavily pre-treated pts across different tumor types. Enrollment in dose escalation continues. Combination studies with immunotherapeutic agents are planned. Clinical trial information: NCT03537690.
Collapse
Affiliation(s)
- Jacob Stephen Thomas
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Diane Habib
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | | | - Irene Kang
- Division of Oncology, USC Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Syma Iqbal
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Francisco Acosta
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | |
Collapse
|
10
|
Barzi A, Choi A, Tsao-Wei D, Iqbal S, El-Khoueiry A, Agafitei DR, Cologne KG, Lenz HJ. Phase II Trial of Neoadjuvant Bevacizumab with Modified FOLFOX7 in Patients with Stage II and III Rectal Cancer. Oncologist 2020; 25:e1879-e1885. [PMID: 32649004 DOI: 10.1634/theoncologist.2020-0642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/28/2020] [Indexed: 01/04/2023] Open
Abstract
LESSONS LEARNED Neoadjuvant bevacizumab with modified FOLFOX7 without radiation failed to meet the goal of pathological complete response rate; however, the low number of recurrence and disease-free survival in this population, with predominantly stage III, is encouraging and worth further exploration. The racial distribution of the patient population, as well as a wait time of more than 4 weeks after last chemotherapy, may have contributed to the findings. BACKGROUND Combination chemotherapy in lieu of radiation in rectal adenocarcinoma is under exploration in multiple trials. We evaluated the efficacy of neoadjuvant FOLFOX + bevacizumab in patients (pts) with clinical stage II and III disease. METHODS Pts received six cycles of bevacizumab (5 mg/kg) and modified FOLFOX7 (oxaliplatin 85 mg/m2 , leucovorin 20 mg/m2 , and fluorouracil [5-FU] 2,400 mg/m2 ). Surgical resection was performed 6-8 weeks after completion of treatment and upon confirmation of nonmetastatic disease. We employed a Simon two-stage design and required three pathological complete responses (pCR) in the first 18 pts, with a prespecified pCR rate of 25% before moving to the next stage. RESULTS Seventeen pts enrolled; 65% at stage III. Median age was 57 (35-79), 65% were male, 47% were Hispanic, 35% were white, and 18% were Asian. All pts but one completed six cycles of therapy. One pCR was observed (6%), and 11 of 17 (65%) pts had pathological downstaging. One patient experienced systemic recurrence and remains on treatment. Probability of disease-free survival (DFS) at 5 years is 0.94 (SE, 0.06). CONCLUSION The study failed to meet the required three pCRs in the first 18 pts. The DFS in this population is encouraging and supports the hypothesis that select pts with rectal cancer may be spared from radiation.
Collapse
Affiliation(s)
- Afsaneh Barzi
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, California
- City of Hope National Medical Center, Duarte, California
| | - April Choi
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Denice Tsao-Wei
- Department of Preventive Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Syma Iqbal
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Anthony El-Khoueiry
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Dana Raluca Agafitei
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, California
| | - Kyle G Cologne
- Department of Surgery, Keck School of Medicine, Los Angeles, California
| | - Heinz-Josef Lenz
- Department of Medicine, USC Norris Comprehensive Cancer Center, Los Angeles, California
| |
Collapse
|
11
|
DuBois SG, Granger M, Groshen SG, Tsao-Wei D, Shamirian A, Czarnecki S, Goodarzian F, Berkovich R, Shimada H, Mosse YP, Shusterman S, Cohn SL, Goldsmith KC, Weiss BD, Yanik GA, Twist C, Irwin M, Park JR, Marachelian A, Matthay KK. Randomized phase II trial of MIBG versus MIBG/vincristine/irinotecan versus MIBG/vorinostat for relapsed/refractory neuroblastoma: A report from the New Approaches to Neuroblastoma Therapy Consortium. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.10500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10500 Background: 131I-metaiodobenzylguanidine (MIBG) remains one of the most active agents for neuroblastoma. It is not clear if putative radiation sensitizers improve upon this activity. The primary aim of this trial was to identify the MIBG treatment regimen with highest response rate among: MIBG monotherapy (Arm A); MIBG/Vincristine/Irinotecan (Arm B); MIBG/Vorinostat (Arm C). The secondary aim was to compare toxicity across arms. Methods: We conducted a multicenter, randomized phase II trial. Patients 1-30 years with relapsed/refractory high-risk neuroblastoma were eligible with at least one MIBG-avid site and adequate autologous stem cells (ASCs). All patients received MIBG 18 mCi/kg on Day 1 and ASC on day 15. Patients on Arm A received only MIBG; patients on Arm B also received vincristine (2 mg/m2) IV on Day 0 and irinotecan (50 mg/m2) IV daily on Days 0-4; patients on Arm C also received vorinostat (180 mg/m2) orally once daily on days -1 to 12. The primary endpoint was response after one course according to NANT response criteria. The trial was designed as a pick-the-winner study with a maximum of 105 eligible and evaluable patients to ensure an 80% chance that the arm with highest response rate is selected, if that response rate is at least 15% higher than the other arms. Results: 114 patients enrolled. Three patients were ineligible and 6 eligible patients never received MIBG, leaving 105 eligible and evaluable patients (36 Arm A; 35 Arm B; and 34 Arm C; 55 boys; median age 6.5 years). 9 patients had received prior MIBG monotherapy, 65 prior irinotecan, and 7 prior vorinostat. After one course, the response rates (Partial Response or better) on Arms A, B, and C were 17% (95% CI 7-33%), 14% (5-31%), and 32% (18-51%). An additional 4, 4, and 7 patients met NANT Minor Response criteria [partial response in one disease category (e.g., bone marrow) and stable disease in other categories] on Arms A, B, and C, respectively. On Arms A, B, and C, rates of any grade 3+ non-hematologic toxicity were 19%, 49% and 32%; rates of grade 3+ diarrhea were 0%, 11%, 0%; and rates of grade 3+ febrile neutropenia were 6%, 11%, and 0%. Conclusions: The combination of vorinostat/MIBG had the highest response rate, with manageable toxicity. Vincristine and irinotecan do not improve the response rate to MIBG and are associated with increased toxicity. These data provide response rates for MIBG monotherapy in a contemporary patient population assessed with current response criteria. Clinical trial information: NCT02035137.
Collapse
Affiliation(s)
- Steven G. DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | | | | | | | | | | | - Fariba Goodarzian
- Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Yael P. Mosse
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Suzanne Shusterman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | | | | | - Brian D. Weiss
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Clare Twist
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | | |
Collapse
|
12
|
Xiong S, Mhawech-Fauceglia P, Tsao-Wei D, Roman L, Gaur RK, Epstein AL, Pinski J. Expression of the luteinizing hormone receptor (LHR) in ovarian cancer. BMC Cancer 2019; 19:1114. [PMID: 31729966 PMCID: PMC6857310 DOI: 10.1186/s12885-019-6153-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
We investigated the association of LHR expression in epithelial ovarian cancer (OC) with clinical and pathologic characteristics of patients. LHR expression was examined immunohistochemically using tissue microarrays (TMAs) of specimens from 232 OC patients. Each sample was scored quantitatively evaluating LHR staining intensity (LHR-I) and percentage of LHR (LHR-P) staining cells in tumor cells examined. LHR-I was assessed as no staining (negative), weak (+ 1), moderate (+ 2), and strong positive (+ 3). LHR-P was measured as 1 to 5, 6 to 50% and > 50% of the tumor cells examined. Positive LHR staining was found in 202 (87%) patients' tumor specimens and 66% patients had strong intensity LHR expression. In 197 (85%) of patients, LHR-P was measured in > 50% of tumor cells. LHR-I was significantly associated with pathologic stage (p = 0.007). We found that 72% of stage III or IV patients expressed strong LHR-I in tumor cells. There were 87% of Silberberg's grade 2 or 3 patients compared to 70% of grade 1 patients with LHR expression observed in > 50% of tumor cells, p = 0.037. Tumor stage was significantly associated with overall survival and recurrence free survival, p < 0.001 for both analyses, even after adjustment for age, tumor grade and whether patient had persistent disease after therapy or not. Our study demonstrates that LHR is highly expressed in the majority of OC patients. Both LHR-I and LHR-P are significantly associated with either the pathologic stage or tumor grade.
Collapse
Affiliation(s)
- Shigang Xiong
- Department of Medicine/Medical Oncology Division, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA, 90033, USA
| | - Paulette Mhawech-Fauceglia
- Aurora Diagnostics, Department of Pathology, Gynecologic Pathology Consultant, San Antonio, TX, 78209, USA
| | - Denice Tsao-Wei
- University of Southern California, Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90033, USA
| | - Lynda Roman
- Department of Obstetrics & Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Rajesh K Gaur
- Department of Medicine/Medical Oncology Division, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA, 90033, USA
| | - Alan L Epstein
- Department of Pathology, University of Southern California, HMR 2011 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Jacek Pinski
- Department of Medicine/Medical Oncology Division, University of Southern California, 1441 Eastlake Ave, Los Angeles, CA, 90033, USA. .,University of Southern California, Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90033, USA.
| |
Collapse
|
13
|
Tuscano JM, Maverakis E, Groshen S, Tsao-Wei D, Luxardi G, Merleev AA, Beaven A, DiPersio JF, Popplewell L, Chen R, Kirschbaum M, Schroeder MA, Newman EM. A Phase I Study of the Combination of Rituximab and Ipilimumab in Patients with Relapsed/Refractory B-Cell Lymphoma. Clin Cancer Res 2019; 25:7004-7013. [PMID: 31481504 DOI: 10.1158/1078-0432.ccr-19-0438] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/03/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Based on the potential for ipilimumab (I) to augment T-cell activation, we hypothesize that ipilimumab would augment the efficacy of rituximab (R) in patients with relapsed/refractory (R/R) CD20+non-Hodgkin's lymphoma (NHL). This phase I study aimed to identify a recommended phase 2 dose, document toxicities, and preliminarily assess efficacy and potential predictive biomarkers. PATIENTS AND METHODS Thirty-three patients with R/R CD20+B-cell lymphoma received R at 375 mg/m2weekly for 4 weeks and I at 3 mg/kg on day 1 and every 3 weeks for four doses. Responding patients went on to maintenance with each agent given every 12 weeks. To facilitate correlative analysis, the expansion phase randomized patients to simultaneous R+I versus R with I delayed 2 weeks. RESULTS Toxicity was manageable; no dose-limiting toxicity was observed at the doses studied. When considering the entire cohort, efficacy was modest, with an objective response rate (ORR) of 24% and median progression-free survival (PFS) of 2.6 months. However, in follicular lymphoma patients, the ORR was 58% with a median PFS of 5.6 months. The randomized comparison of R with R+I demonstrated that R+I resulted in more effective B-cell depletion (BCD). Both B-cell depletion and the ratio of CD45RA-regulatory T cell (Treg) to Treg were associated with response at all time points. CONCLUSIONS The combination of R+I has manageable toxicity and encouraging efficacy in R/R follicular lymphoma. The ratio of CD45RA-Tregs to total Tregs, and peripheral BCD should be studied further as potential predictors of response.
Collapse
Affiliation(s)
- Joseph M Tuscano
- UC Davis Comprehensive Cancer Center, Sacramento, California. .,Veterans Administration Northern California Healthcare System, Sacramento, California
| | | | - Susan Groshen
- Biostatistics Core, University of Southern California/Norris Cancer Center, Los Angeles, California
| | - Denice Tsao-Wei
- Biostatistics Core, University of Southern California/Norris Cancer Center, Los Angeles, California
| | | | | | - Anne Beaven
- University of North Carolina Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - John F DiPersio
- Washington University School of Medicine, St. Louis, Missouri
| | - Leslie Popplewell
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | - Robert Chen
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California, USA
| | | | | | - Edward M Newman
- Division of Molecular Pharmacology, Department of Medical Oncology, City of Hope, Duarte, California, USA
| |
Collapse
|
14
|
Ballas L, Aron M, Xiong Y, McCarthy S, Phuong C, Sali A, Chen M, Clark E, Tsao-Wei D, Dorff T, Bhanvadia S, Magliocco A, Daneshmand S. Can Bladder Cancer Biomarkers from Patients Undergoing Cystectomy Predict the Need for Adjuvant Radiotherapy? Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1941] [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: 10/26/2022]
|
15
|
Barzi A, Lara PN, Tsao-Wei D, Yang D, Gill IS, Daneshmand S, Klein EA, Pinski JK, Penson DF, Quinn DI, Sadeghi S. Influence of the facility caseload on the subsequent survival of men with localized prostate cancer undergoing radical prostatectomy. Cancer 2019; 125:3853-3863. [PMID: 31398279 DOI: 10.1002/cncr.32290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/05/2019] [Accepted: 05/08/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Several studies have investigated the relationship between experience measured by caseload and oncological outcomes, economics, and access to care for prostate cancer care. Oncological outcomes have been limited to biochemical failure after radical prostatectomy. Questions remain regarding the more definitive measures of outcomes and their relationship with caseload. METHODS The National Cancer Database was used to investigate the outcomes of radical prostatectomy in the United States. With overall survival (OS) as the primary outcome, the relationship between the facility annual caseload (FAC) for all prostate cancer encounters and the facility annual surgical caseload (FASC) for those requiring radical prostatectomy was examined with a Cox proportional hazards model. Four volume groups were defined by caseload: <50th percentile (volume group 1 [VG1]), 50th to 74th percentiles (volume group 2 [VG2]), 75th to 89th percentiles (volume group 3 [VG3]), and ≥90th percentile (volume group 4 [VG4]). By FAC/FASC, 11%/8%, 17%/18%, 25%/26%, and 47%/49% of patients were treated in VG1 through VG4, respectively. RESULTS Between 2004 and 2014, 488,389 patients underwent radical prostatectomy. At a median follow-up of 60.75 months, the median OS was not reached. There was a significant OS benefit as the caseload increased. For FAC, the adjusted OS difference between VG1 and VG4 at 90th percentile survivorship reached 13.2 months (hazard ratio [HR], 1.30; 95% CI, 1.23-1.36; P < .0001). For FASC, this was 11.3 months (HR, 1.25; 95% CI, 1.192-1.321; P < .0001). CONCLUSIONS There is a statistically significant OS advantage from performing radical prostatectomy at a facility with a high annual caseload. Caseload measured by all prostate cancer encounters is a better predictor of favorable outcomes than the number of surgeries performed at a facility. LAY SUMMARY An in-depth analysis of 488,389 cases of radical prostatectomy performed in more than 1000 facilities over a 10-year period showed better survival when surgery was performed in facilities with more experience and greater caseload. A survival difference of up to 13 months was observed when comparing patients treated at less experienced versus more experienced centers. Experience across all stages of prostate cancer was a stronger predictor of survival outcome than just the number of surgeries performed.
Collapse
Affiliation(s)
- Afsaneh Barzi
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Primo N Lara
- Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Denice Tsao-Wei
- Department of Preventive Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California
| | - Inderbir S Gill
- Institute of Urology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jacek K Pinski
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David I Quinn
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| | - Sarmad Sadeghi
- Division of Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California
| |
Collapse
|
16
|
Kang I, Spicer DV, Lu JM, Groshen SG, Tsao-Wei D, Garcia AA. Phase II trial of metronomic capecitabine and cyclophosphamide with lapatinib and trastuzumab in patients with HER2-positive metastatic breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12508] [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
e12508 Background: Metronomic chemotherapy is an emerging paradigm of cancer therapy in which low doses of chemotherapy are delivered at frequent intervals. Activity in patients with metastatic breast cancer (MBC) has been demonstrated in several phase II clinical trials. Methods: We proposed a regimen with metronomic chemotherapy and dual HER2 inhibition in HER2 positive patients with MBC. We hypothesized that this regimen will be highly active in MBC and have a favorable toxicity profile. Patients were treated on a 21-day cycle with capecitabine 1500mg PO daily, cyclophosphamide 50mg daily, lapatinib 1000mg PO daily and trastuzumab 6mg/kg IV once per 21-day cycle. This regimen was continued until disease progression or unacceptable toxicity. Primary endpoint was progression free survival (PFS). Secondary endpoints were overall response rate (ORR), clinical benefit rate (CBR), overall survival (OS), and safety and tolerability of this regimen. Eligibility criteria were patients 18 years of age and older who had histologically confirmed HER2-positive metastatic breast cancer with prior trastuzumab use in the adjuvant or metastatic setting with no more than two prior regimens for MBC. Results: Ten patients were accrued from Jan 2014-Oct 2016. Median age was 52 (range 38 - 79) years. Median number of chemotherapy regimens for metastatic disease was 0.5 (range 0-2). Median PFS was 13.7 (95% CI: 2.6, 16.6) months. Median OS was 29.6 (95% CI: 11.8, 60.5+) months. ORR was 30%, and CBR was 70%. Grade 3 or 4 toxicities were identified in 6 patients. The most common toxicities of any grade were fatigue (100%), diarrhea (80%), anemia, neutropenia, ALT increase, nausea and hand-foot syndrome 50% each. One patient achieved CR for over 3 years and continues on treatment at time of this report. 8 patients progressed and 1 patient withdrew from study without response evaluation. The trial was closed due to lack of accrual. Conclusions: The proposed regimen of metronomic capecitabine and cyclophosphamide with lapatinib and trastuzumab appears to be active in patients with HER2 positive MBC but with significant toxicity. Clinical trial information: NCT01873833.
Collapse
Affiliation(s)
- Irene Kang
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | | | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| |
Collapse
|
17
|
Dorff TB, Quinn DI, Pinski JK, Goldkorn A, Sadeghi S, Tsao-Wei D, Groshen S, Kuhn P, Gross ME. Randomized Phase II Trial of Abiraterone Alone or With Dasatinib in Men With Metastatic Castration-resistant Prostate Cancer (mCRPC). Clin Genitourin Cancer 2019; 17:241-247.e1. [PMID: 31227432 DOI: 10.1016/j.clgc.2019.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/06/2019] [Accepted: 02/21/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Signaling via the Src pathway is thought to be a mediator of resistance to androgen targeted therapy in prostate cancer. We studied whether adding the Src inhibitor dasatinib to abiraterone would delay progression. PATIENTS AND METHODS Eligible patients had metastatic castration-resistant prostate cancer (mCRPC), without prior chemotherapy. Abiraterone was prescribed at 1000 mg daily with prednisone 5 mg twice daily in both arms, and dasatinib 100 mg daily was added for Arm B. The primary endpoint was progression-free survival (PFS). The interim analysis was planned after 48 subjects, but the study was terminated early. PFS was evaluated using a 1-sided log rank test. The Fisher exact test was used for other categorical data analyses. Circulating tumor cells (CTCs) were identified with the Epic platform. RESULTS With 26 men randomized and a median follow up of 41.8 months, the median PFS was 15.7 months (95% confidence interval, 8.2-49.0+ months) for Arm B and 9.0 months (95% confidence interval, 4.4-30.7 months) for Arm A (P = .15). Response Evaluation Criteria in Solid Tumors responses were seen in 5 (36%) of 14 patients, including 2 complete responses (CRs) on Arm B, and 2 (17%) of 12 responses without CR on Arm A (P = .39). Grade ≥ 3 toxicities more common in Arm B included hypertension, pleural effusion/dyspnea, and gastrointestinal effects. CTCs were detected at baseline in 10 of 19 evaluable patients (median, 2.7/mL blood [range 0.41-59.7]). At week 4, CTCs increased in 1 (10%) of 10 patients on Arm A and 4 (44%) of 9 patients on Arm B. CONCLUSION Dasatinib did not significantly prolong PFS in combination with abiraterone, although power was limited owing to the incomplete study cohort. Treatment with the combination was associated with robust objective responses, including Response Evaluation Criteria in Solid Tumors CRs.
Collapse
Affiliation(s)
- Tanya B Dorff
- Department of Medical Oncology and Developmental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA.
| | - David I Quinn
- Division of Medical Oncology, USC Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Jacek K Pinski
- Division of Medical Oncology, USC Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Amir Goldkorn
- Division of Medical Oncology, USC Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Sarmad Sadeghi
- Division of Medical Oncology, USC Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Denice Tsao-Wei
- Department of Prevention and Biostatistics, USC Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Susan Groshen
- Department of Prevention and Biostatistics, USC Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Peter Kuhn
- Michelson Center for Convergent Biosciences, University of Southern California, Los Angeles, CA
| | - Mitchell E Gross
- Lawrence J. Ellison Institute for Transformative Medicine of USC and Norris Comprehensive Cancer Center, USC Keck School of Medicine, Los Angeles, CA
| |
Collapse
|
18
|
Khanuja J, Bahrami Tabar S, Tsao-Wei D, Piatek CI, Barzi A. Biliary tract cancers and the associated risk of venous thromboembolism. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.304] [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
304 Background: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients. Because biliary tract cancers (BTC) cholangiocarcinoma and gallbladder (GB) cancer are uncommon, the incidence of VTE in this population are not well-described. Methods: We conducted a retrospective study of patients with BTC identified by the cancer registry at the Los Angeles County-University of Southern California (USC) Medical Center, USC Norris Cancer Center, and USC Keck Hospital between January 2011 to December 2016 to describe the incidence of VTE. 330 BTC patients’ medical records were reviewed for demographics, tumor characteristics, treatment history, and VTE events. 41 patients were excluded due to incomplete records/follow-up. Overall survival (OS) was calculated from date of diagnosis to date of death or last follow-up. Logrank test was used to evaluate the association of VTE with OS. Results: 289 patients with BTC were identified (177 cholangiocarcinoma, 112 GB) with a median follow-up period of 16.7 (0.3-89.0) months (mo). 169 (58%) were women. The median age at diagnosis of 66 years (range 22-89). 144 (59%) underwent cancer surgery and 274 (95%) received chemotherapy. 65 (22%) patients had VTE events: 22 pulmonary embolism [PE] with or without lower extremity (LE) deep vein thrombosis [DVT], 15 with LE DVT alone, three with upper extremity DVT, and 30 with visceral thrombosis (27 portal vein thrombosis [PVT] with or without inferior vena cava thrombosis [IVC], 2 IVC thrombosis, two hepatic vein thrombosis). Five patients had both DVT/PE and visceral thrombosis. The median time from cancer diagnosis to VTE event was not met. Patients with a PVT or any visceral thrombosis had an inferior OS compared to those without (PVT: median OS 16.2 mo [95% CI 12.2-25.8] versus 7.5 [3.4-14.2], p = 0.10, visceral thrombosis: 17.0 mo [95% CI 11.8-25.9] versus 8.4 [95% CI 3.7-14.3], p = 0.30). There was a non-significant trend towards inferior OS in patients with any VTE event type (median OS 17.0 mo [95% CI 11.8-39.0] versus 11.4 [95% CI 7.2-18.4], p = 0.10). There was no difference in OS for patients with PE/DVT compared to those without. Conclusions: VTE is commonly observed in patients with BTC. Visceral thrombosis is associated with inferior survival in patients with BTC.
Collapse
Affiliation(s)
| | | | | | | | - Afsaneh Barzi
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| |
Collapse
|
19
|
DuBois SG, Mosse YP, Fox E, Kudgus RA, Reid JM, McGovern R, Groshen S, Bagatell R, Maris JM, Twist CJ, Goldsmith K, Granger MM, Weiss B, Park JR, Macy ME, Cohn SL, Yanik G, Wagner LM, Hawkins R, Courtier J, Lai H, Goodarzian F, Shimada H, Boucher N, Czarnecki S, Luo C, Tsao-Wei D, Matthay KK, Marachelian A. Phase II Trial of Alisertib in Combination with Irinotecan and Temozolomide for Patients with Relapsed or Refractory Neuroblastoma. Clin Cancer Res 2018; 24:6142-6149. [PMID: 30093449 DOI: 10.1158/1078-0432.ccr-18-1381] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/30/2018] [Accepted: 08/06/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE In phase I testing, alisertib tablets with irinotecan and temozolomide showed significant antitumor activity in patients with neuroblastoma. This study sought to confirm activity of this regimen; evaluate an alisertib oral solution; and evaluate biomarkers of clinical outcomes. PATIENTS AND METHODS We conducted a two-stage phase II trial of alisertib tablets (60 mg/m2/dose × 7 days), irinotecan (50 mg/m2/dose i.v. × 5 days), and temozolomide (100 mg/m2/dose orally × 5 days) in patients with relapsed or refractory neuroblastoma. The primary endpoint was best objective response. A separate cohort was treated with alisertib at 45 mg/m2 using oral solution instead of tablets. Exploratory analyses sought to identify predictors of toxicity, response, and progression-free survival (PFS) using pooled data from phase I, phase II, and oral solution cohorts. RESULTS Twenty and 12 eligible patients were treated in the phase II and oral solution cohorts, respectively. Hematologic toxicities were the most common adverse events. In phase II, partial responses were observed in 19 evaluable patients (21%). The estimated PFS at 1 year was 34%. In the oral solution cohort, 3 patients (25%) had first cycle dose-limiting toxicity (DLT). Alisertib oral solution at 45 mg/m2 had significantly higher median C max and exposure compared with tablets at 60 mg/m2. Higher alisertib trough concentration was associated with first cycle DLT, whereas MYCN amplification was associated with inferior PFS. CONCLUSIONS This combination shows antitumor activity, particularly in patients with MYCN nonamplified tumors. Data on an alisertib oral solution expand the population able to be treated with this agent.
Collapse
Affiliation(s)
- Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts.
| | - Yael P Mosse
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Elizabeth Fox
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rachel A Kudgus
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota
| | - Joel M Reid
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota
| | - Renee McGovern
- Department of Pharmacology, Mayo Clinic, Rochester, Minnesota
| | - Susan Groshen
- Department of Preventive Medicine, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Rochelle Bagatell
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John M Maris
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Clare J Twist
- Department of Pediatrics, Roswell Park Cancer Institute, Buffalo, New York
| | - Kelly Goldsmith
- Department of Pediatrics, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - M Meaghan Granger
- Department of Pediatrics, Cook Children's Hospital, Fort Worth, Texas
| | - Brian Weiss
- Department of Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Julie R Park
- Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Margaret E Macy
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado, Aurora, Colorado
| | - Susan L Cohn
- Department of Pediatrics, Comer Children's Hospital and University of Chicago, Chicago, Illinois
| | - Greg Yanik
- Department of Pediatrics, CS Mott Children's Hospital and University of Michigan, Ann Arbor, Michigan
| | - Lars M Wagner
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Randall Hawkins
- Department of Radiology, UCSF Benioff Children's Hospital and UCSF School of Medicine, San Francisco, California
| | - Jesse Courtier
- Department of Radiology, UCSF Benioff Children's Hospital and UCSF School of Medicine, San Francisco, California
| | - Hollie Lai
- Department of Radiology, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Fariba Goodarzian
- Department of Radiology, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Hiroyuki Shimada
- Department of Pathology, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Najee Boucher
- Department of Pediatrics, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Scarlett Czarnecki
- Department of Pediatrics, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Chunqiao Luo
- Department of Preventive Medicine, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Denice Tsao-Wei
- Department of Preventive Medicine, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Katherine K Matthay
- Department of Pediatrics, UCSF Benioff Children's Hospital and UCSF School of Medicine, San Francisco, California
| | - Araz Marachelian
- Department of Pediatrics, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| |
Collapse
|
20
|
Pinto N, DuBois SG, Marachelian A, Diede SJ, Taraseviciute A, Glade Bender JL, Tsao-Wei D, Groshen SG, Reid JM, Haas-Kogan DA, Reynolds CP, Kang MH, Irwin MS, Macy ME, Villablanca JG, Matthay KK, Park JR. Phase I study of vorinostat in combination with isotretinoin in patients with refractory/recurrent neuroblastoma: A new approaches to Neuroblastoma Therapy (NANT) trial. Pediatr Blood Cancer 2018; 65:e27023. [PMID: 29603591 PMCID: PMC6040651 DOI: 10.1002/pbc.27023] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 01/26/2018] [Accepted: 01/26/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Vorinostat combined with retinoids produces additive antitumor effects in preclinical studies of neuroblastoma. Higher systemic exposures of vorinostat than achieved in pediatric phase I trials with continuous daily dosing are necessary for in vivo increased histone acetylation and cytotoxic activity. We conducted a phase I trial in children with relapsed/refractory neuroblastoma to determine the maximum tolerated dose (MTD) of vorinostat on an interrupted schedule, escalating beyond the previously identified pediatric MTD. METHODS Isotretinoin (cis-13-retinoic acid) 80 mg/m2 /dose was administered by mouth twice daily on days 1-14 in combination with escalating doses of daily vorinostat up to 430 mg/m2 /dose (days 1-4; 8-11) in each 28-day cycle using the standard 3 + 3 design. Vorinostat pharmacokinetic testing and histone acetylation assays were performed. RESULTS Twenty-nine patients with refractory or relapsed neuroblastoma were enrolled and 28 were evaluable for dose escalation decisions. Median number of cycles completed was two (range 1-15); 11 patients received four or more cycles. Three patients experienced cycle 1 dose-limiting toxicities. A total of 18 patients experienced grade 3/4 toxicities related to study therapy. The maximum intended dose of vorinostat (430 mg/m2 /day, days 1-4; 8-11) was tolerable and led to increased histone acetylation in surrogate tissues when compared to lower doses of vorinostat (P = 0.009). No objective responses were seen. CONCLUSIONS Increased dose vorinostat (430 mg/m2 /day) on an interrupted schedule is tolerable in combination with isotretinoin. This dose led to increased vorinostat exposures and demonstrated increased histone acetylation. Prolonged stable disease in patients with minimal residual disease warrants further investigation.
Collapse
Affiliation(s)
- Navin Pinto
- Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Araz Marachelian
- Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Scott J. Diede
- Global Clinical Development—Oncology, Merck Research Laboratories, North Wales, Pennsylvania
| | - Agne Taraseviciute
- Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Julia L. Glade Bender
- Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Medical Center, New York City, New York
| | - Denice Tsao-Wei
- Department of Preventative Medicine, University of Southern California, Los Angeles, California
| | - Susan G. Groshen
- Department of Preventative Medicine, University of Southern California, Los Angeles, California
| | - Joel M. Reid
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - C. Patrick Reynolds
- Cancer Center and Cell Biology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Min H. Kang
- Cancer Center and Cell Biology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Meredith S. Irwin
- Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Margaret E. Macy
- Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Judith G. Villablanca
- Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Katherine K. Matthay
- UCSF Benioff Children’s Hospital, University of California, San Francisco, California,UCSF School of Medicine, University of California, San Francisco, California
| | - Julie R. Park
- Seattle Children’s Hospital, University of Washington, Seattle, Washington
| |
Collapse
|
21
|
Marachelian A, Villablanca J, Duvalyan A, Czarnecki S, Groshen SG, Tsao-Wei D, Sposto R, Malvar J, Sun J, Goldsmith KC, Mosse YP, Granger M, Seibel N, Moscow J, Matthay KK, Sheard M, Seeger R. A phase I NANT study of lenalidomide with ch14.18 and isotretinoin (RA) in patients with refractory/recurrent neuroblastoma (RR-NB). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10522] [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)
| | | | | | | | | | | | | | - Jemily Malvar
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jianping Sun
- Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Yael P. Mosse
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | | | | | | |
Collapse
|
22
|
Zang P, Drakaki A, Faiena I, Chan B, Tsao-Wei D, Groshen SG, Quinn DI, Dorff TB. Immune-related adverse events (irAE) in GU cancer patients receiving immune checkpoint inhibitors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.422] [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
422 Background: Immune checkpoint inhibitors (ICI), particularly PD-1 and PD-L1 antibodies, prolong survival in advanced renal cell (RCC) and urothelial cancer (UC) patients. However, they can cause a variety of serious irAE. We assessed frequency and onset of irAE at experienced centers, and evaluated whether baseline characteristics were associated with irAE. Methods: Pharmacy and clinic schedules identified RCC and UC patients treated with ICI at USC Norris (n = 51) and UCLA (n = 26) from 2014-2016. Prior radiation was defined as completion within 3 months before ICI. Fisher’s exact 2-tailed test was used to evaluate for associations of variables with irAE. Results: 77 patients median age 69 years (49-93) received ICI, 31 with RCC and 46 with UC; 36 received atezolizumab, 29 nivolumab, 9 pembrolizumab, 2 durvalumab, and 1 avelumab. 25 (32.5%) had irAE including pneumonitis (4%), myositis (3%), neurologic event (1%), hepatitis (8%), colitis (1%), rash (8%), endocrinopathy (6%), or hematologic event (1%). 11 (14%) required steroids, 3 (4%) required more intense immunosuppression (infliximab), 1 died of complications from irAE (pneumonitis). 5 were rechallenged with ICI after irAE resolution. Median time to onset of irAEs was 15 weeks; earliest onset of irAE (non-dermatologic) was 3 days after 1st dose, latest onset was 112 weeks. Associations of irAE with variables are listed in the table. Conclusions: irAE were more common in our experience than in published datasets, especially endocrine events, and could occur after the first dose. There was an association between irAE and allergy to antibiotics as well as external beam radiation therapy (EBRT) within 3 months before ICI therapy. [Table: see text]
Collapse
Affiliation(s)
- Peter Zang
- USC Keck School of Medicine, Los Angeles, CA
| | | | - Izak Faiena
- Institute of Urologic Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Betty Chan
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Denice Tsao-Wei
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | - David I. Quinn
- USC Keck School of Medicine Norris Comprehensive Cancer Center, Los Angeles, CA
| | | |
Collapse
|
23
|
Bulbul A, Tsao-Wei D, Mino E, Mustafa A, Rashad S, Abboud H, Chouial S, Braik T, Masoud K, Tripathy D. Pathological proliferation score to predict genomic risk categories in early stage breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.041] [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: 11/14/2022] Open
|
24
|
Mohrbacher AM, Yang AS, Groshen S, Kummar S, Gutierrez ME, Kang MH, Tsao-Wei D, Reynolds CP, Newman EM, Maurer BJ. Phase I Study of Fenretinide Delivered Intravenously in Patients with Relapsed or Refractory Hematologic Malignancies: A California Cancer Consortium Trial. Clin Cancer Res 2017; 23:4550-4555. [PMID: 28420721 DOI: 10.1158/1078-0432.ccr-17-0234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 01/26/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022]
Abstract
Purpose: A phase I study was conducted to determine the MTD, dose-limiting toxicities (DLT), and pharmacokinetics of fenretinide delivered as an intravenous emulsion in relapsed/refractory hematologic malignancies.Experimental Design: Fenretinide (80-1,810 mg/m2/day) was administered by continuous infusion on days 1 to 5, in 21-day cycles, using an accelerated titration design.Results: Twenty-nine patients, treated with a median of three prior regimens (range, 1-7), were enrolled and received the test drug. Ninety-seven courses were completed. An MTD was reached at 1,280 mg/m2/day for 5 days. Course 1 DLTs included 6 patients with hypertriglyceridemia, 4 of whom were asymptomatic; 2 patients experienced DLT thrombocytopenia (asymptomatic). Of 11 patients with response-evaluable peripheral T-cell lymphomas, two had complete responses [CR, progression-free survival (PFS) 68+ months; unconfirmed CR, PFS 14+ months], two had unconfirmed partial responses (unconfirmed PR, PFS 5 months; unconfirmed PR, PFS 6 months), and five had stable disease (2-12 cycles). One patient with mature B-cell lymphoma had an unconfirmed PR sustained for two cycles. Steady-state plasma levels were approximately 10 mcg/mL (mid-20s μmol/L) at 640 mg/m2/day, approximately 14 mcg/mL (mid-30s μmol/L) at 905 mg/m2/day, and approximately 22 mcg/mL (mid-50s μmol/L) at 1,280 mg/m2/day.Conclusions: Intravenous fenretinide obtained significantly higher plasma levels than a previous capsule formulation, had acceptable toxicities, and evidenced antitumor activity in peripheral T-cell lymphomas. A recommended phase II dosing is 600 mg/m2 on day 1, followed by 1,200 mg/m2 on days 2 to 5, every 21 days. A registration-enabling phase II study in relapsed/refractory PTCL (ClinicalTrials.gov identifier: NCT02495415) is ongoing. Clin Cancer Res; 23(16); 4550-5. ©2017 AACR.
Collapse
Affiliation(s)
- Ann M Mohrbacher
- Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Allen S Yang
- Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan Groshen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shivaani Kummar
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Martin E Gutierrez
- John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, New Jersey
| | - Min H Kang
- Cancer Center and Departments of Cell Biology and Biochemistry and Pharmacy, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Denice Tsao-Wei
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - C Patrick Reynolds
- Cancer Center and Departments of Cell Biology and Biochemistry, Pediatrics, and Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Edward M Newman
- Department of Cancer Biology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Barry J Maurer
- Cancer Center and Departments of Cell Biology and Biochemistry, Pediatrics, and Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
| |
Collapse
|
25
|
Dorff TB, Quinn DI, Pinski JK, Goldkorn A, Sadeghi S, Tsao-Wei D, Groshen SG, Kuhn P, Gross ME. Randomized phase II trial of abiraterone +/- dasatinib for patients with metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.167] [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
167 Background: Signaling via Src pathway is thought to be a mediator of resistance to androgen targeted therapy in mCRPC. We sought to determine whether adding the Src inhibitor dasatinib (Das) to abiraterone (Abi) would prolong progression free survival (PFS). Methods: Eligible patients had mCRPC which had progressed on androgen targeted therapies but no prior chemotherapy. Abi was prescribed at 1000 mg daily with prednisone 5 mg BID (both arms) and Das 100 mg daily added for Arm B. Primary endpoint was PFS at 24 weeks. Interim analysis planned after 48 subjects randomized but study terminated early due to lack of funding. PFS was evaluated using logrank testing and responses were compared using Fisher’s exact test. Circulating tumor cells (CTC) were evaluated with EPIC platform. Results: 26 men were randomized, 14 to Abi+Das and 12 to Abi. Median age was 67 (56-85), baseline PSA 19.8 (0.84-1387). Only 1 patient had received ketoconazole, none had received enzalutamide. With 30 months median follow-up, median PFS was 15.7 (95% CI:8.2, 31.1+) months for Abi+Das and 9 (95% CI: 4.4, 45.6+) months for Abi (p = 0.30). 86% were progression free at 24 weeks with Abi+Das compared to 75% on Abi. RECIST responses were seen in 5/14 (35%, 95% CI: 17%, 66%) with 2 CR on Abi+Das and 1/12 (8%, 95% CI (0%, 37%) on Abi (p = 0.16). With a specificity of 83%, the probability that the true rate of CR in intervention arm is higher or doubled (ex: 35% vs 17%) is 71%. Grade > 3 toxicities more common on Das arm included hypertension (43% vs 8% Abi), pleural effusion/dyspnea (14% vs 0 Abi), and gastrointestinal (25% vs 8%). CTC were detected at baseline in 8/17 evaluable patients (3/8 Abi, 5/9 Abi+Das), median 2.7 CTC/mL blood (range 0.5-59.7) At week 4, CTC increased in 1/8 (12.5%) on Abi vs 4/9 (44.4%) on Abi+Das but by week 12 CTC increases persisted in 2/8 (25%) on Abi and 1/9 (11%) on Abi+Das. Conclusions: Das did not significantly prolong PFS in combination with Abi although power was limited due to incomplete study cohort. Abi+Das was associated with robust objective responses including RECIST CR. Clinical trial information: NCT01685125.
Collapse
Affiliation(s)
- Tanya B. Dorff
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David I. Quinn
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Jacek K. Pinski
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Amir Goldkorn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Sarmad Sadeghi
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | - Susan G. Groshen
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Peter Kuhn
- University of Southern California, Los Angeles, CA
| | | |
Collapse
|
26
|
El-Khoueiry A, Gitlitz B, Cole S, Tsao-Wei D, Goldkorn A, Quinn D, Lenz H, Nieva J, Dorff T, Oswald M, Berg J, Menendez X, Karakozian K, Krasnoperov V, Liu R, Thomas J, Groshen S, Gill P. A first-in-human phase I study of sEphB4-HSA in patients with advanced solid tumors with expansion at the maximum tolerated dose (MTD) or recommended phase II dose (RP2D). Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32623-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
27
|
Villablanca JG, Volchenboum SL, Cho H, Kang MH, Cohn SL, Anderson CP, Marachelian A, Groshen S, Tsao-Wei D, Matthay KK, Maris JM, Hasenauer CE, Czarnecki S, Lai H, Goodarzian F, Shimada H, Reynolds CP. A Phase I New Approaches to Neuroblastoma Therapy Study of Buthionine Sulfoximine and Melphalan With Autologous Stem Cells for Recurrent/Refractory High-Risk Neuroblastoma. Pediatr Blood Cancer 2016; 63:1349-56. [PMID: 27092812 PMCID: PMC8992729 DOI: 10.1002/pbc.25994] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myeloablative therapy for high-risk neuroblastoma commonly includes melphalan. Increased cellular glutathione (GSH) can mediate melphalan resistance. Buthionine sulfoximine (BSO), a GSH synthesis inhibitor, enhances melphalan activity against neuroblastoma cell lines, providing the rationale for a Phase 1 trial of BSO-melphalan. PROCEDURES Patients with recurrent/resistant high-risk neuroblastoma received BSO (3 gram/m(2) bolus, then 24 grams/m(2) /day infusion days -4 to -2), with escalating doses of intravenous melphalan (20-125 mg/m(2) ) days -3 and -2, and autologous stem cells day 0 using 3 + 3 dose escalation. RESULTS Among 28 patients evaluable for dose escalation, one dose-limiting toxicity occurred at 20 mg/m(2) melphalan (grade 3 aspartate aminotransferase/alanine aminotransferase) and one at 80 mg/m(2) (streptococcal bacteremia, grade 4 hypotension/pulmonary/hypocalcemia) without sequelae. Among 25 patients evaluable for response, there was one partial response (PR) and two mixed responses (MRs) among eight patients with prior melphalan exposure; one PR and three MRs among 16 patients without prior melphalan; one stable disease with unknown melphalan history. Melphalan pharmacokinetics with BSO were similar to reports for melphalan alone. Melphalan Cmax for most patients was below the 10 μM concentration that showed neuroblastoma preclinical activity with BSO. CONCLUSIONS BSO (75 gram/m(2) ) with melphalan (125 mg/m(2) ) is tolerable with stem cell support and active in recurrent/refractory neuroblastoma. Further dose escalation is feasible and may increase responses.
Collapse
Affiliation(s)
- Judith G. Villablanca
- Department of Pediatrics, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California,Correspondence to: Judith G. Villablanca, Departments of Pediatrics, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #54, Los Angeles, CA 90027.,
| | - Samuel L. Volchenboum
- Department of Pediatrics, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Hwangeui Cho
- Cancer Center and Departments of Cell Biology & Biochemistry, Pediatrics, and Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Min H. Kang
- Cancer Center and Departments of Cell Biology & Biochemistry, Pediatrics, and Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Susan L. Cohn
- Department of Pediatrics, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | | | - Araz Marachelian
- Department of Pediatrics, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Susan Groshen
- Department of Preventative Medicine Statistics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Denice Tsao-Wei
- Department of Preventative Medicine Statistics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Katherine K. Matthay
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - John M. Maris
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Charlotte E. Hasenauer
- Department of Pediatrics, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Scarlett Czarnecki
- Department of Pediatrics, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hollie Lai
- Department of Radiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Fariba Goodarzian
- Department of Radiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hiro Shimada
- Department of Pathology and The Saban Research Institute, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Charles Patrick Reynolds
- Cancer Center and Departments of Cell Biology & Biochemistry, Pediatrics, and Medicine, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| |
Collapse
|
28
|
Dorff TB, Groshen S, Garcia A, Shah M, Tsao-Wei D, Pham H, Cheng CW, Brandhorst S, Cohen P, Wei M, Longo V, Quinn DI. Safety and feasibility of fasting in combination with platinum-based chemotherapy. BMC Cancer 2016; 16:360. [PMID: 27282289 PMCID: PMC4901417 DOI: 10.1186/s12885-016-2370-6] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/19/2016] [Indexed: 12/26/2022] Open
Abstract
Background Short-term starvation prior to chemotherapy administration protects mice against toxicity. We undertook dose-escalation of fasting prior to platinum-based chemotherapy to determine safety and feasibility in cancer patients. Methods 3 cohorts fasted before chemotherapy for 24, 48 and 72 h (divided as 48 pre-chemo and 24 post-chemo) and recorded all calories consumed. Feasibility was defined as ≥ 3/6 subjects in each cohort consuming ≤ 200 kcal per 24 h during the fast period without excess toxicity. Oxidative stress was evaluated in leukocytes using the COMET assay. Insulin, glucose, ketones, insulin-like growth factor-1 (IGF-1) and IGF binding proteins (IGFBPs) were measured as biomarkers of the fasting state. Results The median age of our 20 subjects was 61, and 85 % were women. Feasibility criteria were met. Fasting-related toxicities were limited to ≤ grade 2, most commonly fatigue, headache, and dizziness. The COMET assay indicated reduced DNA damage in leukocytes from subjects who fasted for ≥48 h (p = 0.08). There was a non-significant trend toward less grade 3 or 4 neutropenia in the 48 and 72 h cohorts compared to 24 h cohort (p = 0.17). IGF-1 levels decreased by 30, 33 and 8 % in the 24, 48 and 72 h fasting cohorts respectively after the first fasting period. Conclusion Fasting for 72 h around chemotherapy administration is safe and feasible for cancer patients. Biomarkers such as IGF-1 may facilitate assessment of differences in chemotherapy toxicity in subgroups achieving the physiologic fasting state. An onging randomized trial is studying the effect of 72 h of fasting. Trial registration NCT00936364, registered propectively on July 9, 2009. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2370-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tanya B Dorff
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, 1441 Eastlake Ave. #3440, Los Angeles, CA, 90033, USA
| | - Susan Groshen
- Department of Preventive Medicine, USC Keck School of Medicine, 1441 Eastlake Ave, #4427, Los Angeles, 90033, CA, United States
| | - Agustin Garcia
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, 1441 Eastlake Ave. #3440, Los Angeles, CA, 90033, USA
| | - Manali Shah
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, 1441 Eastlake Ave. #3440, Los Angeles, CA, 90033, USA
| | - Denice Tsao-Wei
- Department of Preventive Medicine, USC Keck School of Medicine, 1441 Eastlake Ave, #4427, Los Angeles, 90033, CA, United States
| | - Huyen Pham
- USC Keck School of Medicine, Department of Obstetrics and Gynecology, 1441 Eastlake Ave, #3440, Los Angeles, 90033, CA, United States
| | - Chia-Wei Cheng
- Longevity Institute, University of Southern California Davis School of Gerontology, Department of Biological Sciences, 3715 McClintock Avenue, Los Angeles, 90089, CA, United States
| | - Sebastian Brandhorst
- Longevity Institute, University of Southern California Davis School of Gerontology, Department of Biological Sciences, 3715 McClintock Avenue, Los Angeles, 90089, CA, United States
| | - Pinchas Cohen
- Longevity Institute, University of Southern California Davis School of Gerontology, Department of Biological Sciences, 3715 McClintock Avenue, Los Angeles, 90089, CA, United States
| | - Min Wei
- Longevity Institute, University of Southern California Davis School of Gerontology, Department of Biological Sciences, 3715 McClintock Avenue, Los Angeles, 90089, CA, United States
| | - Valter Longo
- Longevity Institute, University of Southern California Davis School of Gerontology, Department of Biological Sciences, 3715 McClintock Avenue, Los Angeles, 90089, CA, United States.
| | - David I Quinn
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, 1441 Eastlake Ave. #3440, Los Angeles, CA, 90033, USA.
| |
Collapse
|
29
|
DuBois SG, Marachelian A, Fox E, Kudgus RA, Reid JM, Groshen S, Malvar J, Bagatell R, Wagner L, Maris JM, Hawkins R, Courtier J, Lai H, Goodarzian F, Shimada H, Czarnecki S, Tsao-Wei D, Matthay KK, Mosse YP. Phase I Study of the Aurora A Kinase Inhibitor Alisertib in Combination With Irinotecan and Temozolomide for Patients With Relapsed or Refractory Neuroblastoma: A NANT (New Approaches to Neuroblastoma Therapy) Trial. J Clin Oncol 2016; 34:1368-75. [PMID: 26884555 DOI: 10.1200/jco.2015.65.4889] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Alisertib is an oral Aurora A kinase inhibitor with preclinical activity in neuroblastoma. Irinotecan and temozolomide have activity in patients with advanced neuroblastoma. The goal of this phase I study was to determine the maximum tolerated dose (MTD) of alisertib with irinotecan and temozolomide in this population. PATIENTS AND METHODS Patients age 1 to 30 years with relapsed or refractory neuroblastoma were eligible. Patients received alisertib tablets at dose levels of 45, 60, and 80 mg/m(2) per day on days 1 to 7 along with irinotecan 50 mg/m(2) intravenously and temozolomide 100 mg/m(2) orally on days 1 to 5. Dose escalation of alisertib followed the rolling six design. Samples for pharmacokinetic and pharmacogenomic testing were obtained. RESULTS Twenty-three patients enrolled, and 22 were eligible and evaluable for dose escalation. A total of 244 courses were administered. The MTD for alisertib was 60 mg/m(2), with mandatory myeloid growth factor support and cephalosporin prophylaxis for diarrhea. Thrombocytopenia and neutropenia of any grade were seen in the majority of courses (84% and 69%, respectively). Diarrhea in 55% of courses and nausea in 54% of courses were the most common nonhematologic toxicities. The overall response rate was 31.8%, with a 50% response rate observed at the MTD. The median number of courses per patient was eight (range, two to 32). Progression-free survival rate at 2 years was 52.4%. Pharmacokinetic testing did not show evidence of drug-drug interaction between irinotecan and alisertib. CONCLUSION Alisertib 60 mg/m(2) per dose for 7 days is tolerable with a standard irinotecan and temozolomide backbone and has promising response and progression-free survival rates. A phase II trial of this regimen is ongoing.
Collapse
Affiliation(s)
- Steven G DuBois
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY.
| | - Araz Marachelian
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Elizabeth Fox
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Rachel A Kudgus
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Joel M Reid
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Susan Groshen
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Jemily Malvar
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Rochelle Bagatell
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Lars Wagner
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - John M Maris
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Randall Hawkins
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Jesse Courtier
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Hollie Lai
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Fariba Goodarzian
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Hiroyuki Shimada
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Scarlett Czarnecki
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Denice Tsao-Wei
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Katherine K Matthay
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| | - Yael P Mosse
- Steven G. DuBois, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA; Araz Marachelian, Susan Groshen, Jemily Malvar, Hollie Lai, Fariba Goodarzian, Hiroyuki Shimada, Scarlett Czarnecki, and Denice Tsao-Wei, University of Southern California Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles; Randall Hawkins, Jesse Courtier, and Katherine K. Matthay, University of California, San Francisco, School of Medicine and Benioff Children's Hospital, San Francisco, CA; Elizabeth Fox, Rochelle Bagatell, John M. Maris, and Yael P. Mosse, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Rachel A. Kudgus and Joel M. Reid, Mayo Clinic, Rochester, MN; and Lars Wagner, University of Kentucky College of Medicine, Lexington, KY
| |
Collapse
|
30
|
Yanik GA, Villablanca JG, Maris JM, Weiss B, Groshen S, Marachelian A, Park JR, Tsao-Wei D, Hawkins R, Shulkin BL, Jackson H, Goodarzian F, Shimada H, Courtier J, Hutchinson R, Haas-Koga D, Hasenauer CB, Czarnecki S, Katzenstein HM, Matthay KK. 131I-Metaiodobenzylguanidine with Intensive Chemotherapy and Autologous Stem Cell Transplantation for High-Risk Neuroblastoma. A New Approaches to Neuroblastoma Therapy (NANT) Phase II Study. Biol Blood Marrow Transplant 2015; 21:673-81. [DOI: 10.1016/j.bbmt.2014.12.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 12/09/2014] [Indexed: 12/26/2022]
|
31
|
DuBois SG, Groshen S, Park JR, Haas-Kogan DA, Yang X, Geier E, Chen E, Giacomini K, Weiss B, Cohn SL, Granger MM, Yanik GA, Hawkins R, Courtier J, Jackson H, Goodarzian F, Shimada H, Czarnecki S, Tsao-Wei D, Villablanca JG, Marachelian A, Matthay KK. Phase I Study of Vorinostat as a Radiation Sensitizer with 131I-Metaiodobenzylguanidine (131I-MIBG) for Patients with Relapsed or Refractory Neuroblastoma. Clin Cancer Res 2015; 21:2715-21. [PMID: 25695691 DOI: 10.1158/1078-0432.ccr-14-3240] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 02/07/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE (131)I-metaiodobenzylguanidine (MIBG) is a radiopharmaceutical with activity in neuroblastoma. Vorinostat is a histone deacetylase inhibitor that has radiosensitizing properties. The goal of this phase I study was to determine the MTDs of vorinostat and MIBG in combination. EXPERIMENTAL DESIGN Patients ≤ 30 years with relapsed/refractory MIBG-avid neuroblastoma were eligible. Patients received oral vorinostat (dose levels 180 and 230 mg/m(2)) daily days 1 to 14. MIBG (dose levels 8, 12, 15, and 18 mCi/kg) was given on day 3 and peripheral blood stem cells on day 17. Alternating dose escalation of vorinostat and MIBG was performed using a 3+3 design. RESULTS Twenty-seven patients enrolled to six dose levels, with 23 evaluable for dose escalation. No dose-limiting toxicities (DLT) were seen in the first three dose levels. At dose level 4 (15 mCi/kg MIBG/230 mg/m(2) vorinostat), 1 of 6 patients had DLT with grade 4 hypokalemia. At dose level 5 (18 mCi/kg MIBG/230 mg/m(2) vorinostat), 2 patients had dose-limiting bleeding (one grade 3 and one grade 5). At dose level 5a (18 mCi/kg MIBG/180 mg/m(2) vorinostat), 0 of 6 patients had DLT. The most common toxicities were neutropenia and thrombocytopenia. The response rate was 12% across all dose levels and 17% at dose level 5a. Histone acetylation increased from baseline in peripheral blood mononuclear cells collected on days 3 and 12 to 14. CONCLUSIONS Vorinostat at 180 mg/m(2)/dose is tolerable with 18 mCi/kg MIBG. A phase II trial comparing this regimen to single-agent MIBG is ongoing.
Collapse
Affiliation(s)
- Steven G DuBois
- Department of Pediatrics, University of California San Francisco, San Francisco, California.
| | - Susan Groshen
- Department of Preventive Medicine, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Julie R Park
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Xiaodong Yang
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Ethan Geier
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California
| | - Eugene Chen
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California
| | - Kathy Giacomini
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California
| | - Brian Weiss
- Department of Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Susan L Cohn
- Department of Pediatrics, University of Chicago School of Medicine, Chicago, Illinois
| | - M Meaghan Granger
- Department of Pediatrics, Cook Children's Hospital, Fort Worth, Texas
| | - Gregory A Yanik
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Randall Hawkins
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Jesse Courtier
- Department of Radiology, University of California San Francisco, San Francisco, California
| | - Hollie Jackson
- Department of Radiology, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Fariba Goodarzian
- Department of Radiology, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Hiroyuki Shimada
- Department of Pathology, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Scarlett Czarnecki
- Department of Pediatrics, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Denice Tsao-Wei
- Department of Preventive Medicine, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Judith G Villablanca
- Department of Pediatrics, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Araz Marachelian
- Department of Pediatrics, USC Keck School of Medicine and Children's Hospital Los Angeles, Los Angeles, California
| | - Katherine K Matthay
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| |
Collapse
|
32
|
Rochefort H, El-Khoueiry AB, To CA, Xu Y, Xu T, Tsao-Wei D, Groshen SG, Wei J, Kossari N, Alexopoulos S, Goldkorn A. Circulating tumor cell capture in hepatocellular carcinoma (HCC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e22033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Yucheng Xu
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Tong Xu
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Jenny Wei
- University of Pennsylvania, Philadelphia, PA
| | | | | | - Amir Goldkorn
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| |
Collapse
|
33
|
Pinski J, Dorff T, Hawes D, Tsao-Wei D, Quinn D, Goldkorn A, Liskovsky G, Vogelzang N, Groshen S, Ji L. Updated Analysis of a Combination Herbal Supplement Trial in Biochemically Recurrent Prostate Cancer. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33523-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
34
|
Matthay KK, Weiss B, Villablanca JG, Maris JM, Yanik GA, Dubois SG, Stubbs J, Groshen S, Tsao-Wei D, Hawkins R, Jackson H, Goodarzian F, Daldrup-Link H, Panigrahy A, Towbin A, Shimada H, Barrett J, Lafrance N, Babich J. Dose escalation study of no-carrier-added 131I-metaiodobenzylguanidine for relapsed or refractory neuroblastoma: new approaches to neuroblastoma therapy consortium trial. J Nucl Med 2012; 53:1155-63. [PMID: 22700000 DOI: 10.2967/jnumed.111.098624] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED (131)I-metaiodobenzylguanidine (MIBG) is specifically taken up in neuroblastoma, with a response rate of 20%-37% in relapsed disease. Nonradioactive carrier MIBG molecules inhibit uptake of (131)I-MIBG, theoretically resulting in less tumor radiation and increased risk of cardiovascular toxicity. Our aim was to establish the maximum tolerated dose of no-carrier-added (NCA) (131)I-MIBG, with secondary aims of assessing tumor and organ dosimetry and overall response. METHODS Eligible patients were 1-30 y old with resistant neuroblastoma, (131)I-MIBG uptake, and cryopreserved hematopoietic stem cells. A diagnostic dose of NCA (131)I-MIBG was followed by 3 dosimetry scans to assess radiation dose to critical organs and soft-tissue tumors. The treatment dose of NCA (131)I-MIBG (specific activity, 165 MBq/μg) was adjusted as necessary on the basis of critical organ tolerance limits. Autologous hematopoietic stem cells were infused 14 d after therapy to abrogate prolonged myelosuppression. Response and toxicity were evaluated on day 60. The NCA (131)I-MIBG was escalated from 444 to 777 MBq/kg (12-21 mCi/kg) using a 3 + 3 design. Dose-limiting toxicity (DLT) was failure to reconstitute neutrophils to greater than 500/μL within 28 d or platelets to greater than 20,000/μL within 56 d, or grade 3 or 4 nonhematologic toxicity by Common Terminology Criteria for Adverse Events (version 3.0) except for predefined exclusions. RESULTS Three patients each were evaluable at 444, 555, and 666 MBq/kg without DLT. The dose of 777 MBq/kg dose was not feasible because of organ dosimetry limits; however, 3 assigned patients were evaluable for a received dose of 666 MBq/kg, providing a total of 6 patients evaluable for toxicity at 666 MBq/kg without DLT. Mean whole-body radiation was 0.23 mGy/MBq, and mean organ doses were 0.92, 0.82, and 1.2 mGy/MBq of MIBG for the liver, lung, and kidney, respectively. Eight patients had 13 soft-tissue lesions with tumor-absorbed doses of 26-378 Gy. Four of 15 patients had a complete (n = 1) or partial (n = 3) response, 1 had a mixed response, 4 had stable disease, and 6 had progressive disease. CONCLUSION NCA (131)I-MIBG with autologous peripheral blood stem cell transplantation is feasible at 666 MBq/kg without significant nonhematologic toxicity and with promising activity.
Collapse
|
35
|
Liu SV, Schally AV, Dorff TB, Tsao-Wei D, Groshen SG, Hawes D, Xiong S, Quinn DI, Tai YC, Block NL, Engel J, Pinski JK. A phase I trial of AEZS-108 in castration- and taxane-resistant prostate cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e15153] [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
e15153 Background: The prognosis for patients with castration-resistant prostate cancer (CRPC) remains suboptimal and targeted therapies should be explored. One potential target is the receptor for luteinizing hormone-releasing hormone (LHRH), which is highly expressed on prostate cancer cells. AEZS-108 is an LHRH-cytotoxic hybrid whose rational design covalently couples an LHRH agonist and the cytotoxic doxorubicin. AEZS-108 exploits the presence of LHRH receptors to target delivery of the cytotoxic. We report the phase I trial of AEZS-108 in men with taxane-resistant CRPC. We also report correlative studies of a novel circulating tumor cell (CTC) capture device that will provide enumeration of CTCs and results from AEZS-108 internalization studies that exploit the auto-fluorescence of doxorubicin in captured CTCs. Methods: This is a single-arm, dose-escalation phase I study in men with CRPC to confirm the dose established in a completed phase I trial in females. Eligibility criteria included adequate organ function and progression of disease despite prior therapy with an LHRH agonist and at least one taxane-based regimen. Patients were required to discontinue LHRH agonists to avoid receptor competition. Due to potential cardiotoxicity, patients with an ejection fraction < 50% or prior exposure to doxorubicin or mitoxantrone were excluded. Pituitary function was closely monitored. Patients received AEZS-108 every 21 days for up to 6 cycles until progression or unacceptable toxicity. The primary endpoint was safety. Results: Enrollment began in November 2010 and is ongoing. Currently, 13 patients have been enrolled. The first two planned dose levels had no dose-limiting toxicities observed. Two patients on the third dose level experienced a dose limiting toxicity. The second dose level has been reopened for expansion. There have been no cardiac or pituitary toxicities. At the time of submission, a decrease in PSA was noted in 6 of the 13 patients. Final results detailing safety, response and the suggested dose for the phase II portion will be reported. All correlative studies will also be reported. Conclusions: In general, AEZS-108 has been well tolerated. The phase II portion of the study will begin once the MTD is established.
Collapse
Affiliation(s)
- Stephen V. Liu
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Andrew V Schally
- Veterans Affairs Medical Center, University of Miami Miller School of Medicine, Miami, FL
| | - Tanya B. Dorff
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Denice Tsao-Wei
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Susan G. Groshen
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Debra Hawes
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Shigang Xiong
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - David I. Quinn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Yu-Chong Tai
- California Institute of Technology, Pasadena, CA
| | - Norman L. Block
- Veterans Affairs Medical Center, University of Miami Miller School of Medicine, Miami, FL
| | | | - Jacek K. Pinski
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| |
Collapse
|
36
|
DuBois SG, Chesler L, Groshen S, Hawkins R, Goodarzian F, Shimada H, Yanik G, Tagen M, Stewart C, Mosse YP, Maris JM, Tsao-Wei D, Marachelian A, Villablanca JG, Matthay KK. Phase I study of vincristine, irinotecan, and ¹³¹I-metaiodobenzylguanidine for patients with relapsed or refractory neuroblastoma: a new approaches to neuroblastoma therapy trial. Clin Cancer Res 2012; 18:2679-86. [PMID: 22421195 DOI: 10.1158/1078-0432.ccr-11-3201] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE (131)I-metaiodobenzylguanidine (MIBG) is a targeted radiopharmaceutical with activity in patients with relapsed or refractory neuroblastoma. Irinotecan is a known radiosensitizer with activity in neuroblastoma. This phase I study aimed to determine the recommended phase 2 dose of MIBG together with fixed doses of vincristine and irinotecan. EXPERIMENTAL DESIGN Patients 1 to 30 years old with relapsed or refractory neuroblastoma and MIBG-avid tumors were eligible. All patients had autologous hematopoietic stem cells (PBSC) available and met standard phase I organ function requirements. Irinotecan (20 mg/m(2)/dose IV) was given on days 0 to 4 and 7 to 11, with vincristine (1.5 mg/m(2) IV) on days 0 and 7. MIBG was given on day 1 following a 3 + 3 phase I dose escalation design starting at 8 mCi/kg MIBG. PBSCs were administered at dose level 8 mCi/kg for prolonged myelosuppression and for all patients at 12 mCi/kg or more. RESULTS Twenty-four patients evaluable for dose escalation (median age, 6.7 years; range, 1.9-26.8 years) received 1 (n = 17), 2 (n = 5), or 3 (n = 2) cycles of therapy. Myelosuppression and diarrhea were the most common toxicities. Two of 6 patients at the 18 mCi/kg dose level had dose-limiting toxicity (DLT), including one with protocol-defined DLT with prolonged mild aspartate aminotransferase elevation. Eighteen mCi/kg was the recommended phase 2 dose. Six additional patients were treated at 18 mCi/kg, with one additional DLT. Responses (2 complete and 4 partial responses) occurred in 6 of 24 (25%) evaluable patients. CONCLUSIONS MIBG is tolerable and active at 18 mCi/kg with standard doses of vincristine and irinotecan.
Collapse
Affiliation(s)
- Steven G DuBois
- Department of Pediatrics, UCSF School of Medicine, San Francisco, California 94143, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Mitra A, Tsao-Wei D, Dorff T, Groshen S, Miranda G, Schuckman A, Daneshmand S, Gill I, Skinner D, Skinner E, Quinn D. 1589 INFLUENCE OF SMOKING HISTORY ON BLADDER CANCER PATIENT OUTCOME FOLLOWING RADICAL CYSTECTOMY. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
38
|
Mitra A, Castelao J, Hawes D, Tsao-Wei D, Jiang X, Shi S, Young L, Datar R, Skinner E, Stein J, Groshen S, Yu M, Ross R, Skinner D, Cortessis V, Cote R. 1057 PROTEIN ALTERATIONS PREDICT BLADDER CANCER OUTCOME INDEPENDENT OF CLINICOPATHOLOGIC PROGNOSTIC CRITERIA AND TOBACCO SMOKE EXPOSURE. J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
39
|
Mitra A, Jiang X, Castelao J, Hawes D, Tsao-Wei D, Shi S, Young L, Datar R, Skinner E, Stein J, Groshen S, Ross R, Triche T, Skinner D, Jones P, Cote R. 962 MOLECULAR ALTERATIONS IN BLADDER CANCER ASSOCIATED WITH CARCINOGEN EXPOSURE AND THEIR PROGNOSTIC IMPACT: A LOS ANGELES COUNTY EXPERIENCE. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
40
|
Saha B, Kaur P, Tsao-Wei D, Naritoku WY, Groshen S, Datar RH, Jones LW, Imam SA. Unmethylated E-cadherin gene expression is significantly associated with metastatic human prostate cancer cells in bone. Prostate 2008; 68:1681-8. [PMID: 18712716 DOI: 10.1002/pros.20836] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The concurrent determination of methylation status of E-cadherin gene and E-cadherin protein expression remains scant in metastatic prostate cancer cells in bone, the most prevalent site for metastatic growth. Therefore, the study was undertaken to ascertain the methylation status of E-cadherin gene, a most frequent and known epigenetic mechanism of its regulation, and the protein expression in prostate tissue biopsy specimen. METHODS The methylation of E-cadherin gene was determined by methylation specific-PCR and the protein expression by immunohistochemical method in the consecutive sections of each prostate tissue biopsy specimen. RESULTS The unmethylated E-cadherin gene and homogeneous E-cadherin protein expression was significantly associated with BPH as compared to the primary prostate carcinoma (Fisher's Exact P < 0.001). A significant association was observed between the concurrent methylated gene and markedly reduced expression of the protein in the primary prostate cancer cells as compared to the BPH cells, suggesting methylation-dependent regulation of the gene expression in these cases. In contrast to the primary cancer, a highly significant increase in the frequency of metastatic prostate cancer cells in bone exhibited the concurrent expression of unmethylated gene and homogeneous protein (Fisher's Exact P < 0.001). CONCLUSIONS The study clearly demonstrated a significant association of the concurrent expression of unmethylated E-cadherin gene and E-cadherin protein with metastatic prostate cancer cells in bone, and that its expression may have a role in the intercellular adhesion in the formation of metastatic lesions in bone.
Collapse
Affiliation(s)
- Baisakhi Saha
- Molecular Pathology Program, Huntington Medical Research Institutes, Pasadena, California 91101, USA
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Saha B, Arase A, Imam SS, Tsao-Wei D, Naritoku WY, Groshen S, Jones LW, Imam SA. Overexpression of E-cadherin and beta-catenin proteins in metastatic prostate cancer cells in bone. Prostate 2008; 68:78-84. [PMID: 18008331 DOI: 10.1002/pros.20670] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The expression of E-cadherin in the intercellular adhesion of metastatic prostate cancer cells in bone, which is the most prevalent site of metastatic growth, remains elusive. METHODS The aim of the study was to compare the concurrent membranous expression of E-cadherin and beta-catenin proteins, the state which is known to be associated with the cellular adhesion function of E-cadherin, in prostate biopsy tissue specimens by immunohistochemical staining method. The expression patterns of E-cadherin or beta-catenin were classified as homogeneous (most cells exhibiting positively), heterogeneous (a few scattered patches of cells with positivity) or negative. RESULTS Benign prostate hyperplasia cells exhibited homogeneous expression of both E-cadherin and beta-catenin in 9 of 11 (82%), whereas the primary prostate cancer cells were homogeneously positive for both proteins only in 4 of 22 (18%) of the cases. The results are similar to those reported in literature. However, in contrast to the primary cancer, a significantly increased frequency of the metastatic prostate cancer cells in bone exhibited homogeneous expression of E-cadherin and beta-catenin in 12 of 17 (71%) of the cases. A statistically significant association was observed between the overexpression of both proteins and the metastatic prostate cancer cells in bone (Fisher's exact P < 0.001). CONCLUSIONS The result of the study demonstrated for the first time that the membranous overexpression of E-cadherin and beta-catenin are significantly associated with the metastatic prostate cancer cells in bone and that the high frequency of expression suggest their involvement in the intercellular adhesion of the metastatic cells in bone.
Collapse
Affiliation(s)
- Baisakhi Saha
- Gene Therapy Program, Huntington Medical Research Institutes, Pasadena, California 91101, USA
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
4509 Background: There is extensive literature on occurrence of late effects of cisplatin-based chemotherapy, but it comes from centers of excellence and may reflect case selection or ascertainment biases. Funded by the NIH SEER Program and the Lance Armstrong Foundation, we studied community-based late outcomes via identification of cases from the Los Angeles SEER Tumor Registry and comparison with a control group. Methods: We identified 951 patients treated in Los Angeles County through the records of the L.A. SEER Cancer Registry/Cancer Surveillance Program (CSP) for 1983–1987, giving a minimum follow-up of 12 years. Consent was obtained from physician of record and forms sent to the patients, requesting information about a broad range of demographic, treatment-related and psycho-social issues. In addition, patients were asked to provide a “control”, a friend of approximately the same age at time of diagnosis, known to the patient before diagnosis and known not to have a history of testis cancer. Questionnaires were also sent to controls, to allow data comparison with patients. Anticipated initial difficulties included mobility of young males and invalid addresses. This occurred in > 50% of cases, and we used a planned strategy for acquisition through State agencies, Department of Motor Vehicles, etc. Results: Surveys were returned by 298 cases and 67 control subjects, and 35 patients refused. In 1983–87, success rates were lower, and 142 patients had died. An unexpected problem was reluctance or inability of subjects to identify friends of comparable age to provide a control population. Differences in groups are summarized in the Table. Conclusions: Long term survivors with GCT have an excess of late toxicity, including cardiovascular, neurological, hematologic, musculoskeletal and neoplastic problems, which increase with time. These data should assist in design of surveillance protocols. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- D. Raghavan
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH; USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - M. S. Davis
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH; USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - D. Tsao-Wei
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH; USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - R. Ross
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH; USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - S. Groshen
- Cleveland Clinic Taussig Cancer Center, Cleveland, OH; USC Norris Comprehensive Cancer Center, Los Angeles, CA
| |
Collapse
|
43
|
Cremer M, Jamshidi RM, Muderspach L, Tsao-Wei D, Felix JC, Blumenthal PD. Digital camera assessment for detection of cervical intraepithelial neoplasia in rural El Salvador. Int J Gynaecol Obstet 2006; 91:42-6. [PMID: 16043183 DOI: 10.1016/j.ijgo.2005.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 05/23/2005] [Accepted: 05/23/2005] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the feasibility of digital photography for primary cervical cancer screening in a low-resource setting in El Salvador. METHODS Three independent examiners performed Pap test, visual inspection, digital camera assessment and colposcopy on each subject. RESULTS Lesions were detected in 99 of 504 patients (20%) by visual inspection, 72/504 (14%) by DART and 90/504 (18%) by colposcopic impression. Seven of 504 patients (1.3%) had CIN on histology. Pap detected 2 of 7 subjects (29% sensitivity) (C.I. 4%, 56%), visual inspection detected 5 of 7 (71% sensitivity, C.I. 34%, 95%), digital assessment detected 6 of 7 (86% sensitivity C. I. 45%, 99%), and colposcopic impression detected 5 of 7 (71% sensitivity, C.I. 34%, 95%). CONCLUSION This small pilot trial demonstrates the potential value and feasibility of performing digital camera assessment of the reproductive tract on women in a developing country setting.
Collapse
Affiliation(s)
- M Cremer
- University of Southern California-Women's and Children's Hospital, 1240 N. Mission Rd., Rm 2L33, Los Angeles, CA 90033, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Raghavan D, Brandes LJ, Klapp K, Snyder T, Styles E, Tsao-Wei D, Lieskovsky G, Quinn DI, Ramsey EW. PHASE II TRIAL OF TESMILIFENE PLUS MITOXANTRONE AND PREDNISONE FOR HORMONE REFRACTORY PROSTATE CANCER: HIGH SUBJECTIVE AND OBJECTIVE RESPONSE IN PATIENTS WITH SYMPTOMATIC METASTASES. J Urol 2005; 174:1808-13; discussion 1813. [PMID: 16217292 DOI: 10.1097/01.ju.0000176799.63184.99] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Symptomatic, hormone refractory prostate cancer (HRCAP) is a major cause of morbidity with a median survival of less than 12 months and a 2-year survival of only up to 10% in most series. Mitoxantrone has been approved by the Food and Drug Administration for HRCAP. Preliminary data suggest that DPPE (N,N-diethyl-2-[4-(phenylmethyl) phenoxy]-ethanamine) or tesmilifene modulates cytotoxics to enhance the anticancer effect. In this phase II trial we assessed whether there is sufficient evidence of enhanced efficacy of DPPE and mitoxantrone to lead to a phase III clinical trial. MATERIALS AND METHODS A total of 29 patients with a median age of 73 years, of whom 10% were older than 80 years, with progressive HRCAP received 5.3 mg/kg DPPE intravenously every 3 weeks, 12 mg/m mitoxantrone intravenously every weeks and 5 mg prednisone orally twice daily. All patients had pain at presentation, while 97% had bone metastases, 10% had liver metastases and 17% had lung metastases. Median prostate specific antigen (PSA) was 210 ng/ml (IQR 77 to 430). RESULTS Of the patients 75% had some pain improvement, 66% had decreased analgesia, 59% had a PSA decrease of 50% or greater and 45% had a PSA decrease of 75% or greater. Actual (not actuarial) 2-year survival was 21%. CONCLUSIONS Despite major limitations of historical comparison the PSA decrease and decreased symptoms with DPPE-mitoxantrone-prednisone compare favorably to those of mitoxantrone-prednisone and docetaxel-estramustine in the literature. The 2-year survival rate of 21% mandates further assessment. This will be tested in a phase III Southwest Oncology Group trial.
Collapse
Affiliation(s)
- D Raghavan
- University of Southern California, Los Angeles, California, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Garcia AA, Oza AM, Hirte H, Fleming G, Tsao-Wei D, Roman L, Swenson S, Gandara D, Scudder S, Morgan R. Interim report of a phase II clinical trial of bevacizumab (Bev) and low dose metronomic oral cyclophosphamide (mCTX) in recurrent ovarian (OC) and primary peritoneal carcinoma: A California Cancer Consortium Trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5000] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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)
- A. A. Garcia
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - A. M. Oza
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - H. Hirte
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - G. Fleming
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - D. Tsao-Wei
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - L. Roman
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - S. Swenson
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - D. Gandara
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - S. Scudder
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| | - R. Morgan
- Cedars-Sinai Medcl Ctr, Los Angeles, CA; Princess Margaret Hosp, Toronto, ON, Canada; Univ of Chicago, Chicago, IL; USC Norris Cancer Ctr, Los Angeles, CA; Univ of California-Davis, Sacramento, CA; City of Hope Cancer Ctr, Duarte, CA
| |
Collapse
|
46
|
Abstract
BACKGROUND A retrospective comparison evaluating survival in two well-matched cohorts of patients with cytologically positive neoplastic meningitis (NM) presenting with or without encephalopathy. METHODS Two cohorts were studied: 20 with and 20 without of NM-related encephalopathy defined as a confusional syndrome. Cohorts were matched with respect to age, primary tumor, performance status, absence of CSF compartmentalization and absence of neuroradiographic bulky CNS disease. Primary tumor histology included the following: breast(10 patients); non-small cell lung cancer (8); non-Hodgkin's lymphoma (8); colorectal cancer (6); melanoma (4); small cell lung cancer (2); prostate cancer (2). NM at presentation revealed: encephalopathy (20 patients); spinal cord dysfunction (18); and cranial neuropathy (15). Radiotherapy was administered to 31 patients (whole brain only in 17 patients; restricted spine only in 8 patients; whole brain and restricted spine in 6 patients). All patients received intraventricular chemotherapy and 16 patients received concurrent tumor-specific systemic chemotherapy. RESULTS Median survival was 2.5 months (range 1.5-5 months) in the cohort with NM-related encephalopathy compared to 6 months (range: 2-10 months) in the cohort without NM-related encephalopathy (p < 0.001). No treatment-related deaths were observed. All patients demonstrated progressive disease and died of either NM or systemic cancer. CONCLUSIONS NM-related encephalopathy is a clinical variable that predicts for poor survival in patients with NM. As a consequence, patients with NM-related encephalopathy may be best served by offering supportive care.
Collapse
Affiliation(s)
- Marc C Chamberlain
- Department of Neurology, University of Southern California, Norris Comprehensive Cancer and Hospital, 1441 Eastlake Avenue, Los Angeles, CA 90033-0804, USA.
| | | | | |
Collapse
|
47
|
Schneider S, Uchida K, Brabender J, Baldus SE, Yochim J, Danenberg KD, Salonga D, Chen P, Tsao-Wei D, Groshen S, Hoelscher AH, Schneider PM, Danenberg PV. Downregulation of TS, DPD, ERCC1, GST-Pi, EGFR, and HER2 gene expression after neoadjuvant three-modality treatment in patients with esophageal cancer. J Am Coll Surg 2005; 200:336-44. [PMID: 15737843 DOI: 10.1016/j.jamcollsurg.2004.10.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Revised: 07/20/2004] [Accepted: 10/29/2004] [Indexed: 01/06/2023]
Abstract
BACKGROUND To find out if neoadjuvant therapy could alter tumor response determinants that might affect tumor sensitivity to the treatment, we investigated intratumoral expressions of genes associated with chemosensitivity, radiosensitivity, or both before and after radiochemotherapy. STUDY DESIGN Twenty-four patients with locally advanced, resectable esophageal cancer (cT2-4,Nx,M0) received neoadjuvant 5-FU/cisplatin/36 Gy treatment followed by transthoracic en bloc esophagectomy. Expression levels of thymidylate synthase, dihydropyrimidine dehydrogenase, excision repair cross-complementing gene 1 , glutathione S-transferase Pi, epidermal growth factor receptor, and HER2 were measured in matched preradiochemotherapy endoscopic tumor biopsies and in postradiochemotherapy resection specimens. mRNA was isolated from formalin-fixed, paraffin-embedded, laser microdissected tumor tissues, and a quantitative fluorescent dye real-time reverse transcription polymerase chain reaction system was used for gene expression measurement. RESULTS There was a significant reduction in the expression levels of thymidylate synthase (p < 0.01), dihydropyrimidine dehydrogenase (p = 0.03), excision repair cross-complementing gene 1 (p < 0.01), glutathione S-transferase Pi (p = 0.03), HER2 (p < 0.01), and epidermal growth factor receptor (p = 0.04). The change in the levels of epidermal growth factor receptor mRNA in post- compared with pretreatment specimens was significantly associated with the histopathologic grade of regression (p = 0.01). CONCLUSIONS The expression levels of a set of genes that are possible determinants of 5-FU/cisplatin/radiation therapy antitumor activity are significantly downregulated by neoadjuvant radiochemotherapy in esophageal cancer.
Collapse
Affiliation(s)
- Sylke Schneider
- Department of Molecular Biology and Biochemistry and Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Two cohorts of 20 patients diagnosed with neoplastic meningitis (NM) with or without encephalopathy were matched with respect to age, sex, primary tumor, and performance status. Median survival was 10 weeks (range 6 to 20 weeks) in the cohort with NM-related encephalopathy compared to 24 weeks (range 8 to 40 weeks) in the cohort without NM-related encephalopathy (p < 0.001). NM-related encephalopathy is a clinical variable that predicts for poor survival in patients with NM.
Collapse
Affiliation(s)
- Marc C Chamberlain
- Department of Preventive Medicine, USC/Norris Cancer Center, University of Southern California, Los Angeles, USA.
| | | | | |
Collapse
|
49
|
Garcia AA, Morgan R, McNamara M, Scudder S, Tsao-Wei D, Groshen S, Frgala T, Kim Y, Reynolds CP. Phase II trial of fenretinide (4-HPR) in recurrent ovarian and primary peritoneal carcinoma: A California Cancer Consortium trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5056] [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)
- A. A. Garcia
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| | - R. Morgan
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| | - M. McNamara
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| | - S. Scudder
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| | - D. Tsao-Wei
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| | - S. Groshen
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| | - T. Frgala
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| | - Y. Kim
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| | - C. P. Reynolds
- University of Southern California, Los Angeles, CA; City of Hope, Duarte, CA; University of California-Davis, Davis, CA
| |
Collapse
|
50
|
El-Khoueiry AB, Tagawa ST, Quinn DI, Panares R, Tsao-Wei D, Stein J, Skinner DG, Raghavan D. Adjuvant gemcitabine and cisplatin (GC) for locally advanced cancer of the bladder after radical cystectomy: A USC experience with molecular correlates. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. B. El-Khoueiry
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - S. T. Tagawa
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - D. I. Quinn
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - R. Panares
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - D. Tsao-Wei
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - J. Stein
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - D. G. Skinner
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - D. Raghavan
- University of Southern California, Keck School of Medicine, Los Angeles, CA
| |
Collapse
|