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Nicosia L, Spencer GJ, Brooks N, Amaral FMR, Basma NJ, Chadwick JA, Revell B, Wingelhofer B, Maiques-Diaz A, Sinclair O, Camera F, Ciceri F, Wiseman DH, Pegg N, West W, Knurowski T, Frese K, Clegg K, Campbell VL, Cavet J, Copland M, Searle E, Somervaille TCP. Therapeutic targeting of EP300/CBP by bromodomain inhibition in hematologic malignancies. Cancer Cell 2023; 41:2136-2153.e13. [PMID: 37995682 DOI: 10.1016/j.ccell.2023.11.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/07/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023]
Abstract
CCS1477 (inobrodib) is a potent, selective EP300/CBP bromodomain inhibitor which induces cell-cycle arrest and differentiation in hematologic malignancy model systems. In myeloid leukemia cells, it promotes rapid eviction of EP300/CBP from an enhancer subset marked by strong MYB occupancy and high H3K27 acetylation, with downregulation of the subordinate oncogenic network and redistribution to sites close to differentiation genes. In myeloma cells, CCS1477 induces eviction of EP300/CBP from FGFR3, the target of the common (4; 14) translocation, with redistribution away from IRF4-occupied sites to TCF3/E2A-occupied sites. In a subset of patients with relapsed or refractory disease, CCS1477 monotherapy induces differentiation responses in AML and objective responses in heavily pre-treated multiple myeloma. In vivo preclinical combination studies reveal synergistic responses to treatment with standard-of-care agents. Thus, CCS1477 exhibits encouraging preclinical and early-phase clinical activity by disrupting recruitment of EP300/CBP to enhancer networks occupied by critical transcription factors.
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Affiliation(s)
- Luciano Nicosia
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Gary J Spencer
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | | | - Fabio M R Amaral
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Naseer J Basma
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - John A Chadwick
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Bradley Revell
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Bettina Wingelhofer
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Alba Maiques-Diaz
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Oliver Sinclair
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Francesco Camera
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Filippo Ciceri
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK
| | - Daniel H Wiseman
- Epigenetics of Haematopoiesis Group, The University of Manchester, Manchester M20 4BX, UK
| | - Neil Pegg
- CellCentric Ltd., Cambridge CB10 1XL, UK
| | - Will West
- CellCentric Ltd., Cambridge CB10 1XL, UK
| | | | - Kris Frese
- CellCentric Ltd., Cambridge CB10 1XL, UK
| | | | | | - James Cavet
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Mhairi Copland
- Paul O'Gorman Leukaemia Research Centre, University of Glasgow, Glasgow G12 0YN, UK
| | - Emma Searle
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Tim C P Somervaille
- Leukaemia Biology Laboratory, Cancer Research UK Manchester Institute, The University of Manchester, Manchester M20 4BX, UK; The Christie NHS Foundation Trust, Manchester M20 4BX, UK.
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2
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Lesokhin AM, Tomasson MH, Arnulf B, Bahlis NJ, Miles Prince H, Niesvizky R, Rodrίguez-Otero P, Martinez-Lopez J, Koehne G, Touzeau C, Jethava Y, Quach H, Depaus J, Yokoyama H, Gabayan AE, Stevens DA, Nooka AK, Manier S, Raje N, Iida S, Raab MS, Searle E, Leip E, Sullivan ST, Conte U, Elmeliegy M, Czibere A, Viqueira A, Mohty M. Elranatamab in relapsed or refractory multiple myeloma: phase 2 MagnetisMM-3 trial results. Nat Med 2023; 29:2259-2267. [PMID: 37582952 PMCID: PMC10504075 DOI: 10.1038/s41591-023-02528-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 57.0] [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: 06/18/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
Elranatamab is a humanized B-cell maturation antigen (BCMA)-CD3 bispecific antibody. In the ongoing phase 2 MagnetisMM-3 trial, patients with relapsed or refractory multiple myeloma received subcutaneous elranatamab once weekly after two step-up priming doses. After six cycles, persistent responders switched to biweekly dosing. Results from cohort A, which enrolled patients without prior BCMA-directed therapy (n = 123) are reported. The primary endpoint of confirmed objective response rate (ORR) by blinded independent central review was met with an ORR of 61.0% (75/123); 35.0% ≥complete response. Fifty responders switched to biweekly dosing, and 40 (80.0%) improved or maintained their response for ≥6 months. With a median follow-up of 14.7 months, median duration of response, progression-free survival and overall survival (secondary endpoints) have not been reached. Fifteen-month rates were 71.5%, 50.9% and 56.7%, respectively. Common adverse events (any grade; grade 3-4) included infections (69.9%, 39.8%), cytokine release syndrome (57.7%, 0%), anemia (48.8%, 37.4%), and neutropenia (48.8%, 48.8%). With biweekly dosing, grade 3-4 adverse events decreased from 58.6% to 46.6%. Elranatamab induced deep and durable responses with a manageable safety profile. Switching to biweekly dosing may improve long-term safety without compromising efficacy. ClinicalTrials.gov identifier: NCT04649359 .
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Affiliation(s)
- Alexander M Lesokhin
- Division of Hematology and Oncology, Memorial Sloan Kettering Cancer Center/Weill Cornell Medical College, New York City, NY, USA.
| | | | | | - Nizar J Bahlis
- Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - H Miles Prince
- Epworth Healthcare and University of Melbourne, Melbourne, Victoria, Australia
| | - Ruben Niesvizky
- Weill Cornell Medical College/New York Presbyterian Hospital, New York City, NY, USA
| | | | | | | | | | - Yogesh Jethava
- Indiana Blood & Marrow Transplant, Indianapolis, IN, USA
| | - Hang Quach
- University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Julien Depaus
- Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | | | | | | | | | - Salomon Manier
- Lille University Hospital and INSERM UMR-S1277, Lille, France
| | - Noopur Raje
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Shinsuke Iida
- Department of Hematology & Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Marc-Steffen Raab
- Heidelberg Myeloma Center, Department of Hematology/Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Emma Searle
- The Christie Hospital, The University of Manchester, Manchester, UK
| | | | | | | | | | | | | | - Mohamad Mohty
- Sorbonne University, Hôpital Saint-Antoine, and INSERM UMRs938, Paris, France
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3
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Tan C, Searle E, Anguille S, Bhutani M, Biran N, Boyd K, Cowan A, Matous J, Perrot A, Berdeja J, Janowski W, Popat R, Quach H, Schroeder M, Wong SW, Vishwamitra D, Guo Y, Niu Z, Larsen J, Chen L, Banerjee A, Touzeau C. P865: TECLISTAMAB IN COMBINATION WITH LENALIDOMIDE IN PREVIOUSLY TREATED PATIENTS WITH MULTIPLE MYELOMA IN THE PHASE 1B MULTICOHORT MAJESTEC-2 STUDY. Hemasphere 2023; 7:e162590e. [PMCID: PMC10431062 DOI: 10.1097/01.hs9.0000970364.16259.0e] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Affiliation(s)
- Carlyn Tan
- Memorial Sloan Kettering Cancer Center New York, New York, United States
| | - Emma Searle
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Sébastien Anguille
- Vaccine and Infectious Disease Institute, University of Antwerp, and Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Manisha Bhutani
- Levine Cancer Institute/Atrium Health, Charlotte, United States
| | - Noa Biran
- John Theurer Cancer Center, Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, United States
| | - Kevin Boyd
- The Royal Marsden Hospital, London, United Kingdom
| | - Andrew Cowan
- Fred Hutchinson Cancer Center, University of Washington, Seattle, United States
| | - Jeffrey Matous
- Colorado Blood Cancer Institute and Sarah Cannon Research Institute, Denver, United States
| | - Aurore Perrot
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jesus Berdeja
- Sarah Cannon Research Institute, Nashville, United States
| | | | - Rakesh Popat
- University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - Hang Quach
- University of Melbourne, St Vincent’s Hospital, Parkville, Australia
| | - Mark Schroeder
- Washington University School of Medicine in Saint Louis, St. Louis, United States
| | - Sandy W Wong
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, United States
| | | | - Yue Guo
- Janssen Research & Development, Spring House, United States
| | - Zhuolu Niu
- Janssen Research & Development, Shanghai, China
| | - Julie Larsen
- Janssen Research & Development, Los Angeles, United States
| | - Lingling Chen
- Janssen Research & Development, Spring House, United States
| | - Arnob Banerjee
- Janssen Research & Development, Spring House, United States
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Harris B, Saleem S, Cook N, Searle E. Targeting hypoxia in solid and haematological malignancies. J Exp Clin Cancer Res 2022; 41:318. [PMID: 36320041 PMCID: PMC9628170 DOI: 10.1186/s13046-022-02522-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Tumour hypoxia is a known and extensively researched phenomenon that occurs in both solid and haematological malignancies. As cancer cells proliferate, demand for oxygen can outstrip supply reducing tumour oxygenation. In solid tumours this is contributed to by disorganized blood vessel development. Tumour hypoxia is associated with resistance to treatment, more aggressive disease behaviour and an increased likelihood of metastatic progression. It can be measured using both invasive and non-invasive methods to varying degrees of accuracy. The presence of hypoxia stimulates a complex cellular network of downstream factors including Hypoxia Inducible Factor 1 (HIF1), C-X-C motif chemokine 4 (CXCR4) and Hypoxia‐inducible glycolytic enzyme hexokinase‐2 (HK2) amongst many others. They work by affecting different mechanisms including influencing angiogenesis, treatment resistance, immune surveillance and the ability to metastasize all of which contribute to a more aggressive disease pattern. Tumour hypoxia has been correlated with poorer outcomes and worse prognosis in patients. The correlation between hypoxic microenvironments and poor prognosis has led to an interest in trying to therapeutically target this phenomenon. Various methods have been used to target hypoxic microenvironments. Hypoxia-activated prodrugs (HAPs) are drugs that are only activated within hypoxic environments and these agents have been subject to investigation in several clinical trials. Drugs that target downstream factors of hypoxic environments including HIF inhibitors, mammalian target of rapamycin (mTOR) inhibitors and vascular endothelial growth factor (anti-VEGF) therapies are also in development and being used in combination in clinical trials. Despite promising pre-clinical data, clinical trials of hypoxia targeting strategies have proven challenging. Further understanding of the effect of hypoxia and related molecular mechanisms in human rather than animal models is required to guide novel therapeutic strategies and future trial design. This review will discuss the currently available methods of hypoxia targeting and assessments that may be considered in planning future clinical trials. It will also outline key trials to date in both the solid and haemato-oncology treatment spheres and discuss the limitations that may have impacted on clinical success to date.
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Affiliation(s)
- Bill Harris
- grid.412917.80000 0004 0430 9259Experimental Cancer Medicine Team, Christie NHS Foundation Trust, Manchester, UK
| | - Sana Saleem
- grid.412917.80000 0004 0430 9259Haematology Department, Christie NHS Foundation Trust, Manchester, UK
| | - Natalie Cook
- grid.412917.80000 0004 0430 9259Experimental Cancer Medicine Team, Christie NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Emma Searle
- grid.412917.80000 0004 0430 9259Haematology Department, Christie NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Division of Cancer Sciences, University of Manchester, Manchester, UK
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Abstract
Eagle's syndrome is a condition that typically does not present to pain clinics. It consists of an elongated styloid process greater than 25 mm and/or stylohyoid ligament calcification causing an unusual array of symptoms, relating to anatomical involvement. Multiple specialities may be involved with the diagnosis of this rare condition. Three-dimensional reconstructive computed tomographic (CT) scan remains the gold standard for diagnosis. Depending on the presenting symptoms, care should be directed to an appropriate specialist. Pain surrounding Eagle's syndrome does not typically resolve using simple pharmacological methods. Eagle's syndrome should remain a diagnosis to be considered when faced with non-resolving head/facial pain.
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Affiliation(s)
- Emma Searle
- University Hospitals of Derby and Burton Foundation
Trust, Derby, UK
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6
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Abstract
OBJECTIVES Correct identification of alcohol as a contributor to, or comorbidity of, many psychiatric diseases requires health professionals to be competent and confident to take an accurate alcohol history. Being able to estimate (or calculate) the alcohol content in commonly consumed drinks is a prerequisite for quantifying levels of alcohol consumption. The aim of this study was to assess this ability in medical and nursing students. METHODS A cross-sectional survey of 891 medical and nursing students across different years of training was conducted. Students were asked the alcohol content of 10 different alcoholic drinks by seeing a slide of the drink (with picture, volume and percentage of alcohol by volume) for 30 s. RESULTS Overall, the mean number of correctly estimated drinks (out of the 10 tested) was 2.4, increasing to just over 3 if a 10% margin of error was used. Wine and premium strength beers were underestimated by over 50% of students. Those who drank alcohol themselves, or who were further on in their clinical training, did better on the task, but overall the levels remained low. CONCLUSIONS Knowledge of, or the ability to work out, the alcohol content of commonly consumed drinks is poor, and further research is needed to understand the reasons for this and the impact this may have on the likelihood to undertake screening or initiate treatment.
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Affiliation(s)
- Julia Sinclair
- Associate Professor of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Academic Centre, College Keep 4-12 Terminus, Southampton SO14 3DT, UK
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Searle E, Telfer B, Forster D, Williams K, Davies B, Illidge T, Stratford I. Treatment with the novel Akt inhibitor AZD5363 following radiotherapy improves tumour control in mouse models of head and neck cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61573-3] [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: 10/21/2022]
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Searle E, Patel H, Vilar FJ, Gharib M, Turner AJ, Batra G, Wynn RF. Inflammatory BCG adenitis associated with immune reconstitution following allogeneic haematopoietic stem cell transplant in infancy. Pediatr Blood Cancer 2010; 54:166-9. [PMID: 19606456 DOI: 10.1002/pbc.22143] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe four cases of a localized, granulomatous reaction to BCG including ipsilateral painful, suppurative lymphadenopathy associated with donor immune reconstitution following allogeneic haematopoietic stem cell transplant performed in infancy and preceded by uneventful, routine BCG immunisation. The management of the inflammatory disease in these cases with surgery, antimycobacterial chemotherapy and steroids, is discussed.
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Affiliation(s)
- E Searle
- Department of Blood and Marrow Transplant, Royal Manchester Children's Hospital, Manchester, UK
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9
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Searle E, Pavord S, Alfirevic Z. Recombinant factor VIIa and other pro-haemostatic therapies in primary postpartum haemorrhage. Best Pract Res Clin Obstet Gynaecol 2008; 22:1075-88. [PMID: 18838340 DOI: 10.1016/j.bpobgyn.2008.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Blood products are an essential component of the management of postpartum haemorrhage, although there is lack of evidence to guide optimal use. Prospective intervention studies, including randomized trials, are needed to clarify optimal timing and dosage. The new generation of virally inactivated blood products, such as fibrinogen concentrate, might further enhance our knowledge of the value of individual blood components. It seems likely that antifibrinolytic agents will receive less attention in future. However, rFVIIa promises to be a powerful tool in managing massive obstetric haemorrhage, although many questions concerning its efficacy and safety in differing clinical scenarios remain unanswered.
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Affiliation(s)
- E Searle
- University Hospitals of Leicester, Leicester, UK
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Searle E. Impact of sequester of funds on NCI's 1990 budget. J Natl Cancer Inst 1989; 81:1772. [PMID: 2585526 DOI: 10.1093/jnci/81.23.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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11
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Searle E. Congressional Action on the FY 1990 Budget. J Natl Cancer Inst 1989. [DOI: 10.1093/jnci/81.17.1279] [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
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