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Schuetze SM, Ballman KV, Heise R, Ganjoo KN, Davis EJ, George S, Burgess MA, Choy E, Shepard DR, Tinoco G, Hirbe A, Kelly CM, Attia S, Deshpande HA, Schwartz GK, Siontis BL, Riedel RF, von Mehren M, Kozlowski E, Chen HX, Astbury C, Rubin BP. A Single Arm Phase 2 Trial of Trametinib in Patients With Locally Advanced or Metastatic Epithelioid Hemangioendothelioma. Clin Cancer Res 2024:735082. [PMID: 38446990 DOI: 10.1158/1078-0432.ccr-23-3817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/06/2024] [Accepted: 03/04/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Epithelioid hemangioendothelioma (EHE) is a rare vascular cancer with pathogenic TAZ-CAMTA1 operating as an oncogenic driver through activation of MAPK pathway. Trametinib is an inhibitor of MEK, a critical kinase in the MAPK pathway. We sought to evaluate the effect of trametinib in patients with EHE. PATIENTS AND METHODS A phase 2 trial of trametinib was conducted in patients with locally advanced or metastatic EHE. Eligibility requirements included evidence of tumor progression or presence of EHE-related pain requiring opiates for management prior to enrollment. The primary endpoint was objective response rate (ORR) per RECIST1.1 in cases with TAZ-CAMTA1 confirmed by fusion-FISH. Secondary objectives were to estimate ORR for all patients, median PFS, 2-year OS rate, patient safety, and change in patient-reported global health and pain scores per PROMIS questionnaires. RESULTS 44 patients enrolled and 42 started trametinib. TAZ-CAMTA1 was detected in 27 tumor samples. The ORR was 3.7% (95% CI: 0.094, 19.0), median PFS was 10.4 months (95% CI: 7.1, NA), and 2-year OS rate was 33.3% (95% CI: 19.1, 58.2) in the target population. Median pain intensity and interference scores improved significantly after 4 weeks of trametinib in patients using opiates. Common AEs related to trametinib were rash, fatigue, nausea/vomiting, diarrhea/constipation, alopecia and edema; one Grade 5 ARDS/pneumonitis was related to trametinib. CONCLUSIONS Trametinib was associated with reduction in EHE-related pain and median PFS of more than 6 months providing palliative benefit in patients with advanced EHE, but the trial did not meet the ORR goal.
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Affiliation(s)
| | | | - Rachel Heise
- University of California, San Francisco, New York, NY, United States
| | | | | | | | | | - Edwin Choy
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | | | - Gabriel Tinoco
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Angela Hirbe
- Washington University in St. Louis, saint louis, United States
| | - Ciara M Kelly
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Steven Attia
- Mayo Clinic, Jacksonville, Florida, United States
| | | | - Gary K Schwartz
- Case Western Reserve University, Cleveland, OH, United States
| | | | | | | | - Erin Kozlowski
- Sarcoma Alliance for Research through Collaboration, United States
| | - Helen X Chen
- National Cancer Institute, Bethesda, MD, United States
| | | | - Brian P Rubin
- Cleveland Clinic and Lerner Research Institute, Cleveland, OH, United States
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Schuetze S, Ballman KV, Ganjoo KN, Davis EJ, Morgan JA, Tinoco G, Burgess MA, Van Tine BA, Choy E, Shepard DR, Kelly CM, Riedel RF, von Mehren M, Siontis BL, Attia S, Schwartz GK, Deshpande HA, Kozlowski E, Chen HX, Rubin B. P10015/SARC033: A phase 2 trial of trametinib in patients with advanced epithelioid hemangioendothelioma (EHE). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.11503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11503 Background: EHE is a rare vascular cancer arising in liver, lung, soft tissue and bone. The natural history of metastatic disease varies considerably from indolent growth over years to rapid growth with fatal outcome in months. Treatment of patients (pts) with metastatic EHE with antiangiogenic therapy induces tumor response in a minority of pts, and median PFS is 6-12 months. TAZ-CAMTA1 translocation results in activation of MAPK pathway and is an oncogenic driver in EHE. We sought to evaluate the effect of MEK inhibition using trametinib in pts with unresectable EHE. Methods: A phase 2 trial of trametinib 2 mg daily was conducted in pts with EHE though the Experimental Therapeutics Clinical Trials Network supported by NCI in collaboration with SARC. Additional support was provided by the EHE Rare Cancer Charity and the EHE Foundation. Pts had to have evidence of objective tumor progression or EHE-related pain requiring narcotics for relief prior to enrollment. Presence of TAZ-CAMTA1 translocation was analyzed by fusion-FISH after enrollment. Primary trial endpoint was objective response rate (ORR) per RECIST1.1 with at least 1 objective response required in the 1st 13 pts to expand enrollment to 27. The trial was amended after stage 1 to continue enrollment to 27 pts with TAZ-CAMTA1 detected by FISH with goal of >4 objective responses in this group. Secondary objectives were PFS and OS rates, safety and change in pt-reported global health and pain scores per PROMIS questionnaires. Results: 43 pts were enrolled between 6/2017 – 9/2020 across 10 sites and 41 started therapy. TAZ-CAMTA1 fusion was detected in 26, not detected in 7, test failed in 5 and was not performed due to insufficient tumor in 5. Median pt age was 54 (range 22-81 yrs) and 11 were >65 yrs; 25 were female; ECOG was 0 in 23, 1 in 16 and 2 in 3 pts. Most pts experienced reduction in tumor size. ORR per RECIST was 7% (3/41); in pts with TAZ-CAMTA1 detected, the ORR was 0% (0/26). Mean pain intensity and interference scores had a statistically significant improvement and global quality of life scores did not statistically change after 4 weeks of therapy. 17 pts remained on treatment > 6 months and 7 > 12 months. 25 pts stopped trametinib due to EHE progression, 6 died during treatment, 6 withdrew from treatment, 3 stopped drug due to adverse event and 1 is on treatment. The most common AEs related to trametinib were rash, fatigue, nausea/vomiting, diarrhea, alopecia and edema; Grade >3 AEs included anemia, dyspnea, hypoxia, hypotension, syncope and dermatitis. Conclusions: To our knowledge, this is the largest prospective clinical study focused on pts with EHE. Although the trial did not meet the ORR goal, stable disease > 6 months was seen in 40% of pts, and EHE-related pain improved on treatment. Trametinib was associated with expected cutaneous and GI adverse effects. Additional pt-reported outcomes and biomarkers of inflammation are undergoing analysis. Clinical trial information: NCT03148275.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Edwin Choy
- Massachusetts General Hospital, Boston, MA
| | | | - Ciara Marie Kelly
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Abstract
BACKGROUND The inflammation of atopic eczema (AE) is orchestrated not only by T cells predominantly but also B cells, eosinophils and dendritic cells. Recently, a role of invariant natural killer T (NKT) cells has been reported in bronchial asthma and allergy. Natural killer T cells express a restricted repertoire of T-cell receptor alpha/beta and produce interferon (IFN)-gamma and/or interleukin (IL)-4 upon activation. AIM OF THE STUDY To determine the presence of NKT cells in lesional AE skin in comparison with other eczematous disorders and to analyse their cytokine expression. METHODS Immunofluorescence stainings were carried out using antibodies recognizing NKT cells, CD3+ and CD4+ cells, IFN-gamma and IL-4. RESULTS Natural killer T cells have been detected in small numbers in the majority of AE specimens as well as in atopy patch test (APT) reactions, allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). In AE, the proportion of NKT cells among CD3+ cells was approximately 5%. NKT cells expressed both IFN-gamma and IL-4 in AE, APT and ACD but predominantly IFN-gamma in ICD. CONCLUSION Natural killer T cells are part of the inflammatory infiltrate of AE as well as APT, ACD and ICD, suggesting a pathogenic role of NKT cells in eczematous skin disorders. The pattern of IFN-gamma and IL-4 cytokine expression by NKT cells varied depending on the type of eczematous disease.
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Affiliation(s)
- D Simon
- Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
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Simon D, Kozlowski E, Simon H. Atopic Dermatitis Lesions Accommodate Low Numbers of Invariant Natural Killer T (NKT) Cells Expressing Interleukin-4 and Interferon-gamma. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2008.12.1084] [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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Biziuk M, Kozlowski E, Baiulescu GE. Search For A New Reagents From The Nitrosoamine Group For Spectrophotometric Determination Of Sulphur Dioxide. ANAL LETT 2007. [DOI: 10.1080/00032718108081466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Naini AA, Shimony E, Kozlowski E, Shaikh T, Dang W, Miller C. Interaction of Ca2(+)-activated K+ channels with refolded charybdotoxins mutated at a central interaction residue. Neuropharmacology 1996; 35:915-21. [PMID: 8938722 DOI: 10.1016/0028-3908(96)00112-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 02/03/2023]
Abstract
Charybdotoxin is a small peptide blocker of K+ channels, rigidly held in active conformation by three disulfide bonds. The toxin blocks K+ channels by binding to a receptor site located at the external "vestibule", and thus physically occluding the outer opening of the K+ conduction pore. In the blocked complex, K27, a residue on the toxin's molecular surface, projects its epsilon-amino group into the K(+)-selective pore. The results here show that CTX, produced by heterologous expression in E. coli, may be manipulated to place unnatural positively charged residues at position 27. The toxin folds faithfully to its native conformation when the crucial lysine at position 27 is replaced by a cysteine residue, a maneuver that allows specific chemical modification of this side-chain. Replacements of K27 by side-chains slightly shorter or slightly longer than lysine yield active toxins. The toxin variant with ornithine at this position interacts much less strongly with K+ ions in the pore of slowpoke-type Ca2(+)-activated K+ channels than does wild-type toxin. This result argues that the epsilon-amino group of K27 in bound toxin lies only a few ångstroms away from a K+ ion occupying the blocked pore. The peptide folds with high efficiency to form the correct disulfides even in the presence of strong denaturants.
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Affiliation(s)
- A A Naini
- Howard Hughes Medical Institute, Graduate Department of Biochemistry, Brandeis University, Waltham, Massachusetts, USA
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Kozlowski E, G�recki T, Bownik M. New high-temperature palladium detectors for oxygen determination. Anal Bioanal Chem 1986. [DOI: 10.1007/bf00635685] [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]
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Maciak G, Kozlowski E. Computerized technique in organic microelemental analysis III. Automatic determination of fluorine in organic compounds. Microchem J 1979. [DOI: 10.1016/0026-265x(79)90085-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Labiszewska-Jaruzelska F, Pisulska-Otremba A, Kozlowski E. [Surgical treatment of the lip and palate clefts]. Czas Stomatol 1968; 21:609-14. [PMID: 5241782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Kozlowski E. [Surgical treatment of palatal clefts]. Pol Przegl Chir 1967; 39:332-7. [PMID: 6047113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Kozlowski E, Romański A, Magońska-Oleszycka A. [Surgical treatment of upper cleft lip]. Pol Przegl Chir 1966; 38:972-6. [PMID: 5920022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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