Lymecycline vs. clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasonography evaluation

BACKGROUND

Antibiotic therapy remains the first-line treatment for hidradenitis suppurativa (HS). However, literature data on its comparative clinical efficacy and safety are limited.

AIM

To investigate the efficacy of tetracycline (lymecycline 300 mg daily) vs. the combination therapy clindamycin and rifampicin (600 mg plus 600 mg daily) by evaluating and comparing the clinical response at the end of antibiotic treatment (10 weeks).

METHODS

The study retrospectively analysed 52 patients divided in two groups of 26 patients: Group A received lymecycline and Group B received clindamycin plus rifampicin for 10 weeks. Subjects had mild, moderate and severe HS. The clinical and ultrasonography extent of disease was measured by the Hurley Score, Sonographic Score of Hidradenitis Suppurativa, International Hidradenitis Suppurativa Severity Score System (IHS4), pain visual analogue scale (pain VAS) and Dermatology Life Quality Index (DLQI). The primary outcome was the clinical response at the end of the antibiotic treatment period, according to the Hidradenitis Suppurativa Clinical Response measure.

RESULTS

Both groups showed a significant improvement in IHS4, pain VAS and DLQI from baseline, but this was more marked in Group A. Reductions in nodule counts were similar between the two groups, whereas the number of abscesses and draining tunnels decreased more in Group B. Disease-free survival was similar between the two groups.

CONCLUSION

Lymecycline monotherapy and clindamycin plus rifampicin combination are both effective treatments for patients with moderate-severe HS. Nodular-type HS seems to respond better to lymecycline, whereas the abscess/tunnel type seems to respond better to clindamycin plus rifampicin.

Sex-related differences of clinical features in hidradenitis suppurativa: analysis of an Italian-based cohort

The clinical characteristics associated with hidradenitis suppurativa (HS) severity are poorly understood. In this study, 124 patients with HS from 6 Italian dermatology centres participated in this study. Disease severity was assessed using the Hidradenitis Suppurativa Physician's Global Assessment score (HS-PGA) and Hurley score. The impact of clinical characteristics on disease severity was assessed by logistic regression. Clinical characteristics were similar between men (n = 53) and women (n = 71). Disease severity was also similar; 75% of the patients had Hurley stage II or III disease, and > 60% had moderate, severe or very severe HS as judged by HS-PGA. Lesions were more frequent in the gluteal region in men (32.3% in men vs. 8.7% in women, P < 0.001) and more frequent on the breast in women (16.3% in women vs. 4.6% in men, P = 0.02). Obesity was associated with increased disease severity as measured by HS-PGA (OR: 3.28, 95% CI 1.55-6.95, P < 0.01) and Hurley classification (OR: 3.22, 95% CI 1.34-7.31, P < 0.01). Although severity of HS is similar between the sexes, the localization of lesions is different.

Biologic Therapy in Inflammatory and Immunomediated Skin Diseases: Safety Profile

Biologic treatments have modified the therapeutic armamentarium in the treatment of many dermatological and non- dermatological diseases and data on literature have widely focused on the efficacy and safety of TNF-alpha inhibitors in psoriasis. Although the etiopathogenesis has not completely elucidated, inflammation appears the lait motif unifying the immune-pathogenesis of diverse skin disease, as atopic dermatitis, alopecia areata and hidradenitis suppurativa. Actually, data on the off-label use of biologics in cutaneous immune-mediated inflammatory diseases are scarce and restricted to anecdotal cases and case series. The present review aims to evidence the major off- label use of TNF-alpha inhibitors in dermatology.

Integrin-α10 Dependency Identifies RAC and RICTOR as Therapeutic Targets in High-Grade Myxofibrosarcoma

Myxofibrosarcoma is a common mesenchymal malignancy with complex genomics and heterogeneous clinical outcomes. Through gene-expression profiling of 64 primary high-grade myxofibrosarcomas, we defined an expression signature associated with clinical outcome. The gene most significantly associated with disease-specific death and distant metastasis was ITGA10 (integrin-α10). Functional studies revealed that myxofibrosarcoma cells strongly depended on integrin-α10, whereas normal mesenchymal cells did not. Integrin-α10 transmitted its tumor-specific signal via TRIO and RICTOR, two oncoproteins that are frequently co-overexpressed through gene amplification on chromosome 5p. TRIO and RICTOR activated RAC/PAK and AKT/mTOR to promote sarcoma cell survival. Inhibition of these proteins with EHop-016 (RAC inhibitor) and INK128 (mTOR inhibitor) had antitumor effects in tumor-derived cell lines and mouse xenografts, and combining the drugs enhanced the effects. Our results demonstrate the importance of integrin-α10/TRIO/RICTOR signaling for driving myxofibrosarcoma progression and provide the basis for promising targeted treatment strategies for patients with high-risk disease.

SIGNIFICANCE

Identifying the molecular pathogenesis for myxofibrosarcoma progression has proven challenging given the highly complex genomic alterations in this tumor type. We found that integrin-α10 promotes tumor cell survival through activation of TRIO-RAC-RICTOR-mTOR signaling, and that inhibitors of RAC and mTOR have antitumor effects in vivo, thus identifying a potential treatment strategy for patients with high-risk myxofibrosarcoma. Cancer Discov; 6(10); 1148-65. ©2016 AACR.This article is highlighted in the In This Issue feature, p. 1069.

Ingenol mebutate in actinic keratosis: a clinical, videodermoscopic and immunohistochemical study

BACKGROUND

Actinic keratosis (AK) is a cutaneous intraepithelial neoplasm that typically develops on sun-damaged skin. The incidence of AK is increasing worldwide, and it is accepted as the most frequent pre-malignant lesion in humans.

OBJECTIVES

To demonstrate that ingenol mebutate gel is effective in the treatment of actinic keratoses because of its clinical, dermoscopic, capillaroscopic, histopathological and immunohistochemical treatment outcomes.

METHODS

Sixty individuals with multiple non-hypertrophic AKs were enrolled into this non-randomized, open-label, prospective, trial. Acquisition of clinical, dermoscopic and capillaroscopic images at baseline (T0), immediately after treatment on 3^rd (trunk and/or extremities) or 4^th (scalp and/or face) day (T1), 14 days after the end of the treatment (T2) and at 60 days (T3). A subgroup of 20 patients received a cutaneous biopsy both at baseline and at T3 for histological and immunohistochemical evaluation.

RESULTS

Clinical improvement was observed in 100% of cases: total clearance in 41 patients (68.3%); partial clearance in 19 patients (32.7%). After treatment, dermoscopic improvement of all non-pigmented and pigmented AK lesions was observed. Most of the dermoscopic features disappeared with treatment. Total disappearance of specific vascular structures or significant reduction in the number and calibre of new blood vessels was capillaroscopically observed in all patients analysed (P ≤ 0.001). The immunohistochemical expression of p63 (P = 0.002), Ki-67 (P = 0.015) and VEGF (P = 0.016) significantly decreased.

CONCLUSIONS

The clinical efficacy of ingenol mebutate on AKs is confirmed by its effect on angiogenesis, stem cell activity and cell proliferation in vivo.

Abstract A24: Network models of signaling and drug response in melanoma

Novel combination therapies are potentially key to preventing emergence of resistance to initially successful single agent therapies such as RAF inhibitors in melanoma. In order to systematically nominate novel and effective drug combinations, we have developed an integrated systems biology technology (perturbation biology) for inferring quantitative and predictive network models of signaling. Our modeling strategy combines systematic perturbation experiments, measurement of response profiles to perturbations, inference of network models and simulation of models with in silico perturbations. As a key component of the overall strategy, we have adapted the belief propagation (BP) inference algorithm from statistical physics to construct signaling models with several hundreds of measured entities. In parallel, we have developed a pathway informatics tool to automatically extract prior information from multiple signaling databases. We applied this approach to derive signaling network models in RAF inhibitor resistant melanoma cells and nominate drug combinations to overcome resistance in melanoma. First, we systematically perturb melanoma cells with a set of targeted drugs as single and paired agents. Next, we quantitatively measured proteomic (total and phospho-protein levels) and phenotypic (e.g. cell cycle arrest, cellular viability) responses to perturbations. We incorporated the generic prior information and context specific perturbation response data to construct quantitative network models, which capture multiple oncogenic pathways in melanoma. As shown by cross validation calculations, use of prior information significantly improved predictive power of models. Using the inferred network models of signaling, we systematically predicted response to tens of thousands of in silico perturbations. Our modeling and simulation strategy expanded the volume of drug response profile from few thousand experimental data points to millions of in silico data points. In addition, our models provided quantitative descriptions of signaling events in melanoma. Our perturbation biology technology is suitable for applications in diverse areas of molecular biology beyond cancer research.

Citation Information: Mol Cancer Ther 2013;12(11 Suppl):A24.

Citation Format: Anil Korkut, Weiqing Wang, Evan Molinelli, Martin Miller, Poorvi Kaushik, Arman Aksoy, Xiaohong Jing, Nick Gauthier, Chris Sander. Network models of signaling and drug response in melanoma. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr A24.

Abstract 5227: Quantitative network models of signaling and drug response in melanoma

Use of targeted drug combinations are potentially key to preventing emergence of resistance to initially successful single agents such as RAF inhibitors. Thus, systematic nomination of novel drug combinations is important to develop effective therapeutic strategies. Here, we present an experimental-computational network pharmacology method to infer quantitative signaling networks in tumor cells, predict response to perturbations, and ultimately, nominate targeted drug combinations that will generate a desired phenotypic response. We use a series of targeted drugs, singly or in combination to perturb cancer cells. We measure quantitative proteomic (total and phoshpo-protein levels) and phenotypic (e.g. cell viability, apoptosis, cell cycle progression) response profiles to perturbations. Proteomic responses are measured with the reverse phase protein array technology. Next, we infer quantitative network models, using the response profiles as training sets. Solution space of all network model configurations is prohibitively large and Monte Carlo based inference algorithms fail to generate accurate network models in sizes relevant for cancer biology. In order to solve the inference problem, we have adapted an iterative and probabilistic inference algorithm, belief propagation from statistical physics. Resulting network models are based on simple non-linear differential equations and quantitatively link signaling events to phenotypic changes. We have generated quantitative network models of signaling in RAF inhibitor resistant melanoma cell lines in sizes (i.e. ∼100 nodes) unreachable by other network inference algorithms. We have nominated novel combination therapies through combinatorial in silico perturbations of all nodes in derived networks and experimentally tested the predicted phenotypic responses.

Citation Format: Anil Korkut, Weiqing Wang, Evan Molinelli, Martin Miller, Poorvi Kaushik, Arman Aksoy, Chris Sander. Quantitative network models of signaling and drug response in melanoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5227. doi:10.1158/1538-7445.AM2013-5227

A novel approach to manage skin toxicity caused by therapeutic agents targeting epidermal growth factor receptor

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Background: Inhibition of EGFR represents an important field in cancer therapy.Skin rash is a common adverse reaction in patients receiving EGFR inhibitors. Nicotinamide has been shown to be an effective treatment for skin inflammation in various conditions, since nicotinamide inhibits IL-8 production through the NF-kB and MAPK pathways in an in vitro keratinocytes/P. acnes model of inflammation. Furthermore green tea polyphenols could be useful in attenuation of solar UVB light-induced oxidative stress-mediated and MAPK-caused skin disorders in humans.In this study we evaluated the effect of nicotinamide and green tea polyphenols on skin toxicity EGFRI related.

Methods: Patients with skin toxicity induced by EGFRI were enrolled. They underwent a skin biopsy and skin samples for microbiological analyses at first presentation of skin toxicity (T0). Skin toxicity was assessed with NCI-CTACE,EGFR index and Dermatology Life Quality Index (DLQI) test. Therapy protocol consisted in topical application of moisturizing cream containing green tea polyphenols plus oral administration of nicotinamide 200 mg/die for 12 weeks. Topical application of 1% clindamycin gel and/or systemic administration of minocicline were provided in case of superbacterial infection. All treated patients were monitored for at least 12 weeks (T12), across three time points (T0,T6,T12).

Results: 24 colorectal cancer patients receiving anti-EGFR monoclonal antibodies (cetuximab or panitumumab) and developing skin toxicity were treated by a multidisciplinary team including oncologists, dermatologists, a pathologist and a nurse. All the patients experienced a significant reduction of skin toxicity according to the NCI-CTACE and EGFR index (p<0.05). Papulo-pustular eruption and itching significantly improved after 6 weeks of treatment and erythema decreased after 12 weeks. A significative improvement of the global score and of DLQI was evident. No toxicity related to the treatment of skin toxicity was observed.

Conclusions: Treatment with nicotinamide and green tea polyphenols represent a novel effective approach to manage skin toxicity caused by EGFRI.