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Novik Y, Klar N, Zamora S, Kwa M, Speyer J, Oratz R, Muggia F, Meyers M, Hochman T, Goldberg J, Adams S. 129P Phase II study of pembrolizumab and nab-paclitaxel in HER2-negative metastatic breast cancer: Hormone receptor-positive cohort. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.232] [Citation(s) in RCA: 1] [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: 11/25/2022] Open
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Abstract
Details on the 28-year treatment history of a patient with an endocrine-responsive breast cancer are provided. She was originally diagnosed as having a T1N0M0 cancer after a modified radical mastectomy at age 41. Fifteen years later, in 1998, she presented with hemoptysis and pleuritic chest pain: a 10 cm right atrial tumor and estrogen receptor (ER) positive endobronchial and adjacent lung parenchyma adenocarcinoma were documented. Epithelial markers normalized as she manifested a partial response (PR) lasting 3 years with tamoxifen treatment. From 2001 to 2007 she benefitted from exemestane treatment. Upon progression in the previous lung area and left adrenal, exemestane withdrawal led to transient decrease in markers. Six months later (in July 2008), with growth in her adrenal tumor, laparoscopic adrenalectomy was performed: in addition to ER positivity, the tumor showed Her2 overexpression and amplification. She has subsequently had some control of disease with fulvestrant, letrozole + trastuzumab, and subsequently letrozole + lapatinib. In addition to the chronicity of disease, this history illustrates the expanding range of treatments available for endocrine-responsive breast cancer commensurate to our greater understanding of tumor biology.
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Affiliation(s)
| | | | - F Muggia
- Correspondence to: F Muggia. E-mail:
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Abstract
This clinical vignette illustrates how our therapeutic approaches to early stages of multiple myeloma have changed over the past decade with novel therapies reducing disease and preventing disease progression. Recent paradigms of multiple myeloma describe the disease as a spectrum of clinical stages, including asymptomatic ‘smoldering’ states that progress to symptomatic states. The average 5-year survival rate of patients with multiple myeloma diagnosed between 1996 and 2004 according to surveillance epidemiology and end results (SEER) data is 35.9%. Here, we describe the use of novel therapeutic agents including bortezomib, lenalidomide, bisphosphonates, Doxil/Caelyx, and dexamethasone, and their success in affecting the course of disease. Multiple trials have shown an increased benefit of these newer agents over prior multiple myeloma treatment regimens. At 13 years and 8 months from diagnosis, our patient is doing well, and thus is a model of how long-term control of multiple myeloma prolongs survival.
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Affiliation(s)
| | - F. Muggia
- Division of Medical Oncology, NYU School of Medicine, New York, NY-10016, USA
- Correspondence to: Dr. F. Muggia,
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Kwa M, Novik Y, Oratz R, Jhaveri K, Wu J, Gu P, Meyers M, Muggia F, Bonakdar M, Abidoglu C, Kozhaya L, Li X, Joseph B, Iwano A, Friedman K, Goldberg JD, Unutmaz D, Adams S. Abstract P2-11-11: Phase II trial of exemestane with immunomodulatory oral cyclophosphamide in metastatic hormone receptor (HR)-positive breast cancer: Prolonged progression-free survival (PFS) in patients with distinct T regulatory cell (Treg) profile. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-11-11] [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: 11/16/2022]
Abstract
Abstract
Background: Resistance to endocrine therapies in HR-positive breast cancer is a significant challenge. The steroidal aromatase inhibitor (AI) exemestane (EXE) has demonstrated short-term efficacy in metastatic HR-positive HER2-negative breast cancer (mHR+BC) that has progressed during treatment with a non-steroidal AI. Combination strategies have not shown a survival benefit. Immunotherapy represents a promising approach as it may increase durability of responses. Low dose cyclophosphamide (CTX) has demonstrated efficacy in combination with neoadjuvant letrozole in HR+BC, conceivably by enhancing anti-tumor immune responses. Here we investigated whether EXE combined with immunomodulatory CTX could provide durable responses in heavily pretreated patients and assessed immunological profiles (NCT01963481).
Methods: Phase II trial of EXE (25mg PO daily) with CTX (50 mg PO daily) enrolled postmenopausal women (n=23) with mHR+BC who had progressed on prior endocrine therapy (including nonsteroidal AI, tamoxifen, and/or fulvestrant); prior chemotherapy was allowed. The primary endpoint was PFS (per RECIST 1.1) at 3 months; secondary endpoints were response rate, tolerability, and immune correlates. Detailed functional immune profiling of peripheral T cell subsets were performed by flow cytometry at baseline, 1, 3, 6, 9 & 12 months, with healthy donors available as controls.
Results: All 23 patients have been enrolled, and 21 are evaluable for response. Median age was 54 (range 31-77), median prior lines of endocrine therapy was 2 (1-3) and chemotherapy was 1 (0-5). The majority (15/23) had visceral organ involvement. Combination treatment was well tolerated with one grade 3 urinary tract infection but no grade 4 or 5 toxicity. An objective response was observed in 19% of patients (4/21, 1 CR and 3 PR) and an additional 33% (7/21) had SD, resulting in a 3-month-PFS of 48.5% (95% CI, 30.5-77.1). Responses were durable in all patients, lasting =/> 9 months and included patients with liver metastases.
Comparison of peripheral immune cell subsets of patients (n=16) at baseline to age/sex-matched healthy controls demonstrated an increased proportion of CD4+ memory T cells with central memory phenotype (CD45RO+CD27+, p<0.0001). When patients were stratified based on PFS at 3 months, the proportion of naïve Tregs (CD4+CD45RO-FOXP3+Helios+) at baseline was significantly lower (p=0.003) in the non-progressor group compared to patients with progression. Remarkably, when these patient groups were compared for changes in T cell subsets during treatment, the proportion of both naïve and memory Treg subsets increased from baseline to 3 months (p<0.01), but only in the non-progressor patient group. While preliminary, these findings are possibly indicative of novel predictive biomarkers.
Conclusion: EXE and CTX had a favorable safety profile with evidence of clinical activity in patients with heavily pretreated mHR+BC, including durable responses in liver and bone. Correlative studies are ongoing to identify potential biomarkers of response or resistance to therapy.
Citation Format: Kwa M, Novik Y, Oratz R, Jhaveri K, Wu J, Gu P, Meyers M, Muggia F, Bonakdar M, Abidoglu C, Kozhaya L, Li X, Joseph B, Iwano A, Friedman K, Goldberg JD, Unutmaz D, Adams S. Phase II trial of exemestane with immunomodulatory oral cyclophosphamide in metastatic hormone receptor (HR)-positive breast cancer: Prolonged progression-free survival (PFS) in patients with distinct T regulatory cell (Treg) profile. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-11-11.
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Affiliation(s)
- M Kwa
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Y Novik
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - R Oratz
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - K Jhaveri
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - J Wu
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - P Gu
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - M Meyers
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - F Muggia
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - M Bonakdar
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - C Abidoglu
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - L Kozhaya
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - X Li
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - B Joseph
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - A Iwano
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - K Friedman
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - JD Goldberg
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - D Unutmaz
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - S Adams
- New York University, NY, NY; Jackson Laboratory for Genomic Medicine, Farmington, CT
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Rugo HS, Zagar TM, Formenti SC, Vujaskovic Z, Muggia F, O'Connor BM, Myerson RJ, Hsu ICC, Borys N, Blackwell KL, Dewhirst MW. Abstract P4-15-05: Novel targeted therapy for breast cancer chest wall recurrence: Low temperature liposomal doxorubicin and mild local hyperthermia. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p4-15-05] [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: 11/16/2022]
Abstract
Abstract
Background: Unresectable breast cancer chest wall recurrence (CWR) following radiation is very difficult to treat and often responds poorly to standard chemotherapy. Symptoms include pain, reduced range of motion, disfigurement, and skin erosions with bleeding and infection. We hypothesized that thermally enhanced drug delivery using low temperature liposomal doxorubicin (LTLD, ThermoDox®), given with mild local hyperthermia (MLHT) would be a safe and effective targeted therapy. LTLD is given by iv infusion; it then localizes in CWR tumors due to their leaky vasculature. When heated to ≥ 39.5°C, LTLD releases a high concentration of the heat-enhanced cytotoxic doxorubicin.
Methods: The results of 2 similarly-designed independent phase I trials were combined for analysis. Eligible patients had CWR progressing after radiation, hormone therapy, and chemotherapy. Subjects were to get up to 6 cycles of LTLD every 21-35 days, followed immediately by chest wall MLHT for 1 hour at 40°- 42°C. In Trial A, 18 subjects received LTLD at 20, 30, or 40 mg/m2; in Trial B, 11 subjects received LTLD at 40 or 50 mg/m2. The primary endpoint of each trial was to determine the maximum tolerated dose (MTD); secondary endpoints were local objective response and the pharmacokinetic (PK) and safety profiles of LTLD. Local response was assessed by serial photography and measurements of CWR. PK samples for total plasma doxorubicin and doxorubicinol were collected at Cycle 1 and Cycle 2 for both trials.
Results: Twenty-nine subjects were enrolled and received ≥ 1 cycle (median 4, range 1-6). Median age was 57; 16 (55%) had triple negative disease and 13 (45%) had distant metastases. The median prior exposure to anthracylines was 256 mg/m2 and the median prior dose of radiation was 6,100 cGy. Thirteen subjects were evaluable for MTD in Trial A and 9 in Trial B. Trial B established a phase II dose of 50 mg/m2 recommended by a Data Safety Monitor Board, based on 1 of 6 subjects at the 50 mg/m2 dose level having a DLT (grade 3 hypokalaemia unrelated to study treatment). In Trial A, 2 of 7 subjects at 40 mg/m2 had a DLT (grade 4 neutropenia lasting > 5 days; grade 3 dehydration lasting 27 days). The Cmax concentrations between 18,400 to 20,700 ng/mL were consistent at an equal dose level (40 mg/m2) between trials. Altogether, 7 (24%) subjects developed reversible grade 3-4 neutropenia and 4 (14%) reversible grade 3-4 leukopenia. No cardiac toxicity or hand-foot syndrome was seen. One case of CW thermal burn (grade 3) and one case of radiation recall (grade 2) were reported. Five (17%) complete local responses and 9 (31%) partial local responses were seen. The rate of local response was 48% (14/29; 95% CI: 30%-66%). Seven of 29 subjects (24%) progressed outside the study treatment field.
Conclusion: LTLD plus MLHT is a novel therapy that is safe and produces objective responses in heavily pretreated CWR patients with limited therapeutic options. The primary toxicity is reversible bone marrow suppression. A phase II trial is ongoing at the MTD (50 mg/m2). Future work should test thermally enhanced LTLD delivery in a less advanced, less heavily pretreated patient population.
*Author note-M.W.D. and K.L.B. equally contributed.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-15-05.
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Affiliation(s)
- HS Rugo
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - TM Zagar
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - SC Formenti
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - Z Vujaskovic
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - F Muggia
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - BM O'Connor
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - RJ Myerson
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - IC-C Hsu
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - N Borys
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - KL Blackwell
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
| | - MW Dewhirst
- University of California San Francisco Medical Center, San Francisco, CA; University of North Carolina Hospital, Chapel Hill, NC; New York University Medical Center, New York, NY; University of Maryland Medical Center, Baltimore, MD; Commonwealth Hematology/Oncology PC, Plymouth, MA; Washington University in St. Louis Medical Center, St. Louis, MO; Celsion Corporation, Lawrenceville, NJ; Duke University Medical Center, Durham, NC
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Muggia F, Tommasi S, Lynch H, Paradiso A. Hereditary breast and ovarian cancer: lessening the burden. Ann Oncol 2013; 24 Suppl 8:viii5-viii6. [PMID: 24298633 DOI: 10.1093/annonc/mdt318] [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: 11/13/2022] Open
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Kobrinsky B, Joseph SO, Muggia F, Liebes L, Beric A, Malankar A, Ivy P, Hochster H. A phase I and pharmacokinetic study of oxaliplatin and bortezomib: activity, but dose-limiting neurotoxicity. Cancer Chemother Pharmacol 2013; 72:1073-8. [PMID: 24048674 DOI: 10.1007/s00280-013-2295-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/06/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE The potential synergy of modulating platinum-induced DNA damage by combining the proteasome inhibitor bortezomib with oxaliplatin was studied in patients with solid tumors, with special attention to avoidance of cumulative neurotoxicity (NT). PATIENTS AND METHODS In a 3 + 3 dose escalation design, patients received bortezomib at 1.0-1.5 mg/m² on days 1 and 4 and oxaliplatin at 60-85 mg/m² on day 1 of a 14-day cycle. NT assessments were performed at the start of every two cycles. Oxaliplatin pharmacokinetics (PK) were determined pre- and post-bortezomib. RESULTS Thirty patients were enrolled with 25 (11 men, 14 women) fully evaluable for NT assessments at cycle 2. The median age was 56 years (range 35-74 years); median number of cycles received 2 (range 1-10). At dose levels 2-5 (B 1.3 mg/m²), patients manifested NT grades 3 and 4 at a median 3.4 cycles (range 2-9 cycles): 3 had ataxia (one also with sensory neuropathy or neurogenic hypotension, respectively) and 3 had just sensory neuropathy. A 6th dose-level reducing bortezomib to 1.0 mg/m² with oxaliplatin 85 mg/m²) was explored and no NT or dose limiting toxicities were noted among 7 evaluable patients (5 receiving two or more cycles). Four patients experienced a partial response--one with platinum-resistant ovarian cancer, another with gastroesophageal cancer, another with ampulla of Vater carcinoma, and a patient with cholangiocarcinoma. PK studies at dose levels 1 and 2 showed greater mean ultrafiltrable platinum when oxaliplatin was dosed after bortezomib. CONCLUSIONS Bortezomib 1.0 mg/m² × 2 every 14 days combines safely with oxaliplatin. At higher doses, cumulative NT (i.e., cerebellar signs and sensory neuropathy) occurs at an accelerated pace perhaps from a PK interaction.
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Affiliation(s)
- B Kobrinsky
- Division of Hematology and Oncology, NYU School of Medicine, 550 First Avenue, OBV C&D Bldg Rm 556, New York, NY, 10016, USA
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Ling H, Muggia F, Speyer J, Curtin J, Blank S, Boyd L, Pothuri B, Li X, Goldberg J, Tiersten A. Combination of irinotecan and bevacizumab for heavily pretreated recur- rent ovarian cancer: A phase II trial. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.085] [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]
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Formenti S, Rugo H, Myerson R, Diederich C, Straube W, O'Conner B, Matzkowitz AJ, Goodman RL, Muggia F. Abstract P6-13-01: Lyso-thermosensitive liposomal doxorubicin + local hyperthermia for radiation-pretreated chest wall recurrence. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-13-01] [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: 11/16/2022]
Abstract
Abstract
Background: Chest wall recurrence (CWR) causes much morbidity when not controlled by local measures. Lyso-thermosensitive liposomal doxorubicin (LTLD) provides accelerated release of doxorubicin (Dox) at ≥ 39° C, and is being studied for CWR based on the pioneering thermochemotherapy work of Dewhirst and colleagues at Duke. We now report on its tolerance, pharmacology, and preliminary antitumor effects in a dose-escalation study combined with local hyperthermia (LH) for radiation-refractory CWR. LH selectively increases liposomal permeability in tumor microvasculature, and promotes release of Dox from LTLD, and Dox tumor uptake, in addition to LH anti-tumor effects.
Methods: This phase I study entered patients (pts) with CWRs < 3 cm deep failing all standard Tx including surgery, radiation, and chemotherapy: pts received up to 6 LTLD/LH treatments every 21 days at a starting dose of 40 mg/m2 (cohort 1) and escalated to 50 mg/m2 (cohort 2). LTLD was infused IV over 30 minutes (min); followed within 30 min by microwave or ultrasound LH. The thermal dose goal was 40°C-42°C for 60 min. Pharmacokinetic samples for total plasma Dox and doxorubicinol (Doxol) were taken at 0.5, 5, 10 and 24 hours after starting infusion. Left ventricular ejection fraction was monitored every other cycle.
Results: Eleven pts with a median of 4 prior chemotherapy regimens (range 2 — 12) were enrolled; all but one had prior anthracycline (AC). All pts received ≥ 2 cycles. The within subject variability in Dox and Doxol exposure was small with mean Cycle 2 vs Cycle 1 ratios ranging from 0.99 to 1.06.
Cmax/dose (ng/ml)/(mg/m2) Cycle 1 Cycle 2
Dox 499.82 512.00
Doxol 0.46 0.45
AUClast/dose ((ng*hr/ml)/(mg/m2)
Dox 1338.12 1381.82
Doxol 7.96 8.04
Grade 3 and 4 toxicities included reversible neutropenia in 17 (40.5%) and one case (each) of mucositis (grade 1), chest wall thermal burn, and chest wall cellulitis (both grade 4); these occurred in only ≥ 5% of 42 cycles given. No cardiomyopathy or hand-foot toxicity occurred. The rate of clinically-significant (≥ 6 point) QoL improvement on the FACT-B after 2 cycles was 54.5% (95% CI: 25.1%–83.9%), including 1 lasting > 3 months. The local objective response rate was encouraging: 45.5% (95% CI: 16.1%–74.9%), with 1 complete and 4 partial local responses.
Conclusion: LTLD + LH is safe in CWR after prior radiation and doxorubicin. A phase II study is planned for pharmacologic evaluations and to add pts with less or no anthracycline treatment.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-13-01.
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Affiliation(s)
- S Formenti
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
| | - H Rugo
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
| | - R Myerson
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
| | - C Diederich
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
| | - W Straube
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
| | - B O'Conner
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
| | - AJ Matzkowitz
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
| | - RL Goodman
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
| | - F Muggia
- New York University Cancer Institute, New York, NY; UC San Francisco, San Francisco, CA; Siteman Cancer Center, Saint Louis, MO; Rhode Island Hospital, Providence, RI; New Hope Cancer Center, Hudson, FL; Saint Barnabas Medical Center, Livingston, NJ
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Verschraegen CF, Czok S, Muller CY, Boyd L, Lee SJ, Rutledge T, Blank S, Pothuri B, Eberhardt S, Muggia F. Phase II study of bevacizumab with liposomal doxorubicin for patients with platinum- and taxane-resistant ovarian cancer. Ann Oncol 2012; 23:3104-3110. [PMID: 22851407 DOI: 10.1093/annonc/mds172] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 12/21/2022] Open
Abstract
BACKGROUND Suppression of neoangiogenesis and pegylated liposomal doxorubicin (PLD) each contribute to the management of platinum-resistant/refractory ovarian cancer. The aim of this study is to test the combination of bevacizumab and PLD in women with resistant or refractory ovarian cancer. METHODS Eligibility criteria were no more than two prior treatments with platinum-containing regimens and one additional regimen, without anthracyclines. Treatment was administered every 3 weeks (bevacizumab 15 mg/kg beginning on cycle 2 and PLD 30 mg/m(2)). The primary end point was progression-free survival (PFS) at 6 months; the secondary end points included side-effects, overall response rates (ORR) and survival (OS). RESULTS Forty-six patients were enrolled. The average number of courses administered was 7. The median PFS was 6.6 months (range 1-24.6 months) according to Gynecologic Cancer Intergroup Committee (GCIC) criteria and 7.8 months (range 2-13.3 months) according to Response Evaluation Criteria in Solid Tumors (RECIST). The median OS was 33.2 months (range 3-37.5+ months). The ORR was 30.2% [95% confidence interval (CI) 17.2-46.1] and the clinical benefit rate (CBR) was 86.1% (95% CI 72.1-94.7). Adverse events included mucosal and dermal erosions (30% grade 3) and asymptomatic cardiac dysfunction. Additional toxic effects included hypertension, headache, renal dysfunction and proteinuria, wound healing delay, and one episode each of central nervous system (CNS) ischemia and hemolytic uremic syndrome. CONCLUSION PLD with bevacizumab has improved activity in recurrent ovarian cancer with increased toxicity.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Angiogenesis Inhibitors/adverse effects
- Angiogenesis Inhibitors/therapeutic use
- Antibiotics, Antineoplastic/adverse effects
- Antibiotics, Antineoplastic/therapeutic use
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bevacizumab
- Bridged-Ring Compounds/pharmacology
- Carcinoma, Ovarian Epithelial
- Disease-Free Survival
- Doxorubicin/adverse effects
- Doxorubicin/therapeutic use
- Drug Resistance, Neoplasm
- Female
- Humans
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasms, Glandular and Epithelial/drug therapy
- Neoplasms, Glandular and Epithelial/mortality
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/mortality
- Platinum/pharmacology
- Taxoids/pharmacology
- Treatment Outcome
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Affiliation(s)
- C F Verschraegen
- Department of Hematology/Oncology, University of Vermont Cancer Center, Burlington.
| | - S Czok
- Departments of Obstetrics and Gynecology, New York University Cancer Institute, New York
| | - C Y Muller
- Departments of Gynecologic Oncology, USA
| | - L Boyd
- Departments of Obstetrics and Gynecology, New York University Cancer Institute, New York
| | - S J Lee
- Departments of Mathematics, USA
| | - T Rutledge
- Departments of Gynecologic Oncology, USA
| | - S Blank
- Departments of Obstetrics and Gynecology, New York University Cancer Institute, New York
| | - B Pothuri
- Departments of Obstetrics and Gynecology, New York University Cancer Institute, New York
| | - S Eberhardt
- Radiology, University of New Mexico Cancer Center, Albuquerque, USA
| | - F Muggia
- Departments of Medicine, New York University Cancer Institute, New York
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11
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Lewin S, Dezube D, Guddati A, Mittal K, Muggia F, Klein P. Paraneoplastic hypercalcemia in clear cell ovarian adenocarcinoma. Ecancermedicalscience 2012; 6:271. [PMID: 23056149 PMCID: PMC3463128 DOI: 10.3332/ecancer.2012.271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 05/24/2012] [Indexed: 11/12/2022] Open
Abstract
Background: Hypercalcemia has been reported in association with a number of malignancies, but it is an unusual manifestation of ovarian cancer. This finding at presentation (possibly aggravated by oral calcium intake) led to discovery of a clear cell carcinoma of the ovary. The implications and pathophysiology of this association are reviewed. Case report: Following presentation with abdominal symptoms, this premenopausal woman was found to have bilateral adnexal masses and hypercalcemia. Her parathormone-related polypeptide was found to be elevated. After surgery and staging, she received adjuvant carboplatin and paclitaxel (later substituted by docetaxel). She has done well on her long-term follow-up. Conclusions: This rare paraneoplastic manifestation of ovarian cancer may be associated with long-term survival if discovered at an early stage. In this instance, further benefit may have been obtained from adjuvant platinum-based chemotherapy.
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Affiliation(s)
- S Lewin
- Department of Pediatrics, New York Presbyterian/Weill Cornell Medical Center, New York, NY, USA
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12
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Pothuri B, Sparano J, Blank S, Curtin J, Chuang E, Hershman D, Tiersten A, Liebes L, Chen A, Muggia F. Phase I study of the PARP inhibitor ABT-888 (veliparib) and pegylated liposomal doxorubicin (PLD) in recurrent ovarian (ov) and breast (br) cancers. Gynecol Oncol 2012. [DOI: 10.1016/j.ygyno.2011.12.053] [Citation(s) in RCA: 1] [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: 11/27/2022]
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13
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Andreopoulou E, Chen AP, Zujewski JA, Kalinsky K, Vahdat L, Raptis G, Hershman D, Novic Y, Muggia F, Sparano J. OT3-01-17: Randomized, Double-Blind, Placebo-Controlled Phase II Trial of Low-Dose Metronomic Cyclophosphamide Alone or in Combination with Veliparib (ABT-888) in Chemotherapy-Resistant ER and/or PR-Positive, HER2/neu-Negative Metastatic Breast Cancer: New York Cancer Consortium Trial P8853. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot3-01-17] [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: 11/16/2022]
Abstract
Abstract
Background: Veliparib is an orally available, small molecule inhibitor of poly(ADP-ribose) polymerase (PARP). PARP is an essential nuclear enzyme that plays a role in recognition of DNA damage and facilitation of DNA repair. PARP inhibitors potentiate the cytotoxicity of DNA-damaging agents, including cyclophosphamide (C). The rationale for the proposed trial is as follows: (1) low-dose, continuous metronomic C (50 mp PO daily) has activity in refractory metastatic breast cancer (MBC), (2) PARP is induced by DNA damaging agents, (3) PARP expression is comparable in ER-positive and ER-negative disease, (4) some ER-positive breast cancers exhibit defective homologous recombination pathway repair genes (eg, RAD51 and XRCC3), (5) the PARP inhibitor iniparib appears to be more effective when used in chemotherapy resistant disease. Taken together, these findings suggest that veliparib-C combination may be more effective than metronomic C alone in chemotherapy resistant MBC. Trial design: A randomized Phase II trial design 1:1. S. Blocked randomization will be performed at all participating sites. Patients are randomized to oral C (50mg PO daily) plus either veliparib (60mg PO daily) or matching placebo.
Eligibility criteria:(1) ER- and or PR-positive, HER2−negative MBC, (2) ECOG PS 0–1, (3) at least 2 prior chemotherapy regimens for MBC, including a taxane and capecitabine. 4) at least 1 line of endocrine therapy for metastatic disease (includes relapse while receiving endocrine therapy).
Specific aims: Primary: To determine if the addition of veliparib to metronomic dose C improves median progression free survival (PFS) compared with C alone in patients with ER and/or PR-positive, Her2-negative MBC who progressed on at least two lines of prior chemotherapy and one line of prior endocrine therapy.
Secondary: 1)To determine if the addition veliparib to C chemotherapy improves a) response rate b) clinical benefit rate (defined as objective response plus stable disease for at least 24 weeks from day +1) 2) Survival in patients treated with C alone and C plus veliparib. 3) Adverse event profile in patients treated with C alone and C plus veliparib.
Translational: Exploratory analyses will evaluate whether the macroH2A1.1 and PARP1 expression status in archival paraffin, or veliparib-induced PAR downregulation in peripheral blood mononuclear cells, is predictive of benefit from veliparib.
Statistical methods: The primary endpoint is PFS, and the trial is powered to detect an increase in median PFS from 3 to 6 months (alpha=0.10, beta=0.10), which will require enrollment of 62 eligible patients over 12 months.
Enrollment: The study is active and open to enrollment.
Clinical trials.gov NCT01351909
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT3-01-17.
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Affiliation(s)
- E Andreopoulou
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - AP Chen
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - JA Zujewski
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - K Kalinsky
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - L Vahdat
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - G Raptis
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - D Hershman
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - Y Novic
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - F Muggia
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
| | - J Sparano
- 1Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY; National Cancer Institute, Bethesda, MD; Columbia University Medical Center, New York, NY; Weill Cornell Medical College, New York, NY; Mount Sinai School of Medicine, New York, NY; New York University Langone Medical Center, New York, NY
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14
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Singh JC, Stein S, Volm M, Smith J, Novik Y, Speyer J, Adams S, Meyers M, Muggia F, Schneider R, Formenti S, Omene C, Choi H, Davis S, Goldberg J, Tiersten A. P1-17-07: Phase II Trial of RAD001 Plus Carboplatin in Patients with Triple-Negative Metastatic Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-17-07] [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: 11/16/2022]
Abstract
Abstract
Background: RAD001 is an oral mTOR inhibitor that has exhibited activity in breast cancer. Triple negative breast cancer cells are unable to repair double stranded DNA breaks and hence have sensitivity to platinum agents that cause interstrand cross-links. Rapamycin acts synergistically with platinum agents to induce apoptosis and inhibit proliferation in at least two different breast cancer cell lines (including ER/PR negative cell lines). We propose that combination RAD001 and carboplatin may have activity in triple-negative breast cancer.
Methods: The primary objective of the study is to determine clinical benefit (complete remission (CR) + partial remission (PR) + stable disease (SD)) and the toxicity of this combination in women with triple negative metastatic breast cancer who have had 0–3 prior chemotherapy regimens for metastatic disease. Secondary objectives are to determine progression free survival as well as investigating the relationship between pretreatment sensitivity (biopsy at baseline) and clinical response (biopsy post 2 cycles) using IHC staining for abundance of key proteins in the Akt-mTOR pathway and their activity using surrogate phosphorylation site-specific antibodies (Akt and phospho-serine 473, phospho-threonine and phospho-threonine 308 Akt; mTOR and phospho-serine 2448 mTOR; ribosome protein S6 kinase (S6K) and phospho-threonine 378 S6K; 4E-BP1 and phospho-serine 65 4E-BP1). Prior carboplatin is allowed. Women with treated brain metastasis are eligible. According to the original study plan, carboplatin AUC 6, was to be given intravenously every three weeks. Five mg of RAD001 was to be given daily with a 3 patient run-in and then 10 mg daily if there were no dose-limiting toxicities. Due to a unexpected amount of thrombocytopenia with this combination the dose of carboplatin was first amended to AUC 5 and most recently to AUC 4 with 5 mg of RAD001 (and no plan to escalate to 10 mg).
Results: Fourteen patients of a planned 25 have been recruited thus far. Median age is 58.5. Median number of prior regimens is 2 (0-3). Of the 7 patients assessable for response at this time, there have been 2 PR's and 5 patients with SD. One SD was achieved in a patient progressing on single agent carboplatin at study entry. Median duration of SD + PR is 28.5 weeks (5 patients have ongoing response ranging from 8–46.5 weeks). Five of 8 patients assessable for toxicity had grade 3 or 4 thrombocytopenia and 2 patients had grade 3 neutropenia. No cases of febrile neutropenia were observed. Four patients have required blood transfusion and one patient has required platelet transfusion. All patients have had treatment held and/or dose reductions secondary to hematological toxicity, however, since amended carboplatin dose the regimen has been very well tolerated with only one out of six patients) with grade 3 neutropenia and grade 3 thrombocytopenia. There have been no non-hematological grade 3 or 4 toxicities.
Conclusions: Clinical benefit was observed in all 7 assessable patients. Dose limiting thrombocytopenia was an unexpected side effect requiring protocol amendment. We continue to accrue study subjects at the amended dosing.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-17-07.
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Affiliation(s)
- JC Singh
- 1New York University Hospital Center, New York, NY
| | - S Stein
- 1New York University Hospital Center, New York, NY
| | - M Volm
- 1New York University Hospital Center, New York, NY
| | - J Smith
- 1New York University Hospital Center, New York, NY
| | - Y Novik
- 1New York University Hospital Center, New York, NY
| | - J Speyer
- 1New York University Hospital Center, New York, NY
| | - S Adams
- 1New York University Hospital Center, New York, NY
| | - M Meyers
- 1New York University Hospital Center, New York, NY
| | - F Muggia
- 1New York University Hospital Center, New York, NY
| | - R Schneider
- 1New York University Hospital Center, New York, NY
| | - S Formenti
- 1New York University Hospital Center, New York, NY
| | - C Omene
- 1New York University Hospital Center, New York, NY
| | - H Choi
- 1New York University Hospital Center, New York, NY
| | - S Davis
- 1New York University Hospital Center, New York, NY
| | - J Goldberg
- 1New York University Hospital Center, New York, NY
| | - A Tiersten
- 1New York University Hospital Center, New York, NY
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15
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Singh JC, Stein S, Volm M, Smith JA, Novik Y, Speyer JL, Adams S, Meyers MI, Muggia F, Schneider R, Formenti S, Davis S, Choi H, Tiersten A. Phase II trial of RAD001 plus carboplatin in patients with triple-negative metastatic breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.293] [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
293 Background: RAD001 is an oral mTOR inhibitor that has exhibited activity in breast cancer. Triple negative breast cancer cells are unable to repair double stranded DNA breaks and hence have sensitivity to platinum agents that cause interstrand cross-links. Rapamycin acts synergistically with platinum agents to induce apoptosis and inhibit proliferation in at least two different breast cancer cell lines (including ER/PR negative cell lines). We propose that combination RAD001 and carboplatin may have activity in triple-negative breast cancer. Methods: The primary objective of the study is to determine clinical benefit (complete remission; CR, partial remission; PR and stable disease; SD) and the toxicity of this combination in women with triple negative metastatic breast cancer who had received 0-3 prior chemotherapy regimens for metastatic disease. Prior carboplatin was allowed. Women with treated brain metastasis were eligible. Secondary objectives were to determine progression free survival. According to the original study plan, carboplatin AUC 6, was to be given intravenously every three weeks. 5 mg of RAD001 was to be given daily with a 3 patient run-in and then 10 mg daily if there were no dose-limiting toxicities. Due to a surprising amount of thrombocytopenia with this combination the dose of carboplatin was first amended to AUC 5 and most recently to AUC 4 with 5 mg of RAD001 (and no plan to escalate to 10 mg). Results: Eleven patients of a planned 25 have been recruited thus far. Median age is 62. Median number of prior regimens is 1. Of the 6 patients assessable for response at this time, four have SD and two have had a PR. 1 SD was achieved in a patient progressing on prior carboplatin at study entry. Five of 7 patients assessable for toxicity had grade 3 or 4 thrombocytopenia and 2 patients had grade 3 neutropenia. All patients have had treatment held and/or dose reductions secondary to hematological toxicity. There have been no non-hematological grade 3 or 4 toxicities. Conclusions: Clinical benefit was observed in all 6 evaluable patients. Dose limiting thrombocytopenia was an unexpected side effect requiring protocol amendment. We continue to accrue study subjects at the amended dosing.
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Affiliation(s)
- J. C. Singh
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - S. Stein
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - M. Volm
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - J. A. Smith
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - Y. Novik
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - J. L. Speyer
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - S. Adams
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - M. I. Meyers
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - F. Muggia
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - R. Schneider
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - S. Formenti
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - S. Davis
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - H. Choi
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
| | - A. Tiersten
- New York University Langone Medical Center, New York, NY; New York University School of Medicine, New York, NY; New York University Langone Medical Center, New York University Cancer Institute, New York, NY
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16
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Lai DW, Buckley SA, Schmidt BL, Viet C, Muggia F, Belitskaya-Levy I, Cohen RF, DeLacure MD, Sanfilippo N, Myssiorek D, Hirsch D, Seetharamu N. Exploring factors in diagnostic delays of head and neck cancer at a public hospital. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5544] [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: 11/20/2022] Open
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17
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Cannon TL, Muggia F, Hirsch D, Andreopoulou EA, Kerr AR, DeLacure MD. Multiple cases of squamous cell carcinoma of the tongue and oral cavity in patients treated with long-term pegylated liposomal doxorubicin (PLD) for ovarian cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5557] [Citation(s) in RCA: 4] [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: 11/20/2022] Open
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18
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Kwa M, Baumgartner RA, Shavit L, Barash I, Michael J, Puzanov I, Kopolovic J, Rosengarten O, Hung A, Jones H, Gabizon A, Muggia F. Treatment-related microangiopathic glomerulopathy and severe chronic kidney disease (CKD) in recurrent epithelial ovarian cancer (rEOC): A possible relationship with pegylated liposomal doxorubicin (PLD). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15551] [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: 11/20/2022] Open
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19
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Monk BJ, Herzog TJ, Kaye SB, Krasner CN, Vermorken JB, Muggia F, Pujade-Lourraine E, Zintl P, Parekh TV, Poveda A. Final survival results of the randomized phase III study of trabectedin with pegylated liposomal doxorubicin (PLD) versus PLD in recurrent ovarian cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5046] [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: 11/20/2022] Open
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20
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Andreopoulou E, Chen AP, Zujewski J, Kim M, Hershman DL, Kalinsky K, Cigler T, Vahdat LT, Raptis G, Ramaswamy B, Novik Y, Muggia F, Sparano JA. Randomized, double-blind, placebo-controlled phase II trial of low-dose metronomic cyclophosphamide alone or in combination with veliparib (ABT-888) in chemotherapy-resistant ER and/or PR-positive, HER2/neu-negative metastatic breast cancer: New York Cancer Consortium trial P8853. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps114] [Citation(s) in RCA: 1] [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: 11/20/2022] Open
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21
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Abstract
Advances in the study of BRCA1 and BRCA2 gene functions have relied on the development of animal models for seeking to explore further what we have learned from the human disease. Specifically, mouse models of a 'triple-negative' breast cancer (utilizing conditional knockout of BRCA1 and p53 in the breast), of an endometrioid ovarian cancer (based on oncogenic kras and loss of function of pten), and of anatomic and functional consequences of BRCA1 mutations in granulosa cells, have led to further inquiry into the pathogenesis and therapeutic consequences of genetic alterations. A striking susceptibility of these murine malignancies to platinum drugs has emerged, providing further confidence in their relevance to the human disease. In addition to these models, the pathogenesis of high-grade serous disease derived from risk-reducing surgeries in mutation carriers has pointed to a role of mutations in p53 commonly encountered in tubal intraepithelial carcinomas.
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Affiliation(s)
- F Muggia
- New York University Cancer Institute, New York, NY 10016, USA.
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22
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Czok S, Jewell A, Shawki S, Boyd L, Smith H, Blank S, Muller C, Verschraegen C, Muggia F. Pegylated liposomal doxorubicin with bevacizumab in the treatment of platinum-resistant ovarian cancer: Toxicity profile results. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.198] [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: 10/18/2022]
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24
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25
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Romero I, Colombo N, Kaye SB, Arranz J, Roszak A, Provencher DM, Santabarbara P, Bayever E, Almorin E, Muggia F. Tolerability of long-term use of trabectedin (Tr) in combination with pegylated liposomal doxorubicin (PLD) in patients (pts) with relapsed ovarian cancer (ROC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5121] [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: 11/20/2022] Open
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26
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Borys N, Muggia F, Simonich W, Lewis SA. Phase I/II study evaluating the maximum tolerated dose, pharmacokinetics, safety, and efficacy of approved hyperthermia and lyso-thermosensitive liposomal doxorubicin in patients with breast cancer recurrence at the chest wall. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps117] [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: 11/20/2022] Open
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27
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Safra T, Borgato L, Nicoletto M, Rolnitzky L, Curtin J, Geva R, Peles S, Grenader T, Gabizon A, Muggia F. Pegylated liposomal doxorubicin (PLD) treatment for recurrent epithelial ovarian cancer (rEOC): Implications of BRCA mutations. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5043] [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: 11/20/2022] Open
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28
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Muggia F, Safra T, Borgato L, Gandhi A, Mancinc G, Gabizon A, Liebes L. Pharmacokinetics (PK) of pegylated liposomal doxorubicin (PLD) given alone and with bevacizumab (B) in patients with recurrent epithelial ovarian cancer (rEOC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Borgato L, Safra T, Levinson B, Pothuri J, Hope J, Curtin J, Andreopoulou E, Muggia F. Imatinib mesylate with weekly paclitaxel, a feasible regimen for treatment of recurrent epithelial ovarian cancer (rEOC). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15535] [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: 11/20/2022] Open
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30
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Stein S, Hochster HS, Muggia F, Blank SV, Curtin JP, Shapira I, Goldberg GL, Tiersten A. Oxaliplatin plus continuous infusion topotecan: An ongoing phase II study for recurrent ovarian cancer—A New York Cancer Consortium study (#N01-CM62204). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5092] [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: 11/20/2022] Open
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31
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Seetharamu N, Kim E, Hochster H, Martin F, Muggia F. Phase II study of liposomal cisplatin (SPI-77) in platinum-sensitive recurrences of ovarian cancer. Anticancer Res 2010; 30:541-545. [PMID: 20332467] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Cisplatin is a highly effective chemotherapeutic agent against epithelial ovarian cancer but is associated with significant toxicities. SPI-77 is a liposomal pegylated formulation of cisplatin that was developed to reduce systemic toxicity and to better deliver cisplatin to tumors. We assessed the response rates and safety of SPI-77, in patients with recurrent epithelial ovarian cancer. PATIENTS AND METHODS Patients were selected for having previously achieved a platinum treatment free interval of greater than 6 months (e.g. platinum-sensitive) and high potential of achieving responses when rechallenged with a platinum drug. SPI-77 was administered at a dose of 260 mg/m(2) every 21 days until disease progression. RESULTS Enrollment was terminated after 5 patients were treated because of concern with the adequacy of the formulation. Four out of the five patients had stable disease as best response. While no serious, unexpected adverse events occurred in spite of large cumulative doses of SPI-77, there were concerns related to the large lipid load and prolonged persistence of residual platinum in body stores. CONCLUSION The results of this study, although inconclusive regarding its primary endpoints, provide some important lessons for the development of similar liposomal platinum agents.
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Affiliation(s)
- N Seetharamu
- New York University School of Medicine, New York, NY 10016, USA
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Tiersten A, Sill M, Muggia F, Elera C, Garcia A, Fracasso P, Swensen R, Warshal D, Mannel R. Phase I/feasibility trial of dose-dense carboplatin (C) and paclitaxel (P) in patients (pts) with ovarian cancer: A Gynecologic Oncology Group study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5544] [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
5544 Background: Dose-dense regimens improve outcome for women with breast cancer. We investigated the feasibility of dose-dense CP for women with ovarian cancer. Methods: Pts with untreated stage III/IV ovarian cancer received C AUC 5 and P 175 mg/m2 day 1, pegfilgrastim 6 mg day 2 every 2 weeks for 6 cycles. Dose-limiting toxicity (DLT) was defined as: febrile neutropenia, grade 4 neutropenia ≥7 days, grade 4 thrombocytopenia (tcp), grade 3 tcp with bleeding, dose delay >2 weeks, grade 3/4 non-hematologic toxicity (excluding fatigue, hypersensitivity, nausea/vomiting, alopecia, constipation, diarrhea or bone pain), and any treatment related death. The study utilized a 2-stage sequential design (20 pts/stage) with DLTs in 6 cycles determining regimen feasibility. Results: Between September 2006 and September 2008, 43 pts enrolled. Twenty and 17 patients were evaluable for toxicity over 6 cycles in stages 1 and 2 respectively. Six DLT's were observed for both stages. Thirty pts completed treatment and 12 did not [DLTs (6), paclitaxel hypersensitivity reactions (2), progression (1), patient choice (1), infection (1) and death unrelated to treatment (1)]. One pt remains on treatment. The 6 DLTs resulting in treatment discontinuation included grade 3 neuropathy (2), grade 4 neuropathy (1), grade 4 tcp (1), grade 4 tcp/grade 3 febrile neutropenia (1), and grade 4 SVT (1). Six other DLTs not preventing treatment completion included grade 3 infection (1), grade 3 AST/ALT elevation (1), grade 3 confusion (1), grade 3 dehydration (1), grade 3 neuropathy (1) and grade 4 tcp (1). Other toxicities resulting in treatment delays included grade 3 tcp (1), grade 3 fatigue (1) and grade 2 neuropathy (2). There were 5 P dose reductions and 4 C dose reductions. Conclusions: Seventy-two percent pts completed 6 cycles of dose-dense CP. Based on DLTs (at least 12 in 37 evaluable pts), this regimen is not feasible. Given the neuropathy and tcp, we do not recommend further investigation in a phase III trial. No significant financial relationships to disclose.
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Affiliation(s)
- A. Tiersten
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - M. Sill
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - F. Muggia
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - C. Elera
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - A. Garcia
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - P. Fracasso
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - R. Swensen
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - D. Warshal
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
| | - R. Mannel
- New York University Cancer Institute, New York, NY; Roswell Park Cancer Institute, Buffalo, NY; USC/Norris Comprehensive Cancer Center, Los Angeles, CA; University of Virginia, Charlottesville, VA; University of Washington, Seattle, WA; Cooper University Hospital, Camden, NJ; Oklahoma University, Oklahoma City, OK
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LaNatra N, Hochster H, Muggia F, Blank SV, Curtin J, Fishman D, Shapira IE, Goldberg GL, Parise S, Tiersten A. Oxaliplatin plus continuous infusion topotecan: First stage of an ongoing phase II study for recurrent ovarian cancer: A New York Cancer Consortium study (#N01-CM62204). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5556] [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
5556 Background: Topoisomerase-1 inhibitors and platinums are active in ovarian cancer. Our prior series described infusional topotecan as less myelosuppressive than bolus and more easily combined with oxaliplatin than cisplatin. An NYU phase I study of the combination in previously treated ovarian cancer patients (pts) showed promising activity and good tolerability (Hochster H, Gynecol Oncol 2008). Methods: Ovarian cancer pts treated with 1–2 prior regimens (1 platinum/taxane regimen, no topotecan) were treated with oxaliplatin 85 mg/m2 day 1, 15 and topotecan (0.4 mg/m2/day) continuous infusion x 14 days every 4 weeks (wks). Platinum resistant (stratum I = 10) and sensitive (stratum II = 17) pts are included in this two-stage trial (n = 52) to evaluate overall response rate (ORR) and toxicities. Results: From January 2006 to November 2008, 27 pts entered. Median age was 61 (37–79). Fifteen pts had 1 prior regimen and 12 pts had 2. Five pts discontinued before 2 cycles (3 for predefined toxicity, 2 by pt/physician choice). 102 cycles of chemotherapy were given (median 4, [1–6]). Grade 3/4 toxicities included thrombocytopenia (37% grade 3, 19% grade 4), neutropenia (37% grade 3, 11% grade 4), anemia (15% grade 3), neuropathy (7% grade 3), diarrhea (4% grade 3), transaminitis (4% grade 3), and fatigue (7% grade 3). Twenty-one pts had day 15 oxaliplatin held, 10 pts required dose reductions, and 21 pts had treatment delays mainly from thrombocytopenia. No pts had neutropenic fever. Twenty-one pts are now evaluable. Stratum I had 1 complete and no partial responses, 5 pts with stable disease and 2 with progressive disease. Stratum II had 3 complete and 6 partial responses, 4 pts with stable disease and none progressed. Median response duration is 41 wks (17–62); median duration of stable disease is 17 wks (4–70). Conclusions: Excluding thrombocytopenia, tolerance to this regimen confirms phase I results. In pts with creatinine clearances (CrCl) < 60 ml/min, the incidence of grade 3/4 thrombocytopenia was 75% versus 35 % for pts with CrCl > 60 ml/min. Pts with CrCl of 40–60 ml/min will now start topotecan 0.3 mg/m2/day x 14 days. Reaching our predefined ORR of at least 30% for stratum II and 20% for stratum I, the second stage of accrual has begun. [Table: see text]
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Affiliation(s)
- N. LaNatra
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - H. Hochster
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - F. Muggia
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - S. V. Blank
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - J. Curtin
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - D. Fishman
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - I. E. Shapira
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - G. L. Goldberg
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - S. Parise
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
| | - A. Tiersten
- NYU, New York, NY; Beth Israel Medical Center, New York, NY; Montefiore Medical Center, Bronx, NY
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Wu J, Muggia F, Henderson C, Feun L, Veldhuizen PV, Gold P, Zheng H, Abbadessa 66201 G, Lewis J, Zhu AX. Phase II study of darinaparsin in patients with advanced hepatocellular carcinoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15630] [Citation(s) in RCA: 2] [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
e15630 Background: Inorganic arsenic has reported activity in advanced hepatocellular carcinoma (HCC) in Asia, yet its efficacy is limited by liver toxicity. Darinaparsin is a novel organic arsenic that is capable of reaching higher intracellular concentration in cells with decreased toxicity compared to inorganic arsenic. It is highly active as a single agent in HCC cell lines and animal tumor models. We conducted a multi-center phase II study with darinaparsin in patients with advanced HCC. Methods: Eligibility criteria included unresectable or metastatic measurable HCC, up to two prior systemic treatments, ECOG performance status ≤2, Child Pugh Class A or B and adequate organ functions. Darinaparsin was given at 420 mg/m2 intravenously administered over 60 minutes through a central line, twice weekly at least 72 hours apart for three weeks followed by one-week rest in a four-week cycle. The primary end point of the study was response rate. A Simon two-stage design was used to assess the efficacy of darinaparsin and the study would be terminated if no responses were observed after the first stage. Results: The planned 15 patients of the first stage were enrolled: median age = 60 (35 - 79). M/F = 14/1, ECOG performance status 0/1= 4/11, Child Pugh class A/B = 11/4. Seven patients received prior systemic chemotherapies. No objective responses were observed. Three patients had stable disease. The median number of cycles on study per patient was 2 (1–6). The median progression free survival and overall survival were 55 days (95% confidence interval: 50 - 59) and 190 days (95% confidence interval: 93–227), respectively. Treatment was well tolerated. No treatment related hospitalizations or deaths occurred. Treatment related grade 1–2 toxicities included nausea/vomiting (31%), fatigue (23%), anorexia (15%) and diarrhea (15%). Grade 3 anorexia, wheezing, agitation, right upper quadrant pain and SGPT were observed in 1 patient each (8%), 1 patient experienced grade 4 hypoglycemia (8%). Conclusions: Darinaparsin was safely administered with tolerable toxicity profiles in HCC patients. However, it has shown no objective responses in HCC and this trial was terminated as planned after the first stage of efficacy analysis. [Table: see text]
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Affiliation(s)
- J. Wu
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - F. Muggia
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - C. Henderson
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - L. Feun
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - P. V. Veldhuizen
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - P. Gold
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - H. Zheng
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - G. Abbadessa 66201
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - J. Lewis
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
| | - A. X. Zhu
- NYU Cancer Institute, New York, NY; Piedmont Hospital Research Institute, Atlanta, GA; University of Miami Hospital and Clinics, Miami, FL; Kansas City Veterans Administration Medical Center, Kansas, MO; Swedish Cancer Institute Research, Seattle, WA; Massachusetts General Hospital, Boston, NY; Ziopharm Oncology, Boston, MA; Ziopharm, Boston, MA
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Fasano J, Muggia F. Breast cancer arising in a BRCA-mutated background: therapeutic implications from an animal model and drug development. Ann Oncol 2009; 20:609-14. [DOI: 10.1093/annonc/mdn669] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Smith J, Baer L, Blank S, Dilawari A, Carapetyan K, Alvear M, Utate M, Curtin J, Muggia F. A screening and prevention programme serving an ethnically diverse population of women at high risk of developing breast and/or ovarian cancer. Ecancermedicalscience 2009. [DOI: 10.3332/ecancer.2009.123] [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: 11/06/2022] Open
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Smith J, Baer L, Blank S, Dilawari A, Carapetyan K, Alvear M, Utate M, Curtin J, Muggia F. A screening and prevention programme serving an ethnically diverse population of women at high risk of developing breast and/or ovarian cancer. Ecancermedicalscience 2009; 3:123. [PMID: 22275995 PMCID: PMC3224011 DOI: 10.3332/ecancer.2008.123] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION We describe a screening and prevention programme primarily targeting under-served minority women at high risk of breast and/or ovarian cancer. Women attending this Bellevue Hospital Center (BHC) Clinic were either self-referred from a variety of special outreach programmes or referred internally by medical professionals caring for relatives or friends. Our objective was to delineate referral sources and preliminary risk-assessment findings in relation to demographic features in this population. METHODS Following a detailed family and personal history intake and physical examination, each woman on her initial visit is categorized into a low (standard) risk, high-risk or indeterminate-risk group. Women found to be at high risk of developing breast and/or ovarian cancers are referred for further testing, additional screening measures, or participation in chemoprevention trials. All other women are counselled concerning follow-up and lifestyle issues. RESULT Between 2003 and 2007, 171 women for whom complete information was obtained were analysed. Thirty-four of the women were Caucasians (19.8%) and 137 (80.2%) were ethnically diverse minority women. Sixty-two (36.2%) were found to be at high risk with a median age of 42 years. The majority of the high-risk women were referred to the clinic by medical professionals (58%), most of whom were from within the BHC health care system. In fact, one-fourth of the referrals were women who carried a diagnosis of cancer, mostly arising in the breast, and who were concerned with risks to other family members. Trends in genetic testing results indicate fewer mutations among high-risk Asians than among other ethnicities. CONCLUSION Accurate risk assessments and implementation of screening and prevention measures have been challenging during the first few years of operation. Nevertheless, the need for providing consultation from internal referrals and the potential for genetic and psychosocial research in an ethnically diverse population are powerful incentives for continuing to evolve these services.
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Affiliation(s)
- J Smith
- Department of Medical Oncology, New York University, USA
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Yuan Y, Orlow SJ, Curtin J, Downey A, Muggia F. Pegylated liposomal doxorubicin (PLD): enhanced skin toxicity in areas of vitiligo. Ecancermedicalscience 2008; 2:111. [PMID: 22275986 PMCID: PMC3234058 DOI: 10.3332/ecancer.2008.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/18/2008] [Indexed: 11/06/2022] Open
Abstract
Pegylated liposomal doxorubicin (PLD, Doxil, Caelyx) is widely used for the treatment of ovarian cancer. It is a stable formulation encapsulating doxorubicin in a 'Stealth' (i.e., pegylated) liposome with a half-life of about 72 hours. This drastically altered pharmacology confers on it a considerably lower risk of cardiotoxicity, no acute emesis, and near absence of alopecia or problems with extravasation necrosis. On the other hand, PLD's dose-limiting toxicity is cutaneous. Since the original phase I report, cutaneous toxicities reported with PLD fall into four common categories: the well known hand-foot syndrome (also called palmoplantar erythrodysesthesia, or PPE), a diffuse follicular rash, intertrigo-like eruption, and hyperpigmentation including melanotic macules.
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Affiliation(s)
- Y Yuan
- NYU Cancer Institute and Medical Oncology, NYU Langone Medical Center, New York, NY 10016, USA
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Dilawari A, Cangiarella J, Smith J, Huang A, Downey A, Muggia F. Co-existence of breast and ovarian cancers in BRCA germ-line mutation carriers. Ecancermedicalscience 2008; 2:109. [PMID: 22275985 PMCID: PMC3234065 DOI: 10.3332/ecancer.2008.109] [Citation(s) in RCA: 6] [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: 11/02/2008] [Indexed: 12/21/2022] Open
Abstract
The co-existence of breast and ovarian cancers in the same individual should raise suspicion of a hereditary process. Patients with either BRCA1 or BRCA2 germ-line mutations have an average risk of 39% and 11% respectively of developing ovarian cancer by the age of 70; they have a risk of 35-85% of developing breast cancer in their lifetime. We report here unusual pathologic features in a BRCA2 germ-line mutation carrier recently diagnosed with synchronous breast and ovarian cancers, and summarize the findings in six other women who were diagnosed with ovarian cancer either simultaneously with the diagnosis of breast cancer or at varying times after the diagnosis. While in most instances this may be a coincidental occurrence in highly susceptible individuals, the patient we highlight raises the provocative hypothesis that at times breast cancer metastasizes to the ovaries of mutation carriers and stimulates the development of an ovarian cancer as well as other cancers. In addition, these ovarian cancers may have different mechanisms of metastases predisposing them to travel to unusual sites.
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Affiliation(s)
- A Dilawari
- Department of Medical Oncology, NYU Langone School of Medicine, New York, NY 10016, USA
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Goel S, Goldberg GL, Kuo DYS, Muggia F, Arezzo J, Mani S. Novel neurosensory testing in cancer patients treated with the epothilone B analog, ixabepilone. Ann Oncol 2008; 19:2048-52. [PMID: 18644829 DOI: 10.1093/annonc/mdn420] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We have previously established the recommended phase II dose (RPTD) of ixabepilone as 40 mg/m(2) administered over 1 h repeated every 3 weeks with neuropathy as a cumulative dose-limiting toxicity. We expanded the cohort at the RPTD to include detailed assessment of nerve damage in these patients. We report our findings on vibration perception threshold (VPT) and neuropathy. PATIENTS AND METHODS Forty-four patients were treated with a median (range) of three (1-14) cycles of ixabepilone. The VPT (5-min duration) and nerve conduction test (NCT, 10-min duration) were carried out in the office, before ixabepilone dosing, and every two cycles thereafter. RESULTS Neuropathy (grade 1 and grades 2-3) was observed in 17 (38.6%) and 11 (25%) patients, respectively. The mean increase in VPT as a function of grade 0-1 versus grades 2-3 neuropathy was 0.235 +/- 0.03 versus 0.869 +/- 0.09 (P = 0.049) vibration units. The F-wave frequency and distal motor latency, as assessed using the NCT, did not correlate with clinical neurotoxicity. CONCLUSION The change in VPT is observed early and likely reflects early vibration perception change. Mean change in VPT correlates with the severity of clinical neuropathy. Whether VPT change predicts onset of severe neuropathy warrants prospective testing and validation.
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Affiliation(s)
- S Goel
- Department of Oncology, Albert Einstein College of Medicine and Cancer Center, Bronx, NY, USA.
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Abstract
The authors report and discuss a case of a mucinous carcinoma of the appendix, a rare entity with a distinct natural history that poses diagnostic and therapeutic challenges. Mucinous peritoneal carcinomatosis is most commonly associated with primary tumors of the appendix and colon. Typically, spread remains confined to the abdominal cavity. Imaging assessment of these mucinous lesions is difficult, while tumor markers (CEA and CA19.9) may be surrogates for extent of disease. Treatment consists of surgical debulking, sometimes coupled with intraperitoneal drug delivery, but recurrence is universal. New treatment approaches are needed. Mucin genes are regulated in part by epidermal growth factor receptor signaling. Therefore, we initiated a phase II study of cetuximab for mucinous peritoneal carcinomatosis, that was part of this patient's treatment.
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Affiliation(s)
- E Andreopoulou
- Department of Medicine, New York University School of Medicine, New York, NY, USA.
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Andreopoulou E, Ursin G, Carapetyan K, Utate M, Alvear M, Rosell M, Muggia F, Smith J. Effects of letrozole on mammographic density (MD) in post-menopausal (PM) women at high risk for breast cancer (BC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1548] [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
1548 Background: Letrozole BC chemoprevention is supported by reductions in contralateral cancer in aromatase inhibitor adjuvant BC trials. Decreased MD may be a surrogate for efficacy in prevention trials. Objective: to evaluate the effects of 12-mo letrozole on MD in PM women at high risk for BC. Methods: 20 healthy PM women had Gail model risk profile and baseline MD prior to letrozole 2.5/d for 1 y. MD was determined by a computer assisted method (Cancer Epidemiol Biomarkers and Prevention 2003;12:332–338) and read blindly (baseline, 6mo films and eventually also 12mo by GU). Health status, lipid profile, bone density, and cognitive function were monitored. Results: by December (<1y): 14 Caucasian, 1 Hispanic, 3 Asians, and 2 Blacks were accrued. The table shows changes in MD at baseline & 6mo in the first 6 women: * reader considered this MD technically unsatisfactory (insufficient contrast). Conclusions: One woman discontinued treatment at 3 mo due to muscle aches. Six and 12mo comparisons will be ready in June 2007. Concordant results and decrease in density are suggested by the available data. Acknowledgements: This work is supported in part by The Lynne Cohen Foundation. [Table: see text] [Table: see text]
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Affiliation(s)
- E. Andreopoulou
- New York University Cancer Institute, New York, NY; University of Southern California, Los Angeles, CA
| | - G. Ursin
- New York University Cancer Institute, New York, NY; University of Southern California, Los Angeles, CA
| | - K. Carapetyan
- New York University Cancer Institute, New York, NY; University of Southern California, Los Angeles, CA
| | - M. Utate
- New York University Cancer Institute, New York, NY; University of Southern California, Los Angeles, CA
| | - M. Alvear
- New York University Cancer Institute, New York, NY; University of Southern California, Los Angeles, CA
| | - M. Rosell
- New York University Cancer Institute, New York, NY; University of Southern California, Los Angeles, CA
| | - F. Muggia
- New York University Cancer Institute, New York, NY; University of Southern California, Los Angeles, CA
| | - J. Smith
- New York University Cancer Institute, New York, NY; University of Southern California, Los Angeles, CA
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Chuang E, Vahdat L, Caputo T, Goldberg G, Flam A, Christos P, Colevas A, Muggia F, Wadler S. Phase I clinical trial of ixabepilone and pegylated liposomal doxorubicin in patients with advanced breast or ovarian cancers: New York Cancer Consortium Trial P7229. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.2570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2570 Background: Ixabepilone (IX) is a semisynthetic epothilone B analog with activity in patients (pts) with taxane refractory cancer. Two phase III clinical trials in breast cancer (BC) and a phase II study in ovarian cancer (OC) have recently been completed. Pegylated liposomal doxorubicin (PLD) is used for the treatment of platinum refractory OC and has activity in patients with metastatic BC. Methods: We have completed enrollment of a phase I study of PLD IV and ixabepilone IV over 3 hours. 18 pts with metastatic cancer (10 BC and 8 OC) with median age 51 were enrolled from 1/13/06 to 12/22/06. A total of 60 cycles has been administered to date. 3 OC patients enrolled at dose level 3 have not yet completed 2 cycles of treatment and are not yet evaluable. Results: Dose limiting toxicities (DLT) based on toxicities experienced during the first 2 cycles is provided in the table below. Adverse events (AE) occurring in any cycle were: Grade 4 AE: neutropenia < 7 days (1 pt). Grade 3 AE: palmar plantar erythrodysesthesia (PPE) (4), mucositis (3), infection (2), fatigue (2), neutropenia (2), thrombocytopenia (2), anemia (1), neuropathy (1), bilirubin (1). Non-hematological grade 2 AEs included: mucositis (4), PPE (3), infection (2), neuropathy (2), rash (3), pain (3), fever (1), myalgias (1), and anorexia (1). Responses so far for 10 BC pts are PR (1) SD (3) PD (6) and for 5 OC pts are PR (1) SD (2) PD (2). Updated results will be presented. Conclusions: Although the recommended phase II dose when given every 3 weeks is 30 mg/m2 for PLD and 32 mg/m2 for IX by our criteria, PPE and mucositis became problematic when treatment was continued beyond 2 cycles. We are therefore exploring a 4 week PLD schedule, evaluating IX given either every 4 weeks (as shown) or weekly (on days 1, 8, and 15). A phase II trial of the combination in platinum refractory OC will be initiated upon completion of the phase I. Supported by N01-CM-62204 [Table: see text] [Table: see text]
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Affiliation(s)
- E. Chuang
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
| | - L. Vahdat
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
| | - T. Caputo
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
| | - G. Goldberg
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
| | - A. Flam
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
| | - P. Christos
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
| | - A. Colevas
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
| | - F. Muggia
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
| | - S. Wadler
- Weill Medical College of Cornell Univ, New York, NY; Albert Einstein College of Medicine, New York, NY; CTEP National Cancer Institute, Bethesda, MD; NYU School of Medicine, New York, NY
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Kuo DY, Blank SV, Kobrinsky B, Christos P, Caputo TA, Runowicz CD, Pothuri B, Ivy P, Muggia F, Wadler S. Oxaliplatin plus paclitaxel for recurrent and metastatic cervical cancer (CC): New York Cancer Consortium Trial P5840. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5549] [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
5549 Background: Although cisplatin (cis) is an effective radiosensitizer, its activity in patients (pts) with advanced and recurrent CC is disappointing. Oxaliplatin (O) might exhibit greater activity and be suitable for combination with paclitaxel (P). Methods: Pts with advanced and recurrent CC who had not received prior chemotherapy except radiosensitizing cis were treated with P 175 mg/m2 IV and O 130 mg/m2 IV every 21 d. Response (R), as determined by RECIST criteria and confirmed at 9 weeks (wk), and toxicity were primary outcomes. If R in = 8 patients (pts) of 18, accrual to 46 could ensue. Results: Of 17 pts enrolled, 16 were treated. Histology: 7 adeno/10 squamous.The median age was 57 (range 33–78) and 13 had had prior radiation (10 with cis). Median cycles: 3 (0–8). One CR and 4 PRs were achieved for an overall response rate of 29% (95% confidence interval: 10.3%, 56.0%). Additionally, 4 had stable disease, but this was not confirmed at 15wk. Time to progression in those responding was 21 wk (range 11–51). 7 pts are alive. 6 pts experienced grade (gr) 3/4 hematologic toxicity. Neuropathy occurred following cycle 3 in 2 pts (gr3). Additonal gr 3/4 toxicities were gastrointestinal (GI)/metabolic in 6, thrombotic in 1 and hypersensitivity in 1. There were no treatment-related deaths. Conclusions: In the stage I of our Phase II trial, O and P demonstrate a 29% response rate when used to treat advanced and recurrent CC. Toxicities of this regimen are hematologic, gastrointestinal, and neurologic. Supported by N01-CM-62204. No significant financial relationships to disclose.
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Affiliation(s)
- D. Y. Kuo
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - S. V. Blank
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - B. Kobrinsky
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - P. Christos
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - T. A. Caputo
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - C. D. Runowicz
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - B. Pothuri
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - P. Ivy
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - F. Muggia
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
| | - S. Wadler
- Albert Einstein College of Medicine, Bronx, NY; New York University School of Medicine, New York, NY; New York Presbyterian Weill Cornell Med College, New York, NY; University of Connecticut, Farmington, CT; NIH/NCI, Bethesda, MD; New York Presbyterain Weill Cornell Med College, New York, NY
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Morgan RJ, Synold TW, Gandara D, Muggia F, Scudder S, Reed E, Margolin K, Raschko J, Leong L, Shibata S, Tetef M, Vasilev S, McGonigle K, Longmate J, Yen Y, Chow W, Somlo G, Carroll M, Doroshow JH. Phase II trial of carboplatin and infusional cyclosporine with alpha-interferon in recurrent ovarian cancer: a California Cancer Consortium Trial. Int J Gynecol Cancer 2007; 17:373-8. [PMID: 17362315 DOI: 10.1111/j.1525-1438.2007.00787.x] [Citation(s) in RCA: 3] [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: 11/27/2022] Open
Abstract
The purpose of this study was to estimate the response rate of 26-h continuous infusion cyclosporine A (CSA) combined with carboplatin (CBDCA) and subcutaneous alpha-interferon (IFN), in recurrent ovarian cancer (OC), and to measure their effects on CBDCA pharmacokinetics. OC patients relapsing following platinum-based chemotherapy received CBDCA area under the curve (AUC 3) with CSA and IFN, every 3 weeks. The pharmacokinetics of CSA and CBDCA were determined in a subset of patients. Thirty patients received 84 courses of therapy. Three partial responses were observed. Nine patients were stable for >4 months. Toxicity was similar to that observed in our previously reported phase I study and consisted of myelosuppression, nausea, vomiting, and headache. The mean end of infusion CSA level (high-performance liquid chromatographic assay [HPLC]) was 1109 +/- 291 microg/mL (mean +/- SD). CBDCA pharmacokinetics revealed a measured AUC of 3.61 versus a targeted AUC of 3, suggesting a possible effect of IFN on CBDCA levels versus errors in the estimation of CBDCA clearance using measured creatinine clearance. Steady-state levels of >1 microg/mL CSA (HPLC assay) are achievable in vivo. Insufficient clinical resistance reversal was observed in this study to warrant further investigation of this combination.
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Affiliation(s)
- R J Morgan
- Division of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA 91010, USA.
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Andreopoulou E, Gaiotti D, Kim E, Downey A, Mirchandani D, Hamilton A, Jacobs A, Curtin J, Muggia F. Pegylated liposomal doxorubicin HCL (PLD; Caelyx/Doxil): experience with long-term maintenance in responding patients with recurrent epithelial ovarian cancer. Ann Oncol 2007; 18:716-21. [PMID: 17301073 DOI: 10.1093/annonc/mdl484] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [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: 01/26/2023] Open
Abstract
BACKGROUND We hypothesized that a response to pegylated liposomal doxorubicin (PLD, Caelyx/Doxil) followed by maintenance is beneficial and safe in recurrent ovarian cancer. PATIENTS AND METHODS Sixteen patients have received PLD for more than 1 year for recurrent ovarian (14) or fallopian tube (2) cancer. All had stable disease or better responses to PLD + carboplatin (5) or topotecan (9) doublets or to PLD alone (2). PLD maintenance therapy 30-40 mg/m(2) was given every 4-8 weeks. This analysis focuses on cardiac status, overall tolerance, and time to recurrence. RESULTS Termination of PLD was due to progression in all patients. Noteworthy was the lack of cumulative myelosuppression and, with one exception, clinical cardiac toxicity. This patient was hospitalized with cardiogenic shock and fever complicating grade 4 pancytopenia from topotecan ten months after discontinuation of PLD. Seven patients continue to receive PLD after a median of 1680 mg/m(2) (1180-2460 mg/m(2)). Four of these had documented relapses after 3-6 years on maintenance occurring in the setting of lengthening of the treatment interval. Maintenance PLD was reinstituted after 'reinduction' with a platinum. CONCLUSIONS PLD appears to be safe as long-term maintenance in ovarian cancer and may be important for a continued response.
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Affiliation(s)
- E Andreopoulou
- Division of Medical Oncology, Department of Medicine, New York University School of Medicine, NYU Cancer Institute, New York, NY 10016, USA.
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Mani S, McDaid HM, Grossman A, Muggia F, Goel S, Griffin T, Colevas D, Horwitz SB, Egorin MJ. Peripheral blood mononuclear and tumor cell pharmacodynamics of the novel epothilone B analogue, ixabepilone. Ann Oncol 2007; 18:190-195. [PMID: 17018704 DOI: 10.1093/annonc/mdl315] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/13/2022] Open
Abstract
BACKGROUND We previously demonstrated that peak microtubule bundle formation (MBF) in peripheral blood mononuclear cells (PBMCs) occurs at the end of drug infusion and correlates with drug pharmacokinetics (PK). In the current study, a new expanded evaluation of drug target effect was undertaken. PATIENTS AND METHODS Patients with advanced solid malignancies were treated with ixabepilone 40 mg/m2 administered as a 1-h i.v. infusion every 3 weeks. Blood, plasma, and tumor tissue sampling was carried out to characterize pharmacodynamics and PK. RESULTS Forty-seven patients were treated with 141 cycles of ixabepilone. In both PBMCs (n=27) and tumor cells (n=9), peak MBF occurred at the end of infusion; however, at 24-72 h after drug infusion, the number of cells with MBF was significantly greater in tumor cells, relative to PBMCs. A Hill model (EC50=109.65 ng/ml; r2=0.94) was fitted, which demonstrated a relationship between percentage of PBMCs with MBF and plasma ixabepilone concentration. The percentage of PBMCs with MBF at the end of infusion also correlated with severity of neutropenia (P=0.050). CONCLUSIONS Plasma ixabepilone concentration and severity of neutropenia correlate with the level of MBF in PBMCs. Therefore, this technically straightforward assay should be considered as a complement to the clinical development of novel microtubule-binding agents.
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Affiliation(s)
- S Mani
- The Albert Einstein Comprehensive Cancer Center; Department of Molecular Genetics.
| | - H M McDaid
- The Albert Einstein Comprehensive Cancer Center; Department of Molecular Pharmacology, Albert Einstein College of Medicine
| | - A Grossman
- Department of Molecular Pharmacology, Albert Einstein College of Medicine
| | - F Muggia
- Comprehensive Cancer Center of NYU School of Medicine, New York University, New York
| | - S Goel
- The Albert Einstein Comprehensive Cancer Center
| | | | - D Colevas
- Cancer Therapy Evaluation Program of the National Cancer Institute, Bethesda
| | - S B Horwitz
- The Albert Einstein Comprehensive Cancer Center; Department of Molecular Pharmacology, Albert Einstein College of Medicine
| | - M J Egorin
- University of Pittsburgh Cancer Institute, Pittsburgh, USA
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49
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Alberts DS, Markman M, Muggia F, Ozols RF, Eldermire E, Bookman MA, Chen T, Curtin J, Hess LM, Liebes L, Young RC, Trimble E. Proceedings of a GOG workshop on intraperitoneal therapy for ovarian cancer. Gynecol Oncol 2006; 103:783-92. [PMID: 17070570 PMCID: PMC1987372 DOI: 10.1016/j.ygyno.2006.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 11/18/2022]
Abstract
Ovarian cancer is the leading cause of gynecologic cancer deaths in the U.S. The concept of intraperitoneal drug delivery for therapy of intraperitoneal cancers, such as ovarian cancer, arose in the 1960s. The field of intraperitoneal cisplatin therapy for ovarian cancer was initiated in the late 1970s and early 1980s. The markedly improved survival data resulting from a phase III trial of intraperitoneal cisplatin for ovarian cancer in early 2006 led to an NCI Clinical Announcement and a Gynecologic Oncology Group-sponsored workshop on intraperitoneal therapy in January, 2006, in San Diego, California. The proceedings of this workshop summarize both research trial results and practical implementation issues associated with intraperitoneal therapy discussed at this workshop.
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Affiliation(s)
- D S Alberts
- University of Arizona, Arizona Cancer Center, 1515 N. Campbell Avenue, POB 245024, Tucson, AZ 85724-5024, and Case Western Reserve University Hospital, USA.
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50
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Seiden MV, Burris HA, Matulonis U, Hall JB, Armstrong DK, Speyer J, Weber JDA, Muggia F. A phase II trial of EMD72000 (matuzumab), a humanized anti-EGFR monoclonal antibody, in patients with platinum-resistant ovarian and primary peritoneal malignancies. Gynecol Oncol 2006; 104:727-31. [PMID: 17126894 DOI: 10.1016/j.ygyno.2006.10.019] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [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: 08/15/2006] [Revised: 10/04/2006] [Accepted: 10/04/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary objective of this study was to determine the rate of response to matuzumab in patients with recurrent, EGFR-positive ovarian, or primary peritoneal cancer. Secondary end points included safety and tolerability, time to tumor progression, duration of response, and overall survival. METHODS A multi-institutional single arm phase II trial. RESULTS Of 75 women screened for the study, 37 were enrolled and treated. Median age of the treated patient population was 58 years, and most patients had more than four prior lines of chemotherapy. Therapy was well tolerated, the most common toxicities being a constellation of skin toxicities, including rash, acne, dry skin, and paronychia, as well as headache, fatigue, and diarrhea. Serious adverse events were very rare but included a single episode of pancreatitis that may have been drug related. All patients completed therapy, receiving 1 to 30 infusions of matuzumab. There were no formal responses (RR=0%, 95% CI: 0-9.5%), although 7 patients (21%) were on therapy for more than 3 months with stable disease. CONCLUSIONS Matuzumab at the dose and schedule selected is well tolerated. In this population of very heavily pretreated patients with epithelial ovarian and primary peritoneal malignancies, there was no evidence of significant clinical activity when matuzumab was administered as monotherapy.
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Affiliation(s)
- M V Seiden
- Massachusetts General Hospital, 100 Blossom Street, Cox 640, Boston, MA 02114, USA.
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