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Hapgood G, Civallero M, Stepanishyna Y, Vose J, Cabrera ME, Advani RH, Pileri SA, Manni M, Horwitz SM, Foss FM, Hitz F, Radford J, Dlouhy I, Chiattone C, Kim WS, Skrypets T, Nagler A, Trotman J, Luminari S, Federico M. The SALENTO prognostic model for limited-stage peripheral T-cell lymphoma from the International T-Cell Project Network. Blood Adv 2023; 7:5047-5054. [PMID: 37163360 PMCID: PMC10471929 DOI: 10.1182/bloodadvances.2023010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023] Open
Abstract
The natural history of limited-stage peripheral T-cell lymphomas (PTCLs) remains poorly defined. We investigated outcomes and prognostic variables in patients registered in the T-Cell Project (TCP) (#NCT01142674) to develop a model to predict overall survival (OS) for the common nodal PTCL subtypes (PTCL-NOS, AITL, ALCL). The model was validated in an independent data set from Australian and Brazilian registries. 211 patients registered in the TCP between 2006-2018 were studied. The median age was 59 years (range 18-88) and median follow-up was 49 months. One hundred twenty-seven patients (78%) received anthracycline-based regimens, 5 patients (3%) radiotherapy alone (RT), 24 patients (15%) chemotherapy+RT. 5-year OS and PFS were 47% and 37%, respectively. Age >60 years, elevated LDH and low serum albumin were independent prognostic factors. The model identified 3 groups with low- (26%, score 0), intermediate- (41%, score 1), and high-risk (33%, score 2-3) with 5-year OS of 78% (95% confidence interval [95% CI], 29-127), 46% (95% CI, 24-68), and 25% (95% CI, 20-30), respectively (P < 0.001) and 5-year PFS of 66% (95% CI, 33-99), 37% (95% CI, 9-65), and 17% (95% CI, 9-25), respectively (P < 0.001). The model demonstrated greater discriminatory power than established prognostic indices and an analogous distribution and outcomes in the 3 groups in the validation cohort of 103 patients. The SALENTO Model (Limited Stage Peripheral T-Cell Lymphoma Prognostic Model) is an objective, simple and robust prognostic tool. The high-risk group has poor outcomes, comparable to advanced stage disease, and should be considered for innovative first-line approaches.
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Affiliation(s)
- Greg Hapgood
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Monica Civallero
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Julie Vose
- University of Nebraska Medical Center, Omaha, NE
| | - Monica Elena Cabrera
- Hematology Section, Hospital del Salvador, University of Chile, Santiago de Chile, Chile
| | - Ranjana H. Advani
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
| | - Stefano A. Pileri
- Division of Diagnostic Haematopathology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Martina Manni
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Steven M. Horwitz
- Department Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Felicitas Hitz
- The Swiss Group for Clinical Cancer Research, Department of Oncology/Haematology, Cantonal Hospital, St. Gallen, Switzerland
| | - John Radford
- Medical Oncology, University of Manchester, Manchester, England
| | - Ivan Dlouhy
- Clinic Barcelona, Hospital Universitari, Barcelona, Spain
| | - Carlos Chiattone
- Santa Casa Medical School of Sao Paulo and Samaritan Hospital, Sao Paulo, Brazil
| | - Won Seog Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Tetiana Skrypets
- Hematology, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Arnon Nagler
- Hematology Division BMT and Cord Blood Bank Chaim Sheba Medical Center Tel-Hashomer, Ramat-Gan, Israel
| | - Judith Trotman
- Department of Haematology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Stefano Luminari
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
- Hematology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Federico
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | - International T-Cell Project
- Department of Haematology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
- Kiev National Cancer Institute, Kiev, Ukraine
- University of Nebraska Medical Center, Omaha, NE
- Hematology Section, Hospital del Salvador, University of Chile, Santiago de Chile, Chile
- Division of Oncology, Department of Medicine, Stanford University, Stanford, CA
- Division of Diagnostic Haematopathology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Yale University School of Medicine, New Haven, CT
- The Swiss Group for Clinical Cancer Research, Department of Oncology/Haematology, Cantonal Hospital, St. Gallen, Switzerland
- Medical Oncology, University of Manchester, Manchester, England
- Clinic Barcelona, Hospital Universitari, Barcelona, Spain
- Santa Casa Medical School of Sao Paulo and Samaritan Hospital, Sao Paulo, Brazil
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
- Hematology, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
- Hematology Division BMT and Cord Blood Bank Chaim Sheba Medical Center Tel-Hashomer, Ramat-Gan, Israel
- Department of Haematology, Concord Hospital, University of Sydney, Sydney, Australia
- Hematology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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2
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Chavez JC, Foss FM, William BM, Brammer JE, Smith SM, Prica A, Zain JM, Tuscano JM, Shah H, Mehta-Shah N, Geethakumari PR, Wang BX, Zantinge S, Wang L, Zhang L, Boutrin A, Zhao W, Cheng L, Standifer N, Hewitt L, Enowtambong E, Shao W, Sharma S, Carlesso G, Moscow JA, Siu LL. Targeting the Inducible T-cell Costimulator (ICOS) in Patients with Relapsed/Refractory T-follicular Helper Phenotype Peripheral T-cell and Angioimmunoblastic T-cell Lymphoma. Clin Cancer Res 2023; 29:1869-1878. [PMID: 36826995 PMCID: PMC10716864 DOI: 10.1158/1078-0432.ccr-22-2955] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/26/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Proliferation of T-follicular helper (TFH) CD4+ T cells is a postulated pathogenic mechanism for T-cell non-Hodgkin lymphomas (T-NHL). The inducible T-cell costimulator (ICOS) is highly expressed by TFH, representing a potential target. MEDI-570 is a monoclonal antibody against ICOS, which eliminates ICOS+ cells in preclinical models. PATIENTS AND METHODS We report the safety, pharmacokinetics (PK), pharmacodynamics (PD), and clinical activity of MEDI-570 in T-NHL. NCI-9930 is a phase I, first-in-human study of MEDI-570 in relapsed/refractory malignant T-NHL known to express ICOS. MEDI-570 was administered intravenously every 3 weeks for up to 12 cycles. Primary endpoints were safety, dose-limiting toxicities (DLT), and recommended phase II dose (RP2D). Secondary and exploratory endpoints included efficacy parameters and various correlative studies. This study is supported by the National Cancer Institute (NCT02520791). RESULTS Twenty-three patients were enrolled and received MEDI-570 at five dose levels (0.01-3 mg/kg). Sixteen (70%) had angioimmunoblastic T-cell lymphoma (AITL); median age was 67 years (29-86) and the median prior lines of therapies was 3 (1-16). Most common grade 3 or 4 adverse events were decreased CD4+ T cells (57%), lymphopenia (22%), anemia (13%), and infusion-related reactions (9%). No DLTs were observed. The RP2D was determined at 3 mg/kg. Analysis of T-cell subsets showed reductions in CD4+ICOS+ T cells reflecting its effects on TFH cells. The response rate in AITL was 44%. CONCLUSIONS MEDI-570 was well tolerated and showed promising clinical activity in refractory AITL. MEDI-570 resulted in sustained reduction of ICOS+ T lymphocytes.
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Affiliation(s)
| | | | - Basem M. William
- The Ohio State University Comprehensive Cancer Center, Columbus, OĤ
| | | | | | - Anca Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Harsh Shah
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | - Ben X Wang
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Stephanie Zantinge
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lisa Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ling Zhang
- Department of Hematopathology, Moffitt Cancer Center, Tampa, FL
| | - Anmarie Boutrin
- US Imaging Hub, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD
| | - Weiguang Zhao
- US Imaging Hub, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD
| | - Lily Cheng
- Oncology Safety/Pathology, Clinical Pharmacology and Safety Sciences, AstraZeneca, Gaithersburg, MD
| | - Nathan Standifer
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, South San Francisco, CA*
| | - Lisa Hewitt
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD
| | - Enowmpey Enowtambong
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD
| | - Weiping Shao
- Integrated Bioanalysis, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, Gaithersburg, MD
| | - Shringi Sharma
- Quantitative Clinical Pharmacology, Clinical Pharmacology & Safety Sciences, R&D, AstraZeneca, South San Francisco, CA
| | - Gianluca Carlesso
- Early Oncology Discovery, Early Oncology R&D, AstraZeneca, Gaithersburg, MD
| | - Jeffrey A. Moscow
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Tumor Immunotherapy Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
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3
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Potnis KC, Di M, Isufi I, Gowda L, Seropian SE, Foss FM, Forman HP, Huntington SF. Cost-effectiveness of chimeric antigen receptor T-cell therapy in adults with relapsed or refractory follicular lymphoma. Blood Adv 2023; 7:801-810. [PMID: 36342852 PMCID: PMC10011202 DOI: 10.1182/bloodadvances.2022008097] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Follicular lymphoma (FL) is traditionally considered treatable but incurable. In March 2021, the US Food and Drug Administration approved the use of chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed or refractory (R/R) FL after ≥2 lines of therapy. Priced at $373 000, CAR T-cell therapy is potentially curative, and its cost-effectiveness compared with other modern R/R FL treatment strategies is unknown. We developed a Markov model to assess the cost-effectiveness of third-line CAR T-cell vs standard of care (SOC) therapies in adults with R/R FL. We estimated progression rates for patients receiving CAR T-cell and SOC therapies from the ZUMA-5 trial and the LEO CReWE study, respectively. We calculated costs, discounted life years, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) of CAR T-cell vs SOC therapies with a willingness-to-pay threshold of $150 000 per QALY. Our analysis was conducted from a US payer's perspective over a lifetime horizon. In our base-case model, the cost of the CAR T-cell strategy was $731 682 compared with $458 490 for SOC therapies. However, CAR T-cell therapy was associated with incremental clinical benefit of 1.50 QALYs, resulting in an ICER of $182 127 per QALY. Our model was most sensitive to the utilities associated with CAR T-cell therapy remission and third-line SOC therapies and to the total upfront CAR T-cell therapy cost. Under current pricing, CAR T-cell therapy is unlikely to be cost-effective in unselected patients with FL in the third-line setting. Both randomized clinical trials and longer term clinical follow-up can help clarify the benefits of CAR T-cell therapy and optimal sequencing in patients with FL.
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Affiliation(s)
| | - Mengyang Di
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Iris Isufi
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Lohith Gowda
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Stuart E. Seropian
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Francine M. Foss
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, CT
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT
- Yale School of Management, Yale University, New Haven, CT
| | - Scott F. Huntington
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, CT
- Correspondence: Scott Huntington, Division of Hematology, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, PO Box 208028, New Haven, CT 06520;
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4
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Ren J, Qu R, Rahman NT, Lewis JM, King ALO, Liao X, Mirza FN, Carlson KR, Huang Y, Gigante S, Evans B, Rajendran BK, Xu S, Wang G, Foss FM, Damsky W, Kluger Y, Krishnaswamy S, Girardi M. Integrated transcriptome and trajectory analysis of cutaneous T-cell lymphoma identifies putative precancer populations. Blood Adv 2023; 7:445-457. [PMID: 35947128 PMCID: PMC9979716 DOI: 10.1182/bloodadvances.2022008168] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/05/2022] [Accepted: 07/20/2022] [Indexed: 02/07/2023] Open
Abstract
The incidence of cutaneous T-cell lymphoma (CTCL) increases with age, and blood involvement portends a worse prognosis. To advance our understanding of the development of CTCL and identify potential therapeutic targets, we performed integrative analyses of paired single-cell RNA and T-cell receptor (TCR) sequencing of peripheral blood CD4+ T cells from patients with CTCL to reveal disease-unifying features. The malignant CD4+ T cells of CTCL showed highly diverse transcriptomic profiles across patients, with most displaying a mature Th2 differentiation and T-cell exhaustion phenotype. TCR-CDR3 peptide prediction analysis suggested limited diversity between CTCL samples, consistent with a role for a common antigenic stimulus. Potential of heat diffusion for affinity-based trajectory embedding transition analysis identified putative precancerous circulating populations characterized by an intermediate stage of gene expression and mutation level between the normal CD4+ T cells and malignant CTCL cells. We further revealed the therapeutic potential of targeting CD82 and JAK that endow the malignant CTCL cells with survival and proliferation advantages.
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Affiliation(s)
- Jingjing Ren
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Rihao Qu
- Department of Immunobiology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Nur-Taz Rahman
- Bioinformatics Support Program, Cushing/Whitney Medical Library, Yale School of Medicine, New Haven, CT
| | - Julia M. Lewis
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | | | - Xiaofeng Liao
- Department of Pharmacology, Yale School of Medicine, Yale University, New Haven, CT
| | - Fatima N. Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Kacie R. Carlson
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Yaqing Huang
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Scott Gigante
- Computational Biology and Bioinformatics Program, Yale University, New Haven, CT
| | - Benjamin Evans
- Yale Center for Research Computing, Yale University, New Haven, CT
| | | | - Suzanne Xu
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Guilin Wang
- Yale Center for Genome Analysis, Yale School of Medicine, New Haven, CT
| | - Francine M. Foss
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Yuval Kluger
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | | | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Correspondence: Michael Girardi, Department of Dermatology, Yale University School of Medicine, 333 Cedar St, PO Box 208059, New Haven, CT 06520;
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5
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Hamouche R, Mirza AS, Di M, Isufi I, Bar N, Sethi T, Gowda L, Perreault S, Roberts K, Seropian S, Foss FM. Outcomes after Reduced-Intensity Conditioning with Pentostatin and Low-Dose TBI in Patients with T Cell Prolymphocytic Leukemia (T-PLL): A Single Institution Experience. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00585-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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6
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Shafagati N, Koh MJ, Boussi L, Park HJ, Stuver R, Bain P, Foss FM, Shen C, Jain S. Comparative efficacy and tolerability of novel agents vs chemotherapy in relapsed and refractory T-cell lymphomas: a meta-analysis. Blood Adv 2022; 6:4740-4762. [PMID: 35816645 PMCID: PMC9631658 DOI: 10.1182/bloodadvances.2022007425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Optimal treatment strategies for (relapsed and refractory [R/R]) peripheral T-cell lymphoma (PTCL) have not been well defined, and with the approval of several novel single agents (SA), the comparative efficacy of combination chemotherapy (CC) to single-agent strategies remains unclear. We conducted a meta-analysis to evaluate overall response rates (ORR) and toxicities of SA to CC. MEDLINE, Embase, Web of Science Core Collection, and Cochrane were systematically searched for phase I, phase II, and phase III trials investigating a defined SA or an anthracycline-, ifosfamide-, gemcitabine-, and platinum-based regimens. One hundred and fifty-one articles were included, encompassing single and combinations of 60 phase I trials involving 1075 patients, 95 phase II trials involving 3246, and 23 phase III trials involving 1888 patients. There was a high degree of heterogeneity in the trials. Using a random-effects model, the estimated ORR for SA in phase I trials were 40% (95% confidence interval [CI], 34.7%, 46.9%) relative to 41% for CC (95% CI, 27.4%, 56.1%; P = .97) and in phase II trials 34.4% (95% CI, 30.4%, 38.7%) for SA vs 55.3% (95% CI, 31%, 77.2%; P = .1) for CC. There were significant subgroup differences in ORR between histological subtypes of PTCL and drug classes. Our results highlight SA as an attractive outpatient option for R/R PTCL, and their incorporation in the development of upfront treatment paradigms merits urgent consideration. Our results underscore enrollment in clinical trials of SA as a critical strategy for R/R PTCL.
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Affiliation(s)
- Nazila Shafagati
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Min J. Koh
- School of Medicine, Georgetown University, Washington, DC
| | - Leora Boussi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Robert Stuver
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul Bain
- Harvard Medical School, Harvard University, Boston, MA
| | - Francine M. Foss
- Department of Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT
| | - Changyu Shen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Biogen, Cambridge, MA
| | - Salvia Jain
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA; and
- Harvard Medical School, Boston, MA
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7
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Koh MJ, Merrill MH, Koh MJ, Stuver R, Alonso CD, Foss FM, Mayor AM, Gill J, Epeldegui M, Cachay E, Thorne JE, Silverberg MJ, Horberg MA, Althoff KN, Nijhawan AE, McGinnis KA, Lee JS, Rabkin CS, Napravnik S, Li J, Castilho JL, Shen C, Jain S. Comparative outcomes for mature T-cell and NK/T-cell lymphomas in people with and without HIV and to AIDS-defining lymphomas. Blood Adv 2022; 6:1420-1431. [PMID: 35026839 PMCID: PMC8905704 DOI: 10.1182/bloodadvances.2021006208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022] Open
Abstract
There are no studies comparing the prognosis for mature T-cell lymphoma (TCL) in people with HIV (PWH) to people without HIV (PWoH) and to AIDS-defining B-cell lymphomas (A-BCLs) in the modern antiretroviral therapy era. North American AIDS Cohort Collaboration on Research and Design and Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment are cohorts that enroll patients diagnosed with HIV and TCL, respectively. In our study, 52, 64, 101, 500, and 246 PWH with histologic confirmation of TCL, primary central nervous system lymphoma, Burkitt's lymphoma, diffuse large B-cell lymphoma (DLBCL), and Hodgkin's lymphoma (HL), respectively, and 450 TCLs without HIV were eligible for analysis. At the time of TCL diagnosis, anaplastic large-cell lymphoma (ALCL) was the most common TCL subtype within PWH. Although PWH with TCL diagnosed between 1996 and 2009 experienced a low 5-year survival probability at 0.23 (95% confidence interval [CI]: 0.13, 0.41), we observed a marked improvement in their survival when diagnosed between 2010 and 2016 (0.69; 95% CI: 0.48, 1; P = .04) in contrast to TCLs among PWoH (0.45; 95% CI: 0.41, 0.51; P = .53). Similarly, PWH with ALCLs diagnosed between 1996 and 2009 were associated with a conspicuously inferior 5-year survival probability (0.17; 95% CI: 0.07, 0.42) and consistently lagged behind A-BCL subtypes such as Burkitt's (0.43; 95% CI:0.33, 0.57; P = .09) and DLBCL (0.17; 95% CI: 0.06, 0.46; P = .11) and behind HL (0.57; 95% CI: 0.50, 0.65; P < .0001). Despite a small number, those diagnosed between 2010 and 2016 experienced a remarkable improvement in survival (0.67; 95% CI: 0.3, 1) in comparison with PWoH (0.76; 95% CI: 0.66, 0.87; P = .58). Thus, our analysis confirms improved overall survival for aggressive B- and T-cell malignancies among PWH in the last decade.
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Affiliation(s)
- Min Jung Koh
- School of Medicine, Georgetown University, Washington, DC
| | | | - Min Ji Koh
- Department of Public Health, Brown University, Providence, RI
| | - Robert Stuver
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Carolyn D. Alonso
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Angel M. Mayor
- Retrovirus Research Center, Universidad Central del Caribe, Bayamón, Puerto Rico
| | - John Gill
- Southern Alberta HIV Clinic, Calgary, Canada
| | | | - Edward Cachay
- University of California at San Diego, San Diego, CA
| | | | | | - Michael A. Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Keri N. Althoff
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ank E. Nijhawan
- UT Southwestern Medical Center, Division of Infectious Diseases, Dallas, TX
| | | | - Jennifer S. Lee
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jessica L. Castilho
- Department of Medicine, Division of Infectious Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Changyu Shen
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Biogen, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Salvia Jain
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Massachusetts General Hospital Cancer Center, Boston, MA; and
- Harvard Medical School, Boston, MA
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8
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Mirza AS, Byrne M, Huntington S, Shallis RM, Zeidan A, Foss FM, Isufi I, Podoltsev N, Engelhardt BG, Kassim A, Savani B, Dholaria B, Jayani RV, Perrault S, Schiffer M, Seropian SE, Gowda L. Impact of Post-Remission Consolidation Therapy on Outcomes of Haploidentical Hematopoietic Cell Transplantation for Acute Myelogenous Leukemia. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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King ALO, Mirza FN, Lewis JM, Umlauf S, Surosteva Y, Carlson KR, Foss FM, Girardi M. Uncovering the potential of PI3K inhibitors in cutaneous T cell lymphoma: insights from high throughput in vitro screenings. J Invest Dermatol 2021; 142:254-257. [PMID: 34293349 DOI: 10.1016/j.jid.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/06/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Amber Loren O King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Fatima N Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julia M Lewis
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shiela Umlauf
- Yale Center for Molecular Discovery, Yale University, New Haven, Connecticut, USA
| | - Yulia Surosteva
- Yale Center for Molecular Discovery, Yale University, New Haven, Connecticut, USA
| | - Kacie R Carlson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Francine M Foss
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA.
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10
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Garralda E, Sanborn RE, Minchom AR, Davar D, Curigliano G, Ribrag V, Mehta A, Foss FM, Zain JM, Forero-Torres A, Ansell SM. SGNTGT-001: A phase 1 study of SEA-TGT, an effector-function enhanced monoclonal antibody (mAb), in advanced malignancies (trial in progress). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps2657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS2657 Background: T-cell immunoreceptor with Ig and ITIM domains (TIGIT) is an inhibitory immune checkpoint receptor expressed on subsets of T cells and NK cells. SEA-TGT is an effector-function enhanced human mAb that targets TIGIT with pico-molar affinity and blocks TIGIT’s interaction with CD155 and CD112. SEA-TGT was developed to have amplified binding to and engagement of Fcγ receptors. Enhanced effector function increases TIGIT+ T-regulatory cell depletion, enhances innate immune cell activation, and augments naïve and memory CD8+ T-cell responses. Preclinically, SEA-TGT elicits superior anti-tumor immune responses compared to other TIGIT mAbs without effector-enhanced backbones, with curative anti-tumor activity as monotherapy and in combination with other immune-modulators. Methods: This phase 1, open-label, multicenter, dose-escalation/expansion study (NCT04254107) is assessing the safety, tolerability and preliminary activity of SEA-TGT monotherapy in up to 205 adults (≥18 years) with histologically or cytologically confirmed relapsed, refractory, or progressive metastatic solid tumors (non-small cell lung, gastric/GE junction carcinomas, cutaneous melanoma, head and neck squamous cell carcinoma, bladder cancer, ovarian cancer or triple-negative breast cancer) or lymphomas (classical Hodgkin lymphoma, diffuse large B-cell lymphoma, or peripheral T-cell lymphoma, not otherwise specified). SEA-TGT will be infused on Day 1 of 21-day cycles. In Part A, the safety and tolerability of SEA-TGT will be assessed in ̃25 subjects to identify the maximum tolerated dose and recommended phase II dose (RP2D). In Part B, the safety and antitumor activity of the RP2D will be assessed in ̃180 subjects in disease-specific expansion cohorts. Primary endpoints are adverse events, laboratory abnormalities, dose-limiting toxicities, and dose-level safety and activity. Secondary endpoints are objective response (OR) rates, duration of OR, complete response, progression-free survival, overall survival, PK, and antidrug antibodies. Exploratory biomarkers of SEA-TGT-mediated pharmacodynamic (PD) effects, PK-PD correlations, and correlative analyses of predictive and PD measurements with response, toxicity, and resistance will be explored. The study was opened April 2020 and is enrolling across sites in North America and Europe. Clinical trial information: NCT04254107.
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Affiliation(s)
| | - Rachel E. Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR
| | - Anna Rachel Minchom
- Drug Development Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS and University of Milano, Milan, Italy
| | | | - Amitkumar Mehta
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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11
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Gerstein R, Schiffer M, Perreault S, Gowda L, Foss FM, Isufi I, Seropian SE. The Effect of Cyclophosphamide Pharmacogenomics on Cardiac, Hemorrhagic Cystitis, and Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00606-0] [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: 10/22/2022]
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12
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Perreault S, Schiffer M, Gowda L, Foss FM, Isufi I, Seropian SE. Application of Pharmacogenomic Guided Immunosuppression Dosing in Allogeneic Hematopoietic Stem Cell Transplant (HSCT). Transplant Cell Ther 2021. [DOI: 10.1016/s2666-6367(21)00600-x] [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: 11/26/2022]
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13
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Johnston PB, Cashen AF, Nikolinakos PG, Beaven AW, Barta SK, Bhat G, Hasal SJ, De Vos S, Oki Y, Deng C, Foss FM. Belinostat in combination with standard cyclophosphamide, doxorubicin, vincristine and prednisone as first-line treatment for patients with newly diagnosed peripheral T-cell lymphoma. Exp Hematol Oncol 2021; 10:15. [PMID: 33602316 PMCID: PMC7893947 DOI: 10.1186/s40164-021-00203-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/22/2021] [Indexed: 12/22/2022] Open
Abstract
Background Belinostat is a histone deacetylase inhibitor approved for relapsed refractory peripheral T-cell lymphoma (PTCL). The primary objective of this study was to determine the maximum tolerated dose (MTD) of belinostat combined with CHOP (Bel-CHOP). Secondary objectives included safety/tolerability, overall response rate (ORR), and belinostat pharmacokinetics (PK). Methods Patients were ≥ 18 years with histologically confirmed, previously untreated PTCL. Patients received belinostat (1000 mg/m2 once daily) + standard CHOP for 6 cycles with varying schedules using a 3 + 3 design in Part A. Part B enrolled patients at MTD dose. Results Twenty-three patients were treated. One patient experienced DLT (Grade 3 non-hematologic toxicity) on Day 1–3 schedule, resulting in escalation to Day 1–5 schedule (n = 3). No DLTs were observed and Day 1–5 schedule with 1000 mg/m2 was declared as MTD. Twelve additional patients were enrolled in Part B using MTD. Median relative dose intensity was 98%. All patients experienced adverse events (AEs), including nausea (78%), fatigue (61%), and vomiting (57%). Serious AEs occurred in 43%, with febrile neutropenia (17%) and pyrexia (13%). Overall ORR was 86% with 71% reported CR at MTD. Belinostat PK parameters were similar to single-agent. Conclusions Bel-CHOP was well tolerated and MTD in CHOP combination was the same dose and schedule as single agent dosing. Trial Registration: ClinicalTrials.gov Identifier: NCT01839097.
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Affiliation(s)
| | - Amanda F Cashen
- Division of Oncology, Washington University Medical School, 660 S. Euclid Ave, Campus, Box 8007, St Louis, MO, 63110, USA
| | - Petros G Nikolinakos
- University Cancer and Blood Center, 3320 Old Jefferson Rd #700, Athens, GA, 30607, USA
| | - Anne W Beaven
- Duke University School of Medicine, 2592 Morris Bldg, Box 3406, Durham, NC, 27710, USA
| | - Stefan Klaus Barta
- Dept of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Gajanan Bhat
- Spectrum Pharmaceuticals, 157 Technology Dr, Irvine, CA, 92618, USA
| | - Steven J Hasal
- Spectrum Pharmaceuticals, 157 Technology Dr, Irvine, CA, 92618, USA
| | - Sven De Vos
- Cancer Care, Ronald Reagan University of California At Los Angeles Medical Center, 2020 Santa Monica Blvd, Santa Monica, CA, 90404, USA
| | - Yasuhiro Oki
- Dept of Lymphoma/Myeloma, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0429, Houston, TX, 77030, USA
| | - Changchun Deng
- Center for Lymphoid Malignancies, Columbia University Medical Center, 51 West 51st St, New York, NY, 10019, USA
| | - Francine M Foss
- Medical Oncology, Yale Cancer Center, 333 Cedar St, TMP 3, PO Box 208028, New Haven, CT, 06510, USA
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14
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Mirza FN, Yumeen S, Lewis JM, King ALO, Kim SR, Carlson KR, Umlauf S, Surovtseva YV, Foss FM, Girardi M. Screening Novel Agent Combinations to Expedite CTCL Therapeutic Development. J Invest Dermatol 2021; 141:217-221. [DOI: 10.1016/j.jid.2020.05.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/22/2023]
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15
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King ALO, Mirza FN, Lewis JM, Carlson KR, Huntington S, Foss FM, Girardi M. B-cell lymphoma 2 inhibitor venetoclax treatment of a patient with cutaneous T-cell lymphoma. JAAD Case Rep 2020; 8:89-92. [PMID: 33537387 PMCID: PMC7838714 DOI: 10.1016/j.jdcr.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Amber Loren O King
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Fatima N Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Julia M Lewis
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Kacie R Carlson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Scott Huntington
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Francine M Foss
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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16
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Foss FM, Wang XV, Luger SM, Jegede O, Miller KB, Stadtmauer EA, Whiteside TL, Avigan DE, Gascoyne RD, Arber D, Wagner H, Strair RK, Hogan WJ, Sprague KA, Lazarus HM, Litzow MR, Tallman MS, Horning SJ. Incorporation of extracorporeal photopheresis into a reduced intensity conditioning regimen in myelodysplastic syndrome and aggressive lymphoma: results from ECOG 1402 and 1902. Transfusion 2020; 60:1867-1872. [PMID: 32654201 DOI: 10.1111/trf.15798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) is an immunomodulatory cellular therapy which has been shown to induce a tolerogenic state in patients with acute and chronic graft-vs-host disease. ECOG-ACRIN explored the activity of ECP as a part of a reduced intensity conditioning regimen in two multicenter trials in patients with MDS (E1902) and lymphomas (E1402). While both studies closed before completing accrual, we report results in 23 patients (17 MDS and 6 lymphoma). STUDY DESIGN AND METHODS Patients received 2 days of ECP followed by pentostatin 4 mg/m2 /day for two consecutive days, followed by 600 cGy of total body irradiation prior to stem cell infusion. Immunosuppression for aGVHD was infusional cyclosporine A or tacrolimus and methotrexate on day +1, +3, with mycophenolate mofetil starting on day 100 for chronic GVHD prophylaxis. RESULTS All patients engrafted, with median time to neutrophil and platelet engraftment of 15-18 days and 10-18 days respectively. Grade 3 or 4 aGVHD occurred in 13% and chronic extensive GVHD in 30%. CONCLUSIONS These studies demonstrate that ECP/pentostatin/TBI is well tolerated and associated with adequate engraftment of neutrophils and platelets in patients with lymphomas and MDS.
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Affiliation(s)
- Francine M Foss
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine, Boston, Massachusetts
| | - Xin Victoria Wang
- E-A Biostatistical Center, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Selina M Luger
- Hematology Oncology, University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Opeyemi Jegede
- E-A Biostatistical Center, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kenneth B Miller
- Hematology and Oncology, Tufts Medical Center, Boston, Massachusetts
| | - Edward A Stadtmauer
- Hematology Oncology, University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Theresa L Whiteside
- Department of Pathology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - David E Avigan
- Hematology and Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Randall D Gascoyne
- Department of Pathology and Laboratory Medicine, British Columbia Cancer Center for Lymphoid Malignancies, Vancouver, Canada
| | | | - Henry Wagner
- Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Roger K Strair
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Kellie A Sprague
- Hematology and Oncology, Tufts Medical Center, Boston, Massachusetts
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17
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Lansigan F, Horwitz SM, Pinter-Brown LC, Carson KR, Shustov AR, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Foss FM. Outcomes of Patients with Transformed Mycosis Fungoides: Analysis from a Prospective Multicenter US Cohort Study. Clin Lymphoma Myeloma Leuk 2020; 20:744-748. [PMID: 32532611 DOI: 10.1016/j.clml.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We examined patient characteristics, treatments, and outcomes of patients with transformed mycosis fungoides (tMF) from COMPLETE: a large, multicenter, prospective cohort study of peripheral T-cell lymphoma patients in the United States. METHODS Patients with tMF were enrolled in COMPLETE at the time of transformation. For this analysis, we identified patients with tMF with completed baseline, treatment, and follow-up records. Median survival was assessed using Kaplan-Meier methodology. RESULTS Of the 499 patients enrolled in COMPLETE, 17 had tMF. Median age was 61; 53% were male, 9 had elevated lactate dehydrogenase, and 9 had lymph node involvement. Approximately one-quarter of the patients were African American and 47% had CD30+ disease. Median time to transformation was 53 months. All patients received systemic therapy, with 19% receiving concomitant radiotherapy. Most patients (87%) received single agents, including liposomal doxorubicin, pralatrexate, and gemcitabine. Eight patients (50%) had reported responses to therapy. Median survival was 18 months. One- and 2-year survival rates were 56% and 44%, respectively. CONCLUSIONS tMF often expresses CD30 and presents with lymph node involvement. Responses have been seen with single agents, but survival remains poor. Novel treatment approaches are urgently needed to improve outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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18
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Isufi I, Chandhok N, Boddu P, Pucar D, Seropian SE, Gowda L, Perreault S, Wilson LD, Roberts K, Foss FM. Predictive Value of PET-CT in Patients with T-Cell Lymphoma Undergoing Autologous and Allogeneic Stem Cell Transplant. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.492] [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: 11/27/2022]
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19
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Foss FM, Horwitz SM, Civallero M, Bellei M, Marcheselli L, Kim WS, Cabrera ME, Dlouhy I, Nagler A, Advani RH, Pesce EA, Ko YH, Montoto S, Chiattone C, Moskowitz A, Spina M, Cesaretti M, Biasoli I, Federico M. Incidence and outcomes of rare T cell lymphomas from the T Cell Project: hepatosplenic, enteropathy associated and peripheral gamma delta T cell lymphomas. Am J Hematol 2020; 95:151-155. [PMID: 31709579 DOI: 10.1002/ajh.25674] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 09/12/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022]
Abstract
The T Cell Project was the largest prospective trial to explore the incidence, treatment patterns, and outcomes for T cell lymphomas. The rare subtypes of T cell lymphomas, including hepatosplenic T cell lymphoma (HSTCL), enteropathy associated T cell lymphoma (EATL), and peripheral gamma delta T cell lymphomas (PGDTCLs) are poorly represented in most studies and there is little data regarding treatment patterns. We report results from 115 patients with hepatosplenic (n = 31), enteropathy associated (n = 65), and PGDTCLs (n = 19). While anthracycline regimens were most commonly used as first line therapy, response rates ranged from 20%-40% and were suboptimal for all groups. Autologous stem cell transplantation was performed as a consolidation in first remission in a small number of patients (33% of HSTCL, 7% of EATL, and 12% of PGDTCL), and four patients with HSTCL underwent allogeneic stem cell transplantation in first remission. The progression free survival at 3 years ranged from 28%-40% for these rare subtypes, and the overall survival at 3 years was most favorable for PGDTCL (70%). These data highlight the need for novel treatment approaches for rare subtypes of T cell lymphomas and for their inclusion in clinical trials.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Disease-Free Survival
- Enteropathy-Associated T-Cell Lymphoma/blood
- Enteropathy-Associated T-Cell Lymphoma/mortality
- Enteropathy-Associated T-Cell Lymphoma/therapy
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Incidence
- Lymphoma, T-Cell, Peripheral/blood
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Middle Aged
- Neoplasm Proteins/blood
- Receptors, Antigen, T-Cell, gamma-delta/blood
- Survival Rate
- Transplantation, Autologous
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Affiliation(s)
| | - Steven M Horwitz
- Department Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Monica Civallero
- CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Bellei
- Fondazione Italiana Linfomi (FIL) onlus, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Fondazione Italiana Linfomi (FIL) onlus, University of Modena and Reggio Emilia, Modena, Italy
| | - Won Seog Kim
- Division of Hematology-Oncology, Samsung Medical Center, Seoul, South Korea
| | - Maria E Cabrera
- Sección Hematología, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Ivan Dlouhy
- Hematology Department, Hematologia, Hospital Clinic, Villarroel, Spain
| | - Arnon Nagler
- Department of Bone Marrow Transplantation, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Emanuela A Pesce
- Fondazione Italiana Linfomi (FIL) onlus, University of Modena and Reggio Emilia, Modena, Italy
| | - Young-Hyeh Ko
- Department of Pathology, Sungkyunkwan University, Seoul, Korea
| | - Silvia Montoto
- Department of Haematology, Barts Health NHS Trust, London, UK
| | - Carlos Chiattone
- Departamento de Clínica Médica, FCM da Santa Casa de São Paulo, and Centro de Linfomas Núcleo de Oncologia Hospital Samaritano, São Paulo, Brazil
| | - Alison Moskowitz
- Department Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Michele Spina
- Medical Oncology A, Aviano National Cancer Institute, Aviano, Italy
| | - Marina Cesaretti
- Fondazione Italiana Linfomi (FIL) onlus, University of Modena and Reggio Emilia, Modena, Italy
| | - Irene Biasoli
- Department of Medicine, University Hospital and School of Medicine, Universida de Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Massimo Federico
- CHIMOMO Department University of Modena and Reggio Emilia, Modena, Italy
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20
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Lansigan F, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Shustov AR, Advani RH, Feldman T, Lechowicz MJ, Smith SM, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. Outcomes for Relapsed and Refractory Peripheral T-Cell Lymphoma Patients after Front-Line Therapy from the COMPLETE Registry. Acta Haematol 2019; 143:40-50. [PMID: 31315113 DOI: 10.1159/000500666] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Outcomes for patients with peripheral T-cell lymphoma (PTCL) who fail to achieve complete response (CR) or relapse after front-line therapy are poor with lack of prospective outcomes data. OBJECTIVES COMPLETE is a prospective registry of 499 patients enrolled at academic and community sites in the United States detailing patient demographics, treatment and outcomes for patients with aggressive T cell lymphomas. We report results for patients with primary refractory and relapsed disease. METHODS Primary refractory disease was defined as an evaluable best response to initial treatment (induction ± maintenance or consolidation/transplant) other than CR, and included a partial response, progressive disease, or no response/stable disease. Relapsed disease was defined as an evaluable best response to initial treatment of CR, followed by disease progression at a later date, irrespective of time to progression. Patients were included in the analysis if initial treatment began within 30 days of enrollment and treatment duration was ≥4 days. RESULTS Of 420 evaluable patients, 97 met the definition for primary refractory and 58 with relapsed disease. In the second-line setting, relapsed patients received single-agent therapies more often than refractory patients (52 vs. 28%; p = 0.01) and were more likely to receive single-agent regimens (74 vs. 53%; p = 0.03). The objective response rate to second-line therapy was higher in relapsed patients (61 vs. 40%; p = 0.04) as was the proportion achieving a CR (41 vs. 14%; p = 0.002). Further, relapsed patients had longer overall survival (OS) compared to refractory patients, with a median OS of 29.1 versus 12.3 months. CONCLUSIONS Despite the availability of newer active single agents, refractory patients were less likely to receive these therapies and continue to have inferior outcomes compared to those with relapsed disease. PTCL in the real world remains an unmet medical need, and improvements in front-line therapies are needed.
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Affiliation(s)
| | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | | | | | | | | | | | - Mark Acosta
- Spectrum Pharmaceuticals Inc., Irvine, California, USA
| | - Andrei R Shustov
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Tatyana Feldman
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | | | | | - Anil Tulpule
- University of Southern California, Los Angeles, California, USA
| | | | - John P Greer
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joseph W Leach
- Virginia Piper Cancer Institute, Minneapolis, Minnesota, USA
| | | | - Carla Casulo
- University of Rochester, Rochester, New York, USA
| | - Steven I Park
- Levine Cancer Institute, Chapel Hill, North Carolina, USA
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21
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Stuver RN, Khan N, Schwartz M, Acosta M, Federico M, Gisselbrecht C, Horwitz SM, Lansigan F, Pinter‐Brown LC, Pro B, Shustov AR, Foss FM, Jain S. Single agents vs combination chemotherapy in relapsed and refractory peripheral T-cell lymphoma: Results from the comprehensive oncology measures for peripheral T-cell lymphoma treatment (COMPLETE) registry. Am J Hematol 2019; 94:641-649. [PMID: 30896890 DOI: 10.1002/ajh.25463] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/18/2019] [Accepted: 03/12/2019] [Indexed: 11/11/2022]
Abstract
Single agents have demonstrated activity in relapsed and refractory (R/R) peripheral T-cell lymphoma (PTCL). Their benefit relative to combination chemotherapy remains undefined. Patients with histologically confirmed PTCL were enrolled in the Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment (COMPLETE) registry. Eligibility criteria included those with R/R disease who had received one prior systemic therapy and were given either a single agent or combination chemotherapy as first retreatment. Treatment results for those with R/R disease who received single agents were compared to those who received combination chemotherapy. The primary endpoint was best response to retreatment. Fifty-seven patients met eligibility criteria. At first retreatment, 46% (26/57) received combination therapy and 54.5% (31/57) received single agents. At median follow up of 2 years, a trend was seen towards increased complete response rate for single agents versus combination therapy (41% vs 19%; P = .02). There was also increased median overall survival (38.9 vs 17.1 months; P = .02) and progression-free survival (11.2 vs 6.7 months; P = .02). More patients receiving single agents received hematopoietic stem-cell transplantation (25.8% vs 7.7%, P = .07). Adverse events of grade 3 or 4 occurred more frequently in those receiving combination therapy, although this was not statistically significant. The data confirm the unmet need for better treatment in R/R PTCL. Despite a small sample, the analysis shows greater response and survival in those treated with single agents as first retreatment in R/R setting, while maintaining the ability to achieve transplantation. Large, randomized trials are needed to identify the best strategy.
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Affiliation(s)
- Robert N. Stuver
- Division of Hematologic Malignancies and and Bone Marrow Transplantation, Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Niloufer Khan
- Memorial Sloan Kettering Cancer Center New York New York
| | | | - Mark Acosta
- Spectrum Pharmaceuticals, Inc. Irvine California
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center Chicago Illinois
| | | | | | - Salvia Jain
- Division of Hematologic Malignancies and and Bone Marrow Transplantation, Beth Israel Deaconess Medical Center Boston Massachusetts
- Harvard Medical School Boston Massachusetts
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22
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Foss FM, Parker TL, Girardi M, Li A. Effect of leucovorin administration on mucositis and skin reactions in patients with peripheral T-cell lymphoma or cutaneous T-cell lymphoma treated with pralatrexate. Leuk Lymphoma 2019; 60:2927-2930. [PMID: 31119966 DOI: 10.1080/10428194.2019.1612061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) are rare, heterogeneous non-Hodgkin lymphomas with poor prognoses. Pralatrexate has demonstrated efficacy in T-cell lymphomas; however, mucositis has been reported as the most common dose-modifying adverse event. Leucovorin has been shown to minimize mucositis incidence, without sacrificing pralatrexate efficacy. We retrospectively studied 34 patients (7-PTCL/27-CTCL) treated with pralatrexate alone or pralatrexate and leucovorin. Leucovorin was administered preemptively prior to any mucositis occurrence. Pralatrexate dosing ranged from 10-30 mg/m2 and clinical response or disease stabilization was observed in 85.2%. The incidence of mucositis was reduced in CTCL patients to 17% and was ameliorated in all but one patient with PTCL. There was no change the incidence of skin reactions with the addition of leucovorin. The response rates were similar to those previously reported in CTCL and PTCL. The addition of leucovorin reduced the incidence of mucositis in patients with CTCL and PTCL.
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Affiliation(s)
- Francine M Foss
- Department of Hematology, School of Medicine, Yale University, New Haven, CT, USA
| | - Terri L Parker
- Department of Hematology, School of Medicine, Yale University, New Haven, CT, USA
| | - Michael Girardi
- Department of Dermatology, School of Medicine, Yale University, New Haven, CT, USA
| | - Anlong Li
- School of Medicine, Yale University, New Haven, CT, USA
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Boddu P, Perreault S, Isufi I, Chandhok N, Kim TK, Pillai M, Bar N, Prebet T, Zeidan A, Zelterman D, Seropian SE, Gowda L, Foss FM. Allogeneic Stem Cell Transplantation for T-Cell Lymphomas in the Modern Era: A Single Center Experience. Biol Blood Marrow Transplant 2019. [DOI: 10.1016/j.bbmt.2018.12.796] [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: 12/01/2022]
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24
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Park SI, Horwitz SM, Foss FM, Pinter-Brown LC, Carson KR, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Advani RH, Feldman T, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Shustov AR. The role of autologous stem cell transplantation in patients with nodal peripheral T-cell lymphomas in first complete remission: Report from COMPLETE, a prospective, multicenter cohort study. Cancer 2019; 125:1507-1517. [PMID: 30694529 DOI: 10.1002/cncr.31861] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The role of autologous stem cell transplantation (ASCT) in the first complete remission (CR1) of peripheral T-cell lymphomas (PTCLs) is not well defined. This study analyzed the impact of ASCT on the clinical outcomes of patients with newly diagnosed PTCL in CR1. METHODS Patients with newly diagnosed, histologically confirmed, aggressive PTCL were prospectively enrolled into the Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment (COMPLETE) study, and those in CR1 were included in this analysis. RESULTS Two hundred thirteen patients with PTCL achieved CR1, and 119 patients with nodal PTCL, defined as anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), or PTCL not otherwise specified, were identified. Eighty-three patients did not undergo ASCT, whereas 36 underwent consolidative ASCT in CR1. At the median follow-up of 2.8 years, the median overall survival was not reached for the entire cohort of patients who underwent ASCT, whereas it was 57.6 months for those not receiving ASCT (P = .06). ASCT was associated with superior survival for patients with advanced-stage disease or intermediate-to-high International Prognostic Index scores. ASCT significantly improved overall and progression-free survival for patients with AITL but not for patients with other PTCL subtypes. In a multivariable analysis, ASCT was independently associated with improved survival (hazard ratio, 0.37; 95% confidence interval, 0.15-0.89). CONCLUSIONS This is the first large prospective cohort study directly comparing the survival outcomes of patients with nodal PTCL in CR1 with or without consolidative ASCT. ASCT may provide a benefit in specific clinical scenarios, but the broader applicability of this strategy should be determined in prospective, randomized trials. These results provide a platform for designing future studies of previously untreated PTCL.
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Affiliation(s)
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | - Mark Acosta
- Spectrum Pharmaceuticals, Inc, Irvine, California
| | | | - Tatyana Feldman
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | | | - Frederick Lansigan
- Massachusetts General Hospital, Harvard University School of Medicine, Boston, Massachusetts
| | - Anil Tulpule
- University of Southern California, Los Angeles, California
| | | | | | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri
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25
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Miccio JA, Wilson LD, Kann BH, Jairam V, Beckta J, Foss FM, Yeboa DN. Cutaneous T-Cell Lymphoma: Trends in Radiation Doses and Patterns of Care 2004-2015. Anticancer Res 2019; 39:253-259. [PMID: 30591466 DOI: 10.21873/anticanres.13105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIM Radiotherapy is an effective treatment for cutaneous T-cell lymphoma (CTCL). Since 2009, studies have advocated for low-dose radiotherapy (<30 Gy) given it results in similar response rates and less toxicity compared to higher doses (≥30 Gy). We aimed to see if low-dose radiotherapy has been adopted on a national scale in the USA. MATERIALS AND METHODS A total of 11,292 adult patients with CTCL were identified in the National Cancer Database. Logistic regression models were created to evaluate predictors for use of low-dose radiotherapy. RESULTS A minority of patients received low-dose radiotherapy (22.4%). The annual percentage of patients receiving low-dose radiotherapy increased from 17.2% in 2009 to 38.4% in 2015. High-volume facilities were associated with use of low-dose radiotherapy (5th quintile vs. bottom two quintiles, odds ratio(OR)=1.76, 95% confidence interval(CI)=1.22-2.54, p=0.003). CONCLUSION Although the radiotherapy dose administered is decreasing, most patients with CTCL are still receiving doses that may be higher than needed to palliate their disease effectively.
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Affiliation(s)
- Joseph A Miccio
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, U.S.A.
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, U.S.A
| | - Benjamin H Kann
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, U.S.A
| | - Vikram Jairam
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, U.S.A
| | - Jason Beckta
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, U.S.A
| | - Francine M Foss
- Department of Medicine, Yale School of Medicine, New Haven, CT, U.S.A.,Department of Dermatology, Yale School of Medicine, New Haven, CT, U.S.A
| | - Debra N Yeboa
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, U.S.A
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O’Brien S, Patel M, Kahl BS, Horwitz SM, Foss FM, Porcu P, Jones J, Burger J, Jain N, Allen K, Faia K, Douglas M, Stern HM, Sweeney J, Kelly P, Kelly V, Flinn I. Duvelisib, an oral dual PI3K-δ,γ inhibitor, shows clinical and pharmacodynamic activity in chronic lymphocytic leukemia and small lymphocytic lymphoma in a phase 1 study. Am J Hematol 2018; 93:1318-1326. [PMID: 30094870 PMCID: PMC8260004 DOI: 10.1002/ajh.25243] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/06/2018] [Accepted: 08/03/2018] [Indexed: 02/03/2023]
Abstract
Duvelisib (IPI-145), an oral, dual inhibitor of phosphoinositide-3-kinase (PI3K)-δ and -γ, was evaluated in a Phase 1 study in advanced hematologic malignancies, which included expansion cohorts in relapsed/refractory (RR) chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) and treatment-naïve (TN) CLL. Per protocol, TN patients were at least 65 years old or had a del(17p)/TP53 mutation. Duvelisib was administered twice daily (BID) in 28-day cycles at doses of 8-75 mg in RR patients (n = 55) and 25 mg in TN patients (n = 18.) Diarrhea was the most common nonhematologic AE (TN 78%, RR 47%); transaminase elevations the most frequent lab-abnormality AE (TN 33.3%, RR 30.9%); and neutropenia the most common ≥grade 3 AE (RR 44%, TN 33%). The overall response rates were 56.4% for RR patients (1.8% CR, 54.5% PR) and 83.3% for TN patients (all PRs); median response duration was 21.0 months in RR patients but was not reached for TN patients. Based upon phase 1 efficacy, pharmacodynamics, and safety, duvelisib 25 mg BID was selected for further investigation in a phase 3 study in RR CLL/SLL.
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Affiliation(s)
| | | | | | | | | | - Pierluigi Porcu
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey Jones
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jan Burger
- MD Anderson Cancer Center, Houston, Texas
| | - Nitin Jain
- MD Anderson Cancer Center, Houston, Texas
| | - Kerstin Allen
- Infinity Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Kerrie Faia
- Infinity Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Mark Douglas
- Infinity Pharmaceuticals, Inc., Cambridge, Massachusetts
| | | | | | - Patrick Kelly
- Infinity Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Virginia Kelly
- Infinity Pharmaceuticals, Inc., Cambridge, Massachusetts
| | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, Tennessee
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27
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Foss FM, Parker TL, Girardi M, Li A. Clinical Activity of Pralatrexate in Patients With Cutaneous T-Cell Lymphoma Treated With Varying Doses of Pralatrexate. Clin Lymphoma Myeloma Leuk 2018; 18:e445-e447. [PMID: 30181105 DOI: 10.1016/j.clml.2018.06.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/13/2018] [Accepted: 06/19/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Francine M Foss
- Department of Hematology, Yale University School of Medicine, New Haven, CT.
| | - Terri L Parker
- Department of Hematology, Yale University School of Medicine, New Haven, CT
| | - Michael Girardi
- Department of Dermatology, Yale University School of Medicine, New Haven, CT
| | - Anlong Li
- Yale University School of Medicine, New Haven, CT
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28
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Kim SR, Lewis JM, Cyrenne BM, Monico PF, Mirza FN, Carlson KR, Foss FM, Girardi M. BET inhibition in advanced cutaneous T cell lymphoma is synergistically potentiated by BCL2 inhibition or HDAC inhibition. Oncotarget 2018; 9:29193-29207. [PMID: 30018745 PMCID: PMC6044378 DOI: 10.18632/oncotarget.25670] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 04/30/2018] [Accepted: 06/06/2018] [Indexed: 12/31/2022] Open
Abstract
While several systemic therapies are approved for cutaneous T cell lymphoma (CTCL), a non-Hodgkin lymphoma of skin-homing T cells that may involve lymph nodes and peripheral blood in advanced stages, relapses are common. Mutational analysis of CTCL cells has revealed frequent amplification of the MYC oncogene, and bromodomain and extraterminal (BET) protein inhibitors have been shown to repress MYC expression in various malignancies. Towards a potential novel therapy, we thus sought to examine the effect of BET inhibition on CTCL cells in vitro. Each of the four tested BET inhibitors (JQ1, ABBV-075, I-BET762, CPI-0610) consistently induced dose-dependent decreases in viability of isolated patient-derived CTCL cells and established CTCL cell lines (MyLa, Sez4, HH, Hut78). This effect was synergistically potentiated by combination of BET inhibition with BCL2 inhibition (e.g. venetoclax) or histone deacetylase (HDAC) inhibition (e.g. vorinostat or romidepsin). There was also a marked increase in caspase 3/7 activation when JQ1 was combined with either vorinostat or romidepsin, confirming that the observed synergies are due in major part to induction of apoptosis. Furthermore, MYC and BCL2 expression were each synergistically repressed when CTCL cells were treated with JQ1 plus HDAC inhibitors, suggesting cooperative activities at the level of epigenetic regulation. Taken together, these data indicate that targeting BET proteins in CTCL represents a promising novel therapeutic strategy that may be substantially potentiated by combination with BCL2 or HDAC inhibition.
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Affiliation(s)
- Sa Rang Kim
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Julia M Lewis
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Benoit M Cyrenne
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Patrick F Monico
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Fatima N Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Kacie R Carlson
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Francine M Foss
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT 06510, USA
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29
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Foss FM, Querfeld C, Kim YH, Pinter-Brown LC, William BM, Porcu P, Pacheco T, Haverkos B, DeSimone J, Guitart J, Halwani AS, Eradat HA, Huen A, Seto AG, Pestano LA, Gordon GS, Escolar D, Rubin P, Marshall WS, Williams J. Ph 1 study of MRG-106, an inhibitor of miR-155, in CTCL. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2511] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Basem M. William
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Columbus, OH
| | - Pierluigi Porcu
- Sidney Kimmel Cancer Center at Jefferson, Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Joan Guitart
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Auris Huen
- Department of Dermatology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center,, Houston, TX
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30
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Federico M, Bellei M, Marcheselli L, Schwartz M, Manni M, Tarantino V, Pileri S, Ko YH, Cabrera ME, Horwitz S, Kim WS, Shustov A, Foss FM, Nagler A, Carson K, Pinter-Brown LC, Montoto S, Spina M, Feldman TA, Lechowicz MJ, Smith SM, Lansigan F, Gabus R, Vose JM, Advani RH. Peripheral T cell lymphoma, not otherwise specified (PTCL-NOS). A new prognostic model developed by the International T cell Project Network. Br J Haematol 2018; 181:760-769. [PMID: 29672827 PMCID: PMC6033106 DOI: 10.1111/bjh.15258] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/05/2018] [Indexed: 12/21/2022]
Abstract
Different models to investigate the prognosis of peripheral T cell lymphoma not otherwise specified (PTCL‐NOS) have been developed by means of retrospective analyses. Here we report on a new model designed on data from the prospective T Cell Project. Twelve covariates collected by the T Cell Project were analysed and a new model (T cell score), based on four covariates (serum albumin, performance status, stage and absolute neutrophil count) that maintained their prognostic value in multiple Cox proportional hazards regression analysis was proposed. Among patients registered in the T Cell Project, 311 PTCL‐NOS were retained for study. At a median follow‐up of 46 months, the median overall survival (OS) and progression‐free survival (PFS) was 20 and 10 months, respectively. Three groups were identified at low risk (LR, 48 patients, 15%, score 0), intermediate risk (IR, 189 patients, 61%, score 1–2), and high risk (HiR, 74 patients, 24%, score 3–4), having a 3‐year OS of 76% [95% confidence interval 61–88], 43% [35–51], and 11% [4–21], respectively (P < 0·001). Comparing the performance of the T cell score on OS to that of each of the previously developed models, it emerged that the new score had the best discriminant power. The new T cell score, based on clinical variables, identifies a group with very unfavourable outcomes.
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Affiliation(s)
- Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Bellei
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Martina Manni
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Vittoria Tarantino
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Pileri
- IEO - Istituto Europeo di Oncologia, Unità di Diagnosi Emolinfopatologica, Milano, Italy.,Università degli Studi di Bologna, Scuola di Medicina e Chirurgia, Alma mater Professor of Pathology, Bologna, Italy
| | - Young-Hyeh Ko
- Department of Pathology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Maria E Cabrera
- Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Steven Horwitz
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Won S Kim
- Division of Haematology-Oncology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Andrei Shustov
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Kenneth Carson
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Silvia Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Michele Spina
- Medical Oncology A, National Cancer Institute, Aviano, Italy
| | | | | | | | | | - Raul Gabus
- Service of Haematology and Bone Marrow Transplantation, Hospital Maciel, Montevideo, Uruguay
| | - Julie M Vose
- University of Nebraska Medical Center, UNMC, Internal Medicine, Omaha, NE, USA
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31
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Bellei M, Foss FM, Shustov AR, Horwitz SM, Marcheselli L, Kim WS, Cabrera ME, Dlouhy I, Nagler A, Advani RH, Pesce EA, Ko YH, Martinez V, Montoto S, Chiattone C, Moskowitz A, Spina M, Biasoli I, Manni M, Federico M. The outcome of peripheral T-cell lymphoma patients failing first-line therapy: a report from the prospective, International T-Cell Project. Haematologica 2018; 103:1191-1197. [PMID: 29599200 PMCID: PMC6029527 DOI: 10.3324/haematol.2017.186577] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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: 12/18/2017] [Accepted: 03/26/2018] [Indexed: 12/22/2022] Open
Abstract
This analysis explored factors influencing survival of patients with primary refractory and relapsed peripheral T-cell lymphomas enrolled in the prospective International T-cell Project. We analyzed data from 1020 patients with newly diagnosed disease, enrolled between September 2006 and December 2015. Out of 937 patients who received first-line treatment, 436 (47%) were identified as refractory and 197 (21%) as relapsed. Median time from the end of treatment to relapse was 8 months (range 2-73). Overall, 75 patients (8%) were consolidated with bone marrow transplantation, including 12 refractory and 22 relapsed patients. After a median follow up of 38 months (range 1-96 months) from documentation of refractory/relapsed disease, 440 patients had died. The median overall survival (OS) was 5.8 months; 3-year overall survival rates were 21% and 28% for refractory and relapsed patients, respectively (P<0.001). Patients receiving or not salvage bone marrow transplantation had a 3-year survival of 48% and 18%, respectively (P<0.001). In a univariate Cox regression analysis, refractory disease was associated with a higher risk of death (HR=1.43, P=0.001), whereas late relapse (>12 months, HR 0.57, P=0.001) and salvage therapy with transplantation (HR=0.36, P<0.001) were associated with a better OS. No difference was found in OS with respect to histology. This study accurately reflects outcomes for patients treated according to standards of care worldwide. Results confirm that peripheral T-cell lymphomas patients had dismal outcome after relapse or progression. Patients with chemotherapy sensitive disease who relapsed after more than 12 months might benefit from consolidation bone marrow transplantation.
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Affiliation(s)
- Monica Bellei
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Luigi Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Won Seog Kim
- Hematology-Oncology Samsung Medical Center, Seoul, South Korea
| | - Maria E Cabrera
- Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Ivan Dlouhy
- Department of Hematology, Hospital Clinic, Barcelona, Spain
| | | | | | - Emanuela A Pesce
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Young-Hyeh Ko
- Department of Pathology, Samsung Medical Center, Seoul, South Korea
| | | | - Silvia Montoto
- Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Carlos Chiattone
- Departamento de Clínica Médica, FCM da Santa Casa de São Paulo, Brazil
| | | | - Michele Spina
- Medical Oncology A, National Cancer Institute, Aviano, Italy
| | - Irene Biasoli
- Department of Medicine, University Hospital and School of Medicine, Universidade Federal do Rio de Janeiro, Brazil
| | - Martina Manni
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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32
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Isufi I, Seropian SE, Cooper DL, Roberts K, Wilson LD, Girardi M, Perreault S, Foss FM. Reduced Intensity Conditioning with Pentostatin and Low-Dose TBI in Patients with Relapsed Hematologic Malignancies. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.353] [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: 11/30/2022]
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33
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Kaulen LD, Foss FM, Fulbright RK, Huttner A, Baehring JM. Neurolymphomatosis of the thoracic sympathetic chain. Neurology 2017; 89:1926-1927. [PMID: 28939669 DOI: 10.1212/wnl.0000000000004600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022] Open
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34
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Kann BH, Park HS, Yeboa DN, Aneja S, Girardi M, Foss FM, Roberts KB, Wilson LD. Annual Facility Treatment Volume and Patient Survival for Mycosis Fungoides and Sézary Syndrome. Clin Lymphoma Myeloma Leuk 2017; 17:520-526.e2. [PMID: 28655598 DOI: 10.1016/j.clml.2017.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/30/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Management of mycosis fungoides and Sézary syndrome (MF/SS) is complex, and randomized evidence to guide treatment is lacking. The institutional treatment volumes for MF/SS might vary widely nationally and influence patient survival. PATIENTS AND METHODS Using the National Cancer Database, we identified patients with a diagnosis of MF/SS from 2004 to 2011 in the United States who had received treatment at a reporting facility. The patients were grouped into quintiles according to their treatment facility's average annual treatment volume (ATV). The characteristics associated with ATV were identified and compared using χ2 tests. Overall survival (OS) was compared among the ATV quintiles using the Kaplan-Meier method with log-rank tests and multivariable Cox regression with hazard ratios (HRs). OS was also analyzed using the annual patient volume as a continuous variable. RESULTS A total of 2205 patients treated at 374 facilities were included for analysis. The ATV quintile cutoffs were 1, 3, 6, and 9 patients. With a median follow-up period of 59 months, the 5-year estimated OS survival increased with ATV from 56.7% in the lowest quintile (≤ 1 patient annually) to 83.8% in the highest quintile (> 9 patients annually; P < .001). On multivariable analysis, greater ATV was associated with improved survival when analyzed as a continuous variable (HR, 0.96 per patient per year; 95% confidence interval, 0.94-0.98; P < .001) and when comparing the highest quintile to the lowest quintile (HR, 0.46; 95% confidence interval, 0.39-0.55). CONCLUSION The present national database analysis demonstrated that higher facility ATV is associated with improved OS for patients with MF/SS. Further study is needed to determine the underlying reasons for improved survival with higher facility ATV.
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Affiliation(s)
- Benjamin H Kann
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT.
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Debra N Yeboa
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Sanjay Aneja
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Michael Girardi
- Department of Dermatology, Yale School of Medicine, New Haven, CT
| | - Francine M Foss
- Department of Hematology and Oncology, Yale School of Medicine, New Haven, CT
| | - Kenneth B Roberts
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Lynn D Wilson
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
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Foss FM, Querfeld C, Porcu P, Kim YH, Pacheco T, Halwani AS, DeSimone J, William BM, Seto AG, Ruckman J, Landry ML, Jackson AL, Pestano LA, Dickinson BA, Sanseverino M, Rodman DM, Rubin P, Gordon GS, Marshall WS. Phase 1 trial evaluating MRG-106, a synthetic inhibitor of microRNA-155, in patients with cutaneous t-cell lymphoma (CTCL). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.7564] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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
7564 Background: MRG-106 is an oligonucleotide inhibitor of miR-155, a microRNA with a strong mechanistic link to CTCL, selected based on its activity in mycosis fungoides (MF) cell lines. The objective of this first-in-human study is to evaluate the safety, tolerability, maximum tolerated dose (MTD), pharmacokinetics (PK), and preliminary efficacy of MRG-106 in MF patients. Methods: This Phase 1 trial employs a dose-escalation design to evaluate either intratumoral (IT, 75 mg/dose) or subcutaneous (SC, ≤ 900 mg/dose) administration of MRG-106. Patients were required to have biopsy-proven stage I-III MF and plaque- or tumor-stage lesions. Results: Fifteen patients (12M/3F, median age 59 years) have been dosed over 1-4 weeks. All patients tolerated the IT or SC administrations well with only minor local injection reactions in 8 patients. Thirteen of 15 patients completed dosing as scheduled. There were no clinically significant MRG-106 related adverse events with the exception of one grade 3 pruritus. The MTD has not yet been reached. In the IT cohort, a reduction of ≥50% in the baseline Composite Assessment of Index Lesion Severity (CAILS) score was observed in the MRG-106 treated lesions in all 4 evaluable patients who completed dosing; such responses were maintained to the End of Study visit (Day 28 or 35). Histological examination of pre- and post-treatment biopsies of the MRG-106-injected lesion from most patients revealed a trend in reduction in neoplastic cell density and depth; 1 patient had a complete loss of the neoplastic infiltrate. Gene expression analysis of the pre- and post-treatment biopsies showed reduction of the PI3K/AKT, JAK/STAT, and NFkB survival pathways and increased cell death consistent with the expected MRG-106 mechanism of action. In the SC cohorts, 3/8 patients had a maximal decrease in their modified Severity-Weighted Assessment Tool (mSWAT) of > 39% indicative of a significant response. One patient at the 900 mg SC dose level had a possible flare of their disease after 3 doses that resolved after 3 weeks. Conclusions: Based on favorable clinical safety, efficacy and PK data, additional patients are being accrued. Updated results will be presented as available. Clinical trial information: NCT02580552.
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Affiliation(s)
| | | | | | | | | | | | | | - Basem M. William
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Columbus, OH
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37
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Affiliation(s)
- Francine M. Foss
- Bone Marrow Transplantation and Experimental Therapeutics, Tufts New England Medical Center, Boston, Massachusetts, USA
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38
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Carson KR, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta MA, Shustov AR, Advani RH, Feldman TA, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. A prospective cohort study of patients with peripheral T-cell lymphoma in the United States. Cancer 2016; 123:1174-1183. [PMID: 27911989 DOI: 10.1002/cncr.30416] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Long-term survival in patients with aggressive peripheral T-cell lymphoma (PTCL) is generally poor, and there currently is no clear consensus regarding the initial therapy used for these diseases. Herein, the authors analyzed treatment patterns and outcomes in a prospectively collected cohort of patients with a new diagnosis of nodal PTCL in the United States. METHODS Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment (COMPLETE) is a prospective multicenter cohort study designed to identify the most common prevailing treatment patterns used for patients newly diagnosed with PTCL in the United States. Patients with nodal PTCL and completed records regarding baseline characteristics and initial therapy were included in this analysis. All statistical tests were 2-sided. RESULTS Of a total of 499 patients enrolled, 256 (51.3%) had nodal PTCL and completed treatment records. As initial therapy, patients received doxorubicin-containing regimens (41.8%), regimens containing doxorubicin plus etoposide (20.9%), other etoposide regimens (15.8%), other single-agent or combination regimens (19.2%), and gemcitabine-containing regimens (2.1%). Survival was found to be statistically significantly longer for patients who received doxorubicin (log-rank P = .03). After controlling for disease histology and International Prognostic Index, results demonstrated a trend toward significance in mortality reduction in patients who received doxorubicin compared with those who did not (hazard ratio, 0.71; 95% confidence interval, 0.48-1.05 [P = .09]). CONCLUSIONS To the authors' knowledge, there is no clear standard of care in the treatment of patients with PTCL in the United States. Although efforts to improve frontline treatments are necessary, anthracyclines remain an important component of initial therapy for curative intent. Cancer 2017;123:1174-1183. © 2016 American Cancer Society.
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Affiliation(s)
- Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, Missouri.,Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Horwitz
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Steven T Rosen
- Provost and Chief Scientific Officer, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Barbara Pro
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Mark A Acosta
- Research and Development, Spectrum Pharmaceuticals Inc, Irvine, California
| | - Andrei R Shustov
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ranjana H Advani
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Tatyana A Feldman
- Department of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Mary Jo Lechowicz
- Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Frederick Lansigan
- Department of Medicine, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire
| | - Anil Tulpule
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Michael D Craig
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - John P Greer
- Department of Hematology, Vanderbilt University, Nashville, Tennessee
| | - Brad S Kahl
- Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph W Leach
- Minnesota Oncology, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | | | - Carla Casulo
- Department of Medicine, University of Rochester, Rochester, New York
| | - Steven I Park
- Department of Internal Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Francine M Foss
- Department of Medical Oncology, Yale University, New Haven, Connecticut
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Pro B, Horwitz SM, Prince HM, Foss FM, Sokol L, Greenwood M, Caballero D, Morschhauser F, Wilhelm M, Iyer SP, Shustov AR, Wolfson J, Balser BE, Coiffier B. Romidepsin induces durable responses in patients with relapsed or refractory angioimmunoblastic T-cell lymphoma. Hematol Oncol 2016; 35:914-917. [PMID: 27402335 PMCID: PMC5763404 DOI: 10.1002/hon.2320] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/23/2016] [Accepted: 05/27/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Barbara Pro
- Robert H. Laurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Steven M Horwitz
- Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - H Miles Prince
- Center for Blood Cell Therapies, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | | | - Lubomir Sokol
- Malignant Hematology, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Matthew Greenwood
- Department of Hematology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Franck Morschhauser
- Hematology, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Martin Wilhelm
- Paracelsus Medical University, Klinikum Nuernberg, Nuernberg, Germany
| | | | - Andrei R Shustov
- Clinical Research Division, University of Washington, Seattle, WA, USA
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40
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Foss FM, Parker TL, Li A. Impact of leucovorin on mucositis and skin reactions in pts with peripheral t-cell lymphoma (PTCL) and cutaneous t-cell lymphoma (CTCL) treated with pralatrexate. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.7558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Anlong Li
- Yale University School of Medicine, New Haven, CT
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Perreault S, Pratt K, Baker J, Medoff E, Foss FM, Isufi I, Seropian S, Cooper DL. Carmustine Infusion Reactions Are Common and Not Reduced By Lengthening the Time of Administration. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.462] [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: 10/22/2022]
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42
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Douglas M, Allen K, Sweeney J, O'Brien SM, Flinn I, Horwitz SM, Byrd JC, Patel MR, Kahl BS, Foss FM, Porcu P, Kelly V, Stern H. Serum chemokines and cytokines in CLL patients treated with duvelisib, a PI3K-δ,γ inhibitor. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.7072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Ian Flinn
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | - John C. Byrd
- Ohio State University Medical Center, Columbus, OH
| | - Manish R. Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
| | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
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43
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Federico M, Bellei M, Luminari S, Horwitz SM, Montoto S, Zucca E, Pileri SA, Ko YH, Zinzani PL, Connors JM, Foss FM, Polliack A, Cabrera ME, Kim WS, Spina M, De Souza CA, Bobillo Varela S, Dlouhy I, Advani RH, Vose J. CD30+ expression in Peripheral T-cell lymphomas (PTCLs): A subset analysis from the international, prospective T-Cell Project. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Massimo Federico
- Dept of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Monica Bellei
- Dept of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Silvia Montoto
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Emanuele Zucca
- Onc Inst of Southern Switzerland, Bellinzona, Switzerland
| | - Stefano A Pileri
- Unit of Hematopathology, Institute of Hematology and Medical Oncology, Bologna, Italy
| | - Young-Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea
| | | | | | | | - Aaron Polliack
- Hadassah University Hospital and Hebrew University Medical School, Jerusalem, Israel
| | | | - Won Seog Kim
- Hematology-Oncology, Samsung Medical Center, Seoul, South Korea
| | | | | | | | - Ivan Dlouhy
- Hematologia, Hospital Clinic, Barcelona, Spain
| | - Ranjana H. Advani
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Julie Vose
- University of Nebraska Medical Center, Omaha, NE
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Frankel AE, Woo JH, Ahn C, Foss FM, Duvic M, Neville PH, Neville DM. Resimmune, an anti-CD3ε recombinant immunotoxin, induces durable remissions in patients with cutaneous T-cell lymphoma. Haematologica 2015; 100:794-800. [PMID: 25795722 DOI: 10.3324/haematol.2015.123711] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/18/2015] [Indexed: 11/09/2022] Open
Abstract
Resimmune is a second-generation recombinant immunotoxin composed of the catalytic and translocation domains of diphtheria toxin fused to two single chain antibody fragments reactive with the extracellular domain of CD3ε. We gave intravenous infusions of Resimmune 2.5 - 11.25 μg/kg over 15 minutes to 30 patients (25 with cutaneous T-cell lymphoma, 3 with peripheral T-cell lymphoma, 1 with T-cell large granular lymphocytic leukemia and 1 with T-cell prolymphocytic leukemia) in an inter-patient dose escalation trial. The most common adverse events were fever, chills, hypotension, edema, hypoalbuminemia, hypophosphatemia, and transaminasemia. Among the 25 patients with cutaneous T-cell lymphoma, there were nine responses for a response rate of 36% (95% CI, 18%-57%) including four complete remissions (16%, 95% CI, 5%-36%). The durations of the complete remissions were 72+, 72+, 60+ and 38+ months. There were five partial remissions lasting 3, 3, 3+, 6+ and 14 months. Of 17 patients with a modified skin weighted assessment tool score <50, 17 patients with stage IB/IIB, and 11 patients with both a score <50 and stage IB/IIB, nine (53%), eight (47%), and eight (73%) had responses, respectively. Further studies of Resimmune in patients with low tumor burden, stage IB-IIB cutaneous T-cell lymphoma are warranted. This trial is registered at clinicaltrials.gov as #NCT00611208.
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Affiliation(s)
| | | | - Chul Ahn
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Madeleine Duvic
- The University of Texas MD Anderson Cancer Center, Houston, TX
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45
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Gibson JF, Kapur L, Sokhn J, Xu M, Foss FM. A fatal case of primary cutaneous gamma-delta T-cell lymphoma complicated by HLH and cardiac amyloidosis. Clin Case Rep 2014; 3:34-8. [PMID: 25678971 PMCID: PMC4317209 DOI: 10.1002/ccr3.142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/01/2014] [Accepted: 05/20/2014] [Indexed: 12/15/2022] Open
Abstract
Gamma–delta T-cell lymphomas (GD-TCL) are rare and rapidly fatal neoplasms that are often associated with Hemophagocytic Lymphohistiocytosis (HLH), a syndrome of fevers, cytopenias, and multiorgan failure that often leads to a rapid death. We report the first case demonstrating an association between GD-TCL, HLH, and cardiac amyloidosis, presenting a novel mechanism for rapid deterioration in these patients.
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Affiliation(s)
- Juliet Fraser Gibson
- Department of Medicine, Yale University School of Medicine New Haven, Connecticut
| | - Lucy Kapur
- Hematopathology, Department of Pathology, Yale University School of Medicine New Haven, Connecticut
| | - Joseph Sokhn
- Department of Medicine, Yale University School of Medicine New Haven, Connecticut
| | - Mina Xu
- Hematopathology, Department of Pathology, Yale University School of Medicine New Haven, Connecticut
| | - Francine M Foss
- Hematology and Bone Marrow Transplantation, Yale University School of Medicine New Haven, Connecticut
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46
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Foss FM, Duvic M, Lerner A, Rook A, Whittaker S, Kim EJ, Kim YH. Responses to romidepsin in patients with cutaneous T-cell lymphoma (CTCL) with tumors and/or folliculotropic involvement. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Madeleine Duvic
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Alain Rook
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Sean Whittaker
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ellen J. Kim
- Hospital of the University of Pennsylvania, Philadelphia, PA
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47
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Foss FM, Pro B, Prince HM, Sokol L, Greenwood M, Caballero D, Horwitz SM, Coiffier B. Responses to romidepsin by line of therapy in patients with relapsed/refractory (R/R) peripheral T-cell lymphoma (PTCL). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Barbara Pro
- Kimmel Cancer Center,Thomas Jefferson University, Philadelphia, PA
| | | | - Lubomir Sokol
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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48
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Lloyd S, Chen Z, Foss FM, Girardi M, Wilson LD. Acute toxicity and risk of infection during total skin electron beam therapy for mycosis fungoides. J Am Acad Dermatol 2013; 69:537-43. [DOI: 10.1016/j.jaad.2013.04.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
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Abstract
Peripheral T-cell lymphomas (PTCL) are a heterogeneous group of clinically aggressive diseases historically associated with inferior outcomes using conventional lymphoma therapies. Aggressive first line therapy and consolidation with autologous stem cell transplantation has led to improved survival, but the majority of patients either fails to respond to therapy or are not transplant candidates. Novel approaches have included new classes of drug and biological agents, including antifolates, immunoconjugates, histone deacetylase (HDAC) inhibitors, monoclonal antibodies, and signal transduction inhibitors. Molecular profiling has led to identification of relevant pathways for future novel approaches.
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50
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Patel MR, Kahl BS, Horwitz SM, Younes A, Foss FM, Oki Y, Sweeney J, Allen K, Faia K, Kelly PF, Flinn I. Preliminary safety and efficacy of IPI-145, a potent inhibitor of phosphoinositide-3-kinase-δ,γ, in patients with relapsed/refractory CLL. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
7070 Background: Phosphoinositide-3-kinases (PI3Ks) are pivotal in cell signaling and regulate a variety of cellular functions relevant to oncogenesis. IPI-145, a potent oral inhibitor of the PI3KEδ and PI3K-γ isoforms, is in clinical development for patients (pts) with hematologic malignancies. Early results in pts with relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) from an ongoing Phase I study are reported here. Methods: This dose-escalation study evaluates the safety, maximum tolerated dose (MTD), clinical activity, and pharmacokinetics (PK) of IPI-145. Expansion cohorts (EC) < MTD are allowed. IPI-145 is given orally twice daily (BID) in 28-day cycles. Tumor response is based on modified IWCLL guidelines criteria. Results: 55 pts have been dosed with IPI-145. PK, available through 50 mg BID, are linear with continuous 24 hr inhibition of pAKT (Ser473) in primary pt CLL cells after a single dose of 25 mg. In the 16 pts with CLL (5 pts in dose escalation < 25 mg BID and 11 pts in a 25 mg BID EC), the median [range] number of cycles was 2.7 [1–14] and 81% remain on study. Treatment-related adverse events (TRAEs) occurred in 10 (63%) pts with CLL, a similar incidence as seen in the total study population (56%). The most common > Grade 3 TRAE in pts with CLL was neutropenia (25%). No > Grade 3 ALT elevations occurred in pts with CLL. Among evaluable pts with CLL (n=11), 82% (n=9) had a PR or nodal response after 2 cycles of IPI-145, with a best response to date of 6 PR, 4 SD (all nodal responses), and 1 PD. Conclusions: IPI-145 appeared well tolerated and has shown clinical activity at the doses examined in pts with relapsed/refractory advanced CLL. The single agent MTD has not been determined and dose escalation continues. Updated safety and efficacy data from pts with CLL enrolled in dose escalation and ECs evaluating 25 mg BID and a higher dose (<MTD) of IPIE145 will be presented. Clinical trial information: NCT01476657.
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Affiliation(s)
- Manish R. Patel
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, FL
| | - Brad S. Kahl
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Anas Younes
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Yasuhiro Oki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Kerrie Faia
- Infinity Pharmaceuticals, Inc., Cambridge, MA
| | | | - Ian Flinn
- Sarah Cannon Research Institute, Nashville, TN
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