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Giacchetti S, Laas E, Bachelot T, Lemonnier J, André F, Cameron D, Bliss J, Chabaud S, Hardy-Bessard AC, Lacroix-Triki M, Canon JL, Debled M, Campone M, Cottu P, Dalenc F, Ballesta A, Penault-Llorca F, Asselain B, Dumas E, Reyal F, Gougis P, Lévi F, Hamy AS. Association between endocrine adjuvant therapy intake timing and disease-free survival in patients with high-risk early breast cancer: results of a sub-study of the UCBG- UNIRAD trial. EBioMedicine 2024; 104:105141. [PMID: 38718683 PMCID: PMC11096868 DOI: 10.1016/j.ebiom.2024.105141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Circadian rhythms regulate cellular physiology and could influence the efficacy of endocrine therapy (ET) in breast cancer (BC). We prospectively tested this hypothesis within the UNIRAD adjuvant phase III trial (NCT01805271). METHODS 1278 patients with high-risk hormonal receptor positive (HR+)/HER2 negative (HER2-) primary BC were randomly assigned to adjuvant ET with placebo or everolimus. Patients prospectively reported in a diary the daily timing of ET intake among four 6-h slots (06:00-11:59 (morning), 12:00-17:59 (afternoon), 18:00-23:59 (evening), or 24:00-05:59 (nighttime). The association between ET timing and disease-free survival (DFS) was a prespecified secondary endpoint of the trial and the results of this observational study are reported here. FINDINGS ET timing was recorded by 855 patients (67.2%). Patients declaring morning (n = 465, 54.4%) or afternoon (n = 45, 5.4%) ET intake were older than those declaring evening (n = 339, 39.6%) or nighttime (n = 5, 0.6%) intake. With a median follow-up of 46.7 months, 118 patients had a local (n = 30) or metastasis relapse (n = 84), and 41 patients died. ET intake timing was not associated with DFS in the whole population (HR = 0.77, 95% CI [0.53-1.12]). The association between ET intake timing and DFS according to the stratification factors revealed interactions with ET agent (tamoxifen versus Aromatase inhibitors (AI) with an increased DFS in the group of evening/nighttime versus morning/afternoon tamoxifen intake (HR = 0.43, 95% CI [0.22-0.85]), while no association was found for AI intake (HR = 1.07, 95% CI [0.68-1.69]). The interaction between ET intake timing and ET agent remained in multivariable analysis (HR = 0.38 [0.16-0.91]). INTERPRETATION Tamoxifen intake in the evening/nighttime could be recommended in patients with high-risk HR+/HER2- BC while awaiting for results from further ET timing studies. FUNDING UNIRAD was Supported by a grant from the French Ministry of Health PHRC 2012 and received funding from La Ligue contre le Cancer, Cancer Research-UK, Myriad Genetics, and Novartis.
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Affiliation(s)
- Sylvie Giacchetti
- AP-HP, Hôpital Saint Louis, Senologie, Paris and Chronotherapy, Cancers, and Transplantation Unit, Faculty of Medicine, Paris-Saclay University, France; Chronotherapy, Cancers and Transplatation Unit, Faculty of Medicine, Paris-Saclay, Villejuif, France.
| | - Enora Laas
- Surgery Department, Institut Curie, Universite Paris Cite, Paris, France; RT2Lab, Residual Tumor and Response to Treatment, U932 "Immunity and Cancer", Universite Paris Cité, Paris, France
| | | | | | | | - David Cameron
- ICR-CTSU, Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Judith Bliss
- Medical Oncology, Western General Hospital, Edinburgh, United Kingdom
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Leon Berard, Lyon, France
| | | | | | - Jean-Luc Canon
- Medical Oncology, Grand Hopital de Charleroi, Charleroi, Belgium
| | - Marc Debled
- Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Mario Campone
- Medical Oncology, Institut Cancerologie de l'Ouest, Saint Herblain, France
| | - Paul Cottu
- Medical Oncology, Institut Curie, Universite Paris Cite, Paris, France
| | - Florence Dalenc
- Medical Oncology, Oncopole Claudius Regaud, IUCT, Toulouse, France
| | | | - Frederique Penault-Llorca
- Centre Jean Perrin, Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | | | - Elise Dumas
- RT2Lab, Residual Tumor and Response to Treatment, U932 "Immunity and Cancer", Universite Paris Cité, Paris, France; Department of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; (t)"Chronotherapy, Cancers, and Transplantation" Unit, Faculty of Medicine, Paris-Saclay University, Villejuif, France
| | - Fabien Reyal
- Surgery Department, Institut Curie, Universite Paris Cite, Paris, France; RT2Lab, Residual Tumor and Response to Treatment, U932 "Immunity and Cancer", Universite Paris Cité, Paris, France
| | - Paul Gougis
- RT2Lab, Residual Tumor and Response to Treatment, U932 "Immunity and Cancer", Universite Paris Cité, Paris, France
| | - Francis Lévi
- Chronotherapy, Cancers and Transplatation Unit, Faculty of Medicine, Paris-Saclay, Villejuif, France
| | - Anne-Sophie Hamy
- Medical Oncology, Institut Curie, Universite Paris Cite, Paris, France; RT2Lab, Residual Tumor and Response to Treatment, U932 "Immunity and Cancer", Universite Paris Cité, Paris, France
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2
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Landré T, Karaboué A, Buchwald ZS, Innominato PF, Qian DC, Assié JB, Chouaïd C, Lévi F, Duchemann B. Effect of immunotherapy-infusion time of day on survival of patients with advanced cancers: a study-level meta-analysis. ESMO Open 2024; 9:102220. [PMID: 38232612 PMCID: PMC10937202 DOI: 10.1016/j.esmoop.2023.102220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/18/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have become the standard of care for numerous malignancies. Emerging evidence suggests that the time of day (ToD) of ICI administration could impact the outcomes of patients with cancer. The consistency of ToD effects on ICI efficacy awaits initial evaluation. MATERIALS AND METHODS This meta-analysis integrates progression-free survival (PFS) and overall survival (OS) data from studies with a defined 'cut-off' ToD. Hazard ratios (HRs) [95% confidence interval (CI)] of an earlier progression or death according to 'early' or 'late' ToD of ICIs were collected from each report and pooled. RESULTS Thirteen studies involved 1663 patients (Eastern Cooperative Oncology Group performance status 0-1, 83%; males/females, 67%/33%) with non-small-cell lung cancer (47%), renal cell carcinoma (24%), melanoma (20%), urothelial cancer (5%), or esophageal carcinoma (4%). Most patients received anti-programmed cell death protein 1 or anti-programmed death-ligand 1 (98%), and a small proportion also received anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4) (18%). ToD cut-offs were 13:00 or 14:00 (i.e. ICI median infusion time), for six studies, and 16:00 or 16:30 (i.e. reported threshold for weaker vaccination responses) for seven studies. Pooled analyses revealed that the early ToD groups had longer OS (HR 0.50, 95% CI 0.42-0.58; P < 0.00001) and PFS (HR 0.51, 95% CI 0.42-0.61; P < 0.00001) compared with the late ToD groups. CONCLUSIONS Patients with selected metastatic cancers seemed to largely benefit from early ToD ICI infusions, which is consistent with circadian mechanisms in immune-cell functions and trafficking. Prospective randomized trials are needed to establish recommendations for optimal circadian timing of ICI-based cancer therapies.
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Affiliation(s)
- T Landré
- Hôpitaux Universitaires Paris Saint-Denis, UCOG, Assistance Publique - Hôpitaux de Paris, Sevran
| | - A Karaboué
- Medical Oncology Unit, GHT Paris Grand Nord-Est, Le Raincy-Montfermeil, Montfermeil; UPR 'Chronotherapy, Cancer and Transplantation', Paris-Saclay University Medical School, Villejuif, France
| | - Z S Buchwald
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - P F Innominato
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor; Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - D C Qian
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - J B Assié
- Pneumology Service, CHI Créteil, Créteil; Inserm U955, UPEC, IMRB, Créteil
| | - C Chouaïd
- Pneumology Service, CHI Créteil, Créteil; Inserm U955, UPEC, IMRB, Créteil
| | - F Lévi
- UPR 'Chronotherapy, Cancer and Transplantation', Paris-Saclay University Medical School, Villejuif, France; Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK; Gastro-intestinal and Medical Oncology Service, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif
| | - B Duchemann
- Thoracic and Medical Oncology Unit, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny, France.
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3
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Gouldthorpe C, Ancoli-Israel S, Cash E, Innominato P, Jakobsen G, Lévi F, Miaskowski C, Parganiha A, Pati AK, Pereira D, Revell V, Zeitzer JM, Davies A. International e-Delphi Consensus Recommendations for the Assessment and Diagnosis of Circadian rest-Activity Rhythm Disorders (CARDs) in Patients with Cancer. Cancers (Basel) 2023; 15:3784. [PMID: 37568600 PMCID: PMC10416864 DOI: 10.3390/cancers15153784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Circadian rest-Activity Rhythm Disorders (CARDs) are common in patients with cancer, particularly in advanced disease. CARDs are associated with increased symptom burden, poorer quality of life, and shorter survival. Research and reporting practices lack standardization, and formal diagnostic criteria do not exist. This electronic Delphi (e-Delphi) study aimed to formulate international recommendations for the assessment and diagnosis of CARDs in patients with cancer. METHODS An international e-Delphi was performed using an online platform (Welphi). Round 1 developed statements regarding circadian rest-activity rhythms, diagnostic criteria, and assessment techniques. Rounds 2 and 3 involved participants rating their level of agreement with the statements and providing comments until consensus (defined internally as 67%) and stability between rounds were achieved. Recommendations were then created and distributed to participants for comments before being finalized. RESULTS Sixteen participants from nine different clinical specialties and seven different countries, with 5-35 years of relevant research experience, were recruited, and thirteen participants completed all three rounds. Of the 164 generated statements, 66% achieved consensus, and responses were stable between the final two rounds. CONCLUSIONS The e-Delphi resulted in international recommendations for assessing and diagnosing CARDs in patients with cancer. These recommendations should ensure standardized research and reporting practices in future studies.
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Affiliation(s)
- Craig Gouldthorpe
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head & Neck Surgery & Communicative Disorders, UofL Healthcare-Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Pasquale Innominato
- Oncology Department, Alaw, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
- Cancer Research Centre, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
| | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Francis Lévi
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
- Gastro-Intestinal and General Oncology Service, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, 94800 Villejuif, France
- Division of Biomedical Sciences, Cancer Chronotherapy Team, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, CA 94143, USA
| | - Arti Parganiha
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
| | - Atanu Kumar Pati
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
- Odisha State Higher Education Council, Government of Odisha, Bhubaneswar 751001, India
- Kalinga Institute of Social Sciences, Bhubaneswar 751024, India
| | - Deidre Pereira
- Department of Clinical and Health Psychology, University of Florida Health, Gainesville, FL 32610, USA
| | - Victoria Revell
- Surrey Sleep Research Centre, University of Surrey, Surrey GU2 7XH, UK
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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Akyel YK, Ozturk Civelek D, Ozturk Seyhan N, Gul S, Gazioglu I, Pala Kara Z, Lévi F, Kavakli IH, Okyar A. Diurnal Changes in Capecitabine Clock-Controlled Metabolism Enzymes Are Responsible for Its Pharmacokinetics in Male Mice. J Biol Rhythms 2023; 38:171-184. [PMID: 36762608 PMCID: PMC10037547 DOI: 10.1177/07487304221148779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/11/2023]
Abstract
The circadian timing system controls absorption, distribution, metabolism, and elimination processes of drug pharmacokinetics over a 24-h period. Exposure of target tissues to the active form of the drug and cytotoxicity display variations depending on the chronopharmacokinetics. For anticancer drugs with narrow therapeutic ranges and dose-limiting side effects, it is particularly important to know the temporal changes in pharmacokinetics. A previous study indicated that pharmacokinetic profile of capecitabine was different depending on dosing time in rat. However, it is not known how such difference is attributed with respect to diurnal rhythm. Therefore, in this study, we evaluated capecitabine-metabolizing enzymes in a diurnal rhythm-dependent manner. To this end, C57BL/6J male mice were orally treated with 500 mg/kg capecitabine at ZT1, ZT7, ZT13, or ZT19. We then determined pharmacokinetics of capecitabine and its metabolites, 5'-deoxy-5-fluorocytidine (5'DFCR), 5'-deoxy-5-fluorouridine (5'DFUR), 5-fluorouracil (5-FU), in plasma and liver. Results revealed that plasma Cmax and AUC0-6h (area under the plasma concentration-time curve from 0 to 6 h) values of capecitabine, 5'DFUR, and 5-FU were higher during the rest phase (ZT1 and ZT7) than the activity phase (ZT13 and ZT19) (p < 0.05). Similarly, Cmax and AUC0-6h values of 5'DFUR and 5-FU in liver were higher during the rest phase than activity phase (p < 0.05), while there was no significant difference in liver concentrations of capecitabine and 5'DFCR. We determined the level of the enzymes responsible for the conversion of capecitabine and its metabolites at each ZT. Results indicated the levels of carboxylesterase 1 and 2, cytidine deaminase, uridine phosphorylase 2, and dihydropyrimidine dehydrogenase (p < 0.05) are being rhythmically regulated and, in turn, attributed different pharmacokinetics profiles of capecitabine and its metabolism. This study highlights the importance of capecitabine administration time to increase the efficacy with minimum adverse effects.
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Affiliation(s)
- Yasemin Kubra Akyel
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
- Department of Medical Pharmacology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Dilek Ozturk Civelek
- Department of Pharmacology, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
| | - Narin Ozturk Seyhan
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Seref Gul
- Biotechnology Division, Department of Biology, Faculty of Science, Istanbul University, Istanbul, Turkey
| | - Isil Gazioglu
- Department of Analytical Chemistry, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeliha Pala Kara
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Francis Lévi
- UPR "Chronotherapy, Cancer and Transplantation," Medical School, Paris-Saclay University, Villejuif, France
- Medical Oncology Department, Paul Brousse Hospital, Villejuif, France
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
| | - Ibrahim Halil Kavakli
- Department of Molecular Biology and Genetics, Koc University, Istanbul, Turkey
- Department of Chemical and Biological Engineering, Koc University, Istanbul, Turkey
| | - Alper Okyar
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
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Giacchetti S, Hamy AS, Bachelot T, Lemonnier J, Andre F, Cameron DA, Bliss J, Chabaud S, Hardy-Bessard AC, Lacroix-Triki M, Canon JL, Bonnefoi HR, Campone M, Cottu P, Dalenc F, Ballesta A, Lévi F, Laas E. Abstract P2-02-07: Patients’ selection of daily timing of oral intake of adjuvant hormonotherapy (HT) and everolimus (EVE) for high risk early breast cancer in the UCBG-UNIRAD phase III trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-02-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Everolimus (EVE) addition to adjuvant hormonotherapy (HT) for high-risk early breast cancer (BC) did not improve 3-year disease-free survival (DFS) compared with ET alone in the randomized UNIRAD trial (NCT01805271) (1). Most patients (pts) withdrew from EVE for adverse events nearly midway before the expected treatment duration of 2 years. The main EVE target involves m-TOR-induced S6 protein phosphorylation, which is controlled by the molecular circadian clock in mice and cells. Toward the analysis of possible circadian time-dependencies in EVE toxicities and efficacy, we first determine the actual distribution of the daily times chosen by the patients for both oral EVE and HT intakes.
Patients and methods: The registered pts were asked to record the clock hours they chose for both HT and EVE or placebo (PLAC) intakes within four possible daily 6-h slots, i.e. from 06:00 to 11:59 (morning), 12:00 to 17:59 (midtime), 18:00 to 23:59 (evening), or 24:00 to 05:59, (night) in a daily diary throughout their participation in the trial. Modifications in times of drugs intake were reported. Comparisons between groups involved Kruskal-Wallis sum test and Pearson’s Chi-squared and Fisher’s exact tests.
Results: Out of 1,278 randomized patients, 1063 (83,1 %) recorded the times of EVE or PLAC intakes, 852 recorded those for HT intakes. Only 10 pts reported night EVE/PLAC intakes and were not considered here. Of the 1053 evaluated pts; 549 pts took EVE/PLAC in the morning, 82 pts at midtime and 422 in the evening. As compared with evening intakes, morning or midtime intakes of EVE or PLAC were significantly associated with an older age, and post-menopausal status, whilst younger and premenopausal women preferentially chose evening intakes (p< 0.001 for both). Consistently, HT with aromatase inhibitors (AI) were mostly taken in the morning or at midtime, whereas tamoxifene (TAM) was mostly taken the evening (p = 0.001). Tumor size, lymph nodes involvement, histological grade, hormonal receptors status, and EVE initial dose were similarly distributed among the three time slots (Table 1). A similar distribution of oral intake times as in the whole timing study population was found according to age, menopausal status and HT type in the EVE arm (N=508 pts), and in the HT population (+/- EVE or PLAC) (N=852 pts). Initial oral timing intake was modified for EVE by 50 of 508 pts (10%) and for HT by 10 of 852 pts (1%).
Conclusion: To the best of our knowledge, it is the first time that the patients’ spontaneous selection of daily times for oral intakes of a targeted agent (EVE) and HT is reported in a large series of early breast cancer pts. Age and menopausal status were important determinants of patient-selected daily timing intakes of both EVE and HT, as well as HT types. These findings will be carefully considered in the analyses of possible EVE and HT timing effects on adverse events and efficacy of the current adjuvant regimens.
1) Bachelot T et al, J Clin Oncol. 2022 May 23
Citation Format: Sylvie Giacchetti, Anne-Sophie Hamy, Thomas Bachelot, Jérôme Lemonnier, Fabrice Andre, David A. Cameron, Judith Bliss, Sylvie Chabaud, Anne-Claire Hardy-Bessard, Magali Lacroix-Triki, Jean-Luc Canon, Hervé R. Bonnefoi, Mario Campone, Paul Cottu, Florence Dalenc, Annabelle Ballesta, Francis Lévi, Enora Laas. Patients’ selection of daily timing of oral intake of adjuvant hormonotherapy (HT) and everolimus (EVE) for high risk early breast cancer in the UCBG-UNIRAD phase III trial. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-02-07.
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Affiliation(s)
| | | | | | | | | | - David A. Cameron
- 6The University of Edinburgh, Edinburgh Cancer Research, EDINBURGH, Scotland, United Kingdom
| | - Judith Bliss
- 7Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Jean-Luc Canon
- 11Grand Hôpital de Charleroi, Charleroi, Hainaut, Belgium
| | - Hervé R. Bonnefoi
- 12Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1312, and European Organisation for Research and Treatment of Cancer (EORTC),, Bordeaux, France
| | - Mario Campone
- 13Institut de Cancérologie de l’Ouest, René Gauducheau, Saint-Herblain, France
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Faraut B, Cordina-Duverger E, Aristizabal G, Drogou C, Gauriau C, Sauvet F, Lévi F, Léger D, Guénel P. Immune disruptions and night shift work in hospital healthcare professionals: The intricate effects of social jet-lag and sleep debt. Front Immunol 2022; 13:939829. [PMID: 36164341 PMCID: PMC9509137 DOI: 10.3389/fimmu.2022.939829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives We aimed to examine the effects of circadian and sleep rhythm disruptions on immune biomarkers among hospital healthcare professionals working night shifts and rotating day shifts. Methods Hospital nurses working either as permanent night shifters (n=95) or as day shifters rotating between morning and afternoon shifts (n=96) kept a daily diary on their sleep and work schedules over a full working week. Blood samples were collected at the beginning and end of the last shift during the week, and participants were categorized into three groups based on work shift: morning shift (39 day shifters sampled at 7:00 and 14:00), afternoon shift (57 day shifters sampled at 14:00 and 21:00), and night shift (95 night shifters sampled at 21:00 and 7:00). Circulating blood counts in immune cells, interleukin-6 and C-reactive protein concentrations as well as total sleep time per 24 hours during work days (TST24w) and free days (TST24f), sleep debt (TST24f - TST24w) and social jet-lag (a behavioral proxy of circadian misalignment) were assessed. Results Compared with day shifters, night shifters had shorter sleep duration (TST24w=5.4 ± 1.4h), greater sleep debt (3.2 ± 1.4 h) and social jet-lag (6.7 ± 2.4 h). Variations of immune biomarkers concentrations were consistent with the expected diurnal variations among day shifters (i.e., low level in the morning, increase during the day, peak value in the evening). By contrast, in night shifters, blood concentrations of total lymphocytes, T-helper cells, cytotoxic T-cells, memory B-cells and interleukin-6 were lower at 21:00, increased during the night, and reached higher values at 7:00. Multivariate analyses ruled out significant impact of TST24w, sleep debt, and social jet-lag on immune biomarkers concentrations among day shifters. In contrast, among night shifters, multivariate analyses indicated a combined effect of total sleep time (TST24w), sleep debt and social jet-lag for total lymphocytes and T-helper cells but only a social jet-lag effect for interleukin-6 and a single total sleep time effect for neutrophil and B-Cells. Conclusions Altogether, our results point to intricate response patterns of immune rhythms to circadian misalignment and sleep debt in night shifters. Specifically, these altered pattern expressions of immune cells may increase vulnerability to infections and reduce vaccination efficiency in night workers.
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Affiliation(s)
- Brice Faraut
- Université Paris Cité, VIFASOM (UPR 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France
- APHP, APHP-Centre Université de Paris, Hôtel Dieu, Centre du Sommeil et de La Vigilance, Paris, France
| | - Emilie Cordina-Duverger
- Inserm, CESP (Center for research in Epidemiology and Population Health), Team Exposome and Heredity, University Paris-Saclay, Gustave-Roussy, Villejuif, France
| | - Guillen Aristizabal
- Inserm, CESP (Center for research in Epidemiology and Population Health), Team Exposome and Heredity, University Paris-Saclay, Gustave-Roussy, Villejuif, France
| | - Catherine Drogou
- Université Paris Cité, VIFASOM (UPR 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France
- Institut de Recherche Biomédicale des Armées (IRBA), Unité Fatigue et Vigilance, Brétigny sur Orge, France
| | - Caroline Gauriau
- Université Paris Cité, VIFASOM (UPR 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France
- APHP, APHP-Centre Université de Paris, Hôtel Dieu, Centre du Sommeil et de La Vigilance, Paris, France
| | - Fabien Sauvet
- Université Paris Cité, VIFASOM (UPR 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France
- Institut de Recherche Biomédicale des Armées (IRBA), Unité Fatigue et Vigilance, Brétigny sur Orge, France
| | - Francis Lévi
- UPR “Chronothérapie, Cancers, et Transplantation”, Faculté de Médecine, Université Paris-Saclay, Villejuif, France
- Hepato-Biliary Center, Hôpital Paul Brousse, Villejuif, France
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, United Kingdom
| | - Damien Léger
- Université Paris Cité, VIFASOM (UPR 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France
- APHP, APHP-Centre Université de Paris, Hôtel Dieu, Centre du Sommeil et de La Vigilance, Paris, France
| | - Pascal Guénel
- Inserm, CESP (Center for research in Epidemiology and Population Health), Team Exposome and Heredity, University Paris-Saclay, Gustave-Roussy, Villejuif, France
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7
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Zhang Y, Cordina-Duverger E, Komarzynski S, Attari AM, Huang Q, Aristizabal G, Faraut B, Léger D, Adam R, Guénel P, Brettschneider JA, Finkenstädt BF, Lévi F. Digital circadian and sleep health in individual hospital shift workers: A cross sectional telemonitoring study. EBioMedicine 2022; 81:104121. [PMID: 35772217 PMCID: PMC9253495 DOI: 10.1016/j.ebiom.2022.104121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/11/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Telemonitoring of circadian and sleep cycles could identify shift workers at increased risk of poor health, including cancer and cardiovascular diseases, thus supporting personalized prevention. METHODS The Circadiem cross-sectional study aimed at determining early warning signals of risk of health alteration in hospital nightshifters (NS) versus dayshifters (DS, alternating morning and afternoon shifts). Circadian rhythmicity in activity, sleep, and temperature was telemonitored on work and free days for one week. Participants wore a bluetooth low energy thoracic accelerometry and temperature sensor that was wirelessly connected to a GPRS gateway and a health data hub server. Hidden Markov modelling of activity quantified Rhythm Index, rest quality (probability, p1-1, of remaining at rest), and rest duration. Spectral analyses determined periods in body surface temperature and accelerometry. Parameters were compared and predictors of circadian and sleep disruption were identified by multivariate analyses using information criteria-based model selection. Clusters of individual shift work response profiles were recognized. FINDINGS Of 140 per-protocol participants (133 females), there were 63 NS and 77 DS. Both groups had similar median rest amount, yet NS had significantly worse median rest-activity Rhythm Index (0·38 [IQR, 0·29-0·47] vs. 0·69 [0·60-0·77], p<0·0001) and rest quality p1-1 (0·94 [0·94-0·95] vs 0·96 [0·94-0·97], p<0·0001) over the whole study week. Only 48% of the NS displayed a circadian period in temperature, as compared to 70% of the DS (p=0·026). Poor p1-1 was associated with nightshift work on both work (p<0·0001) and free days (p=0·0098). The number of years of past night work exposure predicted poor rest-activity Rhythm Index jointly with shift type, age and chronotype on workdays (p= 0·0074), and singly on free days (p=0·0005). INTERPRETATION A dedicated analysis toolbox of streamed data from a wearable device identified circadian and sleep rhythm markers, that constitute surrogate candidate endpoints of poor health risk in shift-workers. FUNDING French Agency for Food, Environmental and Occupational Health & Safety (EST-2014/1/064), University of Warwick, Medical Research Council (United Kingdom, MR/M013170), Cancer Research UK(C53561/A19933).
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Affiliation(s)
- Yiyuan Zhang
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Emilie Cordina-Duverger
- Inserm, CESP, Team Exposome and Heredity, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Sandra Komarzynski
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Amal M Attari
- UPR "Chronothérapie, Cancers, et Transplantation", Faculté de Médecine, Université Paris-Saclay, Villejuif, France; Cap Gemini, Velizy Villacoublay, France
| | - Qi Huang
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Guillen Aristizabal
- Inserm, CESP, Team Exposome and Heredity, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Brice Faraut
- Université de Paris, VIFASOM (EA 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France; Assistance Publique-Hôpitaux de Paris, APHP-Centre Université de Paris, Hôtel Dieu, Centre du Sommeil et de La Vigilance, Paris, France
| | - Damien Léger
- Université de Paris, VIFASOM (EA 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France; Assistance Publique-Hôpitaux de Paris, APHP-Centre Université de Paris, Hôtel Dieu, Centre du Sommeil et de La Vigilance, Paris, France
| | - René Adam
- UPR "Chronothérapie, Cancers, et Transplantation", Faculté de Médecine, Université Paris-Saclay, Villejuif, France; Hepato-Biliary Center, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Pascal Guénel
- Inserm, CESP, Team Exposome and Heredity, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | | | - Francis Lévi
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom; UPR "Chronothérapie, Cancers, et Transplantation", Faculté de Médecine, Université Paris-Saclay, Villejuif, France; Department of Medical Oncology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France.
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8
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Spitschan M, Santhi N, Ahluwalia A, Fischer D, Hunt L, Karp N, Lévi F, Pineda-Torra I, Vidafar P, White R. Science Forum: Sex differences and sex bias in human circadian and sleep physiology research. eLife 2022; 11:65419. [PMID: 35179486 PMCID: PMC8963875 DOI: 10.7554/elife.65419] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 12/03/2020] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Growing evidence shows that sex differences impact many facets of human biology. Here we review and discuss the impact of sex on human circadian and sleep physiology, and we uncover a data gap in the field investigating the non-visual effects of light in humans. A virtual workshop on the biomedical implications of sex differences in sleep and circadian physiology then led to the following imperatives for future research: (1) design research to be inclusive and accessible, (2) implement recruitment strategies that lead to a sex-balanced sample, (3) use data visualization to grasp the effect of sex, (4) implement statistical analyses that include sex as a factor and/or perform group analyses by sex, where possible, (5) make participant-level data open and available to facilitate future meta-analytic efforts.
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Affiliation(s)
| | - Nayantara Santhi
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Amrita Ahluwalia
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Dorothee Fischer
- Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany
| | | | - Natasha Karp
- Data Sciences and Quantitative Biology, AstraZeneca, Hinxton, United Kingdom
| | - Francis Lévi
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Ines Pineda-Torra
- Centre for Cardiometabolic and Vascular Science, University College London, London, United Kingdom
| | - Parisa Vidafar
- Department of Psychiatry, University of Michigan, Ann Arbor, United States
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9
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Karaboué A, Collon T, Pavese I, Bodiguel V, Cucherousset J, Zakine E, Innominato PF, Bouchahda M, Adam R, Lévi F. Time-Dependent Efficacy of Checkpoint Inhibitor Nivolumab: Results from a Pilot Study in Patients with Metastatic Non-Small-Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14040896. [PMID: 35205644 PMCID: PMC8870559 DOI: 10.3390/cancers14040896] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 12/28/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Initial clinical observations revealed strikingly longer follow-up for metastatic non-small-cell lung cancer (NSCLC) patients receiving nivolumab infusions predominantly in the morning as compared to those treated in the afternoon. Prior experimental and human studies have demonstrated the temporal distributions of immune cells’ proliferation, trafficking, and antigen recognition and destruction over the 24 h. Here, we hypothesized that circadian timing could play an important role in nivolumab’s efficacy, as previously shown for the toxicity and/or efficacy of chronomodulated chemotherapy in colorectal and lung cancer patients. Following project validation by an internal scientific review board, the dosing times of each of the 1818 nivolumab infusions given to 95 consecutive patients as a standard treatment for metastatic NSCLC were retrieved from the day-hospital records. Adverse events and radiologically documented tumor responses were retrieved and reviewed from patients’ clinical charts. Patients were allocated to ‘morning’ (N = 48 patients) or ‘afternoon’ (N = 47 patients) groups, according to whether they had received the majority of nivolumab infusions before or after 12:54, i.e., the median time of all infusions, respectively. ‘Morning’ nivolumab dosing nearly quadrupled median progression-free and overall survival as compared to ‘afternoon’ dosing. ‘Morning’ nivolumab was significantly more effective irrespective of age, sex, performance status, prior treatments, tumor histology, or PD-L1 expression. In contrast, nivolumab primary resistance was most often observed following ‘afternoon’ dosing. Randomized trials are warranted both to further identify the optimal timing of checkpoint inhibitors in individual cancer patients, and to determine the main mechanisms that precisely drive immunotherapy efficacy and resistance along the circadian timescale. Abstract Hypothesis: Prior experimental and human studies have demonstrated the circadian organization of immune cells’ proliferation, trafficking, and antigen recognition and destruction. Nivolumab targets T(CD8) cells, the functions, and trafficking of which are regulated by circadian clocks, hence suggesting possible daily changes in nivolumab’s efficacy. Worse progression-free survival (PFS), and overall survival (OS) were reported for malignant melanoma patients receiving more than 20% of their immune checkpoint inhibitor infusions after 16:30 as compared to earlier in the day. Methods: Consecutive metastatic non-small-cell cancer (NSCLC) patients received nivolumab (240 mg iv q 2 weeks) at a daily time that was ‘randomly’ allocated for each course on a logistical basis by the day-hospital coordinators. The median time of all nivolumab administrations was computed for each patient. The study population was split into two timing groups based upon the median value of the median treatment times of all patients. CTCAE-toxicity rates, iRECIST-tumor responses, PFS and OS were computed according to nivolumab timing. PFS and OS curves were compared and hazard ratios (HR) were computed for all major categories of characteristics. Multivariable and sensitivity analyses were also performed. Results: The study accrued 95 stage-IV NSCLC patients (PS 0–1, 96%), aged 41–83 years. The majority of nivolumab administrations occurred between 9:27 and 12:54 for 48 patients (‘morning’ group) and between 12:55 and 17:14 for the other 47 (‘afternoon’ group). Median PFS (95% CL) was 11.3 months (5.5–17.1) for the ‘morning’ group and 3.1 months (1.5–4.6) for the ‘afternoon’ one (p < 0.001). Median OS was 34.2 months (15.1–53.3) and 9.6 months (4.9–14.4) for the ‘morning’ group and the ‘afternoon’ one, respectively (p < 0.001). Multivariable analyses identified ‘morning’ timing as a significant predictor of longer PFS and OS, with respective HR values of 0.26 (0.11–0.58) and 0.17 (0.08–0.37). The timing effect was consistent across all patient subgroups tested. Conclusions: Nivolumab was nearly four times as effective following ‘morning’ as compared to ‘afternoon’ dosing in this cohort of NSCLC patients. Prospective timing-studies are needed to minimize the risk of resistance and to maximize the benefits from immune checkpoint inhibitors.
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Affiliation(s)
- Abdoulaye Karaboué
- Medical Oncology Unit, GHT Paris Grand Nord-Est, Le Raincy-Montfermeil, 93770 Montfermeil, France; (T.C.); (I.P.)
- UPR “Chronotherapy, Cancer and Transplantation”, Medical School, Paris-Saclay University, 94800 Villejuif, France; (P.F.I.); (M.B.); (R.A.)
- Correspondence: (A.K.); (F.L.); Tel.: +33-(0)-629369829 (A.K.); +33-(0)-609130780 (F.L.)
| | - Thierry Collon
- Medical Oncology Unit, GHT Paris Grand Nord-Est, Le Raincy-Montfermeil, 93770 Montfermeil, France; (T.C.); (I.P.)
| | - Ida Pavese
- Medical Oncology Unit, GHT Paris Grand Nord-Est, Le Raincy-Montfermeil, 93770 Montfermeil, France; (T.C.); (I.P.)
| | - Viviane Bodiguel
- Pathology Unit, GHT Paris Grand Nord-Est, Le Raincy-Montfermeil, 93370 Montfermeil, France; (V.B.); (J.C.); (E.Z.)
| | - Joel Cucherousset
- Pathology Unit, GHT Paris Grand Nord-Est, Le Raincy-Montfermeil, 93370 Montfermeil, France; (V.B.); (J.C.); (E.Z.)
| | - Elda Zakine
- Pathology Unit, GHT Paris Grand Nord-Est, Le Raincy-Montfermeil, 93370 Montfermeil, France; (V.B.); (J.C.); (E.Z.)
| | - Pasquale F. Innominato
- UPR “Chronotherapy, Cancer and Transplantation”, Medical School, Paris-Saclay University, 94800 Villejuif, France; (P.F.I.); (M.B.); (R.A.)
- North Wales Cancer Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry CV4 7AL, UK
| | - Mohamed Bouchahda
- UPR “Chronotherapy, Cancer and Transplantation”, Medical School, Paris-Saclay University, 94800 Villejuif, France; (P.F.I.); (M.B.); (R.A.)
- Medical Oncology Department, Paul Brousse Hospital, 94800 Villejuif, France
- Medical Oncology Unit, Clinique Saint Jean L’Ermitage, 77000 Melun, France
- Medical Oncology Unit, Clinique du Mousseau, 91000 Evry, France
| | - René Adam
- UPR “Chronotherapy, Cancer and Transplantation”, Medical School, Paris-Saclay University, 94800 Villejuif, France; (P.F.I.); (M.B.); (R.A.)
- Centre Hépato Biliaire, AP-HP, Hôpital Paul Brousse (APHP), 94800 Villejuif, France
| | - Francis Lévi
- UPR “Chronotherapy, Cancer and Transplantation”, Medical School, Paris-Saclay University, 94800 Villejuif, France; (P.F.I.); (M.B.); (R.A.)
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry CV4 7AL, UK
- Centre Hépato Biliaire, AP-HP, Hôpital Paul Brousse (APHP), 94800 Villejuif, France
- Correspondence: (A.K.); (F.L.); Tel.: +33-(0)-629369829 (A.K.); +33-(0)-609130780 (F.L.)
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10
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Lévi F. Daytime versus evening infusions of immune checkpoint inhibitors. Lancet Oncol 2021; 22:1648-1650. [PMID: 34780710 DOI: 10.1016/s1470-2045(21)00607-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Francis Lévi
- UPR "Chronotherapy, Cancers and Transplantation", CNRS Campus, Faculty of Medicine, Paris-Saclay University, Villejuif, 94800, France; Department of Medical Oncology, Paul-Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France; Cancer Chronotherapy Team, Warwick Medical School, Coventry, UK.
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11
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Bouchahda M, Saffroy R, Karaboué A, Hamelin J, Innominato P, Saliba F, Bosselut N, Lemoine A, Lévi F. Reply to P. Gazzaniga et al. JCO Precis Oncol 2021; 5:391-392. [DOI: 10.1200/po.20.00465] [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)
- Mohamed Bouchahda
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Raphael Saffroy
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Abdoulaye Karaboué
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Jocelyne Hamelin
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Pasquale Innominato
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Faouzi Saliba
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Nelly Bosselut
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Antoinette Lemoine
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
| | - Francis Lévi
- Mohamed Bouchahda, MD, Medical Oncology Department, Paul Brousse Hospital, Villejuif, France; UPR “Chronotherapy, Cancer and Transplantation,” Medical School, Paris-Saclay University, Villejuif, France; Medical Oncology Unit, Clinique Saint Jean L'Ermitage, Melun, France; Medical Oncology Unit, Clinique du Mousseau, Evry, France; Raphael Saffroy, MD, Oncogenetics Department, APHP, Université Paris-Saclay, Paul Brousse Hospital, Villejuif, France; Abdoulaye Karaboué, MD, UPR “Chronotherapy, Cancer and
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12
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Martinelli J, Dulong S, Li XM, Teboul M, Soliman S, Lévi F, Fages F, Ballesta A. Model learning to identify systemic regulators of the peripheral circadian clock. Bioinformatics 2021; 37:i401-i409. [PMID: 34252929 PMCID: PMC8557835 DOI: 10.1093/bioinformatics/btab297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
MOTIVATION Personalized medicine aims at providing patient-tailored therapeutics based on multi-type data toward improved treatment outcomes. Chronotherapy that consists in adapting drug administration to the patient's circadian rhythms may be improved by such approach. Recent clinical studies demonstrated large variability in patients' circadian coordination and optimal drug timing. Consequently, new eHealth platforms allow the monitoring of circadian biomarkers in individual patients through wearable technologies (rest-activity, body temperature), blood or salivary samples (melatonin, cortisol) and daily questionnaires (food intake, symptoms). A current clinical challenge involves designing a methodology predicting from circadian biomarkers the patient peripheral circadian clocks and associated optimal drug timing. The mammalian circadian timing system being largely conserved between mouse and humans yet with phase opposition, the study was developed using available mouse datasets. RESULTS We investigated at the molecular scale the influence of systemic regulators (e.g. temperature, hormones) on peripheral clocks, through a model learning approach involving systems biology models based on ordinary differential equations. Using as prior knowledge our existing circadian clock model, we derived an approximation for the action of systemic regulators on the expression of three core-clock genes: Bmal1, Per2 and Rev-Erbα. These time profiles were then fitted with a population of models, based on linear regression. Best models involved a modulation of either Bmal1 or Per2 transcription most likely by temperature or nutrient exposure cycles. This agreed with biological knowledge on temperature-dependent control of Per2 transcription. The strengths of systemic regulations were found to be significantly different according to mouse sex and genetic background. AVAILABILITY AND IMPLEMENTATION https://gitlab.inria.fr/julmarti/model-learning-mb21eccb. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Julien Martinelli
- INSERM UMR-S 900, Institut Curie, MINES ParisTech CBIO, PSL Research University, 92210 Saint-Cloud, France.,Lifeware Group, Inria Saclay Ile-de-France, Palaiseau 91120, France
| | - Sandrine Dulong
- UPR "Chronotherapy, Cancers and Transplantation", Paris-Saclay University, Faculty of Medicine Kremlin Bicêtre, Le Kremlin Bicêtre, 94270, France
| | - Xiao-Mei Li
- UPR "Chronotherapy, Cancers and Transplantation", Paris-Saclay University, Faculty of Medicine Kremlin Bicêtre, Le Kremlin Bicêtre, 94270, France
| | - Michèle Teboul
- Côte d'Azur University, CNRS, INSERM, iBV, Nice 06000, France
| | - Sylvain Soliman
- Lifeware Group, Inria Saclay Ile-de-France, Palaiseau 91120, France
| | - Francis Lévi
- UPR "Chronotherapy, Cancers and Transplantation", Paris-Saclay University, Faculty of Medicine Kremlin Bicêtre, Le Kremlin Bicêtre, 94270, France.,Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif 94800, France
| | - François Fages
- Lifeware Group, Inria Saclay Ile-de-France, Palaiseau 91120, France
| | - Annabelle Ballesta
- INSERM UMR-S 900, Institut Curie, MINES ParisTech CBIO, PSL Research University, 92210 Saint-Cloud, France
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13
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Kumar SA, Needham RJ, Abraham K, Bridgewater HE, Garbutt LA, Xandri-Monje H, Dallmann R, Perrier S, Sadler PJ, Lévi F. Dose- and time-dependent tolerability and efficacy of organo-osmium complex FY26 and its tissue pharmacokinetics in hepatocarcinoma-bearing mice. Metallomics 2021; 13:mfaa003. [PMID: 33595653 PMCID: PMC7853623 DOI: 10.1093/mtomcs/mfaa003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/21/2020] [Accepted: 12/05/2020] [Indexed: 02/07/2023]
Abstract
The organo-osmium complex [OsII(ɳ6-p-cym)(PhAzPy-NMe2)I]+ (FY26) exhibits promising in vitro antitumour activity against mouse hepatocarcinoma Hepa1-6 and other mouse or human cancer cell lines. Here, we drastically enhance water solubility of FY26 through the replacement of the PF6- counter-anion with chloride using a novel synthesis method. FY26⋅PF6 and FY26⋅Cl displayed similar in vitro cytotoxicity in two cancer cell models. We then show the moderate and late anticancer efficacy of FY26⋅PF6 and FY26⋅Cl in a subcutaneous murine hepatocarcinoma mouse model. Both efficacy and tolerability varied according to FY26 circadian dosing time in hepatocarcinoma tumour-bearing mice. Tumour and liver uptake of the drug were determined over 48 h following FY26⋅Cl administration at Zeitgeber time 6 (ZT6), when the drug is least toxic (in the middle of the light span when mice are resting). Our studies suggest the need to administer protracted low doses of FY26 at ZT6 in order to optimize its delivery schedule, for example through the use of chrono-releasing nanoparticles.
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Affiliation(s)
- Swati A Kumar
- Chronotherapy Team, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry CV4 7AL, UK
| | - Russell J Needham
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, UK
| | - Kristin Abraham
- Chronotherapy Team, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry CV4 7AL, UK
| | | | - Lauren A Garbutt
- Chronotherapy Team, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry CV4 7AL, UK
| | - Helena Xandri-Monje
- Chronotherapy Team, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry CV4 7AL, UK
| | - Robert Dallmann
- Chronotherapy Team, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry CV4 7AL, UK
| | - Sebastien Perrier
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, UK
| | - Peter J Sadler
- Department of Chemistry, University of Warwick, Coventry CV4 7AL, UK
| | - Francis Lévi
- Chronotherapy Team, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry CV4 7AL, UK
- UPR ‘Chronotherapy, Cancers and Transplantation’, Faculty of Medicine, Paris Saclay University, Campus CNRS, 7 rue Guy Moquet, 94800 Villejuif, France
- Hepato-Biliary Center, Paul Brousse Hospital, Assistance Publique-Hopitaux de Paris (AP-HP), 12–14 Avenue Paul-Vaillant Couturier, 94800 Villejuif, France
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14
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Bouchahda M, Saffroy R, Karaboué A, Hamelin J, Innominato P, Saliba F, Lévi F, Bosselut N, Lemoine A. Undetectable RAS-Mutant Clones in Plasma: Possible Implication for Anti-EGFR Therapy and Prognosis in Patients With RAS-Mutant Metastatic Colorectal Cancer. JCO Precis Oncol 2020; 4:1900400. [PMID: 33015528 PMCID: PMC7529530 DOI: 10.1200/po.19.00400] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Accepted: 07/17/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Combining cetuximab with chemotherapy provides clinical benefit to 60% of the patients with RAS wild-type (RAS-wt) metastatic colorectal cancer (mCRC). This pilot study investigated the efficacy of cetuximab-based chemotherapy in a sample of patients (40%) with RAS mutation (RAS-mt) in their primary tumor whose circulating tumor DNA (ctDNA) was RAS-wt. MATERIALS AND METHODS The occurrence of Kirsten rat sarcoma viral oncogene homolog (KRAS), neuroblastoma rat sarcoma viral oncogene homolog (NRAS), V-raf murine sarcoma viral oncogene homolog B1 (BRAF), and PI3KCA mutations was determined in ctDNA by using a new ultrasensitive analysis based on mass spectrometry detection. All consenting patients with confirmed RAS-mt mCRC had disease progression on previous chemotherapy that contained no anti–epidermal growth factor receptor (EGFR). The patients with RAS-wt ctDNA received cetuximab + fluorouracil, leucovorin, and irinotecan (FOLFIRI), whereas those with RAS-mt ctDNA were treated with the oncologist’s choice of therapy. RESULTS Of 16 registered patients, 11 were male and five female. They were age 48 to 81 years, and they had unresectable metastatic adenocarcinoma from the colon (n = 11) or rectum (n = 5), with a median of two metastatic sites. They had received a median number of three previous chemotherapy protocols. Plasma genotyping identified RAS-mt in seven patients (44%) and RAS-wt in nine patients (56%). In the patients with wt ctDNA, objective tumor response rate was 50.0%, including one complete response and four partial responses after a median number of 6 courses of cetuximab + FOLFIRI (range, 1 to 16 courses). Two of the nine patients had stable disease, and two had progressive disease. No grade 3 to 4 toxicities were encountered. One-year survival rates were 60.0% for the patients with RAS-wt ctDNA and 17.9% for those with RAS-mt ctDNA. Median overall survival times were not reached and 4.7 months, respectively. CONCLUSION Patients with RAS-mt mCRC whose plasma biopsies contained RAS-wt could benefit from cetuximab-based therapy, a hypothesis to be tested in a prospective randomized trial.
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Affiliation(s)
- Mohamed Bouchahda
- Medical Oncology Department, Paul Brousse Hospital, Villejuif, France.,Medical Oncology Unit, Clinique du Mousseau, Evry, France
| | - Raphael Saffroy
- Oncogenetics Department, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Université Paris-Saclay, Villejuif, France
| | - Abdoulaye Karaboué
- French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.,Medical Oncology Unit, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Jocelyne Hamelin
- Oncogenetics Department, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Université Paris-Saclay, Villejuif, France
| | - Pasquale Innominato
- French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.,North Wales Cancer Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom.,Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, United Kingdom
| | - Faouzi Saliba
- Centre Hépato Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - Francis Lévi
- Medical Oncology Department, Paul Brousse Hospital, Villejuif, France.,French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.,Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, United Kingdom
| | - Nelly Bosselut
- Oncogenetics Department, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Université Paris-Saclay, Villejuif, France
| | - Antoinette Lemoine
- Oncogenetics Department, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Université Paris-Saclay, Villejuif, France
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15
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Lévi F, Komarzynski S, Huang Q, Young T, Ang Y, Fuller C, Bolborea M, Brettschneider J, Fursse J, Finkenstädt B, White DP, Innominato P. Tele-Monitoring of Cancer Patients' Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption. Cancers (Basel) 2020; 12:cancers12071938. [PMID: 32708950 PMCID: PMC7409071 DOI: 10.3390/cancers12071938] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
The dichotomy index (I < O), a quantitative estimate of the circadian regulation of daytime activity and sleep, predicted overall cancer survival and emergency hospitalization, supporting its integration in a mHealth platform. Modifiable causes of I < O deterioration below 97.5%—(I < O)low—were sought in 25 gastrointestinal cancer patients and 33 age- and sex-stratified controls. Rest-activity and temperature were tele-monitored with a wireless chest sensor, while daily activities, meals, and sleep were self-reported for one week. Salivary cortisol rhythm and dim light melatonin onset (DLMO) were determined. Circadian parameters were estimated using Hidden Markov modelling, and spectral analysis. Actionable predictors of (I < O)low were identified through correlation and regression analyses. Median compliance with protocol exceeded 95%. Circadian disruption—(I < O)low—was identified in 13 (52%) patients and four (12%) controls (p = 0.002). Cancer patients with (I < O)low had lower median activity counts, worse fragmented sleep, and an abnormal or no circadian temperature rhythm compared to patients with I < O exceeding 97.5%—(I < O)high—(p < 0.012). Six (I < O)low patients had newly-diagnosed sleep conditions. Altered circadian coordination of rest-activity and chest surface temperature, physical inactivity, and irregular sleep were identified as modifiable determinants of (I < O)low. Circadian rhythm and sleep tele-monitoring results support the design of specific interventions to improve outcomes within a patient-centered systems approach to health care.
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Affiliation(s)
- Francis Lévi
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
- European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France;
- Hepato-Biliary Centre, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 94800 Villejuif, France
- Correspondence: ; Tel.: +44-2476-575-132
| | - Sandra Komarzynski
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
- European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France;
| | - Qi Huang
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
- Department of Statistics, University of Warwick, Coventry CV4 7AL, UK;
| | - Teresa Young
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, Middlesex HA6 2RN, UK;
| | - Yeng Ang
- Salford Royal NHS Foundation Trust, Salford M6 8HD, UK;
- Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Claire Fuller
- North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK;
| | - Matei Bolborea
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
| | | | - Joanna Fursse
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
| | - Bärbel Finkenstädt
- European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France;
- Department of Statistics, University of Warwick, Coventry CV4 7AL, UK;
| | - David Pollard White
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02130, USA;
- Philips Respironics, Murrysville, PA 15668, USA
| | - Pasquale Innominato
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
- European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France;
- North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK;
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16
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Hill RJW, Innominato PF, Lévi F, Ballesta A. Optimizing circadian drug infusion schedules towards personalized cancer chronotherapy. PLoS Comput Biol 2020; 16:e1007218. [PMID: 31986133 PMCID: PMC7004559 DOI: 10.1371/journal.pcbi.1007218] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 06/26/2019] [Revised: 02/06/2020] [Accepted: 11/21/2019] [Indexed: 11/18/2022] Open
Abstract
Precision medicine requires accurate technologies for drug administration and proper systems pharmacology approaches for patient data analysis. Here, plasma pharmacokinetics (PK) data of the OPTILIV trial in which cancer patients received oxaliplatin, 5-fluorouracil and irinotecan via chronomodulated schedules delivered by an infusion pump into the hepatic artery were mathematically investigated. A pump-to-patient model was designed in order to accurately represent the drug solution dynamics from the pump to the patient blood. It was connected to semi-mechanistic PK models to analyse inter-patient variability in PK parameters. Large time delays of up to 1h41 between the actual pump start and the time of drug detection in patient blood was predicted by the model and confirmed by PK data. Sudden delivery spike in the patient artery due to glucose rinse after drug administration accounted for up to 10.7% of the total drug dose. New model-guided delivery profiles were designed to precisely lead to the drug exposure intended by clinicians. Next, the complete mathematical framework achieved a very good fit to individual time-concentration PK profiles and concluded that inter-subject differences in PK parameters was the lowest for irinotecan, intermediate for oxaliplatin and the largest for 5-fluorouracil. Clustering patients according to their PK parameter values revealed patient subgroups for each drug in which inter-patient variability was largely decreased compared to that in the total population. This study provides a complete mathematical framework to optimize drug infusion pumps and inform on inter-patient PK variability, a step towards precise and personalized cancer chronotherapy. Accuracy and safety of infusion pumps remain a critical issue in the clinics and the development of accurate mathematical models to optimize drug administration though such devices has a key part to play in the advancement of precision medicine. Here, PK data from cancer patient receiving irinotecan, oxaliplatin and 5-fluorouracil into the hepatic artery via an infusion pump was mathematically investigated. A pump-to-patient model was designed and revealed significant inconsistencies between intended drug profiles and actual plasma concentrations. This mathematical model was then used to suggest improved profiles in order to minimise error and optimise delivery. Physiologically-based PK models of the three drugs were then linked to the pump-to-patient model. The whole framework achieved a very good fit to data and allowed quantifying inter-patient variability in PK parameters and linking them to potential clinical biomarkers via patient clustering. The developed methodology improves our understanding of patient-specific drug pharmacokinetics towards personalized drug administration.
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Affiliation(s)
- Roger J W Hill
- EPSRC & MRC Centre for Doctoral Training in Mathematics for Real-World Systems, University of Warwick, Coventry, UK
| | - Pasquale F Innominato
- North Wales Cancer Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK.,Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
| | - Francis Lévi
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK.,INSERM and Paris Sud university, UMRS 935, Team "Cancer Chronotherapy and Postoperative Liver Functions", Campus CNRS, Villejuif, F-94807, France. & Honorary position, University of Warwick, UK
| | - Annabelle Ballesta
- INSERM and Paris Sud university, UMRS 935, Team "Cancer Chronotherapy and Postoperative Liver Functions", Campus CNRS, Villejuif, F-94807, France. & Honorary position, University of Warwick, UK
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17
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Innominato P, Komarzynski S, Karaboué A, Ulusakarya A, Bouchahda M, Haydar M, Bossevot-Desmaris R, Mocquery M, Plessis V, Lévi F. Home-Based e-Health Platform for Multidimensional Telemonitoring of Symptoms, Body Weight, Sleep, and Circadian Activity: Relevance for Chronomodulated Administration of Irinotecan, Fluorouracil-Leucovorin, and Oxaliplatin at Home-Results From a Pilot Study. JCO Clin Cancer Inform 2019; 2:1-15. [PMID: 30652550 DOI: 10.1200/cci.17.00125] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the impact of chronomodulated irinotecan fluorouracil-leucovorin and oxaliplatin (chronoIFLO4) delivered at home on the daily life of patients with cancer in real time using a home-based e-Health multifunction and multiuser platform. This involved multidimensional telemonitoring of circadian rest-activity rhythm (CircAct), sleep, patient-reported outcome measures, and body weight changes (BWCs). PATIENTS AND METHODS Patients received chronoIFLO4 fortnightly at home. Patients completed the 19-item MD Anderson Symptom Inventory on an interactive electronic screen, weighed themselves on a dedicated scale, and continuously wore a wrist accelerometer for CircAct and sleep monitoring. Daily data were securely teletransmitted to a specific server accessible by the hospital team. The clinically relevant CircAct parameter dichotomy index I < O and sleep efficiency (SE) were calculated. The dynamic patterns over time of patient-reported outcome measures, BWC, I < O, and SE informed the oncology team on tolerance in real time. RESULTS The platform was installed in the home of 11 patients (48 to 72 years of age; 45% men; 27% with performance status = 0), who were instructed on its use on site. They received 26 cycles and provided 5,891 data points of 8,736 expected (67.4%). The most severe MD Anderson Symptom Inventory scores were: interference with work (mean: 5.1 of 10) or general activity (4.9), fatigue (4.9), distress (4.2), and appetite loss (3.6). Mean BWC was -0.9%, and mean SE remained > 82%. CircAct disruption (I < O ≤ 97.5%) was observed in four (15%) cycles before chronoIFLO4 start and in five (19%) cycles at day 14. CONCLUSION The patient-centered multidimensional telemonitoring solution implemented here was well accepted by patients receiving multidrug chemotherapy at home. Moreover, it demonstrated that chronoIFLO4 was a safe therapeutic option. Such integrated technology allows the design of innovative management approaches, ultimately improving patients' experience with chemotherapy, wellbeing, and outcomes.
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Affiliation(s)
- Pasquale Innominato
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Sandra Komarzynski
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Abdoulaye Karaboué
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Ayhan Ulusakarya
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Mohamed Bouchahda
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Mazen Haydar
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Rachel Bossevot-Desmaris
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Magali Mocquery
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Virginie Plessis
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Francis Lévi
- Pasquale Innominato, North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Denbighshire; Pasquale Innominato, Sandra Komarzynski, and Francis Lévi, Warwick Medical School, Coventry, United Kingdom; Pasquale Innominato, Sandra Komarzynski, Ayhan Ulusakarya, Mohamed Bouchahda, and Francis Lévi, Institut National de la Santé et de la Recherche Médicale, Unit 935; Ayhan Ulusakarya, Mohamed Bouchahda, Mazen Haydar, Rachel Bossevot-Desmaris, Magali Mocquery, Virginie Plessis, and Francis Lévi, Assistance Publique-Hôpitaux de Paris, Paul Brousse Hospital, Villejuif; and Abdoulaye Karaboué, AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
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18
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Komarzynski S, Bolborea M, Huang Q, Finkenstädt B, Lévi F. Predictability of individual circadian phase during daily routine for medical applications of circadian clocks. JCI Insight 2019; 4:130423. [PMID: 31430260 PMCID: PMC6795290 DOI: 10.1172/jci.insight.130423] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/13/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDCircadian timing of treatments can largely improve tolerability and efficacy in patients. Thus, drug metabolism and cell cycle are controlled by molecular clocks in each cell and coordinated by the core body temperature 24-hour rhythm, which is generated by the hypothalamic pacemaker. Individual circadian phase is currently estimated with questionnaire-based chronotype, center-of-rest time, dim light melatonin onset (DLMO), or timing of core body temperature (CBT) maximum (acrophase) or minimum (bathyphase).METHODSWe aimed at circadian phase determination and readout during daily routines in volunteers stratified by sex and age. We measured (a) chronotype, (b) every minute (q1min) CBT using 2 electronic pills swallowed 24 hours apart, (c) DLMO through hourly salivary samples from 1800 hours to bedtime, and (d) q1min accelerations and surface temperature at anterior chest level for 7 days, using a teletransmitting sensor. Circadian phases were computed using cosinor and hidden Markov modeling. Multivariate regression identified the combination of biomarkers that best predicted core temperature circadian bathyphase.RESULTSAmong the 33 participants, individual circadian phases were spread over 5 hours, 10 minutes (DLMO); 7 hours (CBT bathyphase); and 9 hours, 10 minutes (surface temperature acrophase). CBT bathyphase was accurately predicted, i.e., with an error less than 1 hour for 78.8% of the subjects, using a new digital health algorithm (INTime), combining time-invariant sex and chronotype score with computed center-of-rest time and surface temperature bathyphase (adjusted R2 = 0.637).CONCLUSIONINTime provided a continuous and reliable circadian phase estimate in real time. This model helps integrate circadian clocks into precision medicine and will enable treatment timing personalization following further validation.FUNDINGMedical Research Council, United Kingdom; AP-HP Foundation; and INSERM.
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Affiliation(s)
- Sandra Komarzynski
- Medical School, Warwick University, Coventry, United Kingdom.,INSERM-Warwick European Associated Laboratory, INSERM U935, Villejuif, France
| | - Matei Bolborea
- Medical School, Warwick University, Coventry, United Kingdom.,School of Life Sciences and
| | - Qi Huang
- Medical School, Warwick University, Coventry, United Kingdom.,Department of Statistics, Warwick University, Coventry, United Kingdom
| | - Bärbel Finkenstädt
- INSERM-Warwick European Associated Laboratory, INSERM U935, Villejuif, France.,Department of Statistics, Warwick University, Coventry, United Kingdom
| | - Francis Lévi
- Medical School, Warwick University, Coventry, United Kingdom.,INSERM-Warwick European Associated Laboratory, INSERM U935, Villejuif, France
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19
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Cederroth CR, Albrecht U, Bass J, Brown SA, Dyhrfjeld-Johnsen J, Gachon F, Green CB, Hastings MH, Helfrich-Förster C, Hogenesch JB, Lévi F, Loudon A, Lundkvist GB, Meijer JH, Rosbash M, Takahashi JS, Young M, Canlon B. Medicine in the Fourth Dimension. Cell Metab 2019; 30:238-250. [PMID: 31390550 PMCID: PMC6881776 DOI: 10.1016/j.cmet.2019.06.019] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/08/2019] [Accepted: 06/27/2019] [Indexed: 12/21/2022]
Abstract
The importance of circadian biology has rarely been considered in pre-clinical studies, and even more when translating to the bedside. Circadian biology is becoming a critical factor for improving drug efficacy and diminishing drug toxicity. Indeed, there is emerging evidence showing that some drugs are more effective at nighttime than daytime, whereas for others it is the opposite. This suggests that the biology of the target cell will determine how an organ will respond to a drug at a specific time of the day, thus modulating pharmacodynamics. Thus, it is now time that circadian factors become an integral part of translational research.
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Affiliation(s)
- Christopher R Cederroth
- Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Urs Albrecht
- Department of Biology, Unit of Biochemistry, University of Fribourg, Fribourg, Switzerland
| | - Joseph Bass
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Steven A Brown
- Chronobiology and Sleep Research Group, Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | | | - Frederic Gachon
- Institute for Molecular Bioscience, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Carla B Green
- Department of Neuroscience, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Michael H Hastings
- Medical Research Council (MRC) Laboratory of Molecular Biology, Cambridge, UK
| | - Charlotte Helfrich-Förster
- Neurobiology and Genetics, Biocenter, Theodor-Boveri Institute, University of Würzburg, Würzburg, Germany
| | - John B Hogenesch
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francis Lévi
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, UK; Warwick University on "Personalized Cancer Chronotherapeutics through System Medicine" (C2SysMed), European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale and Paris-Sud University, Villejuif, France; Department of Medical Oncology, Paul Brousse Hospital, Assistance Publique-Hopitaux de Paris, 94800 Villejuif, France
| | - Andrew Loudon
- School of Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | | | - Johanna H Meijer
- Department of Neurophysiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Michael Rosbash
- Department of Biology, Howard Hughes Medical Institute and National Center for Behavioral Genomics, Brandeis University, Waltham, MA 02453, USA
| | - Joseph S Takahashi
- Howard Hughes Medical Institute, Department of Neuroscience, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Young
- Laboratory of Genetics, The Rockefeller University, New York, NY 10065, USA
| | - Barbara Canlon
- Experimental Audiology, Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden.
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20
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Affiliation(s)
- Yuan Zhang
- INSERM UMR935, Modèles de Cellules Souches Malignes et Thérapeutiques, Villejuif, France.,Université Paris-Sud, Orsay, France
| | - Francis Lévi
- INSERM UMR935, Modèles de Cellules Souches Malignes et Thérapeutiques, Villejuif, France.,Université Paris-Sud, Orsay, France.,Division of Biomedical Sciences and Zeeman Institute: SBIDER, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Yunhua Chang
- INSERM UMR935, Modèles de Cellules Souches Malignes et Thérapeutiques, Villejuif, France.,Université Paris-Sud, Orsay, France
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21
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Abstract
We propose a novel Bayesian methodology for analyzing nonstationary time series that exhibit oscillatory behavior. We approximate the time series using a piecewise oscillatory model with unknown periodicities, where our goal is to estimate the change-points while simultaneously identifying the potentially changing periodicities in the data. Our proposed methodology is based on a trans-dimensional Markov chain Monte Carlo algorithm that simultaneously updates the change-points and the periodicities relevant to any segment between them. We show that the proposed methodology successfully identifies time changing oscillatory behavior in two applications which are relevant to e-Health and sleep research, namely the occurrence of ultradian oscillations in human skin temperature during the time of night rest, and the detection of instances of sleep apnea in plethysmographic respiratory traces. Supplementary materials for this article are available online.
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Affiliation(s)
| | | | - Mark Fiecas
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Francis Lévi
- Warwick Medical School, University of Warwick, Coventry, UK
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22
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Huang Q, Cohen D, Komarzynski S, Li XM, Innominato P, Lévi F, Finkenstädt B. Hidden Markov models for monitoring circadian rhythmicity in telemetric activity data. J R Soc Interface 2019; 15:rsif.2017.0885. [PMID: 29436510 PMCID: PMC5832732 DOI: 10.1098/rsif.2017.0885] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 11/27/2017] [Accepted: 01/11/2018] [Indexed: 12/22/2022] Open
Abstract
Wearable computing devices allow collection of densely sampled real-time information on movement enabling researchers and medical experts to obtain objective and non-obtrusive records of actual activity of a subject in the real world over many days. Our interest here is motivated by the use of activity data for evaluating and monitoring the circadian rhythmicity of subjects for research in chronobiology and chronotherapeutic healthcare. In order to translate the information from such high-volume data arising we propose the use of a Markov modelling approach which (i) naturally captures the notable square wave form observed in activity data along with heterogeneous ultradian variances over the circadian cycle of human activity, (ii) thresholds activity into different states in a probabilistic way while respecting time dependence and (iii) gives rise to circadian rhythm parameter estimates, based on probabilities of transitions between rest and activity, that are interpretable and of interest to circadian research.
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Affiliation(s)
- Qi Huang
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | - Dwayne Cohen
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Xiao-Mei Li
- INSERM U935, Hospital Paul Brousse and University Paris-Saclay, Villejuif, 94800, France
| | - Pasquale Innominato
- Medical School, University of Warwick, Coventry, CV4 7AL, UK.,Department of Oncology, North Wales Cancer Treatment Centre, Bodelwyddan, LL18 5UJ, UK
| | - Francis Lévi
- Medical School, University of Warwick, Coventry, CV4 7AL, UK.,INSERM U935, Hospital Paul Brousse and University Paris-Saclay, Villejuif, 94800, France
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23
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Labrèche F, Guénel P, Lévi F, Doré JF, Costa G, Lasfargues G, Gronfier C. Night Shift Work Increases Cancer Risk of Women—Letter. Cancer Epidemiol Biomarkers Prev 2019; 28:422. [DOI: 10.1158/1055-9965.epi-18-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/02/2018] [Accepted: 03/05/2018] [Indexed: 11/16/2022] Open
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24
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Gurnani P, Sanchez-Cano C, Abraham K, Xandri-Monje H, Cook AB, Hartlieb M, Lévi F, Dallmann R, Perrier S. RAFT Emulsion Polymerization as a Platform to Generate Well-Defined Biocompatible Latex Nanoparticles. Macromol Biosci 2018; 18:e1800213. [PMID: 30085410 DOI: 10.1002/mabi.201800213] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/03/2018] [Indexed: 12/17/2022]
Abstract
Current approaches to generate core-shell nanoparticles for biomedical applications are limited by factors such as synthetic scalability and circulatory desorption of cytotoxic surfactants. Developments in controlled radical polymerization, particularly in dispersed states, represent a promising method of overcoming these challenges. In this work, well-defined PEGylated nanoparticles are synthesized using reversible addition fragmentation chain transfer emulsion polymerization to control particle size and surface composition and were further characterized with light scattering, electron microscopy, and size exclusion chromatography. Importantly, the nanoparticles are found to be tolerated both in vitro and in vivo, without the need for any purification after particle synthesis. Pharmacokinetic and biodistribution studies in mice, following intraperitoneal injection of the nanoparticles, reveal a long (>76 h) circulation time and accumulation in the liver.
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Affiliation(s)
- Pratik Gurnani
- Department of Chemistry, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Carlos Sanchez-Cano
- Department of Chemistry, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Kristin Abraham
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Helena Xandri-Monje
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Alexander B Cook
- Department of Chemistry, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Matthias Hartlieb
- Department of Chemistry, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Francis Lévi
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Robert Dallmann
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Sébastien Perrier
- Department of Chemistry, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia
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25
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Komarzynski S, Huang Q, Innominato PF, Maurice M, Arbaud A, Beau J, Bouchahda M, Ulusakarya A, Beaumatin N, Breda G, Finkenstädt B, Lévi F. Relevance of a Mobile Internet Platform for Capturing Inter- and Intrasubject Variabilities in Circadian Coordination During Daily Routine: Pilot Study. J Med Internet Res 2018; 20:e204. [PMID: 29704408 PMCID: PMC6018238 DOI: 10.2196/jmir.9779] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 12/14/2022] Open
Abstract
Background Experimental and epidemiologic studies have shown that circadian clocks’ disruption can play an important role in the development of cancer and metabolic diseases. The cellular clocks outside the brain are effectively coordinated by the body temperature rhythm. We hypothesized that concurrent measurements of body temperature and rest-activity rhythms would assess circadian clocks coordination in individual patients, thus enabling the integration of biological rhythms into precision medicine. Objective The objective was to evaluate the circadian clocks’ coordination in healthy subjects and patients through simultaneous measurements of rest-activity and body temperature rhythms. Methods Noninvasive real-time measurements of rest-activity and chest temperature rhythms were recorded during the subject’s daily life, using a dedicated new mobile electronic health platform (PiCADo). It involved a chest sensor that jointly measured accelerations, 3D orientation, and skin surface temperature every 1-5 min and relayed them out to a mobile gateway via Bluetooth Low Energy. The gateway tele-transmitted all stored data to a server via General Packet Radio Service every 24 hours. The technical capabilities of PiCADo were validated in 55 healthy subjects and 12 cancer patients, whose rhythms were e-monitored during their daily routine for 3-30 days. Spectral analyses enabled to compute rhythm parameters values, with their 90% confidence limits, and their dynamics in each subject. Results All the individuals displayed a dominant circadian rhythm in activity with maxima occurring from 12:09 to 20:25. This was not the case for the dominant temperature period, which clustered around 24 hours for 51 out of 67 subjects (76%), and around 12 hours for 13 others (19%). Statistically significant sex- and age-related differences in circadian coordination were identified in the noncancerous subjects, based upon the range of variations in temperature rhythm amplitudes, maxima (acrophases), and phase relations with rest-activity. The circadian acrophase of chest temperature was located at night for the majority of people, but it occurred at daytime for 26% (14/55) of the noncancerous people and 33% (4/12) of the cancer patients, thus supporting important intersubject differences in circadian coordination. Sex, age, and cancer significantly impacted the circadian coordination of both rhythms, based on their phase relationships. Conclusions Complementing rest-activity with chest temperature circadian e-monitoring revealed striking intersubject differences regarding human circadian clocks’ coordination and timing during daily routine. To further delineate the clinical importance of such finding, the PiCADo platform is currently applied for both the assessment of health effects resulting from atypical work schedules and the identification of the key determinants of circadian disruption in cancer patients.
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Affiliation(s)
- Sandra Komarzynski
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Qi Huang
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,Cancer Chronotherapy Team, Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Pasquale F Innominato
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Department of Oncology, North Wales Cancer Treatment Centre, Bodelwyddan, United Kingdom
| | - Monique Maurice
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Alexandre Arbaud
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Jacques Beau
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Mohamed Bouchahda
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Department of Oncology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Ayhan Ulusakarya
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Department of Oncology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | | | | | - Bärbel Finkenstädt
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Cancer Chronotherapy Team, Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Francis Lévi
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Department of Oncology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
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26
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Mteyrek A, Filipski E, Guettier C, Okyar A, Lévi F. Clock gene Per2 as a controller of liver carcinogenesis. Oncotarget 2018; 7:85832-85847. [PMID: 27494874 PMCID: PMC5349878 DOI: 10.18632/oncotarget.11037] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/13/2016] [Indexed: 01/01/2023] Open
Abstract
Environmental disruption of molecular clocks promoted liver carcinogenesis and accelerated cancer progression in rodents. We investigated the specific role of clock gene Period 2 (Per2) for liver carcinogenesis and clock-controlled cellular proliferation, genomic instability and inflammation. We assessed liver histopathology, and determined molecular and physiology circadian patterns in mice on chronic diethylnitrosamine (DEN) exposure according to constitutive Per2 mutation. First, we found that Per2m/m liver displayed profound alterations in proliferation gene expression, including c-Myc derepression, phase-advanced Wee1, and arrhythmic Ccnb1 and K-ras mRNA expressions, as well as deregulated inflammation, through arrhythmic liver IL-6 protein concentration, in the absence of any DEN exposure. These changes could then make Per2m/m mice more prone to subsequently develop liver cancers on DEN. Indeed, primary liver cancers were nearly fourfold as frequent in Per2m/m mice as compared to wild-type (WT), 4 months after DEN exposure. The liver molecular clock was severely disrupted throughout the whole carcinogenesis process, including the initiation stage, i.e. within the initial 17 days on DEN. Per2m/m further exhibited increased c-Myc and Ccnb1 mean 24h expressions, lack of P53 response, and arrhythmic ATM, Wee1 and Ccnb1 expressions. DEN-induced tumor related inflammation was further promoted through increased protein concentrations of liver IL-6 and TNF-α as compared to WT during carcinogenesis initiation. Per2 mutation severely deregulated liver gene or protein expressions related to three cancer hallmarks, including uncontrolled proliferation, genomic instability, and tumor promoting inflammation, and accelerated liver carcinogenesis several-fold. Clock gene Per2 acted here as a liver tumor suppressor from initiation to progression.
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Affiliation(s)
- Ali Mteyrek
- INSERM and Paris Sud University, UMRS 995, Team « Cancer Chronotherapy and Postoperative Liver », Campus CNRS, Villejuif F-94807, France
| | - Elisabeth Filipski
- INSERM and Paris Sud University, UMRS 995, Team « Cancer Chronotherapy and Postoperative Liver », Campus CNRS, Villejuif F-94807, France
| | - Catherine Guettier
- Assistance Publique-Hopitaux de Paris, Department of Medical Oncology and Laboratory of Anatomy and Pathologic Cytology, Hôpital Paul Brousse, Villejuif F-94800, France
| | - Alper Okyar
- Istanbul University Faculty of Pharmacy, Department of Pharmacology, Beyazit TR-34116, Istanbul, Turkey
| | - Francis Lévi
- INSERM and Paris Sud University, UMRS 995, Team « Cancer Chronotherapy and Postoperative Liver », Campus CNRS, Villejuif F-94807, France.,Assistance Publique-Hopitaux de Paris, Department of Medical Oncology and Laboratory of Anatomy and Pathologic Cytology, Hôpital Paul Brousse, Villejuif F-94800, France.,Warwick Medical School, Cancer Chronotherapy Unit, Coventry, CV4 7AL, United Kingdom
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27
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Ozturk N, Ozturk D, Pala-Kara Z, Kaptan E, Sancar-Bas S, Ozsoy N, Cinar S, Deniz G, Li XM, Giacchetti S, Lévi F, Okyar A. The immune system as a chronotoxicity target of the anticancer mTOR inhibitor everolimus. Chronobiol Int 2018; 35:705-718. [PMID: 29400578 DOI: 10.1080/07420528.2018.1432632] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The circadian timing system controls many biological functions in mammals including xenobiotic metabolism, detoxification, cell proliferation, apoptosis and immune functions. Everolimus is a mammalian target of rapamycin inhibitor, whose immunosuppressant properties are both desired in transplant patients and unwanted in cancer patients, where it is indicated for its antiproliferative efficacy. Here we sought whether everolimus circadian timing would predictably modify its immunosuppressive effects so as to optimize this drug through timing. C57BL/6J mice were synchronized with light-dark 12h:12h, with L onset at Zeitgeber Time (ZT) 0. Everolimus was administered orally to male (5 mg/kg/day) and female mice (15 mg/kg/day) at ZT1, during early rest span or at ZT13, during early activity span for 4 weeks. Body weight loss, as well as hematological, immunological and biochemical toxicities, were determined. Spleen and thymus were examined histologically. Everolimus toxicity was less severe following dosing at ZT13, as compared to ZT1, as shown with least body weight inhibition in both genders; least reductions in thymus weight both in males (p < 0.01) and females (p < 0.001), least reduction in female spleen weight (p < 0.05), and less severe thymic medullar atrophy both in males (p < 0.001) and females (p < 0.001). The mean circulating counts in total leukocytes, total lymphocytes, T-helper and B lymphocytes displayed minor and non-significant changes following dosing at ZT13, while they were decreased by 56.9% (p < 0.01), 45.5% (p < 0.01), 43.1% (p < 0.05) and 48.7% (p < 0.01) after everolimus at ZT1, respectively, in only male mice. Chronotherapy of everolimus is an effective way to increase the general tolerability and decrease toxicity on the immune system.
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Affiliation(s)
- Narin Ozturk
- a Department of Pharmacology, Faculty of Pharmacy , Istanbul University , Beyazit-Istanbul , Turkey
| | - Dilek Ozturk
- b Department of Pharmacology, Faculty of Pharmacy , Bezmialem Vakif University , Fatih-İstanbul , Turkey
| | - Zeliha Pala-Kara
- a Department of Pharmacology, Faculty of Pharmacy , Istanbul University , Beyazit-Istanbul , Turkey
| | - Engin Kaptan
- c Department of Biology, Faculty of Science , Istanbul University , Vezneciler-Istanbul , Turkey
| | - Serap Sancar-Bas
- c Department of Biology, Faculty of Science , Istanbul University , Vezneciler-Istanbul , Turkey
| | - Nurten Ozsoy
- d Department of Biochemistry, Faculty of Pharmacy , Istanbul University , Beyazit-Istanbul , Turkey
| | - Suzan Cinar
- e Department of Immunology, Aziz Sancar Institute of Experimental Medicine , Istanbul University , Sehremini- Istanbul , Turkey
| | - Gunnur Deniz
- e Department of Immunology, Aziz Sancar Institute of Experimental Medicine , Istanbul University , Sehremini- Istanbul , Turkey
| | - Xiao-Mei Li
- f INSERM UMRS 935 "Modèles de cellules souches malignes et thérapeutiques" , Campus CNRS , Villejuif-Cedex , France
| | - Sylvie Giacchetti
- g AP-HP, Hôpital Saint-Louis, Breast Disease Unit , University Paris Diderot , Paris , France
| | - Francis Lévi
- f INSERM UMRS 935 "Modèles de cellules souches malignes et thérapeutiques" , Campus CNRS , Villejuif-Cedex , France.,h Warwick Systems Biology Centre, Warwick Medical School , Cancer Chronotherapy Unit , Coventry , UK
| | - Alper Okyar
- a Department of Pharmacology, Faculty of Pharmacy , Istanbul University , Beyazit-Istanbul , Turkey
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28
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Lévi F, Karaboué A, Etienne-Grimaldi MC, Paintaud G, Focan C, Innominato P, Bouchahda M, Milano G, Chatelut E. Pharmacokinetics of Irinotecan, Oxaliplatin and 5-Fluorouracil During Hepatic Artery Chronomodulated Infusion: A Translational European OPTILIV Study. Clin Pharmacokinet 2017; 56:165-177. [PMID: 27393140 DOI: 10.1007/s40262-016-0431-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The combination of hepatic artery infusion (HAI) of irinotecan, 5-fluorouracil and oxaliplatin with intravenous cetuximab has safely achieved prolonged survival in colorectal cancer patients with extensive liver metastases and prior treatment. Systemic exposure to the drugs or their main metabolites was determined during the first course of chronomodulated triplet HAI in 11 patients and related to toxicities after one or three courses. Consistent trends were found between the area under the plasma concentration-time curve (AUC) values of irinotecan, 7-ethyl-10-hydroxycamptothecin (SN38; a bioactive metabolite), total oxaliplatin and platinum ultrafiltrate (P-UF), on the one hand, and subsequent leukopenia severity, on the other hand. Moreover, the maximum plasma concentration (C max) and the AUC of P-UF significantly predicted grades of diarrhoea (p = 0.004 and 0.017, respectively) and anaemia (p = 0.001 and 0.008, respectively) after the first course. Systemic drug exposure helps explain both the adverse events and the low rate of extrahepatic progression-a usual drawback of HAI chemotherapy-thus supporting upfront testing of the regimen. Systems optimization of chronomodulated HAI delivery could further reduce adverse events.
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Affiliation(s)
- Francis Lévi
- INSERM, UMRS 935, Team «Cancer Chronotherapy and Postoperative Liver Function», Campus CNRS, 7 rue Guy Môquet, Villejuif, France.
- Assistance Publique-Hopitaux de Paris, Medical Oncology Department, Hepatobiliary Centre, and Radiology Department, Paul Brousse Hospital, 14 avenue Paul Vaillant Couturier, Villejuif, France.
- Cancer Chronotherapy Unit, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry, CV4 7AL, UK.
| | - Abdoulaye Karaboué
- INSERM, UMRS 935, Team «Cancer Chronotherapy and Postoperative Liver Function», Campus CNRS, 7 rue Guy Môquet, Villejuif, France
- AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | | | - Gilles Paintaud
- Université François-Rabelais de Tours, CNRS, GICC UMR 7292, CHRU de Tours, Service de Pharmacologie-Toxicologie, Tours, France
| | - Christian Focan
- Department of Oncology, Centre Hospitalier Chrétien, Clinique Saint-Joseph, Liège, Belgium
| | - Pasquale Innominato
- INSERM, UMRS 935, Team «Cancer Chronotherapy and Postoperative Liver Function», Campus CNRS, 7 rue Guy Môquet, Villejuif, France
- Assistance Publique-Hopitaux de Paris, Medical Oncology Department, Hepatobiliary Centre, and Radiology Department, Paul Brousse Hospital, 14 avenue Paul Vaillant Couturier, Villejuif, France
- Cancer Chronotherapy Unit, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry, CV4 7AL, UK
| | - Mohamed Bouchahda
- INSERM, UMRS 935, Team «Cancer Chronotherapy and Postoperative Liver Function», Campus CNRS, 7 rue Guy Môquet, Villejuif, France
- Assistance Publique-Hopitaux de Paris, Medical Oncology Department, Hepatobiliary Centre, and Radiology Department, Paul Brousse Hospital, 14 avenue Paul Vaillant Couturier, Villejuif, France
| | - Gérard Milano
- Laboratory of Oncopharmacology, Antoine Lacassagne Centre, Nice, France
| | - Etienne Chatelut
- Institut Claudius-Regaud, CRCT, Université de Toulouse, Inserm, UPS, Toulouse, France
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29
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Lévi F, Karaboué A, Saffroy R, Desterke C, Boige V, Smith D, Hebbar M, Innominato P, Taieb J, Carvalho C, Guimbaud R, Focan C, Bouchahda M, Adam R, Ducreux M, Milano G, Lemoine A. Pharmacogenetic determinants of outcomes on triplet hepatic artery infusion and intravenous cetuximab for liver metastases from colorectal cancer (European trial OPTILIV, NCT00852228). Br J Cancer 2017; 117:965-973. [PMID: 28817838 PMCID: PMC5625679 DOI: 10.1038/bjc.2017.278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/15/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 01/29/2023] Open
Abstract
Background: The hepatic artery infusion (HAI) of irinotecan, oxaliplatin and 5-fluorouracil with intravenous cetuximab achieved outstanding efficacy in previously treated patients with initially unresectable liver metastases from colorectal cancer. This planned study aimed at the identification of pharmacogenetic predictors of outcomes. Methods: Circulating mononuclear cells were analysed for 207 single-nucleotide polymorphisms (SNPs) from 34 pharmacology genes. Single-nucleotide polymorphisms passing stringent Hardy–Weinberg equilibrium test were tested for their association with outcomes in 52 patients (male/female, 36/16; WHO PS, 0–1). Results: VKORC1 SNPs (rs9923231 and rs9934438) were associated with early and objective responses, and survival. For rs9923231, T/T achieved more early responses than C/T (50% vs 5%, P=0.029) and greatest 4-year survival (46% vs 0%, P=0.006). N-acetyltransferase-2 (rs1041983 and rs1801280) were associated with up to seven-fold more macroscopically complete hepatectomies. Progression-free survival was largest in ABCB1 rs1045642 T/T (P=0.026) and rs2032582 T/T (P=0.035). Associations were found between toxicities and gene variants (P<0.05), including neutropenia with ABCB1 (rs1045642) and SLC0B3 (rs4149117 and rs7311358); and diarrhoea with CYP2C9 (rs1057910), CYP2C19 (rs3758581), UGT1A6 (rs4124874) and SLC22A1 (rs72552763). Conclusion: VKORC1, NAT2 and ABCB1 variants predicted for HAI efficacy. Pharmacogenetics could guide the personalisation of liver-targeted medico-surgical therapies.
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Affiliation(s)
- Francis Lévi
- INSERM, UMRS 935 Team 'Cancer Chronotherapy and Postoperative Liver Function', Campus CNRS, 7 rue Guy Môquet, and UMRS 1193 'Physiopathology and treatment of Liver diseases', Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Université Paris Sud, UFR médecine, Institut André Lwoff, Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Assistance Publique-Hopitaux de Paris, Paul Brousse Hospital, Departments of Medical Oncology, Biochemistry and Oncogenetics, and Hepatobiliary Center, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Cancer Chronotherapy Unit, Warwick Medical School, Warwick University, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Abdoulaye Karaboué
- INSERM, UMRS 935 Team 'Cancer Chronotherapy and Postoperative Liver Function', Campus CNRS, 7 rue Guy Môquet, and UMRS 1193 'Physiopathology and treatment of Liver diseases', Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,AK-SCIENCE, Research and Therapeutic Innovation, 34 Boulevard de Stalingrad, 94400 Vitry-Sur-Seine, France
| | - Raphaël Saffroy
- INSERM, UMRS 935 Team 'Cancer Chronotherapy and Postoperative Liver Function', Campus CNRS, 7 rue Guy Môquet, and UMRS 1193 'Physiopathology and treatment of Liver diseases', Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Université Paris Sud, UFR médecine, Institut André Lwoff, Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Assistance Publique-Hopitaux de Paris, Paul Brousse Hospital, Departments of Medical Oncology, Biochemistry and Oncogenetics, and Hepatobiliary Center, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - Christophe Desterke
- INSERM, UMRS 935 Team 'Cancer Chronotherapy and Postoperative Liver Function', Campus CNRS, 7 rue Guy Môquet, and UMRS 1193 'Physiopathology and treatment of Liver diseases', Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Université Paris Sud, UFR médecine, Institut André Lwoff, Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - Valerie Boige
- Gustave-Roussy Institute, 114 Rue Edouard Vaillant, 94400 Villejuif, France
| | - Denis Smith
- Saint André Hospital, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Mohamed Hebbar
- Medical Oncology Unit, Huriez Hospital, 1 rue Polonovski, 59037 Lille, France
| | - Pasquale Innominato
- INSERM, UMRS 935 Team 'Cancer Chronotherapy and Postoperative Liver Function', Campus CNRS, 7 rue Guy Môquet, and UMRS 1193 'Physiopathology and treatment of Liver diseases', Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Cancer Chronotherapy Unit, Warwick Medical School, Warwick University, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - Julien Taieb
- Georges Pompidou European Hospital, 20 Rue Leblanc, 75015 Paris, France
| | - Carlos Carvalho
- Champalimaud Clinical Centre, Medical Oncology Department, Avenida Brasília, 1400-038 Lisbon, Portugal
| | - Rosine Guimbaud
- Digestive Medical Oncology Unit, Toulouse University Hospital, 170 avenue de Casselardit, 31059 Toulouse, France
| | - Christian Focan
- CHC Saint Joseph Clinics, rue de Hesbaye 75, 4000 Liège, Belgium
| | - Mohamed Bouchahda
- INSERM, UMRS 935 Team 'Cancer Chronotherapy and Postoperative Liver Function', Campus CNRS, 7 rue Guy Môquet, and UMRS 1193 'Physiopathology and treatment of Liver diseases', Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Assistance Publique-Hopitaux de Paris, Paul Brousse Hospital, Departments of Medical Oncology, Biochemistry and Oncogenetics, and Hepatobiliary Center, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Ramsay GDS Mousseau Clinics, 2 Avenue de Mousseau, 91035 Evry, France
| | - René Adam
- INSERM, UMRS 935 Team 'Cancer Chronotherapy and Postoperative Liver Function', Campus CNRS, 7 rue Guy Môquet, and UMRS 1193 'Physiopathology and treatment of Liver diseases', Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Université Paris Sud, UFR médecine, Institut André Lwoff, Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Assistance Publique-Hopitaux de Paris, Paul Brousse Hospital, Departments of Medical Oncology, Biochemistry and Oncogenetics, and Hepatobiliary Center, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - Michel Ducreux
- Gustave-Roussy Institute, 114 Rue Edouard Vaillant, 94400 Villejuif, France
| | - Gérard Milano
- Oncopharmacology Laboratory, EA 3836, Antoine Lacassagne Center, 33, Avenue de Valombrose, 06189 Nice, France
| | - Antoinette Lemoine
- INSERM, UMRS 935 Team 'Cancer Chronotherapy and Postoperative Liver Function', Campus CNRS, 7 rue Guy Môquet, and UMRS 1193 'Physiopathology and treatment of Liver diseases', Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Université Paris Sud, UFR médecine, Institut André Lwoff, Paul Brousse Hospital, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France.,Assistance Publique-Hopitaux de Paris, Paul Brousse Hospital, Departments of Medical Oncology, Biochemistry and Oncogenetics, and Hepatobiliary Center, 14 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
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Palesh O, Haitz K, Lévi F, Bjarnason GA, Deguzman C, Alizeh I, Ulusakarya A, Packer MM, Innominato PF. Relationship between subjective and actigraphy-measured sleep in 237 patients with metastatic colorectal cancer. Qual Life Res 2017; 26:2783-2791. [PMID: 28656534 DOI: 10.1007/s11136-017-1617-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with cancers frequently experience sleep and circadian dysfunction. To date, only a few studies have used both a questionnaire and actigraphy for concomitant evaluation of sleep and circadian function in patients with cancer. We sought to evaluate objective sleep and circadian parameters in metastatic colon cancer (MCC) patients and their associations with symptoms and quality of life (QOL). METHODS Patients reported subjective sleep problems on the EORTC QLQ-C30. Sleep and circadian parameters were calculated using a wrist-actigraph that patients wore for 72 h. RESULTS 237 Patients with MCC (mean age: 60.4 years; range: 20.7-77.6; Male/Female ratio: 1.66) participated in this cross-sectional study. Subjective sleep problems were reported by 63.4% of patients (S+). No differences in any sleep parameters (sleep efficiency, sleep latency, total sleep time, total time in bed, wake after sleep onset, activity bathyphase) were observed between S+ and S- patients. However, S+ patients displayed a significantly worse circadian function than S- patients (96.4 vs 98.1%; p = 0.005). The presence of poor subjective sleep and objective circadian dysfunction negatively affected symptoms and QOL domains (p = 0.038). CONCLUSIONS Subjective report of sleep problems was not associated with worse objectively measured sleep parameters in patients with MCC although it was associated with disrupted circadian rest-activity rhythm and poorer QOL. These findings coincide with prior research in cancer patients in that an inconsistent relationship exists between subjective and objective sleep measurements on some sleep domains. This study supports the value of coupled evaluation of self-reported and objective measures of sleep and circadian function in cancer patients.
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA. .,Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA, USA.
| | - Karyn Haitz
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Francis Lévi
- INSERM U935 and AP-HP, Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.,Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, Warwickshire, UK.,Department of Oncology, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Georg A Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Carl Deguzman
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Igbal Alizeh
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Ayhan Ulusakarya
- INSERM U935 and AP-HP, Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Mary Melissa Packer
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA.,Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA, USA
| | - Pasquale F Innominato
- Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, Warwickshire, UK.,Department of Oncology, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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31
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Komarzynski S, Lévi F, Ballesta A, Bouchahda M, Haydar M, Ulusakarya A, Morère J, Innominato PF. 1038 OBJECTIVE CORRELATES OF SLEEP COMPLAINT IN CANCER PATIENTS ON CHEMOTHERAPY TELE-MONITORED AT HOME: NIGHT-BY-NIGHT ANALYSIS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1037] [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: 11/13/2022] Open
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32
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Mteyrek A, Filipski E, Guettier C, Oklejewicz M, van der Horst GTJ, Okyar A, Lévi F. Critical cholangiocarcinogenesis control by cryptochrome clock genes. Int J Cancer 2017; 140:2473-2483. [PMID: 28224616 DOI: 10.1002/ijc.30663] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/15/2016] [Revised: 01/23/2017] [Accepted: 02/09/2017] [Indexed: 01/03/2023]
Abstract
A coordinated network of molecular circadian clocks in individual cells generates 24-hr rhythms in liver metabolism and proliferation. Circadian disruption through chronic jet lag or Per2 clock gene mutation was shown to accelerate hepatocarcinoma development in mice. As divergent effects were reported for clock genes Per and Cry regarding xenobiotic toxicity, we questioned the role of Cry1 and Cry2 in liver carcinogenesis. Male WT and Cry1-/- Cry2-/- mice (C57Bl/6 background) were chronically exposed to diethylnitrosamine (DEN) at ZT11. Rest-activity and body temperature rhythms were monitored using an implanted radiotransmitter. Serum aspartate and alanine aminotransferases (AST and ALT) were determined on four occasions during the progression stage. After 7 months, serum alkaline phosphatases (ALP) were determined, and livers were sampled for microscopic tumor nodule counting and histopathology. Five months after initiation of DEN treatment, we found that Cry1-/- Cry2-/- mice developed severe liver dysplasia, as evident from the increased AST, ALT and ALP levels, as compared to WT mice. DEN exposure induced primary liver cancers in nearly fivefold as many Cry1-/- Cry2-/- mice as compared to WT mice (p = 0.01). Microscopic study revealed no difference in the average number of hepatocarcinomas and a nearly eightfold increase in the average number of cholangiocarcinomas in Cry1-/- Cry2-/- mice, as compared to WT mice. This study validated the hypothesis that molecular circadian clock disruption dramatically increased chemically induced liver carcinogenesis. In addition, the pronounced shift toward cholangiocarcinoma in DEN exposed Cry1-/- Cry2-/- mice revealed a critical role of the Cry clock genes in bile duct carcinogenesis.
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Affiliation(s)
- Ali Mteyrek
- INSERM and Paris Sud university, UMRS 935, Team "Cancer Chronotherapy and Postoperative Liver", Campus CNRS, Villejuif, F-94807, France
| | - Elisabeth Filipski
- INSERM and Paris Sud university, UMRS 935, Team "Cancer Chronotherapy and Postoperative Liver", Campus CNRS, Villejuif, F-94807, France
| | - Catherine Guettier
- Department of Medical Oncology and Laboratory of Anatomy and Pathological Cytology, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris, Villejuif, F-94800, France
| | - Malgorzata Oklejewicz
- Department of Molecular Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Alper Okyar
- Department of Pharmacology, Istanbul University Faculty of Pharmacy, Beyazit, Istanbul, TR-34116, Turkey
| | - Francis Lévi
- INSERM and Paris Sud university, UMRS 935, Team "Cancer Chronotherapy and Postoperative Liver", Campus CNRS, Villejuif, F-94807, France.,Department of Medical Oncology and Laboratory of Anatomy and Pathological Cytology, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris, Villejuif, F-94800, France.,Warwick Medical School, Cancer Chronotherapy Unit, Coventry, CV4 7AL, United Kingdom
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33
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Bouchahda M, Boige V, Smith D, Karaboué A, Ducreux M, Hebbar M, Lepère C, Focan C, Guimbaud R, Innominato P, Awad S, Carvalho C, Tumolo S, Truant S, De Baere T, Castaing D, Rougier P, Morère JF, Taieb J, Adam R, Lévi F. Early tumour response as a survival predictor in previously- treated patients receiving triplet hepatic artery infusion and intravenous cetuximab for unresectable liver metastases from wild-type KRAS colorectal cancer. Eur J Cancer 2016; 68:163-172. [PMID: 27768923 DOI: 10.1016/j.ejca.2016.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 06/13/2016] [Revised: 09/07/2016] [Accepted: 09/13/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Early tumour shrinkage has been associated with improved survival in patients receiving cetuximab-based systemic chemotherapy for liver metastases from colorectal cancer (LM-CRC). We tested this hypothesis for previously treated LM-CRC patients receiving cetuximab (500 mg/m2) and triplet hepatic artery infusion (HAI) within European trial OPTILIV. METHODS Irinotecan (180 mg/m2), 5-fluorouracil (2800 mg/m2) and oxaliplatin (85 mg/m2) were given as chronomodulated or conventional delivery. Patients were retrospectively categorised as early responders (complete or partial RECIST response after three courses) or non-early responders (late or no response). Prognostic factors were determined using multivariate logistic or Cox regression models. RESULTS Response was assessed in 57 of 64 registered patients (89%), who had previously received one to three prior systemic chemotherapy protocols. An early response occurred at 6 weeks in 16 patients (28%; 9 men, 7 women), aged 33-76 years, with a median of 12 liver metastases (LMs) (2-50), involving five segments (1-8). Ten patients had a late response, and 31 patients had no response. Grade 3-4 fatigue selectively occurred in the non-early responders (0% versus 26%; p = 0.024). Early tumour response was jointly predicted by chronomodulation-odds ratio (OR): 6.0 (1.2-29.8; p = 0.029)-and LM diameter ≤57 mm-OR: 5.3 (1.1-25.0; p = 0.033). Early tumour response predicted for both R0-R1 liver resection-OR: 11.8 (1.4-100.2; p = 0.024) and overall survival-hazard ratio: 0.39 (0.17-0.88; p = 0.023) in multivariate analyses. CONCLUSIONS Early tumour response on triplet HAI and systemic cetuximab predicted for complete macroscopic liver resection and prolonged survival for LM-CRC patients within a multicenter conversion-to-resection medicosurgical strategy. Confirmation is warranted for early response on HAI to guide decision making. Protocol numbers: EUDRACT 2007-004632-24 NCT00852228.
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Affiliation(s)
- Mohamed Bouchahda
- AP-HP, Departments of Medical Oncology, Hepato-Biliary Surgery and Radiology, Paul Brousse Hospital, Villejuif, France; INSERM and Paris-Saclay UMR S935, CNRS Campus, Villejuif, France; Ramsay-GDS Mousseau Clinics, Evry, France
| | | | | | - Abdoulaye Karaboué
- INSERM and Paris-Saclay UMR S935, CNRS Campus, Villejuif, France; AK-SCIENCES, Research and Therapeutic Innovation, Vitry-Sur-Seine, France
| | | | | | | | | | - Rosine Guimbaud
- Digestive Medical Oncology Unit, Toulouse University Hospital, Toulouse, France
| | - Pasquale Innominato
- AP-HP, Departments of Medical Oncology, Hepato-Biliary Surgery and Radiology, Paul Brousse Hospital, Villejuif, France; INSERM and Paris-Saclay UMR S935, CNRS Campus, Villejuif, France; Cancer Chronotherapy Unit, Warwick Medical School, Coventry, United Kingdom
| | - Sameh Awad
- AP-HP, Departments of Medical Oncology, Hepato-Biliary Surgery and Radiology, Paul Brousse Hospital, Villejuif, France
| | - Carlos Carvalho
- Medical Oncology Unit, Fernando Fonseca Hospital, Amadora, Portugal
| | | | | | | | - Denis Castaing
- AP-HP, Departments of Medical Oncology, Hepato-Biliary Surgery and Radiology, Paul Brousse Hospital, Villejuif, France
| | | | - Jean-François Morère
- AP-HP, Departments of Medical Oncology, Hepato-Biliary Surgery and Radiology, Paul Brousse Hospital, Villejuif, France
| | - Julien Taieb
- Georges Pompidou European Hospital, Paris, France
| | - René Adam
- AP-HP, Departments of Medical Oncology, Hepato-Biliary Surgery and Radiology, Paul Brousse Hospital, Villejuif, France; INSERM and Paris-Saclay UMR S935, CNRS Campus, Villejuif, France
| | - Francis Lévi
- AP-HP, Departments of Medical Oncology, Hepato-Biliary Surgery and Radiology, Paul Brousse Hospital, Villejuif, France; INSERM and Paris-Saclay UMR S935, CNRS Campus, Villejuif, France; Cancer Chronotherapy Unit, Warwick Medical School, Coventry, United Kingdom.
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34
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Affiliation(s)
- F. Lévi
- Laboratoire “Rythmes Biologiques et Chronothérapeutique,” I.C.I.G., Hôpital Paul Brousse, Villejuif, France
| | - G. Metzger
- Laboratoire “Rythmes Biologiques et Chronothérapeutique,” I.C.I.G., Hôpital Paul Brousse, Villejuif, France
| | - P. Deprés-Brummer
- Laboratoire “Rythmes Biologiques et Chronothérapeutique,” I.C.I.G., Hôpital Paul Brousse, Villejuif, France
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35
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Abstract
The circadian timing system determines the optimal timing and waveform of drug tolerability, yet treatment itself can alter this system. Gemcitabine is an antimetabolite agent that is active against lung and pancreatic cancers. Tolerability for this drug is best following dosing at ZT 11 in mice. The authors investigated the effects of gemcitabine on the circadian rhythms in body temperature and rest activity as physiological markers of the circadian timing system. Healthy unrestrained B6D2F1 mice implanted with radiotelemetry transmitters were kept in LD 12:12 prior to receiving a single intravenous dose of gemcitabine (200, 400, or 600 mg/kg) at ZT 11 or 23. Gemcitabine (400 mg/kg) transiently suppressed the body temperature rhythm in 50% of the mice dosed at ZT 23, as compared to none of the mice treated at ZT 11 within the 2 days following drug dosing (Fisher 's exact test p = 0.04). The rest-activity circadian rhythm was suppressed in 40% (ZT 11) and 50% (ZT 23) of the mice, respectively. In the mice with persistent circadian rhythms, gemcitabine delivery at ZT 23 resulted in more prominent decreases and slower recovery of circadian mesor and amplitude of both rhythms as compared to mice treated at ZT 11. Gemcitabine also induced a transient internal desynchronization between temperature and activity rhythms following dosing at ZT 23 but not at ZT 11. The delivery of a single therapeutic dose of gemcitabine near its time of least toxicity produced least alterations in circadian physiological outputs, a finding that suggests that the extent of circadian disruption contributes to toxicokinetic processes.
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Affiliation(s)
- X M Li
- INSERM, U776 "Rythmes biologiques et cancers", Univ Paris-Sud, Hôpital Paul Brousse, 94800 Villejuif, France.
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36
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Natale V, Innominato PF, Boreggiani M, Tonetti L, Filardi M, Parganiha A, Fabbri M, Martoni M, Lévi F. The difference between in bed and out of bed activity as a behavioral marker of cancer patients: A comparative actigraphic study. Chronobiol Int 2016; 32:925-33. [PMID: 26158757 DOI: 10.3109/07420528.2015.1053909] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 01/20/2023]
Abstract
The current study was conducted to provide normative data on actigraphic dichotomy index (I < O) (the percentage of in bed activity counts that are less than the median of out of bed counts) in healthy population and to assess whether the I < O could be an effective index in discriminating the circadian motor activity of cancer patients from healthy controls. In this retrospective study, we recovered 408 actigraphic records from two databases: healthy controls (n = 182; 79 males; mean age 38.7 ± 12.6) and patients with metastatic colorectal cancer (n = 226; 149 males; mean age 58.4 ± 11.4). Beside the usual actigraphic sleep parameters (time in bed, sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, number of awakenings, and mean motor activity), we also computed the dichotomy index and number of actigraphic wake parameters, namely, diurnal motor activity, diurnal total sleep time, number of sleep episodes, and the mean duration of the longest diurnal sleep episode. Using the Youden index, we calculated the cut off value that performed the best for I < O and actigraphic wake parameters. Finally, we created Receiver Operator Characteristic curves to test the efficacy of each actigraphic parameter to discriminate cancer patient from healthy controls. Mean I < O was 99.5% (SD, 0.48%) in the healthy group, as compared to 96.6% (SD, 3.6%) in the cancer group (p < 0.0001). Important age-related effects appeared unlikely after performing both the main analysis with age as a covariate, and a subset analysis in 104 subjects matched for age and sex. In the main analysis, all actigraphic parameters, except total sleep time, significantly differentiated the two groups of participants. However, the I < O was the one that clearly performed best. Here, we provide the first large dataset on I < O in healthy subjects, we confirm the relevance of this circadian index for discriminating advanced stage colorectal cancer patients from healthy subjects, and we lay the grounds for further investigations of this circadian index in patients with other chronic diseases.
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Affiliation(s)
- Vincenzo Natale
- a Department of Psychology , University of Bologna , Bologna , Italy
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37
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Ortiz-Tudela E, Innominato PF, Rol MA, Lévi F, Madrid JA. Relevance of internal time and circadian robustness for cancer patients. BMC Cancer 2016; 16:285. [PMID: 27102330 PMCID: PMC4839139 DOI: 10.1186/s12885-016-2319-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/15/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adequate circadian timing of cancer treatment schedules (chronotherapy) can enhance tolerance and efficacy several-fold in experimental and clinical situations. However, the optimal timing varies according to sex, genetic background and lifestyle. Here, we compute the individual phase of the Circadian Timing System to decipher the internal timing of each patient and find the optimal treatment timing. METHODS Twenty-four patients (11 male; 13 female), aged 36 to 77 years, with advanced or metastatic gastro-intestinal cancer were recruited. Inner wrist surface Temperature, arm Activity and Position (TAP) were recorded every 10 min for 12 days, divided into three 4-day spans before, during and after a course of a set chronotherapy schedule. Pertinent indexes, I < O and a new biomarker, DI (degree of temporal internal order maintenance), were computed for each patient and period. RESULTS Three circadian rhythms and the TAP rhythm grew less stable and more fragmented in response to treatment. Furthermore, large inter- and intra-individual changes were found for T, A, P and TAP patterns, with phase differences of up to 12 hours among patients. A moderate perturbation of temporal internal order was observed, but the administration of fixed chronomodulated chemotherapy partially resynchronized temperature and activity rhythms by the end of the study. CONCLUSIONS The integrated variable TAP, together with the asynchrony among rhythms revealed by the new biomarker DI, would help in the personalization of cancer chronotherapy, taking into account individual circadian phase markers.
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Affiliation(s)
- Elisabet Ortiz-Tudela
- />Chronobiology Laboratory, Department of Physiology, University of Murcia, IMIB-Arrixaca, Murcia, Spain
- />INSERM, UMRS 776 « Biological Rhythms and Cancers », Villejuif, France
- />Warwick Medical School, Cancer Chronotherapy Unit, Coventry, UK
| | - Pasquale F. Innominato
- />INSERM, UMRS 776 « Biological Rhythms and Cancers », Villejuif, France
- />APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse Hospital, Villejuif, France
| | - Maria Angeles Rol
- />Chronobiology Laboratory, Department of Physiology, University of Murcia, IMIB-Arrixaca, Murcia, Spain
- />Chronobiology Laboratory, Department of Physiology, Faculty of Biology, University of Murcia, Campus de Espinardo, Espinardo, Murcia, Zip Code 30100 Spain
| | - Francis Lévi
- />INSERM, UMRS 776 « Biological Rhythms and Cancers », Villejuif, France
- />APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse Hospital, Villejuif, France
- />Warwick Medical School, Cancer Chronotherapy Unit, Coventry, UK
| | - Juan Antonio Madrid
- />Chronobiology Laboratory, Department of Physiology, University of Murcia, IMIB-Arrixaca, Murcia, Spain
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Abstract
Daily rhythms in physiology significantly modulate drug pharmacokinetics and pharmacodynamics according to the time-of-day, a finding that has led to the concept of chronopharmacology. The importance of biological clocks for xenobiotic metabolism has gained increased attention with the discovery of the molecular circadian clockwork. Mechanistic understanding of the cell-autonomous molecular circadian oscillator and the circadian timing system as a whole has opened new conceptual and methodological lines of investigation to understand first, the clock's impact on a specific drug's daily variations or the effects/side effects of environmental substances, and second, how clock-controlled pathways are coordinated within a given tissue or organism. Today, there is an increased understanding of the circadian modulation of drug effects. Moreover, several molecular strategies are being developed to treat disease-dependent and drug-induced clock disruptions in humans.
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Affiliation(s)
- Robert Dallmann
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK; Warwick Systems Biology Centre, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - Alper Okyar
- Department of Pharmacology, Faculty of Pharmacy, Istanbul University, Beyazit-Istanbul, Turkey
| | - Francis Lévi
- Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK; Warwick Systems Biology Centre, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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39
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Dulong S, Ballesta A, Okyar A, Lévi F. Identification of Circadian Determinants of Cancer Chronotherapy through In Vitro Chronopharmacology and Mathematical Modeling. Mol Cancer Ther 2015; 14:2154-64. [PMID: 26141947 DOI: 10.1158/1535-7163.mct-15-0129] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/23/2015] [Indexed: 11/16/2022]
Abstract
Cancer chronotherapy aims at enhancing tolerability and efficacy of anticancer drugs through their delivery according to circadian clocks. However, mouse and patient data show that lifestyle, sex, genetics, drugs, and cancer can modify both host circadian clocks and metabolism pathways dynamics, and thus the optimal timing of drug administration. The mathematical modeling of chronopharmacology could indeed help moderate optimal timing according to patient-specific determinants. Here, we combine in vitro and in silico methods, in order to characterize the critical molecular pathways that drive the chronopharmacology of irinotecan, a topoisomerase I inhibitor with complex metabolism and known activity against colorectal cancer. Large transcription rhythms moderated drug bioactivation, detoxification, transport, and target in synchronized colorectal cancer cell cultures. These molecular rhythms translated into statistically significant changes in pharmacokinetics and pharmacodynamics according to in vitro circadian drug timing. The top-up of the multiple coordinated chronopharmacology pathways resulted in a four-fold difference in irinotecan-induced apoptosis according to drug timing. Irinotecan cytotoxicity was directly linked to clock gene BMAL1 expression: The least apoptosis resulted from drug exposure near BMAL1 mRNA nadir (P < 0.001), whereas clock silencing through siBMAL1 exposure ablated all the chronopharmacology mechanisms. Mathematical modeling highlighted circadian bioactivation and detoxification as the most critical determinants of irinotecan chronopharmacology. In vitro-in silico systems chronopharmacology is a new powerful methodology for identifying the main mechanisms at work in order to optimize circadian drug delivery.
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Affiliation(s)
- Sandrine Dulong
- INSERM, UMR-SO776 "Rythmes biologiques et cancers," CNRS Campus, Villejuif, France. Université Paris-Sud, Orsay, France
| | - Annabelle Ballesta
- Warwick Systems Biology Centre, Coventry, United Kingdom. Cancer Chronotherapy Unit, Warwick Medical School, Coventry, United Kingdom
| | - Alper Okyar
- INSERM, UMR-SO776 "Rythmes biologiques et cancers," CNRS Campus, Villejuif, France. Université Paris-Sud, Orsay, France. Istanbul University, Faculty of Pharmacy, Department of Pharmacology, Istanbul, Turkey
| | - Francis Lévi
- INSERM, UMR-SO776 "Rythmes biologiques et cancers," CNRS Campus, Villejuif, France. Université Paris-Sud, Orsay, France. Warwick Systems Biology Centre, Coventry, United Kingdom. Cancer Chronotherapy Unit, Warwick Medical School, Coventry, United Kingdom. Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département d'oncologie médicale, Hôpital Paul Brousse, Villejuif, France.
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Sallam H, El-Serafi AT, Filipski E, Terelius Y, Lévi F, Hassan M. The effect of circadian rhythm on pharmacokinetics and metabolism of the Cdk inhibitor, roscovitine, in tumor mice model. Chronobiol Int 2015; 32:608-14. [PMID: 25938685 DOI: 10.3109/07420528.2015.1022782] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 01/20/2023]
Abstract
Roscovitine is a selective Cdk-inhibitor that is under investigation in phase II clinical trials under several conditions, including chemotherapy. Tumor growth inhibition has been previously shown to be affected by the dosing time of roscovitine in a Glasgow osteosarcoma xenograft mouse model. In the current study, we examined the effect of dose timing on the pharmacokinetics, biodistribution and metabolism of this drug in different organs in B6D2F1 mice. The drug was orally administered at resting (ZT3) or activity time of the mice (ZT19) at a dose of 300 mg/kg. Plasma and organs were removed at serial time points (10, 20 and 30 min; 1, 2, 4, 6, 8, 12 and 24 h) after the administration. Roscovitine and its carboxylic metabolite concentrations were analyzed using HPLC-UV, and pharmacokinetic parameters were calculated in different organs. We found that systemic exposure to roscovitine was 38% higher when dosing at ZT3, and elimination half-life was double compared to when dosing at ZT19. Higher organ concentrations expressed as (organ/plasma) ratio were observed when dosing at ZT3 in the kidney (180%), adipose tissue (188%), testis (132%) and lungs (112%), while the liver exposure to roscovitine was 120% higher after dosing at ZT19. The metabolic ratio was approximately 23% higher at ZT19, while the intrinsic clearance (CLint) was approximately 67% higher at ZT19, indicating faster and more efficient metabolism. These differences may be caused by circadian differences in the absorption, distribution, metabolism and excretion processes governing roscovitine disposition in the mice. In this article, we describe for the first time the chronobiodistribution of roscovitine in the mouse and the contribution of the dosing time to the variability of its metabolism. Our results may help in designing better dosing schedules of roscovitine in clinical trials.
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Affiliation(s)
- Hatem Sallam
- Experimental Cancer Medicine, Department of Laboratory Medicine, Karolinska Institutet , Stockholm , Sweden
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Innominato PF, Spiegel D, Ulusakarya A, Giacchetti S, Bjarnason GA, Lévi F, Palesh O. Subjective sleep and overall survival in chemotherapy-naïve patients with metastatic colorectal cancer. Sleep Med 2015; 16:391-8. [DOI: 10.1016/j.sleep.2014.10.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/05/2014] [Accepted: 10/09/2014] [Indexed: 01/20/2023]
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Lévi F, Dugué PA, Innominato P, Karaboué A, Dispersyn G, Parganiha A, Giacchetti S, Moreau T, Focan C, Waterhouse J, Spiegel D. Wrist actimetry circadian rhythm as a robust predictor of colorectal cancer patients survival. Chronobiol Int 2014; 31:891-900. [PMID: 24927369 DOI: 10.3109/07420528.2014.924523] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [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: 12/29/2022]
Abstract
The disruption of the circadian timing system (CTS), which rhythmically controls cellular metabolism and proliferation, accelerated experimental cancer progression. A measure of CTS function in cancer patients could thus provide novel prediction information for outcomes, and help to identify novel specific therapies. The rest-activity circadian rhythm is a reliable and non-invasive CTS biomarker, which was monitored using a wrist watch accelerometer for 2 days in 436 patients with metastatic colorectal cancer. The relative percentage of activity in-bed versus out-of-bed (I < O) constituted the tested CTS measure, whose prognostic value for overall survival (OS) and progression-free survival (PFS) was determined in a pooled analysis of three patient cohorts with different treatment exposures. Median OS was 21.6 months [17.8-25.5] for patients with I < O above the median value of 97.5% as compared to 11.9 months [10.4-13.3] for those with a lower I < O (Log-rank p < 0.001). Multivariate analyses retained continuous I < O as a joint predictor of both OS and PFS, with respective hazard ratios (HR) of 0.954 (p < 0.001) and 0.970 (p < 0.001) for each 1% increase in I < O. HRs had similar values in all the patient subgroups tested. The circadian physiology biomarker I < O constitutes a robust and independent quantitative predictor of cancer patient outcomes, that can be easily and cost-effectively measured during daily living. Interventional studies involving 24-h schedules of clock-targeted drugs, light intensity, exercise and/or meals are needed for testing the relevance of circadian synchronization for the survival of patients with disrupted rhythms.
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Affiliation(s)
- Francis Lévi
- Biological Rhythms and Cancers, INSERM, UMRS , Villejuif Cedex , France
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Filipski E, Berland E, Ozturk N, Guettier C, van der Horst GT, Lévi F, Okyar A. Optimization of irinotecan chronotherapy with P-glycoprotein inhibition. Toxicol Appl Pharmacol 2014; 274:471-9. [DOI: 10.1016/j.taap.2013.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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Siffroi-Fernandez S, Dulong S, Li XM, Filipski E, Gréchez-Cassiau A, Peteri-Brünback B, Meijer L, Lévi F, Teboul M, Delaunay F. Functional genomics identify Birc5/survivin as a candidate gene involved in the chronotoxicity of cyclin-dependent kinase inhibitors. Cell Cycle 2014; 13:984-91. [PMID: 24552823 DOI: 10.4161/cc.27868] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 12/29/2022] Open
Abstract
The circadian timing system orchestrates most of mammalian physiology and behavior in synchrony with the external light/dark cycle. This regulation is achieved through endogenous clocks present in virtually all body cells, where they control key cellular processes, including metabolism, transport, and the cell cycle. Consistently, it has been observed in preclinical cancer models that both the efficacy and toxicity of most chemotherapeutic drugs depend on their time of administration. To further explore the molecular basis underlying the link between the circadian timing system and the cellular response to anticancer drugs, we investigated the circadian transcriptome and CDK inhibitor toxicity in colon mucosa cells. We first show here that among 181 circadian transcripts, approximately 30% of them drive the cell cycle in the healthy mouse colon mucosa, with a majority peaking during the early resting phase. The identification of 26 mitotic genes within this cluster further indicated that the transcriptional coordination of mitosis by the circadian clock participates in the gating of cell division in this tissue. Subsequent selective siRNA-mediated silencing of these 26 targets revealed that low expression levels of the mitotic and anti-apoptotic gene Birc5/survivin significantly and specifically increased the sensitivity of colon epithelial cells to CDK inhibitors. By identifying Birc5/survivin as a potential determinant for the circadian modulation of CDK inhibitor toxicity, these data provide a mechanistic basis for the preclinical development of future CDK inhibitor-based chronotherapeutic strategies.
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Affiliation(s)
- Sandrine Siffroi-Fernandez
- Institut de Biologie Valrose; Université Nice Sophia Antipolis; CNRS UMR7277; INSERM U1091; Nice, France
| | - Sandrine Dulong
- INSERM U776 Rythmes biologiques et cancers; Villejuif, France; University Paris-Sud, Orsay; France
| | - Xiao-Mei Li
- INSERM U776 Rythmes biologiques et cancers; Villejuif, France; University Paris-Sud, Orsay; France
| | - Elisabeth Filipski
- INSERM U776 Rythmes biologiques et cancers; Villejuif, France; University Paris-Sud, Orsay; France
| | - Aline Gréchez-Cassiau
- Institut de Biologie Valrose; Université Nice Sophia Antipolis; CNRS UMR7277; INSERM U1091; Nice, France
| | - Brigitta Peteri-Brünback
- Institut de Biologie Valrose; Université Nice Sophia Antipolis; CNRS UMR7277; INSERM U1091; Nice, France
| | | | - Francis Lévi
- INSERM U776 Rythmes biologiques et cancers; Villejuif, France; University Paris-Sud, Orsay; France; Assistance Publique-Hôpitaux de Paris; Unité de Chronothérapie; Département d'Oncologie Médicale; Hôpital Paul Brousse; Villejuif, France
| | - Michèle Teboul
- Institut de Biologie Valrose; Université Nice Sophia Antipolis; CNRS UMR7277; INSERM U1091; Nice, France
| | - Franck Delaunay
- Institut de Biologie Valrose; Université Nice Sophia Antipolis; CNRS UMR7277; INSERM U1091; Nice, France
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Li XM, Mohammad-Djafari A, Dumitru M, Dulong S, Filipski E, Siffroi-Fernandez S, Mteyrek A, Scaglione F, Guettier C, Delaunay F, Lévi F. A circadian clock transcription model for the personalization of cancer chronotherapy. Cancer Res 2013; 73:7176-88. [PMID: 24154875 DOI: 10.1158/0008-5472.can-13-1528] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Circadian timing of anticancer medications has improved treatment tolerability and efficacy several fold, yet with intersubject variability. Using three C57BL/6-based mouse strains of both sexes, we identified three chronotoxicity classes with distinct circadian toxicity patterns of irinotecan, a topoisomerase I inhibitor active against colorectal cancer. Liver and colon circadian 24-hour expression patterns of clock genes Rev-erbα and Bmal1 best discriminated these chronotoxicity classes, among 27 transcriptional 24-hour time series, according to sparse linear discriminant analysis. An 8-hour phase advance was found both for Rev-erbα and Bmal1 mRNA expressions and for irinotecan chronotoxicity in clock-altered Per2(m/m) mice. The application of a maximum-a-posteriori Bayesian inference method identified a linear model based on Rev-erbα and Bmal1 circadian expressions that accurately predicted for optimal irinotecan timing. The assessment of the Rev-erbα and Bmal1 regulatory transcription loop in the molecular clock could critically improve the tolerability of chemotherapy through a mathematical model-based determination of host-specific optimal timing.
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MESH Headings
- ARNTL Transcription Factors/genetics
- Animals
- Camptothecin/administration & dosage
- Camptothecin/analogs & derivatives
- Chronotherapy/methods
- Circadian Clocks/genetics
- Colonic Neoplasms/drug therapy
- Colonic Neoplasms/genetics
- Colonic Neoplasms/metabolism
- Female
- Gene Expression Regulation, Neoplastic
- Irinotecan
- Liver Neoplasms, Experimental/drug therapy
- Liver Neoplasms, Experimental/genetics
- Liver Neoplasms, Experimental/metabolism
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Inbred CBA
- Mice, Inbred DBA
- Models, Biological
- Nuclear Receptor Subfamily 1, Group D, Member 1/genetics
- Period Circadian Proteins/biosynthesis
- Period Circadian Proteins/genetics
- Period Circadian Proteins/metabolism
- Precision Medicine/methods
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Topoisomerase I Inhibitors/administration & dosage
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Affiliation(s)
- Xiao-Mei Li
- Authors' Affiliations: INSERM UMRS 776 «Rythmes biologiques et cancers», Assistance Publique-Hôpitaux de Paris, Laboratoire d'Anatomie et Cytologie Pathologiques, Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département d'Oncologie Médicale, Hôpital Paul Brousse, Villejuif; Université Paris-Sud, Orsay; Laboratoire des Signaux et Systèmes, UMR8506 CNRS-SUPELEC-UNIV PARIS-SUD, Gif-sur-Yvette; University de Nice-Sophia-Antipolis, Institute de Biologie Valrose, CNRS UMR 7277, INSERM 1091, Nice, France; and Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Ortiz-Tudela E, Iurisci I, Beau J, Karaboue A, Moreau T, Rol MA, Madrid JA, Lévi F, Innominato PF. The circadian rest-activity rhythm, a potential safety pharmacology endpoint of cancer chemotherapy. Int J Cancer 2013; 134:2717-25. [PMID: 24510611 DOI: 10.1002/ijc.28587] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 08/14/2013] [Revised: 10/17/2013] [Accepted: 10/23/2013] [Indexed: 02/03/2023]
Abstract
The robustness of the circadian timing system (CTS) was correlated to quality of life and predicted for improved survival in cancer patients. However, chemotherapy disrupted the CTS according to dose and circadian timing in mice. A continuous and repeated measures longitudinal design was implemented here to characterize CTS dynamics in patients receiving a fixed circadian-based chemotherapy protocol. The rest-activity rhythm of 49 patients with advanced cancer was monitored using a wrist actigraph for 13 days split into four consecutive spans of 3-4 days each, i.e., before, during, right after and late after a fixed chronotherapy course. The relative amount of activity in bed vs. out of bed (I<O, main endpoint), the autocorrelation coefficient r24, the relative 24-hr amplitude (Amp), interdaily stability (IS) and intradaily variability (IV) were compared according to study span. Circadian disruption (I<O ≤ 97.5%) resulted from the administration of the fixed chronotherapy protocols, with all five rest-activity rhythm parameters being worsened in the whole group of patients (p < 0.05). Mean parameter values subsequently recovered to near baseline values. The occurrence of circadian disruption on chemotherapy was associated with a higher risk of clinically relevant fatigue (p = 0.028) or body weight loss (p = 0.05). Four CTS dynamic patterns characterized treatment response including no change (9.5% of the patients); improvement (14.3%); alteration and complete recovery (31%) or sustained deterioration (45%), possibly due to inadequate chronotherapy dosing and/or timing. Improved clinical tolerability could result from the minimization of circadian disruption through the personalization of chronotherapy delivery.
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Affiliation(s)
- Elisabet Ortiz-Tudela
- Department of Physiology Chronobiology Laboratory, University of Murcia, Murcia, Spain; INSERM, UMRS776, Biological Rhythms and Cancers, Villejuif, France
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Costa MJ, Finkenstädt B, Roche V, Lévi F, Gould PD, Foreman J, Halliday K, Hall A, Rand DA. Inference on periodicity of circadian time series. Biostatistics 2013; 14:792-806. [PMID: 23743206 DOI: 10.1093/biostatistics/kxt020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 02/06/2023] Open
Abstract
Estimation of the period length of time-course data from cyclical biological processes, such as those driven by the circadian pacemaker, is crucial for inferring the properties of the biological clock found in many living organisms. We propose a methodology for period estimation based on spectrum resampling (SR) techniques. Simulation studies show that SR is superior and more robust to non-sinusoidal and noisy cycles than a currently used routine based on Fourier approximations. In addition, a simple fit to the oscillations using linear least squares is available, together with a non-parametric test for detecting changes in period length which allows for period estimates with different variances, as frequently encountered in practice. The proposed methods are motivated by and applied to various data examples from chronobiology.
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Affiliation(s)
- Maria J Costa
- Warwick Systems Biology Centre, University of Warwick, Coventry CV4 7AL, UK,.
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Innominato PF, Giacchetti S, Moreau T, Bjarnason GA, Smaaland R, Focan C, Garufi C, Iacobelli S, Tampellini M, Tumolo S, Carvalho C, Karaboué A, Poncet A, Spiegel D, Lévi F. Fatigue and weight loss predict survival on circadian chemotherapy for metastatic colorectal cancer. Cancer 2013; 119:2564-73. [PMID: 23633399 DOI: 10.1002/cncr.28072] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 12/21/2012] [Revised: 02/07/2013] [Accepted: 02/25/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Chemotherapy-induced neutropenia has been associated with prolonged survival selectively in patients on a conventional schedule (combined 5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX2]) but not on a chronomodulated schedule of the same drugs administered at specific circadian times (chronoFLO4). The authors hypothesized that the early occurrence of chemotherapy-induced symptoms correlated with circadian disruption would selectively hinder the efficacy of chronotherapy. METHODS Fatigue and weight loss (FWL) were considered to be associated with circadian disruption based on previous data. Patients with metastatic colorectal cancer (n = 543) from an international phase 3 trial comparing FOLFOX2 with chronoFLO4 were categorized into 4 subgroups according to the occurrence of FWL or other clinically relevant toxicities during the initial 2 courses of chemotherapy. Multivariate Cox models were used to assess the role of toxicity on the time to progression (TTP) and overall survival (OS). RESULTS The proportions of patients in the 4 subgroups were comparable in both treatment arms (P = .77). No toxicity was associated with TTP or OS on FOLFOX2. The median OS on FOLFOX2 ranged from 16.4 (95% confidence limits [CL], 7.2-25.6 months) to 19.8 months (95% CL, 17.7-22.0 months) according to toxicity subgroup (P = .45). Conversely, FWL, but no other toxicity, independently predicted for significantly shorter TTP (P < .0001) and OS (P = .001) on chronoFLO4. The median OS on chronoFLO4 was 13.8 months (95% CL, 10.4-17.2 months) or 21.1 months (95% CL, 19.0-23.1 months) according to presence or absence of chemotherapy-induced FWL, respectively. CONCLUSIONS Early onset chemotherapy-induced FWL was an independent predictor of poor TTP and OS only on chronotherapy. Dynamic monitoring to detect early chemotherapy-induced circadian disruption could allow the optimization of rapid chronotherapy and concomitant improvements in safety and efficacy.
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Affiliation(s)
- Pasquale F Innominato
- National Institute for Health and Medical Research (INSERM) Unit 776, "Biological Rhythms and Cancers," Villejuif, France
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Giacchetti S, Dugué PA, Innominato PF, Bjarnason GA, Focan C, Garufi C, Tumolo S, Coudert B, Iacobelli S, Smaaland R, Tampellini M, Adam R, Moreau T, Lévi F. Sex moderates circadian chemotherapy effects on survival of patients with metastatic colorectal cancer: a meta-analysis. Ann Oncol 2012; 23:3110-3116. [PMID: 22745214 DOI: 10.1093/annonc/mds148] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Molecular circadian clocks can modify cancer chemotherapy effects, with a possible moderation according to sex differences. We investigated whether sex determine the optimal delivery schedule of chemotherapy for metastatic colorectal cancer. PATIENTS AND METHODS A meta-analysis was performed using individual data from three international Phase III trials comparing 5-fluorouracil, leucovorin and oxaliplatin administered in chronomodulated (chronoFLO) or conventional (CONV) infusions. The data from 345 females and 497 males were updated at 9 years. The main end point was survival. RESULTS Overall survival was improved in males on chronoFLO when compared with CONV (P = 0.009), with respective median values of 20.8 (95% CL, 18.7 to 22.9) and 17.5 months (16.1 to 18.8). Conversely, median survival was 16.6 months (13.9 to 19.3) on chronoFLO and 18.4 months (16.6 to 20.2) on CONV in females (P = 0.012). The sex versus schedule interaction was a strong predictive factor of optimal treatment schedule, with a hazard ratio of 1.59 (1.30 to 1.75) for overall survival (P = 0.002) in multivariate analysis. CONCLUSIONS Males lived significantly longer on chronomodulated chemotherapy rather than on conventional chemotherapy. The current chronoFLO schedule deserves prospective assessment as a safe and more effective first-line treatment option than conventional delivery for male patients.
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Affiliation(s)
- S Giacchetti
- INSERM, UMRS776 'Biological Rhythms and Cancers', Villejuif; Paris South University, UMR-S0776, Orsay; APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse hospital, Villejuif; Faculty of Medicine, Paris XI University, le Kremlin-Bicêtre, France
| | - P A Dugué
- INSERM, UMRS776 'Biological Rhythms and Cancers', Villejuif; Paris South University, UMR-S0776, Orsay; APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse hospital, Villejuif; Faculty of Medicine, Paris XI University, le Kremlin-Bicêtre, France
| | - P F Innominato
- INSERM, UMRS776 'Biological Rhythms and Cancers', Villejuif; Paris South University, UMR-S0776, Orsay; APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse hospital, Villejuif; Faculty of Medicine, Paris XI University, le Kremlin-Bicêtre, France
| | - G A Bjarnason
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - C Focan
- Department of Medical Oncology, Centre Hospitalier Chrétien, Clinique Saint-Joseph, Liège, Belgium
| | - C Garufi
- Department of Medical Oncology C, Istituto Regina Elena, Roma
| | - S Tumolo
- Department of Medical Oncology, Azienda Ospedaliera Santa Maria Degli Angeli, Pordenone, Italy
| | - B Coudert
- Department of Medical Oncology, Georges-François Leclerc Center, Dijon, France
| | - S Iacobelli
- Department of Medical Oncology, G. D'Annunzio di Chieti University, Chieti, Italy
| | - R Smaaland
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger; University of Bergen, Norway
| | - M Tampellini
- Department of Medical and Biological Sciences, University of Torino, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
| | - R Adam
- INSERM, UMRS776 'Biological Rhythms and Cancers', Villejuif; Paris South University, UMR-S0776, Orsay; APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse hospital, Villejuif; Faculty of Medicine, Paris XI University, le Kremlin-Bicêtre, France; Onco-surgery Unit, Hepato-biliary Center, France
| | - T Moreau
- Department of Biostatistics, INSERM U1018, Paul Brousse Hospital, Villejuif, France
| | - F Lévi
- INSERM, UMRS776 'Biological Rhythms and Cancers', Villejuif; Paris South University, UMR-S0776, Orsay; APHP, Chronotherapy Unit, Department of Oncology, Paul Brousse hospital, Villejuif; Faculty of Medicine, Paris XI University, le Kremlin-Bicêtre, France.
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Abstract
Chronotherapeutics aims at the adjustment of treatments to ∼ 24 h rhythms, which result from the moderation of most biological functions by the circadian timing system (CTS). The integration of CTS-related knowledge in drug delivery concepts challenges most current views, where steady-state constant drug levels are synonymous to enhanced tolerability and efficacy. In contrast, robust molecular clocks rhythmically control Phase I, II and III drug metabolism, as well as pharmacodynamics. Thus, circadian timing of medications predictably modifies drug tolerability and/or efficacy up to several-fold in rodents, as well as in patients. Optimal dosing times indeed complement the recommendations for optimal doses of glucocorticoids, NSAIDs, bronchodilators and so on. Clinically-driven in vitro and in silico circadian data now provide mechanistic insights for the effective translation of chronotherapeutic delivery, especially for cancer therapies. Programmable-in-time electronic or polymeric drug delivery systems are being used for improving health in patients with cancer or rheumatoid diseases, respectively. Current research aims at the optimization of circadian amplitude and phase of drug delivery according to CTS biomarkers. Intelligent drug delivery systems could then integrate the critical rhythmic information stemming from the individual patient and achieve a critical leap forward in the safe administration of potentially toxic therapeutic agents.
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