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Santoro A, Assenat E, Yau T, Delord JP, Maur M, Knox J, Cattan S, Lee KH, Del Conte G, Springfeld C, Leo E, Xyrafas A, Fairchild L, Mardjuadi F, Chan SL. A phase Ib/II trial of capmatinib plus spartalizumab vs. spartalizumab alone in patients with pretreated hepatocellular carcinoma. JHEP Rep 2024; 6:101021. [PMID: 38617599 PMCID: PMC11009449 DOI: 10.1016/j.jhepr.2024.101021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/22/2023] [Accepted: 01/11/2024] [Indexed: 04/16/2024] Open
Abstract
Background & aims This phase Ib/II trial evaluated the safety and efficacy of capmatinib in combination with spartalizumab or spartalizumab alone in patients with advanced hepatocellular carcinoma (HCC). Methods Eligible patients who had progressed or were intolerant to sorafenib received escalating doses of capmatinib 200 mg, 300 mg, and 400 mg twice a day (bid) plus spartalizumab 300 mg every 3 weeks (q3w) in the phase Ib study. Once the recommended phase II dose (RP2D) was determined, the phase II study commenced with randomised 1:1 treatment with either capmatinib + spartalizumab (n = 32) or spartalizumab alone (n = 30). Primary endpoints were safety and tolerability (phase Ib) and investigator-assessed overall response rate per RECIST v1.1 for combination vs. single-agent arms using a Bayesian logistic regression model (phase II). Results In phase Ib, the RP2D for capmatinib in combination with spartalizumab was determined to be 400 mg bid. Dose-limiting toxicity consisting of grade 3 diarrhoea was reported in one patient at the capmatinib 400 mg bid + spartalizumab 300 mg q3w dose level. The primary endpoint in the phase II study was not met. The observed overall response rate in the capmatinib + spartalizumab arm was 9.4% vs. 10% in the spartalizumab arm. The most common any-grade treatment-related adverse events (TRAEs, ≥20%) were nausea (37.5%), asthenia and vomiting (28.1% each), diarrhoea, pyrexia, and decreased appetite (25.0% each) in the combination arm; TRAEs ≥10% were pruritus (23.3%), and rash (10.0%) in the spartalizumab-alone arm. Conclusion Capmatinib at 400 mg bid plus spartalizumab 300 mg q3w was established as the RP2D, with manageable toxicities and no significant safety signals, but the combination did not show superior clinical activity compared with spartalizumab single-agent treatment in patients with advanced HCC who had previously been treated with sorafenib. Impact and implications Simultaneous targeting of MET and programmed cell death protein 1 may provide synergistic clinical benefit in patients with advanced HCC. This is the first trial to report a combination of capmatinib (MET inhibitor) and spartalizumab (programmed cell death protein 1 inhibitor) as second-line treatment after sorafenib for advanced HCC. The combination did not show superior clinical activity compared with spartalizumab single-agent treatment in patients with advanced HCC who had previously been treated with sorafenib. The results indicate that there is a clear need to identify a reliable predictive marker of response for HCC and to identify patients with HCC that would benefit from the combination of checkpoint inhibitor +/- targeted therapy. Clinical trial number NCT02795429.
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Affiliation(s)
- Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele – Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Via Manzoni 56, Rozzano, Milan, Italy
| | - Eric Assenat
- Hopital Arnaud de Villeneuve Montpellier Cedex 5, Herault, France
| | - Thomas Yau
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | | | - Michela Maur
- Oncology Unit, AOU Policlinico Modena and University Study of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Kyung-Hun Lee
- Seoul National University Hospital, Seoul, South Korea
| | - Gianluca Del Conte
- Department of Oncology, IRCCS San Raffaele Scientific Institute Hospital, Milan, Italy
| | - Christoph Springfeld
- Nat. Centrum f. Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Elisa Leo
- Novartis Pharma AG, Basel, Switzerland
| | | | - Lauren Fairchild
- Oncology Data Science, Novartis Institutes for BioMedical Research, Cambridge, USA
| | - Feby Mardjuadi
- Novartis Institutes for Biomedical Research Co., Ltd., Shanghai, China
| | - Stephen L. Chan
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Piccart M, Hennequin A, Borrego MR, Escrivá-de-Romani S, Williams A, Rodríguez BJ, Conte GD, Howell SJ, Palleschi M, Simonelli M, Duhoux FP, Tosi D, Uribe BDDS, Gilarranz YJ, Tassone P, Curigliano G, Waters S, Aftimos P, Wildiers H, Scartoni S, Vallespir BP, Shankaraiah RC, Grzegorzewski K, Habboubi N. Abstract PD18-05: MEN1611, a PI3K inhibitor, combined with trastuzumab ± fulvestrant for HER2+/PIK3CA mutant advanced or metastatic breast cancer: updated safety and efficacy results from the ongoing phase 1b study (B-PRECISE-01). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd18-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: MEN1611 (MEN) is an oral PI3K inhibitor active on the p110α mutant and wild type, β and γ isoforms, while sparing the δ. B-PRECISE-01 is an open-label, 2-arm, phase 1b study investigating MEN1611 in combination with trastuzumab ± fulvestrant in patients with HER2 positive/PIK3CA mutated metastatic breast cancer (MBC). No dose-limiting toxicities were observed during the dose-escalation step and MEN1611 48 mg BID was selected as the recommended phase 2 dose (RP2D) for cohort expansion (CE). Methods: Eligible patients had HER2+/PIK3CA-mutated MBC and were treated with at least 2 prior lines of anti-HER2-based therapy in the advanced/metastatic setting including trastuzumab. Patients received MEN1611 + trastuzumab (MEN+T); hormone receptor positive (HR+) postmenopausal women received M+ T + fulvestrant (MEN+T+F). Recruitment was closed in December 2021. Pooled safety and efficacy data from the two subpopulations of CE are presented herein. Results: As of June 2022, 62 female patients were treated: 56 of them with MEN1611 48 mg BID (25 MEN+T and 31 MEN+T+F). Median age 55.5 years (range 34-78), 21% premenopausal, ECOG PS 0-1: 95.2%. Median metastatic regimens 4; 71.0% had prior pertuzumab and 91.9% had prior T-DM1. Common treatment-emergent adverse events (TEAEs, ≥20%) were diarrhea 66.1%, nausea 45.2%, hyperglycemia 43.6%, anemia 35.5%, asthenia 29.0%, decreased appetite 27.4%, rash 25.8%, aspartate aminotransferase increased 22.6%, vomiting 22.6%, and pyrexia 22.6%. Common TEAEs with CTCAE grade ≥3 (≥10%) were hyperglycemia (22.6%) and diarrhea (11.3%). Most treatment-related AEs (TRAEs) were reversible and manageable by supportive care. TEAEs leading to permanent treatment discontinuation occurred in 9 patients (14.5%), the only TEAE occurring in more than one patient was lipase increased (3.2%). TEAEs caused temporary treatment interruptions in 32 patients (51.6%), the most common being hyperglycemia (21.0%) and diarrhea (9.7%). TEAEs leading to dose reduction occurred in 14 patients (22.6%), the most common being diarrhea (6.5%), hyperglycemia (3.2%) and stomatitis (3.2%). Serious TRAEs were experienced by 12 patients (19.4%): hyperglycemia 6 patients, diarrhea 3 patients, anemia, general physical health deterioration, generalized edema, lipase increased, ketoacidosis and pneumonitis (1 patient each). In the efficacy-evaluable population at the RP2D (n=41) 14 patients (34.1%) showed partial response (MEN+T 5/15, MEN+T+F 9/26), 1 patient (2.4%) had a complete response (MEN+T 1/15) and 23 patients (56.1%) had stable disease (MEN+T 6/15, MEN+T+F 17/26) as best response. At the RP2D, the median (95% CI) overall survival (OS) was 21.9 (11.9, NE) months and the median (95% CI) progression free survival (PFS) 5.6 (3.7, 7.2) months. In the MEN+T group, the median OS was 11.9 (5.7, NE) months and median PFS 3.9 (2.3, 6.7) months. In the MEN+T+F group the median OS was 21.9 (16.9, NE) months and median PFS 5.7 (3.7, 11.5) months. Five patients continue on treatment. Conclusions: Updated results from B-PRECISE-01 demonstrated that MEN1611 combined with trastuzumab ± fulvestrant continued to show a manageable safety profile with encouraging anti-tumor activity and duration of response in heavily pre-treated patients with HER2+/PIK3CA-mutated advanced or metastatic breast cancer.
Citation Format: Martine Piccart, Audrey Hennequin, Manuel Ruiz Borrego, Santiago Escrivá-de-Romani, Anja Williams, Begoña Jiménez Rodríguez, Gianluca Del Conte, Sacha J. Howell, Michela Palleschi, Matteo Simonelli, Francois P. Duhoux, Diego Tosi, Bernard Doger de Speville Uribe, Yolanda Jerez Gilarranz, Pierfrancesco Tassone, Giuseppe Curigliano, Simon Waters, Philippe Aftimos, Hans Wildiers, Simona Scartoni, Bartomeu Piza Vallespir, Ram Charan Shankaraiah, Krzysztof Grzegorzewski, Nassir Habboubi. MEN1611, a PI3K inhibitor, combined with trastuzumab ± fulvestrant for HER2+/PIK3CA mutant advanced or metastatic breast cancer: updated safety and efficacy results from the ongoing phase 1b study (B-PRECISE-01) [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 PD18-05.
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Affiliation(s)
- Martine Piccart
- 1Institut Jules Bordet – Université Libre de Bruxelles, Anderlecht, Brussels Hoofdstedelijk Gewest, Belgium
| | - Audrey Hennequin
- 2Unité de Phase I, Centre Georges François Leclerc, Dijon Cedex, France
| | | | | | - Anja Williams
- 5Sarah Cannon Research Institute SCRI UK, London, United Kingdom, London, England, United Kingdom
| | | | - Gianluca Del Conte
- 7Department of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sacha J. Howell
- 8Department of Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Michela Palleschi
- 9Department of Medical Oncology, IRCCS- Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Matteo Simonelli
- 10Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy, and IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | | | - Diego Tosi
- 12Early Clinical Trial Unit, Institut du Cancer de Montpellier, Montpellier, France
| | | | | | - Pierfrancesco Tassone
- 15Translational Medical Oncology, AOU Mater Domini, Magna Graecia University, Catanzaro, Italy
| | | | - Simon Waters
- 17Clinical Trials Unit, Velindre Cancer Centre, Cardiff, United Kingdom
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Dalla Volta A, Valcamonico F, Zivi A, Procopio G, Sepe P, Del Conte G, Di Meo N, Foti S, Zamboni S, Messina C, Lucchini E, Rizzi A, Ravanelli M, Milella M, Calza S, Simeone C, Maroldi R, Farina D, Berruti A. Whole-body diffusion-weighted magnetic resonance imaging to assess bone response in patients with hormone-sensitive metastatic prostate cancer randomly assigned to receive androgen deprivation + enzalutamide ± zoledronic acid. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.46] [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: 03/16/2023] Open
Abstract
46 Background: Bone is frequently involved in metastatic hormone sensitive prostate cancer (mHSPC). Whole-body diffusion-weighted magnetic resonance imaging (WB-DW-MRI) is a promising imaging technique for the assessment of bone response in prostate cancer. It is not known whether the addition of antiresorptive agents can improve disease response in bone in mHSPC patients undergoing next generation hormonal agents. Methods: In this multicenter phase II study patients with de novo or relapsed mHSPC and bone metastases at bone scan were randomly allocated with a 1:1 ratio to receive either androgen deprivation therapy (ADT) plus Enzalutamide (E arm) or the same combination with the addition of Zoledronic Acid (EZ arm). The study was designed to observe a significant increase in bone response rate in the experimental arm after 12 months of treatment, as assessed through WB-DW-MRI. WB-DW-MRI was performed centrally at baseline and after 6 and 12 months and images were evaluated by the same radiologist. Results: From February 2018 to June 2021, 126 mHSPC patients were randomized, 64 in EZ arm and 62 in E arm. A total of 111 patients, 54 from E arm and 57 from EZ arm, were eligible for WB-DW-MRI assessment (15 patients were excluded because of the absence of bone target lesions at MRI or specific contraindications to MRI). Bone response at 6 months was observed in 41 patients (76%) in E arm and 41 patients (72%) in EZ arm; the corresponding bone response at 12 months were 44 (82%) and 44 (77%), respectively (OR 0.77; 95%IC 0.30-1.93; p = 0.6). Complete response was the best overall bone response after 12 months in 9 patients (17%) from E arm and in 11 patients (19%) from EZ arm. In the same period, treatment was interrupted due to disease progression in 7 (13%) and 7 (12%) patients in E and EZ arm, respectively. Conclusions: The addition of Zoledronic Acid to Enzalutamide and ADT did not improve bone disease response in patients with mHSPC. WB-DW-MRI was able to detect bone responses in a great proportion of patients. Clinical trial information: NCT03336983 .
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Affiliation(s)
| | | | - Andrea Zivi
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | | | - Pierangela Sepe
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Nunzia Di Meo
- Radiology Unit - ASST Spedali Civili, Brescia, Italy
| | | | | | - Caterina Messina
- Medical Oncology Unit - ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Anna Rizzi
- Medical Oncology Unit - ASST Garda, Manerbio, Italy
| | | | - Michele Milella
- Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Roberto Maroldi
- Department of Radiology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Davide Farina
- Radiology Unit - ASST Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
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Vieito M, Sepulveda JM, Moreno V, de Vos F, Geurts M, Lorenzi E, Macchini M, van den Bent M, Del Conte G, Martín-Soberón MC, Brandal P, Garcia MM, Amoroso B, Sanchez-Perez T, Zuraek M, Hanna B, Filvaroff E, Chang H, Parro MA, Wei X, Liu Y, Nikolova Z, Simonelli M. CTNI-21. TROTABRESIB (CC-90010) IN COMBINATION WITH CONCOMITANT TEMOZOLOMIDE PLUS RADIOTHERAPY AND ADJUVANT TEMOZOLOMIDE IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA: UPDATED RESULTS FROM A PHASE 1B/2 STUDY. Neuro Oncol 2022. [PMCID: PMC9660752 DOI: 10.1093/neuonc/noac209.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Trotabresib, a novel bromodomain and extraterminal protein inhibitor, has demonstrated antitumor activity and blood–brain barrier penetration in patients with high-grade gliomas, and enhanced the antiproliferative effects of temozolomide in preclinical models. CC-90010-GBM-002 (NCT04324840) is a phase 1b/2 study investigating the addition of trotabresib to standard-of-care (SOC) concomitant temozolomide plus radiotherapy and adjuvant temozolomide, followed by maintenance trotabresib, in patients with newly diagnosed glioblastoma. The design of the dose escalation (part A) has been described previously (Vieito M, et al. SNO 2021. Abstract CTNI-51). Primary objectives of part A were to establish the safety, tolerability, and maximum tolerated dose/recommended phase 2 dose (RP2D) of trotabresib. In part A, addition of trotabresib to SOC was safe and well tolerated in the concomitant (N = 14) and adjuvant (N = 18) cohorts; the most frequent grade 3/4 treatment-related adverse event was thrombocytopenia (7/14 and 9/18 patients, respectively). The RP2D for trotabresib was 30 mg/day 4 days on/24 days off in both settings. At data cutoff (February 20, 2022), median duration of treatment was 34 weeks (concomitant cohort) and 33 weeks (adjuvant cohort); progression-free survival data are not yet mature. Trotabresib plasma pharmacokinetics and pharmacodynamics were consistent with monotherapy. At last follow-up, 6 and 5 patients remained on treatment in the concomitant and adjuvant dose-escalation cohorts, respectively, including 1 patient in cycle 20 with ongoing complete response. The ongoing randomized phase 2 dose expansion (part B; planned N = 162) is comparing concomitant trotabresib at the RP2D + SOC followed by adjuvant trotabresib at the RP2D + SOC, followed by maintenance trotabresib 45 mg/day 4 days on/24 days off, versus SOC alone in patients with newly diagnosed IDH–wild-type glioblastoma. Key objectives are to compare progression-free and overall survival, safety, and tolerability. Longer follow-up from part A and the first disclosure of data from part B will be presented.
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Affiliation(s)
- Maria Vieito
- Vall d’Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | | | - Victor Moreno
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz , Madrid , Spain
| | - Filip de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University , Utrecht , Netherlands
| | | | | | - Marina Macchini
- Department of Medical Oncology, Ospedale San Raffaele Scientific Institute , Milan , USA
| | | | - Gianluca Del Conte
- Department of Medical Oncology, Ospedale San Raffaele Scientific Institute , Milan , Italy
| | - Maria Cruz Martín-Soberón
- Neuro-Oncology Unit, Department of Medical Oncology, Hospital Universitario 12 de Octubre , Madrid , Spain
| | | | | | - Barbara Amoroso
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company , Seville , Spain
| | - Tania Sanchez-Perez
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company , Seville , Spain
| | | | | | | | - Henry Chang
- Bristol Myers Squibb , San Francisco, CA , USA
| | | | - Xin Wei
- Bristol Myers Squibb , Princeton, NJ , USA
| | - Yu Liu
- Bristol Myers Squibb , Cambridge, MA , USA
| | - Zariana Nikolova
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company , Seville , Spain
| | - Matteo Simonelli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Rozzano, Italy , Rozzano , Italy
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Vieito M, Simonelli M, de Vos F, Moreno V, Geurts M, Lorenzi E, Macchini M, van den Bent MJ, Del Conte G, de Jonge M, Martín-Soberón MC, Amoroso B, Sanchez-Perez T, Zuraek M, Hanna B, Aronchik I, Filvaroff E, Chang H, Mendez C, Arias Parro M, Wei X, Nikolova Z, Sepulveda JM. Trotabresib (CC90010) in combination with adjuvant temozolomide or concomitant temozolomide plus radiotherapy in patients with newly diagnosed glioblastoma. Neurooncol Adv 2022; 4:vdac146. [PMID: 36382109 PMCID: PMC9653173 DOI: 10.1093/noajnl/vdac146] [Citation(s) in RCA: 5] [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] [Indexed: 11/07/2022] Open
Abstract
Background Standard-of-care treatment for newly diagnosed glioblastoma (ndGBM), consisting of surgery followed by radiotherapy (RT) and temozolomide (TMZ), has improved outcomes compared with RT alone; however, prognosis remains poor. Trotabresib, a novel bromodomain and extraterminal inhibitor, has demonstrated antitumor activity in patients with high-grade gliomas. Methods In this phase Ib, dose-escalation study (NCT04324840), we investigated trotabresib 15, 30, and 45 mg combined with TMZ in the adjuvant setting and trotabresib 15 and 30 mg combined with TMZ+RT in the concomitant setting in patients with ndGBM. Primary endpoints were to determine safety, tolerability, maximum tolerated dose, and/or recommended phase II dose (RP2D) of trotabresib. Secondary endpoints were assessment of preliminary efficacy and pharmacokinetics. Pharmacodynamics were investigated as an exploratory endpoint. Results The adjuvant and concomitant cohorts enrolled 18 and 14 patients, respectively. Trotabresib in combination with TMZ or TMZ+RT was well tolerated; most treatment-related adverse events were mild or moderate. Trotabresib pharmacokinetics and pharmacodynamics in both settings were consistent with previous data for trotabresib monotherapy. The RP2D of trotabresib was selected as 30 mg 4 days on/24 days off in both settings. At last follow-up, 5 (28%) and 6 (43%) patients remain on treatment in the adjuvant and concomitant settings, respectively, with 1 patient in the adjuvant cohort achieving complete response. Conclusions Trotabresib combined with TMZ in the adjuvant setting and with TMZ+RT in the concomitant setting was safe and well tolerated in patients with ndGBM, with encouraging treatment durations. Trotabresib 30 mg was established as the RP2D in both settings.
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Affiliation(s)
- Maria Vieito
- Vall d’Hebron Institute of Oncology (VHIO) , Barcelona, Spain
- Universidad Autonoma de Barcelona , Barcelona, Spain
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University , Milan, Italy
- IRCCS Humanitas Research Hospital , Milan, Italy
| | - Filip de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University , Utrecht, the Netherlands
| | - Victor Moreno
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz , Madrid, Spain
| | | | | | - Marina Macchini
- Department of Oncology, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | | | - Gianluca Del Conte
- Department of Oncology, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - Maja de Jonge
- Erasmus MC Cancer Institute , Rotterdam, the Netherlands
| | - Maria Cruz Martín-Soberón
- Neuro-Oncology Unit, Department of Medical Oncology, Hospital Universitario 12 de Octubre , Madrid, Spain
| | - Barbara Amoroso
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company , Seville, Spain
| | - Tania Sanchez-Perez
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company , Seville, Spain
| | | | | | | | | | - Henry Chang
- Bristol Myers Squibb, San Francisco , CA, USA
| | - Cristina Mendez
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company , Seville, Spain
| | | | - Xin Wei
- Bristol Myers Squibb, Princeton , NJ, USA
| | - Zariana Nikolova
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company , Seville, Spain
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Ochsenreither S, Fiedler WM, Conte GD, Macchini M, Matos I, Habel B, Ahrens-Fath I, Raspagliesi F, Lorusso D, Keilholz U, Rolling C, Kebenko M, Klinghammer KF, Saavedra O, Baumeister H, Zurlo A, Garralda E. Safety and preliminary activity results of the GATTO study, a phase Ib study combining the anti-TA-MUC1 antibody gatipotuzumab with the anti-EGFR tomuzotuximab in patients with refractory solid tumors. ESMO Open 2022; 7:100447. [PMID: 35397434 PMCID: PMC9058922 DOI: 10.1016/j.esmoop.2022.100447] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The phase I GATTO study (NCT03360734) explored the feasibility, tolerability and preliminary activity of combining gatipotuzumab, a novel humanized monoclonal antibody binding to the tumor-associated epitope of mucin 1 (TA-MUC1) and an anti-epidermal growth factor receptor (anti-EGFR) antibody in refractory solid tumors. PATIENTS AND METHODS Initially the study enrolled primary phase (PP) patients with EGFR-positive metastatic solid tumors, for whom no standard treatment was available. Patients received gatipotuzumab administered at 1400 mg every 2 weeks, 6 weeks after the start of the glyco-optimized anti-EGFR antibody tomuzotuximab at 1200 mg every 2 weeks. As this regimen was proven safe, enrollment continued in an expansion phase (EP) of patients with refractory metastatic colorectal cancer, non-small-cell lung cancer, head and neck cancer and breast cancer. Tomuzotuximab and gatipotuzumab were given at the same doses and gatipotuzumab treatment started 1 week after the first dose of the anti-EGFR antibody. Additionally, investigators could use a commercial anti-EGFR antibody in place of tomuzotuximab. RESULTS A total of 52 patients were enrolled, 20 in the PP and 32 in the EP. The combined treatment was well tolerated and no dose-limiting toxicity was observed in the whole study, nor related serious adverse event or death. Preliminary activity of the combination was observed, with one and four RECIST partial responses in the PP and EP, all in colorectal cancer patients. The trial was accompanied by a comprehensive translational research program for identification of biomarkers, including soluble TA-MUC1 (sTA-MUC1) in serum. In the EP, patients with baseline sTA-MUC1 levels above the median appeared to have improved progression-free survival and overall survival. CONCLUSIONS Combination of a TA-MUC1-targeting antibody and an EGFR-targeting antibody is safe and feasible. Interesting antitumor activity was observed in heavily pretreated patients. Future studies should test this combination together with chemotherapy and explore the potential of sTA-MUC1 as a companion biomarker for further development of the combination.
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Affiliation(s)
- S Ochsenreither
- Charité Comprehensive Cancer Center, Berlin, Germany; Charité, Department of Hematology, Oncology and Tumor Immunology, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany.
| | - W M Fiedler
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - G D Conte
- Fondazione IRCCS San Raffaele Hospital, Milan, Italy
| | - M Macchini
- Fondazione IRCCS San Raffaele Hospital, Milan, Italy
| | - I Matos
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - B Habel
- Glycotope GmbH, Berlin, Germany
| | | | - F Raspagliesi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Lorusso
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - U Keilholz
- Charité Comprehensive Cancer Center, Berlin, Germany; German Cancer Consortium (DKTK), Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Rolling
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - M Kebenko
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - K F Klinghammer
- Charité Comprehensive Cancer Center, Berlin, Germany; Charité, Department of Hematology, Oncology and Tumor Immunology, Berlin, Germany
| | - O Saavedra
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | - A Zurlo
- Glycotope GmbH, Berlin, Germany
| | - E Garralda
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
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Galsky MD, Del Conte G, Foti S, Yu EY, Machiels JPH, Doger B, Necchi A, De Braud FG, Hamilton EP, Hennequin A, Van den Mooter T, Debruyne PR, Moreno I, Arkenau HT, Tsuchihashi Z, Cheng FC, Augustine B, Cheng B, Barrios D, Lüftner D. Primary analysis from DS8201-A-U105: A phase 1b, two-part, open-label study of trastuzumab deruxtecan (T-DXd) with nivolumab (nivo) in patients (pts) with HER2-expressing urothelial carcinoma (UC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.438] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
438 Background: HER2 overexpression has been found in invasive UC, suggesting a role for HER2 in disease progression and prognosis (Kruger Int J Oncol 2002). T-DXd is an antibody-drug conjugate comprising an anti-HER2 antibody, a cleavable linker, and a topoisomerase I inhibitor payload. Preclinical models showed that T-DXd combined with an anti-PD-1 antibody had greater efficacy versus either agent alone (Iwata Mol Cancer Ther 2018). We conducted a phase 1b, 2-part, open-label, multicenter study of T-DXd in combination with nivo in pts with HER2-expressing advanced/metastatic UC (NCT03523572). Methods: Pts aged ≥18 y had pathologically documented advanced/metastatic UC with centrally confirmed HER2 expression by immunohistochemistry (IHC) 2+/3+ (cohort 3; high expression) or IHC 1+ (cohort 4; low expression) who received prior platinum-based therapy with documented progression. Pts received T-DXd at 5.4 mg/kg and nivo 360 mg IV every 3 weeks (recommended dose for expansion). The primary endpoint was confirmed objective response rate (ORR) assessed by independent central review (ICR) per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints (assessed by ICR) included duration of response (DOR), progression-free survival (PFS), time to response (TTR), and overall survival (OS), and safety. Results: At the primary analysis data cutoff (July 22, 2021), 34 pts (cohort 3, n = 30; cohort 4, n = 4) received T-DXd and nivo. Median age was 70.9 y (range, 41.4-80.5), 88.2% were male, 61.8% received ≥1 prior regimens for locally advanced/metastatic disease, and 26.5% had a history of liver metastases. Median treatment duration (all pts) was 3.2 mo (range, 1-21) for T-DXd and 4.1 mo (range, 1-20) for nivo. In cohort 3, ORR by ICR was 36.7% (95% CI, 19.9-56.1; complete response, 13.3%; partial response, 23.3%), median DOR was 13.1 mo (95% CI, 4.1- NE), median PFS was 6.9 mo (95% CI, 2.7-14.4), median TTR was 1.9 mo (range 1.2-6.9), and median OS was 11.0 mo (95% CI, 7.2-NE). Grade (G) ≥3 treatment-emergent adverse events (TEAEs) occurred in 73.5% of all pts (44.1% related to T-DXd; 26.5% related to nivo). TEAEs leading to drug discontinuation occurred in 32.4% of all pts (17.6% related to T-DXd; 23.5% related to nivo). The most common any-grade TEAEs were nausea (73.5%), fatigue (52.9%), and vomiting (44.1%). Adjudicated drug-related interstitial lung disease (ILD)/pneumonitis occurred in 23.5% of all pts (2 G1; 4 G2; 1 G3; 1 G5). Conclusions: T-DXd combined with nivo showed antitumor activity in pts with high-expressing HER2 UC. The safety profile was consistent with prior studies for T-DXd in other indications and nivo monotherapy in UC pts. Adjudicated ILD/pneumonitis was within the range observed in other T-DXd monotherapy studies. Ongoing clinical trials are further exploring T-DXd in this population. Clinical trial information: NCT03523572.
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Affiliation(s)
| | | | | | - Evan Y. Yu
- University of Washington and Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | - Andrea Necchi
- Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | | | - Philip R. Debruyne
- AZ Groeninge Hospital, Kortrijk, Belgium, and Anglia Ruskin University, Cambridge, United Kingdom
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8
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Vieito M, Simonelli M, de Vos F, Moreno V, Geurts M, Lorenzi E, Macchini M, van den Bent M, Del Conte G, de Jonge M, Amoroso B, Sanchez-Perez T, Zuraek M, Hanna B, Aronchik I, Filvaroff E, Mendez C, Wei X, Nikolova Z, Sepulveda JM. CTNI-51. ADJUVANT TROTABRESIB, A REVERSIBLE POTENT BROMODOMAIN AND EXTRATERMINAL INHIBITOR, PLUS TEMOZOLOMIDE IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA: INTERIM RESULTS FROM A PHASE 1B DOSE-FINDING STUDY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Trotabresib (CC-90010) demonstrated antitumor activity as monotherapy in patients with advanced malignancies (Moreno et al. ESMO 2020. Abstract 5270) and enhanced the antiproliferative effects of temozolomide in preclinical studies. CC-90010-GBM-002 (NCT04324840) is a phase 1B dose-finding study investigating standard-of-care temozolomide + radiotherapy followed by adjuvant trotabresib + temozolomide or concomitant trotabresib + temozolomide + radiotherapy followed by adjuvant trotabresib + temozolomide, post-resection, in patients with newly diagnosed glioblastoma. We present interim results for adjuvant trotabresib + temozolomide. Patients received trotabresib 15, 30, or 45 mg daily (4 days on/24 days off) + temozolomide administered per label for 6 cycles, followed by trotabresib 45 mg monotherapy daily (4 days on/24 days off). Primary objectives are to establish the safety, maximum tolerated dose (MTD), and recommended phase 2 dose (RP2D) of trotabresib. Preliminary efficacy, pharmacokinetics, and pharmacodynamics are also being investigated. Of 13 patients enrolled, 5, 6, and 2 received trotabresib 15, 30, and 45 mg, respectively, plus temozolomide. Grade 3/4 treatment-related adverse events were reported in 2, 4, and 1 patients receiving trotabresib 15, 30, and 45 mg, respectively. MTD and RP2D are not yet reached; dose limiting toxicity (grade 4 thrombocytopenia) was reported in 1 patient in the 30-mg group. Of 10 evaluable patients, 1 had complete response and 7 had stable disease per RANO criteria. Trotabresib exposure increased proportionally with dose. Day 4 time to peak trotabresib concentration was 0.5–2.0 hours; mean terminal half life was 60–70 hours. Day 4 blood CCR1 RNA 2–4 hours post-dose was downregulated below baseline in the 15-mg group and ≥ 50% in the 30-mg group. Adjuvant trotabresib + temozolomide appears well tolerated, with promising preliminary efficacy. Treatment was ongoing at data cutoff in 9 patients in the adjuvant cohort; enrollment is continuing in the adjuvant and concomitant therapy dose-escalation cohorts.
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Affiliation(s)
- Maria Vieito
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Matteo Simonelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Filip de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Victor Moreno
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Marina Macchini
- Department of Medical Oncology, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | | | - Gianluca Del Conte
- Department of Medical Oncology, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | | | - Barbara Amoroso
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company, Seville, Spain
| | - Tania Sanchez-Perez
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company, Seville, Spain
| | | | | | | | | | - Cristina Mendez
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company, Seville, Spain
| | - Xin Wei
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Zariana Nikolova
- Centre for Innovation and Translational Research Europe, A Bristol Myers Squibb Company, Seville, Spain
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9
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Garralda E, Del Conte G, Macchini M, Matos I, Klinghammer KF, Saavedra Santa Gadea O, Fiedler WM, Rolling CC, Kebenko M, Raspagliesi F, Larusso D, ahrens-Fath I, Habel B, Baumeister H, Zurlo A, Ochsenreither S. Activity results of the GATTO study, a phase Ib study combining the anti-TA-MUC1 antibody gatipotuzumab with the anti-EGFR tomuzotuximab or panitumumab in patients with refractory solid tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2522 Background: The phase I GATTO study explored the feasibility, tolerability and preliminary activity of combining Gatipotuzumab (GAT), a novel humanized monoclonal antibody binding to the tumor-associated epitope of mucin-1 (TA-MUC1), and an anti-EGFR antibody. Preclinical evidence suggests a complex interaction between TA-MUC1 and EGFR on the cell surface of epithelial tumors and synergistic antibody dependent cell cytotoxicity activity with the double targeting. Methods: Initially 20 patients with refractory metastatic disease were treated with GAT administered at 1400 mg Q2W in combination with the glyco-optimized anti-EGFR antibody Tomuzotuximab (TOM) at 1200 mg Q2W. Due to the risk of infusion related reactions, three cycles of TOM were given before start of combined treatment with GAT. After this regimen was proven safe and no DLT was observed, 30 additional patients including colorectal cancer (CRC) already treated with anti-EGFR antibodies, non-small cell lung cancer (NSCLC), head and neck and breast cancers received TOM and GAT administered at the same doses, with GAT treatment starting already one week after the first dose of the anti-EGFR antibody. As allowed in the study expansion, Panitumumab (PAN) was used in place of TOM in 9 CRC patients at investigator’s choice. Results: By the time of the final analysis in January 2021, 52 patients were enrolled, and 50 received at least one dose of both GAT and anti-EGFR antibodies. Safety was overall good and results are reported in a separate abstract. Because of the difference in treatment schedule, activity results of the two parts of the study are summarized separately. There were 2 and 4 RECIST partial responses in the first and second part of the study, all in CRC patients. In the expansion phase, the median Progression Free Survival (PFS) of CRC patients who received TOM (10) and PAN (9) was 1.9 and 5.5 months, respectively. There were 2 responses in each subgroup and the duration of response was 3.8 and 7.2 months in patients receiving TOM and PAN, respectively. The PFS for NSCLC was 5.3 months and 2 heavily pretreated patients achieved a prolonged control of disease of 10.6 and 9.4 months. The trial was accompanied by a comprehensive translational research program for identification of biomarkers, including soluble TA-MUC1 in serum. In the extension phase patients with baseline values above median appeared to have improved PFS and overall survival; this was not the case for patients of the first part of the study who received GAT only after 3 doses of TOM. Conclusions: Combination of TA-MUC1 and EGFR targeting antibody is safe and feasible. Interesting anti-tumor activity was observed in heavily pretreated CRC and NSCLC patients. Levels of soluble TA-MUC1 may have predictive value and potentially be a companion biomarker for further development of the combination Clinical trial information: NCT03360734.
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Affiliation(s)
- Elena Garralda
- Early Drug Development Unit (UITM), Vall d'Hebron University Hospital and Institute of Oncology (VHIO) and Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Gianluca Del Conte
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Marina Macchini
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Ignacio Matos
- Early Drug Development Unit (UITM), Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Omar Saavedra Santa Gadea
- Early Drug Development Unit (UITM), Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Walter M. Fiedler
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - Christina C Rolling
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - Maxim Kebenko
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
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10
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Ochsenreither S, Zurlo A, Garralda E, Matos I, Klinghammer KF, Del Conte G, Macchini M, Rolling CC, Kebenko M, Saavedra Santa Gadea O, Raspagliesi F, Larusso D, ahrens-Fath I, Habel B, Baumeister H, Fiedler WM. Safety and tolerability results of the GATTO study, a phase Ib study combining the anti-TA-MUC1 antibody gatipotuzumab with the anti-EGFR tomuzotuximab or panitumumab in patients with refractory solid tumors. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.2524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2524 Background: The phase I GATTO study explored the feasibility, tolerability and preliminary activity of combining gatipotuzumab (GAT), a novel humanized monoclonal antibody binding to the tumor-associated epitope of mucin-1 (TA-MUC1) and an anti-EGFR antibody. Preclinical evidence suggests a complex interaction between TA-MUC1 and EGFR on the cell surface of epithelial tumors driving carcinogenesis processes and synergistic antibody dependent cell cytotoxicity activity with the dual targeting. Methods: Initially the study enrolled in a primary phase (PP) 20 patients with EGFR positive metastatic solid tumors, for whom no standard treatment was available. The first 6 patients were enrolled into a safety run-in phase and the number of dose-limiting toxicities (DLTs) was evaluated, in order to de-escalate the doses if needed. Patients received GAT administered at 1400 mg Q2W in combination with the glyco-optimized anti-EGFR antibody tomuzotuximab (TOM) at 1200 mg Q2W. Due to the risk of infusion related reactions (IRR), the first dose of TOM was reduced to 720 mg split over 2 consecutive days and three cycles of TOM monotherapy were given before start of treatment with GAT. As this regimen was proven safe, no DLT was observed and the initial dose remained unchanged, the study was amended to enroll in an expansion phase (EP) 30 additional patients with refractory colorectal cancer (CRC), non-small cell lung cancer (NSCLC), head and neck and breast cancers. TOM and GAT were given at the same doses and GAT treatment started already one week after the first dose of the anti-EGFR antibody. Additionally investigator had the choice to use a commercial anti-EGFR antibody in place of TOM. Results: By the time of the final analysis in January 2021, 52 refractory patients were enrolled and 50 received at least one dose of both GAT and anti-EGFR antibodies. Panitumumab (PAN) was used in 9 CRC patients. Because of the difference in treatment schedule, results are summarized separately for the 20 and 30 patients in PP and EP. Overall, the combined treatment was well tolerated and no DLT was observed in the whole study, nor related SAE or death. There were no treatment emergent adverse events (TEAEs) leading to dose interruptions or reductions in the PP and 2/30 (6.7%) patients in EP stopped both TOM and GAT. 16 IRRs were reported in 8/20 (40%) PP patients, and 40 IRRs in 10 (33.3%) EP patients. Only one event of chills was severe and only 6 events were related to GAT in the EP, all others to TOM. Other frequent TEAEs were those commonly observed with anti-EGFR treatment such as skin toxicity in 17 (85%) PP and 26 (86.7%) EP patients and hypomagnesemia in 10 (50%) PP and 7 (23.3%) EP patients. Conclusions: Combination of TA-MUC1 and EGFR targeting antibody is safe and feasible. Future studies should test this combination together with chemotherapy Clinical trial information: NCT03360734.
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Affiliation(s)
| | | | - Elena Garralda
- Early Drug Development Unit (UITM), Vall d'Hebron University Hospital and Institute of Oncology (VHIO) and Medical Oncology, Vall d’Hebron University Hospital (HUVH), Barcelona, Spain
| | - Ignacio Matos
- Early Drug Development Unit (UITM), Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Gianluca Del Conte
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Marina Macchini
- Department of Medical Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Christina C Rolling
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - Maxim Kebenko
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - Omar Saavedra Santa Gadea
- Early Drug Development Unit (UITM), Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | | | | | - Walter M. Fiedler
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
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11
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Trevisani F, Di Marco F, Capitanio U, Larcher A, Bettiga A, Dosio F, Ghidini M, Del Conte G, Vago R, Cinque A, Gianolli L, Salonia A, Briganti A, Luis-Lima S, Negrín-Mena N, Montorsi F, Porrini E. Renal Function Assessment Gap in Clinical Practice: An Awkward Truth. Kidney Blood Press Res 2020; 45:166-179. [PMID: 31982867 DOI: 10.1159/000504649] [Citation(s) in RCA: 7] [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] [Received: 09/10/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION An accurate assessment of renal function is needed in the majority of clinical settings. Unfortunately, the most used estimated glomerular filtration rate (eGFR) formulas are affected by significant errors in comparison to gold standards methods of measured GFR (mGFR). OBJECTIVE The objective of the study is to determine the extent of the error of eGFR formulas compared to the mGFR in different specific clinical settings. METHODS A total retrospectively consecutive cohort of 1,320 patients (pts) enrolled in 2 different European Hospitals (Center 1: 470 pts; Center 2: 850 pts) was collected in order to compare the most common eGFR formulas used by physicians with the most widespread mGFR methods in daily clinical practice (Iohexol Plasma Clearance -Center 1 [mGFR-iox] and Renal Scintigraphy -Center 2 [mGFR-scnt]). The study cohort was composed by urological, oncological, and nephrological pts. The agreement between eGFR and mGFR was evaluated using bias (as median of difference), precision (as interquartile range of difference) accuracy (as P30), and total deviation index. RESULTS The most accurate eGFR formula in the comparison with gold standard method (Iohexol plasma clearance) in Center 1 was represented by s-creatinine and cystatin C combined Chronic Kidney Disease-Epidemiology Collaboration-cr-cy, even though the P30 is reduced (84%) under the threshold of 60 mL/min/1.73 m2. Similar results were found in Center 2, with a wider discrepancy between mGFR-scnt and eGFR formulas due to the minor accuracy of the nuclear tool in respect to the mGFR-iox. CONCLUSIONS The loss of accuracy observed for the formulas at lower values of GFR suggests the mandatory use of gold standards methods as Iohexol Plasma Clearance to assess the correct status of renal function for critical cases. The center 2 showed lower levels of agreement between mGFR and eGFR suggesting that the errors are partially accounted for the Renal Scintigraphy technique too. In particular, we suggest the use of mGFR-iox in oncological urological and nephrological pts with an eGFR lower than 60 mL/min/1.73 m2.
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Affiliation(s)
- Francesco Trevisani
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy, .,Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy,
| | - Federico Di Marco
- Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Capitanio
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Larcher
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Arianna Bettiga
- Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Flaviano Dosio
- Nuclear Medicine Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Riccardo Vago
- Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Cinque
- Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Unit, Scientific Institute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Sergio Luis-Lima
- Department of Nephrology, University Hospital of the Canary Island, University of La Laguna, Tenerife, Spain
| | - Natalia Negrín-Mena
- Department of Nephrology, University Hospital of the Canary Island, University of La Laguna, Tenerife, Spain
| | - Francesco Montorsi
- Department of Urology, San Raffaele Scientific Institute, Milan, Italy.,Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Esteban Porrini
- Department of Nephrology, University Hospital of the Canary Island, University of La Laguna, Tenerife, Spain
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Ochsenreither S, Keilholz U, Klinghammer KF, Dicke C, Kebenko M, Garralda E, Tabernero J, Matos I, Lorusso D, Raspagliesi F, Gianni L, Del Conte G, Habel B, Baumeister H, Belli R, Zurlo A, Fiedler WM. The GATTO study: A phase I of the anti-MUC1 Gatipotuzumab (GAT) in combination with the anti-EGFR Tomuzotuximab (TO) in patients with EGFR positive solid tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps2596] [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)
| | | | | | - Christina Dicke
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - Maxim Kebenko
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
| | - Elena Garralda
- Medical Oncology Department, Vall d’Hebron University Hospital; Molecular Therapeutics Research Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Ignacio Matos
- Vall d'Hebron UNiversity Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Walter M. Fiedler
- University Medical Center Hamburg-Eppendorf, Hubertus-Wald University Cancer Center, Hamburg, Germany
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13
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Passalacqua R, Lazzarelli S, Donini M, Montironi R, Tambaro R, De Giorgi U, Pignata S, Palumbo R, Ceresoli GL, Del Conte G, Tonini G, Morelli F, Nolè F, Panni S, Rondini E, Guida A, Zucali PA, Doni L, Iezzi E, Caminiti C. Real-life clinical practice results with vinflunine in patients with relapsed platinum-treated metastatic urothelial carcinoma: an Italian multicenter study (MOVIE-GOIRC 01-2014). BMC Cancer 2017; 17:493. [PMID: 28724419 PMCID: PMC5517798 DOI: 10.1186/s12885-017-3466-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/30/2017] [Indexed: 01/06/2023] Open
Abstract
Background Vinflunine is the only chemotherapeutic agent shown to improve survival in platinum-refractory patients with metastatic transitional cell carcinoma of the urothelium (TCCU) in a phase III clinical trial, which led to product registration for this indication in Europe. The aim of this study was to assess the efficacy of vinflunine and to evaluate the prognostic significance of risk factors in a large, unselected cohort of patients with metastatic TCCU treated according to routine clinical practice. Methods This was a retrospective multicenter study. Italian cancer centers were selected if, according to the Registry of the Italian Medicines Agency (AIFA), at least four patients had been treated with vinflunine between February 2011 and June 2014, after first- or second-line platinum-based chemotherapy. The primary objective was to test whether the efficacy measured by overall survival (OS) in the registration study could be confirmed in routine clinical practice. Multivariate analysis was carried out using Cox proportional hazard model. Results A total of 217 patients were treated in 28 Italian centers. Median age was 69 years (IQR 62–76) and 84% were male; Eastern Cooperative Oncology Group performance status (ECOG PS) was ≥ 1 in 53% of patients. The median number of cycles was 4 (IQR 2–6); 29%, 35%, and 36% received an initial dose of 320 mg/m2, 280 mg/m2 or a lower dose, respectively. Median progression-free survival (PFS) and OS for the entire population was 3.2 months (2.6–3.7) and 8.1 months (6.3–8.9). A complete response was observed in six patients, partial response in 21, stable disease in 60, progressive disease in 108, with a disease control rate of 40%. Multivariate analysis showed that ECOG PS, number of metastatic sites and liver involvement were unfavorable prognostic factors for OS. Toxicity was mild, and grade 3–4 adverse effects were mainly: neutropenia (9%), anemia (6%), asthenia/fatigue (7%) and constipation (5%). Conclusions In routine clinical practice the results obtained with VFL seem to be better than the results of the registration trial and reinforce evidence supporting its use after failure of a platinum-based chemotherapy. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3466-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Silvia Lazzarelli
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Maddalena Donini
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Rosa Tambaro
- Department of Urogynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | - Ugo De Giorgi
- Oncologia Genitourinaria, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sandro Pignata
- Department of Urogynaecological Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G Pascale", IRCCS, Naples, Italy
| | | | | | | | - Giuseppe Tonini
- Dipartimento di Oncologia, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Franco Morelli
- Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Franco Nolè
- Oncologia, Istituto Europeo di Oncologia, Milan, Italy
| | - Stefano Panni
- Division of Oncology, ASST- Istituti Ospitalieri Cremona, Cremona, Italy
| | - Ermanno Rondini
- Oncologia, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Annalisa Guida
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Laura Doni
- Oncologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Elisa Iezzi
- Ricerca e Innovazione, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Caterina Caminiti
- Ricerca e Innovazione, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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Passalacqua R, Lazzarelli S, Montironi R, Tambaro R, De Giorgi U, Bernardo A, Ceresoli GL, Del Conte G, Donini M, Iezzi E, Morelli F, Nole F, Panni S, Perrucci B, Rondini E, Sabbatini R, Sequino M, Tonini G, Zucali PA, Caminiti C. Vinflunine (VFL) in patients (pts) with metastatic transitional cell carcinoma of the urothelial tract (mTCCU): Clinical outcome and prognostic factors in a nationwide, real-life setting (MOVIE trial). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | | | - Rodolfo Montironi
- Institute of Pathological Anatomy, Polithecnic University of the Marche Region, A.O. Ospedali Riuniti, Ancona, Italy
| | - Rosa Tambaro
- Istituto Nazionale Tumori IRCCS, Fondazione Pascale, Napoli, Italy
| | | | | | | | | | | | - Elisa Iezzi
- Azienda Ospedaliero Universitaria, Parma, Italy
| | - Franco Morelli
- Medical Oncology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Franco Nole
- Medical Oncology Division of Urogenital and Head and Neck Tumors. European Institute of Oncology, Milan, Italy
| | | | | | - Ermanno Rondini
- Oncologia, Ospedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
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Tosi D, Laghzali Y, Vinches M, Alexandre M, Homicsko K, Fasolo A, Del Conte G, Durigova A, Hayaoui N, Gourgou S, Gianni L, Mollevi C. Clinical Development Strategies and Outcomes in First-in-Human Trials of Monoclonal Antibodies. J Clin Oncol 2015; 33:2158-65. [PMID: 26014300 DOI: 10.1200/jco.2014.58.1082] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We conducted a comprehensive review of the design, implementation, and outcome of first-in-human (FIH) trials of monoclonal antibodies (mAbs) to clearly determine early clinical development strategies for this class of compounds. METHODS We performed a PubMed search using appropriate terms to identify reports of FIH trials of mAbs published in peer-reviewed journals between January 2000 and April 2013. RESULTS A total of 82 publications describing FIH trials were selected for analysis. Only 27 articles (33%) reported the criteria used for selecting the starting dose (SD). Dose escalation was performed using rule-based methods in 66 trials (80%). The median number of planned dose levels was five (range, two to 13). The median of the ratio between the highest planned dose and the SD was 27 (range, two to 3,333). Although in 56 studies (68%) at least one grade 3 or 4 toxicity event was reported, no dose-limiting toxicity was observed in 47 trials (57%). The highest planned dose was reached in all trials, but the maximum-tolerated dose (MTD) was defined in only 13 studies (16%). The median of the ratio between MTD and SD was eight (range, four to 1,000). The recommended phase II dose was indicated in 34 studies (41%), but in 25 (73%) of these trials, this dose was chosen without considering toxicity as the main selection criterion. CONCLUSION This literature review highlights the broad design heterogeneity of FIH trials testing mAbs. Because of the limited observed toxicity, the MTD was infrequently reached, and therefore, the recommended phase II dose for subsequent clinical trials was only tentatively defined.
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Affiliation(s)
- Diego Tosi
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy.
| | - Yassine Laghzali
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Marie Vinches
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Marie Alexandre
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Krisztian Homicsko
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Angelica Fasolo
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Gianluca Del Conte
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Anna Durigova
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Nadia Hayaoui
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Sophie Gourgou
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Luca Gianni
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
| | - Caroline Mollevi
- Diego Tosi, Yassine Laghzali, Marie Vinches, Marie Alexandre, Nadia Hayaoui, Sophie Gourgou, and Caroline Mollevi, Institut Régional du Cancer de Montpellier-Val d'Aurelle, Montpellier, France; Krisztian Homicsko, Centre Hospitalier Universitaire Vaudois, Lausanne; Anna Durigova, Geneva University Hospitals, Geneva, Switzerland; and Angelica Fasolo, Gianluca Del Conte, and Luca Gianni, San Raffaele-Scientific Institute, Milan, Italy
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Moreno García V, Olmos D, Gomez-Roca C, Cassier PA, Morales-Barrera R, Del Conte G, Gallerani E, Brunetto AT, Schöffski P, Marsoni S, Schellens JH, Penel N, Voest E, Evans J, Plummer R, Wilson RH, Soria JC, Tabernero J, Verweij J, Kaye SB. Dose–Response Relationship in Phase I Clinical Trials: A European Drug Development Network (EDDN) Collaboration Study. Clin Cancer Res 2014; 20:5663-71. [DOI: 10.1158/1078-0432.ccr-14-0719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bahleda R, Sessa C, Del Conte G, Gianni L, Capri G, Varga A, Oprea C, Daglish B, Hospitel M, Soria JC. Phase I clinical and pharmacokinetic study of ombrabulin (AVE8062) combined with cisplatin/docetaxel or carboplatin/paclitaxel in patients with advanced solid tumors. Invest New Drugs 2014; 32:1188-96. [PMID: 24898305 DOI: 10.1007/s10637-014-0119-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/22/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Preclinical evidence supports synergy between the vascular disrupting agent ombrabulin and various chemotherapy agents. Ombrabulin was combined with two standard taxane/platinum doublets in a phase I study to determine the recommended combination doses. METHODS Ombrabulin (30-min infusion, day 1 every 3 weeks) was escalated from 15.5 to 35 mg/m(2) with two chemotherapy doublets; OCD, 75 mg/m(2) cisplatin (C), day 1 (cohort 1) or day 2 (cohort 2) with 60/75 mg/m(2) docetaxel (D), day 2; and OCP, AUC5/6 carboplatin (C) and paclitaxel (P) 175 mg/m(2) (cohort 3) or 200 mg/m(2) (cohort 4), day 2. Safety, pharmacokinetics, and tumor response were evaluated. RESULTS Sixty-nine patients were treated (32 OCD, 37 OCP). Four had DLTs in cycle 1, two in cohort 1 (grade 4 febrile neutropenia, grade 4 pulmonary embolism) and one each in cohorts 2 (grade 3 ALT elevation) and 4 (grade 3 peripheral ischemia). Ombrabulin escalation in cohorts 2, 3 and 4 was halted at the highest planned dose (35 mg/m(2)). Asthenia, nausea, paresthesia, alopecia, vomiting, and stomatitis were common, as was grade 3-4 neutropenia. Ombrabulin clearance was high with a short terminal half-life and a medium volume of distribution. Pharmacokinetic analysis showed no clinically relevant drug interactions between the taxane-platinum doublet and ombrabulin or its active metabolite RPR258063, however docetaxel and carboplatin pharmacokinetics were slightly altered. One complete and 15 partial responses (10 OCD, 5 OCP; median duration 5.5 and 4.4 months, respectively) were reported. CONCLUSIONS The addition of ombrabulin to standard doses of cisplatin/docetaxel or carboplatin/paclitaxel proved feasible with manageable overlapping toxicities but appears to have limited impact on the efficacy of these doublets. Recommended combination doses are 35 mg/m(2) ombrabulin with 75 mg/m(2) cisplatin/75 mg/m(2) docetaxel or 200 mg/m(2) paclitaxel/AUC6 carboplatin, every 3 weeks.
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Affiliation(s)
- Rastislav Bahleda
- Drug Development Department (DITEP), University Paris Sud, Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France
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Sessa C, Del Conte G, Christinat A, Cresta S, Perotti A, Gallerani E, Lardelli P, Kahatt C, Alfaro V, Iglesias JL, Fernández-Teruel C, Gianni L. Phase I clinical and pharmacokinetic study of trabectedin and cisplatin given every three weeks in patients with advanced solid tumors. Invest New Drugs 2013; 31:1236-43. [DOI: 10.1007/s10637-013-9942-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022]
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Ong M, Del Conte G, Bahleda R, Mateo J, Damian S, Perotti A, Lassau N, Farace F, Lovosgaldeano J, Tunariu N, Hospitel M, Mariani P, Cohen P, Capri G, Soria JC, Gianni L, Molife LR, Sessa C. A phase I study of ombrabulin (O) combined with bevacizumab (B) in patients with advanced solid tumors. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2535 Background: O, a vascular-disrupting agent derived from combretastatin A4-phosphate, induces rapid tumor vascular shutdown via endothelial cell damage. Resistance to O may occur by surges in circulating endothelial progenitors (CEP) that repopulate the tumor vasculature. Experimental models suggest prolonged and synergistic antitumor activity when O is combined with VEGF-blockade, with reduction in CEP surge. This phase I study was performed to determine the maximum tolerated dose, safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD) and preliminary antitumor activity of O combined with B. Methods: Patients (pts) with advanced treatment-refractory solid tumors, ECOG PS ≤1, and adequate organ function were eligible. O (mg/m²) was administered intravenously (IV) on day (d)1 with B (mg/kg) IV on d2 in 21d cycles (C). A Bayesian model informed dose escalation steps. PK sampling, dynamic contrast-enhanced ultrasound (DCE-US) for tumor perfusion, and CEP samples were collected. Results: 39 pts (M:F 10:29; median age 51 years [range 25-75]) were treated at 12 dose levels combining O [8 to 50mg/m2] with B [5, 10, or 15mg/kg]. Ovary (16/39, 41%) and colon (4/39, 10%) were the most common primary sites. No C1 dose-limiting toxicities occurred in 37 evaluable pts. Drug-related grade 3-4 treatment emergent adverse events (AE) were hypertension (6/39, 15%), intestinal perforation (2/39, 5%), headache (1/39, 3%), myocardial infarction (1/39, 3%), and pulmonary embolism (1/39, 3%). 36 pts (14 ovarian) were evaluable for response by RECIST 1.1. Antitumor activity was observed at O 20mg/m2+ B 10mg/kg and above, with confirmed partial responses in 2/14 pts with ovarian primary (14%), CA125 responses in 2 further ovary/endometrial cancers lasting ≥ 6 months, and stable disease in 15/36 pts (42%) lasting ≥ 6 months in 3 pts. PK indicated no interactions of O+B. Analyses of CEP levels post O and paired DCE-US data are ongoing. Conclusions: The maximum administered dose (MAD) was O 50mg/m2 with B 15mg/kg, with no dose-limiting toxicities and vascular toxicity that was manageable. Promising antitumor activity was observed at doses below the MAD and warrants further evaluation. Clinical trial information: NCT01193595.
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Affiliation(s)
- Michael Ong
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | | | - Joaquin Mateo
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Silvia Damian
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Jimena Lovosgaldeano
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Paola Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Giuseppe Capri
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Luca Gianni
- San Raffaele Scientific Institute, Milan, Italy
| | - L Rhoda Molife
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Cristiana Sessa
- Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
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Bianchini G, Pusztai L, Karn T, Iwamoto T, Rody A, Kelly CM, Müller V, Schmidt M, Qi Y, Holtrich U, Becker S, Santarpia L, Fasolo A, Del Conte G, Zambetti M, Sotiriou C, Haibe-Kains B, Symmans WF, Gianni L. Proliferation and estrogen signaling can distinguish patients at risk for early versus late relapse among estrogen receptor positive breast cancers. Breast Cancer Res 2013; 15:R86. [PMID: 24060333 PMCID: PMC3978752 DOI: 10.1186/bcr3481] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/16/2013] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION We examined if a combination of proliferation markers and estrogen receptor (ER) activity could predict early versus late relapses in ER-positive breast cancer and inform the choice and length of adjuvant endocrine therapy. METHODS Baseline affymetrix gene-expression profiles from ER-positive patients who received no systemic therapy (n = 559), adjuvant tamoxifen for 5 years (cohort-1: n = 683, cohort-2: n = 282) and from 58 patients treated with neoadjuvant letrozole for 3 months (gene-expression available at baseline, 14 and 90 days) were analyzed. A proliferation score based on the expression of mitotic kinases (MKS) and an ER-related score (ERS) adopted from Oncotype DX® were calculated. The same analysis was performed using the Genomic Grade Index as proliferation marker and the luminal gene score from the PAM50 classifier as measure of estrogen-related genes. Median values were used to define low and high marker groups and four combinations were created. Relapses were grouped into time cohorts of 0-2.5, 0-5, 5-10 years. RESULTS In the overall 10 years period, the proportional hazards assumption was violated for several biomarker groups indicating time-dependent effects. In tamoxifen-treated patients Low-MKS/Low-ERS cancers had continuously increasing risk of relapse that was higher after 5 years than Low-MKS/High-ERS cancers [0 to 10 year, HR 3.36; p = 0.013]. High-MKS/High-ERS cancers had low risk of early relapse [0-2.5 years HR 0.13; p = 0.0006], but high risk of late relapse which was higher than in the High-MKS/Low-ERS group [after 5 years HR 3.86; p = 0.007]. The High-MKS/Low-ERS subset had most of the early relapses [0 to 2.5 years, HR 6.53; p < 0.0001] especially in node negative tumors and showed minimal response to neoadjuvant letrozole. These findings were qualitatively confirmed in a smaller independent cohort of tamoxifen-treated patients. Using different biomarkers provided similar results. CONCLUSIONS Early relapses are highest in highly proliferative/low-ERS cancers, in particular in node negative tumors. Relapses occurring after 5 years of adjuvant tamoxifen are highest among the highly-proliferative/high-ERS tumors although their risk of recurrence is modest in the first 5 years on tamoxifen. These tumors could be the best candidates for extended endocrine therapy.
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Affiliation(s)
| | | | | | - Takayuki Iwamoto
- University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Achim Rody
- University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | | | | | - Yuan Qi
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Uwe Holtrich
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Sven Becker
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Libero Santarpia
- Translational Research Unit and Istituto Toscano Tumori, Prato, Italy
| | | | | | | | - Christos Sotiriou
- Institut Jules Bordet, Univerité Libre de Bruxelies, Brussels, Belgium
| | - Benjamin Haibe-Kains
- Bioinformatics and Computational Genomics Laboratory, Institut de recherches cliniques de Montréal, Montreal, Canada
| | - W Fraser Symmans
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Luca Gianni
- San Raffaele - Scientific Institute, Milan, Italy
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Del Conte G, Bahleda R, Moreno V, Damian S, Perotti A, Lassau N, Farace F, Ong M, Stimpson SJ, Tunariu N, Micallef S, Demers B, Oprea C, Capri G, Soria JC, Sessa C, Molife LR. A phase I study of ombrabulin (O) combined with bevacizumab (B) in patients with advanced solid tumors (NCT01193595). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3080 Background: O is a vascular-disrupting agent derived from combretastatin A4-phosphate that induces rapid but transient tumor vascular shutdown. In experimental models, the combination of O with VEGF-blockade induced more regressions than O alone. This phase I study was performed to determine the maximum tolerated dose (MTD), and assess the overall safety, pharmacokinetics (PK), pharmacodynamics (PD) and preliminary antitumor activity of O plus B. Trial is funded by sanofi. Methods: Patients (pt) with advanced solid tumors, ECOG PS ≤1, and adequate organ function were eligible. Increasing doses of O (mg/m²) was administered intravenously (IV) on day (d) 1; B (5 or 10mg/kg) was administered IV on d2, in 21d cycles (C). A Bayesian design was applied to determine dose escalation steps and MTD. PK sampling was performed in C1 and C2. PD sampling for circulating endothelial cells (CEC) and progenitors (CEP) were performed throughout. Dynamic contrast-enhanced ultrasound (DCE-US) to assess tumor perfusion was performed before and after C1 and C2 dosing. Results: 25 pts (M:F 6:19; median age 49 years [range 27-75]) have been treated at 8 dose levels of O/B: 8/5 (3), 11.5/5 (4), 11.5/10 (3), 15.5/10 (3), 20/10 (3), 25/10 (3); 35/10 (3) and 42/10 (3). Ovarian cancer was the most frequent tumor type (n=11). Median Cs received was 3 (1 to 14). No DLTs were observed during C1. Drug-related grade (g) 3-4 adverse events (AE) included hypertension in 2 pts (8/5; 11.5/5) and ileal perforation in 1 pt with peritoneal carcinomatosis at laparotomy (11.5/10). A case of duodenal perforation was unlikely related (25/10). Two pts with ovarian cancer (11.5/5; 20/10) had confirmed partial responses (4.4 months (mo) and 7+ mo). 13/23 (57%) pts with ≥ 1 tumor assessment had stable disease (n=8; median 4.3 mo [1.8-9.5]; 5 ongoing). Data from cohorts 1 and 2 demonstrated no evidence of a PK interaction.17/25 patients demonstrated a peak in CEC, and 7/9 patients a peak in CEP. 4/7 DCE-US evaluable pts had >50% drop in tumor perfusion (AUC) at Day 8 of C1. Conclusions: O combined with B is well tolerated with early evidence of clinical activity. The MTD has not been reached (current dose level 50/10); cohorts of O combined with B at 15 mg/kg will be tested.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael Ong
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Sarah Jane Stimpson
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research and Royal Marsden Foundation Trust, Sutton, United Kingdom
| | | | | | | | - Giuseppe Capri
- Montabone Unit for New Drug Development, Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Cristiana Sessa
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Rhoda Molife
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
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Olmos D, A'hern RP, Marsoni S, Morales R, Gomez-Roca C, Verweij J, Voest EE, Schöffski P, Ang JE, Penel N, Schellens JH, Del Conte G, Brunetto AT, Evans TRJ, Wilson R, Gallerani E, Plummer R, Tabernero J, Soria JC, Kaye SB. Patient selection for oncology phase I trials: a multi-institutional study of prognostic factors. J Clin Oncol 2012; 30:996-1004. [PMID: 22355064 DOI: 10.1200/jco.2010.34.5074] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The appropriate selection of patients for early clinical trials presents a major challenge. Previous analyses focusing on this problem were limited by small size and by interpractice heterogeneity. This study aims to define prognostic factors to guide risk-benefit assessments by using a large patient database from multiple phase I trials. PATIENTS AND METHODS Data were collected from 2,182 eligible patients treated in phase I trials between 2005 and 2007 in 14 European institutions. We derived and validated independent prognostic factors for 90-day mortality by using multivariate logistic regression analysis. RESULTS The 90-day mortality was 16.5% with a drug-related death rate of 0.4%. Trial discontinuation within 3 weeks occurred in 14% of patients primarily because of disease progression. Eight different prognostic variables for 90-day mortality were validated: performance status (PS), albumin, lactate dehydrogenase, alkaline phosphatase, number of metastatic sites, clinical tumor growth rate, lymphocytes, and WBC. Two different models of prognostic scores for 90-day mortality were generated by using these factors, including or excluding PS; both achieved specificities of more than 85% and sensitivities of approximately 50% when using a score cutoff of 5 or higher. These models were not superior to the previously published Royal Marsden Hospital score in their ability to predict 90-day mortality. CONCLUSION Patient selection using any of these prognostic scores will reduce non-drug-related 90-day mortality among patients enrolled in phase I trials by 50%. However, this can be achieved only by an overall reduction in recruitment to phase I studies of 20%, more than half of whom would in fact have survived beyond 90 days.
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Affiliation(s)
- David Olmos
- The Royal Marsden National Health Service Foundation Trust, Sutton, United Kingdom
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Sessa C, Guibal A, Del Conte G, Rüegg C. Biomarkers of angiogenesis for the development of antiangiogenic therapies in oncology: tools or decorations? ACTA ACUST UNITED AC 2008; 5:378-91. [DOI: 10.1038/ncponc1150] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Accepted: 12/06/2007] [Indexed: 12/26/2022]
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