International Working Group consensus response evaluation criteria in lymphoma (RECIL 2017)

In recent years, the number of approved and investigational agents that can be safely administered for the treatment of lymphoma patients for a prolonged period of time has substantially increased. Many of these novel agents are evaluated in early-phase clinical trials in patients with a wide range of malignancies, including solid tumors and lymphoma. Furthermore, with the advances in genome sequencing, new "basket" clinical trial designs have emerged that select patients based on the presence of specific genetic alterations across different types of solid tumors and lymphoma. The standard response criteria currently in use for lymphoma are the Lugano Criteria which are based on [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography or bidimensional tumor measurements on computerized tomography scans. These differ from the RECIST criteria used in solid tumors, which use unidimensional measurements. The RECIL group hypothesized that single-dimension measurement could be used to assess response to therapy in lymphoma patients, producing results similar to the standard criteria. We tested this hypothesis by analyzing 47 828 imaging measurements from 2983 individual adult and pediatric lymphoma patients enrolled on 10 multicenter clinical trials and developed new lymphoma response criteria (RECIL 2017). We demonstrate that assessment of tumor burden in lymphoma clinical trials can use the sum of longest diameters of a maximum of three target lesions. Furthermore, we introduced a new provisional category of a minor response. We also clarified response assessment in patients receiving novel immune therapy and targeted agents that generate unique imaging situations.

Abstract OT1-4-05: Phase I dose-escalation study of oral administration of abexinostat (S 78454, PCI-24781) given with tamoxifen 20 mg in the treatment of patients with advanced breast cancer

Background: Around 20% of patients initially diagnosed with local stage breast cancer will develop metastatic breast cancer, with an about 23% median 5-year survival rate from diagnosis. Patients whose tumors express ER and PR (ER+, PR+) are frequently treated with antiestrogens and aromatase inhibitors (AI). Primary and secondary resistances to hormone therapy lead to tumor progression and shorten survival expectancy.

In preclinical models, treatment of ER+ breast cancer cells with HDAC inhibitors leads to transcriptional down regulation and post-translation modification of the ER. This treatment reverses tamoxifen-induced ER stabilization, followed by induction of pro-apoptotic genes and apoptotic cell death. Epigenetic modulation of ER signaling by HDAC inhibitor represents a novel strategy to reverse hormonal resistance.

Abexinostat is a hydroxamate-based pan-HDAC inhibitor of class I/II, in phase I/II clinical trials. Abexinostat inhibits tumor growth in a panel of commonly used ER+ breast cancer cell lines including ATCC and NCI. Abexinostat potentiates the anti-tumor activity of tamoxifen in vitro in ER+ breast cancer cells, by down-regulation of ER protein expression and its pro-growth response genes (PgR, Cyclin D). It abrogates AKT cell signaling by directly down-regulating AKT1 at the transcriptional and post-translational level. Furthermore, cell death is induced by activating the apoptotic program.

Study design: phase I dose-finding of abexinostat for 4 consecutive days each week of a 3-week cycle given in combination with daily tamoxifen at 20 mg. Dose levels of abexinostat, 120, 140 and 160 mg bid, of 3 to 6 patients will be explored. Two dose de-escalation levels (100/80 mg) are allowed depending on toxicity. Dose-Limiting Toxicities assessment will be done at the end of cycle 2. Once the Maximum Tolerated Dose is determined up to 20 additional patients will be treated at the recommended dose in a confirmatory cohort.

Main eligibility criteria: Female≥ 18 years with histologically confirmed primary adenocarcinoma of the breast; ER+ (IHC≥ 10%), HER2- tumors. Patients must have had tumor progression on an AI administered for advanced/metastatic disease OR recurrence while on or within 12 months of completion of adjuvant AI, OR recurrence within 12 months of adjuvant tamoxifen completion and must have had up to 3 prior chemotherapy regimens in metastatic/advanced setting. Patients must have progressive tumor measurable or evaluable (RECIST criteria version 1.1).

Main objectives: Primary: to assess the safety and the tolerability of the combination treatment and to determine a recommended Phase II dose. Secondary: to determine the pharmacokinetic profile of both the drugs in combination and metabolites; to measure tumor response to the combination; to measure drug target inhibition by assessing acetylation state of histones proteins, HbF level and HDAC2 expression in peripheral blood mononuclear cells and in peripheral blood samples; to assess circulating tumor cells; to analyze biomarkers on tissue sample and pharmacogenomic of genes implicated in the metabolism of combination (optional).

Status: Study opened in September 2012, currently recruiting.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-4-05.

Tamoxifen-related uterine carcinosarcomas occur under/after prolonged treatment: report of five cases and review of the literature

The risk of tamoxifen-related endometrial adenocarcinoma is well established with daily dose and treatment duration of adjuvant tamoxifen as risk factors. There have also been in the past years, a few descriptions of uterine nonepithelial malignancies occurring after tamoxifen. We describe five recent cases of uterine carcinosarcomas occurring under/after tamoxifen administered in an adjuvant setting. None of these patients had received prior pelvic radiation therapy. Their median age at the diagnosis of breast cancer was 58 years (41-68), and 69 years (50-84) at the diagnosis of uterine carcinosarcoma. The median length of exposure to tamoxifen was 9 years (5-20), and the median time from the initiation of tamoxifen to the diagnosis of the uterine malignancy (latency period) 9 years (7-20). All patients presented with an advanced stage (IIA-IVA). Our data, together with those of the literature, plead for a causal role of a prolonged exposure to tamoxifen on the subsequent development of uterine carcinosarcoma. The long latency period observed even in patients receiving only 5 years of treatment leads us also to consider a prolonged gynecologic follow-up of the patients.

Tamoxifen-related uterine carcinosarcomas occur under/after prolonged treatment: Report of five cases and review of the literature

The risk of tamoxifen-related endometrial adenocarcinoma is well established with daily dose and treatment duration of adjuvant tamoxifen as risk factors. There have also been in the past years, a few descriptions of uterine nonepithelial malignancies occuring after tamoxifen. We describe five recent cases of uterine carcinosarcomas occurring under/after tamoxifen administered in an adjuvant setting. None of these patients had received prior pelvic radiation therapy. Their median age at the diagnosis of breast cancer was 58 years (41–68), and 69 years (50–84) at the diagnosis of uterine carcinosarcoma. The median length of exposure to tamoxifen was 9 years (5–20), and the median time from the initiation of tamoxifen to the diagnosis of the uterine malignancy (latency period) 9 years (7–20). All patients presented with an advanced stage (IIA-IVA). Our data, together with those of the literature, plead for a causal role of a prolonged exposure to tamoxifen on the subsequent development of uterine carcinosarcoma. The long latency period observed even in patients receiving only 5 years of treatment leads us also to consider a prolonged gynecologic follow-up of the patients.

[Inspiratory stridor as the only symptom of esophageal foreign body]

An eleven month old infant girl presented with a two-month history of inspiratory stridor. Analysis of her symptoms indicated airway obstruction located in the middle of the trachea; a barium esophagogram revealed an esophageal foreign body with tracheal compression. By endoscopy, a chestnut shell was extracted from the esophagus. In infancy, esophageal foreign bodies may cause mainly respiratory symptoms.