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Skubleny D, Ghosh S, Spratlin J, Schiller DE, Rayat GR. Feature-specific quantile normalization and feature-specific mean-variance normalization deliver robust bi-directional classification and feature selection performance between microarray and RNAseq data. BMC Bioinformatics 2024; 25:136. [PMID: 38549046 DOI: 10.1186/s12859-024-05759-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Cross-platform normalization seeks to minimize technological bias between microarray and RNAseq whole-transcriptome data. Incorporating multiple gene expression platforms permits external validation of experimental findings, and augments training sets for machine learning models. Here, we compare the performance of Feature Specific Quantile Normalization (FSQN) to a previously used but unvalidated and uncharacterized method we label as Feature Specific Mean Variance Normalization (FSMVN). We evaluate the performance of these methods for bidirectional normalization in the context of nested feature selection. RESULTS FSQN and FSMVN provided clinically equivalent bidirectional model performance with and without feature selection for colon CMS and breast PAM50 classification. Using principal component analysis, we determine that these methods eliminate batch effects related to technological platforms. Without feature selection, no statistical difference was identified between the performance of FSQN and FSMVN of cross-platform data compared to within-platform distributions. Under optimal feature selection conditions, balanced accuracy was FSQN and FSMVN were statistically equivalent to the within-platform distribution performance in multivariable linear regression analysis. FSQN and FSMVN also provided similar performance to within-platform distributions as the number of selected genes used to create models decreases. CONCLUSIONS In the context of generating supervised machine learning classifiers for molecular subtypes, FSQN and FSMVN are equally effective. Under optimal modeling conditions, FSQN and FSMVN provide equivalent model accuracy performance on cross-platform normalization data compared to within-platform data. Using cross-platform data should still be approached with caution as subtle performance differences may exist depending on the classification problem, training, and testing distributions.
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Affiliation(s)
- Daniel Skubleny
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada.
| | - Sunita Ghosh
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
- Department of Mathematical and Statistical Sciences, Faculty of Science, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Jennifer Spratlin
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Daniel E Schiller
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Gina R Rayat
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R3, Canada
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Skubleny D, Spratlin J, Ghosh S, Greiner R, Schiller DE, Rayat GR. Individual Survival Distributions Generated by Multi-Task Logistic Regression Yield a New Perspective on Molecular and Clinical Prognostic Factors in Gastric Adenocarcinoma. Cancers (Basel) 2024; 16:786. [PMID: 38398176 PMCID: PMC10887062 DOI: 10.3390/cancers16040786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Recent advances in our understanding of gastric cancer biology have prompted a shift towards more personalized therapy. However, results are based on population-based survival analyses, which evaluate the average survival effects of entire treatment groups or single prognostic variables. This study uses a personalized survival modelling approach called individual survival distributions (ISDs) with the multi-task logistic regression (MTLR) model to provide novel insight into personalized survival in gastric adenocarcinoma. We performed a pooled analysis using 1043 patients from a previously characterized database annotated with molecular subtypes from the Cancer Genome Atlas, Asian Cancer Research Group, and tumour microenvironment (TME) score. The MTLR model achieved a 5-fold cross-validated concordance index of 72.1 ± 3.3%. This model found that the TME score and chemotherapy had similar survival effects over the entire study time. The TME score provided the greatest survival benefit beyond a 5-year follow-up. Stage III and Stage IV disease contributed the greatest negative effect on survival. The MTLR model weights were significantly correlated with the Cox model coefficients (Pearson coefficient = 0.86, p < 0.0001). We illustrate how ISDs can accurately predict the survival time for each patient, which is especially relevant in cases of molecular subtype heterogeneity. This study provides evidence that the TME score is principally associated with long-term survival in gastric adenocarcinoma. Additional external validation and investigation into the clinical utility of this ISD model in gastric cancer is an area of future research.
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Affiliation(s)
- Daniel Skubleny
- Department of Surgery, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada; (D.E.S.); (G.R.R.)
| | - Jennifer Spratlin
- Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.S.); (S.G.)
| | - Sunita Ghosh
- Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.S.); (S.G.)
- Department of Mathematical and Statistical Sciences, Faculty of Science, College of Natural and Applied Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Russell Greiner
- Department of Computing Science, Faculty of Science, College of Natural and Applied Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Alberta Machine Intelligence Institute, Edmonton, AB T5J 3B1, Canada
| | - Daniel E. Schiller
- Department of Surgery, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada; (D.E.S.); (G.R.R.)
| | - Gina R. Rayat
- Department of Surgery, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada; (D.E.S.); (G.R.R.)
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Lin CC, Garralda E, Schöffski P, Hong DS, Siu LL, Martin M, Maur M, Hui R, Soo RA, Chiu J, Zhang T, Ma B, Kyi C, Tan DSW, Cassier PA, Sarantopoulos J, Weickhardt A, Carvajal RD, Spratlin J, Esaki T, Rolland F, Akerley W, Deschler-Baier B, Rispoli L, Samant TS, Chowdhury NR, Gusenleitner D, Kwak EL, Askoxylakis V, De Braud F. A phase 2, multicenter, open-label study of anti-LAG-3 ieramilimab in combination with anti-PD-1 spartalizumab in patients with advanced solid malignancies. Oncoimmunology 2023; 13:2290787. [PMID: 38170160 PMCID: PMC10761073 DOI: 10.1080/2162402x.2023.2290787] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
Ieramilimab, a humanized anti-LAG-3 monoclonal antibody, was well tolerated in combination with the anti-PD-1 antibody spartalizumab in a phase 1 study. This phase 2 study aimed to further investigate the efficacy and safety of combination treatment in patients with selected advanced (locally advanced or metastatic) solid malignancies. Eligible patients with non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma (RCC), mesothelioma, and triple-negative breast cancer (TNBC) were grouped depending on prior anti-PD-1/L1 therapy (anti-PD-1/L1 naive or anti-PD-1/L1 pretreated). Patients received ieramilimab (400 mg) followed by spartalizumab (300 mg) every 3 weeks. The primary endpoint was objective response rate (ORR), along with safety, pharmacokinetics, and biomarker assessments. Of 235 patients, 142 were naive to anti-PD-1/L1 and 93 were pretreated with anti-PD-1/L1 antibodies. Durable responses (>24 months) were seen across all indications for patients naive to anti-PD-1/L1 and in melanoma and RCC patients pretreated with anti-PD1/L1. The most frequent study drug-related AEs were pruritus (15.5%), fatigue (10.6%), and rash (10.6%) in patients naive to anti-PD-1/L1 and fatigue (18.3%), rash (14.0%), and nausea (10.8%) in anti-PD-1/L1 pretreated patients. Biomarker assessment indicated higher expression of T-cell-inflamed gene signature at baseline among responding patients. Response to treatment was durable (>24 months) in some patients across all enrolled indications, and safety findings were in accordance with previous and current studies exploring LAG-3/PD-1 blockade.
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Affiliation(s)
- Chia-Chi Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Elena Garralda
- Vall d’Hebron Institute of Oncology (VHIO), Vall d´Hebron Hospital, Barcelona, Spain
| | - Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - David S. Hong
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas and MD Anderson Cancer Center, Houston, TX, USA
| | - Lillian L. Siu
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Miguel Martin
- Gregorio Marañón Hospital, Universidad Complutense, Madrid, Spain
| | - Michela Maur
- Oncology and Haematology Department, Università degli Studi di Modena e Reggio Emilia, Emilia-Romagna, Italy
| | - Rina Hui
- Department of Medical Oncology, Westmead Hospital and the University of Sydney, Sydney, Australia
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Joanne Chiu
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Tian Zhang
- Department of Medicine, Duke Cancer Institute, Durham, NC, USA
| | - Brigette Ma
- Phase 1 Clinical Trial Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Chrisann Kyi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel SW Tan
- National Cancer Centre, Singapore and Duke-NUS Medical School, Singapore
| | | | - John Sarantopoulos
- Institute for Drug Development, Mays Cancer Center at University of Texas Health San Antonio MD Anderson Cancer Center, San Antonio, TX, USA
| | - Andrew Weickhardt
- Medical Oncology Dept, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Victoria, Australia
| | - Richard D. Carvajal
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | | | - Taito Esaki
- Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Fréderic Rolland
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – Centre René Gauducheau, Nantes, France
| | - Wallace Akerley
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Barbara Deschler-Baier
- Translational Oncology, Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | | | - Eunice L. Kwak
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | | | - Filippo De Braud
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy and Oncology and Hemato-oncology Department, University of Milan, Milan, Italy
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Abraham AG, Riauka T, Hudson M, Ghosh S, Zebak S, Alba V, Vaihenberg E, Warkentin H, Tankel K, Severin D, Bedard E, Spratlin J, Mulder K, Joseph K. 18F-Fluorodeoxyglucose Positron Emission Tomography Parameters can Predict Long-Term Outcome Following Trimodality Treatment for Oesophageal Cancer. Clin Oncol (R Coll Radiol) 2023; 35:177-187. [PMID: 36402622 DOI: 10.1016/j.clon.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/06/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
AIMS 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT) is routinely used for the pre-treatment staging of oesophageal or gastro-oesophageal junction cancers (EGEJC). The aim of this study was to identify objective 18FDG-PET/CT-derived parameters that can aid in predicting the patterns of recurrence and prognostication in patients with EGEJC. PATIENTS AND METHODS EGEJC patients referred for consideration of preoperative chemoradiation therapy were identified and clinicopathological data were collected. 18FDG-PET/CT imaging data were reviewed and correlated with treatment outcomes. Maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis were assessed and association with recurrence-free survival (RFS), locoregional recurrence-free survival (LR-RFS), oesophageal cancer-specific survival (ECSS) and overall survival were evaluated using receiver operating characteristic curves, as well as Cox regression and Kaplan-Meier models. RESULTS In total, 191 EGEJC patients completed trimodality treatment and 164 with 18FDG-PET/CT data were included in this analysis. At the time of analysis, 15 (9.1%), 70 (42.7%) and two (1.2%) patients were noted to have locoregional, distant and both locoregional and distant metastases, respectively. The median RFS was 30 months (9.6-50.4) and the 5-year RFS was 31.1%. The 5-year overall survival and ECSS were both noted to be 34.8%. Pre-treatment MTV25 > 28.5 cm3 (P = 0.029), MTV40 > 12.4 cm3 (P = 0.018) and MTV50 > 10.2 cm3 (P = 0.005) predicted for worse LR-RFS, ECSS and overall survival for MTV definition of voxels ≥25%, 40% and 50% of SUVmax. CONCLUSION 18FDG-PET/CT parameters MTV and total lesion glycolysis are useful prognostic tools to predict for LR-RFS, ECSS and overall survival in EGEJC. MTV had the highest accuracy in predicting clinical outcomes. The volume cut-off points we identified for different MTV thresholds predicted outcomes with significant accuracy and may potentially be used for decision making in clinical practice.
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Affiliation(s)
- A G Abraham
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - T Riauka
- Department of Nuclear Medicine, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, Canada
| | - M Hudson
- Department of Nuclear Medicine, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - S Ghosh
- Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - S Zebak
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - V Alba
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - E Vaihenberg
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - H Warkentin
- Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, Canada
| | - K Tankel
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - D Severin
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - E Bedard
- Department of Thoracic Surgery, Royal Alexandra Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - J Spratlin
- Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - K Mulder
- Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada
| | - K Joseph
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada.
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Skubleny D, Garg S, Wickware J, Purich K, Ghosh S, Spratlin J, Schiller DE, Rayat GR. Murine and Human Gastric Tissue Establishes Organoids after 48 Hours of Cold Ischemia Time during Shipment. Biomedicines 2023; 11:biomedicines11010151. [PMID: 36672658 PMCID: PMC9855865 DOI: 10.3390/biomedicines11010151] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/25/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023] Open
Abstract
An inadequate supply of fresh tissue is a major limitation of three-dimensional patient-derived gastric organoid research. We propose that tissue procurement for organoid culture could be increased by developing a cold storage shipment protocol for fresh surgical tissues. Sixty stomach specimens from C57BL/6J mice were resected, of which forty-five were stored in Hank's Balanced Salt (HBSS), University of Wisconsin (UW), or Histidine-Tryptophan-Ketoglutarate (HTK) solutions for subsequent organoid culture. Stomachs were dissociated and processed into gastric organoids as fresh tissue or after transport at 4 °C for 24 or 48 h. All gastric organoid cultures were established and maintained for 10 passages. Cold storage for 24 or 48 h did not significantly affect organoid viability. Although cold storage was associated with decreased organoid growth rate, there were no differences in viability, cytotoxic dose response, or LGR5 and TROY stem cell gene expression compared to organoids prepared from fresh tissue. As a proof of concept, six human gastric cancer organoids were established after 24 or 48 h of storage. Patient-derived gastric organoids from mouse and human gastric tissue can be established after 48 h of cold ischemia. Our method, which only requires ice packs, standard shipping containers, and HBSS is feasible and reliable. This method does not affect the reliability of downstream dose-response assays and maintains organoid viability for at least 10 passages. The shipment of fresh tissue for organoid procurement could serve to enhance multicenter collaboration and achieve more elaborate or controlled organoid experimentation.
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Affiliation(s)
- Daniel Skubleny
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Saurabh Garg
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Jim Wickware
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Kieran Purich
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Sunita Ghosh
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Department of Mathematical and Statistical Sciences, Faculty of Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Jennifer Spratlin
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Dan E. Schiller
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Gina R. Rayat
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Correspondence:
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Miller W, Provencher D, Chu QC, Jonker D, Oza A, Batist G, Jamal R, Goel R, Hilton J, Spratlin J, Smith P, Darling I, Stille J, Fortier C, Mangat R, Polzer J. 743P A phase Ib dose escalation study of CD137 mAb agonist OC-001 as monotherapy in patients with advanced or metastatic cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Anaka M, Lee M, Lim E, Ghosh S, Cheung WY, Spratlin J. Changing Rates of Goals of Care Designations in Patients With Advanced Pancreatic Cancer During a Multifactorial Advanced Care Planning Initiative: A Real-World Evidence Study. JCO Oncol Pract 2022; 18:e869-e876. [PMID: 35108030 DOI: 10.1200/op.21.00649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/03/2021] [Accepted: 01/10/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Goals of care (GoC) designations are an important part of advanced care planning (ACP) for patients with incurable cancers. Studies of outpatient oncology records show that most patients do not have GoC documented. We performed a retrospective analysis of changes in GoC designations in patients with advanced pancreatic cancer in Northern Alberta, Canada, during a system-wide ACP quality improvement initiative. METHODS Four hundred seventy-one patients with newly diagnosis of advanced, non-neuroendocrine pancreatic cancer between 2010 and 2015 in Northern Alberta, Canada, were included. The ACP initiation launched April 2014, and included educational materials for patients and families, and a coded system of GoC designations describing care philosophies and preferences for resuscitation and medical interventions. Data sources included the Alberta Cancer Registry and oncology-specific electronic medical records. RESULTS 25.5% of patients had a documented GoC, which increased over the study period (Mantel-Haenszel test-of-trend P < .001; increased from 7.8% in 2010 to 50.0% in 2015). GoC designations occurred later in patients who received palliative chemotherapy versus those who did not (median 130 days from diagnosis [95% CI, 76.019 to 183.981] v 36 days [95% CI, 28.107 to 43.893]; P < .001), and coincided with the end of treatment (median 4.5 days from last treatment). 64.8% of GoC designations were documented by palliative care physicians, but the proportion documented by medical oncologists increased with time (Mantel-Haenszel test-of-trend P = .020; increased from 0% in 2010 to 52.1% in 2015). CONCLUSION GoC documentation increased in the outpatient records of patients with advanced pancreatic cancer during the system-wide, multifactorial ACP initiative. GoC documentation by medical oncologists also increased. These data provide real-world evidence supporting the impact of a specific ACP initiative to improve rates of GoC designation in patients with advanced cancer.
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Affiliation(s)
| | - Minji Lee
- University of Alberta, Edmonton, AB, Canada
| | - Elisa Lim
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Sunita Ghosh
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Winson Y Cheung
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Sangha R, Davies NM, Namdar A, Chu M, Spratlin J, Beauchamp E, Berthiaume LG, Mackey JR. Novel, First-In-Human, Oral PCLX-001 Treatment in a Patient with Relapsed Diffuse Large B-Cell Lymphoma. Curr Oncol 2022; 29:1939-1946. [PMID: 35323358 PMCID: PMC8947478 DOI: 10.3390/curroncol29030158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/19/2022] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 11/24/2022] Open
Abstract
Patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) have limited treatment options, particularly if they are transplantation or chimeric antigen receptor (CAR) T-cell ineligible, and novel therapeutics are needed. An 86-year-old woman with relapsed DLBCL received a novel, first-in-class small molecule inhibitor of N-myristoyltransferase (NMT) as the initial patient on a phase I dose escalation trial. Daily oral administration of 20 mg PCLX-001 tablets produced a pharmacokinetic profile suitable for single daily dosing: rapid oral absorption, followed by an apparent elimination half-life of 16 h, without systemic accumulation of drug by day 15. Pharmacodynamic tests showed no clear change in NMT1 and NMT2 levels or selected NMT substrate Lyn and HGAL protein levels in normal circulating blood mononuclear cells, suggesting a higher dose will be required for normal tissue toxicity. The patient did not experience any dose-limiting toxicities but had disease progression after 28 days of study therapy. Dose escalation continues in other patients in this first-in-human study of a new class of anticancer drug. We conclude that PCLX-001 oral monotherapy has suitable pharmacokinetic parameters for dose escalation, and that higher doses are required to achieve pharmacodynamic evidence of on-target activity in normal tissues. The current protocol is appropriately designed to achieve these ends, and the study proceeds without modification.
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Affiliation(s)
- Randeep Sangha
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G1Z2, Canada; (M.C.); (J.S.); (J.R.M.)
- Correspondence: ; Tel.: +1-780-432-8248
| | - Neal M. Davies
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB T6G2H1, Canada;
| | - Afshin Namdar
- Department of Cell Biology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G2H7, Canada; (A.N.); (L.G.B.)
| | - Michael Chu
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G1Z2, Canada; (M.C.); (J.S.); (J.R.M.)
| | - Jennifer Spratlin
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G1Z2, Canada; (M.C.); (J.S.); (J.R.M.)
| | | | - Luc G. Berthiaume
- Department of Cell Biology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G2H7, Canada; (A.N.); (L.G.B.)
- Pacylex Pharmaceuticals Inc., Edmonton, AB T5J4P6, Canada;
| | - John R. Mackey
- Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G1Z2, Canada; (M.C.); (J.S.); (J.R.M.)
- Pacylex Pharmaceuticals Inc., Edmonton, AB T5J4P6, Canada;
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Yang R, Younis M, Joseph K, Ghosh S, Nijjar T, Severin D, Tankel K, Tamhane Y, Fairchild A, Spratlin J, Mulder K, Usmani N. Impact of dose-capping chemotherapy in concurrent chemoradiotherapy in rectal cancer patients. J Oncol Pharm Pract 2020; 27:1596-1603. [PMID: 33023385 DOI: 10.1177/1078155220962192] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The study evaluated the effect of chemotherapy dose-capping on disease recurrence, toxicity and survival of rectal cancer patients treated with chemoradiotherapy (CRT). METHODS 601 consecutive rectal cancer patients treated with concurrent CRT were retrospectively analysed. Dose-capped patients were defined as having a body surface area (BSA) ≥2.0 m2 and who received <95% full weight-based chemotherapy dose. Binary logistic regression was used to study the factors associated with the outcome variables (capped vs. uncapped). Kaplan-Meier estimation evaluated significant predictors of survival. RESULTS The median follow-up time was 7.54 years. The rate of disease recurrence was significantly higher in dose-capped patients (35%) compared to those without dose-capping (24%, P = 0.016). The adjusted odds ratio for dose-capped patients experiencing recurrence was 1.64 compared to uncapped patients (95% CI, 1.10-2.43). Overall, dose-capped patients were less likely to experience significant toxicity requiring dose reduction and/or treatment break when compared to uncapped patients (15% and 28% respectively, P = 0.008).There was significant differences in PFS between capped and uncapped group (77% vs. 85%; P = 0.017). The 5-year OS in the capped group was 75.0%, and 80% in the uncapped group (P = 0.149). CONCLUSIONS Rectal cancer patients treated with dose-capped CRT were at increased risk of disease recurrence. Patients dosed by actual BSA did experience excessive toxicity compared to dose-capped group. We recommend that chemotherapy dose-capping based on BSA should not be practiced in rectal cancer patients undergoing CRT.
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Affiliation(s)
- Ran Yang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Moftah Younis
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Kurian Joseph
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Sunita Ghosh
- Division of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Tirath Nijjar
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Diane Severin
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Keith Tankel
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Yash Tamhane
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Alysa Fairchild
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Jennifer Spratlin
- Division of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Karen Mulder
- Division of Medical Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Faculty of Medicine and Dentistry, University of Alberta and Cross Cancer Institute, Edmonton, AB, Canada
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10
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Abdel-Rahman O, Spratlin J, Koski S. Vitamin and herbal supplements’ use among patients with advanced gastrointestinal cancers included in eight clinical trials. J Cancer Res Clin Oncol 2020; 146:2089-2097. [DOI: 10.1007/s00432-020-03201-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/24/2020] [Indexed: 12/28/2022]
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11
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Javle M, Borbath I, Clarke S, Hitre E, Louvet C, Macarulla T, Oh D, Spratlin J, Valle J, Weiss K, Berman C, Howland M, Ye Y, Cho T, Moran S, Abou-Alfa G. Phase 3 multicenter, open-label, randomized study of infigratinib versus gemcitabine plus cisplatin in the first-line treatment of patients with advanced cholangiocarcinoma with FGFR2 gene fusions/translocations: the PROOF trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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12
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Amin A, Plimack ER, Ernstoff MS, Lewis LD, Bauer TM, McDermott DF, Carducci M, Kollmannsberger C, Rini BI, Heng DYC, Knox J, Voss MH, Spratlin J, Berghorn E, Yang L, Hammers HJ. Correction to: Safety and efficacy of nivolumab in combination with sunitinib or pazopanib in advanced or metastatic renal cell carcinoma: the CheckMate 016 study. J Immunother Cancer 2019; 7:73. [PMID: 30871617 PMCID: PMC6416882 DOI: 10.1186/s40425-019-0559-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 01/18/2023] Open
Affiliation(s)
- Asim Amin
- Immunotherapy program, Levine Cancer Institute, Carolinas HealthCare System, 1024 Morehead Medical Drive, Charlotte, NC, 28204, USA.
| | - Elizabeth R Plimack
- Division of Genitourinary Medical Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
| | - Marc S Ernstoff
- Division of Oncology, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14203, USA
| | - Lionel D Lewis
- Department of Medicine at The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Todd M Bauer
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN, 37203, USA
| | - David F McDermott
- Department of Medicine, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA, 02215, USA
| | - Michael Carducci
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, 21287, USA
| | | | - Brian I Rini
- Lerner College of Medicine, Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, 44195, USA
| | - Daniel Y C Heng
- Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB, T2N 4N2, Canada
| | - Jennifer Knox
- Cancer Clinical Research Unit (CCRU), Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada
| | - Martin H Voss
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Jennifer Spratlin
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, T6G 1Z2, Canada
| | - Elmer Berghorn
- Oncology - Global Clinical Research, Bristol-Myers Squibb, Princeton, NJ, 08541, USA
| | - Lingfeng Yang
- Oncology - Global Clinical Research, Bristol-Myers Squibb, Princeton, NJ, 08541, USA
| | - Hans J Hammers
- Department of Internal Medicine, UT Southwestern - Kidney Cancer Program, Dallas, TX, 75390, USA
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13
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Xu Y, Steckle S, Lui A, Dixon E, Ball CG, Sutherland FR, Spratlin J, Bathe OF. Effect of proximity to specialty care on outcomes for biliary cancers: a population-based retrospective cohort study. CMAJ Open 2019; 7:E131-E139. [PMID: 30819693 PMCID: PMC6397033 DOI: 10.9778/cmajo.20180082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The management of biliary cancers is complex and requires a multidisciplinary approach. Because it is unknown how access to specialty care affects resource use and survival in patients with biliary cancer, we conducted a population-based study to understand the needs of these patients and the relation of geography to care delivery and clinical outcomes for biliary cancer in Alberta. METHODS All patients with biliary cancer diagnosed in Alberta from Sept. 1, 2001, to Dec. 31, 2015 were included in this population-based retrospective cohort study. Data were extracted from administrative databases and the 2011 Canadian census. Driving time and types of medical services were tracked throughout the patients' clinical course. We categorized proximity to specialty care according to driving time to the nearest specialist. The primary outcome was overall survival. We conducted Cox proportional hazard regression to evaluate the effects of driving time on overall survival and multivariate logistic regression to evaluate the effect of driving time on treatment types and stage at diagnosis. RESULTS We identified 1610 patients with biliary cancer; they accounted for 117 381 medical encounters. Patients living 120 minutes or more from the nearest hepatobiliary surgeon and from the nearest cancer centre had significantly decreased survival (hazard ratio [and 95% confidence interval (CI)] 1.27 [1.17-1.37]) and 1.27 [1.14-1.41], respectively). Location of residence was not associated with advanced stage or probability of undergoing surgery or a biliary drainage procedure. Patients who lived 120 minutes or more from a cancer centre were less likely than those who lived less than 120 minutes away to receive chemotherapy (odds ratio 0.51, 95% CI 0.29-0.88). Subgroup analysis showed that the effect of travel time was especially pronounced among those who received only best supportive care and those who had biliary drains. INTERPRETATION Geography and accessibility to specialty care affected survival in patients with biliary cancer. Further study is required to understand how patients with biliary drains and those receiving best supportive care are affected by proximity to specialty care. This will aid in the identification of strategies to provide improved care for this subgroup who are particularly affected by geography.
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Affiliation(s)
- Yuan Xu
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Sue Steckle
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Arthur Lui
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Elijah Dixon
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Chad G Ball
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Francis R Sutherland
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Jennifer Spratlin
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta
| | - Oliver F Bathe
- Beijing You-An Hospital (Xu), Capital Medical University, Beijing, China; Departments of Community Health Sciences (Xu, Dixon) and Surgery (Xu, Dixon, Ball, Sutherland, Bathe), University of Calgary; Innervative Strategies (Steckle), Calgary, Alta.; Department of Oncology (Lui, Spratlin), University of Alberta, Edmonton, Alta.; Department of Oncology (Dixon, Ball, Sutherland, Bathe), University of Calgary, Calgary, Alta.
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14
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Amin A, Plimack ER, Ernstoff MS, Lewis LD, Bauer TM, McDermott DF, Carducci M, Kollmannsberger C, Rini BI, Heng DYC, Knox J, Voss MH, Spratlin J, Berghorn E, Yang L, Hammers HJ. Safety and efficacy of nivolumab in combination with sunitinib or pazopanib in advanced or metastatic renal cell carcinoma: the CheckMate 016 study. J Immunother Cancer 2018; 6:109. [PMID: 30348216 PMCID: PMC6196426 DOI: 10.1186/s40425-018-0420-0] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/26/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Combination treatment with immune checkpoint inhibitors and antiangiogenic drugs has shown encouraging preliminary antitumor activity across various tumor types including advanced or metastatic renal cell carcinoma (aRCC). The open-label, parallel-cohort, dose-escalation, phase I CheckMate 016 study evaluated the efficacy and safety of nivolumab in combination with antiangiogenic tyrosine kinase inhibitors or ipilimumab. Long-term outcomes from this study for the combination of nivolumab plus sunitinib or pazopanib in aRCC are presented. METHODS Patients with aRCC received nivolumab plus either sunitinib (50 mg/day, 4 weeks on/2 weeks off; N + S) or pazopanib (800 mg/day; N + P) until progression/unacceptable toxicity. The nivolumab starting dose was 2 mg/kg every 3 weeks, with planned escalation to 5 mg/kg every 3 weeks. Primary endpoints were safety and tolerability; antitumor activity was a secondary endpoint. RESULTS Arm N + S enrolled 33 patients, 19 of whom were treatment-naïve; this arm advanced to the expansion phase. Median follow-up was 50.0 months. Patients experienced high frequencies of adverse events (AEs) including treatment-related AEs (100%), grade 3/4 treatment-related AEs (82%), and treatment-related AEs leading to discontinuation (39%). Investigator-assessed objective response rate (ORR) was 55% (18/33) and median progression-free survival (PFS) was 12.7 months. Median overall survival (OS) was not reached. Arm N + P enrolled 20 patients, all had ≥1 prior systemic therapy; this arm was closed due to dose-limiting toxicities and did not proceed to expansion. Median follow-up was 27.1 months. Patients treated with N + P experienced high frequencies of AEs including treatment-related AEs (100%), grade 3/4 treatment-related AEs (70%), and treatment-related AEs leading to discontinuation (25%). Investigator-assessed ORR was 45% (9/20) and median PFS was 7.2 months. Median OS was 27.9 months. CONCLUSIONS The addition of standard doses of sunitinib or pazopanib to nivolumab resulted in a high incidence of high-grade toxicities limiting future development of either combination regimen. While there was no adverse impact on response and the OS outcome was notable, the findings suggest that the success of combination regimens based on immune checkpoint inhibitors and antiangiogenic drugs may be dependent on careful selection of the antiangiogenic component and dose. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01472081 . Registered 16 November 2011.
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Affiliation(s)
- Asim Amin
- Immunotherapy program, Levine Cancer Institute, Carolinas HealthCare System, 1024 Morehead Medical Drive, Charlotte, NC 28204 USA
| | - Elizabeth R Plimack
- Division of Genitourinary Medical Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111 USA
| | - Marc S Ernstoff
- Division of Oncology, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14203 USA
| | - Lionel D Lewis
- Department of Medicine at The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756 USA
| | - Todd M Bauer
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN 37203 USA
| | - David F McDermott
- Department of Medicine, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA 02215 USA
| | - Michael Carducci
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287 USA
| | | | - Brian I Rini
- Lerner College of Medicine, Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195 USA
| | - Daniel Y C Heng
- Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB T2N 4N2 Canada
| | - Jennifer Knox
- Cancer Clinical Research Unit (CCRU), Princess Margaret Cancer Centre, Toronto, ON M5G 1Z5 Canada
| | - Martin H Voss
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - Jennifer Spratlin
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2 Canada
| | - Elmer Berghorn
- Oncology - Global Clinical Research, Bristol-Myers Squibb, Princeton, NJ 08541 USA
| | - Lingfeng Yang
- Oncology - Global Clinical Research, Bristol-Myers Squibb, Princeton, NJ 08541 USA
| | - Hans J Hammers
- Department of Internal Medicine, UT Southwestern – Kidney Cancer Program, Dallas, TX 75390 USA
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15
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Yusuf D, Vos L, Lui A, Abdelaziz Z, Ghosh S, Spratlin J, Mackey J. Antibodies matter: A meta-analysis of the prognostic value of human equilibrative nucleoside transporter 1 (hENT1) antibodies in pancreatobiliary cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Lui A, Mulder K, Brezden-Masley C, Vickers M, Monzon J, Kennecke H, Goel R, Vos L, Ghosh S, Marginean H, Fields A, Maroun J, Spratlin J. A multicentre, open-label phase II study of Irinotecan, capecitabine (Xeloda®), and Oxaliplatin (IXO) as first-line treatment in patients with metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma. Invest New Drugs 2018; 36:674-682. [PMID: 29725881 DOI: 10.1007/s10637-018-0599-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/27/2018] [Indexed: 01/01/2023]
Abstract
Purpose Chemotherapy remains the primary treatment for metastatic gastric/GEJ cancer but optimal agents and schedule remain controversial. This study examined the safety and efficacy of first-line Irinotecan, capecitabine (Xeloda®), and Oxaliplatin (IXO). Patients and Methods Eligible patients with HER2-unamplified/unknown, metastatic gastric/GEJ adenocarcinoma were treated with 21-day cycle IXO at dose level 1 (DL1: Day 1 O-100 mg/m2 & I-160 mg/m2 IV, Day 2-15 X-1900 mg/m2/day PO divided doses) or modified IXO (mIXO): Day 1 O-85 mg/m2 & I-120 mg/m2 IV, Day 2-15 X-1425 mg/m2/day PO divided doses). This Bryant and Day two-stage designed study had dual primary endpoints of objective response rate (ORR) and toxicity. Secondary endpoints were overall survival (OS) and progression-free survival (PFS). Results Fifty patients were enrolled and received a median of 7 cycles. After accrual of 9 patients at DL1, evaluable RR was 88% however dose limiting toxicity (DLT) rate was 56% thus doses were adjusted to mIXO. Fifteen patients accrued at mIXO had a RR of 60% and DLT rate of 13% allowing continuation to stage 2. Overall, 48 and 49 patients were evaluable for efficacy and safety, respectively, with ORR of 54% and DLTs in 24% of patients (DL1 = 56%; mIXO = 18%). Disease control rate was 85%. The most frequent grade 3/4 adverse events were diarrhea, neutropenia, fatigue, hypokalemia, and nausea. Median PFS and OS were 7.5 and 13.0 months, respectively, with a median follow-up of 9.7 months. Conclusion mIXO demonstrates promising ORR, PFS, OS, and acceptable toxicity compared to standard triplet regimens. IXO should be evaluated in phase III trials.
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Affiliation(s)
- Arthur Lui
- Medical Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Karen Mulder
- Medical Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | | | | | - Jose Monzon
- Medical Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Hagen Kennecke
- Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.,Medical Oncology, Virginia Mason Cancer Institute, Seattle, WA, USA
| | - Rakesh Goel
- Medical Oncology, Ottawa Hospital, Ottawa, ON, Canada
| | - Larissa Vos
- Medical Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Sunita Ghosh
- Medical Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | | | - Anthony Fields
- Medical Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada.,Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Jean Maroun
- Medical Oncology, Ottawa Hospital, Ottawa, ON, Canada
| | - Jennifer Spratlin
- Medical Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada.
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17
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Lui A, Gallivan A, Iafolla M, Abdelaziz Z, Yusuf D, Ghosh S, Spratlin J, Mulder K, Sawyer M. Sarcopenia, myosteatosis, and weight loss as determinants of survival and toxicity in patients with resectable esophageal and gastroesophageal junction (GEJ) cancer receiving preoperative chemoradiotherapy (CRT). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Chu MP, Hecht JR, Slamon D, Wainberg ZA, Bang YJ, Hoff PM, Sobrero A, Qin S, Afenjar K, Houe V, King K, Koski S, Mulder K, Hiller JP, Scarfe A, Spratlin J, Huang YJ, Khan-Wasti S, Chua N, Sawyer MB. Association of Proton Pump Inhibitors and Capecitabine Efficacy in Advanced Gastroesophageal Cancer: Secondary Analysis of the TRIO-013/LOGiC Randomized Clinical Trial. JAMA Oncol 2017; 3:767-773. [PMID: 27737436 DOI: 10.1001/jamaoncol.2016.3358] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Capecitabine is an oral cytotoxic chemotherapeutic commonly used across cancer subtypes. As with other oral medications though, it may suffer from drug interactions that could impair its absorption. Objective To determine if gastric acid suppressants such as proton pump inhibitors (PPIs) may impair capecitabine efficacy. Design, Setting, and Participants This secondary analysis of TRIO-013, a phase III randomized trial, compares capecitabine and oxaliplatin (CapeOx) with or without lapatinib in 545 patients with ERBB2/HER2-positive metastatic gastroesophageal cancer (GEC); patients were randomized 1:1 between CapeOx with or without lapatinib. Proton pump inhibitor use was identified by medication records. Progression-free survival (PFS) and overall survival (OS) were compared between patients treated with PPIs vs patients who were not. Specific subgroups were accounted for, such as younger age (<60 years), Asian ethnicity, female sex, and disease stage (metastatic/advanced) in multivariate Cox proportional hazards modeling. The TRIO-013 trial accrued and randomized patients between June 2008 and January 2012; this analysis took place in January 2014. Interventions Patients were divided based on PPI exposure. Main Outcomes and Measures Primary study outcome was PFS and OS between patients treated with PPIs vs patients who were not. Secondary outcomes included disease response rates and toxicities. Results Of the 545 patients with GEC (median age, 60 years; 406 men [74%]) included in the study, 229 received PPIs (42.0%) and were evenly distributed between arms. In the placebo arm, PPI-treated patients had poorer median PFS, 4.2 vs 5.7 months (hazard ratio [HR], 1.55; 95% CI, 1.29-1.81, P < .001); OS, 9.2 vs 11.3 months (HR, 1.34; 95% CI, 1.06-1.62; P = .04); and disease control rate (83% vs 72%; P = .02) vs patients not treated with PPIs. In multivariate analysis considering age, race, disease stage, and sex, PPI-treated patients had poorer PFS (HR, 1.68; 95% CI, 1.42-1.94; P < .001) and OS (HR, 1.41; 95% CI, 1.11-1.71; P = .001). In patients treated with CapeOx and lapatinib, PPIs had less effect on PFS (HR, 1.08; P = .54) and OS (HR, 1.26; P = .10); however, multivariate analysis in this group demonstrated a significant difference in OS (HR, 1.38; 95% CI, 1.06-1.66; P = .03). Conclusions and Relevance Proton pump inhibitors negatively effected capecitabine efficacy by possibly raising gastric pH levels, leading to altered dissolution and absorption. These results are consistent with previous erlotinib and sunitinib studies. Whether PPIs affected lapatinib is unclear given concurrent capecitabine. Given capecitabine's prevalence in treatment breast cancer and colon cancer, further studies are under way. Trial Registration clinicaltrials.gov Identifier: NCT00680901.
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Affiliation(s)
- Michael P Chu
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
| | - J Randolph Hecht
- Jonsson Comprehensive Cancer Center, Department of Clinical and Translational Research, University of California-Los Angeles, Los Angeles
| | - Dennis Slamon
- Jonsson Comprehensive Cancer Center, Department of Clinical and Translational Research, University of California-Los Angeles, Los Angeles
| | - Zev A Wainberg
- Jonsson Comprehensive Cancer Center, Department of Clinical and Translational Research, University of California-Los Angeles, Los Angeles
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Paulo M Hoff
- Instituto do Cancer do Estado de Sao Paulo, Universidade de Sao Paolo, Sao Paolo, Brazil
| | - Alberto Sobrero
- IRCCS Ospedale San Martino IST, Medical Oncology, Largo Benzi 10 Genova, 16132, Italy
| | - Shukui Qin
- Department of Oncology, The 81 Hospital of the Chinese People's Liberation Army, Nanjing, China
| | - Karen Afenjar
- Project Management, Translational Research in Oncology (TRIO), Paris, France
| | - Vincent Houe
- Department of Biostatistics, TRIO, Paris, France
| | - Karen King
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
| | - Sheryl Koski
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
| | - Karen Mulder
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
| | - Julie Price Hiller
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
| | - Andrew Scarfe
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
| | - Jennifer Spratlin
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
| | - Yingjie J Huang
- Department of Research and Development Projects, Clinical Platforms and Sciences, GlaxoSmithKline (GSK), Middlesex, United Kingdom
| | - Saba Khan-Wasti
- Department of Research and Development Projects, Clinical Platforms and Sciences, GlaxoSmithKline (GSK), Middlesex, United Kingdom
| | - Neil Chua
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
| | - Michael B Sawyer
- Cross Cancer Institute, Department of Oncology, Edmonton, Alberta, Canada
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19
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Hammers HJ, Plimack ER, Infante JR, Rini BI, McDermott DF, Lewis LD, Voss MH, Sharma P, Pal SK, Razak ARA, Kollmannsberger C, Heng DYC, Spratlin J, McHenry MB, Amin A. Safety and Efficacy of Nivolumab in Combination With Ipilimumab in Metastatic Renal Cell Carcinoma: The CheckMate 016 Study. J Clin Oncol 2017; 35:3851-3858. [PMID: 28678668 DOI: 10.1200/jco.2016.72.1985] [Citation(s) in RCA: 324] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Combination treatment with immune checkpoint inhibitors has shown enhanced antitumor activity compared with monotherapy in tumor types such as melanoma. The open-label, parallel-cohort, dose-escalation, phase I CheckMate 016 study evaluated the efficacy and safety of nivolumab plus ipilimumab in combination, and nivolumab plus a tyrosine kinase inhibitor in metastatic renal cell carcinoma (mRCC). Safety and efficacy results from the nivolumab plus ipilimumab arms of the study are presented. Patients and Methods Patients with mRCC received intravenous nivolumab 3 mg/kg plus ipilimumab 1 mg/kg (N3I1), nivolumab 1 mg/kg plus ipilimumab 3 mg/kg (N1I3), or nivolumab 3 mg/kg plus ipilimumab 3 mg/kg (N3I3) every 3 weeks for four doses followed by nivolumab monotherapy 3 mg/kg every 2 weeks until progression or toxicity. End points included safety (primary), objective response rate, and overall survival (OS). Results All patients in the N3I3 arm (n = 6) were censored at the time of analysis as a result of dose-limiting toxicity or other reasons. Forty-seven patients were treated in both the N3I1 and the N1I3 arm, and baseline patient characteristics were balanced between arms. Grade 3 to 4 treatment-related adverse events were reported in 38.3% and 61.7% of the patients in the N3I1 and N1I3 arms, respectively. At a median follow-up of 22.3 months, the confirmed objective response rate was 40.4% in both arms, with ongoing responses in 42.1% and 36.8% of patients in the N3I1 and N1I3 arms, respectively. The 2-year OS was 67.3% and 69.6% in the N3I1 and N1I3 arms, respectively. Conclusion Nivolumab plus ipilimumab therapy demonstrated manageable safety, notable antitumor activity, and durable responses with promising OS in patients with mRCC.
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Affiliation(s)
- Hans J Hammers
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Elizabeth R Plimack
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Jeffrey R Infante
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Brian I Rini
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - David F McDermott
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Lionel D Lewis
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Martin H Voss
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Padmanee Sharma
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Sumanta K Pal
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Albiruni R Abdul Razak
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Christian Kollmannsberger
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Daniel Y C Heng
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Jennifer Spratlin
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - M Brent McHenry
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Asim Amin
- Hans J. Hammers, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Elizabeth R. Plimack, Fox Chase Cancer Center, Philadelphia, PA; Jeffrey R. Infante, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Brian I. Rini, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; David F. McDermott, Beth Israel Deaconess Medical Center, Dana-Farber/Harvard Cancer Center, Boston, MA; Lionel D. Lewis, The Geisel School of Medicine and The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH; Martin H. Voss, Memorial Sloan Kettering Cancer Center, New York, NY; Padmanee Sharma, MD Anderson Cancer Center, University of Texas, Houston, TX; Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Albiruni R. Abdul Razak, Princess Margaret Cancer Centre, Toronto, Ontario; Christian Kollmannsberger, British Columbia Cancer Agency, Vancouver, British Columbia; Daniel Y.C. Heng, Tom Baker Cancer Center, University of Calgary, Calgary; Jennifer Spratlin, Cross Cancer Institute, University of Alberta, Edmonton, Alberta, Canada; M. Brent McHenry, Bristol-Myers Squibb, Princeton, NJ; and Asim Amin, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
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Moore M, Gill S, Asmis T, Berry S, Burkes R, Zbuk K, Alcindor T, Jeyakumar A, Chan T, Rao S, Spratlin J, Tang PA, Rothenstein J, Chan E, Bendell J, Kudrik F, Kauh J, Tang S, Gao L, Kambhampati SRP, Nasroulah F, Yang L, Ramdas N, Binder P, Strevel E. Randomized phase II study of modified FOLFOX-6 in combination with ramucirumab or icrucumab as second-line therapy in patients with metastatic colorectal cancer after disease progression on first-line irinotecan-based therapy. Ann Oncol 2016; 27:2216-2224. [PMID: 27733377 DOI: 10.1093/annonc/mdw412] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND Icrucumab and ramucirumab are recombinant human IgG1 monoclonal antibodies that bind VEGF receptors 1 and 2 (VEGFR-1 and -2), respectively. This randomized phase II study evaluated the antitumor activity and safety of icrucumab and ramucirumab each in combination with mFOLFOX-6 in patients with metastatic colorectal cancer after disease progression on first-line therapy with a fluoropyrimidine and irinotecan. PATIENTS AND METHODS Eligible patients were randomly assigned to receive mFOLFOX-6 alone (mFOLFOX-6) or in combination with ramucirumab 8 mg/kg IV (RAM+mFOLFOX-6) or icrucumab 15 mg/kg IV (ICR+mFOLFOX-6) every 2 weeks. Randomization was stratified by prior bevacizumab therapy. The primary end point was progression-free survival (PFS). Secondary end points included overall survival (OS), tumor response, safety, and PK. RESULTS In total, 158 patients were randomized, but only 153 received treatment (49 on mFOLFOX-6, 52 on RAM+mFOLFOX-6, and 52 on ICR+mFOLFOX-6). Median PFS was 18.4 weeks on mFOLFOX-6, 21.4 weeks on RAM+mFOLFOX-6, and 15.9 weeks on ICR+mFOLFOX-6 (RAM+mFOLFOX-6 versus mFOLFOX-6, stratified hazard ratio [HR] 1.116 [95% CI 0.713-1.745], P = 0.623; ICR+mFOLFOX-6 versus mFOLFOX-6, stratified HR 1.603 [95% CI 1.011-2.543], P = 0.044). Median survival was 53.6 weeks on mFOLFOX-6, 41.7 weeks on RAM+mFOLFOX-6, and 42.0 weeks on ICR+mFOLFOX-6. The most frequent adverse events reported on the ramucirumab arm (RAM+mFOLFOX-6) were fatigue, nausea, and peripheral sensory neuropathy; those on the icrucumab arm (ICR+mFOLFOX-6) were fatigue, diarrhea, and peripheral sensory neuropathy. Grade ≥3 serious adverse events occurred at comparable frequency across arms. CONCLUSIONS In this study population, combining ramucirumab or icrucumab with mFOLFOX-6 did not achieve the predetermined improvement in PFS. CLINICALTRIALSGOV NCT01111604.
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Affiliation(s)
- M Moore
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver
| | - S Gill
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver
| | - T Asmis
- The Ottawa Hospital Cancer Centre, Ottawa
| | - S Berry
- Sunnybrook Odette Cancer Centre, Toronto
| | | | - K Zbuk
- Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton
| | - T Alcindor
- Department of Oncology, McGill University, Montréal
| | - A Jeyakumar
- Atlantic Clinical Cancer Research Unit, QEII Health Sciences Centre, Nova Scotia Cancer Centre, Halifax
| | - T Chan
- Fraser Valley Cancer Centre, British Columbia Cancer Agency, Surrey
| | - S Rao
- Kelowna Cancer Centre, British Columbia Cancer Agency, Kelowna
| | | | - P A Tang
- Tom Baker Cancer Centre, Calgary
| | - J Rothenstein
- RSM Durham Regional Cancer Centre, Lakeridge Health Oshawa, Oshawa, Canada
| | - E Chan
- Vanderbilt-Ingram Cancer Center, Nashville
| | - J Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville
| | - F Kudrik
- South Carolina Oncology Associates, Sarah Cannon Research Institute, Columbia
| | - J Kauh
- Eli Lilly and Company, Indianapolis, USA
| | - S Tang
- Eli Lilly and Company, Indianapolis, USA
| | - L Gao
- Eli Lilly and Company, Indianapolis, USA
| | | | | | - L Yang
- Eli Lilly and Company, Indianapolis, USA
| | - N Ramdas
- Eli Lilly and Company, Indianapolis, USA
| | - P Binder
- Eli Lilly and Company, Indianapolis, USA
| | - E Strevel
- Trillium Health Partners, Mississauga, Canada
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Sun J, Ilich A, Kim C, Wong G, Ghosh S, Spratlin J, Mulder K, Danilak M, Chambers C, Sawyer M. Capecitabine (cape) dosing using skeletal muscle index (SMI) compared to body surface area (BSA). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hammers H, Plimack E, Infante J, Rini B, McDermott D, Lewis L, Voss M, Sharma P, Pal S, Razak A, Kollmannsberger C, Heng D, Spratlin J, McHenry B, Gagnier P, Amin A. Updated results from a phase I study of nivolumab (Nivo) in combination with ipilimumab (Ipi) in metastatic renal cell carcinoma (mRCC): The CheckMate 016 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw378.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Kessler ER, Eckhardt SG, Pitts TM, Bradshaw-Pierce EL, O'byrant CL, Messersmith WA, Nallapreddy S, Weekes C, Spratlin J, Lieu CH, Kane MA, Eppers S, Freas E, Leong S. Phase I trial of vandetanib in combination with gemcitabine and capecitabine in patients with advanced solid tumors with an expanded cohort in pancreatic and biliary cancers. Invest New Drugs 2015; 34:176-83. [PMID: 26715573 DOI: 10.1007/s10637-015-0316-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vandetanib is a multitargeted tyrosine kinase inhibitor that affects vascular endothelial growth factor receptor (VEGF), epidermal growth factor (EGF), and rearranged during transfection (RET) mediated receptors which are important for growth and invasion of biliary and pancreatic cancers. This phase I study evaluated the safety profile of vandetanib in combination with standard doses of gemcitabine and capecitabine in order to determine the maximum tolerated dose (MTD). METHODS In this single center phase I trial, patients received gemcitabine intravenously (i.v.) at 1000 mg/m2 days 1, 8, 15 in a 28 day cycle, capecitabine orally at 850 mg/m2 twice daily on days 1-21, and escalating doses of vandetanib (200 or 300 mg orally daily). Once the MTD was defined, an expansion cohort of patients with advanced biliary cancers and locally advanced or metastatic pancreatic cancer was enrolled. Blood samples were also collected at predetermined time points for biomarker analysis. RESULTS Twenty-three patients were enrolled: 9 in the dose escalation and 14 in the dose expansion cohort. One dose limiting toxicity (DLT), of grade 4 neutropenia, occurred in the 200 mg vandetanib cohort. The most common adverse effects were diarrhea (39 %), nausea and vomiting (34%), and rash (33%). There were 3 partial responses and stable disease of >2 months (range 2-45, median 5) was observed in 15/23 patients. There was no association between changes in biomarker analytes and disease response. CONCLUSION The combination of gemcitabine, capecitabine and vandetanib is well tolerated at the recommended phase II dose of gemcitabine 1000 mg/m2 weekly for three consecutive weeks, capecitabine 850 mg/m2 BID days 1-21, and vandetanib 300 mg daily, every 28 days. This combination demonstrated promising activity in pancreaticobiliary cancers and further evaluation is warranted in these diseases. NCT00551096.
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Affiliation(s)
- Elizabeth R Kessler
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA.,University of Colorado Cancer Center, Aurora, Colorado, USA
| | - S Gail Eckhardt
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA.,University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Todd M Pitts
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA.,University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Erica L Bradshaw-Pierce
- University of Colorado Cancer Center, Aurora, Colorado, USA.,Department of Pharmaceutical Sciences, Skaggs School of Pharmacy, Aurora, CO, USA
| | - Cindy L O'byrant
- Department of Clinical Pharmacy, Skaggs School of Pharmacy, Aurora, CO, USA
| | - Wells A Messersmith
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA.,University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Sujatha Nallapreddy
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA.,University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Colin Weekes
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA.,University of Colorado Cancer Center, Aurora, Colorado, USA
| | | | - Christopher H Lieu
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA.,University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Madeleine A Kane
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA.,University of Colorado Cancer Center, Aurora, Colorado, USA
| | - Sarah Eppers
- University of Colorado Cancer Center, Aurora, Colorado, USA
| | | | - Stephen Leong
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, MS 8117, 12801 E 17th Avenue, Room 8120, Aurora, CO, 80045, USA. .,University of Colorado Cancer Center, Aurora, Colorado, USA.
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Chi KN, Spratlin J, Kollmannsberger C, North S, Pankras C, Gonzalez M, Bernard A, Stieltjes H, Peng L, Jiao J, Acharya M, Kheoh T, Griffin TW, Yu MK, Chien C, Tran NP. Food effects on abiraterone pharmacokinetics in healthy subjects and patients with metastatic castration-resistant prostate cancer. J Clin Pharmacol 2015; 55:1406-14. [DOI: 10.1002/jcph.564] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/03/2015] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Lixian Peng
- Janssen Research & Development; Raritan NJ USA
| | - James Jiao
- Janssen Research & Development; Raritan NJ USA
| | | | - Thian Kheoh
- Janssen Research & Development; San Diego CA USA
| | | | | | - Caly Chien
- Janssen Research & Development; Titusville NJ USA
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25
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Chu QSC, Sangha R, Spratlin J, Vos LJ, Mackey JR, McEwan AJB, Venner P, Michelakis ED. A phase I open-labeled, single-arm, dose-escalation, study of dichloroacetate (DCA) in patients with advanced solid tumors. Invest New Drugs 2015; 33:603-10. [PMID: 25762000 DOI: 10.1007/s10637-015-0221-y] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/18/2015] [Indexed: 02/06/2023]
Abstract
Purpose Preclinical evidence suggests dichloroacetate (DCA) can reverse the Warburg effect and inhibit growth in cancer models. This phase 1 study was undertaken to assess the safety, recommended phase 2 dose (RP2D), and pharmacokinetic (PK) profile of oral DCA in patients with advanced solid tumors. Patients and Methods Twenty-four patients with advanced solid malignancies were enrolled using a standard 3 + 3 protocol at a starting dose of 6.25 mg/kg twice daily (BID). Treatment on 28 days cycles was continued until progression, toxicity, or consent withdrawal. PK samples were collected on days 1 and 15 of cycle 1, and day 1 of subsequent cycles. PET imaging ((18) F-FDG uptake) was investigated as a potential biomarker of response. Results Twenty-three evaluable patients were treated with DCA at two doses: 6.25 mg/kg and 12.5 mg/kg BID (median of 2 cycles each). No DLTs occurred in the 6.25 mg/kg BID cohort so the dose was escalated. Three of seven patients had DLTs (fatigue, vomiting, diarrhea) at 12.5 mg/kg BID. Thirteen additional patients were treated at 6.25 mg/kg BID. Most toxicities were grade 1-2 with the most common being fatigue, neuropathy and nausea. No responses were observed and eight patients had stable disease. The DCA PK profile in cancer patients was consistent with previously published data. There was high variability in PK values and neuropathy among patients. Progressive increase in DCA trough levels and a trend towards decreased (18) F-FDG uptake with length of DCA therapy was observed. Conclusions The RP2D of oral DCA is 6.25 mg/kg BID. Toxicities will require careful monitoring in future trials.
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Affiliation(s)
- Quincy Siu-Chung Chu
- Department of Oncology, University of Alberta and Division of Medical Oncology, Cross Cancer Institute, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada,
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Kim C, Mulder K, Spratlin J. How prognostic and predictive biomarkers are transforming our understanding and management of advanced gastric cancer. Oncologist 2014; 19:1046-55. [PMID: 25142842 PMCID: PMC4201005 DOI: 10.1634/theoncologist.2014-0006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 07/15/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gastric cancer (GC) is the second leading cause of cancer death worldwide. GC is a heterogeneous disease in terms of histology, anatomy, and epidemiology. There is also wide variability in how GC is treated in both the resectable and unresectable settings. Identification of prognostic and predictive biomarkers is critical to help direct and tailor therapy for this deadly disease. METHODS A literature search was done using Medline and MeSH terms for GC and predictive biomarkers and prognostic biomarkers. The search was limited to human subjects and the English language. There was no limit on dates. Published data and unpublished abstracts with clinical relevance were included. RESULTS Many potential prognostic and predictive biomarkers have been assessed for GC, some of which are becoming practice changing. This review is focused on clinically relevant biomarkers, including EGFR, HER2, various markers of angiogenesis, proto-oncogene MET, and the mammalian target of rapamycin. CONCLUSION GC is a deadly and heterogeneous disease for which biomarkers are beginning to change our understanding of prognosis and management. The recognition of predictive biomarkers, such as HER2 and vascular endothelial growth factor, has been an exciting development in the management of GC, validating the use of targeted drugs trastuzumab and ramucirumab. MET is another potential predictive marker that may be targeted in GC with drugs such as rilotumumab, foretinib, and crizotinib. Further identification and validation of prognostic and predictive biomarkers has the potential transform how this deadly disease is managed.
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Affiliation(s)
| | - Karen Mulder
- Cross Cancer Institute, Edmonton, Alberta, Canada
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Hammers H, Plimack E, Infante J, Ernstoff M, Rini B, McDermott D, Razak A, Pal S, Voss M, Sharma P, Kollmannsberger C, Heng D, Shen Y, Kurland J, Spratlin J, Gagnier P, Amin A. Phase I Study of Nivolumab in Combination with Ipilimumab in Metastatic Renal Cell Carcinoma (Mrcc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu342.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Chu Q, Sangha R, Spratlin J, Vos L, Mackey J, McEwan A, Venner P, Michelakis E. A Phase I Open-Labelled, Single-Arm, Dose-Escalation, Study of Dichloroacetate (Dca) in Patients with Advanced Solid Tumours. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu331.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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29
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Chu M, Hecht J, Slamon D, Fontaine A, King K, Koski S, Mulder K, Hiller JP, Scarfe A, Spratlin J, Bang Y, Hoff P, Sobrero A, Qin S, Afenjar K, Houe V, Huang Y, Khan-Wasti S, Chua N, Sawyer M. Proton Pump Inhibitor (Ppis) Therapy May Impair Capecitabine (Cape) Efficacy in Metastatic Gastroesophageal Cancer (Gec), Results from the Trio-013/Logic Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Spratlin J, Mulder K, Brezden-Masley C, Vickers M, Kennecke H, Fields A, Au H, Maroun J. First Stage Analysis of Irinotecan, Capecitabine (Xeloda®), and Oxaliplatin (Ixo) As First-Line Treatment of Her2- Metastatic Gastric or Gastroesophageal Junction (Gej) Adenocarcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Amin A, Plimack E, Infante J, Ernstoff M, Rini B, McDermott D, Knox J, Pal S, Voss M, Sharma P, Kollmannsberger C, Heng D, Spratlin J, Shen Y, Kurland J, Gagnier P, Hammers H. Nivolumab (N) (Anti-Pd-1; Bms-936558, Ono-4538) in Combination with Sunitinib (S) or Pazopanib (P) in Patients (Pts) with Metastatic Renal Cell Carcinoma (Mrcc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu342.5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Wolpin BM, O'Reilly EM, Ko YJ, Blaszkowsky LS, Rarick M, Rocha-Lima CM, Ritch P, Chan E, Spratlin J, Macarulla T, McWhirter E, Pezet D, Lichinitser M, Roman L, Hartford A, Morrison K, Jackson L, Vincent M, Reyno L, Hidalgo M. Global, multicenter, randomized, phase II trial of gemcitabine and gemcitabine plus AGS-1C4D4 in patients with previously untreated, metastatic pancreatic cancer. Ann Oncol 2013; 24:1792-1801. [PMID: 23448807 PMCID: PMC3716216 DOI: 10.1093/annonc/mdt066] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/08/2012] [Accepted: 01/28/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We evaluated AGS-1C4D4, a fully human monoclonal antibody to prostate stem cell antigen (PSCA), with gemcitabine in a randomized, phase II study of metastatic pancreatic cancer. PATIENTS AND METHODS Patients with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and previously untreated, metastatic pancreatic adenocarcinoma were randomly assigned 1:2 to gemcitabine (1000 mg/m(2) weekly seven times, 1 week rest, weekly three times q4weeks) or gemcitabine plus AGS-1C4D4 (48 mg/kg loading dose, then 24 mg/kg q3weeks IV). The primary end point was 6-month survival rate (SR). Archived tumor samples were collected for pre-planned analyses by PSCA expression. RESULTS Between April 2009 and May 2010, 196 patients were randomly assigned to gemcitabine (n = 63) or gemcitabine plus AGS-1C4D4 (n = 133). The 6-month SR was 44.4% (95% CI, 31.9-57.5) in the gemcitabine arm and 60.9% (95% CI, 52.1-69.2) in the gemcitabine plus AGS-1C4D4 arm (P = 0.03), while the median survival was 5.5 versus 7.6 months and the response rate was 13.1% versus 21.6% in the two arms, respectively. The 6-month SR was 57.1% in the gemcitabine arm versus 79.5% in the gemcitabine plus AGS-1C4D4 arm among the PSCA-positive subgroup and 31.6% versus 46.2% among the PSCA-negative subgroup. CONCLUSIONS This randomized, phase II study achieved its primary end point, demonstrating an improved 6-month SR with addition of AGS-1C4D4 to gemcitabine among patients with previously untreated, metastatic pancreatic adenocarcinoma. ClinicalTrials.gov identifier: NCT00902291.
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Affiliation(s)
| | - E M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - Y J Ko
- Sunnybrook Health Science Center, Toronto, Canada
| | | | - M Rarick
- Kaiser Permanente Northwest Region Oncology Hematology, Portland
| | - C M Rocha-Lima
- Sylvester Comprehensive Cancer Center, University of Miami, Miami
| | - P Ritch
- Medical College of Wisconsin, Milwaukee
| | - E Chan
- Vanderbilt University Medical Center, Nashville, USA
| | - J Spratlin
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - T Macarulla
- Hospital Vall d'Hebrón, Servicio de Oncología, Barcelona, Spain
| | - E McWhirter
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - D Pezet
- Inserm U1071, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France
| | - M Lichinitser
- State Institution 'Blokhin Cancer Research Centre RAMS', Moscow
| | - L Roman
- State Healthcare Institution 'Leningrad Regional Oncologic Dispensary', Saint Petersburg, Russia
| | | | | | | | | | - L Reyno
- Agensys, Inc., Santa Monica, USA
| | - M Hidalgo
- Centro Integral Oncológico 'Clara Campal', Madrid; Centro Nacional de Investigaciones Oncologicas, Madrid, Spain
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Dechaphunkul A, Mulder K, El-Gehani F, Ghosh S, Deschenes J, Spratlin J. Clinicopathologic characteristics and survival outcomes of patients with advanced esophageal, gastroesophageal junction, and gastric adenocarcinoma: a single-institution experience. ACTA ACUST UNITED AC 2013; 19:302-7. [PMID: 23300355 DOI: 10.3747/co.19.1081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
UNLABELLED Most patients with gastric or gastroesophageal junction (gej) cancer are diagnosed with inoperable advanced or metastatic disease. In these cases, chemotherapy is the only treatment demonstrating survival benefit. The present study compares clinicopathologic characteristics and survival outcomes for patients with advanced esophageal, gej, and gastric adenocarcinoma treated with first-line chemotherapy [epirubicin-cisplatin-5-fluorouracil (ecf), epirubicin-cisplatin-capecitabine (ecx), or etoposide-leucovorin-5-fluorouracil (elf)] or best supportive care (bsc) at our institution with those for historical controls. METHODS We retrospectively reviewed medical information for 401 patients with newly diagnosed advanced esophageal, gej, or gastric adenocarcinoma treated with first-line chemotherapy (ecf, ecx, or elf) or bsc from January 1, 2004, through December 31, 2010. Descriptive statistics were used to compare the data collected with data for historical control patients. RESULTS Of the study patients, 93% were diagnosed with metastatic disease (n = 374), and 63% received bsc only (n = 251). The main reasons that patients received bsc only included poor Eastern Cooperative Oncology Group performance status (55%), patient decision (31%), and comorbidities (14%). Of the remaining patients, 98 (24%) received ecf or ecx and 52 (13%) received elf as first-line treatment. Median overall survival was significantly longer in patients treated with ecf or ecx or with elf than in those receiving bsc (12.7 months vs. 12.7 months vs. 5.5 months respectively). Chemotherapy also significantly reduced the risk of death (64% reduction with ecf or ecx, 58% with elf). CONCLUSIONS We confirmed the substantial overall survival benefit of combination chemotherapy compared with bsc, with better survival in our patient population than in historical controls. However, novel treatment options are still warranted to improve outcomes in this patient population.
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Affiliation(s)
- A Dechaphunkul
- Department of Oncology and Faculty of Medicine, Cross Cancer Institute, University of Alberta, Edmonton, AB. ; Holistic Center for Cancer Study and Care ( hoccpsu ), Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Leong S, Eckhardt SG, Chan E, Messersmith WA, Spratlin J, Camidge DR, Diab S, Khosravan R, Lin X, Chow Maneval E, Lockhart AC. A phase I study of sunitinib combined with modified FOLFOX6 in patients with advanced solid tumors. Cancer Chemother Pharmacol 2012; 70:65-74. [PMID: 22623210 DOI: 10.1007/s00280-012-1880-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/30/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE This phase I study assessed the safety, tolerability, maximum tolerated dose (MTD), pharmacokinetics, and preliminary antitumor effects of sunitinib combined with modified FOLFOX6 (mFOLFOX6). METHODS Patients with advanced solid malignancies received mFOLFOX6 in 2-week cycles with escalating sunitinib doses (25, 37.5, and 50 mg/day) on three schedules: 2 weeks on, 2 weeks off (2/2); 4 weeks on, 2 weeks off (4/2); or continuous daily dosing (CDD). Patients received up to 8 treatment cycles (Schedule 2/2 and CDD schedule) or 6 cycles (Schedule 4/2). An expansion cohort enrolled patients with metastatic colorectal cancer at the Schedule 2/2 MTD. RESULTS Overall, 53 patients were enrolled, with 43 evaluable for dose-limiting toxicity (DLT). On Schedule 2/2 (n = 18), DLTs occurred in three patients at 50 mg/day (grade 4 neutropenia [n = 1]; grades 3 and 4 thrombocytopenia [n = 2]) and two patients achieved partial responses (PRs). On Schedule 4/2 (n = 13), 37.5 mg/day exceeded the MTD with two DLTs (febrile neutropenia and grade 4 hypokalemia, respectively). On the CDD schedule (n = 12), the MTD was 25 mg/day; one DLT (grade 3 stomatitis) was reported and two patients achieved PRs. The most common adverse events were neutropenia, fatigue, and thrombocytopenia. No clinically significant drug-drug interactions were apparent between sunitinib, its metabolite SU12662, and mFOLFOX6. CONCLUSIONS Sunitinib combined with mFOLFOX6 had acceptable tolerability. The MTDs were sunitinib 50 mg/day on Schedule 2/2 and 25 mg/day on the CDD schedule. A MTD for Schedule 4/2 was not established.
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Affiliation(s)
- S Leong
- Medical Oncology, Developmental Therapeutics Program/GI Malignancies, University of Colorado Cancer Center, University of Colorado at Denver, Mail Stop 8117, 12801 E 17th Ave, Room 8120, Aurora, CO 80045, USA.
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Infante JR, Kurzrock R, Spratlin J, Burris HA, Eckhardt SG, Li J, Wu K, Skolnik JM, Hylander-Gans L, Osmukhina A, Huszar D, Herbst RS. A Phase I study to assess the safety, tolerability, and pharmacokinetics of AZD4877, an intravenous Eg5 inhibitor in patients with advanced solid tumors. Cancer Chemother Pharmacol 2011; 69:165-72. [PMID: 21638123 DOI: 10.1007/s00280-011-1667-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/02/2011] [Indexed: 12/30/2022]
Abstract
PURPOSE Inhibition of kinesin spindle protein or Eg5 causes the formation of monoastral mitotic spindles, which leads to cell death. AZD4877 is a specific, potent inhibitor of Eg5. METHODS This was a Phase I, open-label, two-part study to evaluate the maximum tolerated dose (MTD) and safety and tolerability of AZD4877 in patients with advanced solid malignancies. In part A, the MTD of AZD4877, administered as three weekly 1-h intravenous (iv) infusions in a 28-day schedule, was determined by evaluating dose-limiting toxicity (DLT). In part B, the safety, tolerability, and pharmacokinetic profile of AZD4877 at the MTD were evaluated. RESULTS In part A, 29 patients received at least one dose of AZD4877 (5 mg, n = 4; 7.5 mg, n = 4; 10 mg, n = 3; 15 mg, n = 3; 20 mg, n = 3; 30 mg, n = 6; 36 mg, n = 3; 45 mg, n = 3). The MTD was defined as 30 mg, with the primary DLT being neutropenia. Although exposures appeared to be similar at the AZD4877 20 and 30 mg doses, dose reductions and omissions were higher in the 30-mg cohort; therefore, an intermediate dose, 25 mg, was evaluated in part B (n = 14). In part B, neutropenia remained the most commonly reported causally related adverse event. Exposure to AZD4877 was approximately dose proportional. Severity of neutropenia was related to exposure. CONCLUSION The MTD of AZD4877 given as a 1-h iv infusion on days 1, 8, and 15 of a 28-day cycle was 30 mg. At the selected 25 mg dose, AZD4877 had an acceptable safety profile.
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Affiliation(s)
- J R Infante
- Sarah Cannon Research Institute, Nashville, TN, USA
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Abstract
Angiogenesis, a well-recognized characteristic of malignancy, has been exploited more than any other pathway targeted by biologic anti-neoplastic therapies. Vascular endothelial growth factor receptor-2 (VEGFR-2) is the critical receptor involved in malignant angiogenesis with its activation inducing a number of other cellular modifications resulting in tumor growth and metastases. Ramucirumab (IMC-1121B; ImClone Systems Corporation, Branchburg, NJ) is a fully human monoclonal antibody developed to specifically inhibit VEGFR-2. Ramucirumab is currently being investigated in multiple clinical trials across a variety of tumor types. Herein, angiogenesis inhibition in cancer is reviewed and up-to-date information on the clinical development of ramucirumab is presented.
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Affiliation(s)
- Jennifer Spratlin
- Cross Cancer Institute, University of Alberta, 11560 University Avenue, Edmonton, Alberta, Canada.
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Mulder K, Scarfe A, Chua N, Spratlin J. The role of bevacizumab in colorectal cancer: understanding its benefits and limitations. Expert Opin Biol Ther 2011; 11:405-13. [DOI: 10.1517/14712598.2011.557657] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mulder K, Koski S, Scarfe A, Chu Q, King K, Spratlin J. Antiangiogenic agents in advanced gastrointestinal malignancies: past, present and a novel future. Oncotarget 2010; 1:515-29. [PMID: 21317448 PMCID: PMC3248127 DOI: 10.18632/oncotarget.101006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/15/2010] [Indexed: 12/14/2022] Open
Abstract
Advanced gastrointestinal (GI) malignancies are varied in presentation, prognosis, and treatment options. With the exception of resectable recurrent colorectal cancer, metastatic GI malignancies are incurable. Cytotoxic chemotherapies have been the mainstay of therapy for decades but limited extension of survival or clinical benefit has been achieved in non-colorectal GI cancers. There has been great interest in the incorporation of antiangiogenic strategies to improve outcomes for these patients. Clear benefits have been identified with bevacizumab and sorafenib in colorectal cancer and hepatocellular cancer, respectively; other GI tumor sites have lacked impressive results with antiangiogenic agents. In this review, we will present the benefits, or lack thereof, of clinically tested antiangiogenic compounds in GI malignancies and explore some potential new therapeutic anti-angiogenesis options for these diseases.
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Affiliation(s)
- Karen Mulder
- Medical Oncology, Cross Cancer Institute, University of Alberta, Alberta, Canada
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Mulder K, Koski S, Scarfe A, Chu Q, King K, Spratlin J. Antiangiogenic agents in advanced gastrointestinal malignancies: past, present and a novel future. Oncotarget 2010; 1:515-529. [PMID: 21317448 PMCID: PMC3248127 DOI: 10.18632/oncotarget.187] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/15/2010] [Indexed: 11/25/2022] Open
Abstract
Advanced gastrointestinal (GI) malignancies are varied in presentation, prognosis, and treatment options. With the exception of resectable recurrent colorectal cancer, metastatic GI malignancies are incurable. Cytotoxic chemotherapies have been the mainstay of therapy for decades but limited extension of survival or clinical benefit has been achieved in non-colorectal GI cancers. There has been great interest in the incorporation of antiangiogenic strategies to improve outcomes for these patients. Clear benefits have been identified with bevacizumab and sorafenib in colorectal cancer and hepatocellular cancer, respectively; other GI tumor sites have lacked impressive results with antiangiogenic agents. In this review, we will present the benefits, or lack thereof, of clinically tested antiangiogenic compounds in GI malignancies and explore some potential new therapeutic anti-angiogenesis options for these diseases.
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Serkova N, Spratlin J, Eckhardt S, Milestone B, Chiorean E, Youssoufian H, Fox F, Rowinsky E, Cohen R. 41 POSTER DCE-MRI endpoints reveal decreased tumor vascularity in patients with liver metastases: a Phase I dose escalating study with IMC-1121B. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71973-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Leong S, Obryant C, Messersmith W, Diab S, Kane M, Nallapreddy S, Weekes C, Spratlin J, Call J, Eckhardt S. 402 POSTER A phase I study of gemcitabine, capecitabine and vandetanib in patients with advanced solid tumors with an expanded cohort in biliary and pancreatic malignancies. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Spratlin J, Arkenau H, George S, Serkova N, Germuska M, Brock K, Gedrich R, Scurr M, Demetri G, Camidge D. 49 POSTER Analyses of pharmacodynamic (PD) assessments collected during expanded cohorts (EC) of a phase I trial with OSI-930, a multi-targeted oral tyrosine kinase inhibitor (TKI). EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Morelli M, Spratlin J, Eckhardt S. Combination of Anti-EGFR Drugs with Anti-Angiogenic or Other Signal Transduction Inhibitors as a Rational Approach to Cancer Therapy. CCTR 2007. [DOI: 10.2174/157339407782497013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Paclitaxel is one of the most widely used and effective anticancer drugs. Paclitaxel's clinical utility spans many tumor sites, including treatment of ovarian, breast, lung, head and neck, and unknown primary cancers. As is the case with most chemotherapy drugs, paclitaxel is administered empirically with little individualization of dose other than adjustment for body surface area. Metabolism of the drug is predominantly by the liver by cytochromes P450 2C8 and 3A4. Recent evidence points to the presence of polymorphisms in these enzymes. The clinical relevance of these polymorphisms is not yet fully explored, though they are expected to be key in fulfilling the ultimate goal of individualized dosing of paclitaxel. Here we review the pharmacology of paclitaxel and consider the possible effects pharmacogenetics may have on paclitaxel therapy.
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Affiliation(s)
- Jennifer Spratlin
- Cross Cancer Institute, Department of Medical Oncology, University of Alberta, Edmonton, Alberta, Canada
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45
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Jones LW, Eves ND, Mackey JR, Peddle CJ, Haykowsky M, Joy AA, Courneya KS, Tankel K, Spratlin J, Reiman T. Safety and feasibility of cardiopulmonary exercise testing in patients with advanced cancer. Lung Cancer 2006; 55:225-32. [PMID: 17113185 DOI: 10.1016/j.lungcan.2006.10.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/03/2006] [Accepted: 10/05/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The use of cardiopulmonary exercise testing (CPET) is increasing in many areas of disease management, the clinical utility of this procedure in patients with advanced cancer remains to be determined. Accordingly, we conducted a pilot study to comprehensively evaluate the safety and feasibility of CPET in 85 patients diagnosed with inoperable non-small cell lung cancer (NSCLC) or metastatic breast cancer (MBC). METHODS Using a cross-sectional design, consecutive patients with histologically or cytologically confirmed inoperable NSCLC or MBC were screened for eligibility by their attending oncologist. All consenting patients performed complete pulmonary function tests (NSCLC only) and a symptom-limited CPET on a cycle ergometer with gas exchange analysis. RESULTS A total of 85 patients (NSCLC, n=46; MBC, n=39) were recruited and tested. Overall, there were a total of three (3.5%) positive exercise tests [NSCLC, n=2 (4.3%); MBC, n=1 (2.6%)]; 68 (80.0%) negative tests [NSCLC, n=33 (71.7%); MBC, n=35 (89.7%)]; and 14 (16.5%) indeterminate tests [NSCLC, n=11 (23.3%); MBC, n=3 (7.7%)]. Two patients experienced an adverse event during exercise testing. Mean VO(2peak) was 17.0mlkg(-1)min(-1) and 16.5mlkg(-1)min(-1) for NSCLC and MBC patients, respectively. The mean percentage of age and sex-predicted VO(2peak) maximum for both groups was 67%. CONCLUSION A symptom-limited, individualized CPET appears to be a relatively safe and feasible assessment tool to objectively evaluate physical functioning in selected patients with advanced cancer. This study provides important information to future investigations examining the potential role of exercise training in this patient population.
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Affiliation(s)
- Lee W Jones
- Duke University Medical Center, Durham, NC, USA.
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Spratlin J, Sangha R, Glubrecht D, Dabbagh L, Young JD, Dumontet C, Cass C, Lai R, Mackey JR. The absence of human equilibrative nucleoside transporter 1 is associated with reduced survival in patients with gemcitabine-treated pancreas adenocarcinoma. Clin Cancer Res 2005; 10:6956-61. [PMID: 15501974 DOI: 10.1158/1078-0432.ccr-04-0224] [Citation(s) in RCA: 304] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Gemcitabine monotherapy is the standard palliative chemotherapy for pancreatic adenocarcinoma. Gemcitabine requires plasma membrane nucleoside transporter proteins to efficiently enter cells and exert it cytotoxicity. In vitro studies have demonstrated that deficiency of human equilibrative nucleoside transporter 1 (hENT1), the most widely abundant and distributed nucleoside transporter in human cells, confers resistance to gemcitabine toxicity, but the distribution and abundance of nucleoside transporters in normal and malignant pancreatic tissue is unknown. EXPERIMENTAL DESIGN We studied tumor blocks from normal pancreas and 21 Alberta patients with gemcitabine-treated pancreatic cancer. Immunohistochemistry on the formalin-fixed, paraffin-embedded tissues was performed with specific hENT1 and human Concentrative Nucleoside Transporter 3 monoclonal antibodies and scored by a pathologist blinded to clinical outcomes. RESULTS hENT1 was detected in normal Langerhan cells and lymphocytes but not in normal glandular elements. Patients in whom all adenocarcinoma cells had detectable hENT1 had significantly longer median survivals from gemcitabine initiation than those for whom hENT1 was absent in a proportion (10 to 100%) of adenocarcinoma cells (median survival, 13 versus 4 months, P = 0.01). Immunohistochemistry for human Concentrative Nucleoside Transporter 3 revealed moderate to high-intensity staining in all adenocarcinoma tissue samples. CONCLUSIONS Patients with pancreatic adenocarcinoma with uniformly detectable hENT1 immunostaining have a significantly longer survival after gemcitabine chemotherapy than tumors without detectable hENT1. Immunohistochemistry for hENT1 shows promise as a molecular predictive assay to appropriately select patients for palliative gemcitabine chemotherapy but requires formal validation in prospective, randomized trials.
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Affiliation(s)
- Jennifer Spratlin
- University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
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Salehi P, Spratlin J, Chong TF, Churchill TA. Beneficial effects of supplemental buffer and substrate on energy metabolism during small bowel storage. Cryobiology 2004; 48:245-53. [PMID: 15157773 DOI: 10.1016/j.cryobiol.2004.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2003] [Accepted: 01/06/2004] [Indexed: 11/30/2022]
Abstract
Successful preservation of small bowel (SB) is closely correlated with the maintenance of cellular energetics. This study was designed to assess the ability of a modified UW solution supplemented with buffer and glucose to facilitate ATP production during cold storage. In part A, rats SB (n = 4) were flushed vascularly as follows: Group 1, UW solution (control); Group 2, HUW solution (UW+90 mM histidine). Inclusion of histidine resulted in a >3-fold increase in buffering capacity over the pH range 7.4-6.8. Positive effects of histidine on ATP and energy charge were apparent after 4-10h storage. Examination of the key regulatory enzyme, Phosphofructokinase (PFK), reflected a sustained activation was over 1-4h in the HUW group only. In part B, groups were vascularly flushed as follows: Group 1, HUW solution (control); Group 2, Group 1+20mM glucose; and Group 3, Group 2+luminal flush. Elevated ATP and total adenylates over 2-10h in Group 3 compared to control were a direct consequence of improved glycolytic activity. This data supports the hypothesis that tissue energetics can be significantly improved during cold storage using a histidine-buffered UW solution supplemented with carbohydrate substrate.
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Affiliation(s)
- Payam Salehi
- Surgical-Medical Research Institute, 1074 Dentistry-Pharmacy Building, University of Alberta, Edmonton, Alta., Canada T6G 2N8
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