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Salabarria SM, Corti M, Coleman KE, Wichman MB, Berthy JA, D’Souza P, Tifft CJ, Herzog RW, Elder ME, Shoemaker LR, Leon-Astudillo C, Tavakkoli F, Kirn DH, Schwartz JD, Byrne BJ. Thrombotic microangiopathy following systemic AAV administration is dependent on anti-capsid antibodies. J Clin Invest 2024; 134:e173510. [PMID: 37988172 PMCID: PMC10760971 DOI: 10.1172/jci173510] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/06/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUNDSystemic administration of adeno-associated virus (AAV) can trigger life-threatening inflammatory responses, including thrombotic microangiopathy (TMA), acute kidney injury due to atypical hemolytic uremic syndrome-like complement activation, immune-mediated myocardial inflammation, and hepatic toxicity.METHODSWe describe the kinetics of immune activation following systemic AAV serotype 9 (AAV9) administration in 38 individuals following 2 distinct prophylactic immunomodulation regimens. Group 1 received corticosteroids and Group 2 received rituximab plus sirolimus in addition to steroids to prevent anti-AAV antibody formation.RESULTSGroup 1 participants had a rapid increase in immunoglobulin M (IgM) and IgG. Increase in D-dimer, decline in platelet count, and complement activation are indicative of TMA. All Group 1 participants demonstrated activation of both classical and alternative complement pathways, as indicated by depleted C4 and elevated soluble C5b-9, Ba, and Bb antigens. Group 2 patients did not have a significant change in IgM or IgG and had minimal complement activation.CONCLUSIONSThis study demonstrates that TMA in the setting of AAV gene therapy is antibody dependent (classical pathway) and amplified by the alternative complement pathway. Critical time points and interventions are identified to allow for management of immune-mediated events that impact the safety and efficacy of systemic gene therapy.
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Affiliation(s)
| | - Manuela Corti
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Kirsten E. Coleman
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Megan B. Wichman
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Julie A. Berthy
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Precilla D’Souza
- National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Cynthia J. Tifft
- National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | | | - Melissa E. Elder
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | | | | | | | - David H. Kirn
- 4D Molecular Therapeutics, Emeryville, California, USA
| | | | - Barry J. Byrne
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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Long-Boyle JR, Kohn DB, Shah AJ, Spencer SM, Sevilla J, Booth C, López Lorenzo JL, Nicoletti E, Shah A, Reatz M, Matos J, Schwartz JD. Busulfan and subsequent malignancy: An evidence-based risk assessment. Pediatr Blood Cancer 2024; 71:e30738. [PMID: 37856098 DOI: 10.1002/pbc.30738] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/22/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The incidence of secondary malignancies associated with busulfan exposure is considered low, but has been poorly characterized. Because this alkylating agent is increasingly utilized as conditioning prior to gene therapy in nonmalignant hematologic and related disorders, more precise characterization of busulfan's potential contribution to subsequent malignant risk is warranted. PROCEDURE We conducted a literature-based assessment of busulfan and subsequent late effects, with emphasis on secondary malignancies, identifying publications via PubMed searches, and selecting those reporting at least 3 years of follow-up. RESULTS We identified eight pediatric and 13 adult publications describing long-term follow-up in 570 pediatric and 2076 adult hematopoietic cell transplant (HCT) recipients. Secondary malignancies were reported in 0.5% of pediatric HCT recipients, with no cases of myelodysplastic syndrome (MDS) or acute myelocytic leukemia (AML). Fatal secondary malignancies were reported in 0.8% of 1887 evaluable adult HCT recipients, and an overall incidence of secondary malignancies of 4.8% was reported in a subset of 389 evaluable adult patients. We also reviewed long-term results from eight publications evaluating lentiviral- and human promotor-based HSC-targeted gene therapy in 215 patients with nonmalignant conditions, in which busulfan/treosulfan monotherapy or busulfan/fludarabine was the only conditioning. Two malignancies were reported in patients with sickle cell disease (SCD), one of which was potentially busulfan-related. No additional malignancies were reported in 173 patients with follow-up of 5-12 years. CONCLUSION The incidence of busulfan-related secondary malignancies is low, and likely to be substantially less than 1% in pediatric transplant recipients, especially those receiving busulfan monotherapy for nonmalignant conditions other than SCD.
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Affiliation(s)
| | - Donald B Kohn
- University of California, Los Angeles, California, USA
| | - Ami J Shah
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California, USA
| | | | - Julian Sevilla
- Hematología y Hemoterapia, Fundación para la investigación Biomédica, Hospital Infantil Universitario Niño Jesús (HIUNJ), Madrid, Spain
| | - Claire Booth
- Great Ormond Street Hospital, and Great Ormond Street Hospital NHS Foundation Trust, University College of London, Institute of Child Health, London, UK
| | - José Luis López Lorenzo
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Arpita Shah
- Rocket Pharmaceuticals, Inc., Cranbury, New Jersey, USA
| | | | - Joana Matos
- Rocket Pharmaceuticals, Inc., Cranbury, New Jersey, USA
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Lasaga M, Río P, Vilas-Zornoza A, Planell N, Navarro S, Alignani D, Fernández-Varas B, Mouzo D, Zubicaray J, Pujol RM, Nicoletti E, Schwartz JD, Sevilla J, Ainciburi M, Ullate-Agote A, Surrallés J, Perona R, Sastre L, Prosper F, Gomez-Cabrero D, Bueren JA. Gene therapy restores the transcriptional program of hematopoietic stem cells in Fanconi anemia. Haematologica 2023; 108:2652-2663. [PMID: 37021532 PMCID: PMC10542844 DOI: 10.3324/haematol.2022.282418] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/16/2022] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Clinical trials have shown that lentiviral-mediated gene therapy can ameliorate bone marrow failure (BMF) in nonconditioned Fanconi anemia (FA) patients resulting from the proliferative advantage of corrected FA hematopoietic stem and progenitor cells (HSPC). However, it is not yet known if gene therapy can revert affected molecular pathways in diseased HSPC. Single-cell RNA sequencing was performed in chimeric populations of corrected and uncorrected HSPC co-existing in the BM of gene therapy-treated FA patients. Our study demonstrates that gene therapy reverts the transcriptional signature of FA HSPC, which then resemble the transcriptional program of healthy donor HSPC. This includes a down-regulated expression of TGF-β and p21, typically up-regulated in FA HSPC, and upregulation of DNA damage response and telomere maintenance pathways. Our results show for the first time the potential of gene therapy to rescue defects in the HSPC transcriptional program from patients with inherited diseases; in this case, in FA characterized by BMF and cancer predisposition.
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Affiliation(s)
- Miren Lasaga
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Paula Río
- Hematopoietic Innovative Therapies Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Instituto de Investigaciones Sanitarias. Fundación Jiménez Díaz, Madrid, Spain
| | - Amaia Vilas-Zornoza
- Area de Hemato-Oncología, Centro de Investigación Médica Aplicada (CIMA), and Servicio de Hematologia y Terapia Celular, Clínica Universidad de Navarra, IDISNA, Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC
| | - Nuria Planell
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Susana Navarro
- Hematopoietic Innovative Therapies Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Instituto de Investigaciones Sanitarias. Fundación Jiménez Díaz, Madrid, Spain
| | - Diego Alignani
- Flow Cytometry Core, CIMA, Universidad de Navarra, Pamplona, Spain
| | - Beatriz Fernández-Varas
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Instituto de Investigaciones Biomédicas Alberto Sols, CSIC/UAM
| | - Daniel Mouzo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Josune Zubicaray
- Hemoterapia y Hematología Pediátrica, Fundación para la Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Roser M Pujol
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Departmento de Genética y Microbiología, Universitat Autónoma de Barcelona, Barcelona, Spain; Fundación Instituto de Investigación del Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | | | | | - Julián Sevilla
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Hemoterapia y Hematología Pediátrica, Fundación para la Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marina Ainciburi
- Area de Hemato-Oncología, Centro de Investigación Médica Aplicada (CIMA), and Servicio de Hematologia y Terapia Celular, Clínica Universidad de Navarra, IDISNA, Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC
| | - Asier Ullate-Agote
- Area de Hemato-Oncología, Centro de Investigación Médica Aplicada (CIMA), and Servicio de Hematologia y Terapia Celular, Clínica Universidad de Navarra, IDISNA, Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC
| | - Jordi Surrallés
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Departmento de Genética y Microbiología, Universitat Autónoma de Barcelona, Barcelona, Spain; Fundación Instituto de Investigación del Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - Rosario Perona
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Instituto de Investigaciones Biomédicas Alberto Sols, CSIC/UAM; Instituto de Salud Carlos III, Madrid, Spain
| | - Leandro Sastre
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Instituto de Investigaciones Biomédicas Alberto Sols, CSIC/UAM
| | - Felipe Prosper
- Area de Hemato-Oncología, Centro de Investigación Médica Aplicada (CIMA), and Servicio de Hematologia y Terapia Celular, Clínica Universidad de Navarra, IDISNA, Pamplona, Spain; Centro de Investigación Biomédica en Red de Cáncer, CIBERONC.
| | - David Gomez-Cabrero
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; Biological and Environmental Science and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia; Bioscience Program, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia.
| | - Juan A Bueren
- Hematopoietic Innovative Therapies Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain; Instituto de Investigaciones Sanitarias. Fundación Jiménez Díaz, Madrid, Spain.
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McKone EL, Breen W, Foster NR, Bogan AW, Alstat RA, Boyce S, Schwartz JD, Ahmed SK, Mahajan A, Laack NN. Memantine for Pediatric Patients Receiving Cranial Irradiation: A Pilot Study. Int J Radiat Oncol Biol Phys 2023; 117:S134-S135. [PMID: 37784344 DOI: 10.1016/j.ijrobp.2023.06.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While memantine has become standard in certain adults receiving brain RT to decrease the cognitive impacts of RT, it is unknown whether pediatric patients can take and tolerate memantine or experience benefit. In this prospective single-arm feasibility study, we hypothesized pediatric patients receiving brain RT would tolerate memantine with good treatment adherence. MATERIALS/METHODS Patients aged 4-18 years with a primary CNS malignancy (excluding WHO Grade IV astrocytoma and glioblastoma) receiving intracranial RT were eligible. A 6-month course of memantine was given during and after RT. Dosing began once daily at 5 mg with up-titration in 5 mg increments over 4 weeks to a weight-based maximum (0.4 mg/kg to the closest 5 mg), not to exceed 10 mg BID. To reduce patient and clinical research associate (CRA) burden, medication adherence was tracked via the Medisafe Pill and Reminder application which study staff helped install on the patient or parent's smart phone. A paper pill diary was provided for those unable to use the app. The primary endpoint was to achieve 80% adherence rate to memantine in 80% of patients measured 1-month post-RT. RESULTS Eighteen patients (14 male and 4 female, median age 11.5 years (range: 4-18)) were enrolled from 2020-2022. The study closed early after enrolling 18 of 20 planned patients to avoid competing with the phase III randomized Children's Oncology Group (COG) study AACL2031. One patient withdrew for cognition-altering substance-use, leaving 17 patients with data available for analysis. Histologies included germ cell tumor (n = 6), craniopharyngioma (n = 3), choroid plexus papilloma (n = 2), ependymoma (n = 2), glial/astrocytoma (n = 2), medulloblastoma (n = 1), and meningioma (n = 1). Thirteen had surgery, and 9 received chemotherapy. Eight received craniospinal irradiation (CSI). Median RT dose was 54 Gy (range 36-59.4) in 30 fractions (range: 20-33). At data freeze, all 17 had passed the 1-month post-RT time point. One patient discontinued memantine after a single dose due to nausea. Pill-reports were available for 14 of the remaining 16; two patients did not complete digital pill logs. For those with complete logs, all adherence rates were above 80%, with a median of 99.32% pill completion rate (range: 92.67-100). Seven (50%) took 100% of prescribed doses. Irrespective of adherence for the 2 unavailable for evaluation, the primary endpoint was still achieved. Grade 1 toxicities included headache (n = 6, 35%) and constipation (n = 1, 6%); there were no grade 2+ toxicities. At last follow-up, 15/16 have completed the full 6-month memantine course. Secondary endpoints including neurocognitive evaluations have not yet been met and will be the subject of future reports. CONCLUSION Memantine is a feasible and well-tolerated addition to multi-modality treatment for pediatric brain tumors. Secondary endpoints of this study and results of the ongoing COG study are awaited to define the value of memantine in this population.
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Affiliation(s)
- E L McKone
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - W Breen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N R Foster
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - A W Bogan
- Department of Qualitative Health Sciences, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ
| | | | - S Boyce
- Mayo Clinic College of Medicine and Science Rochester, Rochester, MN
| | - J D Schwartz
- Department of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, MN
| | - S K Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ
| | - A Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - N N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
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Bauman MMJ, Giesken MB, Naylor RM, Keating GF, Schwartz JD, Daniels DJ. Predicting disease progression and the need for tumor-directed treatment in tectal plate gliomas. J Neurosurg Pediatr 2023; 32:332-342. [PMID: 37347621 DOI: 10.3171/2023.4.peds22485] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/21/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Tectal plate gliomas are rare, slow-growing tumors of the midbrain that are discovered predominantly in the pediatric population. Because of their indolent nature, treatment mainly consists of observation and management of hydrocephalus. Unfortunately, a subset of tectal gliomas may exhibit tumor enlargement and disease progression. Currently, there are no established guidelines for predicting future progression of tectal gliomas or the need for tumor-directed treatment. In this paper, the authors present a large case series of tectal plate gliomas with the aim of determining early indicators of tumor progression and the need for tumor-directed treatment in a pediatric population, along with providing their experience in treating progressive tumors. METHODS A retrospective chart review of 170 patients diagnosed with tectal plate glioma from a single institution, of whom 67 were pediatric patients (≤ 18 years of age), was performed. Univariate analysis was used to determine statistically significant predictors of symptomatic disease progression requiring eventual tumor-directed therapy. RESULTS The median patient age of the full cohort was 24 years (range 0-73 years). Compared with the pediatric population, the adult population had more instances of incidental lesions (p < 0.001) and lower rates of hydrocephalus (50% vs 84%, p < 0.001). Of the pediatric patients who had ≥ 5 years of follow-up (n = 51), 12 (24%) experienced radiological progression and 13 (25%) required treatment for their tumor. The 1-year, 5-year, and 10-year radiographic progression-free survival (PFS) rates were 98%, 90%, and 86%, respectively. In univariate analysis, lesion involvement of the pons, moderate T1 hypointensity, and moderate contrast enhancement on baseline radiology were significantly associated with worse radiographic PFS. Alternatively, significant predictors of requiring tumor-directed treatment included extraocular eye movement abnormalities at presentation, involvement of the lesion beyond the tectum on baseline radiology, moderate T1 hypointensity, moderate contrast enhancement, and an increase in total lesion size during progression. At the most recent follow-up, 94% of the patients had stable/nonprogressive disease, 2% had progressive disease, and 4% died of tumor progression. CONCLUSIONS Patients who demonstrate radiographic progression may not necessarily experience clinical/symptomatic progression or require tumor-directed treatment. Certain patient presentation characteristics and baseline radiographic features may be predictive of worse radiographic PFS or the need for future tumor-directed treatment in the pediatric population. Typically, the natural history of these lesions lends to excellent long-term survival, even in patients who experience clinical progression, should appropriate treatment be initiated.
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Affiliation(s)
- Megan M J Bauman
- 1Mayo Clinic Alix School of Medicine, Rochester; and
- Departments of2Neurological Surgery
| | - Max B Giesken
- 1Mayo Clinic Alix School of Medicine, Rochester; and
- Departments of2Neurological Surgery
| | | | - Gesina F Keating
- 3Neurology, and
- 4Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - David J Daniels
- Departments of2Neurological Surgery
- 4Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Al Nofal A, Hanna C, Lteif AN, Pittock ST, Schwartz JD, Brumbaugh JE, Creo AL. Copeptin levels in hospitalized infants and children with suspected vasopressin-dependent disorders: a case series. J Pediatr Endocrinol Metab 2023; 36:492-499. [PMID: 37029788 DOI: 10.1515/jpem-2022-0525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES There have been recent advances assessing copeptin levels in adults with suspected disorders of vasopressin release. Very limited data exits on copeptin levels in children and infants, especially in a critically-ill hospitalized population where hyper- and hypo-natremia are very common. Our objective is to describe the institutional experience assessing copeptin levels in hospitalized infants and children with hyper- or hypo-natremia. METHODS We performed a single-center retrospective case series of all infants, children, and adolescents who had an ultrasensitive plasma copeptin level obtained between 2019-2021. RESULTS A total of 29 critically ill patients (6 infants) were identified with 38 % of patients having copeptin levels after neurosurgical procedures for tumors or trauma. Approximately 13/17 children with hypernatremia had CDI to diagnose CDI, A copeptin level ≤ 4.9 pmol/L resulted in an 88 % sensitivity (95 % CI 47-99 %), and 66 % specificity (95 % CI 30-93 %). Amongst those with hyponatremia levels were more variable, 8/12 children had SIAD with copeptin levels ranging 4.7-72.6 pmol/L. CONCLUSIONS While difficult to conclude due to multiple limitations, this case series highlights that typical copeptin cutoffs used to diagnose DI in adults in an ambulatory setting may also translate to a critically-ill pediatric population. Large prospective studies are needed to confirm this observation. In addition, postoperative copeptin levels could potentially be utilized as an additional marker to predict permanent from transient DI, but much larger studies are needed. Further work is needed to establish normative copeptin levels in infants and patients with SIAD.
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Affiliation(s)
- Alaa Al Nofal
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, USA
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ana L Creo
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
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Fares J, Davis ZB, Rechberger JS, Toll SA, Schwartz JD, Daniels DJ, Miller JS, Khatua S. Advances in NK cell therapy for brain tumors. NPJ Precis Oncol 2023; 7:17. [PMID: 36792722 PMCID: PMC9932101 DOI: 10.1038/s41698-023-00356-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
Despite advances in treatment regimens that comprise surgery, chemotherapy, and radiation, outcome of many brain tumors remains dismal, more so when they recur. The proximity of brain tumors to delicate neural structures often precludes complete surgical resection. Toxicity and long-term side effects of systemic therapy remain a concern. Novel therapies are warranted. The field of NK cell-based cancer therapy has grown exponentially and currently constitutes a major area of immunotherapy innovation. This provides a new avenue for the treatment of cancerous lesions in the brain. In this review, we explore the mechanisms by which the brain tumor microenvironment suppresses NK cell mediated tumor control, and the methods being used to create NK cell products that subvert immune suppression. We discuss the pre-clinical studies evaluating NK cell-based immunotherapies that target several neuro-malignancies and highlight advances in molecular imaging of NK cells that allow monitoring of NK cell-based therapeutics. We review current and ongoing NK cell based clinical trials in neuro-oncology.
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Affiliation(s)
- Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Northwestern Medicine Malnati Brain Tumor Institute, Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Zachary B Davis
- Department of Medicine, Division of Hematology, Oncology and Transplantation, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Julian S Rechberger
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, 55905, USA
| | - Stephanie A Toll
- Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit, MI, 48201, USA
| | - Jonathan D Schwartz
- Department of Pediatric Hematology/Oncology, Section of Neuro-Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, 55905, USA
| | - Jeffrey S Miller
- Department of Medicine, Division of Hematology, Oncology and Transplantation, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55454, USA.
| | - Soumen Khatua
- Department of Pediatric Hematology/Oncology, Section of Neuro-Oncology, Mayo Clinic, Rochester, MN, 55905, USA.
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Mesa-Núñez C, Damián C, Fernández-García M, Díez B, Rao G, Schwartz JD, Law KM, Sevilla J, Río P, Yáñez R, Bueren JA, Almarza E. Preclinical safety and efficacy of lentiviral-mediated gene therapy for leukocyte adhesion deficiency type I. Molecular Therapy - Methods & Clinical Development 2022; 26:459-470. [PMID: 36092365 PMCID: PMC9418989 DOI: 10.1016/j.omtm.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/31/2022] [Indexed: 11/08/2022]
Abstract
Leukocyte adhesion deficiency type I (LAD-I) is a primary immunodeficiency caused by mutations in the ITGB2 gene, which encodes for the CD18 subunit of β2-integrins. Deficient expression of β2-integrins results in impaired neutrophil migration in response to bacterial and fungal infections. Using a lentiviral vector (LV) that mediates a preferential myeloid expression of human CD18 (Chim.hCD18-LV), we first demonstrated that gene therapy efficiently corrected the phenotype of mice with severe LAD-I. Next, we investigated if the ectopic hCD18 expression modified the phenotypic characteristics of human healthy donor hematopoietic stem cells and their progeny. Significantly, transduction of healthy CD34+ cells with the Chim.hCD18-LV did not modify the membrane expression of CD18 nor the adhesion of physiological ligands to transduced cells. Additionally, we observed that the repopulating properties of healthy CD34+ cells were preserved following transduction with the Chim.hCD18-LV, and that a safe polyclonal repopulation pattern was observed in transplanted immunodeficient NOD scid gamma (NSG) mice. In a final set of experiments, we demonstrated that transduction of CD34+ cells from a severe LAD-I patient with the Chim.hCD18-LV restores the expression of β2-integrins in these cells. These results offer additional preclinical safety and efficacy evidence supporting the gene therapy of patients with severe LAD-I.
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Campagna GA, Chew L, Pettenkofer M, Nicoletti E, Schwartz JD, Choi G, Fernandes AO, Terrazas D, Kohn DB, Tsui I. Findings on Optical Coherence Tomography in Malignant Infantile Osteopetrosis. Ophthalmic Surg Lasers Imaging Retina 2022; 53:398-402. [PMID: 35858232 DOI: 10.3928/23258160-20220613-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Malignant infantile osteopetrosis is a rare inherited disorder with neurological complications and a shortened life expectancy. Vision loss is typically attributed to osseous compression of the optic nerves at the level of the optic canal. Fundus imaging is reported, as well as the first optical coherence tomography and optical coherence tomography angiography in this rare condition. Imaging revealed optic nerve pallor, subfoveal ellipsoid zone disruption, and an enlarged foveal avascular zone. These results provide insight regarding other potential mechanisms of vision loss in these patients. [Ophthalmic Surg Lasers Imaging Retina 2022; 53:398-402.].
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10
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Shah AJ, Schwartz JD, Segovia JC. Mitapivat versus Placebo for Pyruvate Kinase Deficiency. N Engl J Med 2022; 386:2539. [PMID: 35767453 DOI: 10.1056/nejmc2206275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Jose C Segovia
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain
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11
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Power EA, Rechberger JS, Gupta S, Schwartz JD, Daniels DJ, Khatua S. Drug delivery across the blood-brain barrier for the treatment of pediatric brain tumors - An update. Adv Drug Deliv Rev 2022; 185:114303. [PMID: 35460714 DOI: 10.1016/j.addr.2022.114303] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 02/10/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 12/14/2022]
Abstract
Even though the last decade has seen a surge in the identification of molecular targets and targeted therapies in pediatric brain tumors, the blood brain barrier (BBB) remains a significant challenge in systemic drug delivery. This continues to undermine therapeutic efficacy. Recent efforts have identified several strategies that can facilitate enhanced drug delivery into pediatric brain tumors. These include invasive methods such as intra-arterial, intrathecal, and convection enhanced delivery and non-invasive technologies that allow for transient access across the BBB, including focused ultrasound and nanotechnology. This review discusses current strategies that are being used to enhance delivery of different therapies across the BBB to the tumor site - a major unmet need in pediatric neuro-oncology.
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Affiliation(s)
- Erica A Power
- Mayo Clinic Graduate School of Biomedical Sciences, 200 First Street SW, Rochester, MN 55905, United States; Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Julian S Rechberger
- Mayo Clinic Graduate School of Biomedical Sciences, 200 First Street SW, Rochester, MN 55905, United States; Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Sumit Gupta
- Department of Pediatric Hematology/Oncology, Roseman University of Health Sciences, Las Vegas, NV 89118, United States
| | - Jonathan D Schwartz
- Department of Pediatric Hematology/Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Soumen Khatua
- Department of Pediatric Hematology/Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
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12
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Schwartz JD, Barcellini W, Grace RF, Bianchi P, Zanella A, López Lorenzo JL, Sevilla J, Shah AJ, Glader B, Nicoletti E, Navarro Ordoñez S, Segovia JC. Who should be eligible for gene therapy clinical trials in red blood cell pyruvate kinase deficiency (PKD)?: Toward an expanded definition of severe PKD. Am J Hematol 2022; 97:E120-E125. [PMID: 34989415 PMCID: PMC9305868 DOI: 10.1002/ajh.26458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | - Wilma Barcellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Hematology Unit, Pathophysiology of Anemias Unit Milan Italy
| | - Rachel F. Grace
- Dana‐Farber/Boston Children's Cancer and Blood Disorders Center Harvard Medical School Boston Massachusetts USA
| | - Paola Bianchi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Hematology Unit, Pathophysiology of Anemias Unit Milan Italy
| | - Alberto Zanella
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Hematology Unit, Pathophysiology of Anemias Unit Milan Italy
| | - José Luis López Lorenzo
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS‐FJD), Hospital Universitario Fundación Jiménez Díaz Madrid Spain
| | - Julián Sevilla
- Hospital Infantil Universitario Niño Jesús (HIUNJ), Fundación para la Investigación Biomédica HIUNJ Madrid Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Madrid Spain
| | - Ami J. Shah
- Lucile Packard Children's Hospital Stanford University School of Medicine Stanford California USA
| | - Bertil Glader
- Lucile Packard Children's Hospital Stanford University School of Medicine Stanford California USA
| | | | - Susana Navarro Ordoñez
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Madrid Spain
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT) Madrid Spain
| | - José Carlos Segovia
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Madrid Spain
- Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT) Madrid Spain
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13
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Sevilla J, Iriondo J, Sebastian E, Gonzalez-Vicent M, Schwartz JD, Zubicaray J. Letter to the Editor: Hematopoietic Stem and Progenitor Cell Mobilization and Collection for Patients Diagnosed with Osteopetrosis and Hurler Syndrome. Hum Gene Ther 2022; 33:213-214. [PMID: 35167372 DOI: 10.1089/hum.2022.29197.jse] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julián Sevilla
- Hematology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - June Iriondo
- Hematology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elena Sebastian
- Hematology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Marta Gonzalez-Vicent
- Hematopoietic Transplant Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Josune Zubicaray
- Hematology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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14
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Goyal A, Nesvick CL, Raghunathan A, Schwartz JD, Daniels DJ. Precision Medicine in Pediatric Bithalamic Glioma: Significance of the EGFR exon 20 Insertion Mutation. World Neurosurg 2021; 149:271-273. [PMID: 33940677 DOI: 10.1016/j.wneu.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Anshit Goyal
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cody L Nesvick
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Schwartz
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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15
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Ramírez MJ, Pujol R, Trujillo‐Quintero JP, Minguillón J, Bogliolo M, Río P, Navarro S, Casado JA, Badell I, Carrasco E, Balmaña J, Català A, Sevilla J, Beléndez C, Argilés B, López M, Díaz de Heredia C, Rao G, Nicoletti E, Schwartz JD, Bueren JA, Surrallés J. Natural gene therapy by reverse mosaicism leads to improved hematology in Fanconi anemia patients. Am J Hematol 2021; 96:989-999. [PMID: 33984160 DOI: 10.1002/ajh.26234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/31/2022]
Abstract
Fanconi anemia (FA) is characterized by chromosome fragility, bone marrow failure (BMF) and predisposition to cancer. As reverse genetic mosaicism has been described as "natural gene therapy" in patients with FA, we sought to evaluate the clinical course of a cohort of FA mosaic patients followed at referral centers in Spain over a 30-year period. This cohort includes patients with a majority of T cells without chromosomal aberrations in the DEB-chromosomal breakage test. Relative to non-mosaic FA patients, we observed a higher proportion of adult patients in the cohort of mosaics, with a later age of hematologic onset and a milder evolution of (BMF). Consequently, the requirement for hematopoietic stem cell transplant (HSCT) was also lower. Additional studies allowed us to identify a sub-cohort of mosaic FA patients in whom the reversion was present in bone marrow (BM) progenitor cells leading to multilineage mosaicism. These multilineage mosaic patients are older, have a lower percentage of aberrant cells, have more stable hematology and none of them developed leukemia or myelodysplastic syndrome when compared to non-mosaics. In conclusion, our data indicate that reverse mosaicism is a good prognostic factor in FA and is associated with more favorable long-term clinical outcomes.
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Affiliation(s)
- María José Ramírez
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
| | - Roser Pujol
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
| | - Juan Pablo Trujillo‐Quintero
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Unitat de Genètica Clínica Pediàtrica Parc Taulí Hospital Universitari Barcelona Spain
| | - Jordi Minguillón
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
| | - Massimo Bogliolo
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
| | - Paula Río
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Division of Hematopoietic Innovative Therapies Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas Madrid Spain
- Advanced Therapies Unit IIS‐Fundacion Jimenez Diaz (IIS‐FJD, UAM) Madrid Spain
| | - Susana Navarro
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Division of Hematopoietic Innovative Therapies Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas Madrid Spain
- Advanced Therapies Unit IIS‐Fundacion Jimenez Diaz (IIS‐FJD, UAM) Madrid Spain
| | - José A. Casado
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Division of Hematopoietic Innovative Therapies Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas Madrid Spain
- Advanced Therapies Unit IIS‐Fundacion Jimenez Diaz (IIS‐FJD, UAM) Madrid Spain
| | - Isabel Badell
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Pediatrics Department Hospital de Sant Pau Barcelona Spain
| | | | - Judith Balmaña
- High Risk and Cancer Prevention Unit VHIO Barcelona Spain
- Medical Oncology Department Hospital Vall d'Hebron Barcelona Spain
| | - Albert Català
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Pediatric Hematology Department Institut de Recerca Hospital Sant Joan de Déu Barcelona Barcelona Spain
| | - Julián Sevilla
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Hematología y Hemoterapia Fundación para la Investigación Biomédica Hospital Niño Jesus Madrid Spain
| | | | - Bienvenida Argilés
- Pediatric Hematology Department Hospital Universitario la Fe Valencia Spain
| | - Mónica López
- Hematology Department University Hospital Marqués de Valdecilla (IDIVAL) Santander Spain
| | | | - Gayatri Rao
- Rocket Pharmaceuticals, Inc. Cranbury New Jersey USA
| | | | | | - Juan A. Bueren
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Division of Hematopoietic Innovative Therapies Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas Madrid Spain
- Advanced Therapies Unit IIS‐Fundacion Jimenez Diaz (IIS‐FJD, UAM) Madrid Spain
| | - Jordi Surrallés
- Genomic Instability and DNA Repair Syndromes Group and Joint Research Unit on Genomic Medicine UAB‐Sant Pau Biomedical Research Institute (IIB Sant Pau) Institut de Recerca Hospital de la Santa Creu i Sant Pau‐IIB Sant Pau Barcelona Spain
- Department of Genetics and Microbiology Universitat Autònoma de Barcelona Barcelona Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER) Madrid Spain
- Department of Genetics Sant Pau Hospital Barcelona Spain
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16
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Manso AM, Hashem SI, Nelson BC, Gault E, Soto-Hermida A, Villarruel E, Brambatti M, Bogomolovas J, Bushway PJ, Chen C, Battiprolu P, Keravala A, Schwartz JD, Shah G, Gu Y, Dalton ND, Hammond K, Peterson K, Saftig P, Adler ED. Systemic AAV9.LAMP2B injection reverses metabolic and physiologic multiorgan dysfunction in a murine model of Danon disease. Sci Transl Med 2021; 12:12/535/eaax1744. [PMID: 32188720 DOI: 10.1126/scitranslmed.aax1744] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/18/2019] [Accepted: 02/20/2020] [Indexed: 12/27/2022]
Abstract
Danon disease (DD) is a rare X-linked autophagic vacuolar myopathy associated with multiorgan dysfunction, including the heart, skeletal muscle, and liver. There are no specific treatments, and most male patients die from advanced heart failure during the second or third decade of life. DD is caused by mutations in the lysosomal-associated membrane protein 2 (LAMP2) gene, a key mediator of autophagy. LAMP2 has three isoforms: LAMP2A, LAMP2B, and LAMP2C. LAMP2B is the predominant isoform expressed in cardiomyocytes. This study evaluates the efficacy of human LAMP2B gene transfer using a recombinant adeno-associated virus 9 carrying human LAMP2B (AAV9.LAMP2B) in a Lamp2 knockout (KO) mouse, a DD model. AAV9.LAMP2B was intravenously injected into 2- and 6-month-old Lamp2 KO male mice to assess efficacy in adolescent and adult phenotypes. Lamp2 KO mice receiving AAV9.LAMP2B demonstrated dose-dependent restoration of human LAMP2B protein in the heart, liver, and skeletal muscle tissue. Impaired autophagic flux, evidenced by increased LC3-II, was abrogated by LAMP2B gene transfer in all tissues in both cohorts. Cardiac function was also improved, and transaminases were reduced in AAV9.LAMP2B-treated KO mice, indicating favorable effects on the heart and liver. Survival was also higher in the older cohort receiving high vector doses. No anti-LAMP2 antibodies were detected in mice that received AAV9.LAMP2B. In summary, LAMP2B gene transfer improves metabolic and physiologic function in a DD murine model, suggesting that a similar therapeutic approach may be effective for treating patients with this highly morbid disease.
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Affiliation(s)
- Ana Maria Manso
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Sherin I Hashem
- Department of Pathology, UC San Diego, San Diego, CA 92037, USA
| | - Bradley C Nelson
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Emily Gault
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Angel Soto-Hermida
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Elizza Villarruel
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Michela Brambatti
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Julius Bogomolovas
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Paul J Bushway
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Chao Chen
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | | | | | | | - Gaurav Shah
- Rocket Pharmaceuticals, New York, NY 10118, USA
| | - Yusu Gu
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Nancy D Dalton
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Kirk Hammond
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Kirk Peterson
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA
| | - Paul Saftig
- Biochemical Institute, Christian Albrechts-University, Kiel 24118, Germany
| | - Eric D Adler
- Division of Cardiology, Department of Medicine, UC San Diego, San Diego, CA 92037, USA.
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17
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Moscatelli I, Almarza E, Schambach A, Ricks D, Schulz A, Herzog CD, Henriksen K, Askmyr M, Schwartz JD, Richter J. Gene therapy for infantile malignant osteopetrosis: review of pre-clinical research and proof-of-concept for phenotypic reversal. Mol Ther Methods Clin Dev 2021; 20:389-397. [PMID: 33575431 PMCID: PMC7848732 DOI: 10.1016/j.omtm.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Infantile malignant osteopetrosis is a devastating disorder of early childhood that is frequently fatal and for which there are only limited therapeutic options. Gene therapy utilizing autologous hematopoietic stem and progenitor cells represents a potentially advantageous therapeutic alternative for this multisystemic disease. Gene therapy can be performed relatively rapidly following diagnosis, will not result in graft versus host disease, and may also have potential for reduced incidences of other transplant-related complications. In this review, we have summarized the past sixteen years of research aimed at developing a gene therapy for infantile malignant osteopetrosis; these efforts have culminated in the first clinical trial employing lentiviral-mediated delivery of TCIRG1 in autologous hematopoietic stem and progenitor cells.
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Affiliation(s)
- Ilana Moscatelli
- Department of Molecular Medicine and Gene Therapy, Lund Strategic Center for Stem Cell Biology, Lund University, Lund, Sweden
| | | | - Axel Schambach
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.,Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Ricks
- Rocket Pharmaceuticals, Inc., New York, NY, USA
| | - Ansgar Schulz
- Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Germany
| | | | | | - Maria Askmyr
- Department of Molecular Medicine and Gene Therapy, Lund Strategic Center for Stem Cell Biology, Lund University, Lund, Sweden
| | | | - Johan Richter
- Department of Molecular Medicine and Gene Therapy, Lund Strategic Center for Stem Cell Biology, Lund University, Lund, Sweden
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18
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Bind MAC, Rubin DB, Cardenas A, Dhingra R, Ward-Caviness C, Liu Z, Mirowsky J, Schwartz JD, Diaz-Sanchez D, Devlin RB. Heterogeneous ozone effects on the DNA methylome of bronchial cells observed in a crossover study. Sci Rep 2020; 10:15739. [PMID: 32978449 PMCID: PMC7519112 DOI: 10.1038/s41598-020-72068-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/18/2020] [Indexed: 01/08/2023] Open
Abstract
We used a randomized crossover experiment to estimate the effects of ozone (vs. clean air) exposure on genome-wide DNA methylation of target bronchial epithelial cells, using 17 volunteers, each randomly exposed on two separated occasions to clean air or 0.3-ppm ozone for two hours. Twenty-four hours after exposure, participants underwent bronchoscopy to collect epithelial cells whose DNA methylation was measured using the Illumina 450 K platform. We performed global and regional tests examining the ozone versus clean air effect on the DNA methylome and calculated Fisher-exact p-values for a series of univariate tests. We found little evidence of an overall effect of ozone on the DNA methylome but some suggestive changes in PLSCR1, HCAR1, and LINC00336 DNA methylation after ozone exposure relative to clean air. We observed some participant-to-participant heterogeneity in ozone responses.
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Affiliation(s)
- M-A C Bind
- Department of Statistics, Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA.
| | - D B Rubin
- Yau Center for Mathematical Sciences, Tsinghua University, Beijing, China.,Department of Statistical Science, Fox School of Business, Temple University, Philadelphia, PA, USA
| | - A Cardenas
- Department of Environmental Health Sciences, UC Berkeley School of Public Health, Berkeley, CA, USA
| | - R Dhingra
- Department of Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - C Ward-Caviness
- Environmental Public Health Division, NHEERL, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Z Liu
- Department of Statistics and Actuarial Sciences, University of Hong Kong, Pok Fu Lam, Hong Kong
| | - J Mirowsky
- Department of Chemistry, SUNY College of Environmental Science and Forestry, Syracuse, NY, USA
| | - J D Schwartz
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - D Diaz-Sanchez
- Environmental Public Health Division, NHEERL, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - R B Devlin
- Environmental Public Health Division, NHEERL, US Environmental Protection Agency, Research Triangle Park, NC, USA
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19
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Lu VM, Raghunathan A, Schwartz JD, Daniels DJ. Diffuse Midline Gliomas without the H3 K27M Mutation: Surgical Biopsy is Needed to Better our Diagnostic Understanding. World Neurosurg 2020; 137:472-473. [PMID: 32365434 DOI: 10.1016/j.wneu.2020.02.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Victor M Lu
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jonathan D Schwartz
- Department of Pediatric Oncology, Mayo Clinic Children's Center, Rochester, Minnesota, USA
| | - David J Daniels
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
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20
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Nicoletti E, Rao G, Bueren JA, Río P, Navarro S, Surrallés J, Choi G, Schwartz JD. Mosaicism in Fanconi anemia: concise review and evaluation of published cases with focus on clinical course of blood count normalization. Ann Hematol 2020; 99:913-924. [PMID: 32065290 PMCID: PMC7196946 DOI: 10.1007/s00277-020-03954-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Abstract
Fanconi anemia (FA) is a DNA repair disorder resulting from mutations in genes encoding for FA DNA repair complex components and is characterized by variable congenital abnormalities, bone marrow failure (BMF), and high incidences of malignancies. FA mosaicism arises from reversion or other compensatory mutations in hematopoietic cells and may be associated with BMF reversal and decreased blood cell sensitivity to DNA-damaging agents (clastogens); this sensitivity is a phenotypic and diagnostic hallmark of FA. Uncertainty regarding the clinical significance of FA mosaicism persists; in some cases, patients have survived multiple decades without BMF or hematologic malignancy, and in others hematologic failure occurred despite the presence of clastogen-resistant cell populations. Assessment of mosaicism is further complicated because clinical evaluation is frequently based on clastogen resistance in lymphocytes, which may arise from reversion events both in lymphoid-specific lineages and in more pluripotent hematopoietic stem/progenitor cells (HSPCs). In this review, we describe diagnostic methods and outcomes in published mosaicism series, including the substantial intervals (1-6 years) over which blood counts normalized, and the relatively favorable clinical course in cases where clastogen resistance was demonstrated in bone marrow progenitors. We also analyzed published FA mosaic cases with emphasis on long-term clinical outcomes when blood count normalization was identified. Blood count normalization in FA mosaicism likely arises from reversion events in long-term primitive HSPCs and is associated with low incidences of BMF or hematologic malignancy. These observations have ramifications for current investigational therapeutic programs in FA intended to enable gene correction in long-term repopulating HSPCs.
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Affiliation(s)
| | - Gayatri Rao
- Rocket Pharmaceuticals, Inc., New York, NY, USA
| | - Juan A Bueren
- Hematopoietic Innovative Therapies Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Paula Río
- Hematopoietic Innovative Therapies Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Susana Navarro
- Hematopoietic Innovative Therapies Division, Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Instituto de Investigaciones Sanitarias Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Jordi Surrallés
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Genome Instability and DNA Repair Syndromes Group, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Servicio de Genética e Instituto de Investigaciones Biomédicas del Hospital de Sant Pau, Barcelona, Spain
| | - Grace Choi
- Rocket Pharmaceuticals, Inc., New York, NY, USA
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21
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Yoon HH, Bendell JC, Braiteh FS, Firdaus I, Philip PA, Cohn AL, Lewis N, Anderson DM, Arrowsmith E, Schwartz JD, Gao L, Hsu Y, Xu Y, Ferry D, Alberts SR, Wainberg ZA. Ramucirumab combined with FOLFOX as front-line therapy for advanced esophageal, gastroesophageal junction, or gastric adenocarcinoma: a randomized, double-blind, multicenter Phase II trial. Ann Oncol 2019; 30:2016. [PMID: 31893488 PMCID: PMC8902979 DOI: 10.1093/annonc/mdz454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
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22
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Río P, Navarro S, Wang W, Sánchez-Domínguez R, Pujol RM, Segovia JC, Bogliolo M, Merino E, Wu N, Salgado R, Lamana ML, Yañez RM, Casado JA, Giménez Y, Román-Rodríguez FJ, Álvarez L, Alberquilla O, Raimbault A, Guenechea G, Lozano ML, Cerrato L, Hernando M, Gálvez E, Hladun R, Giralt I, Barquinero J, Galy A, García de Andoín N, López R, Catalá A, Schwartz JD, Surrallés J, Soulier J, Schmidt M, Díaz de Heredia C, Sevilla J, Bueren JA. Successful engraftment of gene-corrected hematopoietic stem cells in non-conditioned patients with Fanconi anemia. Nat Med 2019; 25:1396-1401. [PMID: 31501599 DOI: 10.1038/s41591-019-0550-z] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/18/2019] [Indexed: 12/20/2022]
Abstract
Fanconi anemia (FA) is a DNA repair syndrome generated by mutations in any of the 22 FA genes discovered to date1,2. Mutations in FANCA account for more than 60% of FA cases worldwide3,4. Clinically, FA is associated with congenital abnormalities and cancer predisposition. However, bone marrow failure is the primary pathological feature of FA that becomes evident in 70-80% of patients with FA during the first decade of life5,6. In this clinical study (ClinicalTrials.gov, NCT03157804 ; European Clinical Trials Database, 2011-006100-12), we demonstrate that lentiviral-mediated hematopoietic gene therapy reproducibly confers engraftment and proliferation advantages of gene-corrected hematopoietic stem cells (HSCs) in non-conditioned patients with FA subtype A. Insertion-site analyses revealed the multipotent nature of corrected HSCs and showed that the repopulation advantage of these cells was not due to genotoxic integrations of the therapeutic provirus. Phenotypic correction of blood and bone marrow cells was shown by the acquired resistance of hematopoietic progenitors and T lymphocytes to DNA cross-linking agents. Additionally, an arrest of bone marrow failure progression was observed in patients with the highest levels of gene marking. The progressive engraftment of corrected HSCs in non-conditioned patients with FA supports that gene therapy should constitute an innovative low-toxicity therapeutic option for this life-threatening disorder.
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Affiliation(s)
- Paula Río
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Susana Navarro
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Wei Wang
- Division of Translational Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany.,GeneWerk, Heidelberg, Germany
| | - Rebeca Sánchez-Domínguez
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Roser M Pujol
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Servicio de Genética, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Instituto de Investigaciones Biomédicas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José C Segovia
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Massimo Bogliolo
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Servicio de Genética, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Instituto de Investigaciones Biomédicas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eva Merino
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Servicio de Hematología y Oncología Pediátrica, Fundación de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Ning Wu
- Division of Translational Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
| | - Rocío Salgado
- Servicio de Hematología, Hospital Universitario Fundación Jiménez Diaz, Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - María L Lamana
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Rosa M Yañez
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - José A Casado
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Yari Giménez
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Francisco J Román-Rodríguez
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Lara Álvarez
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Omaira Alberquilla
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Anna Raimbault
- Université de Paris (IRSL, INSERM, CNRS), Paris, France.,Hôpital Saint-Louis, Paris, France
| | - Guillermo Guenechea
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - M Luz Lozano
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Cerrato
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Miriam Hernando
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain
| | - Eva Gálvez
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Servicio de Hematología y Oncología Pediátrica, Fundación de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Raquel Hladun
- Servicio de Oncología y Hematología Pediátricas, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Irina Giralt
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | | | | | - Ricardo López
- Osakidetza Basque Health Service, Pediatric Oncology and Hematology Unit, Cruces University Hospital, Barakaldo, Spain
| | - Albert Catalá
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Servicio de Hematología y Oncología, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Jordi Surrallés
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Servicio de Genética, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Instituto de Investigaciones Biomédicas, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jean Soulier
- Université de Paris (IRSL, INSERM, CNRS), Paris, France.,Hôpital Saint-Louis, Paris, France
| | - Manfred Schmidt
- Division of Translational Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany.,GeneWerk, Heidelberg, Germany
| | - Cristina Díaz de Heredia
- Servicio de Oncología y Hematología Pediátricas, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Julián Sevilla
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,Servicio de Hematología y Oncología Pediátrica, Fundación de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Juan A Bueren
- Hematopoietic Innovative Therapies Division, Centro de investigaciones Energéticas, Medioambientales y Tecnológicas, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain. .,Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz, Madrid, Spain.
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23
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Haworth KG, Ironside C, Ramirez MA, Weitz S, Beard BC, Schwartz JD, Adair JE, Kiem HP. Minimal conditioning in Fanconi anemia promotes multi-lineage marrow engraftment at 10-fold lower cell doses. J Gene Med 2018; 20:e3050. [PMID: 30129972 DOI: 10.1002/jgm.3050] [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: 07/12/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Gene therapy approaches for the treatment of Fanconi anemia (FA) hold promise for patients without a suitably matched donor for an allogeneic bone marrow transplant. However, significant limitations include the collection of sufficient stem cell numbers from patients, the fragility of these cells during ex vivo manipulation, and clinically meaningful engraftment following transplantation. With these challenges in mind, we were interested in determining (i) whether gene-corrected cells at progressively lower numbers can successfully engraft in FA; (ii) whether low-dose conditioning facilitates this engraftment; and (iii) whether these cells can be selected for post-transplant. METHODS Utilizing a well characterized mouse model of FA, we infused donor bone marrow from healthy heterozygote littermates that are unaffected carriers of the FANCA mutation to mimic a gene-corrected product, after administering low-dose conditioning. Once baseline engraftment was observed, we administered a second, very-low selective dose to determine whether gene-corrected cells could be selected for in vivo. RESULTS We demonstrate that upfront low-dose conditioning greatly increases successful engraftment of hematopoietic corrected cells in a pre-clinical animal model of FA. Additionally, without conditioning, cells can still engraft and demonstrate a selective advantage in vivo over time following transplantation, and these corrected cells can be directly selected for in vivo after engraftment. CONCLUSIONS Minimal conditioning prior to bone marrow transplant in Fanconi anemia promotes the multi-lineage engraftment of 10-fold fewer cells compared to nonconditioned controls. These data provide important insights into the potential of minimally toxic conditioning protocols for FA gene therapy applications.
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Affiliation(s)
- Kevin G Haworth
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Christina Ironside
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Megan A Ramirez
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sarah Weitz
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Jennifer E Adair
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Hans-Peter Kiem
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Pathology, University of Washington, Seattle, WA, USA
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24
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Bind MA, VanderWeele TJ, Schwartz JD, Coull BA. Quantile causal mediation analysis allowing longitudinal data. Stat Med 2017; 36:4182-4195. [PMID: 28786129 PMCID: PMC5788575 DOI: 10.1002/sim.7423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 05/08/2015] [Revised: 05/20/2017] [Accepted: 06/29/2017] [Indexed: 12/16/2022]
Abstract
Mediation analysis has mostly been conducted with mean regression models. With this approach modeling means, formulae for direct and indirect effects are based on changes in means, which may not capture effects that occur in units at the tails of mediator and outcome distributions. Individuals with extreme values of medical endpoints are often more susceptible to disease and can be missed if one investigates mean changes only. We derive the controlled direct and indirect effects of an exposure along percentiles of the mediator and outcome using quantile regression models and a causal framework. The quantile regression models can accommodate an exposure-mediator interaction and random intercepts to allow for longitudinal mediator and outcome. Because DNA methylation acts as a complex "switch" to control gene expression and fibrinogen is a cardiovascular factor, individuals with extreme levels of these markers may be more susceptible to air pollution. We therefore apply this methodology to environmental data to estimate the effect of air pollution, as measured by particle number, on fibrinogen levels through a change in interferon-gamma (IFN-γ) methylation. We estimate the controlled direct effect of air pollution on the qth percentile of fibrinogen and its indirect effect through a change in the pth percentile of IFN-γ methylation. We found evidence of a direct effect of particle number on the upper tail of the fibrinogen distribution. We observed a suggestive indirect effect of particle number on the upper tail of the fibrinogen distribution through a change in the lower percentiles of the IFN-γ methylation distribution.
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Affiliation(s)
- M-A Bind
- Department of Statistics, Harvard University, Cambridge, MA, U.S.A
| | - T J VanderWeele
- Epidemiology, Harvard School of Public Health, Boston, MA, U.S.A
| | - J D Schwartz
- Environmental Health, Harvard School of Public Health, Boston, MA, U.S.A
| | - B A Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, U.S.A
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25
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Yoon HH, Bendell JC, Braiteh FS, Firdaus I, Philip PA, Cohn AL, Lewis N, Anderson DM, Arrowsmith E, Schwartz JD, Gao L, Hsu Y, Xu Y, Ferry D, Alberts SR, Wainberg ZA. Ramucirumab combined with FOLFOX as front-line therapy for advanced esophageal, gastroesophageal junction, or gastric adenocarcinoma: a randomized, double-blind, multicenter Phase II trial. Ann Oncol 2016; 27:2196-2203. [PMID: 27765757 PMCID: PMC7360144 DOI: 10.1093/annonc/mdw423] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We report the first randomized, Phase II trial of ramucirumab, an anti-vascular endothelial growth factor receptor-2 monoclonal antibody, as front-line therapy in patients with advanced adenocarcinoma of the esophagus or gastric/gastroesophageal junction (GEJ). PATIENTS AND METHODS Patients from the USA with advanced esophageal, gastric, or GEJ adenocarcinoma randomly received (1:1) mFOLFOX6 plus ramucirumab (8 mg/kg) or mFOLFOX6 plus placebo every 2 weeks. The primary end point was progression-free survival (PFS) with 80% power to detect a hazard ratio (HR) of 0.71 (one-sided α = 0.15). Secondary end points included evaluation of response and overall survival (OS); an exploratory ramucirumab exposure-response analysis was undertaken. RESULTS Of 168 randomized patients, 52% of tumors were located in the stomach/GEJ and 48% in the esophagus. The trial did not meet the primary end point of PFS [6.4 versus 6.7 months, HR 0.98 (95% confidence interval 0.69-1.37)] or the secondary end point of OS (11.7 versus 11.5 months) in the intent-to-treat (ITT) population. Objective response rates (45.2% versus 46.4%) were similar between arms. Most Grade ≥3 toxicities did not differ significantly between arms, yet premature discontinuation of FOLFOX and ramucirumab (for reasons other than progressive disease) was more common among ramucirumab- versus placebo-treated patients. In an exploratory analysis that censored for premature discontinuation, the HR for PFS favored the ramucirumab arm (HR 0.76), particularly in patients with gastric/GEJ cancer. An exploratory exposure-response analysis indicated that patients with higher ramucirumab exposure had longer OS. CONCLUSION The addition of ramucirumab to front-line mFOLFOX6 did not improve PFS in the ITT population. CLINICALTRIALSGOV IDENTIFIER NCT01246960.
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Affiliation(s)
- H H Yoon
- Medical Oncology, Mayo Clinic, Rochester, MN
| | - J C Bendell
- GI Cancer Research Program, Sarah Cannon Research Institute, Tennessee Oncology, Nashville
| | - F S Braiteh
- Medical Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas
| | - I Firdaus
- Medical Oncology, Sarah Cannon Research Institute/Oncology Hematology Care, Inc., Cincinnati
| | - P A Philip
- Department of Oncology, Barbara Ann Karmanos Cancer Institute/Wayne State University, Detroit
| | - A L Cohn
- Medical Oncology, Rocky Mountain Cancer Centers/US Oncology, Denver
| | - N Lewis
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia
| | - D M Anderson
- Department of Hematology, Oncology and Transplantation, Metro-Minnesota Community Clinical Oncology Program, St. Louis Park
| | - E Arrowsmith
- Medical Oncology, Sarah Cannon Research Institute/Tennessee Oncology, Chattanooga
| | | | - L Gao
- Oncology, Eli Lilly and Company, Bridgewater
| | - Y Hsu
- Oncology, Eli Lilly and Company, Bridgewater
| | - Y Xu
- Oncology, Eli Lilly and Company, Bridgewater
| | - D Ferry
- Oncology, Eli Lilly and Company, Bridgewater
| | - S R Alberts
- Medical Oncology, Mayo Clinic, Rochester, MN
| | - Z A Wainberg
- Division of Hematology Oncology, David Geffen School of Medicine at UCLA, Los Angeles, USA
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26
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Bind MAC, Vanderweele TJ, Coull BA, Schwartz JD. Causal mediation analysis for longitudinal data with exogenous exposure. Biostatistics 2016; 17:122-34. [PMID: 26272993 PMCID: PMC4731412 DOI: 10.1093/biostatistics/kxv029] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/18/2015] [Accepted: 07/19/2015] [Indexed: 11/14/2022] Open
Abstract
Mediation analysis is a valuable approach to examine pathways in epidemiological research. Prospective cohort studies are often conducted to study biological mechanisms and often collect longitudinal measurements on each participant. Mediation formulae for longitudinal data have been developed. Here, we formalize the natural direct and indirect effects using a causal framework with potential outcomes that allows for an interaction between the exposure and the mediator. To allow different types of longitudinal measures of the mediator and outcome, we assume two generalized mixed-effects models for both the mediator and the outcome. The model for the mediator has subject-specific random intercepts and random exposure slopes for each cluster, and the outcome model has random intercepts and random slopes for the exposure, the mediator, and their interaction. We also expand our approach to settings with multiple mediators and derive the mediated effects, jointly through all mediators. Our method requires the absence of time-varying confounding with respect to the exposure and the mediator. This assumption is achieved in settings with exogenous exposure and mediator, especially when exposure and mediator are not affected by variables measured at earlier time points. We apply the methodology to data from the Normative Aging Study and estimate the direct and indirect effects, via DNA methylation, of air pollution, and temperature on intercellular adhesion molecule 1 (ICAM-1) protein levels. Our results suggest that air pollution and temperature have a direct effect on ICAM-1 protein levels (i.e. not through a change in ICAM-1 DNA methylation) and that temperature has an indirect effect via a change in ICAM-1 DNA methylation.
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Affiliation(s)
- M-A C Bind
- Departments of Biostatistics, Epidemiology, and Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA
| | - T J Vanderweele
- Departments of Biostatistics, Epidemiology, and Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA
| | - B A Coull
- Departments of Biostatistics, Epidemiology, and Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA
| | - J D Schwartz
- Departments of Biostatistics, Epidemiology, and Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA
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27
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Hussain M, Rathkopf D, Liu G, Armstrong A, Kelly WK, Ferrari A, Hainsworth J, Joshi A, Hozak RR, Yang L, Schwartz JD, Higano CS. A randomised non-comparative phase II trial of cixutumumab (IMC-A12) or ramucirumab (IMC-1121B) plus mitoxantrone and prednisone in men with metastatic docetaxel-pretreated castration-resistant prostate cancer. Eur J Cancer 2015; 51:1714-24. [PMID: 26082390 PMCID: PMC5024789 DOI: 10.1016/j.ejca.2015.05.019] [Citation(s) in RCA: 22] [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: 02/11/2015] [Revised: 04/27/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cixutumumab, a human monoclonal antibody (HuMAb), targets the insulin-like growth factor receptor. Ramucirumab is a recombinant HuMAb that binds to vascular endothelial growth factor receptor-2. A non-comparative randomised phase II study evaluated cixutumumab or ramucirumab plus mitoxantrone and prednisone (MP) in metastatic castration-resistant prostate cancer (mCRPC). PATIENTS AND METHODS Men with progressive mCRPC during or after docetaxel therapy received mitoxantrone 12 mg/m(2) on day 1 and prednisone 5mg twice daily and were randomised 1:1 to receive either cixutumumab or ramucirumab 6 mg/kg intravenously weekly in a 21-day cycle. Primary end-point was composite progression-free survival (cPFS). Secondary end-points included safety, response, radiographic progression-free survival (PFS) and overall survival (OS). Sample size was based on a 50% increase in median cPFS from 2.6 (MP) to 3.9 months (either combination). RESULTS 132 men were treated (66 per arm). Median cPFS was 4.1 months (95% confidence interval (CI), 2.2-5.6) for cixutumumab and 6.7 months (95% CI, 4.5-8.3) for ramucirumab. Median time to radiographic progression was 7.5 months for cixutumumab and 10.2 months for ramucirumab, with a median OS of 10.8 and 13.0 months, respectively. Fatigue was the most frequent adverse event (AE). Incidence of most non-haematologic grade 3-4 AEs was <10% on both arms. Grade 3 cardiac dysfunction occurred in 7.6% of patients on ramucirumab. CONCLUSION Combinations of cixutumumab or ramucirumab plus MP were feasible and associated with moderate toxicities in docetaxel-pretreated men with mCRPC. Of the two regimens, the ramucirumab regimen is worthy of further testing based on the observed cPFS relative to the historical control.
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Affiliation(s)
- Maha Hussain
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, United States.
| | - Dana Rathkopf
- Memorial Sloan-Kettering, New York, NY, United States
| | - Glenn Liu
- University of Wisconsin, Carbone Cancer Center, Madison, WI, United States
| | - Andrew Armstrong
- Duke Cancer Institute and Duke Prostate Center, Duke University, Durham, NC, United States
| | - Wm Kevin Kelly
- Thomas Jefferson University, Philadelphia, PA, United States
| | - Anna Ferrari
- New York University Clinical Cancer Center, New York, NY, United States
| | - John Hainsworth
- Sarah Cannon Research Institute, Nashville, TN, United States
| | - Adarsh Joshi
- Eli Lilly and Company, Bridgewater, NJ, United States
| | | | - Ling Yang
- Eli Lilly and Company, Bridgewater, NJ, United States
| | | | - Celestia S Higano
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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Zhu AX, Park JO, Ryoo BY, Yen CJ, Poon R, Pastorelli D, Blanc JF, Chung HC, Baron AD, Pfiffer TEF, Okusaka T, Kubackova K, Trojan J, Sastre J, Chau I, Chang SC, Abada PB, Yang L, Schwartz JD, Kudo M. Ramucirumab versus placebo as second-line treatment in patients with advanced hepatocellular carcinoma following first-line therapy with sorafenib (REACH): a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol 2015; 16:859-70. [PMID: 26095784 DOI: 10.1016/s1470-2045(15)00050-9] [Citation(s) in RCA: 591] [Impact Index Per Article: 65.7] [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: 03/11/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND VEGF and VEGF receptor-2-mediated angiogenesis contribute to hepatocellular carcinoma pathogenesis. Ramucirumab is a recombinant IgG1 monoclonal antibody and VEGF receptor-2 antagonist. We aimed to assess the safety and efficacy of ramucirumab in advanced hepatocellular carcinoma following first-line therapy with sorafenib. METHODS In this randomised, placebo-controlled, double-blind, multicentre, phase 3 trial (REACH), patients were enrolled from 154 centres in 27 countries. Eligible patients were aged 18 years or older, had hepatocellular carcinoma with Barcelona Clinic Liver Cancer stage C disease or stage B disease that was refractory or not amenable to locoregional therapy, had Child-Pugh A liver disease, an Eastern Cooperative Oncology Group performance status of 0 or 1, had previously received sorafenib (stopped because of progression or intolerance), and had adequate haematological and biochemical parameters. Patients were randomly assigned (1:1) to receive intravenous ramucirumab (8 mg/kg) or placebo every 2 weeks, plus best supportive care, until disease progression, unacceptable toxicity, or death. Randomisation was stratified by geographic region and cause of liver disease with a stratified permuted block method. Patients, medical staff, investigators, and the funder were masked to treatment assignment. The primary endpoint was overall survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01140347. FINDINGS Between Nov 4, 2010, and April 18, 2013, 565 patients were enrolled, of whom 283 were assigned to ramucirumab and 282 were assigned to placebo. Median overall survival for the ramucirumab group was 9·2 months (95% CI 8·0-10·6) versus 7·6 months (6·0-9·3) for the placebo group (HR 0·87 [95% CI 0·72-1·05]; p=0·14). Grade 3 or greater adverse events occurring in 5% or more of patients in either treatment group were ascites (13 [5%] of 277 patients treated with ramucirumab vs 11 [4%] of 276 patients treated with placebo), hypertension (34 [12%] vs ten [4%]), asthenia (14 [5%] vs five [2%]), malignant neoplasm progression (18 [6%] vs 11 [4%]), increased aspartate aminotransferase concentration (15 [5%] vs 23 [8%]), thrombocytopenia (13 [5%] vs one [<1%]), hyperbilirubinaemia (three [1%] vs 13 [5%]), and increased blood bilirubin (five [2%] vs 14 [5%]). The most frequently reported (≥1%) treatment-emergent serious adverse event of any grade or grade 3 or more was malignant neoplasm progression. INTERPRETATION Second-line treatment with ramucirumab did not significantly improve survival over placebo in patients with advanced hepatocellular carcinoma. No new safety signals were noted in eligible patients and the safety profile is manageable. FUNDING Eli Lilly and Co.
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Affiliation(s)
- Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Joon Oh Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Baek-Yeol Ryoo
- Asan Medical Center, University of Ulsan School of Medicine, Seoul, South Korea
| | - Chia-Jui Yen
- National Cheng Kung University Hospital, Tainan City, Taiwan
| | | | | | | | - Hyun Cheol Chung
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Ari D Baron
- California Pacific Medical Center, San Francisco, CA, USA
| | | | | | | | - Jorg Trojan
- University Hospital Cancer Center, Frankfurt, Germany
| | | | - Ian Chau
- Royal Marsden Hospital, Surrey, UK
| | | | | | - Ling Yang
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | - Masatoshi Kudo
- Kinki University School of Medicine, Osaka-Sayama City, Osaka, Japan
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Chiorean EG, Hurwitz HI, Cohen RB, Schwartz JD, Dalal RP, Fox FE, Gao L, Sweeney CJ. Phase I study of every 2- or 3-week dosing of ramucirumab, a human immunoglobulin G1 monoclonal antibody targeting the vascular endothelial growth factor receptor-2 in patients with advanced solid tumors. Ann Oncol 2015; 26:1230-1237. [PMID: 25787923 DOI: 10.1093/annonc/mdv144] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [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: 02/06/2015] [Accepted: 03/04/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Ramucirumab is a fully human immunoglobulin G1 monoclonal antibody receptor antagonist designed to block the ligand-binding site of vascular endothelial growth factor receptor-2 (VEGFR-2). An initial phase I study evaluated ramucirumab administered weekly in advanced cancer patients. This phase I study of ramucirumab [administered every 2 or 3 weeks (Q2W or Q3W)] examined safety, maximum tolerated dose, pharmacokinetics, immunogenicity, antitumor activity, and pharmacodynamics. PATIENTS AND METHODS Patients with advanced solid malignancies were treated with escalating doses of ramucirumab i.v. over 1 h. Blood was sampled for pharmacokinetics studies throughout treatment; levels of circulating vascular endothelial growth factor-A (VEGF-A) and soluble VEGF receptors (R)-1 and -2 were assessed. RESULTS Twenty-five patients were treated with ramucirumab: 13 with 6, 8, or 10 mg/kg Q2W, and 12 with 15 or 20 mg/kg Q3W. The median treatment duration was 12 weeks (range 2-81). No dose-limiting toxicities were observed. The most frequently reported adverse events (AEs) included proteinuria and hypertension (n = 6 each), and diarrhea, fatigue and headache (n = 4 each). Treatment-related grade 3/4 AEs were: two grade 3 hypertension (10 and 20 mg/kg), one each grade 3 vomiting, fatigue (20 mg/kg), atrial flutter (15 mg/kg), and one each grade 4 duodenal ulcer hemorrhage (6 mg/kg) and grade 4 pneumothorax (20 mg/kg). Pharmacokinetic analysis revealed low clearance and half-life of ∼110-160 h. Analysis of serum biomarkers indicated considerable patient-to-patient variability, but trends toward elevated VEGF-A and a transient decline in soluble VEGFR-2. Fifteen patients (60%) had best response of stable disease, with a median duration of 13 months (range 2-18 months) in tumor types including colorectal, renal, liver, and neuroendocrine cancers. CONCLUSION Ramucirumab was well tolerated. Study results led to recommended phase II doses of 8 mg/kg Q2W and 10 mg/kg Q3W. Prolonged stable disease was observed, suggesting ramucirumab efficacy in various solid tumors. CLINICALTRIALSGOV NCT00786383.
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Affiliation(s)
- E G Chiorean
- Division of Medical Oncology, Department of Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle.
| | - H I Hurwitz
- GI Oncology Unit, Duke University School of Medicine, Durham
| | - R B Cohen
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, School of Medicine, Philadelphia
| | - J D Schwartz
- Clinical Development, Eli Lilly and Company, Bridgewater
| | - R P Dalal
- Clinical Development, Eli Lilly and Company, Bridgewater
| | - F E Fox
- Clinical Development, Eli Lilly and Company, Bridgewater
| | - L Gao
- Clinical Development, Eli Lilly and Company, Bridgewater
| | - C J Sweeney
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
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Chen J, Brooks CL, McDonald P, Schwartz JD, Sakakibara K, Saito N, Sato T, Kawabe T, Rowinsky EK. Preclinical activity of SL-801, a reversible inhibitor of Exportin-1 (XPO1)/Chromosome Region Maintenance-1 (CRM1) in solid and hematologic cancers. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Higano CS, Berlin J, Gordon M, LoRusso P, Tang S, Dontabhaktuni A, Schwartz JD, Cosaert J, Mehnert JM. Safety, tolerability, and pharmacokinetics of single and multiple doses of intravenous cixutumumab (IMC-A12), an inhibitor of the insulin-like growth factor-I receptor, administered weekly or every 2 weeks in patients with advanced solid tumors. Invest New Drugs 2015; 33:450-62. [PMID: 25749986 DOI: 10.1007/s10637-015-0217-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/05/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Type 1 insulin-like growth factor receptor (IGF-IR) signaling is often dysregulated in cancer. Cixutumumab, a fully human IgG1 monoclonal antibody, blocks IGF-IR and inhibits downstream signaling. The current study determined the recommended dose, safety, and pharmacokinetic (PK) profile of weekly or every-2-week dosing of cixutumumab. PATIENTS AND METHODS Two open-label, multicenter phase I studies evaluated weekly (3-15 mg/kg) or every-2-weeks (6-15 mg/kg) dosing of cixutumumab in patients with advanced solid tumors. Serial blood samples for PK were collected up to 168-336 h (day 8-15) following the first administration of cixutumumab. Efficacy was evaluated as best overall tumor response. RESULTS A total of 24 and 16 patients were enrolled in the weekly and every-2-week dosing studies, respectively. Treatment-emergent adverse events (≥10%) included hyperglycemia, fatigue, anemia, nausea, and vomiting. Severe adverse events (AE) were infrequent; one serious AE (grade 3 electrocardiogram QT prolongation) was deemed possibly cixutumumab-related (10 mg/kg every-2-weeks). One death occurred due to disease progression (6 mg/kg weekly cohort). Maximum serum concentrations increased with dose. A maximum tolerated dose was not identified; pre-determined target serum minimum concentrations (60 μg/mL) were achieved with ≥6 mg/kg weekly and ≥10 mg/kg every-2-week dosing. Cixutumumab terminal elimination half-life is approximately a week (individual range, t1/2 = 4.58-9.33 days based upon 10 mg/kg every 2 weeks). Overall, stable disease was achieved in 25% of all patients. CONCLUSIONS Cixutumumab was associated with favorable safety and PK profiles. A dosing regimen of 10 mg/kg every 2 weeks was recommended for subsequent disease-focused clinical trials.
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Affiliation(s)
- C S Higano
- Departments of Medicine and Urology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, USA,
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Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Sugimoto N, Lipatov O, Kim TY, Cunningham D, Rougier P, Komatsu Y, Ajani J, Emig M, Carlesi R, Ferry D, Chandrawansa K, Schwartz JD, Ohtsu A. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol 2014; 15:1224-35. [PMID: 25240821 DOI: 10.1016/s1470-2045(14)70420-6] [Citation(s) in RCA: 1591] [Impact Index Per Article: 159.1] [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: 02/07/2023]
Abstract
BACKGROUND VEGFR-2 has a role in gastric cancer pathogenesis and progression. We assessed whether ramucirumab, a monoclonal antibody VEGFR-2 antagonist, in combination with paclitaxel would increase overall survival in patients previously treated for advanced gastric cancer compared with placebo plus paclitaxel. METHODS This randomised, placebo-controlled, double-blind, phase 3 trial was done at 170 centres in 27 countries in North and South America, Europe, Asia, and Australia. Patients aged 18 years or older with advanced gastric or gastro-oesophageal junction adenocarcinoma and disease progression on or within 4 months after first-line chemotherapy (platinum plus fluoropyrimidine with or without an anthracycline) were randomly assigned with a centralised interactive voice or web-response system in a 1:1 ratio to receive ramucirumab 8 mg/kg or placebo intravenously on days 1 and 15, plus paclitaxel 80 mg/m(2) intravenously on days 1, 8, and 15 of a 28-day cycle. A permuted block randomisation, stratified by geographic region, time to progression on first-line therapy, and disease measurability, was used. The primary endpoint was overall survival. Efficacy analysis was by intention to treat, and safety analysis included all patients who received at least one treatment with study drug. This trial is registered with ClinicalTrials.gov, number NCT01170663, and has been completed; patients who are still receiving treatment are in the extension phase. FINDINGS Between Dec 23, 2010, and Sept 23, 2012, 665 patients were randomly assigned to treatment-330 to ramucirumab plus paclitaxel and 335 to placebo plus paclitaxel. Overall survival was significantly longer in the ramucirumab plus paclitaxel group than in the placebo plus paclitaxel group (median 9·6 months [95% CI 8·5-10·8] vs 7·4 months [95% CI 6·3-8·4], hazard ratio 0·807 [95% CI 0·678-0·962]; p=0·017). Grade 3 or higher adverse events that occurred in more than 5% of patients in the ramucirumab plus paclitaxel group versus placebo plus paclitaxel included neutropenia (133 [41%] of 327 vs 62 [19%] of 329), leucopenia (57 [17%] vs 22 [7%]), hypertension (46 [14%] vs eight [2%]), fatigue (39 [12%] vs 18 [5%]), anaemia (30 [9%] vs 34 [10%]), and abdominal pain (20 [6%] vs 11 [3%]). The incidence of grade 3 or higher febrile neutropenia was low in both groups (ten [3%] vs eight [2%]). INTERPRETATION The combination of ramucirumab with paclitaxel significantly increases overall survival compared with placebo plus paclitaxel, and could be regarded as a new standard second-line treatment for patients with advanced gastric cancer. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Hansjochen Wilke
- Department of Medical Oncology/Haematology, Kliniken Essen-Mitte, Germany.
| | - Kei Muro
- Aichi Cancer Center Hospital, Japan
| | - Eric Van Cutsem
- University Hospitals Leuven and Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - György Bodoky
- St László Hospital, Department of Oncology, Budapest Gastrointestinal Medical Oncology, Budapest, Hungary
| | | | | | - Naotoshi Sugimoto
- Clinical Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
| | - Oleg Lipatov
- Republican Clinical Oncology Dispensary, Ufa, Russia
| | - Tae-You Kim
- Seoul National University Cancer Hospital, Seoul, South Korea
| | | | - Philippe Rougier
- Centre Hospitalier Universitaire Georges Pompidou Assistance Publique-Hôpitaux de Paris, Université Paris V, France
| | | | - Jaffer Ajani
- University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | - Atsushi Ohtsu
- Gastrointestinal, Oncology, National Cancer Center Hospital East, Japan
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Penson RT, Moore KM, Fleming GF, Braly P, Schimp V, Nguyen H, Matulonis UA, Banerjee S, Haluska P, Gore M, Bodurka DC, Hozak RR, Joshi A, Xu Y, Schwartz JD, McGuire WP. A phase II study of ramucirumab (IMC-1121B) in the treatment of persistent or recurrent epithelial ovarian, fallopian tube or primary peritoneal carcinoma. Gynecol Oncol 2014; 134:478-85. [PMID: 25016924 PMCID: PMC5166425 DOI: 10.1016/j.ygyno.2014.06.029] [Citation(s) in RCA: 24] [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: 04/10/2014] [Revised: 06/25/2014] [Accepted: 06/28/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Vascular endothelial growth factor (VEGF) receptor-mediated signaling contributes to ovarian cancer pathogenesis. Elevated VEGF expression is associated with poor clinical outcomes. We investigated ramucirumab, a fully human anti-VEGFR-2 antibody, in patients with persistent or recurrent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma. Primary endpoints were progression-free survival at 6 months (PFS-6) and confirmed objective response rate (ORR). METHODS Women who received ≥ 1 platinum-based chemotherapeutic regimen and had a platinum-free interval of <12 months with measurable disease were eligible. Patients received 8 mg/kg ramucirumab intravenously every 2 weeks. RESULTS Sixty patients were treated; one patient remained on study as of September 2013. The median age was 62 years (range: 27-80), and median number of prior regimens was 3. Forty-five (75%) patients had platinum refractory/resistant disease. Thirty-nine patients (65.0%) had serous tumors. PFS-6 was 25.0% (n=15/60, 95% CI: 14.7-37.9%). Best overall response was: partial response 5.0% (n=3/60), stable disease 56.7% (n=34/60), and progressive disease 33.3% (n=20/60). The most common treatment-emergent adverse events possibly related to study drug were headache (65.0%; 10.0% Grade ≥ 3), fatigue (56.7%; 3.3% Grade ≥ 3), diarrhea (28.3%; 1.7% Grade ≥ 3), hypertension (25.0%; 3.3% Grade ≥ 3), and nausea (20.0%; no Grade ≥ 3). Two patients experienced intestinal perforations (3.3% Grade ≥ 3). Pharmacodynamic analyses revealed changes in several circulating VEGF proteins following initial ramucirumab infusion, including increased VEGF-A, PlGF and decreased sVEGFR-2. CONCLUSIONS Although antitumor activity was observed, the predetermined efficacy endpoints were not met.
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Affiliation(s)
- Richard T Penson
- Massachusetts General Hospital for the Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - Kathleen M Moore
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Patricia Braly
- Hematology and Oncology Specialists, LLC, Marrero, LA, USA
| | | | - Hoa Nguyen
- Gynecologic Oncology Associates, Inc., Hollywood, USA
| | | | | | | | | | - Diane C Bodurka
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Yihuan Xu
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company, Bridgewater, NJ, USA
| | - Jonathan D Schwartz
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company, Bridgewater, NJ, USA
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Carvajal RD, Wong MK, Thompson JA, Gordon MS, Lewis KD, Pavlick AC, Wolchok JD, Rojas PB, Schwartz JD, Bedikian AY. A phase 2 randomised study of ramucirumab (IMC-1121B) with or without dacarbazine in patients with metastatic melanoma. Eur J Cancer 2014; 50:2099-107. [PMID: 24930625 PMCID: PMC5702465 DOI: 10.1016/j.ejca.2014.03.289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/27/2014] [Accepted: 03/26/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND To evaluate the efficacy and safety of ramucirumab (IMC-1121B; LY3009806), a fully human monoclonal antibody targeting the vascular endothelial growth factor receptor-2, alone and in combination with dacarbazine in chemotherapy-naïve patients with metastatic melanoma (MM). METHODS Eligible patients received ramucirumab (10mg/kg) + dacarbazine (1000 mg/m(2)) (Arm A) or ramucirumab only (10mg/kg) (Arm B) every 3 weeks. The primary end-point was progression-free survival (PFS); secondary end-points included overall survival (OS), overall response and safety. FINDINGS Of 106 randomised patients, 102 received study treatment (Arm A, N=52; Arm B, N=50). Baseline characteristics were similar in both arms. Median PFS was 2.6 months (Arm A) and 1.7 months (Arm B); median 6-month PFS rates were 30.7% and 17.9% and 12-month PFS rates were 23.7% and 15.6%, respectively. In Arm A, 9 (17.3%) patients had partial response (PR) and 19 (36.5%), stable disease (SD); PR and SD in Arm B were 2 (4.0%) and 21 (42.0%), respectively. Median OS was 8.7 months in Arm A and 11.1 months in Arm B. Patients in both arms tolerated the treatment with limited Grade 3/4 toxicities. INTERPRETATION Ramucirumab alone or in combination with dacarbazine was associated with an acceptable safety profile in patients with MM. Although the study was not powered for comparison between treatment arms, PFS appeared greater with combination therapy. Sustained disease control was observed on both study arm.
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Affiliation(s)
| | - Michael K Wong
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | | | | | | | - Jedd D Wolchok
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Patrick B Rojas
- ImClone Systems LLC, a wholly-owned subsidiary of Eli Lilly and Company, Bridgewater, NJ, USA
| | - Jonathan D Schwartz
- ImClone Systems LLC, a wholly-owned subsidiary of Eli Lilly and Company, Bridgewater, NJ, USA
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Garcia JA, Hudes GR, Choueiri TK, Stadler WM, Wood LS, Gurtler J, Bhatia S, Joshi A, Hozak RR, Xu Y, Schwartz JD, Thompson JA. A phase 2, single-arm study of ramucirumab in patients with metastatic renal cell carcinoma with disease progression on or intolerance to tyrosine kinase inhibitor therapy. Cancer 2014; 120:1647-55. [PMID: 24577874 DOI: 10.1002/cncr.28634] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/07/2013] [Accepted: 08/12/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Multitargeted tyrosine kinase inhibitors (TKIs) have antitumor activity in metastatic renal cell carcinoma (mRCC). Resistance to these agents develops frequently, and their use is often limited by intolerance. Ramucirumab is a recombinant human monoclonal antibody directed against human vascular endothelial growth factor receptor-2. For this study, the authors investigated the clinical efficacy and safety of ramucirumab in patients with TKI-resistant/intolerant mRCC. METHODS In this single-arm phase 2 trial, patients received ramucirumab 8 mg/kg every 2 weeks until they developed disease progression or intolerable toxicity. The primary endpoint was the best objective response rate (ORR); additional endpoints included the disease control rate (DCR), progression-free survival (PFS), the median duration of overall response, and safety. RESULTS Thirty-nine patients with RCC received ramucirumab monotherapy. Prior TKI therapy included sunitinib (59% of patients), sunitinib and sorafenib (30.8% of patients), and sorafenib (10.3% of patients). The ORR was 5.1% (95% confidence interval [CI], 0.6%-17.3%). The 12-week DCR was 64.1% (95% CI, 47.2%-78.8%). The median PFS was 7.1 months (95% CI, 4.1-9.7 months), and the median overall survival was 24.8 months (95% CI, 18.9-32.6 months). Grade 3 or higher adverse events that occurred in ≥5% of patients included grade 3 hypertension (7.7%) and proteinuria (5.1%). There was 1 on-study death from multiorgan failure. CONCLUSIONS Although the study did not meet its primary endpoint of ≥15% ORR, ramucirumab was associated with evidence of antitumor activity in patients with TKI-resistant/intolerant mRCC. Ramucirumab was safe and well tolerated.
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Affiliation(s)
- Jorge A Garcia
- Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
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Yoon HH, Bendell JC, Braiteh FS, Firdaus I, Philip PA, Cohn AL, Lewis N, Anderson DM, Arrowsmith E, Schwartz JD, Xu Y, Koshiji M, Alberts SR, Wainberg ZA. Ramucirumab (RAM) plus FOLFOX as front-line therapy (Rx) for advanced gastric or esophageal adenocarcinoma (GE-AC): Randomized, double-blind, multicenter phase 2 trial. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Irfan Firdaus
- Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH
| | | | | | - Nancy Lewis
- Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Yihuan Xu
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, Bridgewater, NJ
| | - Minori Koshiji
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company, Kobe, Japan
| | | | - Zev A. Wainberg
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
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Fuchs CS, Tomasek J, Cho JY, Tomasello G, Goswami C, dos Santos LV, Aprile G, Ferry D, Melichar B, Tehfe MA, Topuzov E, Zalcberg JR, Chau I, Tabernero J, Hsu Y, Schwartz JD, Koshiji M, Safran H. REGARD: A phase 3, randomized, double-blind trial of ramucirumab (RAM) and best supportive care (BSC) versus placebo (PL) and BSC in the treatment of metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma following disease progression (PD) on first-line platinum- and/or fluoropyrimidine-containing combination therapy: Age subgroup analysis. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.4057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | | | | | | | | | - David Ferry
- New Cross Hospital, Wolverhampton, United Kingdom
| | - Bohuslav Melichar
- Palacky University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | | | | | | | - Ian Chau
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | | | - Yanzhi Hsu
- ImClone Systems, a wholly owned subsidiary of Eli Lilly & Co., Bridgewater, NJ
| | | | - Minori Koshiji
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company, Kobe, Japan
| | - Howard Safran
- Brown University Oncology Research Group, Providence, RI
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Garcia-Carbonero R, Rivera F, Maurel J, Ayoub JPM, Moore MJ, Cervantes A, Asmis TR, Schwartz JD, Nasroulah F, Ballal S, Tabernero J. An open-label phase II study evaluating the safety and efficacy of ramucirumab combined with mFOLFOX-6 as first-line therapy for metastatic colorectal cancer. Oncologist 2014; 19:350-1. [PMID: 24674871 PMCID: PMC3983832 DOI: 10.1634/theoncologist.2014-0028] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 01/24/2014] [Accepted: 02/12/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR-2) are believed to mediate angiogenesis in colorectal cancer (CRC). Ramucirumab (RAM; IMC-1121B) is a human IgG1 monoclonal antibody that inhibits VEGF ligand binding to VEGFR-2, inhibiting VEGFR-2 activation and signaling. METHODS Patients with metastatic CRC, Eastern Cooperative Oncology Group performance status 0-1, and adequate organ function who had not received chemotherapy for metastatic disease received RAM and the modified FOLFOX-6 regimen every 2 weeks. Endpoints included progression-free survival (PFS), objective response rate, overall survival, and safety. The sample size was based on a potentially improved median PFS from 8 months to 11 months. RESULTS Forty-eight patients received therapy. Median PFS was 11.5 months (95% confidence interval [CI]: 8.6-13.1 months). The objective response rate was 58.3% (95% CI: 43.21-72.39). The disease control rate (complete or partial response plus stable disease) was 93.8% (95% CI: 82.8-98.7). Median overall survival was 20.4 months (95% CI: 18.5-25.1 months). The most frequent grade 3-4 adverse events included neutropenia (grade 3: 33.3%; grade 4: 8.3%), hypertension (grade 3: 16.7%), and neuropathy (grade 3: 12.5%). Two patients died during the study due to myocardial infarction and cardiopulmonary arrest. CONCLUSION RAM may enhance the efficacy of modified FOLFOX-6 chemotherapy with an acceptable safety profile in metastatic CRC.
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Affiliation(s)
- Rocio Garcia-Carbonero
- Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (center affiliated with the Red Temática de Investigación Cooperativa en Cancer, Instituto Carlos III, Spanish Ministry of Science and Innovation), Sevilla, Spain
| | - Fernando Rivera
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Joan Maurel
- Hospital Clinic i Provincial, Barcelona, Spain
| | | | - Malcolm J. Moore
- Princess Margaret Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Andres Cervantes
- Department of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | | | - Jonathan D. Schwartz
- ImClone Systems (a wholly-owned subsidiary of Eli Lilly and Company), Bridgewater, New Jersey, USA
| | - Federico Nasroulah
- ImClone Systems (a wholly-owned subsidiary of Eli Lilly and Company), Bridgewater, New Jersey, USA
| | - Shaila Ballal
- ImClone Systems (a wholly-owned subsidiary of Eli Lilly and Company), Bridgewater, New Jersey, USA
| | - Josep Tabernero
- Vall d’Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona (center affiliated with the Red Temática de Investigación Cooperativa en Cancer, Instituto Carlos III, Spanish Ministry of Science and Innovation), Barcelona, Spain
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Fuchs CS, Tomasek J, Yong CJ, Dumitru F, Passalacqua R, Goswami C, Safran H, Dos Santos LV, Aprile G, Ferry DR, Melichar B, Tehfe M, Topuzov E, Zalcberg JR, Chau I, Campbell W, Sivanandan C, Pikiel J, Koshiji M, Hsu Y, Liepa AM, Gao L, Schwartz JD, Tabernero J. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2014; 383:31-39. [PMID: 24094768 DOI: 10.1016/s0140-6736(13)61719-5] [Citation(s) in RCA: 1463] [Impact Index Per Article: 146.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) and VEGF receptor-2 (VEGFR-2)-mediated signalling and angiogenesis can contribute to the pathogenesis and progression of gastric cancer. We aimed to assess whether ramucirumab, a monoclonal antibody VEGFR-2 antagonist, prolonged survival in patients with advanced gastric cancer. METHODS We did an international, randomised, double-blind, placebo-controlled, phase 3 trial between Oct 6, 2009, and Jan 26, 2012, at 119 centres in 29 countries in North America, Central and South America, Europe, Asia, Australia, and Africa. Patients aged 24-87 years with advanced gastric or gastro-oesophageal junction adenocarcinoma and disease progression after first-line platinum-containing or fluoropyrimidine-containing chemotherapy were randomly assigned (2:1), via a central interactive voice-response system, to receive best supportive care plus either ramucirumab 8 mg/kg or placebo, intravenously once every 2 weeks. The study sponsor, participants, and investigators were masked to treatment assignment. The primary endpoint was overall survival. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00917384. FINDINGS 355 patients were assigned to receive ramucirumab (n=238) or placebo (n=117). Median overall survival was 5·2 months (IQR 2·3-9·9) in patients in the ramucirumab group and 3·8 months (1·7-7·1) in those in the placebo group (hazard ratio [HR] 0·776, 95% CI 0·603-0·998; p=0·047). The survival benefit with ramucirumab remained unchanged after multivariable adjustment for other prognostic factors (multivariable HR 0·774, 0·605-0·991; p=0·042). Rates of hypertension were higher in the ramucirumab group than in the placebo group (38 [16%] vs nine [8%]), whereas rates of other adverse events were mostly similar between groups (223 [94%] vs 101 [88%]). Five (2%) deaths in the ramucirumab group and two (2%) in the placebo group were considered to be related to study drug. INTERPRETATION Ramucirumab is the first biological treatment given as a single drug that has survival benefits in patients with advanced gastric or gastro-oesophageal junction adenocarcinoma progressing after first-line chemotherapy. Our findings validate VEGFR-2 signalling as an important therapeutic target in advanced gastric cancer. FUNDING ImClone Systems.
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Affiliation(s)
- Charles S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | - Jiri Tomasek
- Department of Complex Oncology Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Cho Jae Yong
- Department of Medical Oncology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Filip Dumitru
- Oncology Department, Emergency County Hospital "Dr Constantin Opris", Baia Mare, Romania
| | | | - Chanchal Goswami
- Department of Medical Oncology, B P Poddar Hospital and Medical Research, Kolkata, West Bengal
| | - Howard Safran
- Department of Medicine, The Brown University Oncology Group, Brown University, Providence, RI, USA
| | - Lucas Vieira Dos Santos
- Medical Oncology Department, Gastrointestinal Oncology Division, Hospital de Câncer de Barretos and Hemomed Instituto de Oncologia e Hematologia, São Paulo, Brazil
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy
| | - David R Ferry
- Department of Medical Oncology, New Cross Hospital, West Midlands, UK
| | - Bohuslav Melichar
- Department of Oncology, Palacky University Medical School and Teaching Hospital, Olomouc, CzechRepublic
| | - Mustapha Tehfe
- Department of Medical Oncology, Hôpital Notre Dame de CHUM, Montreal, Quebec
| | - Eldar Topuzov
- State Budgetary Educational Institution of Higher Professional Education (SBEIHPE), "Northwest State Medical University na II Mechnikov", Ministry of Healthcare of the Russian Federation, Russia
| | - John Raymond Zalcberg
- Division of Cancer Medicine, Peter McCallum Cancer Centre, East Melbourne, VIC, Australia; Departments of Medicine and Oncology, Faculty of Medicine, University of Melbourne, Australia
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, London and Surrey, England
| | - William Campbell
- Department of Oncology, Hospital Herrera Llerandi-Clinicas Médicas, Guatemala
| | | | | | | | - Yanzhi Hsu
- ImClone Systems LLC, Bridgewater, NJ, USA
| | | | - Ling Gao
- ImClone Systems LLC, Bridgewater, NJ, USA
| | | | - Josep Tabernero
- Medical Oncology Department Vall d'Hebron University Hospital, UniversitatAutònoma de Barcelona, Barcelona, Spain
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Zhu AX, Finn RS, Mulcahy M, Gurtler J, Sun W, Schwartz JD, Dalal RP, Joshi A, Hozak RR, Xu Y, Ancukiewicz M, Jain RK, Nugent FW, Duda DG, Stuart K. A phase II and biomarker study of ramucirumab, a human monoclonal antibody targeting the VEGF receptor-2, as first-line monotherapy in patients with advanced hepatocellular cancer. Clin Cancer Res 2013; 19:6614-23. [PMID: 24088738 PMCID: PMC4795808 DOI: 10.1158/1078-0432.ccr-13-1442] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [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] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the efficacy and safety of the anti-VEGF receptor-2 (VEGFR-2) antibody ramucirumab as first-line therapy in patients with advanced hepatocellular carcinoma and explore potential circulating biomarkers. EXPERIMENTAL DESIGN Adults with advanced hepatocellular carcinoma and no prior systemic treatment received ramucirumab 8 mg/kg every two weeks until disease progression or limiting toxicity. The primary endpoint was progression-free survival (PFS); secondary endpoints included objective response rate (ORR) and overall survival (OS). Circulating biomarkers were evaluated before and after ramucirumab treatment in a subset of patients. RESULTS Forty-two patients received ramucirumab. Median PFS was 4.0 months [95% confidence interval (CI), 2.6-5.7], ORR was 9.5% (95% CI, 2.7-22.6; 4/42 patients had a partial response), and median OS was 12.0 months (95% CI, 6.1-19.7). For patients with Barcelona Clinic Liver Cancer (BCLC) stage C disease, median OS was 4.4 months (95% CI, 0.5-9.0) for patients with Child-Pugh B cirrhosis versus 18.0 months (95% CI, 6.1-23.5) for patients with Child-Pugh A cirrhosis. Treatment-related grade ≥ 3 toxicities included hypertension (14%), gastrointestinal hemorrhage and infusion-related reactions (7% each), and fatigue (5%). There was one treatment-related death (gastrointestinal hemorrhage). After treatment with ramucirumab, there was an increase in serum VEGF and placental growth factor (PlGF) and a transient decrease in soluble VEGFR-2. CONCLUSION Ramucirumab monotherapy may confer anticancer activity in advanced hepatocellular carcinoma with an acceptable safety profile. Exploratory biomarker studies showed changes in circulating VEGF, PlGF, and sVEGFR-2 that are consistent with those seen with other anti-VEGF agents.
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Affiliation(s)
- Andrew X. Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Richard S. Finn
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Mary Mulcahy
- Northwestern University Feinberg School of Medicine, Chicago Illinois
| | - Jayne Gurtler
- East Jefferson General Hospital, Metairie, Louisiana
| | - Weijing Sun
- Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jonathan D. Schwartz
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and company, Bridgewater, New Jersey
| | - Rita P. Dalal
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and company, Bridgewater, New Jersey
| | | | | | - Yihuan Xu
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly and company, Bridgewater, New Jersey
| | - Marek Ancukiewicz
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Rakesh K. Jain
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Francis W. Nugent
- Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts
| | - Dan G. Duda
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Keith Stuart
- Lahey Hospital and Medical Center, Tufts University School of Medicine, Burlington, Massachusetts
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Fuchs CS, Tomasek J, Cho JY, Dumitru F, Passalacqua R, Goswami C, Safran H, dos Santos LV, Aprile G, Ferry DR, Melichar B, Tehfe M, Topuzov E, Tabernero J, Zalcberg JR, Chau I, Koshiji M, Hsu Y, Schwartz JD, Ajani JA. REGARD: A phase III, randomized, double-blinded trial of ramucirumab and best supportive care (BSC) versus placebo and BSC in the treatment of metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma following disease progression on first-line platinum- and/or fluoropyrimidine-containing combination therapy. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.lba5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5 Background: VEGF and VEGF receptor-2 mediated signaling and angiogenesis may contribute to gastric cancer pathogenesis. Ramucirumab (RAM; IMC-1121B) is a fully human IgG1 monoclonal antibody targeting VEGF-receptor 2. We conducted a placebo-controlled, double-blind, phase III international trial to evaluate the safety and efficacy of RAM in pts with metastatic gastric or GEJ adenocarcinoma progressing on first-line platinum- and/or fluoropyrimidine containing combination therapy. Methods: Pts were randomized 2:1 to receive RAM (8 mg/kg IV) plus BSC or placebo (PL) plus BSC every 2 weeks (wks) until disease progression, unacceptable toxicity, or death. Eligible patients had disease progression within 4 months (m) after 1st-line therapy for metastatic disease or within 6 m after adjuvant therapy. The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), 12-wk PFS rate, overall response rate (ORR) and safety. Results: From 10/09 to 01/12, 355 pts were randomized (RAM: 238; PL: 117). Baseline characteristics were well balanced between arms. The Hazard Ratio (HR) for OS was 0.776 (95% CI, 0.603-0.998; p = 0.0473). Median OS was 5.2 m for RAM and 3.8 m for PL. The HR for PFS was 0.483 (95% CI, 0.376-0.620; p < 0.0001). Median PFS was 2.1 m for RAM and 1.3 m for PL. 12-wk PFS was 40% for RAM and 16% for PL. ORR was 3.4% for RAM and 2.6% for PL. Disease control rate was 49% for RAM and 23% for PL (p < 0.0001). Use of anti-cancer therapy post-study: 32% RAM; 39% PL. The most frequent of grade ≥ 3 adverse events (AEs) were: hypertension (7.2% RAM; 2.6% PL), anemia (6.4% RAM; 7.8% PL), abdominal pain (5.1% RAM; 2.6% PL), ascites (4.2% RAM; 4.3% PL), fatigue (4.2% RAM; 3.5% PL), decreased appetite (3.4% RAM; 3.5% PL) and hyponatremia (3.4% RAM; 0.9% PL). Conclusions: Ramucirumab conferred a statistically significant benefit in OS and PFS compared to PL in metastatic gastric or GEJ adenocarcinoma following progression on 1st-line therapy with an acceptable safety profile. Clinical trial information: NCT00917384.
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Affiliation(s)
| | - Jiri Tomasek
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Filip Dumitru
- Spitalul Judetean de Urgenta "Constantin Opris", Baia Mare, Romania
| | | | - Chanchal Goswami
- B.P. Poddar Hospital and Medical Research Ltd, Kolkata, West Bengal, India
| | | | | | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | - Bohuslav Melichar
- Fakultní Nemocnice Olomouc - Onkologická Klinika, Olomouc, Czech Republic
| | | | | | - Josep Tabernero
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Ian Chau
- Royal Marsden Hospital, Sutton, Surrey, England
| | - Minori Koshiji
- ImClone Systems, a wholly owned subsidiary of Eli Lilly & Co., Bridgewater, NJ
| | - Yanzhi Hsu
- ImClone Systems, a wholly owned subsidiary of Eli Lilly & Co., Bridgewater, NJ
| | | | - Jaffer A. Ajani
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Rowinsky EK, Schwartz JD, Zojwalla N, Youssoufian H, Fox F, Pultar P, Novosyadlyy R, Cosaert J, Ludwig DL. Blockade of insulin-like growth factor type-1 receptor with cixutumumab (IMC-A12): a novel approach to treatment for multiple cancers. Curr Drug Targets 2012; 12:2016-33. [PMID: 21777192 DOI: 10.2174/138945011798829401] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 11/18/2011] [Accepted: 11/22/2011] [Indexed: 11/22/2022]
Abstract
Insulin-like growth factor type-1 receptor (IGF-1R) plays a central role in cell proliferation and survival and is overexpressed in many tumor types. Notably, IGF-1R-mediated signaling confers resistance to diverse cytotoxic, hormonal, and biologic agents, suggesting that therapies targeting IGF-1R may be effective against a broad range of human malignancies. Cixutumumab (IMC-A12; ImClone Systems) is a fully human immunoglobulin G1 (IgG1) monoclonal antibody that specifically inhibits IGF-1R signaling. Binding of cixutumumab to IGF-1R results in receptor internalization and degradation. Because cixutumumab is an IgG1 monoclonal antibody, it may induce additional cytotoxicity via immune effector mechanisms such as antibody-dependent cellular cytotoxicity. In preclinical studies, cixutumumab monotherapy resulted in growth inhibition of multiple experimental cancers. Moreover, cixutumumab safely enhanced the tumor growth inhibitory and cytotoxic effects of a broad range of chemotherapeutics, and modulated the action of agents that target hormone receptors and signal transduction, which may have implications for cancer therapy. Herein, we review published preclinical and clinical data for cixutumumab and provide a comprehensive overview of selected clinical studies.
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Affiliation(s)
- Eric K Rowinsky
- Department of Clinical Research and Regulatory Affairs, ImClone Systems, a wholly-owned subsidiary of Eli Lilly and Company, Bridgewater, NJ, USA
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Petrylak DP, Chi KN, Vogelzang NJ, Sonpavde G, Rutstein MD, Schwartz JD, Fox FE, Wang W, Abad LW, Cosaert J, Grebennik DO. Randomized phase II study of docetaxel with or without ramucirumab (IMC-1121B) or icrucumab (IMC-18F1) in patients with urothelial transitional cell carcinoma (TCC) following progression on first-line platinum-based therapy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.tps4675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS4675^ Background: The vascular endothelial growth factor (VEGF) pathway may play an important role in the pathogenesis of bladder cancer. Two antibodies (ramucirumab or icrucumab) in combination with docetaxel are being tested in this clinical study. Ramucirumab is a fully human IgG1 monoclonal antibody (MAb) that specifically binds with high affinity to VEGF receptor-2 (VEGFR-2), thereby blocking the interaction of VEGF ligands. Ramucirumab inhibits VEGF-mediated proliferation of human endothelial cells and migration of human leukemia cells. Icrucumab is a fully human IgG1 MAb that specifically binds with high affinity to VEGFR-1 and blocks the binding of VEGF-A, VEGF-B, and placental growth factor (PlGF) to the receptor, thereby inhibiting subsequent signaling. Blockage of VEGFR-1 and VEGFR-2 by antibodies demonstrates antiangiogenic and antitumor activity and prevents dissemination and growth of lung metastases in several tumor xenograft models. Methods: This study includes patients (pts) with TCC with progressive disease after prior platinum-based therapy. Pts are randomized equally to 1 of 3 open-label treatments given on a 21-day cycle: docetaxel (75 mg/m2) on Day 1 (Arm A); docetaxel on Day 1 and ramucirumab (10 mg/kg) on Day 1 (Arm B); or docetaxel on Day 1 and icrucumab (12 mg/kg) on Days 1 and 8 (Arm C). Randomization is stratified by the absence/presence of visceral metastases and receipt of prior antiangiogenic therapy. The primary endpoint is progression-free survival (PFS). Secondary outcome measures include response rate and duration of response, overall survival, and pharmacodynamic markers, including circulating levels of PlGF, VEGF-A, VEGF-B, soluble VEGFR-1, and soluble VEGFR-2. Exploratory analyses of VEGF, VEGFR-1, and VEGFR-2 genetic polymorphisms will be performed. As of 12 January 2012, approximately 20% of 138 planned pts were randomized in the US and Canada. The sample size will allow differentiation of an expected increase in median PFS from 3.0 months to 4.5 months with a one-sided alpha of 0.1 and a power of 71%. ClinicalTrials.gov identifier: NCT01282463.
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Affiliation(s)
| | - Kim N. Chi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | - Guru Sonpavde
- Texas Oncology and US Oncology Research, Baylor College of Medicine, Houston, TX
| | - Mark D. Rutstein
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, Bridgewater, NJ
| | | | - Floyd E. Fox
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, Bridgewater, NJ
| | - Weigang Wang
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, New York, NY
| | - Leslie W Abad
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, New York, NY
| | - Jan Cosaert
- ImClone Systems International GmbH, Heidelberg, Germany
| | - Dmitri O. Grebennik
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, Bridgewater, NJ
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Penson RT, Moore KN, Fleming GF, Braly PS, Schimp VL, Nguyen H, Matulonis U, Banerjee SN, Haluska P, Gore ME, Bodurka DC, Morozov A, Xu Y, Rutstein MD, Schwartz JD, McGuire WP. A phase II, open-label, multicenter study of IMC-1121B (ramucirumab; RAM) monotherapy in the treatment of persistent or recurrent epithelial ovarian (EOC), fallopian tube (FTC), or primary peritoneal (PPC) carcinoma (CP12-0711/NCT00721162). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.5012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5012 Background: VEGF receptor-mediated-signaling contributes to ovarian cancer pathogenesis. Elevated VEGF expression and serum levels are associated with poor clinical outcomes. We investigated RAM, a fully human VEGFR-2 antagonist antibody, in patients (pts) with persistent or recurrent EOC/FTC/PPC. Methods: Adult women with EOC/FTC/PPC who had completed ≥1 platinum (P)-based chemotherapeutic (ct) regimen and had a P-free interval (PFI) of <12 months (m), progression on, or persistent disease after P-based therapy were eligible. Any number of prior ct regimens was allowed. ECOG PS 0-1 and adequate organ function were required. Pts received 8 mg/kg RAM IV every 2 weeks. Primary endpoints were progression-free survival at 6m (PFS-6) and confirmed objective response rate (ORR) by RECIST 1.0. Results: 60 pts were treated; 1 remains on study as of Dec 2011. Median age was 62 years (range 27-80). Median number of prior regimens was 3 (range 1– 14). 51 pts (85%) received ≥ 2 prior regimens; 25 pts (42%) received >3 prior regimens. 45 pts (75%) were P resistant or refractory, with 65% (39 pts) serous tumors. PFS-6: 34.2% (95% CI: 21.7% – 47%). Best overall response: 3 PR (5%), 34 SD (57%), 20 PD (33%) and 3 not evaluable (5%). Median duration of PR: 5.6m (3.7, 5.6, 17.5); median PFS: 3.5m (95% CI: 2.3 – 5.3). Median OS: 11.1m (95% CI: 8.3 – 17.0). No unexpected toxicities were observed. Grade (G) 3 adverse events (AEs) observed in >5% of pts were: headache (10%) and fatigue (8%). No G4 AEs were observed in >5% of pts. 5 deaths occurred on RAM or within 30 days of discontinuation; 4 due to PD, and 1 due to intestinal perforation. 1 G4 bowel perforation and one G4 colo-vaginal fistula were noted. All 3 cases of perforation/fistula occurred in the setting of progressive, large-volume disease. Correlative biomarker studies are ongoing to identify patients most likely to benefit. Conclusions: Ramucirumab was reasonably tolerated and demonstrated single-agent activity in persistent or recurrent ovarian carcinoma, with approximately one-third of patients progression free at 6 months.
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Affiliation(s)
| | | | | | | | | | - Hoa Nguyen
- Gynecologic Oncology Associates, Hollywood, FL
| | | | | | | | | | | | - Alexei Morozov
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, Bridgewater, NJ
| | - Yihuan Xu
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, Bridgewater, NJ
| | - Mark D. Rutstein
- ImClone Systems, a wholly-owned subsidiary of Eli Lilly & Co, Bridgewater, NJ
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Hussain M, Rathkopf DE, Liu G, Armstrong AJ, Kelly WK, Ferrari AC, Hainsworth JD, Yang L, Schwartz JD, Higano CS. A phase II randomized study of cixutumumab (IMC-A12: CIX) or ramucirumab (IMC‐1121B: RAM) plus mitoxantrone (M) and prednisone (P) in patients (pts) with metastatic castrate-resistant prostate cancer (mCRPC) following disease progression (PD) on docetaxel (DCT) therapy. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.97] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
97 Background: Vascular endothelial growth factor (VEGF)-mediated angiogenesis and insulin-like growth factor (IGF-IR)-mediated signaling contribute to mCRPC growth. CIX and RAM are fully human IgG1 human monoclonal antibodies targeting IGF‐IR and VEGF receptor-2 (VEGFR-2) respectively. We investigated the safety and efficacy of CIX or RAM in combination with M + P in mCRPC pts with PD on DCT. Methods: Eligible pts had mCRPC and PD during/within 120 days of DCT, ECOG PS 0-2, PSA ≥ 2 ng/mL, and adequate organ function. All pts received M 12 mg/m2 IV every 3 weeks (w) + P 5 mg PO BID for up to 12 cycles and were randomized to either CIX 6 mg/kg or RAM 6 mg/kg IV q w. Tumor assessments were after the first 3 cycles and then q6w. Primary endpoint was composite progression-free survival (cPFS: either RECIST PD, bone scan PD or new skeletal events). Other endpoints included safety, response and overall survival (OS). Sample size was based on a targeted 50% increase in median (mdn) cPFS from 2.6 months (m) to 3.9 m. Results: 132 pts were treated; 66 each to CIX or RAM. Mdn age and baseline PSA was 65 yr and 129 ng/mL for pts treated with CIX and 68 yr and 111 ng/mL for RAM. Involvement of sites other than bone was CIX: 79% and RAM: 70%. The most frequent Grade ≥3 related adverse events for CIX/M/P: fatigue 17%, leukopenia 12%, and neutropenia 8%, and for RAM/M/P: leukopenia 8%, neutropenia 8% and hypertension 8%. Left ventricular dysfunction/CHF: 12% for CIX (0% G3) and 23% for RAM (8% G3). Mdn number of Rx cycles were 5 for CIX and 6 for RAM. Mdn follow-up was 22.7 m for CIX and 21.8 m for RAM. PSA response was 18.4% (8.8-32% 95% CI) on CIX and 22.0% (11.5-36% 95% CI) on RAM. Mdn cPFS and OS were 4.1 m (3.0-5.6 m 95% CI) and 10.8 m (6.5-13.0 m 95% CI) for CIX and 6.7 m (4.5-8.3 m 95% CI) and 13.0 m (9.5-16.0 m 95% CI) for RAM. Conclusions: CIX/M/P and RAM/M/P were reasonably tolerated and achieved the primary endpoint. Preliminary cPFS and OS of RAM/M/P appear encouraging; sustained disease control was observed in pts on both rx arms. Correlation of serum markers of IGF and VEGF activity with clinical endpoints is planned.
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Affiliation(s)
- Maha Hussain
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - Dana E. Rathkopf
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - Glenn Liu
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - Andrew J. Armstrong
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - William Kevin Kelly
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - Anna C. Ferrari
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - John D. Hainsworth
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - Ling Yang
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - Jonathan D. Schwartz
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
| | - Celestia S. Higano
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY; University of Wisconsin Carbone Cancer Center, Madison, WI; Duke Cancer Institute, Durham, NC; Thomas Jefferson University Hospital, Philadelphia, PA; New York University Cancer Institute, New York, NY; Sarah Cannon Research Institute, Nashville, TN; ImClone Systems, Bridgewater, NJ; Fred Hutchinson Cancer Research Center, Seattle
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Garcia-Carbonero R, Rivera F, Maurel J, Ayoub JPM, Moore MJ, Cervantes-Ruiperez A, Asmis TR, Schwartz JD, Ballal S, Tabernero J. A phase II, open-label study evaluating the safety and efficacy of ramucirumab combined with mFOLFOX-6 as first-line therapy in patients (pts) with metastatic colorectal cancer (mCRC): CP12-0709/NCT00862784. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
533^ Background: Vascular endothelial growth factor (VEGF) and the VEGF receptor-2 (VEGFR-2) are overexpressed in CRC and mediate angiogenesis. Ramucirumab (RAM; IMC-1121B) is a fully human IgG1 MAb that inhibits binding of VEGF ligands to VEGFR-2 and inhibits VEGFR-2 activation and signaling. In preclinical CRC models VEGFR-2 inhibition confers antitumor activity. RAM was administered with mFOLFOX-6 as 1st-line therapy (rx) in mCRC. Methods: Eligible pts had mCRC with no prior chemo Rx (prior adjuvant rx was allowed), at least 1 measurable target lesion by RECIST v1.0, ECOG PS 0-1, and adequate organ function. Pts received RAM (8 mg/kg IV on D1), oxaliplatin (85 mg/m² IV on D1), folinic acid (400 mg/m² IV on D1), fluorouracil (5-FU, 400 mg/m² bolus followed by 2400 mg/m² continuous infusion over 46 hours on D1). Rx cycles were q2w and tumor assessments were q8w. Endpoints included progression-free survival (PFS), objective response rate (ORR), overall survival (OS), safety, and pharmacokinetics/immunogenicity. Sample size was based on an improved median (medn) PFS from 8 to 11 months (m). Results: 48 pts received therapy. All were white; 25 M/23 F; median age 60.5 y. ECOG PS was 0/1 in 30/18 pts. 42 pts (88%) had metastatic disease, with liver (79%) and lung (35%) as most frequent sites. 13 (27%) pts had liver-only mCRC. The most frequently observed RAM-related adverse events (AEs) included hypertension 46% (15% Grade [G] ≥3); diarrhea 31% (2% G≥3); and nausea and infusion-related reactions, each 19% (0% G≥3). 2 pts died on study due to acute MI or cardiopulmonary arrest. Medn PFS was 11.5 m (9-13 m 95% CI) with 1-yr PFS of 48% (32-62% 95% CI). ORR: 67% (52-80% 95% CI); disease control rate (DCR: CR+PR+SD): 94% (83-99% 95% CI; 5 pts had CR, 27 had PR and 13 had SD). Medn duration of response was 11.0 m (7-12 m 95% CI). One-year OS was 85% (72-93% 95% CI). As of 4/15/2011, 2 pts continued to receive rx, 20 had died and 28 (58.3%) remained alive. Conclusions: RAM combined with mFOLFOX-6 was reasonably tolerated in pts with mCRC. Median PFS exceeds 11 m. PFS, ORR, and DCR are encouraging and favor investigation of this regimen and of RAM in mCRC.
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Affiliation(s)
- Rocio Garcia-Carbonero
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Fernando Rivera
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Juan Maurel
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Jean-Pierre M. Ayoub
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Malcolm J. Moore
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Andres Cervantes-Ruiperez
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Timothy R. Asmis
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Jonathan D. Schwartz
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Shaila Ballal
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
| | - Josep Tabernero
- Hospital Universitario Virgen del Roca, Sevilla, Spain; University Hospital Marqués de Valdecilla, Santander, Spain; Hospital Clinic i Provincial, Barcelona, Spain; Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Princess Margaret Hospital and University of Toronto, Toronto, ON, Canada; Department of Hematology and Medical Oncology, INCLIVA, University of Valencia, Valencia, Spain; The Ottawa Hospital, Ottawa, ON, Canada; ImClone Systems, Bridgewater, NJ; Vall d'Hebron University
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Schwartz JD. Diarrhea from ipilimumab in melanoma. N Engl J Med 2010; 363:2262; author reply 2262-3. [PMID: 21121842 DOI: 10.1056/nejmc1010475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schwartz JD, Rowinsky EK, Youssoufian H, Pytowski B, Wu Y. Vascular endothelial growth factor receptor-1 in human cancer: concise review and rationale for development of IMC-18F1 (Human antibody targeting vascular endothelial growth factor receptor-1). Cancer 2010; 116:1027-32. [PMID: 20127948 DOI: 10.1002/cncr.24789] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The human vascular endothelial growth factor receptor-1 (VEGFR-1, or Flt-1) is widely expressed in normal and pathologic tissue and contributes to the pathogenesis of both neoplastic and inflammatory diseases. In human cancer, VEGFR-1 mediated signaling is responsible for both direct tumor activation and angiogenesis. VEGFR-1 mediated activation of nonmalignant supporting cells, particularly stromal, dendritic, hematopoietic cells, and macrophages, is also likely important for cancer pathogenesis. VEGFR-1 is also hypothesized to enable the development of cancer metastases by means of activation and premetastatic localization in distant organs of bone marrow-derived hematopoietic progenitor cells, which express VEGFR-1. IMC-18F1 is a fully human IgG(1) antibody that binds to VEGFR-1 and has been associated with the inhibition of cancer growth in multiple in vitro and human tumor xenograft models. The preliminary results of phase 1 investigations have also indicated a favorable safety profile for IMC-18F1 at doses that confer antibody concentrations that are associated with relevant antitumor activity in preclinical models.
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Shah GD, Loizos N, Youssoufian H, Schwartz JD, Rowinsky EK. Rationale for the development of IMC-3G3, a fully human immunoglobulin G subclass 1 monoclonal antibody targeting the platelet-derived growth factor receptor alpha. Cancer 2010; 116:1018-26. [PMID: 20127943 DOI: 10.1002/cncr.24788] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A large body of evidence suggests that the platelet-derived growth factor (PDGF) family and associated receptors are potential targets in oncology therapeutic development because of their critical roles in the proliferation and survival of various cancers and in the regulation and growth of the tumor stroma and blood vessels. Several small molecules that nonspecifically target the PDGF signaling axis are in current use or development as anticancer therapies. However, for the majority of these agents, PDGF and its receptors are neither the primary targets nor the principal mediators of anticancer activity. IMC-3G3, a fully human monoclonal antibody of the immunoglobulin G subclass 1, specifically binds to the human PDGF receptor alpha (PDGFRalpha) with high affinity and blocks PDGF ligand binding and PDGFRalpha activation. The results of preclinical studies and the frequent expression of PDGFRalpha in many types of cancer and in cancer-associated stroma support a rationale for the clinical development of IMC-3G3. Currently, IMC-3G3 is being evaluated in early clinical development for patients with several types of solid malignancies.
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Affiliation(s)
- Gaurav D Shah
- ImClone Systems Corporation, 33 ImClone Drive, Branchburg, NJ 08876, USA.
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Zhong Z, Carroll KD, Policarpio D, Osborn C, Gregory M, Bassi R, Jimenez X, Prewett M, Liebisch G, Persaud K, Burtrum D, Wang S, Surguladze D, Ng S, Griffith H, Balderes P, Doody J, Schwartz JD, Youssoufian H, Rowinsky EK, Ludwig DL, Witte L, Zhu Z, Wu Y. Anti-transforming growth factor beta receptor II antibody has therapeutic efficacy against primary tumor growth and metastasis through multieffects on cancer, stroma, and immune cells. Clin Cancer Res 2010; 16:1191-205. [PMID: 20145179 DOI: 10.1158/1078-0432.ccr-09-1634] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Transforming growth factor beta (TGFbeta) is a pleiotropic cytokine that affects tumor growth, metastasis, stroma, and immune response. We investigated the therapeutic efficacy of anti-TGFbeta receptor II (TGFbeta RII) antibody in controlling metastasis and tumor growth as well as enhancing antitumor immunity in preclinical tumor models. EXPERIMENTAL DESIGN We generated neutralizing antibodies to TGFbeta RII and assessed the antibody effects on cancer, stroma, and immune cells in vitro. The efficacy and mechanism of action of the antibody as monotherapy and in combination with chemotherapy in suppression of primary tumor growth and metastasis were evaluated in several tumor models. RESULTS Anti-TGFbeta RII antibody blocked TGFbeta RII binding to TGFbeta 1, 2, and 3, and attenuated the TGFbeta-mediated activation of downstream Smad2 kinase, invasion of cancer cells, motility of endothelial and fibroblast cells, and induction of immunosuppressive cells. Treatment with the antibody significantly suppressed primary tumor growth and metastasis and enhanced natural killer and CTL activity in tumor-bearing mice. Immunohistochemistry analysis showed cancer cell apoptosis and massive necrosis, and increased tumor-infiltrating T effector cells and decreased tumor-infiltrating Gr-1+ myeloid cells in the antibody-treated tumors. Fluorescence-activated cell sorting analysis indicated the significant reduction of peripheral Gr-1+/CD11b+ myeloid cells in treated animals. Concomitant treatment with the cytotoxic agent cyclophosphamide resulted in a significantly increased antitumor efficacy against primary tumor growth and metastasis. CONCLUSIONS These preclinical data provide a foundation to support using anti-TGFbeta RII antibody as a therapeutic agent for TGFbeta RII-dependent cancer with metastatic capacity.
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Affiliation(s)
- Zhaojing Zhong
- Department of Antibody Technology & Immunology, Clinical Research, and Research, ImClone Systems, New York, New York 10014, USA
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