1
|
Nogueira-Rodrigues A, Rosa DD, Suzuki DA, Paulino E, Landeiro LCG, Scaranti M, Madi MR, Hoff PM. Breast and gynecologic cancers as a Brazilian health priority. Rev Assoc Med Bras (1992) 2023; 69:e2023S120. [PMID: 37556639 PMCID: PMC10411703 DOI: 10.1590/1806-9282.2023s120] [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] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Cancer imposes a profound burden on low- and middle-income countries where 65% of the global cancer deaths occurred in 2020. The objective of the present review was to describe female cancer epidemiology in Brazil, barriers to prevention, screening, and treatment, and to propose strategies to a better control. METHODS For the process of literature search and scientific acquisition, we have utilized the terms "female cancer" AND "breast cancer," AND "cervical cancer" AND "endometrial cancer" AND "ovarian cancer" AND "Brazil" in PubMed. References of the articles included in this review were manually searched in order to identify relevant studies on the topic. The official Brazilian epidemiology data were extensively analyzed at the governmental site www.inca.gov.br. RESULTS Considering cases of breast and gynecologic cancers together, 105,770 new cases are expected to be diagnosed yearly, positioning female cancer as the highest cancer incidence in Brazil. Female breast cancer is the most common and the leading cause of death from cancer in the female population in all regions of Brazil, except in the North, where cervical cancer ranks first. Cervical cancer, a preventable disease, corresponds to the third-most common neoplasia in women, with higher incidences in the North and Northeast regions of Brazil. An upward trend has been observed in endometrial cancer incidence, a tendency that follows the increase of its two most common risk factors: population aging and obesity. Ovarian cancer currently occupies the eighth position among female cancers in Brazil, but it is the most lethal gynecologic cancer. The main strategies to reduce female cancer mortality rates are the reduction of inequalities in healthcare services and the early diagnosis of cases. The lack of a specific national cancer program results in a reactive and unplanned approach to healthcare provision, ultimately leading to suboptimal resource utilization and higher expenditure. CONCLUSION Analyzed together, breast and gynecologic cancers correspond to the leading cause of cancer in Brazil. A heterogeneous group, female cancer includes diseases with a high primary and secondary prevention potential. The organization of a female cancer program in Brazil prioritizing primary and secondary prevention strategies, such as adequate mammography screening and human papillomavirus vaccination coverage, could significantly improve female cancer control in the country.
Collapse
Affiliation(s)
| | | | | | - Eduardo Paulino
- Sociedade Brasileira de Oncologia Clínica – São Paulo (SP), Brazil
| | | | - Mariana Scaranti
- Sociedade Brasileira de Oncologia Clínica – São Paulo (SP), Brazil
| | | | | |
Collapse
|
2
|
de Andrade DAP, Guimarães APG, de Melo AC, Nogueira-Rodrigues A, Gomes LM, Scaranti M, Maia JML, Morelle AM, Santos CADAL, Souza CDP, de Freitas D, Callegaro Filho D, Paulino E, Júnior EWA, Pimenta JM, dos Santos MB, de Almeida MS, Souza RP, Cabral S, Maluf FC. Management of patients with recurrent/metastatic endometrial cancer: Consensus recommendations from an expert panel from Brazil. Front Oncol 2023; 13:1133277. [PMID: 36969061 PMCID: PMC10033867 DOI: 10.3389/fonc.2023.1133277] [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] [Received: 12/28/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundEndometrial cancer is of increasing concern in several countries, including Brazil, in part because of an ageing population, declines in fertility, and the increasing prevalence of obesity. Although endometrial tumors had lagged behind other cancer types in terms of treatment improvements, molecular characterization of these tumors is paving the way for novel therapies and an expansion of the therapeutic arsenal. We aimed to help medical oncologists who manage patients with recurrent or metastatic endometrial cancer in the Brazilian healthcare setting.MethodsThe panel, composed of 20 medical oncologists, convened in November 2021 to address 50 multiple-choice questions on molecular testing and treatment choices. We classified the level of agreement among panelists as (1) consensus (≥75% choosing the same answer), (2) majority vote (50% to <75%), or (3) less than majority vote (<50%).ResultsConsensus was present for 25 of the 50 questions, whereas majority vote was present for an additional 23 questions. Key recommendations include molecular testing for every patient with recurrent/metastatic endometrial cancer; choice of first-line treatment according to microsatellite instability and HER2, with the addition of programmed death ligand 1 (PD-L1) and hormone receptors (HRs) for second-line therapy; carboplatin and paclitaxel as the preferred option in first-line treatment of HER2-negative disease, with the addition of trastuzumab in HER2-positive disease; pembrolizumab plus lenvatinib as a key option in second line, regardless of HER2, PD-L1 or HRs; and various recommendations regarding treatment choice for patients with distinct comorbidities.ConclusionDespite the existing gaps in the current literature, the vast majority of issues addressed by the panel provided a level of agreement sufficient to inform clinical practice in Brazil and in other countries with similar healthcare environments.
Collapse
Affiliation(s)
- Diocésio Alves Pinto de Andrade
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- InORP Oncoclínicas Group, Ribeirão Preto, Brazil
- *Correspondence: Diocésio Alves Pinto de Andrade,
| | | | - Andréia Cristina de Melo
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Brazilian Nacional Cancer Institute – INCA, Rio de Janeiro, Brazil
| | - Angélica Nogueira-Rodrigues
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Larissa Müller Gomes
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- CPO Oncoclínicas Group, São Paulo, Brazil
| | - Mariana Scaranti
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- DASA – Hospital 9 de Julho, São Paulo, Brazil
| | - Joyce Maria Lisboa Maia
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Cancer Treatment Center, MedRadius –, Maceió, Brazil
| | - Alessandra Menezes Morelle
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Cristiano de Pádua Souza
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Barretos Cancer Hospital, Barretos, Brazil
| | - Daniela de Freitas
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Donato Callegaro Filho
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Eduardo Paulino
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Brazilian Nacional Cancer Institute – INCA, Rio de Janeiro, Brazil
| | | | - Juliana Martins Pimenta
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Michelle Samora de Almeida
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital do Coração HCOR Oncologia, São Paulo, Brazil
| | - Ronaldo Pereira Souza
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- AC Camargo Cancer Center, São Paulo, Brazil
| | - Samantha Cabral
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Cotait Maluf
- Brazilian Gynecologic Oncology Group, EVA, São Paulo, Brazil
- Hospital Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Scaranti M, Lopes Yamamoto G, Guarischi Sousa R, J Paniza AC, Milanezi F, Scapulatempo-Neto C. Distribution of homologous recombination deficiency (HRD) and BRCA mutations (m) detected by HRD-One test among Brazilian patients (pts) with newly diagnosed advanced epithelial ovarian, fallopian tube, or peritoneal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17600 Background: In the Phase III PAOLA-1/ENGOT-ov25 (NCT02477644) and PRIMA/ENGOT-OV26/GOG-3012 (NCT02655016) trials, the addition of a poly(ADP-ribose) polymerase (PARP) inhibitor as maintenance therapy led to a significant progression-free survival benefit in pts with newly diagnosed advanced ovarian cancer, particularly in those who were HRD positive, both including pts with BRCA1m and/or BRCA2m and pts without a BRCAm. Both trials used Myriad's myChoice to determine HRD status. However, this test is economically inaccessible for a significant fraction of the Brazilian population. Methods: We explored the prevalence and distribution of HRD and tumor (t) BRCAm in Brazilian pts using the HRD-One test that detects not only sequence variants in genes involved in homologous recombination repair (HRR) but also the genomic scars due to HRD that might be present even when a pathogenic variant in one of the HRR genes is not detected. Firstly, 59 high-grade serous epithelial ovarian cancer (HGSOC) samples were tested and the accuracy of the HRD-One score was established both by correlation with Myriad's myChoice score and an internal validation considering that most of the samples that carry a pathogenic variant in BRCA1 or BRCA2 should have HRD. HRD-One score of 2.0 or greater predicted HRD and correlated to Myriad's myChoice score of 42. HRD-One achieved an overall categorical concordance of 94.74% with the previously available commercial HRD test. We then tested stage III and IV HGSOC and high-grade endometrioid ovarian cancer pts’ tumor samples with HRD-One test only. Results: Of the 468 pts, 224 (47,9%) had HRD positive tumors, 213 (45,5%) were HRD negative, and 31 (6,6%) had inconclusive results. Ninety-six pts had t BRCAm, 95 (98.9%) of them had a genomic instability score compatible with HRD, and 59 (61%) had BRCA1m . BRCA1c.5266dupC was the most prevalent pathogenic variant in this population followed by BRCA1c.470_471del, c.5074+2T > C, c.5251C > T, and c.3331_3334del. The most prevalent BRCA2m were c.8488-1G > A, c.5216dupA, c.5073dupA, c.1796_1800del, c.8351G > A, c.2808_2811del, and c.9382C > T. Median age at diagnosis was 63 in the study population, 57 in the BRCA1m, and 60 in the BRCA2m group. 47,6% of the HGSOC were HRD positive, whereas 25% of the high-grade endometrioid ovarian cancer were HRD positive. Conclusions: This is the first study to report HRD prevalence in a cohort of Brazilian pts using HRD-One test validated to detect HRD genomic scars and t BRCAm. HRD was detected in approximately 50% of HGSOC pts which is in line with previous studies in different populations. HRD-One might help us select pts to receive PARP inhibitors in the front-line therapy noticeably in a low-resource setting where Myriad's myChoice is not widely available.
Collapse
|
4
|
Wanderley CWS, Correa TS, Scaranti M, Cunha FQ, Barroso-Sousa R. Targeting PARP1 to Enhance Anticancer Checkpoint Immunotherapy Response: Rationale and Clinical Implications. Front Immunol 2022; 13:816642. [PMID: 35572596 PMCID: PMC9094400 DOI: 10.3389/fimmu.2022.816642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Reinvigorating the antitumor immune response using immune checkpoint inhibitors (ICIs) has revolutionized the treatment of several malignancies. However, extended use of ICIs has resulted in a cancer-specific response. In tumors considered to be less immunogenic, the response rates were low or null. To overcome resistance and improve the beneficial effects of ICIs, novel strategies focused on ICI-combined therapies have been tested. In particular, poly ADP-ribose polymerase inhibitors (PARPi) are a class of agents with potential for ICI combined therapy. PARPi impairs single-strand break DNA repair; this mechanism involves synthetic lethality in tumor cells with deficient homologous recombination. More recently, novel evidence indicated that PAPRi has the potential to modulate the antitumor immune response by activating antigen-presenting cells, infiltrating effector lymphocytes, and upregulating programmed death ligand-1 in tumors. This review covers the current advances in the immune effects of PARPi, explores the potential rationale for combined therapy with ICIs, and discusses ongoing clinical trials.
Collapse
Affiliation(s)
- Carlos Wagner S. Wanderley
- Center for Research in Inflammatory Diseases (CRID), Ribeirao Preto Medical School, Ribeirao Preto, Brazil
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | | | | | - Fernando Queiroz Cunha
- Center for Research in Inflammatory Diseases (CRID), Ribeirao Preto Medical School, Ribeirao Preto, Brazil
- Department of Pharmacology, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | | |
Collapse
|
5
|
Vieira AC, Xavier CB, Vieira TD, Carvalho FM, Scaranti M, Munhoz RR, Carvalho JP. CIC-DUX4 rearranged uterine cervix round-cell sarcoma exhibiting near-complete pathologic response following radiation and neoadjuvant chemotherapy: A case report. Gynecol Oncol Rep 2021; 36:100745. [PMID: 33850994 PMCID: PMC8022141 DOI: 10.1016/j.gore.2021.100745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/04/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Jesus Paula Carvalho
- Oncology Center, Hospital Sírio-Libanês, São Paulo, Brazil.,Discipline of Gynecology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
6
|
Scaranti M, Mathias-Machado MC, Guo C. MEK inhibition for low-grade serous ovarian cancer: are we there yet? Int J Gynecol Cancer 2020; 31:155-156. [PMID: 33172923 DOI: 10.1136/ijgc-2020-002122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/26/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mariana Scaranti
- Hospital Sírio-Libanês, Sao Paulo, Brazil .,Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, Sao Paulo, SP, Brazil
| | - Maria Cecília Mathias-Machado
- Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira, Sao Paulo, SP, Brazil
| | - Christina Guo
- Royal Marsden NHS Foundation Trust, London, London, UK.,The Institute of Cancer Research, London, London, UK
| |
Collapse
|
7
|
Guo C, Chénard-Poirier M, Roda D, de Miguel M, Harris SJ, Candilejo IM, Sriskandarajah P, Xu W, Scaranti M, Constantinidou A, King J, Parmar M, Turner AJ, Carreira S, Riisnaes R, Finneran L, Hall E, Ishikawa Y, Nakai K, Tunariu N, Basu B, Kaiser M, Lopez JS, Minchom A, de Bono JS, Banerji U. Intermittent schedules of the oral RAF-MEK inhibitor CH5126766/VS-6766 in patients with RAS/RAF-mutant solid tumours and multiple myeloma: a single-centre, open-label, phase 1 dose-escalation and basket dose-expansion study. Lancet Oncol 2020; 21:1478-1488. [PMID: 33128873 DOI: 10.1016/s1470-2045(20)30464-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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] [Received: 03/26/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND CH5126766 (also known as VS-6766, and previously named RO5126766), a novel MEK-pan-RAF inhibitor, has shown antitumour activity across various solid tumours; however, its initial development was limited by toxicity. We aimed to investigate the safety and toxicity profile of intermittent dosing schedules of CH5126766, and the antitumour activity of this drug in patients with solid tumours and multiple myeloma harbouring RAS-RAF-MEK pathway mutations. METHODS We did a single-centre, open-label, phase 1 dose-escalation and basket dose-expansion study at the Royal Marsden National Health Service Foundation Trust (London, UK). Patients were eligible for the study if they were aged 18 years or older, had cancers that were refractory to conventional treatment or for which no conventional therapy existed, and if they had a WHO performance status score of 0 or 1. For the dose-escalation phase, eligible patients had histologically or cytologically confirmed advanced or metastatic solid tumours. For the basket dose-expansion phase, eligible patients had advanced or metastatic solid tumours or multiple myeloma harbouring RAS-RAF-MEK pathway mutations. During the dose-escalation phase, we evaluated three intermittent oral schedules (28-day cycles) in patients with solid tumours: (1) 4·0 mg or 3·2 mg CH5126766 three times per week; (2) 4·0 mg CH5126766 twice per week; and (3) toxicity-guided dose interruption schedule, in which treatment at the recommended phase 2 dose (4·0 mg CH5126766 twice per week) was de-escalated to 3 weeks on followed by 1 week off if patients had prespecified toxic effects (grade 2 or worse diarrhoea, rash, or creatinine phosphokinase elevation). In the basket dose-expansion phase, we evaluated antitumour activity at the recommended phase 2 dose, determined from the dose-escalation phase, in biomarker-selected patients. The primary endpoints were the recommended phase 2 dose at which no more than one out of six patients had a treatment-related dose-limiting toxicity, and the safety and toxicity profile of each dosing schedule. The key secondary endpoint was investigator-assessed response rate in the dose-expansion phase. Patients who received at least one dose of the study drug were evaluable for safety and patients who received one cycle of the study drug and underwent baseline disease assessment were evaluable for response. This trial is registered with ClinicalTrials.gov, NCT02407509. FINDINGS Between June 5, 2013, and Jan 10, 2019, 58 eligible patients were enrolled to the study: 29 patients with solid tumours were included in the dose-escalation cohort and 29 patients with solid tumours or multiple myeloma were included in the basket dose-expansion cohort (12 non-small-cell lung cancer, five gynaecological malignancy, four colorectal cancer, one melanoma, and seven multiple myeloma). Median follow-up at the time of data cutoff was 2·3 months (IQR 1·6-3·5). Dose-limiting toxicities included grade 3 bilateral retinal pigment epithelial detachment in one patient who received 4·0 mg CH5126766 three times per week, and grade 3 rash (in two patients) and grade 3 creatinine phosphokinase elevation (in one patient) in those who received 3·2 mg CH5126766 three times per week. 4·0 mg CH5126766 twice per week (on Monday and Thursday or Tuesday and Friday) was established as the recommended phase 2 dose. The most common grade 3-4 treatment-related adverse events were rash (11 [19%] patients), creatinine phosphokinase elevation (six [11%]), hypoalbuminaemia (six [11%]), and fatigue (four [7%]). Five (9%) patients had serious treatment-related adverse events. There were no treatment-related deaths. Eight (14%) of 57 patients died during the trial due to disease progression. Seven (27% [95% CI 11·6-47·8]) of 26 response-evaluable patients in the basket expansion achieved objective responses. INTERPRETATION To our knowledge, this is the first study to show that highly intermittent schedules of a RAF-MEK inhibitor has antitumour activity across various cancers with RAF-RAS-MEK pathway mutations, and that this inhibitor is tolerable. CH5126766 used as a monotherapy and in combination regimens warrants further evaluation. FUNDING Chugai Pharmaceutical.
Collapse
Affiliation(s)
- Christina Guo
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Maxime Chénard-Poirier
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Desamparados Roda
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Maria de Miguel
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Samuel J Harris
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Irene Moreno Candilejo
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Priya Sriskandarajah
- Division of Cancer Therapeutics, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Wen Xu
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Mariana Scaranti
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Anastasia Constantinidou
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Jenny King
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Mona Parmar
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Alison J Turner
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | | | - Ruth Riisnaes
- Cancer Biomarkers, The Institute of Cancer Research, London, UK
| | - Laura Finneran
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Yuji Ishikawa
- Translational Research Division, Chugai Pharmaceutical, Tokyo, Japan
| | - Kiyohiko Nakai
- Translational Research Division, Chugai Pharmaceutical, Tokyo, Japan
| | - Nina Tunariu
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Bristi Basu
- Department of Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Martin Kaiser
- Division of Molecular Pathology and Myeloma Molecular Therapy Group, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Juanita Suzanne Lopez
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Anna Minchom
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Johann S de Bono
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK
| | - Udai Banerji
- Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK.
| |
Collapse
|
8
|
Terbuch A, Tiu C, Candilejo IM, Scaranti M, Curcean A, Bar D, Estevez Timon M, Ameratunga M, Ang JE, Ratoff J, Minchom AR, Banerji U, de Bono JS, Tunariu N, Lopez JS. Radiological Patterns of Drug-induced Interstitial Lung Disease (DILD) in Early-phase Oncology Clinical Trials. Clin Cancer Res 2020; 26:4805-4813. [PMID: 32332017 DOI: 10.1158/1078-0432.ccr-20-0454] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Drug-induced interstitial lung disease (DILD) is a rare, but potentially fatal toxicity. Clinical and radiological features of DILD in the early experimental setting are poorly described. PATIENTS AND METHODS A total of 2,499 consecutive patients with advanced cancer on phase I clinical trials were included. DILD was identified by a dedicated radiologist and investigators, categorized per internationally recognized radiological patterns, and graded per Common Terminology Criteria for Adverse Events (CTCAE) and the Royal Marsden Hospital (RMH) DILD score. Clinical and radiological features of DILD were analyzed. RESULTS Sixty patients overall (2.4%) developed DILD. Median time to onset of DILD was 63 days (range, 14-336 days). A total of 45% of patients who developed DILD were clinically asymptomatic. Incidence was highest in patients receiving drug conjugates (7.4%), followed by inhibitors of the PI3K/AKT/mTOR pathway (3.9%). The most common pattern seen was hypersensitivity pneumonitis (33.3%), followed by nonspecific interstitial pneumonia (30%), and cryptogenic organizing pneumonia (26.7%). A higher DILD score [OR, 1.47, 95% confidence interval (CI), 1.19-1.81; P < 0.001] and the pattern of DILD (OR, 5.83 for acute interstitial pneumonia; 95% CI, 0.38-90.26; P = 0.002) were significantly associated with a higher CTCAE grading. The only predictive factor for an improvement in DILD was an interruption of treatment (OR, 0.05; 95% CI, 0.01-0.35; P = 0.01). CONCLUSIONS DILD in early-phase clinical trials is a toxicity of variable onset, with diverse clinical and radiological findings. Radiological findings precede clinical symptoms. The extent of the affected lung parenchyma, scored by the RMH DILD score, correlates with clinical presentation. Most events are low grade, and improve with treatment interruption, which should be considered early.
Collapse
Affiliation(s)
- Angelika Terbuch
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Crescens Tiu
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Irene Moreno Candilejo
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Division of Medical Oncology, START Madrid-HM Sanchinarro CIOCC Early Phase Program, Medical University Hospital of Sanchinarro, Madrid, Spain
| | - Mariana Scaranti
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Andra Curcean
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Dan Bar
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Miriam Estevez Timon
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Malaka Ameratunga
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Monash University, Melbourne, Australia
| | - Joo Ern Ang
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jonathan Ratoff
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
- Epsom and St. Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Anna R Minchom
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Udai Banerji
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Johann S de Bono
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Nina Tunariu
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Juanita S Lopez
- Phase I Drug Development Unit, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom.
| |
Collapse
|
9
|
Lopez JS, Biondo A, Tiu C, Scaranti M, Ameratunga M, Zachariou A, Turner A, Tunariu N, Prout T, Parmar M, Badham H, Swales K, Yuan W, Morilla R, Crespo M, Daly R, Figueiredo I, Gurel B, Pereira R, Riisnaes R, Vivanco I, Minchom A, Jenkins B, Yap C, Banerji U, De Bono J. Abstract CT140: Proof-of-concept evidence of immune modulation by blockade of the phosphatidylinositol 3-kinase (PI3K)-AKT signaling pathway in the phase I dose escalation study of Ipatasertib (Ipa) in combination with atezolizumab (A) in patients (pts) with advanced solid tumors (Ice-CAP). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Hyperactivation of the PI3K/AKT pathway correlates with impaired anti-tumor responses, including reduced T cell infiltration into tumor, and reduced efficacy of immune checkpoint inhibitors. Blockade of this pathway synergizes with PD-L1/PD-1 axis blockade preclinically.
Methods: This Phase I clinical trial (NCT03673787) assessed the safety, pharmacodynamic, and preliminary clinical activity of Ipa (200mg or 400mg OD) given in combination with A 1200mg q3 wk in refractory pts. Serial paired blood and tumor samples were analysed to interrogate the effect of Ipa on the tumor micro-environment and host immune system prior to the addition of the immune check point inhibitor, A.
Results: 18 adult pts were treated in dose escalation. Median age 49 yrs. All pts had ECOG PS 0-1 and median 7 prior therapies. Most common TRAEs (>15%) were mild Gr1-2 diarrhea (56%), rash (50%), fatigue (33%), nausea (33%), raised ALT/AST (33%), headache (28%) and arthralgia (22%). 1 pt had G2 systemic immune activation; 2 pts had G3 rash, both rapidly reversible. 1 DLT of G3 raised ALT seen at 200mg (1 DLT/9 evaluable pts) but none at 400mg (0 DLT/6). Of 14 RECIST evaluable patients, there were 2 confirmed PRs, and 5 SD (clinical benefit rate 50%). Reductions of CD4+FOXP3+ Tregs in tumor microenvironment were seen after 2wks of single agent Ipa, regardless of PIK3/AKT somatic mutation status (Table 1). Responding pts had a >400% median increase in intra-tumoral CD8+ Teff cell infiltration, effectively switching from a desert phenotype to an inflamed phenotype. Paired changes in FACS, transcriptome and cytokine will also be presented.Conclusions: The RP2D of Ipa 400mg OD combination with A was well tolerated with early efficacy signals. Further biomarker work is ongoing and will be evaluated in expansion cohorts.
Table 1:Changes in immune cell populations as assessed by multicolour Immunofluorescence in paired biopsies of breast/gynae patients, % change in cell number/mm2 from baseline (median [min,max$])&Post 2 weeks single agent Ipatasertib(n=9)Post 1 cycle of combination Ipatasertib and Atezolizumab(n=7)CD4+FOXP3+Tregs cellsCD 8+ Teff cellsCD4+FOXP3+Tregs cellsCD 8+ Teff cellsIntra-tumourstromaIntra-tumourstromaIntra-tumourstromaIntra-tumourstromaAll patients-23.9*[-89.7, BL0]-30.0*[-91.6, BL0]-37.7*[-84.4, -24.5]-28.4[-92.4, 259.8]335.9[-44.0,BL0]45.4[-51.0, BL0]59.6[-60.6,493.3]64.7[-51.7,293.3]Stratified by somatic PI3K/AKT/PTEN mutational statusPathogenic mutations (mt)11.1[-82.2, BL0]#-10.7[-91.6, BL0]Φnsnsnsns-30.5[-60.6,-0.5]11.3[-51.7,50.0]Wildtype (wt)-63.1[-89.7,19.0]#-47.5[-77.0,11.1]Φnsnsnsns426.5[59.6,493.3]126.7[79.4,293.3]Stratified by responseResponders (PR + SD>4 cycles). 1 ER+ HER2+ breast cancer (wt), 1 ER+ HER2- breast cancer (wt)459.9[426.5,493.3]@103.1[79.4,126.7]Non-responders (PD at 4 cycles) 1 cervical cancer, 4 ER+ breast cancer-0.5[-60.6, 59.6]@30.6[-51.7,293.3]*significant change (p≤0.05; Wilcoxon sign-rank test) from baseline, $maximum values denoted by BL0indicate that the baseline value was zero, and so percentage change from baseline is not defined. For the analysis, the baseline value has been replaced by a nominal value of 0.1 so that a large percentage increase is associated with these cases. Note that these large percentage increases do not affect the non-parametric statistical tests used.#no significant difference in distribution of reduction in intra-tumoural CD4+ FOXP3+Tregsbetween pts with pathogenic mutations in PI3K/AKT and those without (p=0.30; Wilcoxon rank-sum test)Φno significant difference in distribution of reduction in stromal CD4+FOXP3+Tregsbetween pts with pathogenic mutations in PI3K/AKT and those without (p=0.44; Wilcoxon rank-sum test) @ difference between responders and non-responders p=0.083; Wilcoxon rank-sum test)mt pathogenic mutations in PI3K/AKT and PTEN as per COSMIC database present in tumour or PTEN loss by IHC. wt no pathogenic mutations in PI3K/AKT and PTEN as per COSMIC database detected in tumour and intact PTEN expression by IHC. &exploratory analyses with no adjustment for multiple testing
Citation Format: Juanita S. Lopez, Andrea Biondo, Crescens Tiu, Mariana Scaranti, Malaka Ameratunga, Anna Zachariou, Alison Turner, Nina Tunariu, Toby Prout, Mona Parmar, Hannah Badham, Karen Swales, Wei Yuan, Ricardo Morilla, Mateus Crespo, Rob Daly, Ines Figueiredo, Bora Gurel, Rita Pereira, Ruth Riisnaes, Igor Vivanco, Anna Minchom, Ben Jenkins, Christina Yap, Udai Banerji, Johann De Bono. Proof-of-concept evidence of immune modulation by blockade of the phosphatidylinositol 3-kinase (PI3K)-AKT signaling pathway in the phase I dose escalation study of Ipatasertib (Ipa) in combination with atezolizumab (A) in patients (pts) with advanced solid tumors (Ice-CAP) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT140.
Collapse
Affiliation(s)
- Juanita S. Lopez
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Andrea Biondo
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Crescens Tiu
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Mariana Scaranti
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Malaka Ameratunga
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Anna Zachariou
- 2The Institute of Cancer Research, London, United Kingdom
| | - Alison Turner
- 2The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Toby Prout
- 2The Institute of Cancer Research, London, United Kingdom
| | - Mona Parmar
- 2The Institute of Cancer Research, London, United Kingdom
| | - Hannah Badham
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Karen Swales
- 2The Institute of Cancer Research, London, United Kingdom
| | - Wei Yuan
- 2The Institute of Cancer Research, London, United Kingdom
| | - Ricardo Morilla
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Mateus Crespo
- 2The Institute of Cancer Research, London, United Kingdom
| | - Rob Daly
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | | | - Bora Gurel
- 2The Institute of Cancer Research, London, United Kingdom
| | - Rita Pereira
- 2The Institute of Cancer Research, London, United Kingdom
| | - Ruth Riisnaes
- 2The Institute of Cancer Research, London, United Kingdom
| | - Igor Vivanco
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Anna Minchom
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Ben Jenkins
- 2The Institute of Cancer Research, London, United Kingdom
| | - Christina Yap
- 2The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| | - Johann De Bono
- 1The Royal Marsden NHS Foundation Trust Hospital and the Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
10
|
Abstract
Folate receptor α (FRα) came into focus as an anticancer target many decades after the successful development of drugs targeting intracellular folate metabolism, such as methotrexate and pemetrexed. Binding to FRα is one of several methods by which folate is taken up by cells; however, this receptor is an attractive anticancer drug target owing to the overexpression of FRα in a range of solid tumours, including ovarian, lung and breast cancers. Furthermore, using FRα to better localize effective anticancer therapies to their target tumours using platforms such as antibody-drug conjugates, small-molecule drug conjugates, radioimmunoconjugates and, more recently, chimeric antigen receptor T cells could further improve the outcomes of patients with FRα-overexpressing cancers. FRα can also be harnessed for predictive biomarker research. Moreover, imaging FRα radiologically or in real time during surgery can lead to improved functional imaging and surgical outcomes, respectively. In this Review, we describe the current status of research into FRα in cancer, including data from several late-phase clinical trials involving FRα-targeted therapies, and the use of new technologies to develop FRα-targeted agents with improved therapeutic indices.
Collapse
Affiliation(s)
- Mariana Scaranti
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Elena Cojocaru
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Susana Banerjee
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Udai Banerji
- The Institute of Cancer Research, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
| |
Collapse
|
11
|
Chamberlain F, Cojocaru E, Scaranti M, Noujaim J, Thway K, Fisher C, Messiou C, Strauss D, Miah A, Zaidi S, Benson C, Gennatas S, Jones R. Adult soft tissue myoepithelial carcinoma: Treatment outcomes and efficacy of chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz433.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
12
|
Scaranti M, Nava Rodrigues D, Banerji U. Deep and sustained radiological response after MEK-RAF inhibition in HRAS mutant apocrine carcinoma of the scalp. Eur J Cancer 2019; 122:9-11. [PMID: 31600639 DOI: 10.1016/j.ejca.2019.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/16/2019] [Accepted: 08/18/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Mariana Scaranti
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, London, SM2 5PT, United Kingdom.
| | - Daniel Nava Rodrigues
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, London, SM2 5PT, United Kingdom.
| | - Udai Banerji
- Drug Development Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, Downs Road, London, SM2 5PT, United Kingdom.
| |
Collapse
|
13
|
Scaranti M, Caldwell R, Miralles MS, Shinde R, Pal A, Ang J, Biondo A, Guo C, Cojocaru E, Gennatas S, Lockie F, Bertan C, Baker C, Carreira S, Banerjee S, Kaye S, de Bono J, Banerji U, Minchom A, Lopez J. Clinical impact of molecular profiling of cervical cancer (CC) patients (pts) in a dedicated phase I (P1) unit. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
da Costa SCS, Bonadio RC, Gabrielli FCG, Aranha AS, Dias Genta MLN, Miranda VC, de Freitas D, Abdo Filho E, Ferreira PAO, Machado KK, Scaranti M, Carvalho HDA, Estevez-Diz MDP. Neoadjuvant Chemotherapy With Cisplatin and Gemcitabine Followed by Chemoradiation Versus Chemoradiation for Locally Advanced Cervical Cancer: A Randomized Phase II Trial. J Clin Oncol 2019; 37:3124-3131. [PMID: 31449470 DOI: 10.1200/jco.19.00674] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Although chemoradiation therapy (CRT) with cisplatin remains the standard treatment of patients with locally advanced cervical cancer (LACC), 40% of patients present with disease recurrence. Additional treatment strategies are required to improve outcomes. We conducted a trial to evaluate the efficacy and safety of neoadjuvant chemotherapy (NAC) with cisplatin and gemcitabine followed by CRT. METHODS In this phase II trial, patients with LACC (International Federation of Gynecology and Obstetrics stage IIB to IVA or with positive lymph nodes) were randomly assigned to three cycles of NAC with cisplatin and gemcitabine followed by standard CRT with weekly cisplatin plus pelvic radiotherapy or to standard CRT alone. The primary end point was 3-year progression-free survival (PFS). Secondary end points were response rate, 3-year locoregional control, 3-year overall survival (OS), safety, and quality of life. RESULTS From 107 patients enrolled in the trial, 55 were randomly assigned to the NAC arm and 52 to the CRT-alone arm. The majority of patients had squamous cell carcinoma (87.8%). After a median follow-up of 31.7 months, NAC was associated with an inferior PFS, with 3-year PFS rates of 40.9% v 60.4% in the CRT arm (hazard ratio, 1.84; 95% CI, 1.04 to 3.26; P = .033). NAC also was associated with a lower OS (3-year OS rate, 60.7% v 86.8%; hazard ratio, 2.79; 95% CI, 1.29 to 6.01; P = .006). After treatment completion, complete response rates were 56.3% in the NAC arm and 80.3% in the CRT arm (P = .008). Toxicities were similar in both arms, with the exception of hypomagnesemia and neuropathy being more common with NAC. CONCLUSION This study shows that the addition of NAC consisting of cisplatin and gemcitabine to standard CRT is not superior and is possibly inferior to CRT alone for the treatment of LACC.
Collapse
|
15
|
Scaranti M, Murali K, Orbegoso C, Vroobel K, Banerjee SN, Gore ME, Attygalle A, George A. Prevalence and clinical implications of mismatch repair (MMR) deficiency in unselected non-serous epithelial ovarian cancer (EOC) patients (pts). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1521 Background: It has previously been reported that 6-7% of clear cell (CC) and endometrioid (E) ovarian cancers are MMR deficient (MMRd). The prevalence of MMRd in other histological subtypes and correlation with germline (g) MMR (Lynch Syndrome) mutations in unselected non-serous EOC pts is less clear. MMRd in solid tumors has been associated with enhanced response to immunotherapy, hence knowledge of MMR status has therapeutic and familial implications. We aimed to study the prevalence and implications of MMRd and gMMRd in unselected pts with non-serous EOC. Methods: Routine immunohistochemistry (IHC) was performed for the MMR proteins MLH1, MSH2, MSH6 and PMS2 in all non-serous EOC pts from June 2016; retrospective MMR IHC testing in pts in follow-up was performed. Pts with MMRd tumors were referred for gMMR testing. Results: We analyzed 66 unselected pts with non-serous EOC. Median age was 56.4 years (yrs). The majority had E ovarian cancer (54.5%) followed by CC (25.8%), mixed histology (12.1%), mucinous (4.5%) and mullerian (3%) subtypes. Endometriosis was noted in 45.5% of pts, and 75% were FIGO stage I and II at diagnosis. Seventeen pts (25.8%) had concurrent endometrial cancer, all Grade I. On IHC, 15.2% were MMRd: 5 E, 2 CC, 2 mixed and 1 mullerian-type. Of these, 3 pts (30%) had gMMR mutation, 2/3 did not meet the Revised Bethesda criteria for testing. A lower average body mass index (Kg/m2) was noted in MMRd 25.9 versus 30.1 in MMR proficient (MMRp). Median age at diagnosis was 53.5 yrs in the MMRd and 57.7 yrs in MMRp. A higher frequency of concurrent endometrial cancer was observed on the MMRd group (60%) versus (20%) on MMRp (p = 0.007). No statistically significant difference in overall survival or disease-free survival was observed between the MMRd and MMRp population. Conclusions: Our study has shown a higher prevalence of somatic MMRd in non-serous EOC (15.2%) than in previously published literature with a significant proportion found to carry gMMR mutations (4.5%). These interim findings support the role of universal MMR IHC testing in non-serous EOC regardless of family history. [Table: see text]
Collapse
Affiliation(s)
- Mariana Scaranti
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Krithika Murali
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Susana N. Banerjee
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | - Ayoma Attygalle
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Angela George
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
16
|
Scaranti M, Sundar R, Daly R, Collins DC, Dolling D, Gennatas S, Rao Baikady B, Kaye SB, Banerji U, Lopez JS, De Bono JS, Minchom AR. Evaluation of Electronic Activity Monitors (EAMs) during phase I clinical trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18175 Background: EAMs are wearable devices that record aspects of activity, including heart rate and step count. Medical oncologists use performance status (PS) (such as ECOG and Karnofsky) to assess patient’s physical function and to aid treatment decisions. These are subject to patient and physician bias. Our study evaluated the use of EAMs (Fitbit ®) during phase I trials, correlating EAM indices with PS and patient outcomes. Methods: We recruited patients in an academic hospital Drug Development Unit. Patients participating in a phase I trial consented to wear an EAM prior to starting and during the first treatment cycle. Physicians assessed PS at 4 timepoints. Outcomes (progression free survival (PFS), overall survival (OS), adverse events) were recorded. Results: Twenty-five patients were enrolled. At the time of data analysis results were available for 16 patients. Patients wore the EAM for an average of 70.3% (standard deviation 21%) of their time on study, defined as time with recordable heart rate. Mean step count per day varied with ECOG PS although the correlation did not reach statistical significance (co-efficient -1611.1 steps for each change in ECOG PS, p = 0.07, mixed effect regression model). A higher mean step count/day correlated with longer OS (HR0.67, p = 0.01, Cox proportional hazard model). Physician-assessed PS did not correlate with OS (HR2.65, p = 0.37, Cox proportional hazard model). There was no correlation between mean step count and PFS (HR1.7, p = 0.39, Cox proportional hazard model). Conclusions: The use of EAMs is feasible in this patient group. A higher step count correlated with longer OS whereas physician-assessed PS did not. Further research into the potential of EAMs as a means of predicting patient survival to guide decisions on eligibility for phase I trials and the potential for devising a revised Royal Marsden prognostic score incorporating EAM indices is warranted. Clinical trial information: SE536. [Table: see text]
Collapse
Affiliation(s)
- Mariana Scaranti
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Raghav Sundar
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Robert Daly
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Dearbhaile Catherine Collins
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - David Dolling
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Spyridon Gennatas
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Bindumalini Rao Baikady
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Stan B Kaye
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Udai Banerji
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Juanita Suzanne Lopez
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Johann S. De Bono
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Anna Rachel Minchom
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| |
Collapse
|
17
|
Lopez JS, Kristeleit RS, Rulach R, Haris NM, Scaranti M, Mulholland PJ, Crawford D, Bashir S, Aversa C, Hannah AL, Anderson S, Engelhardt M, Kaindl T, Larger P, McKernan P, Evans TRJ, Plummer E. Phase 1/2a study of once daily oral BAL101553, a novel tumor checkpoint controller (TCC), in adult patients with progressive or recurrent glioblastoma (GBM) or high-grade glioma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
2025 Background: BAL101553 (prodrug of BAL27862) is a novel TCC that promotes tumor cell death by modulating the spindle assembly checkpoint. BAL27862 is a lipophilic, small molecule shown in rodents to penetrate the brain (brain/plasma ratio around unity), with promising antitumor activity in orthotopic preclinical GBM models as monotherapy or in combination with radiotherapy (RT) with or without temozolomide. In this ongoing study (NCT02490800, CDI-CS-002), daily oral BAL101553 was initially examined in solid-tumor patients, with an MTD of 16 mg/d and DLTs of G4 hyponatremia and G2 hallucinations (Lopez 2018, JCO 36, 2018, suppl. A2530). Subsequently the study was expanded by including a separate cohort of patients with progressive or recurrent GBM or high-grade glioma (Ingles Garces 2017, JCO 35, 2018, suppl. TPS2601). Methods: Patients with histologically-confirmed GBM or high-grade glioma, with progressive or recurrent disease after prior RT with/without chemotherapy, received once-daily oral BAL101553 (28-day cycles) in a 3+3 dose-escalation design to determine the maximum tolerated dose (MTD). Adverse events were assessed by CTCAE v4.03 grade (G), and tumor response by RANO every two cycles. Pharmacokinetics (PK) were evaluated on Day 1 of Cycles 1 and 2. Results: In the ongoing study, 23 pts (13M/10F; median age 50 y), median (min–max) number of prior regimens = 2 (1–5), received doses of 8, 15, 20, 25 or 30 mg oral BAL101553 once daily. One DLT of reversible G2 depression and fatigue occurred at 20 mg. Both mean Cmax and AUC increased with dose between 8 and 30 mg. The PK exposure in GBM patients was lower than for solid tumor patients, in particular at 20 and 25 mg. At 25 mg/d (n = 3), one patient with IDH-mutated GBM had a partial response (63% area reduction per RANO) and continues on study > 8 months, and another patient had stable disease for 5 months. At 15–20 mg/d, stable disease was observed in 3/10 patients. Conclusions: The current data in patients with GBM or high-grade glioma suggest that BAL101553 is well tolerated at dose levels above the MTD established in patients with advanced solid tumors, and shows indications of clinical activity. Clinical trial information: 02490800.
Collapse
Affiliation(s)
- Juanita Suzanne Lopez
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Robert Rulach
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Noor Md Haris
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Mariana Scaranti
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | - Donna Crawford
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Saira Bashir
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Caterina Aversa
- The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Marc Engelhardt
- Basilea Pharmaceutica International Ltd., Basel, Switzerland
| | - Thomas Kaindl
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Patrice Larger
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Phil McKernan
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - TR Jeffry Evans
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | |
Collapse
|
18
|
Terbuch A, Moreno Candilejo I, Scaranti M, Bar D, Estevez Timon M, Ameratunga M, Ang JE, Ratoff J, Minchom A, Banerji U, De Bono JS, Tunariu N, Lopez JS. Distinct radiological patterns of drug-induced pneumonitis (R-DIP) in early-phase clinical trials and predictive factors affecting outcome: A 10-year systematic review from the Royal Marsden Hospital Phase I Drug Development Unit experience. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3088 Background: We studied clinical and radiological parameters influencing DIP in patients (pts) participating in phase I clinical trials, aiming to investigate predictive factors affecting DIP, in particular those affecting outcome. Methods: 2439 consecutive stage IV cancer pts on phase I clinical trials from 2007 to 2017 were identified. Pts with respiratory symptoms or abnormal lung imaging were reviewed in detail, with longitudinal analysis of imaging by an experienced radiologist. R-DIP was categorized according to internationally recognized criteria. Results: 60 pts developed R-DIP (overall incidence 2.5%); most frequent in pts receiving drug conjugates (31.1%) followed by targeted therapies (8.3%). Hypersensitivity pneumonitis was most common (33.3%) followed by non-specific interstitial pneumonitis (30%) and cryptogenic organising pneumonitis (26.7%). 45% pts who developed R-DIP were clinically asymptomatic. The number of affected lobes (OR 1.47, 95% CI: 1.19-1.81, p < 0.001) and the pattern of R-DIP (OR 5.83 for ARDS, 95% CI: 0.38-90.26, p = 0.002) were significantly associated with a higher CTCAE pneumonitis grading. 23% pts (14/60) had investigational medicinal product (IMP) temporarily discontinued or had a dose reduction while 42% pts (25/60) had IMP permanently discontinued. 48% pts were treated with steroids. The number of affected lobes, pattern of R-DIP and steroid therapy did not influence an improvement in R-DIP (p = 0.65, 0.27 and 0.23 respectively). Continuation of treatment resulted in worsening of DIP in 42.9% of cases. The only predictive factor for an improvement in DIP was an interruption of treatment (OR 0.05, 95% CI: 0.01-0.35, p = 0.01). 14 pts were retreated with a reoccurrence of R-DIP in 4 pts (28.6%). Conclusions: R-DIP from novel agents in early phase clinical trials presents in varied radiological patterns, with findings often preceding clinical symptoms. Treatment interruption leads to improvement of DIP and should be considered early. Close clinical and radiological surveillance is recommended should IMP be restarted.
Collapse
Affiliation(s)
- Angelika Terbuch
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | | | - Mariana Scaranti
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Daniel Bar
- The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Joo Ern Ang
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Jonathan Ratoff
- Epsom and St. Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Anna Minchom
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Udai Banerji
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Johann S. De Bono
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Juanita Suzanne Lopez
- Drug Development Unit-The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| |
Collapse
|
19
|
Silva S, Colombo Bonadio RRC, Gabrielli F, Aranha AS, Genta ML, Miranda VC, Freitas D, Filho EA, Ferreira PADO, Kalil K, Scaranti M, Estevez-Diz MDP. Neoadjuvant chemotherapy with cisplatin and gemcitabine followed by chemoradiation with cisplatin in locally advanced cervical cancer: A phase II, prospective, randomized, trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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)
- Samantha Silva
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | | | - Maria Luiza Genta
- Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Daniela Freitas
- Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | | | | | - Karime Kalil
- Instituto do Câncer do estado de São Paulo, São Paulo, Brazil
| | | | | |
Collapse
|
20
|
Abstract
Immune checkpoint inhibitors have recently become a cornerstone for the treatment of different advanced cancers. These drugs, represented mainly by monoclonal antibodies anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4), anti-programmed cell death protein-1 (PD-1) and anti-PD-1 ligand molecules (PD-L1 and L2), have the ability to reactivate the immune system against tumor cells, but can also trigger a myriad of autoimmune side effects, termed immune-related adverse events (irAEs). In particular, there are a number of endocrine-related irAEs. Current data from clinical trials show increased incidence of hypophysitis with CTLA4 inhibition and thyroid dysfunction with PD-(L)1 blockade. In addition, a few cases of type 1 diabetes mellitus and primary adrenal insufficiency have been reported. We discuss the incidence, clinical manifestations, diagnosis and management of immune-related endocrinopathies in this highly complex context of oncological patients in need of immunotherapies.
Collapse
Affiliation(s)
- Priscilla Cukier
- Department of EndocrinologyInstituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fernando C Santini
- Department of OncologyInstituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Scaranti
- Department of OncologyInstituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana O Hoff
- Department of EndocrinologyInstituto do Cancer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW This article provides a background for an evidence-based decision regarding the prescription of vitamin D for cancer prevention and improvement of outcomes in oncology. RECENT FINDINGS In 2014, Feldman and colleagues published a review suggesting a beneficial role for vitamin D in cancer development. In the same year, a Cochrane meta-analysis that included 18 randomized clinical trials comparing vitamin D administration versus no intervention in healthy population found no difference regarding cancer incidence between the groups. One year later, a phase III trial published in the New England Journal of Medicine did not show any protective effect of vitamin D against adenoma development. SUMMARY Vitamin D is well known for its importance in calcium and phosphate homeostasis, being essential for bone mineralization. However, calcitriol, or 1,25-dyhydroxy-vitamin D3, is a multifunctional steroid hormone with many extra skeletal actions and may regulate signaling pathways related to cancer development and progression. In preclinical studies, it was shown that vitamin D can promote cell differentiation and inhibit proliferation, angiogenesis, and cell migration. Inconsistent results are found in epidemiological studies and early trials regarding clinical effects of vitamin D supplementation and cancer in terms of prevention and impact in cancer-related mortality.
Collapse
Affiliation(s)
- Mariana Scaranti
- aInstituto do Câncer do Estado de São Paulo bHospital Sírio Libanês, Sao Paulo, Brazil
| | | | | |
Collapse
|
22
|
Mota JM, Scaranti M, Fonseca LG, Tolói DA, de Camargo VP, Munhoz RR, Feher O, Hoff PM. Response to Paclitaxel in an Adult Patient with Advanced Kaposiform Hemangioendothelioma. Case Rep Oncol 2016; 9:481-487. [PMID: 27721772 PMCID: PMC5043218 DOI: 10.1159/000448111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare neoplasm of vascular origin that typically arises from the skin or soft tissues as a solitary tumor. The optimal therapy for this disease is still unknown. We report the case of an adult patient presenting with metastatic KHE of the spleen, who had a partial response after treatment with paclitaxel. CASE PRESENTATION A 36-year-old man presented in November 2012 with a nontraumatic rupture of the spleen. A splenectomy was performed, and the pathology was consistent with a nonspecific vascular proliferation. Follow-up scans revealed lytic bone lesions and liver metastasis. A biopsy of the liver was performed and confirmed KHE. The decision was made to proceed with treatment with gemcitabine and docetaxel, which was discontinued due to myelotoxicity. The patient was then transferred to our institution, and a pathology review supported the diagnosis of metastatic KHE. His disease remained stable until February 2014, when he developed progression in the liver. Chemotherapy was restarted with paclitaxel, and a partial response was documented after 3 cycles. Unfortunately, disease progression occurred after 24 weeks, and subsequent treatments included prednisone, doxorubicin, interferon-α, gemcitabine, and ifosfamide, without any response. The patient developed Kasabach-Merritt phenomenon and passed away 1 week later due to a major gastrointestinal bleeding. CONCLUSIONS This case report suggests that paclitaxel could be considered as a treatment option for advanced KHE, a rare condition for which no standard treatment exists.
Collapse
Affiliation(s)
- José Maurício Mota
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Scaranti
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo G Fonseca
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Diego Araújo Tolói
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Veridiana Pires de Camargo
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Ramella Munhoz
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Olavo Feher
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo M Hoff
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
23
|
Carneiro BA, Meeks JJ, Kuzel TM, Scaranti M, Abdulkadir SA, Giles FJ. Emerging therapeutic targets in bladder cancer. Cancer Treat Rev 2015; 41:170-8. [PMID: 25498841 DOI: 10.1016/j.ctrv.2014.11.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [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: 09/26/2014] [Revised: 11/14/2014] [Accepted: 11/15/2014] [Indexed: 12/11/2022]
Abstract
Treatment of muscle invasive urothelial bladder carcinoma (BCa) remains a major challenge. Comprehensive genomic profiling of tumors and identification of driver mutations may reveal new therapeutic targets. This manuscript discusses relevant molecular drivers of the malignant phenotype and agents with therapeutic potential in BCa. Small molecule pan-FGFR inhibitors have shown encouraging efficacy and safety results especially among patients with activating FGFR mutations or translocations. mTOR inhibitors for patients with TSC1 mutations and concomitant targeting of PI3K and MEK represent strategies to block PI3K/AKT/mTOR pathway. Encouraging preclinical results with ado-trastuzumab emtansine (T-DM1) exemplifies a new potential treatment for HER2-positive BCa along with innovative bispecific antibodies. Inhibitors of cell cycle regulators (aurora kinase, polo-like kinase 1, and cyclin-dependent kinase 4) are being investigated in combination with chemotherapy. Early results of clinical studies with anti-CTLA4 and anti-PDL1 are propelling immune modulating drugs to the forefront of emerging treatments for BCa. Collectively, these novel therapeutic targets and treatment strategies hold promise to improve the outcome of patients afflicted with this malignancy.
Collapse
MESH Headings
- Ado-Trastuzumab Emtansine
- Antibodies, Monoclonal, Humanized/pharmacology
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Aurora Kinases/metabolism
- B7-H1 Antigen/antagonists & inhibitors
- Biomarkers, Tumor/metabolism
- CTLA-4 Antigen/antagonists & inhibitors
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Cell Cycle Proteins/antagonists & inhibitors
- Cell Cycle Proteins/metabolism
- Clinical Trials as Topic
- Cyclin D1/metabolism
- Cyclin-Dependent Kinase 4/metabolism
- Heat-Shock Proteins/metabolism
- Humans
- Immunotherapy/methods
- Maytansine/analogs & derivatives
- Maytansine/pharmacology
- Molecular Targeted Therapy/methods
- Mutation
- Neoplasm Invasiveness
- Phosphatidylinositol 3-Kinases/metabolism
- Protein Serine-Threonine Kinases/metabolism
- Proto-Oncogene Proteins/metabolism
- Proto-Oncogene Proteins c-akt/metabolism
- Receptor, ErbB-2/metabolism
- Receptor, Fibroblast Growth Factor, Type 1/genetics
- Signal Transduction/drug effects
- TOR Serine-Threonine Kinases/metabolism
- Translocation, Genetic
- Trastuzumab
- Tuberous Sclerosis Complex 1 Protein
- Tumor Suppressor Proteins/genetics
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/pathology
- Polo-Like Kinase 1
Collapse
Affiliation(s)
- Benedito A Carneiro
- Northwestern Medicine Developmental Therapeutics Institute, Feinberg School of Medicine, Northwestern University, United States; Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States.
| | - Joshua J Meeks
- Department of Urology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| | - Timothy M Kuzel
- Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| | - Mariana Scaranti
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | - Sarki A Abdulkadir
- Department of Urology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| | - Francis J Giles
- Northwestern Medicine Developmental Therapeutics Institute, Feinberg School of Medicine, Northwestern University, United States; Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| |
Collapse
|
24
|
Isaacsson P, Teixeira M, Scaranti M, Matutino A, Negrao M, Fraile N, Souza K, Yen C, Pinheiro G, Hoff P, G.C.. Acute Infusional Reactions to Chemotherapy in an Outpatient Unit: Experience from 21,394 Treatment Cycles in Brazil. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu353.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
25
|
Scaranti M, Segundo Correia Mota JM, Gouveia de Lima AS, Santana Lemos BA, Lucena-Araujo AR, Rego EM. Comparison of angiopoietin-1 and -2 and VEGF expression in bone marrow and peripheral blood leukemic cells of patients with acute promyelocytic leukemia. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mariana Scaranti
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Eduardo Magalhaes Rego
- Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
26
|
Toloi DDA, Scaranti M, Fraile NMP, De Santana IA, Mencarini ACM, Munhoz RR, Camargo VPD, Castanheira VRC, Feher O, Chammas R, Hoff PM. Influence of histopathologic features and other risk factors on the outcomes of uveal melanoma patients submitted to ocular enucleation. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e20028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Diego de Araujo Toloi
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Scaranti
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Iuri Amorim De Santana
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rodrigo Ramella Munhoz
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Vera Regina Cardoso Castanheira
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Departamento de Oftalomologia, São Paulo, Brazil
| | - Olavo Feher
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Roger Chammas
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | |
Collapse
|