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Luke JJ, Piha-Paul SA, Medina T, Verschraegen CF, Varterasian M, Brennan AM, Riese RJ, Sokolovska A, Strauss J, Hava DL, Janku F. Phase I Study of SYNB1891, an Engineered E. coli Nissle Strain Expressing STING Agonist, with and without Atezolizumab in Advanced Malignancies. Clin Cancer Res 2023; 29:2435-2444. [PMID: 37227176 DOI: 10.1158/1078-0432.ccr-23-0118] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 01/14/2023] [Revised: 03/18/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE SYNB1891 is a live, modified strain of the probiotic Escherichia coli Nissle 1917 (EcN) engineered to produce cyclic dinucleotides under hypoxia, leading to STimulator of INterferon Genes (STING) activation in phagocytic antigen-presenting cells in tumors and activating complementary innate immune pathways. PATIENTS AND METHODS This first-in-human study (NCT04167137) enrolled participants with refractory advanced cancers to receive repeat intratumoral injections of SYNB1891 either alone or in combination with atezolizumab, with the primary objective of evaluating the safety and tolerability of both regimens. RESULTS Twenty-four participants received monotherapy across six cohorts, and 8 participants received combination therapy in two cohorts. Five cytokine release syndrome events occurred with monotherapy, including one that met the criteria for dose-limiting toxicity at the highest dose; no other SYNB1891-related serious adverse events occurred, and no SYNB1891-related infections were observed. SYNB1891 was not detected in the blood at 6 or 24 hours after the first intratumoral dose or in tumor tissue 7 days following the first dose. Treatment with SYNB1891 resulted in activation of the STING pathway and target engagement as assessed by upregulation of IFN-stimulated genes, chemokines/cytokines, and T-cell response genes in core biopsies obtained predose and 7 days following the third weekly dose. In addition, a dose-related increase in serum cytokines was observed, as well as stable disease in 4 participants refractory to prior PD-1/L1 antibodies. CONCLUSIONS Repeat intratumoral injection of SYNB1891 as monotherapy and in combination with atezolizumab was safe and well tolerated, and evidence of STING pathway target engagement was observed.
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Affiliation(s)
- Jason J Luke
- UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | | | - Theresa Medina
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | | | | | | | | | | | - Filip Janku
- University of Texas, MD Anderson Cancer Center, Houston, Texas
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Maitz CA, Tate D, Bechtel S, Lunceford J, Henry C, Flesner B, Collins A, Varterasian M, Tung D, Zhang L, Saha S, Bryan JN. Paired 18F-Fluorodeoxyglucose (18F-FDG), and 64Cu-Copper(II)-diacetyl-bis(N(4)-methylthiosemicarbazone) (64Cu-ATSM) PET Scans in Dogs with Spontaneous Tumors and Evaluation for Hypoxia-Directed Therapy. Radiat Res 2021; 197:253-260. [PMID: 34855934 DOI: 10.1667/rade-20-00186.1] [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: 08/04/2020] [Accepted: 10/01/2021] [Indexed: 11/03/2022]
Abstract
Hypoxia is associated with neoplastic tissue, protecting cancer cells from death by irradiation and chemotherapy. Identification of hypoxic volume of tumors could optimize patient selection for hypoxia-directed medical, immunological, and radiation therapies. Clostridium novyi-NT (CNV-NT) is an oncolytic bacterium derived from attenuated wild-type Clostridium novyi spores, which germinates exclusively in the anaerobic core of tumors with low-oxygen content. The hypothesis was that 64Cu-ATSM would localize to regions of hypoxia, and that greater hypoxic volume would result in greater germination of Clostridium novyi-NT (CNV-NT). Tumor-bearing companion dogs were recruited to a veterinary clinical trial. Dogs received a CT scan, 18F-FDG PET scan (74 MBq) and 64Cu-ATSM PET scan (74 MBq). Scan regions of interest were defined as the highest 20% of counts/voxel for each PET scan, and regions with voxels overlapping between the two scans. Maximum standardized uptake value (MaxSUV) and threshold volume were calculated. Direct oximetry was performed in select tumors. Tumor types evaluated included nerve sheath tumor (10), apocrine carcinoma (1), melanoma (3) and oral sarcoma (6). MaxSUVATSM ranged from 0.3-6.6. Measured oxygen tension ranged from 0.05-89.9 mmHg. Inverse of MaxSUVATSM had a linear relationship with oxygen tension (R2 = 0.53, P = 0.0048). Hypoxia <8 mmHg was associated with an SUVATSM > 1.0. Hypoxic volume ranged from 0 to 100% of gross tumor volume (GTV) and MaxSUVATSM was positively correlated with hypoxic volume (R = 0.674; P = 0.0001), but not GTV (P = 0.182). Tumor hypoxic volume was heterogeneous in location and distribution. 64Cu-ATSM-avid regions were associated with differential CT attenuation. Hypoxic volume did not predict CNV-NT germination. 64Cu-ATSM PET scanning predicts hypoxia patterns within spontaneously occurring tumors of dogs as measured by direct oxymetry. Total tumor volume does not accurately predict degree or proportion of tumor hypoxia.
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Affiliation(s)
- Charles A Maitz
- Department of Veterinary Medicine and Surgery, University of Missouri - Columbia, Missouri
| | - Deborah Tate
- Department of Veterinary Medicine and Surgery, University of Missouri - Columbia, Missouri
| | - Sandra Bechtel
- Department of Veterinary Medicine and Surgery, University of Missouri - Columbia, Missouri
| | - Joni Lunceford
- Department of Veterinary Medicine and Surgery, University of Missouri - Columbia, Missouri
| | - Carolyn Henry
- Department of Veterinary Medicine and Surgery, University of Missouri - Columbia, Missouri
| | - Brian Flesner
- Department of Veterinary Medicine and Surgery, University of Missouri - Columbia, Missouri
| | | | | | - David Tung
- Biomed Valley Discoveries, Inc., Kansas City, Missouri
| | - Linping Zhang
- Biomed Valley Discoveries, Inc., Kansas City, Missouri
| | - Saurabh Saha
- Biomed Valley Discoveries, Inc., Kansas City, Missouri
| | - Jeffrey N Bryan
- Department of Veterinary Medicine and Surgery, University of Missouri - Columbia, Missouri
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Riese R, Luke J, Lewis K, Janku F, Piha-Paul S, Verschraegen C, Brennan A, Armstrong M, Varterasian M, Sokolovska A, Strauss J. 500 SYNB1891, a bacterium engineered to produce a STING agonist, demonstrates target engagement in humans following intratumoral injection. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BackgroundSYNB1891 is a live, modified strain of probiotic E. coli Nissle engineered to produce cyclic dinucleotides under hypoxia leading to stimulator of interferon genes (STING)-activation in phagocytic antigen-presenting cells in tumors and activating complementary innate immune pathways.MethodsThis first-in-human study (NCT04167137) enrolled patients with refractory advanced solid tumors to receive intratumoral (IT) injections of SYNB1891 monotherapy or in combination atezolizumab. Patients enrolled in the monotherapy arms received doses of 1x106 - 3x108 live cells on Days 1, 8 and 15 of the first 21-day cycle and then on Day 1 of each subsequent cycle. Patients enrolled in the 2 combination cohorts received doses of 1x107 - 3x107 live cells in combination with atezolizumab administered on a 21-day cycle. The primary objective of the study was to evaluate safety and tolerability of SYNB1891 alone and in combination with atezolizumab. Other objectives include SYNB1891 kinetics in blood and injected tumor, STING-target engagement as assessed by IT gene expression and serum cytokines, and tumor responses.ResultsThis interim analysis includes 23 patients across 6 monotherapy cohorts dosed at 1x106, 3x106, 1x107, or 3x107, 1x108 and 3x108 live cells, and 7 patients dosed in 2 combination therapy cohorts (1x107 and 3x107 live cells). The mean (range) age was 61 (25–82); 19 patients were female. There were 4 cytokine release syndrome events in monotherapy cohorts, including one grade 3 event which met the criterion for dose limiting toxicity at 3x108 live cells; there were no other SYNB1891-related serious adverse events. There were no SYNB1891-related infections. SYNB1891 was not detected in the blood at 6 or 24 hours after the first dose or intratumorally 7 days following the first dose. Treatment with SYNB1891 demonstrated activation of the STING pathway and target engagement as assessed by upregulation of interferon-stimulated genes (ISG15, IFIT1, IFIt2), chemokines/cytokines (CXCL9, CXCL10, TNFRS18, TNFSF10) and T-cell response genes (GZMA, CD4, PD-L2) in core biopsies obtained pre-dose and 7 days following the third weekly dose. In addition, there was a dose-response increase in serum cytokines. Durable, stable disease was observed in two patients treated with SYNB1891 monotherapy refractory to prior PD-1/L1 antibodies with vulvar melanoma (1x106 live cells; RECIST -28%) and small cell lung cancer (1x107 live cells; RECIST -12%).ConclusionsRepeat IT injection of SYNB1891 as monotherapy and in combination atezolizumab in this ongoing study is safe and well-tolerated up to at least 1x108 live cells, and shows evidence of STING pathway target engagement.AcknowledgementsWe thank Inessa Vulfova for her clinical support in conduct of this study.Trial Registration clinicaltrials.gov (NCT04167137)Ethics ApprovalThe study protocol, the informed consent form (ICF), and printed subject information materials were reviewed and approved by the institutional review board (IRB) at the investigational site before any study procedures were performed. Written informed consent to participate in the study was obtained from each subject before any study-specific procedures were performed.The Ohio State University Cancer Institutional Review Board; Approval ID: 2020C0194MD Anderson Cancer Center Institutional Review Board; Approval ID: 2019–0576Mary Crawley Medical Research Center Institutional Review Board; Approval ID: 19–31 SYNB1891-CP-001North Texas Institutional Review Board; Approval ID: 2019.040WIRB Approval ID: 20192779University of Pittsburgh Institutional Review Board Approval ID: STUDY20010116
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Janku F, Luke JJ, Brennan A, Riese R, Varterasian M, Armstrong MB, Kuhn KL, Sokolovska A, Strauss JF. Abstract CT110: Intratumoral injection of SYNB1891, a synthetic biotic designed to activate the innate immune system, demonstrates target engagement in humans including intratumoral STING activation. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct110] [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
Introduction: SYNB1891 is a live, modified strain of the probiotic E. coli Nissle engineered to produce cyclic dinucleotides under hypoxia leading to stimulator of interferon genes (STING)-activation in phagocytic antigen-presenting cells in tumors and activating complementary innate immune pathways.
Methods: This first-in-human study (NCT04167137) is enrolling patients with refractory advanced solid tumors or lymphoma to receive an intratumoral (IT) injection of SYNB1891 on Days 1, 8 and 15 of the first 21-day cycle and then on Day 1 of each subsequent cycle. Dose escalation is planned across 7 cohorts (1x106 - 1x109 live cells) with Arm 1 consisting of escalating doses of SYNB1891 as monotherapy, and Arm 2 in combination with atezolizumab. The primary objective is to determine the single-agent maximum tolerated dose as monotherapy and the recommended Phase 2 dose in combination with atezolizumab. Other objectives include SYNB1891 kinetics in blood and the injected tumor, STING-target engagement as assessed by IT gene expression and serum cytokines, and tumor responses.
Results: This interim analysis includes the first 11 patients across 4 cohorts dosed at 1x106, 3x106, 1x107, or 3x107 live cells, with a total of 59 doses administered. The mean (range) age was 56 (25-70); 9 patients were female. There were no dose-limiting toxicities, SYNB1891-related infections or discontinuations due to adverse events. There was one SYNB1891-related serious adverse event in a patient who experienced a grade 2 cytokine release syndrome that resolved within one day, and one patient experienced a grade 2 injection site reaction of erythema which resolved. SYNB1891 was not detected in the blood at 6 or 24 hours after the first dose or intratumorally 7 days following the first dose. Treatment with SYNB1891 demonstrated activation of the STING pathway and target engagement as assessed by upregulation of interferon-stimulated genes (ISG15, IFIT1, IFIt2), chemokines/cytokines (CXCL9, CXCL10, TNFRS18, TNFSF10) and T-cell response genes (GZMA, CD4, PD-L2) in core biopsies obtained pre-dose and 7 days following the third weekly dose. In addition, there was a dose-response increase in serum cytokines at dose levels of 1x107 and 3x107 live cells (IL-6, TNFα, IFNγ, IL-1Ra) at 6 hours post-dose. Durable, stable disease was observed in two patients refractory to prior PD-1/L1 antibodies with vulvar melanoma (1x106 live cells) and small cell lung cancer (1x107 live cells).
Conclusions: Repeat IT injection of SYNB1891 as monotherapy is safe and well-tolerated up to at least 3x107 cells and shows evidence of STING pathway target engagement. These data support the continued dose escalation of SYNB1891 as monotherapy, and initiation of Arm 2 in combination with atezolizumab.
Citation Format: Filip Janku, Jason J. Luke, Aoife Brennan, Richard Riese, Mary Varterasian, Michael B. Armstrong, Karen L. Kuhn, Anna Sokolovska, James F. Strauss. Intratumoral injection of SYNB1891, a synthetic biotic designed to activate the innate immune system, demonstrates target engagement in humans including intratumoral STING activation [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT110.
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Affiliation(s)
- Filip Janku
- 1The University of Texas MD Anderson Cancer Center, Houston, TX
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Wu J, Liu D, Offin M, Lezcano C, Torrisi JM, Brownstein S, Hyman DM, Gounder MM, Abida W, Drilon A, Harding JJ, Sullivan RJ, Janku F, Welsch D, Varterasian M, Groover A, Li BT, Lacouture ME. Characterization and management of ERK inhibitor associated dermatologic adverse events: analysis from a nonrandomized trial of ulixertinib for advanced cancers. Invest New Drugs 2021; 39:785-795. [PMID: 33389388 DOI: 10.1007/s10637-020-01035-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022]
Abstract
Background Ulixertinib is the first-in-class ERK1/2 kinase inhibitor with encouraging clinical activity in BRAF- and NRAS-mutant cancers. Dermatologic adverse events (dAEs) are common with ulixertinib, so management guidelines like those established for epidermal growth factor receptor inhibitor (EGFRi)-associated dAEs are needed. Patients and Methods This was an open-label, multicenter, phase I dose escalation and expansion trial of ulixertinib evaluating data from 135 patients with advanced malignancies enrolled between March 2013 and July 2017. Histopathological features, management, and dAEs in 34 patients are also reported. Twice daily oral ulixertinib was administered at 10 to 900 mg in the dose escalation cohort (n = 27) and at 600 mg in 21-day cycles in the expansion cohort (n = 108). Results The incidence of ulixertinib-induced dAEs and combined rash were 79% (107/135) and 76% (102/135). The most common dAEs included acneiform rash (45/135, 33%), maculopapular rash (36/135, 27%), and pruritus (34/135, 25%). Grade 3 dAEs were observed in 19% (25/135) of patients; no grade 4 or 5 dAEs were seen. The presence of at least 1 dAE was associated with stable disease (SD) or partial response (PR) (OR = 3.64, 95% CI 1.52-8.72; P = .003). Acneiform rash was associated with a PR (OR = 10.19, 95% CI 2.67-38.91; P < .001). Conclusion The clinical spectrum of ulixertinib-induced dAEs was similar to EGFR and MEK inhibitors; dAEs may serve as a surrogate marker of tumor response. We propose treatment algorithms for common ERK inhibitor-induced dAEs to maintain patients' quality of life and dose intensity for maximal clinical benefit. Clinical Trial Registration: NCT01781429.
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Affiliation(s)
- J Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Linkou, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - D Liu
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - M Offin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - C Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - J M Torrisi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - S Brownstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - D M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - M M Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - W Abida
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - A Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.,Thoracic Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA
| | - J J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - R J Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, 02114, USA
| | - F Janku
- MD Anderson Cancer Center, The University of Texas, Houston, TX, 77030, USA
| | - D Welsch
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - M Varterasian
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - A Groover
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - B T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA. .,Thoracic Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA.
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA.
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Janku F, Zhang HH, Pezeshki A, Goel S, Murthy R, Wang-Gillam A, Shepard DR, Helgason T, Masters T, Hong DS, Piha-Paul SA, Karp DD, Klang M, Huang SY, Sakamuri D, Raina A, Torrisi J, Solomon SB, Weissfeld A, Trevino E, DeCrescenzo G, Collins A, Miller M, Salstrom JL, Korn RL, Zhang L, Saha S, Leontovich AA, Tung D, Kreider B, Varterasian M, Khazaie K, Gounder MM. Intratumoral Injection of Clostridium novyi-NT Spores in Patients with Treatment-refractory Advanced Solid Tumors. Clin Cancer Res 2020; 27:96-106. [PMID: 33046513 DOI: 10.1158/1078-0432.ccr-20-2065] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/24/2020] [Accepted: 10/07/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Intratumorally injected Clostridium novyi-NT (nontoxic; lacking the alpha toxin), an attenuated strain of C. novyi, replicates within hypoxic tumor regions resulting in tumor-confined cell lysis and inflammatory response in animals, which warrants clinical investigation. PATIENTS AND METHODS This first-in-human study (NCT01924689) enrolled patients with injectable, treatment-refractory solid tumors to receive a single intratumoral injection of C. novyi-NT across 6 dose cohorts (1 × 104 to 3 × 106 spores, 3+3 dose-escalation design) to determine dose-limiting toxicities (DLT), and the maximum tolerated dose. RESULTS Among 24 patients, a single intratumoral injection of C. novyi-NT led to bacterial spores germination and the resultant lysis of injected tumor masses in 10 patients (42%) across all doses. The cohort 5 dose (1 × 106 spores) was defined as the maximum tolerated dose; DLTs were grade 4 sepsis (n = 2) and grade 4 gas gangrene (n = 1), all occurring in three patients with injected tumors >8 cm. Other treatment-related grade ≥3 toxicities included pathologic fracture (n = 1), limb abscess (n = 1), soft-tissue infection (n = 1), respiratory insufficiency (n = 1), and rash (n = 1), which occurred across four patients. Of 22 evaluable patients, nine (41%) had a decrease in size of the injected tumor and 19 (86%) had stable disease as the best overall response in injected and noninjected lesions combined. C. novyi-NT injection elicited a transient systemic cytokine response and enhanced systemic tumor-specific T-cell responses. CONCLUSIONS Single intratumoral injection of C. novyi-NT is feasible. Toxicities can be significant but manageable. Signals of antitumor activity and the host immune response support additional studies of C. novyi-NT in humans.
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Affiliation(s)
- Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | | | | | - Sanjay Goel
- Montefiore/Albert Einstein Cancer Center, Bronx, New York
| | - Ravi Murthy
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | - Thorunn Helgason
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tyler Masters
- Early Drug Development Service, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - David S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel D Karp
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Klang
- Early Drug Development Service, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Steven Y Huang
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Divya Sakamuri
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anjali Raina
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean Torrisi
- Early Drug Development Service, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Stephen B Solomon
- Early Drug Development Service, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | | | | | | | | | - Maria Miller
- BioMed Valley Discoveries Inc., Kansas City, Missouri
| | | | | | - Linping Zhang
- BioMed Valley Discoveries Inc., Kansas City, Missouri
| | - Saurabh Saha
- BioMed Valley Discoveries Inc., Kansas City, Missouri.,Atlas Venture, Boston, Massachusetts
| | | | - David Tung
- BioMed Valley Discoveries Inc., Kansas City, Missouri
| | - Brent Kreider
- BioMed Valley Discoveries Inc., Kansas City, Missouri
| | | | | | - Mrinal M Gounder
- Early Drug Development Service, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, New York.
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Janku F, Gounder M, Pezeshki AM, Murthy R, Wang-Gillam A, Shepard D, Hong DS, Piha-Paul SA, Raina A, Leontovich AA, DeCrescenzo G, Kreider BL, Tung D, Varterasian M, Zhang HH, Khazaie K. Abstract A011: First-in-man clinical trial of intratumoral injection of Clostridiumnovyi-NT spores in patients with treatment-refractory advanced solid tumors: Safety, activity, and immune responses. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-a011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Bacteriolytic strategies offer unique advantages to combat a broad range of cancers often refractive to conventional chemotherapies and/or radiotherapies. C. novyi-NT is an attenuated strain of Clostridium novyi, a spore-forming, gram-positive, obligate anaerobe that lacks a lethal alpha- toxin, expressed by the parental strain. When administered intravenously or intratumorally with percutaneous injection, C. novyi-NT colonizes and replicates within the hypoxic region of the tumors, eliciting robust, tumor-confined cell lysis. In this first-in-man phase 1 study, patients with injectable treatment-refractory solid tumors received a single intratumoral injection of C. novyi-NT spores across 6 dose cohorts (spore concentrations of 104, 3x104, 105, 3x105, 106, 3x106) using a 3+3 trial design. The primary endpoints were to assess the safety profile, the dose limiting toxicity, and the maximum tolerated dose of C. novyi-NT. Key secondary endpoints included assessments of the preliminary antitumor activity of the injected tumor, an overall response evaluated by RECIST v. 1.1, and the host immune and inflammatory response to C. novyi-NT. Twenty-four patients were enrolled between November, 2013 and April, 2017. A single intratumoral injection of C. novyi-NT led to germination and resultant tumor lysis of injected tumor masses in 46% of patients across all dosing cohorts. The cohort 5 dose of 106 spores was defined as the maximum tolerated dose. Dose-limiting toxicities were grade 4 sepsis and grade 4 gas gangrene (n=1), all in patients with germination. In the 22 evaluable patients, 21 (95%) had stable disease (SD) as the best response for the injected lesion (tumor shrinkage of > 10% was observed in 21% of patients) and 19 (86%) had overall SD as the best response per RECIST 1.1. C. novyi-NT injection resulted in transient serum cytokine responses consistent with inflammasome activity, activation of innate immunity, tissue remodeling, and angiogenesis. Tumor antigen specific ELISPOT assays pre- and post- treatment documented enhanced secretion of IFNγ and TNFα by circulating T-cells, indicating improved systemic tumor specific T-cell responses. Multiparametric in situ immunostaining of core biopsies suggested improved immune cell infiltration in metastatic lesions. These early signs of improved antitumor activity in patients with advanced solid tumors have encouraged a new trial of C. novyi-NT in combination with immune checkpoint inhibitors.
Citation Format: Filip Janku, Mrinal Gounder, Abdul Mohammad Pezeshki, Ravi Murthy, Andrea Wang-Gillam, Dale Shepard, David S. Hong, Sarina A. Piha-Paul, Anjali Raina, Alexey A. Leontovich, Gary DeCrescenzo, Brent L. Kreider, David Tung, Mary Varterasian, Halle H. Zhang, Khashayarsha Khazaie. First-in-man clinical trial of intratumoral injection of Clostridiumnovyi-NT spores in patients with treatment-refractory advanced solid tumors: Safety, activity, and immune responses [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr A011.
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Affiliation(s)
- Filip Janku
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Mrinal Gounder
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Abdul Mohammad Pezeshki
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Ravi Murthy
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Andrea Wang-Gillam
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Dale Shepard
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - David S. Hong
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Sarina A. Piha-Paul
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Anjali Raina
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Alexey A. Leontovich
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Gary DeCrescenzo
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Brent L. Kreider
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - David Tung
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Mary Varterasian
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Halle H. Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
| | - Khashayarsha Khazaie
- University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, NY; Washington University School of Medicine Siteman Cancer Center, St. Louis, MO; Cleveland Clinic, Cleveland, OH; BioMed Valley Discoveries, Kansas City, MO
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Sullivan RJ, Infante JR, Janku F, Wong DJL, Sosman JA, Keedy V, Patel MR, Shapiro GI, Mier JW, Tolcher AW, Wang-Gillam A, Sznol M, Flaherty K, Buchbinder E, Carvajal RD, Varghese AM, Lacouture ME, Ribas A, Patel SP, DeCrescenzo GA, Emery CM, Groover AL, Saha S, Varterasian M, Welsch DJ, Hyman DM, Li BT. First-in-Class ERK1/2 Inhibitor Ulixertinib (BVD-523) in Patients with MAPK Mutant Advanced Solid Tumors: Results of a Phase I Dose-Escalation and Expansion Study. Cancer Discov 2017; 8:184-195. [PMID: 29247021 DOI: 10.1158/2159-8290.cd-17-1119] [Citation(s) in RCA: 256] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 12/15/2022]
Abstract
Ulixertinib (BVD-523) is an ERK1/2 kinase inhibitor with potent preclinical activity in BRAF- and RAS-mutant cell lines. In this multicenter phase I trial (NCT01781429), 135 patients were enrolled to an accelerated 3 + 3 dose-escalation cohort and six distinct dose-expansion cohorts. Dose escalation included 27 patients, dosed from 10 to 900 mg twice daily and established the recommended phase II dose (RP2D) of 600 mg twice daily. Ulixertinib exposure was dose proportional to the RP2D, which provided near-complete inhibition of ERK activity in whole blood. In the 108-patient expansion cohort, 32% of patients required dose reduction. The most common treatment-related adverse events were diarrhea (48%), fatigue (42%), nausea (41%), and dermatitis acneiform (31%). Partial responses were seen in 3 of 18 (17%) patients dosed at or above maximum tolerated dose and in 11 of 81 (14%) evaluable patients in dose expansion. Responses occurred in patients with NRAS-, BRAF V600-, and non-V600 BRAF-mutant solid tumors.Significance: Here, we describe the first-in-human dose-escalation study of an ERK1/2 inhibitor for the treatment of patients with advanced solid tumors. Ulixertinib has an acceptable safety profile with favorable pharmacokinetics and has shown early evidence of clinical activity in NRAS- and BRAF V600- and non-V600-mutant solid-tumor malignancies. Cancer Discov; 8(2); 184-95. ©2017 AACR.See related commentary by Smalley and Smalley, p. 140This article is highlighted in the In This Issue feature, p. 127.
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Affiliation(s)
- Ryan J Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.
| | - Jeffrey R Infante
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, Tennessee
| | - Filip Janku
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Deborah Jean Lee Wong
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | | | - Vicki Keedy
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Manish R Patel
- Sarah Cannon Research Institute, Florida Cancer Specialists, Sarasota, Florida
| | - Geoffrey I Shapiro
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - James W Mier
- Beth-Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Keith Flaherty
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Antoni Ribas
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Sapna P Patel
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Saurabh Saha
- BioMed Valley Discoveries, Inc., Kansas City, Missouri
| | | | - Dean J Welsch
- BioMed Valley Discoveries, Inc., Kansas City, Missouri
| | - David M Hyman
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bob T Li
- Memorial Sloan Kettering Cancer Center, New York, New York.
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9
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Sullivan RJ, Janku F, Li BT, Wong D, Sosman J, Keedy V, Buchbinder E, Tolcher A, Varghese A, Hyman DM, Flaherty KT, Ribas A, Carvajal R, Wang-Gillam A, Kluger H, Patel M, Langecker P, Varterasian M, Welsch D, Infante J. Abstract CT003: Activity of the ERK1/2 inhibitor ulixertinib (BVD-523) in patients with BRAF and NRAS mutant melanoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Activating mutations of BRAF (50%) or NRAS (25%) are present in over 75% of patients with metastatic melanoma. Inhibitors of BRAF or MEK have been shown to improve survival in patients with specific BRAF-mutations, whereas inhibitors of MEK are associated with responses in over 20% of patients with NRAS mutations. ERK1/2 are serine-threonine kinases downstream of NRAS and BRAF in the MAPK pathway. Ulixertinib is a potent, selective, reversible, ATP-competitive ERK1/2 inhibitor that has demonstrated anti-proliferative effects in cells has been shown to reduce tumor growth and induce tumor regression in BRAF- and RAS-mutant xenograft models.
Methods: Fifty-two patients with metastatic melanoma were enrolled to either the dose escalation (8) or expansion (44) portions of this study (NCT01781429). The dose escalation phase enrolled a total of 27 patients (10-900 mg, BID) and established the recommended phase 2 dose (RP2D) of 600 mg, BID. In cohort expansion, BRAF-mutant melanoma patients without or with prior BRAF/MEK inhibitor therapy, and NRAS-mutant melanoma patients not treated with BRAF /MEK inhibitors were enrolled at the RP2D. Best response was determined by RECIST1.1.
Results: Overall, of the evaluable melanoma patients with BRAF mutations treated in this study (24), 4 had a partial response (PR, [17%]). Among the 8 melanoma patients treated in dose escalation, 6 had BRAFV600 mutations and 3 of these 6 had a partial response (PR), including one patient with PR who was not previously treated with BRAF/MEK inhibitor (all others were). In the expansion phase, only one melanoma patient was enrolled that had not previously received BRAF or MEK inhibitor and had a best response to therapy of stable disease (SD) that lasted over four months. For the 21 melanoma patients enrolled that had prior BRAF/MEK inhibitor therapy, including 20 with BRAFV600 mutation and 1 with a BRAF fusion, 15 were evaluable for response. Of these, 1 had a PR (7%), 6 SD, and 8 with progressive disease (PD). In the NRAS mutant melanoma cohort of 22 patients, including Q61 (17) or G13 (3) or unspecified mutations (2), 17 were evaluable for response; 2 PR (12%), 6 SD, and 9 PD. The most common treatment related adverse events (AEs) were diarrhea (54%), rash (46%), fatigue (42%), nausea (40%), and dermatitis acneiform (31%). 26 treatment-related Grade 3 events occurred in 21 patients, with acneiform rash (3), maculopapular rash (3), diarrhea (3), anemia (3), and fatigue (2) being the only events occurring multiple times. No treatment related grade 4 or 5 events occurred.
Conclusions: Ulixertinib was well tolerated and associated with activity in patients with metastatic melanoma with either a BRAF mutation, in both the BRAF/MEK inhibitor treatment naïve and refractory setting, or NRAS mutation. Further studies, either as single-agent or in combination, to determine the clinical utility of ulixertinib in cancer patients are ongoing.
Citation Format: Ryan J. Sullivan, Filip Janku, Bob T. Li, Deborah Wong, Jeffrey Sosman, Vicki Keedy, Elizabeth Buchbinder, Anthony Tolcher, Anna Varghese, David M. Hyman, Keith T. Flaherty, Antoni Ribas, Richard Carvajal, Andrea Wang-Gillam, Harriet Kluger, Manish Patel, Peter Langecker, Mary Varterasian, Dean Welsch, Jeffrey Infante. Activity of the ERK1/2 inhibitor ulixertinib (BVD-523) in patients with BRAF and NRAS mutant melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT003. doi:10.1158/1538-7445.AM2017-CT003
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Affiliation(s)
| | | | - Bob T. Li
- 3Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Vicki Keedy
- 6Vanderbilt Ingram Cancer Center, Nashville, TN
| | | | - Anthony Tolcher
- 8South Texas Accelerated Research Therapeutics, San Antonio, TX
| | - Anna Varghese
- 3Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | | | - Dean Welsch
- 13BioMed Valley Discoveries, Kansas City, MO
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Janku F, Murthy R, Wang-Gillam A, Shepard D, Helgason T, Henry T, Rudin C, Huang S, Sakamuri D, Solomon S, Collins A, Kreider B, Miller M, Saha S, Tung D, Varterasian M, Zhang L, Zhang H, Gounder M. Phase I clinical study of intratumoral injection of oncolytic Clostridium novyi-NT spores in patients with advanced cancers. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32878-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Roberts NJ, Zhang L, Janku F, Collins A, Bai RY, Staedtke V, Rusk AW, Tung D, Miller M, Roix J, Khanna KV, Murthy R, Benjamin RS, Helgason T, Szvalb AD, Bird JE, Roy-Chowdhuri S, Zhang HH, Qiao Y, Karim B, McDaniel J, Elpiner A, Sahora A, Lachowicz J, Phillips B, Turner A, Klein MK, Post G, Diaz LA, Riggins GJ, Papadopoulos N, Kinzler KW, Vogelstein B, Bettegowda C, Huso DL, Varterasian M, Saha S, Zhou S. Intratumoral injection of Clostridium novyi-NT spores induces antitumor responses. Sci Transl Med 2015; 6:249ra111. [PMID: 25122639 DOI: 10.1126/scitranslmed.3008982] [Citation(s) in RCA: 247] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Species of Clostridium bacteria are notable for their ability to lyse tumor cells growing in hypoxic environments. We show that an attenuated strain of Clostridium novyi (C. novyi-NT) induces a microscopically precise, tumor-localized response in a rat orthotopic brain tumor model after intratumoral injection. It is well known, however, that experimental models often do not reliably predict the responses of human patients to therapeutic agents. We therefore used naturally occurring canine tumors as a translational bridge to human trials. Canine tumors are more like those of humans because they occur in animals with heterogeneous genetic backgrounds, are of host origin, and are due to spontaneous rather than engineered mutations. We found that intratumoral injection of C. novyi-NT spores was well tolerated in companion dogs bearing spontaneous solid tumors, with the most common toxicities being the expected symptoms associated with bacterial infections. Objective responses were observed in 6 of 16 dogs (37.5%), with three complete and three partial responses. On the basis of these encouraging results, we treated a human patient who had an advanced leiomyosarcoma with an intratumoral injection of C. novyi-NT spores. This treatment reduced the tumor within and surrounding the bone. Together, these results show that C. novyi-NT can precisely eradicate neoplastic tissues and suggest that further clinical trials of this agent in selected patients are warranted.
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Affiliation(s)
- Nicholas J Roberts
- The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA
| | - Linping Zhang
- BioMed Valley Discoveries Inc., 4520 Main Street, Kansas City, MO 64111, USA
| | - Filip Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Amanda Collins
- BioMed Valley Discoveries Inc., 4520 Main Street, Kansas City, MO 64111, USA
| | - Ren-Yuan Bai
- Department of Neurosurgery, The Johns Hopkins Medical Institutes, Baltimore, MD 21231, USA
| | - Verena Staedtke
- Department of Neurosurgery, The Johns Hopkins Medical Institutes, Baltimore, MD 21231, USA.,Department of Neurology, The Johns Hopkins Medical Institutes, Baltimore, MD 21231, USA
| | - Anthony W Rusk
- Animal Clinical Investigation LLC, 4926 Wisconsin Avenue, NW Washington, DC 20016, USA
| | - David Tung
- BioMed Valley Discoveries Inc., 4520 Main Street, Kansas City, MO 64111, USA
| | - Maria Miller
- BioMed Valley Discoveries Inc., 4520 Main Street, Kansas City, MO 64111, USA
| | - Jeffrey Roix
- BioMed Valley Discoveries Inc., 4520 Main Street, Kansas City, MO 64111, USA
| | - Kristen V Khanna
- Animal Clinical Investigation LLC, 4926 Wisconsin Avenue, NW Washington, DC 20016, USA
| | - Ravi Murthy
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Robert S Benjamin
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Thorunn Helgason
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ariel D Szvalb
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Justin E Bird
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Halle H Zhang
- BioMed Valley Discoveries Inc., 4520 Main Street, Kansas City, MO 64111, USA
| | - Yuan Qiao
- The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA
| | - Baktiar Karim
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jennifer McDaniel
- The Veterinary Cancer Center, 129 Glover Avenue, Norwalk, CT 06850, USA
| | - Amanda Elpiner
- VCA Great Lakes Veterinary Specialists, 5035 Richmond Road, Bedford Heights, OH 44146, USA
| | - Alexandra Sahora
- The Oncology Service, Friendship Hospital for Animals, 4105 Brandywine Street, NW, Washington, DC 20016, USA
| | - Joshua Lachowicz
- BluePearl Veterinary Partners, 410 West 55th Street, New York, NY 10019, USA
| | - Brenda Phillips
- Veterinary Specialty Hospital of San Diego, 10435 Sorrento Valley Road, San Diego, CA 92121, USA
| | - Avenelle Turner
- Veterinary Cancer Group of Los Angeles at City of Angels Veterinary Specialty Center, 9599 Jefferson Boulevard, Culver City, CA 90232, USA
| | - Mary K Klein
- Southern Arizona Veterinary Specialty and Emergency Center, 141 East Fort Lowell, Tucson, AZ 85705, USA
| | - Gerald Post
- The Veterinary Cancer Center, 129 Glover Avenue, Norwalk, CT 06850, USA
| | - Luis A Diaz
- The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA.,The Swim Across America Laboratory at Johns Hopkins, Baltimore, MD 21231, USA
| | - Gregory J Riggins
- Department of Neurosurgery, The Johns Hopkins Medical Institutes, Baltimore, MD 21231, USA
| | - Nickolas Papadopoulos
- The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA
| | - Kenneth W Kinzler
- The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA
| | - Bert Vogelstein
- The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA
| | - Chetan Bettegowda
- The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA.,Department of Neurosurgery, The Johns Hopkins Medical Institutes, Baltimore, MD 21231, USA
| | - David L Huso
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Mary Varterasian
- BioMed Valley Discoveries Inc., 4520 Main Street, Kansas City, MO 64111, USA
| | - Saurabh Saha
- BioMed Valley Discoveries Inc., 4520 Main Street, Kansas City, MO 64111, USA
| | - Shibin Zhou
- The Ludwig Center for Cancer Genetics and Therapeutics and The Howard Hughes Medical Institute at The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD 21287, USA
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12
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Ibrahim D, Smith MR, Varterasian M, Karanes C, Millenson M, Yeslow G, Pemberton P, Lai P, Abrams J, Al-Katib A. Phase II Study of PEND Chemotherapy in Patients with Refractory/Relapsed Hodgkin Lymphoma. Leuk Lymphoma 2009; 45:2079-84. [PMID: 15370253 DOI: 10.1080/1042819042000223831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/26/2022]
Abstract
High-dose chemotherapy with autologous marrow or stem cell rescue (HDC/ASCT) is an effective strategy in patients with relapsed Hodgkin lymphoma. Various chemotherapy regimens have been used for cytoreduction prior to HDC/ASCT. In this study, our objective was to determine the response rate to PEND in a group of patients with relapsed Hodgkin lymphoma. Nineteen patients with relapsed or primary refractory Hodgkin lymphoma underwent treatment with the PEND regimen and received a median of 2 cycles (1 - 6 cycles). The PEND regimen builds on our prior results with ABDIC and consists of prednisone 40 mg/m2 orally (PO) daily x 5 days; etoposide 50 mg/m2 PO daily x 14 days; mitoxantrone 5 mg/m2/d IV, days 1 and 3; and DTIC 200 mg/m2/d intravenous continuous infusion (CIV) over 24 h, days 1 to 5, via central venous catheter. The treatment was given every 28 days. There were 3 complete responses (16%) and 10 partial responses (53%) yielding a total response rate of 69% (95% C.I. 43%, 87%). Myelosuppression was the predominant toxicity; no deaths were due to toxicity. After achieving maximum response to PEND, 10 eligible patients received a consolidative treatment with HDC/ASCT. All 6 patients who did not respond to PEND died from disease progression whereas 5 of 13 responders were alive after 10 years of follow-up (3 without disease). There were 11 deaths due to disease progression; three from other causes. The initial response to PEND before subsequent ASCT consolidation treatment appears to be associated with survival. All patients who failed to achieve a response have died. We conclude that PEND is an effective treatment strategy in Hodgkin lymphoma patients previously treated with both ABVD and MOPP.
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Affiliation(s)
- Dina Ibrahim
- Lymphoma and Myeloma Service, Division of Hematology/Oncology, Wayne State University, Detroit, Michigan, USA
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13
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Fingert H, Varterasian M. Safety biomarkers and the clinical development of oncology therapeutics: considerations for cardiovascular safety and risk management. AAPS J 2006; 8:E89-94. [PMID: 16584137 PMCID: PMC2751426 DOI: 10.1208/aapsj080110] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the clinical development of oncology therapeutics, new safety biomarkers are being employed with broad applications and implications for risk management and regulatory approval. Clinical laboratory results, used as safety biomarkers, can influence decision making at many levels during the clinical development and regulatory review of investigational cancer therapies, including (1) initial eligibility for protocol therapy; (2) analyses used to estimate and characterize the safety profile; and (3) treatment delivery, based on specific rules to modify or discontinue protocol treatment. With the increasing applications of safety biomarkers in clinical studies, consideration must be given to possible unintended consequences, including (1) restricted access to promising treatments; (2) delays in study completion; and (3) limitations to dose delivery, escalation, and determination of the maximal tolerated dose, the recommended phase 2 dose, and the optimal biologic dose selected for registration studies. This review will compare and contrast 2 biomarkers for cardiac safety that are employed in an increasing number of clinical programs designed for investigational oncology therapeutics: (1) assessment of left ventricular ejection fraction by either echocardiography or multigated acquisition scan; and (2) electrophysiological measurement of QT/QTc duration, assessed by electrocardiogram, for predicting risk of a potentially fatal arrhythmia called torsades de pointes. While these and other new safety biomarkers have major value in the development of oncology therapeutics, their applications require careful consideration to avoid unintended consequences that could negatively affect (1) the care of patients with advanced malignancy and (2) the advancement of promising new agents.
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Affiliation(s)
- Howard Fingert
- Pfizer Global Research and Development, 50 Pequot Ave B4258, New London, CT, USA.
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14
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Lorusso PM, Adjei AA, Varterasian M, Gadgeel S, Reid J, Mitchell DY, Hanson L, DeLuca P, Bruzek L, Piens J, Asbury P, Van Becelaere K, Herrera R, Sebolt-Leopold J, Meyer MB. Phase I and pharmacodynamic study of the oral MEK inhibitor CI-1040 in patients with advanced malignancies. J Clin Oncol 2005; 23:5281-93. [PMID: 16009947 DOI: 10.1200/jco.2005.14.415] [Citation(s) in RCA: 317] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This phase I study was undertaken to define the toxicity, pharmacokinetics, pharmacodynamics, maximum tolerated dose (MTD), and clinical activity of CI-1040, a small-molecule inhibitor of the dual-specificity kinases MEK(mitogen-activated protein kinase kinase) -1 and MEK2 , in patients with advanced malignancy. PATIENTS AND METHODS CI-1040 was tested in multiple daily dosing frequencies administered for 21 days repeated every 28 days leading ultimately to continuous administration, and effect of food on absorption was tested. Single dose and steady-state pharmacokinetics were assessed during cycle 1 and phosphorylated extracellular receptor kinase (pERK) levels were assessed in WBCs and also in tumor tissue from selected patients. RESULTS Seventy-seven patients received CI-1040 at dose levels ranging from 100 mg QD to 800 mg tid. Grade 3 asthenia was dose limiting at the highest dose level tested, 800 mg tid administered with food. Ninety-eight percent of all drug-related adverse events were grade 1 or 2 in severity; most common toxicities included diarrhea, asthenia, rash, nausea, and vomiting. Plasma concentrations of CI-1040 and its active metabolite, PD 0184264, increased in a less than dose proportional manner from 100 to 800 mg QD. Administration with a high-fat meal resulted in an increase in drug exposure. The MTD and recommended phase II dose was 800 mg BID administered with food. Sixty-six patients were assessable for response. One partial response was achieved in a patient with pancreatic cancer and 19 patients (28%) achieved stable disease lasting a median of 5.5 months (range, 4 to 17 months). Inhibition of tumor pERK (median, 73%; range, 46% to 100%) was demonstrated in 10 patients. CONCLUSION CI-1040 was well tolerated at 800 mg BID administered with food. Both target suppression and antitumor activity were demonstrated in this phase I study.
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Affiliation(s)
- Patricia M Lorusso
- Barbara Ann Karmanos Cancer Institute, 4100 John R 4 HWCRC, Room 4206, Detroit, MI 48201, USA.
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Lorusso P, Krishnamurthi S, Rinehart JR, Nabell L, Croghan G, Varterasian M, Sadis SS, Menon SS, Leopold J, Meyer MB. A phase 1–2 clinical study of a second generation oral MEK inhibitor, PD 0325901 in patients with advanced cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3011] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [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)
- P. Lorusso
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - S. Krishnamurthi
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - J. R. Rinehart
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - L. Nabell
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - G. Croghan
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - M. Varterasian
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - S. S. Sadis
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - S. S. Menon
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - J. Leopold
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
| | - M. B. Meyer
- Wayne State Univ, Detroit, MI; Case Comprehensive Cancer Ctr, Cleveland, OH; Univ of Alabama-Birmingham, Birmingham, AL; Mayo Clinic & Fdn, Rochester, MN; Pfizer Global Research and Development, Michigan Laboratories, Ann Arbor, MI
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Affiliation(s)
- N. Sarapa
- Pfizer Global R&D, San Diego, CA; Pfizer Global R&D, Ann Arbor, MI; Pfizer Global R&D, New London, CT
| | - X. Huang
- Pfizer Global R&D, San Diego, CA; Pfizer Global R&D, Ann Arbor, MI; Pfizer Global R&D, New London, CT
| | - M. Varterasian
- Pfizer Global R&D, San Diego, CA; Pfizer Global R&D, Ann Arbor, MI; Pfizer Global R&D, New London, CT
| | - H. Fingert
- Pfizer Global R&D, San Diego, CA; Pfizer Global R&D, Ann Arbor, MI; Pfizer Global R&D, New London, CT
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Rinehart J, Adjei AA, Lorusso PM, Waterhouse D, Hecht JR, Natale RB, Hamid O, Varterasian M, Asbury P, Kaldjian EP, Gulyas S, Mitchell DY, Herrera R, Sebolt-Leopold JS, Meyer MB. Multicenter phase II study of the oral MEK inhibitor, CI-1040, in patients with advanced non-small-cell lung, breast, colon, and pancreatic cancer. J Clin Oncol 2004; 22:4456-62. [PMID: 15483017 DOI: 10.1200/jco.2004.01.185] [Citation(s) in RCA: 509] [Impact Index Per Article: 25.5] [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: 01/27/2023] Open
Abstract
PURPOSE This multicenter, open-label, phase II study was undertaken to assess the antitumor activity and safety of the oral mitogen-activated extracellular signal regulated kinase kinase (MEK) inhibitor, CI-1040, in breast cancer, colon cancer, non-small-cell lung cancer (NSCLC), and pancreatic cancer. PATIENTS AND METHODS Patients with advanced colorectal, NSCLC, breast, or pancreatic cancer received oral CI-1040 continuously at 800 mg bid. All patients had measurable disease at baseline, a performance status of 2 or less, and adequate bone marrow, liver, and renal function. Expression of pERK, pAkt, and Ki-67 was assessed in archived tumor specimens by quantitative immunohistochemistry. RESULTS Sixty-seven patients with breast (n = 14), colon (n = 20), NSCLC (n = 18), and pancreatic (n = 15) cancer received a total of 194 courses of treatment (median, 2.0 courses; range, one to 14 courses). No complete or partial responses were observed. Stable disease (SD) lasting a median of 4.4 months (range, 4 to 18 months) was confirmed in eight patients (one breast, two colon, two pancreas, and three NSCLC patients). Treatment was well tolerated, with 81% of patients experiencing toxicities of grade 2 or less severity. Most common toxicities included diarrhea, nausea, asthenia, and rash. A mild association (P < .055) between baseline pERK expression in archived tumor specimens and SD was observed. CONCLUSION CI-1040 was generally well tolerated but demonstrated insufficient antitumor activity to warrant further development in the four tumors tested. PD 0325901, a second generation MEK inhibitor, has recently entered clinical development and, with significantly improved pharmacologic and pharmaceutical properties compared with CI-1040, it may better test the therapeutic potential of MEK inhibition in cancer.
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Affiliation(s)
- John Rinehart
- University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Varterasian M, Fingert H, Agin M, Meyer M. Consideration of QT/QTc Interval Data in a Phase I Study in Patients with Advanced Cancer. Clin Cancer Res 2004; 10:5967-8; author reply 5968-9. [PMID: 15355930 DOI: 10.1158/1078-0432.ccr-04-0534] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Varterasian M, Meyer M, Fingert H, Radlowski D, Asbury P, Zhou X, Healey D. Baseline heart rate-corrected QT and eligibility for clinical trials in oncology. J Clin Oncol 2003; 21:3378-9. [PMID: 12947082 DOI: 10.1200/jco.2003.99.104] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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20
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Vaishampayan U, Karanes C, Du W, Varterasian M, al-Katib A. Outcome of relapsed non-Hodgkin's lymphoma patients after allogeneic and autologous transplantation. Cancer Invest 2002; 20:303-10. [PMID: 12025224 DOI: 10.1081/cnv-120001174] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A retrospective review of 58 patients with non-Hodgkin's lymphoma (NHL) relapse or progression after autologous bone marrow transplantation (auto BMT), peripheral stem cell transplantation (PSCT), or allogeneic bone marrow transplantation (allo BMT) between November 1988 and December 1997 was performed. Forty-six (79%) patients had autologous transplant and 12 (21%) patients had allogeneic transplant. Median time to relapse post-transplant was 4.8 months with 49 relapses within 12 months after transplant. Overall 5-year survival was 22% (auto BMT or PSCT 25%, allo BMT 18%, p = 0.38) with a median survival of 10 months (auto BMT or PSCT 10.2 months, allo BMT 7 months, p = 0.38). Thirty-five patients received salvage therapy and, of these, 13 demonstrated objective response. The 3-year survival of responders and non-responders was 55 and 14% and median survivals were 27.8 and 8 months, respectively (p = 0.02). Interval between BMT and relapse (p = 0.0001), and response to salvage therapy (p = 0.02) were the only significant predictors of survival.
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Affiliation(s)
- Ulka Vaishampayan
- Division of Hematology and Oncology, Department of Internal Medicine, Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA.
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Gaynor ER, Unger JM, Miller TP, Grogan TM, White LA, Mills GM, Balcerzak SP, Varterasian M, LeBlanc M, Fisher RI. Infusional CHOP chemotherapy (CVAD) with or without chemosensitizers offers no advantage over standard CHOP therapy in the treatment of lymphoma: a Southwest Oncology Group Study. J Clin Oncol 2001; 19:750-5. [PMID: 11157027 DOI: 10.1200/jco.2001.19.3.750] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [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: 11/20/2022] Open
Abstract
PURPOSE Two phase II studies were conducted to evaluate infusional cyclophosphamide, doxorubicin, vincristine, and dexamethasone chemotherapy, termed the CVAD regimen, alone (Southwest Oncology Group [SWOG] 9240) and with the chemosensitizers verapamil and quinine (SWOG 9125) to assess effects on response, survival, and toxicity in intermediate- and high-grade advanced-stage non-Hodgkin's lymphoma (NHL). The results were compared with the historic group of patients randomized to CHOP chemotherapy on Intergroup (INT) 0067 (SWOG 8516). PATIENTS AND METHODS All patients had biopsy-proven intermediate- or high-grade NHL (lymphoblastic histology excluded), were ambulatory and previously untreated, and had bulky stage II, III, or IV disease. One hundred twelve patients were registered on SWOG 9240 and received cyclophosphamide 750 mg/m(2) by intravenous bolus day 1, doxorubicin 12.5 mg/m(2)/d and vincristine 0.5 mg/d delivered as a continuous 96-hour infusion on days 1 through 4, and dexamethasone 40 mg/d orally on days 1 through 4 (CVAD). Cycles were repeated every 21 days for eight cycles. One hundred patients on SWOG 9125 received the same chemotherapy and the chemosensitizers verapamil 240 mg bid and quinine 40 mg tid. Chemosensitizers were begun 24 hours before chemotherapy and continued for a total of 6 days. RESULTS Eighty-one patients were eligible for each study. The complete response (CR) rates were 39% on SWOG 9125 and 31% on SWOG 9240. With a median follow-up of 5.8 years on SWOG 9125 and 4.5 years on SWOG 9240, the 2-year failure-free survival (FFS) rate was 42% on SWOG 9125 and 41% on SWOG 9240. Two-year overall survival (OS) rate was 64% on SWOG 9125 and 58% on SWOG 9240. These results are comparable to a 44% CR rate, a 2-year FFS of 46%, and 2-year OS of 63% observed in 225 patients treated with CHOP on INT 0067 (SWOG 8516). CONCLUSION CVAD combination chemotherapy alone or with the chemosensitizers verapamil and quinine is not promising therapy with respect to improved response or OS in intermediate- and high-grade advanced-stage NHL.
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Affiliation(s)
- E R Gaynor
- Loyola University Medical Center, Maywood, IL, USA
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Aref A, Narayan S, Tekyi-Mensah S, Varterasian M, Dan M, Eilender D, Karanes C, al-Katib A. Value of radiation therapy in the management of chemoresistant intermediate grade non-Hodgkin's lymphoma. Radiat Oncol Investig 1999; 7:186-91. [PMID: 10406061 DOI: 10.1002/(sici)1520-6823(1999)7:3<186::aid-roi8>3.0.co;2-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to evaluate the probability and extent of response to radiation therapy in patients with chemotherapy-resistant intermediate grade non-Hodgkin's lymphoma. Thirty-five patients with chemotherapy-resistant non-Hodgkin's lymphoma received local radiation therapy after initial treatment with at least six cycles of systemic chemotherapy. There were 17 men and 18 women in our study. Ages ranged from 15 to 68 years, median age was 42 years. Chemotherapy resistance was defined as relapse after initial chemotherapy (11 patients) or failure to achieve complete remission (partial response in 18 patients, stable disease in 1 patient, and disease progression in 5 patients). Radiation doses were between 1,980-5,040 cGy (median dose of 3,200 cGy). Treatment outcome was evaluated with respect to any subsequent relapse either within or outside the irradiated region. The 2-year actuarial survival was 65%. The cumulative incidence of isolated local failure and any local failure at 2 years were 33% and 54%, respectively. Tumors that responded to initial chemotherapy had a better local control probability than tumors that did not respond. The 2-year actuarial local failure rates for these two groups were 51% and 83%, respectively (P = 0.01). There was a trend for improved local control with radiation doses > or = 3,960 cGy, suggesting the presence of a dose-control relationship. The rate of disease progression within an irradiated region in patients with intermediate grade non-Hodgkin's lymphoma that relapsed after or failed to respond completely to full course chemotherapy was substantially higher than the historical in-field failure rates when radiation therapy was used as the sole modality of treatment. Prior response to initial chemotherapy was a predicting factor for local control following radiation therapy.
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Affiliation(s)
- A Aref
- Department of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
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Abstract
We have identified five African-American patients with Waldenström's macroglobulinemia (WM) diagnosed at a young age (ages 35, 38, 38, 40, 51; 4 males, 1 female). All had a history of intravenous heroin abuse and four also used cocaine. Their manner of presentation and clinical course were typical. Three of three patients tested for the hepatitis C virus (HCV) were positive and three of three patients tested were HIV negative. The potential relationship between intravenous drug abuse and/or HCV to development of WM in this group of young patients is provocative, especially since a polyclonal increase in serum IgM is commonly seen in chronic intravenous heroin addicts. More recently, the contribution of HCV is being evaluated in lymphoproliferative disorders. Although WM is typically a disease of older people, it should also be considered in the differential in a young patient with a suggestive clinical picture.
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Affiliation(s)
- S Ahmed
- Department of Internal Medicine, Barbara Ann Karmanos Cancer Institute and Wayne State University, Detroit, Michigan, USA
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Mohammad RM, Pettit GR, Almatchy VP, Wall N, Varterasian M, Al-Katib A. Synergistic interaction of selected marine animal anticancer drugs against human diffuse large cell lymphoma. Anticancer Drugs 1998; 9:149-56. [PMID: 9510501 DOI: 10.1097/00001813-199802000-00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 02/06/2023]
Abstract
We studied the antitumor effects of dolastatin 10, its structural modification, auristatin PE (TZT-1027), and vincristine alone and in combination with bryostatin 1 on a human diffuse large cell lymphoma line (WSU-DLCL2) in vitro and in vivo. WSU-DLCL2 cells were cultured in RPMI 1640 at a concentration of 2 x 10(5)/ml using a 24-well plate. Agents were added to triplicate wells, and cell count, viability, mitosis and apoptosis were assessed. Dolastatin 10 showed no apparent inhibition of cell growth at concentrations less than 500 pg/ ml. Auristatin PE showed significant growth inhibition at concentrations as low as 10 pg/ml, while vincristine had a minimal effect at 50 pg/ml. Dolastatin 10, auristatin PE and vincristine-treated cultures, at 50 pg/ml, exhibited 11, 1.7; 45, 11.8%; and 39, 25% mitosis and apoptosis, respectively. In the WSU-DLCL2 SCID mouse xenograft model, the efficacy of these agents alone or in combination with bryostatin 1 was evaluated. Tumor growth inhibition (T/C), tumor growth delay (T-C) and log10 kill for dolastatin 10, auristatin PE, vincristine and bryostatin 1 were 30%, 14 days and 1.4; 0.0%, 55 days and 5.5; 29.6%, 16 days and 1.6; and 39%, 7 days and 0.7, respectively. When given in combination, two out of five mice treated with auristatin PE + bryostatin 1 were free of tumors for 150 days and were considered cured. Dolastatin 10 + bryostatin 1 and vincristine + bryostatin 1 combinations were highly active but no cure was observed. We conclude that: (i) auristatin PE is more effective in this model than dolastatin 10, vincristine or bryostatin 1, (ii) auristatin PE can be administered at a concentration 10 times greater than dolastatin 10, and (iii) there is a synergistic effect between these agents and bryostatin 1, which is more apparent in the bryostatin 1 + auristatin PE combination. The use of these agents should be further explored clinically in the treatment of lymphoma.
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Affiliation(s)
- R M Mohammad
- Department of Internal Medicine, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, MI 48201, USA
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Mohammad RM, Katato K, Almatchy VP, Wall N, Liu KZ, Schultz CP, Mantsch HH, Varterasian M, al-Katib AM. Sequential treatment of human chronic lymphocytic leukemia with bryostatin 1 followed by 2-chlorodeoxyadenosine: preclinical studies. Clin Cancer Res 1998; 4:445-53. [PMID: 9516935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We have previously reported that bryostation 1 (Bryo 1) induces differentiation of chronic lymphocytic leukemia (CLL) in vitro to a hairy cell (HC) stage. This study tests the hypothesis that Bryo 1-differentiated CLL cells are more susceptible to 2-chlorodeoxyadenosine (2-CdA) than parent CLL cells. A recently established EBV-negative CLL line (WSU-CLL) from a patient resistant to chemotherapy including fludarabine was used to test this hypothesis. Both Bryo 1 (10-1000 nM) and 2-CdA (5.6-22.4 microM) exhibited a dose-dependent growth inhibitory effect on the WSU-CLL cell line. In vitro, the sequential exposure to Bryo 1 (100 nM for 72 h) followed by 2-CdA (11.2 microM) resulted in significantly higher rates of growth inhibition than either agent alone. Changes in immunophenotype, enzymes, lipids, proteins, and the DNA of WSU-CLL cells were studied before and after Bryo 1 treatment. Bryo 1 induced a positive tartrate-resistant acid phosphatase reaction and two important markers, CD11c and CD25, after 72 h of culture, confirming the differentiation of CLL to HC. The Fourier transformation infrared spectroscopic analysis showed that the amount of membrane lipids significantly increased in Bryo 1-treated cells compared to controls after 24 h, whereas the protein content, as well as the DNA content, decreased. This finding supports the change of CLL to HC. To evaluate the in vivo efficacy of Bryo 1 and 2-CdA, we used a xenograft model of CLL in WSU-CLL-bearing mice with severe combined immune deficiency. s.c. tumors were developed by injection of 10(7) WSU-CLL cells, and fragments were then transplanted into a new batch of severe combined immunodeficient mice. Bryo 1 and 2-CdA at the maximum tolerated doses (75 micrograms/kg i.p. and 30 mg/kg s.c., respectively) were administered to the mice at different combinations and schedules. The survival in days, the tumor growth inhibition ratio, the tumor growth delay, and the log10 kill of the mice treated with Bryo 1 followed by 2-CdA were significantly better than the control and other groups. We conclude that the sequential treatment with Bryo 1 followed by 2-CdA resulted in higher antitumor activity and improved animal survival.
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MESH Headings
- Acid Phosphatase/metabolism
- Aged
- Animals
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Apoptosis/drug effects
- Bryostatins
- Cell Division/drug effects
- Cladribine/administration & dosage
- DNA, Neoplasm/metabolism
- Drug Administration Schedule
- Drug Screening Assays, Antitumor
- Humans
- Lactones/administration & dosage
- Leukemia, Hairy Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Lipid Metabolism
- Macrolides
- Male
- Mice
- Mice, SCID
- Neoplasm Proteins/metabolism
- Neoplasm Transplantation
- Spectroscopy, Fourier Transform Infrared
- Transplantation, Heterologous
- Tumor Cells, Cultured
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Affiliation(s)
- R M Mohammad
- Karmanos Cancer Institute, Wayne State University School of Medicine, Department of Medicine, Detroit, Michigan 48201, USA.
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Abstract
The successful treatment of sarcomas with intensive regimens combining high-dose chemotherapy and irradiation has led to not only improved survival but also to an increased incidence of therapy-related acute non-lymphocytic leukemia (t-ANLL) and myelodysplastic syndrome (MDS). We report 4 patients having sarcoma treated with chemotherapy or chemoradiotherapy who subsequently developed MDS or t-ANLL.
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Affiliation(s)
- M Varterasian
- Karmanos Cancer Institute and Wayne State University, Detroit, Michigan, USA
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Varterasian M, Janakiraman N, Karanes C, Abella E, Uberti J, Dragovic J, Raman SB, al-Katib A, Du W, Silver SM, Adams PT, Sensenbrenner L, Ratanatharathorn V. Transplantation in patients with multiple myeloma: a multicenter comparative analysis of peripheral blood stem cell and allogeneic transplant. Am J Clin Oncol 1997; 20:462-6. [PMID: 9345328 DOI: 10.1097/00000421-199710000-00005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We performed a multicenter comparative analysis of autologous peripheral blood stem cell transplantation (PBSCT) and allogeneic bone marrow transplantation (alloBMT) in multiple myeloma. Forty-eight consecutive patients received either PBSCT (24 patients) or alloBMT (24 patients) at one of three institutions in the study group. Preparatory regimens consisted of melphalan and total body irradiation (TBI) or melphalan alone in the PBSCT group. The alloBMT group received one of four regimens: cyclophosphamide and TBI; cyclophosphamide, VP-16 and 1,3-bis(2-chloroethyl)-1-nitrosourea (CVB); busulfan and cyclophosphamide (BU/CY) and total marrow irradiation (TMI); or melphalan and TBI. Procedure-related mortality was 12.5% for the PBSCT group and 25% for the alloBMT group. With a median follow-up for survivors in the PBSCT and alloBMT groups of 11 months (range, 4-46) and 15 months (range, 2-84 months), respectively, there was no significant difference in median overall survival (33.5 versus 38.6 months, p = 0.7637) or event-free survival (16.7 versus 31 months, p = 0.8450). There was, however, a plateau in survival at 40% in the alloBMT group. No plateau in survival was seen in the PBSCT group. Clinical relapses occurred as late as 39 months posttransplant. Patients have survived up to 28 months postrelapse.
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Varterasian M, Ratanatharathorn V, Uberti JP, Karanes C, Abella E, Momin F, Kasten-Sportes C, Al-Katib A, Lum L, Heilbrun LK. Clinical course and outcome of patients with Hodgkin's disease who progress after autologous transplantation. Leuk Lymphoma 1995; 20:59-65. [PMID: 8750624 DOI: 10.3109/10428199509054754] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty-six of fifty-eight patients undergoing autologous bone marrow transplantation (autoBMT) or peripheral stem cell transplantation (PSCT) for Hodgkin's disease had progression of lymphoma (Hodgkin's or non-Hodgkin's) during the course of their follow-up. The majority of progressions, 81% (21/26), occurred within the first year of transplant; 12% (3/26) occurred at three years or more. Three patients developed a non-Hodgkin's lymphoma; all B-cell tumors primarily involving the gastrointestinal tract. The majority of patients (23/26) received at least one therapy after progression and 65% (17/26) of patients received multiple therapies. One patient who received a second BMT is alive without evidence of disease at 49 months following the second autologous BMT. The median survival for the entire group is 11 months. Forty-six percent (12/26) of patients survived more than one year and twenty-three percent (6/26) survived more than two years after disease progression. Post-progression survival is significantly related to time to progression.
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Affiliation(s)
- M Varterasian
- Department of Medicine, Wayne State University/Detroit Medical Center, Michigan, USA
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31
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Mohamed AN, Koppitch F, Varterasian M, Karanes C, Yao KL, Sarkar FH. BCR/ABL fusion located on chromosome 9 in chronic myeloid leukemia with a masked Ph chromosome. Genes Chromosomes Cancer 1995; 13:133-7. [PMID: 7542908 DOI: 10.1002/gcc.2870130210] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A reciprocal translocation, t(10;22)(q22;q11), resulting in a masked Ph chromosome was identified in a patient diagnosed with chronic myeloid leukemia (CML). Both homologs of chromosome 9 were of the normal pattern. Two signals for the ABL probe, both of them hybridized to chromosome 9, were demonstrated via fluorescence in situ hybridization (FISH). Furthermore, cohybridization with two differently labeled BCR/ABL translocation DNA probes indicated a BCR/ABL fusion apparently located on 9q34. Molecular studies revealed a rearrangement of the BCR region and expression of a chimeric BCR/ABL mRNA of CML configuration. These findings indicate that the BCR/ABL fusion resulted from an unusual relocation of the BCR gene from its normal position on 22q11 to 9q34 adjacent to the ABL gene.
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Affiliation(s)
- A N Mohamed
- Department of Pathology, Harper Hospital, Wayne State University, Detroit, Michigan 48201, USA
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Varterasian M, Ratanatharathorn V, Karanes C, Uberti J, Momin F, Abella E, Lum LG, Heilbrun LK, Sensenbrenner LL. Bone marrow transplantation for multiple myeloma: the Wayne State experience. Bone Marrow Transplant 1995; 15:328-9. [PMID: 7773230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Varterasian M, Lipkowitz S, Karsch-Mizrachi I, Paterson B, Kirsch I. Two new Drosophila genes related to human hematopoietic and neurogenic transcription factors. Cell Growth Differ 1993; 4:885-9. [PMID: 8297794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We have identified two new basic domain helix-loop-helix (bHLH) genes in Drosophila melanogaster, DroSCL and DroNHLH. DroSCL was identified because of its homology to the mammalian hematopoietic transcription factor SCL. DroNHLH was similarly identified by homology to NHLH1 and NHLH2, two bHLH genes expressed in the developing mammalian nervous system. A partial DroSCL complementary DNA clone was obtained from an early pupal (5.5-7.5-day) Drosophila library. DroSCL is 73% identical to SCL within the 55-amino acid region of the bHLH domain. A DroNHLH complementary DNA clone was obtained from an early instar (I and II) Drosophila library. Its coding region consists of 162 amino acids and encodes a predicted protein of 18,312 daltons. DroNHLH is 87% identical to NHLH1 and NHLH2 within the bHLH domain. DroSCL and DroNHLH are located on the X chromosome. A 1.7-kilobase DroSCL transcript and a 1.5-kilobase DroNHLH transcript were detected by Northern analysis of total Drosophila RNA. Examination of Drosophila embryos by tissue in situ hybridization reveals restricted expression of both genes in a subset of cells in the developing central nervous system.
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Affiliation(s)
- M Varterasian
- National Cancer Institute-Navy Medical Oncology Branch, National Naval Medical Center, Bethesda, Maryland 20889-5105
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