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Zakharia Y, Monga V, Swami U, Bossler AD, Freesmeier M, Frees M, Khan M, Frydenlund N, Srikantha R, Vanneste M, Henry M, Milhem M. Targeting epigenetics for treatment of BRAF mutated metastatic melanoma with decitabine in combination with vemurafenib: A phase lb study. Oncotarget 2017; 8:89182-89193. [PMID: 29179510 PMCID: PMC5687680 DOI: 10.18632/oncotarget.21269] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/16/2017] [Indexed: 01/22/2023] Open
Abstract
Introduction Epigenetic modifications play an important role in progression and development of resistance in V600EBRAF positive metastatic melanoma. Therefore, we hypothesized that the action of vemurafenib (BRAF inhibitor) can be made more effective by combining with low dose decitabine (a DNA methyltransferase inhibitor). The primary objective of this phase lb study was to determine the dose limiting toxicity and maximum tolerated dose of combination of subcutaneous decitabine with oral vemurafenib in patients with V600EBRAF positive metastatic melanoma with or without any prior treatment. Experimental Design The study employed 3+3 dose escalation combining subcutaneous decitabine at different doses and schedules (4 cohorts) with the standard oral dose of vemurafenib 960 mg twice daily. Preclinical assessment and further analysis were also performed in A375 melanoma cell line. Results Fourteen patients received study treatment. No dose limiting toxicity was encountered and maximum tolerated dose was not reached. Important toxicities included fatigue, increased creatinine, neutropenia, leucopenia, hypophosphatemia, rash and hyperuricemia. Three patients achieved complete response, three had partial response and five had stable disease. Preclinical assessment demonstrated action of the combination which delayed the development of acquired resistance and improved duration of treatment sensitivity. Conclusions The combination of oral vemurafenib with subcutaneous decitabine is safe and showed activity in V600EBRAF positive metastatic melanoma. Since most responses were seen in cohort 1, which utilized low-dose, long-term decitabine, future studies of this combination treatment should utilize longer duration of decitabine, at the lowest dose of 0.1 mg/kg.
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Affiliation(s)
- Yousef Zakharia
- Department of Hematology, Oncology and Blood and Marrow Transplantation and the Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Varun Monga
- Department of Hematology, Oncology and Blood and Marrow Transplantation and the Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Umang Swami
- Department of Hematology, Oncology and Blood and Marrow Transplantation and the Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Aaron D Bossler
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Michele Freesmeier
- Department of Hematology, Oncology and Blood and Marrow Transplantation and the Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Melanie Frees
- Department of Hematology, Oncology and Blood and Marrow Transplantation and the Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Mirza Khan
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Noah Frydenlund
- The University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Rithu Srikantha
- The University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Marion Vanneste
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Michael Henry
- Department of Molecular Physiology and Biophysics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Mohammed Milhem
- Department of Hematology, Oncology and Blood and Marrow Transplantation and the Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Hansen J, Stephan JM, Freesmeier M, Bender D, Button A, Goodheart MJ. The effect of weight-based chemotherapy dosing in a cohort of gynecologic oncology patients. Gynecol Oncol 2015; 138:154-8. [PMID: 25958318 DOI: 10.1016/j.ygyno.2015.04.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/29/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Many clinicians limit chemotherapy doses based on a maximum body surface area (BSA) of 2m(2). We sought to determine how chemotherapy-related toxicities compared between groups of patients that varied with respect to BSA. We hypothesized that obese patients receiving weight-based (WB) dosing would not have significantly higher chemotherapy-related toxicities than control groups. METHODS We performed a retrospective review of patients with BSA≥2m(2) who received WB chemotherapy for a gynecologic cancer between January and August 2013. Subjects were matched with two controls: patients with BSA<2m(2) who received WB dosing, and patients with BSA≥2m(2) who received capped dosing at BSA=2m(2). Groups were matched for medical co-morbidities and prior cancer treatment. Demographic and clinical information was extracted and analyzed via ANOVA and Fisher's exact test. RESULTS A total of 75 patients were included. The three groups were similar in their medical co-morbidities and prior cancer treatment. When comparing pre- and post-treatment laboratory values, there was no difference in hematologic toxicities. There was no difference between groups with regard to treatment delays, unplanned admissions, transfusions, or dose reductions for toxicity. CONCLUSIONS Gynecologic cancer patients with BSA≥2m(2) treated with WB chemotherapy had no increase in hematologic or non-hematologic toxicities when compared to controls. Consideration should be given to using WB dosing in obese patients with gynecologic malignancies. Further investigation is required to determine the effect of WB dosing on progression-free and overall survival in obese gynecologic cancer patients.
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Affiliation(s)
- Jean Hansen
- Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Jean-Marie Stephan
- Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Michele Freesmeier
- Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - David Bender
- Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Anna Button
- Department of Biostatistics, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Michael J Goodheart
- Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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Hansen J, Stephan J, Freesmeier M, Bender D, Button A, Goodheart M. Abstract number 9: Weight-based chemotherapy dosing does not increase chemotherapy-related toxicity in obese gynecologic cancer patients. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hansen J, Stephan J, Freesmeier M, Bender D, Button A, Goodheart M. Weight-based chemotherapy dosing does not increase chemotherapy-related toxicity in obese gynecologic cancer patients. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hansen J, Stephan J, Freesmeier M, Bender D, DeGeest K, Button A, Goodheart M. The effect of weight-based chemotherapy dosing in a cohort of gynecologic oncology patients. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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