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Zauderer MG, Szlosarek PW, Le Moulec S, Popat S, Taylor P, Planchard D, Scherpereel A, Jahan TM, Koczywas M, Forster M, Cameron RB, Peikert T, Argon EK, Michaud N, Yang J, Kansra V, Fennell DA. Safety and efficacy of tazemetostat, an enhancer of zeste-homolog 2 inhibitor, in patients with relapsed or refractory malignant mesothelioma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9058] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9058 Background: Breast cancer gene 1 (BRCA1)-associated protein 1 (BAP1), a nuclear deubiquitinase, is commonly inactivated in malignant mesothelioma. Preclinical data showed that BAP1 inactivation sensitizes mesothelial cells to inhibition of enhancer of zeste-homolog 2 (EZH2), a methyltransferase implicated as an oncogenic driver in this tumor. This study evaluated the safety and efficacy of tazemetostat (TAZ), a potent and selective EZH2 inhibitor, in relapsed/refractory (R/R) malignant mesothelioma with BAP1-inactivation. Methods: EZH-203 (NCT02860286) was a 2-part, open-label, phase 2 study that assessed the pharmacokinetics (PK), safety, and efficacy of TAZ in pts with R/R malignant mesothelioma. In part 1, pts received TAZ 800 mg QD on day 1 (D1) and 800 mg BID, beginning day 2 of cycle 1 (C1). In part 2, pts received 800 mg of TAZ BID on D1 of C1. A two-stage Green-Dahlberg design was used for part 2. Primary endpoints were PK profiling of TAZ in all pts (part 1), and disease control rate (DCR) at week 12 in pts with BAP1-deficient R/R malignant mesothelioma (part 2). Secondary endpoints included safety, overall response rate (ORR), progression-free survival, overall survival, and duration of response (DOR). Results: The study enrolled 74 pts with R/R malignant mesothelioma, 70 pts (95%) were centrally confirmed to be BAP1-deficient. Median prior lines of therapy were 2 (range, 1-9). Observed clinical data in the presence of CYP3A4 inhibitors and inducers suggest a low DDI potential of TAZ. The 12 week DCR was 47% (n = 35). The ORR per RECIST version 1.1 was 3% [complete response: 0%; partial response (PR): 3% (n = 2)]. Of the 2 patients with PR, 1 had a DOR of 21 weeks and the other is ongoing (15.3 weeks at data cut off). 47 pts (64%) and 21 pts (28%) had stable disease (SD) and progressive disease, respectively. Overall, 91% pts discontinued, either due to disease progression (n = 65), death (n = 5), or treatment discontinuation (n = 1). Grade ≥3 treatment-emergent adverse events (TEAEs) occurred in ≤5% of patients, most commonly anemia (5%) and dyspnea (4%). No pts discontinued due to TEAEs. There were no treatment related deaths. Conclusions: Based on disease control rate and stable disease, TAZ showed antitumor activity in pts with BAP1-deficient R/R malignant mesothelioma. TAZ monotherapy was generally well-tolerated. The current data support further clinical evaluation of TAZ in these pts. Furthermore, this trial presents an optimal paradigm for drug development in molecularly-enriched cohorts in mesothelioma. Clinical trial information: NCT02860286.
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Affiliation(s)
| | | | | | | | - Paul Taylor
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | - Martin Forster
- UCL Cancer Institute and University College London Hospitals, London, United Kingdom
| | | | | | | | | | | | | | - Dean A. Fennell
- University of Leicester and University Hospitals of Leicester, Leicester, United Kingdom
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2
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Wimalasingham AG, Phillips MM, Lim L, Rashid S, Hall PE, Khadeir R, Steele JPC, Conibear J, Feng X, Ellis S, Chan PY, Thomson J, Johnston AL, Bomalaski JS, Pacey S, Sheaff M, Szlosarek PW. Phase 1 dose-expansion study of pegylated arginine deiminase, cisplatin, and pemetrexed in patients with argininosuccinate synthetase 1 (ASS1)–deficient non-squamous non-small cell lung cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9097 Background: Pegylated arginine deiminase (ADI-PEG20) targets ASS1-ve tumors, including non–small-cell lung cancer (NSCLC), by potentiating pemetrexed cytotoxicity via arginine depletion. In Beddowes et al (JCO 2017) we showed a 100% disease control rate in thoracic cancers treated with ADI-PEG20, cisplatin and pemetrexed (ADIPemCis). Thus, we tested ADIPemCis in a phase I dose-expansion cohort study of patients (pts) with non-squamous NSCLC. Methods: Good performance (ECOG 0-1) advanced non-squamous NSCLC pts were enrolled at the maximum tolerated dose (MTD) of ADIPemCis, using tumoral ASS1 loss as a selection biomarker. Pem (500mg/m2) and Cis (75mg/m2) were given every 3 weeks with weekly IM ADI-PEG20 (36mg/m2) for up to 4 cycles with maintenance ADI-PEG20 or Pem in responding pts. Primary endpoint was tumor response rate (RR by RECIST 1.1), with secondary endpoints including progression-free survival (PFS), overall survival (OS), and toxicity. We also measured plasma [arginine] and [citrulline], anti-ADI-PEG20 antibodies, and PD-L1 expression. Results: 21 of 70 screened pts (median age 60.1) were enrolled between April 15 and August 17. A confirmed partial response (PR) was observed in 55.6 % (n = 10/18 evaluable pts). Median PFS and OS were 4 months (95% CI 2.9-4.8) and 7.2 months (95% CI 5.1-18.4), respectively. 9% (n = 2/21) remain alive on subsequent therapies. 43% (n = 9/21) experienced grade 3/4 treatment-related toxicities, commonly non-febrile neutropenia. Plasma [arginine] declined rapidly and [citrulline] increased; both changes persisted at 16 weeks. 55% of pts’ tumors (n = 6/11 ) were PD-L1 < 1% by immunohistochemistry. Conclusions: The ADIPemCis regimen is active and safe in ASS1-ve NSCLC pts almost doubling the expected RR. However, the short survival compared with ASS1-agnostic historical controls indicates that ASS1 (and frequent PD-L1) loss selects for a biologically more aggressive and immunorefractory NSCLC phenotype. The iTRAP study opening Q2 of 2019 will assess the safety and tolerability of ADIPemPlatinum(Carbo) with atezolizumab in pts with ASS1-deficient non-squamous NSCLC. Clinical trial information: NCT02029690.
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Affiliation(s)
| | | | - Louise Lim
- Barts Health NHS Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | - Simon Pacey
- University of Cambridge, Cambridge, United Kingdom
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Chan PY, Phillips MM, Khadeir R, Ellis S, Thomson J, Johnston A, Feng X, Wu BW, Bomalaski JS, Sheaff M, Szlosarek PW. Phase 1 study of pegargiminase combined with cisplatin and pemetrexed in patients with ASS1-deficient uveal melanoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ramsay Khadeir
- Queen Mary, University of London, London, United Kingdom
| | | | | | | | | | - Bor-Wen Wu
- Polaris Pharmaceuticals Inc., San Diego, CA
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Fennell DA, Kirkpatrick EV, Cozens K, Danson S, Hanna GG, Lester JF, Lord J, Nye M, Ottensmeier CH, Szlosarek PW, Steele NL, Barnes DT, Vadher KD, Maishman T, Hill SJ, Griffiths G. CONFIRM: A phase III randomized trial to evaluate the efficacy of nivolumab versus placebo in relapsed mesothelioma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps8586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Kelly Cozens
- Southampton Clinical Trials Unit University of Southampton, Southampton, United Kingdom
| | - Sarah Danson
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom
| | | | - Jason Francis Lester
- University Hospital of Wales, Heath Park, Cardiff/United Kingdom, Cardiff, United Kingdom
| | - Joanne Lord
- Wessex Institute Univerity of Southampton, Southampton, United Kingdom
| | - Mavis Nye
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | | | | | | | - Daniel T Barnes
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Karan D Vadher
- Southampton Clinical Trials Unit,University of Southampton, Southampton, United Kingdom
| | - Tom Maishman
- Southampton Clinical Trials Unit University of Southampton, Southampton, United Kingdom
| | - Stephanie J Hill
- Southampton Clinical Trials Unit University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
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Hall PE, Lewis R, Syed N, Shaffer R, Evanson J, Ellis S, Williams M, Feng X, Johnston A, Thomson J, Harris F, Jena R, Khadeir R, Wu BW, Bomalaski JS, Crook T, Sheaff M, Pacey S, Plowman N, Szlosarek PW. A phase I expansion study of pegargiminase, cisplatin, and pemetrexed in argininosuccinate synthetase 1-negative recurrent high grade gliomas (HGGs). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Fiona Harris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Raj Jena
- University of Cambridge, Cambridge, United Kingdom
| | | | - Bor-Wen Wu
- Polaris Pharmaceuticals Inc., San Diego, CA
| | | | | | | | - Simon Pacey
- University of Cambridge, Cambridge, United Kingdom
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Phillips M, Szyszko T, Hall P, Cook GJR, Khadeir R, Steele JPC, Spicer JF, Feng X, Hategan M, Rashid S, Johnston A, Bomalaski JS, Shamash J, Pacey S, Sheaff M, Szlosarek PW. Expansion study of ADI-PEG 20, pemetrexed and cisplatin in patients with ASS1-deficient malignant pleural mesothelioma (TRAP). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.8553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8553 Background: Argininosuccinate synthetase 1 (ASS1)-deficient malignant pleural mesothelioma (MPM) cells are sensitive to arginine deprivation with pegylated arginine deiminase (ADI-PEG20), which also potentiates the cytotoxic effect of pemetrexed (PEM). In the phase I dose-escalation TRAP study (NCT02029690) we showed that ADI-PEG20 with first-line PEM and cisplatin (CIS) chemotherapy (ADIPEMCIS) produced a 100% disease control rate (DCR) in patients (pts; n = 9) with ASS1-deficient thoracic cancers, with no additional toxicity (Beddowes et al 2017). Here, we present the TRAP expansion cohort experience in MPM. Methods: Good performance (ECOG 0-1) MPM pts with non-resectable disease and measurable by modified RECIST, were enrolled in a phase I TRAP expansion cohort at the maximum tolerated dose (MTD) of ADIPEMCIS, using tumoral ASS1 loss as a selection biomarker. PEM (500mg/m2) and CIS (75mg/m2) were given every 3 weeks with weekly IM ADI-PEG20 (36mg/m2) for a maximum of 6 cycles with maintenance ADI-PEG20 in responding pts. Primary endpoint was tumor response rate (modified RECIST), with secondary endpoints including progression-free survival (PFS), overall survival (OS), and toxicity. We measured plasma arginine and citrulline concentrations, ADI-PEG20 antibodies, and biopsied patients on progression to explore resistance mechanisms. Results: 31 ASS1-deficient MPM pts (median age 67) were enrolled (11 epithelioid, 10 biphasic and 10 sarcomatoid) out of 92 screened pts. Plasma arginine decreased with a reciprocal increase in plasma citrulline. The partial response rate was 35.5% (95% CI 19.2%-54.6%) with a DCR of 93.5% (95% CI 78.6%-99.2%). Median PFS was 5.6 months (95% CI 4-6) and median OS was 10.1 months (95% CI 6.7-17.7). 10/31 pts (32.3%) experienced grade 3/4 treatment-related toxicities, the most common being neutropenia (16.1%). Upregulation of ASS1 expression was observed in 2/3 biopsies on progression. Conclusions: The ADIPEMCIS regimen is active in ASS1-deficient MPM pts, including non-epithelioid disease. Based on these data the ATOMIC-meso phase 2/3 trial has opened comparing ADIPEMCIS versus PEMCISPlacebo, focusing on pts with non-epithelioid MPM. Clinical trial information: NCT02029690.
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Affiliation(s)
| | | | - Peter Hall
- St Bartholomew's Hospital, London, United Kingdom
| | - Gary J. R. Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Ramsay Khadeir
- Queen Mary, University of London, London, United Kingdom
| | | | | | | | - Mirela Hategan
- Early Phase Clinical Trials Team, Cambridge Cancer Centre, Cambridge, United Kingdom
| | | | | | | | | | - Simon Pacey
- St Bartholomew's Hospital, London, United Kingdom
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Szlosarek PW, Baas P, Ceresoli GL, Fennell DA, Gilligan D, Johnston A, Lee P, Mansfield AS, Nolan L, Nowak AK, Steele JPC, Taylor P, Tsao AS, Zauderer MG, Bomalaski JS. ATOMIC-Meso: A randomized phase 2/3 trial of ADI-PEG20 or placebo with pemetrexed and cisplatin in patients with argininosuccinate synthetase 1-deficient non-epithelioid mesothelioma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps8582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8582 Background: Argininosuccinate synthetase 1 (ASS1)-deficient malignant pleural mesothelioma (MPM) is sensitive to arginine deprivation therapy with pegylated arginine deiminase (ADI-PEG20), which also enhances the cytotoxicity of pemetrexed. The TRAP Phase 1 trial (NCT02029690) of ADI-PEG 20 combined with 1st-line pemetrexed (PEM) and cisplatin (CDDP) chemotherapy revealed a 94% disease control rate in non-epithelioid (biphasic and sarcomatoid) MPM subtypes characterized by a 75% rate of ASS1 loss. Thus, we plan to assess the efficacy of ADI-PEG20 or placebo combined with PEM and CDDP in patients (pts) with poor prognosis MPM in a randomized, placebo-controlled, double-blind phase 2/3 global trial. Methods: Up to 386 good performance (ECOG 0-1) pts with non-epithelioid malignant pleural mesothelioma will be enrolled in a phase 2/3 adaptive, biomarker-driven study design. Biopsies will be required prior to randomization: ASS1-agnostic pts will be enrolled initially (phase 2 stage) with an option to restrict enrolment to ASS1-deficient MPM (phase 3 stage). Pts will be randomized to receive weekly ADI-PEG20 (36 mg/m2 IM) or placebo with standard doses of PEM and CDDP for a maximum of 18 weeks (6 cycles) of treatment. Pts who develop CDDP toxicity may be switched to carboplatin. Pts will be assessed every 6 weeks using modified RECIST (RECIST 1.1 allowed for pts with significant extrathoracic disease). The primary endpoint for the phase 2 stage will be overall response rate (ORR) with secondary endpoints of overall survival (OS), safety and toxicity. The phase 2 will test ORR proportions with the placebo triplet set at 15% vs. 35% for the ADI-PEG 20 triplet, with a 1:1 randomization, 80% power. After recruitment of 176 pts, the phase 2 will convert to a phase 3 study with the primary endpoint of OS. In summary, ATOMIC-Meso is the first triplet chemotherapy study to assess the role of targeted arginine deprivation in aggressive subtypes of mesothelioma. Pt accrual has commenced across the US and Asia, with enrolment due in Europe and Australia by 2nd quarter of 2017. [Trial sponsored by Polaris Group]. Clinical trial information: NCT02709512.
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Affiliation(s)
| | - Paul Baas
- The Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
| | | | | | | | | | - Phuong Lee
- Polaris Pharmaceuticals Inc., San Diego, United Kingdom
| | | | - Luke Nolan
- Southampton University Hospital, Hampshire, United Kingdom
| | | | | | - Paul Taylor
- Wythenshawe Hospital, Manchester, United Kingdom
| | - Anne S. Tsao
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Szlosarek PW, Szyszko T, Pacey S, Spicer JF, Phillips M, Steele JPC, Barba A, Diaz M, Johnston A, Wu BW, Bomalaski JS, Cook GJR. 18-FLT-PET/CT as an imaging biomarker in patients with ASS1-deficient thoracic cancers treated with ADI-PEG20, pemetrexed and cisplatin. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.11567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Simon Pacey
- St Bartholomew's Hospital, London, United Kingdom
| | - James F. Spicer
- King's College London at Guy's Hospital, London, United Kingdom
| | | | | | | | | | | | - Bor-Wen Wu
- Polaris Pharmaceuticals Inc, San Diego, CA
| | | | - Gary J. R. Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
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Pacey S, Spicer JF, Chan PY, Hategan M, Repana D, Steele JP, Schmid P, Cook GJR, Diaz M, Johnston A, Baird R, Barba A, Khadeir R, Sheaff M, Roca J, Szyszko T, Bomalaski J, Szlosarek PW. Abstract B23: A phase 1 study in patients with mesothelioma or non small cell lung tumours requiring arginine to assess ADI-PEG 20 with pemetrexed and cisplatin (TRAP study). Clin Trials 2016. [DOI: 10.1158/1535-7163.targ-15-b23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Szlosarek PW, Spicer JF, Szyszko T, Cook GJR, Chan PY, Hategan M, Repana D, Steele JP, Schmid P, Diaz M, Johnston A, Sheaff M, Khadeir R, Bomalaski JS, Pacey S. Phase I study of ADI-PEG 20 in combination with pemetrexed and cisplatin (TRAP) in patients with ASS1-deficient mesothelioma and non-squamous lung cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Gary J. R. Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | | | | | - Dimitra Repana
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Peter Schmid
- Queen Mary, University of London, London, United Kingdom
| | | | | | | | - Ramsay Khadeir
- Queen Mary, University of London, London, United Kingdom
| | | | - Simon Pacey
- The University of Cambridge, Addenbrookes Hospital, Cambridge, United Kingdom
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Ghazaly EA, Luong P, Chmielewska-Kassassir M, Wozniak L, Bomalaski JS, Gribben JG, Szlosarek PW. Metabolomic analysis of pegylated arginine deiminase treatment in patients with malignant pleural mesothelioma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Essam Ahmed Ghazaly
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Phuong Luong
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | | | | | | | - John G. Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Peter Wojciech Szlosarek
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Szlosarek PW, Steele JP, Nolan L, Gilligan D, Taylor P, Spicer JF, Lind MJ, Bomalaski JS, Fennell DA, Hackshaw A. Randomized trial of arginine deprivation with pegylated arginine deiminase in patients with malignant pleural mesothelioma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Luke Nolan
- Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | | | - Paul Taylor
- Wythenshawe Hospital, Manchester, United Kingdom
| | - James F. Spicer
- King’s College London, Guy’s Hospital, London, United Kingdom
| | - Michael J. Lind
- Cancer Biology Proteomics Group, University of Hull, Hull, United Kingdom
| | | | | | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre/UCL Cancer Institute, London, United Kingdom
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Hatzimichael E, Dasoula A, Syed N, Szlosarek PW, Dranitsaris G, Crook T, Briasoulis EC. Epigenetic inactivation to target the arginine biosynthetic pathway in multiple myeloma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18567 Background: Argininoosuccinate synthetase-1 (ASS1) catalyses the rate-limiting step in arginine biosynthesis, the conversion of citruline to arginine. Argininosuccinate lyase (ASL) is an enzyme that catalyses the reversible breakdown of arginosuccinate producing arginine and fumerate. Arginine deprivation using arginine deiminase (ADI-PEG20) is currently considered as a novel therapeutic intervention for cancer. In this perspective, we investigated the methylation status of the ASS1 and ASL CpG islands in multiple myeloma (MM) and analyzed for clinical relevance. Methods: Genomic DNA was extracted from bone marrow aspirate samples from 46 MM patients (28 male, 18 female, median age 64 years) obtained at diagnosis. Methylation-specific PCR was employed to study the methylation in the ASS1 and ASL CpG islands. DNA was isolated and bisulphite modified using commercially available kits. Logistic regression analyses were used to measure the association between gene methylation and sex, age>65, ISS stage, presence of extramedullary disease, renal failure and bone disease. Kaplan-Meier curves were used to estimate the probabilities of survival and the Log-rank test to assess the statistical significance of differences in event rates. Results: Methylation in the CpG island of ASS1 was detected in 71.7% patients and of ASL in 37% patients, while simultaneous methylation in both genes was present in 10 patients. None of the two genes was detectably methylated in the control group. Patients with ASS1 methylation were less likely to have bone disease (p=0.04, OR=0.22) and extramedullary disease (p=0.05, OR=0.22) and a trend was also noted that these patients were less likely to be >65 years of age (p=0.2, OR=0.37). We did not detect any statistically significant difference in overall survival by methylation status of the studied genes in this small study size. Conclusions: We demonstrate for the first time that arginine biosynthesis genes ASS1 and ASL are methylated in MM.Methylation of ASS1 was found to be more frequent and negatively associated with bone or extramedullary disease. Further evaluation of ASS1 and ASL is warranted in MM and supports the expansion of arginine deprivation trials in these patients
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Affiliation(s)
| | - Aggeliki Dasoula
- Department of Haematology, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - George Dranitsaris
- Department of Medical Oncology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Tim Crook
- Dundee Cancer Centre, University of Dundee, Ninewells Hospital, Dundee, United Kingdom
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Szlosarek PW. Recent advances in palliative care. United Kingdom continues to lead in palliative care. BMJ 2001; 322:234. [PMID: 11159631 PMCID: PMC1119482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Abstract
The elderly population has much to gain from the advances of molecular medicine, although at present genetic pharmacology remains mostly at the conceptual level. Cancer, in particular, is an increasing health burden and the majority (over 70%) of gene therapy trials are aimed at tackling this problem. Available strategies employ both viral and synthetic vectors with the selective delivery and expression of therapeutic genes a pivotal requirement. Clinical trials are now in progress with a view to modulating disease at many different levels, including the direct replacement of abnormal genes. suicide-gene formulations, and the delivery of 'gain of function' genes, which seek to alter the malignant phenotype by indirect means, such as, immunopotentiation and stromal reorganisation. Early data from these studies is tantalising and we must remain optimistic that gene therapy will benefit the patient with cancer by both reducing morbidity and extending life.
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Affiliation(s)
- P W Szlosarek
- Department of Medical Oncology, Guy's Hospital, London, England.
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Szlosarek PW, Lofts FJ, Pettengell R, Carter P, Young M, Harmer C. Effective treatment of a patient with a high-grade endometrial stromal sarcoma with an accelerated regimen of carboplatin and paclitaxel. Anticancer Drugs 2000; 11:275-8. [PMID: 10898543 DOI: 10.1097/00001813-200004000-00008] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The rarity of endometrial stromal sarcoma (ESS) and its poor response to treatment provides fertile ground for investigational therapies. An accelerated regimen of carboplatin and paclitaxel is investigated. A patient with a recent history of treated tuberculosis of the lung represented with infertility and acute abdominal pain from suspected fibroids, and underwent a laparotomy with a diagnosis of a high-grade ESS. A novel therapeutic approach using a regimen of carboplatin and paclitaxel with the reinfusion of filgrastim-mobilized peripheral blood progenitor cells is described. A partial response was observed following six cycles of chemotherapy. Grade IV thrombocytopenia occurred after the last cycle, with recovery prior to pelvic radiotherapy. The patient remained well 1 year post-diagnosis. High-grade ESS is responsive to combination chemotherapy with paclitaxel and carboplatin, and requires further evaluation. The use of an accelerated regimen may also have contributed to the response and this question awaits randomized trials.
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Affiliation(s)
- P W Szlosarek
- Department of Medical Oncology, St George's Hospital Medical School, London, UK.
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