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Hansen A, Massard C, Ott P, Haas N, Lopez J, Ejadi S, Wallmark J, Keam B, Delord JP, Aggarwal R, Gould M, Yang P, Keefe S, Piha-Paul S. Pembrolizumab for advanced prostate adenocarcinoma: findings of the KEYNOTE-028 study. Ann Oncol 2018; 29:1807-1813. [DOI: 10.1093/annonc/mdy232] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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2
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Patnaik A, Appleman LJ, Tolcher AW, Papadopoulos KP, Beeram M, Rasco DW, Weiss GJ, Sachdev JC, Chadha M, Fulk M, Ejadi S, Mountz JM, Lotze MT, Toledo FGS, Chu E, Jeffers M, Peña C, Xia C, Reif S, Genvresse I, Ramanathan RK. First-in-human phase I study of copanlisib (BAY 80-6946), an intravenous pan-class I phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors and non-Hodgkin's lymphomas. Ann Oncol 2017; 27:1928-40. [PMID: 27672108 PMCID: PMC5035790 DOI: 10.1093/annonc/mdw282] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [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: 03/30/2016] [Accepted: 07/06/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To evaluate the safety, tolerability, pharmacokinetics, and maximum tolerated dose (MTD) of copanlisib, a phosphatidylinositol 3-kinase inhibitor, in patients with advanced solid tumors or non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Phase I dose-escalation study including patients with advanced solid tumors or NHL, and a cohort of patients with type 2 diabetes mellitus. Patients received three weekly intravenous infusions of copanlisib per 28-day cycle over the dose range 0.1-1.2 mg/kg. Plasma copanlisib levels were analyzed for pharmacokinetics. Biomarker analysis included PIK3CA, KRAS, BRAF, and PTEN mutational status and PTEN immunohistochemistry. Whole-body [(18)F]-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) was carried out at baseline and following the first dose to assess early pharmacodynamic effects. Plasma glucose and insulin levels were evaluated serially. RESULTS Fifty-seven patients received treatment. The MTD was 0.8 mg/kg copanlisib. The most frequent treatment-related adverse events were nausea and transient hyperglycemia. Copanlisib exposure was dose-proportional with no accumulation; peak exposure positively correlated with transient hyperglycemia post-infusion. Sixteen of 20 patients treated at the MTD had reduced (18)FDG-PET uptake; 7 (33%) had a reduction >25%. One patient achieved a complete response (CR; endometrial carcinoma exhibiting both PIK3CA and PTEN mutations and complete PTEN loss) and two had a partial response (PR; both metastatic breast cancer). Among the nine NHL patients, all six with follicular lymphoma (FL) responded (one CR and five PRs) and one patient with diffuse large B-cell lymphoma had a PR by investigator assessment; two patients with FL who achieved CR (per post hoc independent radiologic review) were on treatment >3 years. CONCLUSION Copanlisib, dosed intermittently on days 1, 8, and 15 of a 28-day cycle, was well tolerated and the MTD was determined to be 0.8 mg/kg. Copanlisib exhibited dose-proportional pharmacokinetics and promising anti-tumor activity, particularly in patients with NHL. CLINICALTRIALSGOV NCT00962611; https://clinicaltrials.gov/ct2/show/NCT00962611.
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Affiliation(s)
- A Patnaik
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | | | - A W Tolcher
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - K P Papadopoulos
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - M Beeram
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - D W Rasco
- South Texas Accelerated Research Therapeutics (START) Center for Cancer Care, San Antonio
| | - G J Weiss
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale Cancer Treatment Centers of America, Goodyear
| | - J C Sachdev
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - M Chadha
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - M Fulk
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | - S Ejadi
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
| | | | - M T Lotze
- University of Pittsburgh, Pittsburgh
| | | | - E Chu
- University of Pittsburgh, Pittsburgh
| | - M Jeffers
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - C Peña
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - C Xia
- Bayer HealthCare Pharmaceuticals, Inc., Whippany, USA
| | - S Reif
- Bayer Pharma AG, Berlin, Germany
| | | | - R K Ramanathan
- Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare/TGen, Scottsdale
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Ott PA, Piha-Paul SA, Munster P, Pishvaian MJ, van Brummelen EMJ, Cohen RB, Gomez-Roca C, Ejadi S, Stein M, Chan E, Simonelli M, Morosky A, Saraf S, Emancipator K, Koshiji M, Bennouna J. Safety and antitumor activity of the anti-PD-1 antibody pembrolizumab in patients with recurrent carcinoma of the anal canal. Ann Oncol 2017; 28:1036-1041. [PMID: 28453692 PMCID: PMC5406758 DOI: 10.1093/annonc/mdx029] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Safety and efficacy of pembrolizumab, a humanized programmed death 1 monoclonal antibody, was assessed in KEYNOTE-028, a multicohort, phase Ib trial for patients with programmed death ligand 1 (PD-L1)-positive advanced solid tumors. We report results for the cohort of patients with advanced anal carcinoma. Patients and methods Patients with PD-L1-positive tumors (≥1%) received intravenous pembrolizumab 10 mg/kg once every 2 weeks for up to 2 years or until confirmed progression or unacceptable toxicity. Response was assessed every 8 weeks for the first 6 months and every 12 weeks thereafter per Response Evaluation Criteria In Solid Tumors, version 1.1. Primary endpoints were safety and overall response rate per investigator review. Secondary endpoints included progression-free survival, overall survival, and response duration. Data cutoff date was 1 July 2015. Results Of the 43 patients with advanced anal carcinoma evaluable for PD-L1 expression, 32 (74%) had PD-L1-positive tumors as assessed with the 22C3 prototype assay, of whom 25 were enrolled between April and September 2014. Sixteen patients (64%) experienced treatment-related adverse events; the most common ones were diarrhea and fatigue in four patients (16%) each and nausea in three patients (12%). There were no treatment-related deaths or discontinuations as of the data cutoff date. Among the 24 patients with squamous cell carcinoma histology, four had confirmed partial response, for an overall response rate of 17% [95% confidence interval (CI), 5%-37%) and 10 (42%) had confirmed stable disease, for a disease control rate of 58%. One additional patient with non-squamous histology had confirmed stable disease. Conclusion In this population of patients with PD-L1-positive advanced squamous cell anal carcinoma, pembrolizumab demonstrated a manageable safety profile and encouraging antitumor activity. These data support further study of pembrolizumab for this patient population. ClinicalTrials.gov NCT02054806.
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MESH Headings
- Aged
- Aged, 80 and over
- Anal Canal/pathology
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/therapeutic use
- Anus Neoplasms/drug therapy
- Anus Neoplasms/mortality
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Disease-Free Survival
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/mortality
- Treatment Outcome
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Affiliation(s)
- P. A. Ott
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston
| | - S. A. Piha-Paul
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - P. Munster
- Department of Medicine (Hematology/Oncology), Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - M. J. Pishvaian
- Department of Hematology/Oncology, Georgetown University, Washington DC, USA
| | - E. M. J. van Brummelen
- Department of Molecular Pathology & Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R. B. Cohen
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - C. Gomez-Roca
- Clinical Research Unit, Institut Claudius Regaud and Institut Universitaire du Cancer—Oncopole, Toulouse, France
| | - S. Ejadi
- Department of Medical Oncology, Virginia G. Piper Cancer Center, Scottsdale
| | - M. Stein
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick
| | - E. Chan
- Department of Medicine (Hematology/Oncology), Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - M. Simonelli
- Department of Medical Oncology and Hematology, Humanitas Cancer Center, Rozzano, Italy
| | - A. Morosky
- Department of Clinical Oncology, Merck & Co, Inc., Kenilworth, USA
| | - S. Saraf
- Department of Clinical Oncology, Merck & Co, Inc., Kenilworth, USA
| | - K. Emancipator
- Department of Clinical Oncology, Merck & Co, Inc., Kenilworth, USA
| | - M. Koshiji
- Department of Clinical Oncology, Merck & Co, Inc., Kenilworth, USA
| | - J. Bennouna
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Nantes, France
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Hansen A, Massard C, Ott P, Haas N, Lopez J, Ejadi S, Wallmark J, Keam B, Delord JP, Aggarwal R, Gould M, Qiu P, Saraf S, Keefe S, Piha-Paul S. Pembrolizumab for patients with advanced prostate adenocarcinoma: Preliminary results from the KEYNOTE-028 study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.09] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morris M, Vogelzang N, Sartor O, Armour A, Petrylak D, Tolcher A, Ejadi S, Babiker H. Phase 1 study of the PSMA-targeted tubulysin small-molecule drug conjugate EC1169 in patients with metastatic castrate-resistant prostate cancer (mCRPC): Study update. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.15] [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: 11/14/2022] Open
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Hsu C, Lee SH, Ejadi S, Even C, Cohen R, Le Tourneau C, Mehnert J, Algazi A, van Brummelen E, Saraf S, Thanigaimani P, Cheng J, Hansen A. 315O_PR Antitumor activity and safety of pembrolizumab in patients with PD-L1-positive nasopharyngeal carcinoma: Interim results from a phase 1b study. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv527.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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O'Neil B, Wallmark J, Lorente D, Elez E, Raimbourg J, Gomez-Roca C, Ejadi S, Piha-Paul S, Moss R, Siu L, Dotti K, Santoro A, Gould M, Yuan S, Koshiji M, Han S. 502 Pembrolizumab (MK-3475) for patients (pts) with advanced colorectal carcinoma (CRC): Preliminary results from KEYNOTE-028. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30304-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ejadi S, Vogelzang N, Sartor A, Clark R, Tolcher A. 362 Phase 1 study of the PSMA-targeted tubulysin small-molecule drug conjugate EC1169 in patients with metastatic castrate-resistant prostate cancer (mCRPC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30225-8] [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: 11/28/2022]
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Disis M, Patel M, Pant S, Hamilton E, Lockhart A, Kelly K, Thaddeus-Beck J, Gordon M, Weiss G, Ejadi S, Taylor M, Chin K, Cuillerot J, Von Heydebreck A, Gulley J. 2749 Avelumab (MSB0010718C), an anti-PD-L1 antibody, in patients with recurrent or refractory ovarian cancer: A phase Ib trial reporting safety and clinical activity. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31515-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ott P, Piha-Paul S, Munster P, Pishvaian M, Van Brummelen E, Cohen R, Gomez-Roca C, Ejadi S, Stein M, Chan E, Simonelli M, Morosky A, Yuan S, Koshiji M, Bennouna J. 500 Pembrolizumab (MK-3475) for PD-L1-positive squamous cell carcinoma (SCC) of the anal canal: Preliminary safety and efficacy results from KEYNOTE-028. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(15)30008-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Tolcher A, Ejadi S, Sartor A, Nguyen B, Habbe A, Vogelzang N. A ph 1 study of 2 different schedules of the PSMA-tubulysin small-molecule drug conjugate EC1169 in pts with rec Met Cast-Resist PC (MCRPC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv090.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sekulic A, Miller A, Barrett M, Ejadi S, Mengos A, Pockaj B, Markovic S. Identification of targetable cellular subsets within melanoma tumors. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9082] [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
9082 Background: Human tumors, including melanoma, are complex mixtures of individual, molecularly distinct subpopulations, or clones of cancer cells. Effective cancer therapy will likely require targeting of all tumor subsets within a given cancer. Understanding the tumor complexity and the ability to identify points of therapeutic vulnerability within the individual tumor subsets will be essential for development of effective personalized cancer therapies. Methods: We have developed an approach that combines identification of individual tumor subsets using a multiparameter nuclear flow cytometry coupled with a high-resolution genomic analysis using the array-based comparative genomic hybridization (aCGH). Melanoma nuclei were isolated from tumor tissues and subjected to flow cytomery using melanocyte-specific antibodies (to separate melanoma cells from stroma) and DNA content, to separate individual tumor subpopulations. DNA extracted from isolated nuclear subpopulations was extracted and analyzed by aCGH. This approach was adopted for both fresh-frozen and paraffin-embedded clinical specimens. Results: We initially demonstrate the feasibility of the outlined approach by successful separation of melanoma from stromal nuclei and separation of individual melanoma nuclear subpopulations by DNA content. aCGH analysis of the DNA derived from isolated tumor subpopulations allowed successful identification of potentially targetable molecular aberrations in individual subsets of tumor cells. Notably, such aberrations were often not detected in unsorted, bulk tumors analyzed by the same high-resolution aCGH approach. Conclusions: We demonstrate a feasible approach to in-depth molecular analysis of tumor subpopulations within a clinical cancer tissue. This approach allows identification of potentially targetable molecular aberrations within individual tumor subsets, thus opening a possibility for a broad tumor targeting through design of individually-tailored therapeutic approaches. No significant financial relationships to disclose.
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Affiliation(s)
- A. Sekulic
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Translational Genomics Institute, Scottsdale, AZ
| | - A. Miller
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Translational Genomics Institute, Scottsdale, AZ
| | - M. Barrett
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Translational Genomics Institute, Scottsdale, AZ
| | - S. Ejadi
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Translational Genomics Institute, Scottsdale, AZ
| | - A. Mengos
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Translational Genomics Institute, Scottsdale, AZ
| | - B. Pockaj
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Translational Genomics Institute, Scottsdale, AZ
| | - S. Markovic
- Mayo Clinic Arizona, Scottsdale, AZ; Mayo Clinic Rochester, Rochester, MN; Translational Genomics Institute, Scottsdale, AZ
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Rietschel P, Ejadi S, Wolchok J, Krown S, Gerst S, Jungbluth A, Busam K, Panageas K, Smith K, Chapman P. Phase II trial of extended-dosing temozolomide in patients with melanoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.8531] [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
8531 Background: To test the hypothesis that the ∼30% response rate we observed in metastatic melanoma (mel) patients (pts) treated with temozolomide (TMZ) using an extended dosing schedule with either thalidomide or interferon was largely due to TMZ alone, we conducted a phase II trial of TMZ alone. We also hypothesized that mel expression of methylguanine methyltransferase (MGMT) would correlate with drug resistance. Methods: Stage IV mel pts without brain metastases or prior chemotherapy were stratified into two cohorts based on whether or not they had stage M1c disease. Each cycle consisted of TMZ 75 mg/m2/day for 6 weeks followed by 2 weeks with no treatment. Treatment cycles were repeated as long as pts did not progress. The primary endpoint was the proportion of complete or partial responses by RECIST criteria. The trial was powered to exclude the null hypothesis that the response rate in each cohort was <30%. MGMT promoter methylation status was assessed by methylation-specific pyrosequencing. In pts with insufficient tumor material for pyrosequencing, MGMT expression was measured by immunohistochemistry using the monoclonal antibody MT3.1. Results: To date we have accrued 48 pts, 23 in the M1c cohort. 7 pts are still receiving treatment and are not yet evaluable for response. There have been 4 partial responses observed, 2 in each cohort. The median number of cycles was 2 (range 1–6). 9/41 pts (22%) were stable for =6 months and received =3 cycles. 56% of pts developed CD4+ lymphopenia (<500/μl) during treatment; 37% of pts developed CD4+ lymphopenia <200/μl and received PCP prophylaxis. Opportunistic infections were not observed. Conclusions: The overall response rate is 9.8% (95% CI 0.8%-19%). The estimated median survival is 11 months for the stage III/M1a/b cohort and 9.7 months for the M1c cohort. To date, the response proportion to TMZ alone appears to be <30%. There would need to be 3 more responses in a cohort to reject the null hypothesis for that cohort. MGMT analyses are ongoing and will be used to determine if promoter methylation status correlates with objective response rate or time to progression. The study was supported by Schering-Plough. No significant financial relationships to disclose.
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Affiliation(s)
- P. Rietschel
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Ejadi
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Wolchok
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Krown
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Gerst
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A. Jungbluth
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - K. Busam
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - K. Panageas
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - K. Smith
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - P. Chapman
- Maimonides Cancer Center, Brooklyn, NY; Memorial Sloan-Kettering Cancer Center, New York, NY
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Rietschel P, Ejadi S, Wolchok J, Krown S, Gerst S, Jungbluth AA, Busam K, Smith K, Panageas K, Chapman P. Phase II trial of extended-dosing temozolomide in patients with melanoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8042] [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
8042 Background: We previously reported a 30% response rate in metastatic melanoma (mel) patients (pts) treated with temozolomide (TMZ) using an extended dosing schedule of 6 weeks on/ 2 weeks off with either thalidomide or interferon. We hypothesized that these responses were largely due to TMZ alone and conducted a phase II trial using extended dosing TMZ alone. We also tested the hypothesis that a) mel expression of methylguanine methyltransferase (MGMT) would correlate with drug resistance, and b) TMZ would cause decreased CD4+ T cell function during the first cycle of therapy. Methods: A phase II trial stratified metastatic mel patients into two cohorts based on whether or not they had stage IV M1c. 25 patients/cohort are planned. No brain metastases or prior chemotherapy were allowed. Each cycle consisted of TMZ 75mg/m2/day for 6 weeks followed by 2 weeks with no treatment. Primary endpoint was the proportion of objective responses by RECIST criteria. The trial was powered to exclude the null hypothesis that the response rate in each cohort was ≤10%. MGMT promoter methylation status was assessed by methylation-specific PCR. MGMT tumor expression was measured by immunohistochemistry (IHC). CD4+ T cell function was assessed by measuring interferon-γ responses to CMV by intracellular cytokine FACS analysis (FastImmune, BD Biosciences) at pretreatment, week 4 and week 8 of cycle 1. Results: To date 19 evaluable pts, 8 in the M1c cohort, have progressed with no objective responses; 6 other patients are currently on study. 4/19 pts who have gone off study because of progression were stable for 6 months and received ≥3 cycles. To date, 14/15 tumors analyzed for MGMT promoter methylation were unmethylated (≤15%). Promoter methylation of 21% was seen in one tumor. Conclusions: The MGMT promoter of metastatic mel tumors are hypomethylated predicting expression of the enzyme. This is being assessed directly by IHC and will be correlated with promoter methylation and clinical response. The effect of TMZ on anti-CMV CD4+ T cell function is being assessed. Accrual is ongoing and will be completed in Spring 2006. The study was supported by Schering-Plough. No significant financial relationships to disclose.
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Affiliation(s)
- P. Rietschel
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Ejadi
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Wolchok
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Krown
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Gerst
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - K. Busam
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - K. Smith
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - K. Panageas
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - P. Chapman
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Affiliation(s)
- S Ejadi
- Johns Hopkins University, Baltimore, MD, USA
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Ejadi S, Bhattacharya ID, Voss K, Singletary K, Milner JA. In vitro and in vivo effects of sodium selenite on 7,12-dimethylbenz[a]anthracene--DNA adduct formation in isolated rat mammary epithelial cells. Carcinogenesis 1989; 10:823-6. [PMID: 2539914 DOI: 10.1093/carcin/10.5.823] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/01/2023] Open
Abstract
Supplementation with increasing quantities of selenium (Se), as sodium selenite, to cultures of rat mammary epithelial cells resulted in a proportional depression in 7,12-dimethylbenz[a]anthracene (DMBA) binding to DNA. A depression in the two major anti bay-region dihydrodiol epoxide-deoxyribonucleoside adducts largely accounted for the reduced binding. DMBA-DNA binding in freshly isolated mammary cells from rats fed a diet containing 2.0 p.p.m. Se and incubated in culture with DMBA for 24 h was decreased 32% compared to binding in cells obtained from rats fed 0.1 p.p.m. Se. DMBA-DNA binding in mammary cells obtained from rats fed supplemental Se for 2 weeks or more was depressed compared to that occurring in cells from unsupplemented rats. The reduced ability of cells obtained from rats previously fed a 2.0 p.p.m. Se diet to activate DMBA to intermediates capable of binding to DNA became increasingly apparent with the duration of exposure to the carcinogen. Consistent with the in vitro supplementation study, cells isolated from rats previously fed a diet containing 2.0 p.p.m. Se had a reduced occurrence of the two major anti dihydrodiol epoxide adducts. The depression in DMBA binding following selenite supplementation, both in vitro and in vivo, supports the ability of Se to inhibit the initiation phase of carcinogenesis.
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Affiliation(s)
- S Ejadi
- Division of Nutritional Sciences, University of Illinois, Urbana 61801
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Benasutti M, Ejadi S, Whitlow MD, Loechler EL. Mapping the binding site of aflatoxin B1 in DNA: systematic analysis of the reactivity of aflatoxin B1 with guanines in different DNA sequences. Biochemistry 1988; 27:472-81. [PMID: 2831961 DOI: 10.1021/bi00401a068] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.2] [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: 01/02/2023]
Abstract
The mutagenic and carcinogenic chemical aflatoxin B1 (AFB1) reacts almost exclusively at the N(7)-position of guanine following activation to its reactive form, the 8,9-epoxide (AFB1 oxide). In general N(7)-guanine adducts yield DNA strand breaks when heated in base, a property that serves as the basis for the Maxam-Gilbert DNA sequencing reaction specific for guanine. Using DNA sequencing methods, other workers have shown that AFB1 oxide gives strand breaks at positions of guanines; however, the guanine bands varied in intensity. This phenomenon has been used to infer that AFB1 oxide prefers to react with guanines in some sequence contexts more than in others and has been referred to as "sequence specificity of binding". Herein, data on the reaction of AFB1 oxide with several synthetic DNA polymers with different sequences are presented, and (following hydrolysis) adduct levels are determined by high-pressure liquid chromatography. These results reveal that for AFB1 oxide (1) the N(7)-guanine adduct is the major adduct found in all of the DNA polymers, (2) adduct levels vary in different sequences, and, thus, sequence specificity is also observed by this more direct method, and (3) the intensity of bands in DNA sequencing gels is likely to reflect adduct levels formed at the N(7)-position of guanine. Knowing this, a reinvestigation of the reactivity of guanines in different DNA sequences using DNA sequencing methods was undertaken. The reactivities of 190 guanines were determined quantitatively and considered in a pentanucleotide context, 5'-WXGYZ-3', where the central, underlined G represents the reactive guanine and W, X, Y, and Z can be any of the nucleotide bases. Methods are developed to determine that the X (5'-side) base and the Y (3'-side) base are most influential in determining guanine reactivity. The influence of the bases in the 5'-position (X) is 5'-G (1.0) greater than C (0.8) greater than A (0.3) greater than T (0.2), while the influence of the bases in the 3'-position (Y) is 3'-G (1.0) greater than T (0.8) greater than C (0.4) greater than A (0.3). These rules in conjunction with molecular modeling studies (to be published elsewhere) were used to assess the binding sites that might be utilized by AFB1 oxide in its reaction with DNA.
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Affiliation(s)
- M Benasutti
- Department of Biology, Boston University, Massachusetts 02215
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