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Rahman MM, Wells G, Rantala JK, Helleday T, Muthana M, Danson SJ. In-vitro assays for immuno-oncology drug efficacy assessment and screening for personalized cancer therapy: scopes and challenges. Expert Rev Clin Immunol 2024:1-18. [PMID: 38546609 DOI: 10.1080/1744666x.2024.2336583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Immunotherapies have revolutionized cancer treatment, but often fail to produce desirable therapeutic outcomes in all patients. Due to the inter-patient heterogeneity and complexity of the tumor microenvironment, personalized treatment approaches are gaining demand. Researchers have long been using a range of in-vitro assays including 2D models, organoid co-cultures, and cancer-on-a-chip platforms for cancer drug screening. A comparative analysis of these assays with their suitability, high-throughput capacity, and clinical translatability is required for optimal translational use. AREAS COVERED The review summarized in-vitro platforms with their comparative advantages and limitations including construction strategies, and translational potential for immuno-oncology drug efficacy assessment. We also discussed end-point analysis strategies so that researchers can contextualize their usefulness and optimally design experiments for personalized immunotherapy efficacy prediction. EXPERT OPINION Researchers developed several in-vitro platforms that can provide information on personalized immunotherapy efficacy from different angles. Image-based assays are undoubtedly more suitable to gather a wide range of information including cellular morphology and phenotypical behaviors but need significant improvement to overcome issues including background noise, sample preparation difficulty, and long duration of experiment. More studies and clinical trials are needed to resolve these issues and validate the assays before they can be used in real-life scenarios.
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Affiliation(s)
- Md Marufur Rahman
- Sheffield Ex vivo Group, Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Directorate General of Health Services, Dhaka, Bangladesh
| | - Greg Wells
- Sheffield Ex vivo Group, Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
| | - Juha K Rantala
- Sheffield Ex vivo Group, Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Misvik Biology Ltd, Turku, Finland
| | - Thomas Helleday
- Sheffield Ex vivo Group, Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
- Department of Oncology-Pathology, Karolinska Institutet, Huddinge, Sweden
| | - Munitta Muthana
- Nanobug Oncology Sheffield, Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
| | - Sarah J Danson
- Sheffield Ex vivo Group, Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK
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2
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Gagg H, Williams ST, Conroy S, Myers KN, McGarrity-Cottrell C, Jones C, Helleday T, Rantala J, Rominiyi O, Danson SJ, Collis SJ, Wells G. Ex-vivo drug screening of surgically resected glioma stem cells to replace murine avatars and provide personalise cancer therapy for glioblastoma patients. F1000Res 2024; 12:954. [PMID: 37799492 PMCID: PMC10548111 DOI: 10.12688/f1000research.135809.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 10/07/2023] Open
Abstract
With diminishing returns and high clinical failure rates from traditional preclinical and animal-based drug discovery strategies, more emphasis is being placed on alternative drug discovery platforms. Ex vivo approaches represent a departure from both more traditional preclinical animal-based models and clinical-based strategies and aim to address intra-tumoural and inter-patient variability at an earlier stage of drug discovery. Additionally, these approaches could also offer precise treatment stratification for patients within a week of tumour resection in order to direct tailored therapy. One tumour group that could significantly benefit from such ex vivo approaches are high-grade gliomas, which exhibit extensive heterogeneity, cellular plasticity and therapy-resistant glioma stem cell (GSC) niches. Historic use of murine-based preclinical models for these tumours has largely failed to generate new therapies, resulting in relatively stagnant and unacceptable survival rates of around 12-15 months post-diagnosis over the last 50 years. The near universal use of DNA damaging chemoradiotherapy after surgical resection within standard-of-care (SoC) therapy regimens provides an opportunity to improve current treatments if we can identify efficient drug combinations in preclinical models that better reflect the complex inter-/intra-tumour heterogeneity, GSC plasticity and inherent DNA damage resistance mechanisms. We have therefore developed and optimised a high-throughput ex vivo drug screening platform; GliExP, which maintains GSC populations using immediately dissociated fresh surgical tissue. As a proof-of-concept for GliExP, we have optimised SoC therapy responses and screened 30+ small molecule therapeutics and preclinical compounds against tumours from 18 different patients, including multi-region spatial heterogeneity sampling from several individual tumours. Our data therefore provides a strong basis to build upon GliExP to incorporate combination-based oncology therapeutics in tandem with SoC therapies as an important preclinical alternative to murine models (reduction and replacement) to triage experimental therapeutics for clinical translation and deliver rapid identification of effective treatment strategies for individual gliomas.
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Affiliation(s)
- Hannah Gagg
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
| | - Sophie T. Williams
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Neurosurgery, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Samantha Conroy
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Urology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Katie N. Myers
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
| | | | - Callum Jones
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
| | - Thomas Helleday
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Karolinska Institut, Solnavägen, Solna, 171 77, Sweden
| | - Juha Rantala
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Misvik Biology Ltd, Karjakatu, Turku, FI-20520, Finland
| | - Ola Rominiyi
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Neurosurgery, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Sarah J. Danson
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Weston Park Hospital, Sheffield, S10 2SJ, UK
| | - Spencer J. Collis
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
| | - Greg Wells
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
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Kwan A, Winder N, Atkinson E, Al-Janabi H, Allen RJ, Hughes R, Moamin M, Louie R, Evans D, Hutchinson M, Capper D, Cox K, Handley J, Wilshaw A, Kim T, Tazzyman SJ, Srivastava S, Ottewell P, Vadakekolathu J, Pockley G, Lewis CE, Brown JE, Danson SJ, Conner J, Muthana M. Macrophages Mediate the Antitumor Effects of the Oncolytic Virus HSV1716 in Mammary Tumors. Mol Cancer Ther 2021; 20:589-601. [PMID: 33298589 DOI: 10.1158/1535-7163.mct-20-0748] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/25/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
Oncolytic viruses (OV) have been shown to activate the antitumor functions of specific immune cells like T cells. Here, we show OV can also reprogram tumor-associated macrophage (TAM) to a less immunosuppressive phenotype. Syngeneic, immunocompetent mouse models of primary breast cancer were established using PyMT-TS1, 4T1, and E0771 cell lines, and a metastatic model of breast cancer was established using the 4T1 cell line. Tumor growth and overall survival was assessed following intravenous administration of the OV, HSV1716 (a modified herpes simplex virus). Infiltration and function of various immune effector cells was assessed by NanoString, flow cytometry of dispersed tumors, and immunofluorescence analysis of tumor sections. HSV1716 administration led to marked tumor shrinkage in primary mammary tumors and a decrease in metastases. This was associated with a significant increase in the recruitment/activation of cytotoxic T cells, a reduction in the presence of regulatory T cells and the reprograming of TAMs towards a pro-inflammatory, less immunosuppressive phenotype. These findings were supported by in vitro data demonstrating that human monocyte-derived macrophages host HSV1716 replication, and that this led to immunogenic macrophage lysis. These events were dependent on macrophage expression of proliferating cell nuclear antigen (PCNA). Finally, the antitumor effect of OV was markedly diminished when TAMs were depleted using clodronate liposomes. Together, our results show that TAMs play an essential role in support of the tumoricidal effect of the OV, HSV1716-they both host viral replication via a novel, PCNA-dependent mechanism and are reprogramed to express a less immunosuppressive phenotype.
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Affiliation(s)
- Amy Kwan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Natalie Winder
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Emer Atkinson
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Haider Al-Janabi
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Richard J Allen
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Russell Hughes
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Mohammed Moamin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Rikah Louie
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Dhanajay Evans
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Matthew Hutchinson
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Drew Capper
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Katie Cox
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Joshua Handley
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Adam Wilshaw
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Taewoo Kim
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Simon J Tazzyman
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Sanjay Srivastava
- Department of Immunotherapeutics and Biotechnology and Center for Tumor Immunology and Targeted Cancer Therapy, Texas Tech University Health Sciences Center, Abilene, Texas
| | - Penelope Ottewell
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Jayakumar Vadakekolathu
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
- Centre for Health and Understanding Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Graham Pockley
- John van Geest Cancer Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
- Centre for Health and Understanding Disease (CHAUD), School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - Claire E Lewis
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
- Sheffield ECMC, Cancer Clinical Trials Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - Janet E Brown
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
- Sheffield ECMC, Cancer Clinical Trials Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - Sarah J Danson
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom
- Sheffield ECMC, Cancer Clinical Trials Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - Joe Conner
- Virttu Biologics Ltd., BioCity Scotland, Newhouse, United Kingdom
| | - Munitta Muthana
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom.
- Sheffield ECMC, Cancer Clinical Trials Centre, Weston Park Hospital, Sheffield, United Kingdom
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Gomes F, Lewis A, Morris R, Parks R, Kalsi T, Babic-Illamn G, Baxter M, Colquhoun K, Rodgers L, Smith E, Greystoke A, Bayman N, Cree A, Ng C, de Liguori Carino N, Basile S, Moore J, Merchant Z, Swinson D, Parbhoo A, Jones R, Davies E, Danson SJ, Young R, Morgan J, Wyld L, Corrie PG, Doherty GJ, Crawford K, Wright J, Reed M, Ugolini F, Lind M, Cheung KL, Harari D, Simcock R. The care of older cancer patients in the United Kingdom. Ecancermedicalscience 2020; 14:1101. [PMID: 33082851 PMCID: PMC7532033 DOI: 10.3332/ecancer.2020.1101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient’s biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one’s fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.
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Affiliation(s)
- Fabio Gomes
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Anna Lewis
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Rob Morris
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Ruth Parks
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Tania Kalsi
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RS, UK.,King's College London, London SE5 9RS, UK
| | | | - Mark Baxter
- Ninewells Hospital, NHS Tayside, Dundee DD2 1SG, UK
| | - Kirsty Colquhoun
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Lisa Rodgers
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Eleanor Smith
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Alastair Greystoke
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Neil Bayman
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Anthea Cree
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Cassandra Ng
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | | | - Simone Basile
- Royal Manchester Infirmary, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - John Moore
- Royal Manchester Infirmary, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Zoe Merchant
- Greater Manchester Cancer, Manchester M20 4BX, UK
| | | | - Anita Parbhoo
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea SA2 8QA, UK
| | - Rachel Jones
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea SA2 8QA, UK
| | - Eleri Davies
- University Hospital of Llandough, Cardiff and Vale University Health Board, Cardiff CF64 2XX, UK
| | - Sarah J Danson
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Robin Young
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Pippa G Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Gary J Doherty
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Kyle Crawford
- Belfast Health and Social Care Trust, Belfast BT13 1FD, UK
| | - Juliet Wright
- Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PX, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PX, UK
| | - Fiammetta Ugolini
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Sussex BN2 5BD, UK
| | - Michael Lind
- Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, UK
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.,Co-senior authorship
| | - Danielle Harari
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RS, UK.,King's College London, London SE5 9RS, UK.,Co-senior authorship
| | - Richard Simcock
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Sussex BN2 5BD, UK.,Co-senior authorship
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5
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Danson SJ, Conner J, Edwards JG, Blyth KG, Fisher PM, Muthana M, Salawu A, Taylor F, Hodgkinson E, Joyce P, Roman J, Simpson K, Graham A, Learmonth K, Woll PJ. Oncolytic herpesvirus therapy for mesothelioma - A phase I/IIa trial of intrapleural administration of HSV1716. Lung Cancer 2020; 150:145-151. [PMID: 33160198 DOI: 10.1016/j.lungcan.2020.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 04/28/2020] [Revised: 08/14/2020] [Accepted: 10/10/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Malignant Pleural Mesothelioma (MPM) remains a major oncological challenge with limited therapeutic options. HSV1716 is a replication restricted oncolytic herpes simplex virus with anti-tumor effects in multiple cell lines including MPM. Intrapleural treatment appeals because MPM is typically multifocal but confined to the pleura, and distant metastases are uncommon. We assessed the safety and possible efficacy of intrapleural HSV1716 for inoperable MPM. MATERIALS AND METHODS Patients with MPM received 1 × 107iu HSV1716 injected via an indwelling intrapleural catheter (IPC) on one, two or four occasions a week apart. The primary endpoint was the safety and tolerability of HSV1716. Secondary endpoints were assessment of HSV1716 replication, detection of immune response and evaluation of tumor response. RESULTS Of thirteen patients enrolled, five had received previous pemetrexed-cisplatin chemotherapy, and eight were chemotherapy naïve. Three patients were enrolled to receive one dose, three patients to two doses and seven patients to four doses. The treatment was well-tolerated with few virus-related adverse events and no dose limiting toxicities. Twelve patients were evaluable for response, as one patient withdrew early after a catheter fracture. There was evidence of viral replication/persistence in pleural fluid in seven of the twelve patients. Induction of Th1 cytokine responses to HSV1716 treatment occurred in eight patients and four patients developed novel anti-tumor IgG. No objective responses were observed but disease stabilization was reported in 50 % of patients at 8 weeks. CONCLUSIONS Intrapleural HSV1716 was well-tolerated and demonstrated an anti-tumor immune response in MPM patients. These results provide a rationale for further studies with this agent in MPM and in combination with other therapies.
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Affiliation(s)
- Sarah J Danson
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK.
| | - Joe Conner
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - John G Edwards
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Patricia M Fisher
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Munitta Muthana
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Abdulazeez Salawu
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Fiona Taylor
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Elizabeth Hodgkinson
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Patrick Joyce
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Jennifer Roman
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Kathleen Simpson
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Alexander Graham
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Kirsty Learmonth
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Penella J Woll
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
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6
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR, Nathan P, Lorigan P, Dziewulski P, Holikova S, Panwar U, Tahir S, Faust G, Thomas A, Corrie P, Sirohi B, Kelly C, Middleton M, Marples M, Danson S, Lester J, Marshall E, Ajaz M, Houston S, Board R, Eaton D, Waterston A, Nobes J, Loo S, Gray G, Stubbings H, Gore M, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Marsden J, Westwell S, Casasola R, Chao D, Maraveyas A, Marshall E, Patel P, Ottensmeier C, Farrugia D, Humphreys A, Eccles B, Dega R, Herbert C, Price C, Brunt M, Scott-Brown M, Hamilton J, Hayward RL, Smyth J, Woodings P, Nayak N, Burrows L, Wolstenholme V, Wagstaff J, Nicolson M, Wilson A, Barlow C, Scrase C, Podd T, Gonzalez M, Stewart J, Highley M, Wolstenholme V, Grumett S, Goodman A, Talbot T, Nathan K, Coltart R, Gee B, Gore M, Farrugia D, Martin-Clavijo A, Marsden J, Price C, Farrugia D, Nathan K, Coltart R, Nathan K, Coltart R. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 29:1843-1852. [PMID: 30010756 PMCID: PMC6096737 DOI: 10.1093/annonc/mdy229] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor shown to improve survival in advanced solid cancers. We evaluated the role of adjuvant bevacizumab in melanoma patients at high risk of recurrence. Patients and methods Patients with resected AJCC stage IIB, IIC and III cutaneous melanoma were randomised to receive either adjuvant bevacizumab (7.5 mg/kg i.v. 3 weekly for 1 year) or standard observation. The primary end point was detection of an 8% difference in 5-year overall survival (OS) rate; secondary end points included disease-free interval (DFI) and distant metastasis-free interval (DMFI). Tumour and blood were analysed for prognostic and predictive markers. Results Patients (n=1343) recruited between 2007 and 2012 were predominantly stage III (73%), with median age 56 years (range 18–88 years). With 6.4-year median follow-up, 515 (38%) patients had died [254 (38%) bevacizumab; 261 (39%) observation]; 707 (53%) patients had disease recurrence [336 (50%) bevacizumab, 371 (55%) observation]. OS at 5 years was 64% for both groups [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82–1.16, P = 0.78). At 5 years, 51% were disease free on bevacizumab versus 45% on observation (HR 0.85; 95% CI 0.74–0.99, P = 0.03), 58% were distant metastasis free on bevacizumab versus 54% on observation (HR 0.91; 95% CI 0.78–1.07, P = 0.25). Forty four percent of 682 melanomas assessed had a BRAFV600 mutation. In the observation arm, BRAF mutant patients had a trend towards poorer OS compared with BRAF wild-type patients (P = 0.06). BRAF mutation positivity trended towards better OS with bevacizumab (P = 0.21). Conclusions Adjuvant bevacizumab after resection of high-risk melanoma improves DFI, but not OS. BRAF mutation status may predict for poorer OS untreated and potential benefit from bevacizumab. Clinical Trial Information ISRCTN 81261306; EudraCT Number: 2006-005505-64
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Affiliation(s)
- P G Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - P D Nathan
- Medical Oncology, Mount Vernon Hospital, Northwood, UK
| | - P Lorigan
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - M Gore
- Royal Marsden Hospital NHS Trust, London, UK
| | - S Tahir
- Oncology Research, Broomfield Hospital, Chelmsford, UK
| | - G Faust
- Oncology Department, Leicester Royal Infirmary, Leicester, UK
| | - C G Kelly
- Sir Bobby Robson Cancer Trials Research Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Marples
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - S J Danson
- Weston Park Hospital, Academic Unit of Clinical Oncology, Sheffield, UK
| | - E Marshall
- Cancer & Palliative Care, St. Helen's Hospital, St. Helens, UK
| | - S J Houston
- Oncology Department, Royal Surrey County Hospital, Guildford, UK
| | - R E Board
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - A M Waterston
- Clinical Trials Unit, Beatson WOS Cancer Centre, Glasgow, UK
| | - J P Nobes
- Department of Clinical Oncology, Norfolk & Norwich University Hospital, Norwich, UK
| | - M Harries
- Guy's & St. Thomas' Hospital, Guy's Cancer Centre, London, UK
| | - S Kumar
- Velindre Cancer Centre, Cardiff, UK
| | - A Goodman
- Exeter Oncology Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - A Dalgleish
- St George's Hospital, Cancer Centre, London, UK
| | | | - S Westwell
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - R Casasola
- Cancer Centre, Ninewells Hospital, Dundee, UK
| | - D Chao
- Royal Free Hospital, London, UK
| | | | - P M Patel
- Academic Unit of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C H Ottensmeier
- CRUK and NIHR Southampton Experimental Cancer Medicine Centre, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - D Farrugia
- Oncology Centre, Cheltenham General Hospital, Cheltenham, UK
| | - A Humphreys
- Oncology Department, James Cook University Hospital, Middlesbrough, UK
| | - B Eccles
- Oncology Department, Poole Hospital, Dorset, UK
| | - G Young
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E O Barker
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C Harman
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Weiss
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K A Myers
- Department of Oncology, University of Oxford, Oxford, UK; Experimental Cancer Medicine Centre, Oxford, UK
| | - A Chhabra
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 30:2013-2014. [PMID: 31430371 PMCID: PMC6938599 DOI: 10.1093/annonc/mdz237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Crabb S, Danson SJ, Catto JWF, McDowell C, Lowder JN, Caddy J, Dunkley D, Rajaram J, Ellis D, Hill S, Hathorn D, Whitehead A, Kalevras M, Huddart R, Griffiths G. SPIRE - combining SGI-110 with cisplatin and gemcitabine chemotherapy for solid malignancies including bladder cancer: study protocol for a phase Ib/randomised IIa open label clinical trial. Trials 2018; 19:216. [PMID: 29615077 PMCID: PMC5883402 DOI: 10.1186/s13063-018-2586-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urothelial bladder cancer (UBC) accounts for 10,000 new diagnoses and 5000 deaths annually in the UK (Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bladder-cancer , Cancer Research UK, Accessed 26 Mar 2018). Cisplatin-based chemotherapy is standard of care therapy for UBC for both palliative first-line treatment of advanced/metastatic disease and radical neoadjuvant treatment of localised muscle invasive bladder cancer. However, cisplatin resistance remains a critical cause of treatment failure and a barrier to therapeutic advance in UBC. Based on supportive pre-clinical data, we hypothesised that DNA methyltransferase inhibition would circumvent cisplatin resistance in UBC and potentially other cancers. METHODS The addition of SGI-110 (guadecitabine, a DNA methyltransferase inhibitor) to conventional doublet therapy of gemcitabine and cisplatin (GC) is being tested within the phase Ib/IIa SPIRE clinical trial. SPIRE incorporates an initial, modified rolling six-dose escalation phase Ib design of up to 36 patients with advanced solid tumours followed by a 20-patient open-label randomised controlled dose expansion phase IIa component as neoadjuvant treatment for UBC. Patients are being recruited from UK secondary care sites. The dose escalation phase will determine a recommended phase II dose (RP2D, primary endpoint) of SGI-110, by subcutaneous injection, on days 1-5 for combination with GC at conventional doses (cisplatin 70 mg/m2, IV infusion, day 8; gemcitabine 1000 mg/m2, IV infusion, days 8 and 15) in every 21-day cycle. In the dose expansion phase, patients will be randomised 1:1 to GC with or without SGI-110 at the proposed RP2D. Secondary endpoints will include toxicity profiles, SGI-110 pharmacokinetics and pharmacodynamic biomarkers, and pathological complete response rates in the dose expansion phase. Analyses will not be powered for formal statistical comparisons and descriptive statistics will be used to describe rates of toxicity, efficacy and translational endpoints by treatment arm. DISCUSSION SPIRE will provide evidence for whether SGI-110 in combination with GC chemotherapy is safe and biologically effective prior to future phase II/III trials as a neoadjuvant therapy for UBC and potentially in other cancers treated with GC. TRIAL REGISTRATION EudraCT Number: 2015-004062-29 (entered Dec 7, 2015) ISRCTN registry number: 16332228 (registered on Feb 3, 2016).
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Affiliation(s)
- Simon Crabb
- Southampton Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | - Sarah J. Danson
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - James W. F. Catto
- Academic Urology Unit, The Medical school, University of Sheffield, Sheffield, UK
| | | | | | - Joshua Caddy
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Denise Dunkley
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Jessica Rajaram
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Deborah Ellis
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Stephanie Hill
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - David Hathorn
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Amy Whitehead
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | - Mihalis Kalevras
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
| | | | - Gareth Griffiths
- Southampton Clinical Trials Unit, Centre for Cancer Immunology, University of Southampton, Southampton, UK
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Danson SJ, Perets R, Lopez J, Joensuu H, Peer A, Harris SJ, Souza F, Ploeger B, Pereira KMC, Geva R. Abstract P1-16-03: An open-label, multicenter phase 1b trial of radium-223 + paclitaxel in cancer patients with bone metastases: Safety results from the breast cancer patient subgroup. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-16-03] [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: Taxanes have an established role in treating breast cancer (BC), and combination with radium-223 (Ra-223) may be an option in patients (pts) with bone metastases. Both therapies impact hematologic parameters, but myelosuppression risk in combination is unknown. A phase 1b trial (NCT02442063) in cancer pts with bone metastases studied Ra-223+paclitaxel (PTX) safety and mode of interaction regarding myelosuppression; BC subgroup safety results are presented.
Methods: Eligible pts had a malignant solid tumor with ≥2 bone metastases and were PTX candidates. Treatment (tx) was 7 PTX cycles (90 mg/m2/wk IV per local standard of care, 3 wk on/1wk off) + 6 Ra-223 cycles (55 kBq/kg IV; 1 injection q4wk, starting at PTX cycle 2). Primary endpoint was % pts with neutropenia and thrombocytopenia during Ra-223+PTX (cycles 2, 3) vs PTX alone (cycle 1). A dose-exposure-response model describing time course of Ra-223+PTX–induced suppression of absolute neutrophil counts was used to evaluate Ra-223+PTX mode of interaction (additive or synergistic) in the total population.
Results: 15/22 enrolled pts were treated (total population); 7 had BC (BC subgroup). Baseline characteristics of the 2 groups were similar; ECOG PS was better in BC pts (Table). Fewer BC pts had prior taxane therapy (29% vs 53%), but rates of ≥3 prior chemotherapy regimens were similar (43% vs 47%). BC pts, vs total population, had slightly longer median tx duration for Ra-223 (6 vs 5.5 cycles) and PTX (7 vs 6 cycles), and more pts who completed 6 Ra-223 doses (57% vs 47%). Tx discontinuation related to disease progression in 29% of BC pts vs 33% in total population. Table shows TEAEs. In the BC subgroup, all 7 pts completed cycle 3 and Gr 3 neutropenia rates were 43% in cycle 2 and 14% in cycle 3, vs 29% in cycle 1; there was no Gr 4 neutropenia or Gr 3/4 thrombocytopenia. In the total population, 13 pts completing cycle 3 were in the pharmacodynamics analysis. Their Gr 3 neutropenia rates were 31% in cycle 2 and 8% in cycle 3, vs 23% in cycle 1; there was no Gr 4 neutropenia or Gr 3/4 thrombocytopenia. Myelosuppression model for the total population showed an additive effect of Ra-223 to PTX-induced neutropenia, with an additional 10% average decrease in absolute neutrophil count vs PTX alone. BC subgroup modeling was not feasible due to small sample size.
Total Population n=15BC Subgroup n=7Median age (range), y61(45-76)58(45-68)Tumor type, n (%) Breast7(47)7(100)Prostate4(27)0Bladder1(7)0Non-small cell lung1(7)0Other2(13)0ECOG score, n (%) 06(40)5(71)18(53)1(14)Prior taxane therapy, n (%)8(53)2(29)≥3 prior chemotherapy regimens, n (%)7(47)3(43)TEAEs, n (%) Gr 3/49(60)2(29)Serious6(40)2(29)Gr 3/4 TEAEs, n (%)* Neutrophil count decreased6(40)3(43)White blood cell count decreased4(27)2(29) TEAE=treatment-emergent adverse event.*In >15% of patients.
Conclusions: Ra-223 was well tolerated when combined with PTX in pts with solid tumors and bone metastases. The BC subgroup vs total population had slightly higher hematologic AE rates, but fewer Gr 3/4 and serious TEAEs; more BC pts also completed study tx. The combination should be explored further in pts with bone metastases.
Citation Format: Danson SJ, Perets R, Lopez J, Joensuu H, Peer A, Harris SJ, Souza F, Ploeger B, Pereira KMC, Geva R. An open-label, multicenter phase 1b trial of radium-223 + paclitaxel in cancer patients with bone metastases: Safety results from the breast cancer patient subgroup [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-16-03.
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Affiliation(s)
- SJ Danson
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Perets
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - J Lopez
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H Joensuu
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Peer
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - SJ Harris
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - F Souza
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - B Ploeger
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - KMC Pereira
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Geva
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom; Rambam Health Care Campus, Haifa, Israel; The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom; Helsinki University Hospital, Helsinki, Finland; Bayer HealthCare Pharmaceuticals, Whippany, NJ; Bayer Pharma AG, Berlin, Germany; Bayer Pharma AG, São Paulo, Brazil; Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Colley HE, Muthana M, Danson SJ, Jackson LV, Brett ML, Harrison J, Coole SF, Mason DP, Jennings LR, Wong M, Tulasi V, Norman D, Lockey PM, Williams L, Dossetter AG, Griffen EJ, Thompson MJ. An Orally Bioavailable, Indole-3-glyoxylamide Based Series of Tubulin Polymerization Inhibitors Showing Tumor Growth Inhibition in a Mouse Xenograft Model of Head and Neck Cancer. J Med Chem 2015; 58:9309-33. [DOI: 10.1021/acs.jmedchem.5b01312] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Helen E. Colley
- School
of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield S10 2TA, U.K
| | - Munitta Muthana
- Department
of Oncology, The University of Sheffield, Medical School, Beech
Hill Road, Sheffield S10
2RX, U.K
| | - Sarah J. Danson
- Academic
Unit of Clinical Oncology and Sheffield Experimental Medicine Centre, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, U.K
| | - Lucinda V. Jackson
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, U.K
| | - Matthew L. Brett
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, U.K
| | - Joanne Harrison
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, U.K
| | - Sean F. Coole
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, U.K
| | - Daniel P. Mason
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, U.K
| | - Luke R. Jennings
- School
of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield S10 2TA, U.K
| | - Melanie Wong
- Charles River, 8−9 Spire
Green Centre, Harlow, Harlow, Essex CM19 5TR, U.K
| | - Vamshi Tulasi
- Charles River, 8−9 Spire
Green Centre, Harlow, Harlow, Essex CM19 5TR, U.K
| | - Dennis Norman
- Charles River, 8−9 Spire
Green Centre, Harlow, Harlow, Essex CM19 5TR, U.K
| | - Peter M. Lockey
- Charles River, 8−9 Spire
Green Centre, Harlow, Harlow, Essex CM19 5TR, U.K
| | - Lynne Williams
- Department
of Oncology, The University of Sheffield, Medical School, Beech
Hill Road, Sheffield S10
2RX, U.K
| | - Alexander G. Dossetter
- MedChemica Limited, Ebenezer House,
Ryecroft, Newcastle-Under-Lyme, Staffordshire ST5 2BE, U.K
| | - Edward J. Griffen
- MedChemica Limited, Ebenezer House,
Ryecroft, Newcastle-Under-Lyme, Staffordshire ST5 2BE, U.K
| | - Mark J. Thompson
- Department
of Chemistry, University of Sheffield, Brook Hill, Sheffield S3 7HF, U.K
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Rowland C, Danson SJ, Rowe R, Merrick H, Woll PJ, Hatton MQ, Wadsley J, Ellis S, Crabtree C, Horsman JM, Eiser C. Quality of life, support and smoking in advanced lung cancer patients: a qualitative study. BMJ Support Palliat Care 2014; 6:35-42. [DOI: 10.1136/bmjspcare-2013-000589] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 04/08/2014] [Indexed: 11/12/2022]
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Corrie PG, Marshall A, Dunn JA, Middleton MR, Nathan PD, Gore M, Davidson N, Nicholson S, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Young G, Lorigan P. Adjuvant bevacizumab in patients with melanoma at high risk of recurrence (AVAST-M): preplanned interim results from a multicentre, open-label, randomised controlled phase 3 study. Lancet Oncol 2014; 15:620-30. [PMID: 24745696 DOI: 10.1016/s1470-2045(14)70110-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Bevacizumab, a monoclonal antibody that targets VEGF, has shown restricted activity in patients with advanced melanoma. We aimed to assess the role of bevacizumab as adjuvant treatment for patients with resected melanoma at high risk of recurrence. We report results from the preplanned interim analysis. METHODS We did a multicentre, open-label, randomised controlled phase 3 trial at 48 centres in the UK between July 18, 2007, and March 29, 2012. Patients aged 16 years or older with American Joint Committee on Cancer stage (AJCC) stage IIB, IIC, and III cutaneous melanoma were randomly allocated (1:1), via a central, computer-based minimisation procedure, to receive intravenous bevacizumab 7.5 mg/kg, every 3 weeks for 1 year, or to observation. Randomisation was stratified by Breslow thickness of the primary tumour, N stage according to AJCC staging criteria, ulceration of the primary tumour, and patient sex. The primary endpoint was overall survival; secondary endpoints included disease-free interval, distant-metastases interval and quality of life. Analysis was by intention-to-treat. This trial is registered as an International Standardised Randomised Controlled Trial, number ISRCTN81261306. FINDINGS 1343 patients were randomised to either the bevacizumab group (n=671) or the observation group (n=672). Median follow-up was 25 months (IQR 16-37) in the bevacizumab group and 25 months (17-37) in the observation group. At the time of interim analysis, 286 (21%) of 1343 enrolled patients had died: 140 (21%) of 671 patients in the bevacizumab group, and 146 (22%) of 672 patients in the observation group. 134 (96%) of patients in the bevacizumab group died because of melanoma versus 139 (95%) in the observation group. We noted no significant difference in overall survival between treatment groups (hazard ratio [HR] 0.97, 95% CI 0.78-1.22; p=0.76); this finding persisted after adjustment for stratification variables (HR 1.03; 95% CI 0.81-1.29; p=0.83). Median duration of treatment with bevacizumab was 51 weeks (IQR 21-52) and dose intensity was 86% (41-96), showing good tolerability. 180 grade 3 or 4 adverse events were recorded in 101 (15%) of 671 patients in the bevacizumab group, and 36 (5%) of 672 patients in the observation group. Bevacizumab resulted in a higher incidence of grade 3 hypertension than did observation (41 [6%] vs one [<1%]). There was an improvement in disease-free interval for patients in the bevacizumab group compared with those in the observation group (HR 0.83, 95% CI 0.70-0.98, p=0.03), but no significant difference between groups for distant-metastasis-free interval (HR 0.88, 95% CI 0.73-1.06, p=0.18). No significant differences were noted between treatment groups in the standardised area under the curve for any of the quality-of-life scales over 36 months. Three adverse drug reactions were regarded as both serious and unexpected: one patient had optic neuritis after the first bevacizumab infusion, a second patient had persistent erectile dysfunction, and a third patient died of a haemopericardium after receiving two bevacizumab infusions and was later identified to have had significant predisposing cardiovascular risk factors. INTERPRETATION Bevacizumab has promising tolerability. Longer follow-up is needed to identify an effect on the primary endpoint of overall survival at 5 years.
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Affiliation(s)
- Pippa G Corrie
- Cambridge Cancer Trials Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Mark R Middleton
- Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - Paul D Nathan
- Medical Oncology, Mount Vernon Hospital, Northwood, Middlesex, UK
| | - Martin Gore
- Royal Marsden Hospital NHS Trust, London, UK
| | | | - Steve Nicholson
- Oncology Department, Leicester Royal Infirmary, Leicester, UK
| | - Charles G Kelly
- Sir Bobby Robson Cancer Trials Research Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Maria Marples
- Cancer Research, St James's University Hospital, Leeds, UK
| | - Sarah J Danson
- Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Ernest Marshall
- Cancer and Palliative Care, St Helen's Hospital, St Helens, UK
| | | | - Ruth E Board
- Oncology Department, Royal Preston Hospital, Preston, UK
| | - Ashita M Waterston
- Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Jenny P Nobes
- Clinical Oncology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Gemma Young
- Cambridge Cancer Trials Centre/Cambridge Clinical Trials Unit-Cancer Theme, Addenbrooke's Hospital, Cambridge, UK
| | - Paul Lorigan
- Deptartment of Medical Oncology, Christie Hospital, Manchester, UK
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Khan F, Ottensmeier C, Popat S, Dua D, Dorey N, Ellis S, Szabo M, Upadhyay S, Califano R, Chan S, Lee L, Ali CW, Nicolson M, Bates AT, Button M, Chaudhuri A, Mulvenna P, Shaw HM, Danson SJ. Afatinib use in non-small cell lung cancer previously sensitive to epidermal growth factor receptor inhibitors: the United Kingdom Named Patient Programme. Eur J Cancer 2014; 50:1717-1721. [PMID: 24726055 DOI: 10.1016/j.ejca.2014.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 01/21/2014] [Revised: 02/26/2014] [Accepted: 03/02/2014] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Afatinib prolongs progression-free survival (PFS) in patients with non-small cell lung cancer (NSCLC) who were previously sensitive to erlotinib or gefitinib. This study investigated experience of afatinib under a Named Patient Use (NPU) programme. PATIENTS AND METHODS Retrospective data for 63 patients were collected, including demographics, dose, toxicity and clinical efficacy. RESULTS Response rate and median PFS were 14.3% and 2.6months, respectively. Diarrhoea and rash were the most common toxicities; 46% of patients required a dose reduction and 41% had a dose delay. CONCLUSIONS Efficacy and safety in the NPU programme are consistent with the LUX-Lung 1 trial.
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Affiliation(s)
- F Khan
- Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield S10 2SJ, United Kingdom
| | - C Ottensmeier
- Southampton NIHR Experimental Cancer Medicine Center and Southampton University Hospitals NHS Foundation, Southampton SO16 6YD, United Kingdom
| | - S Popat
- Royal Marsden Hospital, London SW3 6JJ, United Kingdom
| | - D Dua
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RT, United Kingdom
| | - N Dorey
- Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, United Kingdom
| | - S Ellis
- Royal Bournemouth Hospital, Bournemouth BH7 7DW, United Kingdom
| | - M Szabo
- Southampton NIHR Experimental Cancer Medicine Center and Southampton University Hospitals NHS Foundation, Southampton SO16 6YD, United Kingdom
| | - S Upadhyay
- Hull and East Yorkshire Hospitals NHS Trust, Hull HU16 5JQ, United Kingdom
| | - R Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - S Chan
- Harrogate and District NHS Foundation Trust, Harrogate HG2 7SX, United Kingdom
| | - L Lee
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - C W Ali
- Beatson West of Scotland Cancer Centre, Glasgow G12 0YN, United Kingdom
| | - M Nicolson
- Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, United Kingdom
| | - A T Bates
- Southampton NIHR Experimental Cancer Medicine Center and Southampton University Hospitals NHS Foundation, Southampton SO16 6YD, United Kingdom
| | - M Button
- Velindre Cancer Centre, Cardiff CF14 2TL, United Kingdom
| | - A Chaudhuri
- United Lincolnshire Hospitals NHS Trust, Lincoln LN2 5QY, United Kingdom
| | - P Mulvenna
- Newcastle upon Tyne NHS Foundation Trust, Newcastle NE7 7DN, United Kingdom
| | - H M Shaw
- University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom
| | - S J Danson
- Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield S10 2SJ, United Kingdom.
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Danson SJ, Johnson P, Ward TH, Dawson M, Denneny O, Dickinson G, Aarons L, Watson A, Jowle D, Cummings J, Robson L, Halbert G, Dive C, Ranson M. Phase I pharmacokinetic and pharmacodynamic study of the bioreductive drug RH1. Ann Oncol 2011; 22:1653-1660. [PMID: 21378203 DOI: 10.1093/annonc/mdq638] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This trial describes a first-in-man evaluation of RH1, a novel bioreductive drug activated by DT-diaphorase (DTD), an enzyme overexpressed in many tumours. PATIENTS AND METHODS A dose-escalation phase I trial of RH1 was carried out. The primary objective was to establish the maximum tolerated dose (MTD) of RH1. Secondary objectives were assessment of toxicity, pharmacokinetic determination of RH1 and pharmacodynamic assessment of drug effect through measurement of DNA cross linking in peripheral blood mononuclear cells (PBMCs) and tumour, DTD activity in tumour and NAD(P)H:quinone oxidoreductase 1 (NQO1) polymorphism status. RESULTS Eighteen patients of World Health Organization performance status of zero to one with advanced refractory solid malignancies were enrolled. MTD was 1430 μg/m(2)/day with reversible bone marrow suppression being dose limiting. Plasma pharmacokinetic analysis showed RH1 is rapidly cleared from blood (t(1/2) = 12.3 min), with AUC increasing proportionately with dose. The comet-X assay demonstrated dose-related increases in DNA cross linking in PBMCs. DNA cross linking was demonstrated in tumours, even with low levels of DTD. Only one patient was homozygous for NQO1 polymorphism precluding any conclusion of its effect. CONCLUSIONS RH1 was well tolerated with predictable and manageable toxicity. The MTD of 1430 μg/m(2)/day is the dose recommended for phase II trials. The biomarkers of DNA cross linking, DTD activity and NQO1 status have been validated and clinically developed.
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Affiliation(s)
- S J Danson
- Department of Medical Oncology, University of Manchester, Christie Hospital NHS Foundation Trust, Manchester; Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research.
| | - P Johnson
- Cancer Research UK Clinical Centre, Southampton General Hospital, Southampton
| | - T H Ward
- Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research
| | - M Dawson
- Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research
| | - O Denneny
- Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research
| | - G Dickinson
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester
| | - L Aarons
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester
| | - A Watson
- Cancer Research UK Clinical Centre, Southampton General Hospital, Southampton
| | - D Jowle
- Department of Medical Oncology, University of Manchester, Christie Hospital NHS Foundation Trust, Manchester
| | - J Cummings
- Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research
| | - L Robson
- Cancer Research UK Drug Development Office, Cancer Research UK, London
| | - G Halbert
- Cancer Research UK Formulation Unit, University of Strathclyde, Glasgow, UK
| | - C Dive
- Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research
| | - M Ranson
- Department of Medical Oncology, University of Manchester, Christie Hospital NHS Foundation Trust, Manchester; Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research
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Wilson C, Danson SJ. Standing the test of time in Europe? Gefitinib in the treatment of non-small-cell lung cancer. Lung Cancer (Auckl) 2010; 1:37-51. [PMID: 28210105 DOI: 10.2147/lctt.s9974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Lung cancer is the most common cancer worldwide, with 1.3 million new cases diagnosed every year. Non-small-cell lung carcinoma (NSCLC) has previously had a very poor prognosis with few effective therapies; however, research has identified that it is associated with a high rate of expression of epidermal growth factor receptor (EGFR) tyrosine kinase. This has led to discoveries in drug manipulation of this receptor, to provide effective new therapies against NSCLC. Gefitinib is a small molecule kinase inhibitor which inhibits the cytoplasmic domain of the EGFR; the evidence behind its use and future role is presented in this review.
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Affiliation(s)
- Caroline Wilson
- Academic Unit of Clinical Oncology, University of Sheffield, Broomcross Building, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah J Danson
- Academic Unit of Clinical Oncology, University of Sheffield, Broomcross Building, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Abstract
Temozolomide is an imidazotetrazine with a mechanism of action and efficacy similar to dacarbazine (DTIC). However, it differs from DTIC in that it can be taken orally, degrades spontaneously to an active metabolite and penetrates the blood-brain barrier. It is well tolerated, making it a suitable candidate for combination chemotherapy. Trials to date have focussed on its activity in advanced metastatic melanoma and high-grade malignant glioma. Investigations into other indications, in particular solid tumors with central nervous system metastases, are ongoing. Studies of new drug schedules and of drugs to ameliorate temozolomide resistance offer the prospect of increased efficacy.
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Affiliation(s)
- S J Danson
- Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester, M20 9BX, UK
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