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Monk BJ, Colombo N, Tewari KS, Tekin C, Keefe SM, Lorusso D. Reply to P.-H. Luo et al. J Clin Oncol 2024; 42:1596-1598. [PMID: 38452314 DOI: 10.1200/jco.24.00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Bradley J Monk
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Nicoletta Colombo
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Krishnansu S Tewari
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Cumhur Tekin
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Stephen M Keefe
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
| | - Domenica Lorusso
- Bradley J. Monk, MD, FACS, FACOG, Florida Cancer Specialists and Research Institute, West Palm Beach, FL; Nicoletta Colombo, MD, PhD, Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy, Università degli Studi di Milano Bicocca, Milan, Italy; Krishnansu S. Tewari, MD, FACOG, FACS, FRSM, Obstetrics & Gynecology, University of California, Irvine, Orange, CA; Cumhur Tekin, MD and Stephen M. Keefe, MD, MSCE, Oncology, Merck & Co, Inc, Rahway, NJ; and Domenica Lorusso, MD, PhD, Director of Gynaecological Oncology Unit at Humanitas Hospital, San Pio X, Milan, Italy, Full Professor of Obstetrics and Gynaecology, Humanitas University, Rozzano (MI), Italy
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Lorusso D, Xiang Y, Hasegawa K, Scambia G, Leiva M, Ramos-Elias P, Acevedo A, Sukhin V, Cloven N, Pereira de Santana Gomes AJ, Contreras Mejía F, Reiss A, Ayhan A, Lee JY, Saevets V, Zagouri F, Gilbert L, Sehouli J, Tharavichitkul E, Lindemann K, Lazzari R, Chang CL, Lampé R, Zhu H, Oaknin A, Christiaens M, Polterauer S, Usami T, Li K, Yamada K, Toker S, Keefe SM, Pignata S, Duska LR. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): a randomised, double-blind, phase 3 clinical trial. Lancet 2024; 403:1341-1350. [PMID: 38521086 DOI: 10.1016/s0140-6736(24)00317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Pembrolizumab has shown efficacy in persistent, recurrent, or metastatic cervical cancer. The effect of chemoradiotherapy might be enhanced by immunotherapy. In this phase 3 trial, we assessed the efficacy and safety of adding pembrolizumab to chemoradiotherapy in locally advanced cervical cancer. METHODS In this randomised, double-blind, placebo-controlled, phase 3 ENGOT-cx11/GOG-3047/KEYNOTE-A18 clinical trial, adults (age ≥18 years) at 176 medical centres in 30 countries with newly diagnosed, high-risk, locally advanced cervical cancer were randomly assigned (1:1) using an interactive voice-response system with integrated web response to receive 5 cycles of pembrolizumab (200 mg) or placebo every 3 weeks plus chemoradiotherapy, followed by 15 cycles of pembrolizumab (400 mg) or placebo every 6 weeks. Randomisation was stratified by planned external beam radiotherapy type (intensity-modulated radiotherapy or volumetric-modulated arc therapy vs non-intensity-modulated radiotherapy or non-volumetric-modulated arc therapy), cervical cancer stage at screening (International Federation of Gynecology and Obstetrics 2014 stage IB2-IIB node positive vs stage III-IVA), and planned total radiotherapy (external beam radiotherapy plus brachytherapy) dose (<70 Gy vs ≥70 Gy equivalent dose in 2 Gy fractions). Primary endpoints were progression-free survival per Response Evaluation Criteria in Solid Tumours version 1.1-by investigator or by histopathologic confirmation of suspected disease progression-and overall survival. Primary analysis was conducted in the intention-to-treat population, which included all randomly allocated participants. Safety was assessed in the as-treated population, which included all randomly allocated patients who received at least one dose of study treatment. This study is registered with ClinicalTrials.gov, NCT04221945, and is closed to new participants. FINDINGS Between June 9, 2020, and Dec 15, 2022, 1060 participants were randomly assigned to treatment, with 529 assigned to the pembrolizumab-chemoradiotherapy group and 531 to the placebo-chemoradiotherapy group. At data cutoff (Jan 9, 2023), median follow-up was 17·9 months (IQR 11·3-22·3) in both treatment groups. Median progression-free survival was not reached in either group; rates at 24 months were 68% in the pembrolizumab-chemoradiotherapy group versus 57% in the placebo-chemoradiotherapy group. The hazard ratio (HR) for disease progression or death was 0·70 (95% CI 0·55-0·89, p=0·0020), meeting the protocol-specified primary objective. Overall survival at 24 months was 87% in the pembrolizumab-chemoradiotherapy group and 81% in the placebo-chemoradiotherapy group (information fraction 42·9%). The HR for death was 0·73 (0·49-1·07); these data have not crossed the boundary of statistical significance. Grade 3 or higher adverse event rates were 75% in the pembrolizumab-chemoradiotherapy group and 69% in the placebo-chemoradiotherapy group. INTERPRETATION Pembrolizumab plus chemoradiotherapy significantly improved progression-free survival in patients with newly diagnosed, high-risk, locally advanced cervical cancer. FUNDING Merck Sharp & Dohme, a subsidiary of Merck & Co (MSD).
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Affiliation(s)
- Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy.
| | - Yang Xiang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Kosei Hasegawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Giovanni Scambia
- Scientific Directorate, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
| | - Manuel Leiva
- Instituto de Oncologia y Radioterapia Clinica Ricardo Palma, Lima, Peru
| | - Pier Ramos-Elias
- Integra Cancer Institute, Edificio Integra Medical Center, Guatemala City, Guatemala
| | | | - Vladyslav Sukhin
- Grigoriev Institute for Medical Radiology and Oncology NAMS Ukraine, Kharkiv, Ukraine
| | - Noelle Cloven
- Texas Oncology-Fort Worth Cancer Center, Fort Worth, TX, USA
| | | | | | - Ari Reiss
- Rambam Medical Center, Gyneco-oncology Unit, Haifa, Israel
| | - Ali Ayhan
- Turkish Society of Gynecologic Oncology, Başkent University, Ankara, Türkiye
| | - Jung-Yun Lee
- Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Valeriya Saevets
- Chelyabinsk Regional Clinical Center for Oncology and Nuclear Medicine, Chelyabinsk, Russia
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
| | - Lucy Gilbert
- Division of Gynecologic Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Jalid Sehouli
- Charité Universitätsmedizin, Berlin, Germany; North-Eastern German Society of Gynecological Oncology, Berlin, Germany
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kristina Lindemann
- Department of Gynecological Oncology, Oslo University Hospital and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Nordic Society of Gynaecological Oncology Clinical Trial Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Roberta Lazzari
- Division of Radiotherapy, European Institute of Oncology IRCCS, Milan, Italy
| | - Chih-Long Chang
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Rudolf Lampé
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Hunan, China
| | - Ana Oaknin
- Medical Oncology Service, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Melissa Christiaens
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stephan Polterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria; AGO Austria, Austria
| | | | - Kan Li
- Merck & Co, Rahway, NJ, USA
| | | | | | | | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G Pascale, Naples, Italy
| | - Linda R Duska
- University of Virginia School of Medicine, Charlottesville, VA, USA
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Tewari KS, Colombo N, Monk BJ, Dubot C, Cáceres MV, Hasegawa K, Shapira-Frommer R, Salman P, Yañez E, Gümüş M, Olivera Hurtado de Mendoza M, Samouëlian V, Castonguay V, Arkhipov A, Tekin C, Li K, Toker S, Keefe SM, Lorusso D. Pembrolizumab or Placebo Plus Chemotherapy With or Without Bevacizumab for Persistent, Recurrent, or Metastatic Cervical Cancer: Subgroup Analyses From the KEYNOTE-826 Randomized Clinical Trial. JAMA Oncol 2024; 10:185-192. [PMID: 38095881 PMCID: PMC10722390 DOI: 10.1001/jamaoncol.2023.5410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/22/2023] [Indexed: 12/17/2023]
Abstract
Importance The KEYNOTE-826 randomized clinical trial showed statistically significant and clinically meaningful survival benefits with the addition of pembrolizumab to chemotherapy with or without bevacizumab in patients with persistent, recurrent, or metastatic cervical cancer. Treatment effects in patient subgroups of the study population are unknown. Objective To assess efficacy outcomes in patient subgroups of KEYNOTE-826. Design, Setting, and Participants Exploratory subgroup analyses were conducted in a global, phase 3, randomized, double-blind, placebo-controlled clinical trial. Participants included women with persistent, recurrent, or metastatic adenocarcinoma, adenosquamous carcinoma, or squamous cell carcinoma of the cervix that had not been treated with systemic chemotherapy and was not amenable to curative treatment. This subanalysis was conducted from November 20, 2018, to May 3, 2021. Interventions Pembrolizumab, 200 mg, every 3 weeks or placebo for up to 35 cycles plus chemotherapy (paclitaxel, 175 mg/m2, plus cisplatin, 50 mg/m2, or carboplatin AUC 5 [area under the free carboplatin plasma concentration vs time curve]) with or without bevacizumab, 15 mg/kg. Main Outcomes and Measures Overall survival (OS) and progression-free survival (PFS) by investigator assessment per Response Evaluation Criteria in Solid Tumors version 1.1 in subgroups defined by use of bevacizumab (yes or no), choice of platinum (carboplatin or cisplatin), prior chemoradiotherapy (CRT) exposure only (yes or no), and histologic type (squamous or nonsquamous) in patients with programmed cell death ligand 1-positive tumors (defined as a combined positive score [CPS] ≥1) and in the intention-to-treat population. Results A total of 617 patients (median age, 51 years; range, 22-82 years) were enrolled in the trial. In the CPS greater than or equal to 1 population, hazard ratios (HRs) for OS favored the pembrolizumab group in all subgroups: with bevacizumab (HR, 0.62; 95% CI, 0.45-0.87) and without bevacizumab (HR, 0.67; 95% CI, 0.47-0.96), use of carboplatin (HR, 0.65; 95% CI, 0.50-0.85) and cisplatin (HR, 0.53; 95% CI, 0.27-1.04), with prior CRT only (HR, 0.56; 95% CI, 0.39-0.81) and without prior CRT only (HR, 0.72; 95% CI, 0.52-1.00), and squamous (HR, 0.60; 95% CI, 0.46-0.79) and nonsquamous (HR, 0.70; 95% CI, 0.41-1.20) histologic type. In the intention-to-treat population, HRs for OS also favored the pembrolizumab group in all subgroups: with bevacizumab (HR, 0.63; 95% CI, 0.47-0.87) and without bevacizumab (HR, 0.74; 95% CI, 0.53-1.04), use of carboplatin (HR, 0.69; 95% CI, 0.54-0.89) or cisplatin (HR, 0.59; 95% CI, 0.32-1.09), with prior CRT only (HR, 0.64; 95% CI, 0.45-0.91) and without prior CRT only (HR, 0.71; 95% CI, 0.53-0.97), and squamous (HR, 0.61; 95% CI, 0.47-0.80) and nonsquamous (HR, 0.76; 95% CI, 0.47-1.23) histologic type. Similar to OS, the addition of pembrolizumab prolonged PFS across all subgroups in the CPS greater than or equal to 1 and intention-to-treat populations. Conclusions and Relevance The findings of this trial suggest that adding pembrolizumab to chemotherapy with or without bevacizumab improved OS across subgroups of patients with persistent, recurrent, or metastatic cervical cancer. Trial Registration ClinicalTrials.gov Identifier: NCT03635567.
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Affiliation(s)
| | - Nicoletta Colombo
- Gynecologic Oncology, European Institute of Oncology IRCCS and Università degli Studi di Milano Bicocca, Milan, Italy
| | - Bradley J. Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix
| | - Coraline Dubot
- Oncologie Médicale, Institut Curie Saint Cloud, and GINECO, Paris, France
| | - M. Valeria Cáceres
- Medical Oncology, Instituto de Oncologia Angel H. Roffo, Buenos Aires, Argentina
| | - Kosei Hasegawa
- Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Pamela Salman
- Medical Oncology, Oncovida Cancer Center, Providencia, Santiago, Chile
| | - Eduardo Yañez
- Medical Oncology, Universidad de la Frontera, Temuco, Chile
| | - Mahmut Gümüş
- Medical Oncology, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | - Vanessa Samouëlian
- Gynecologic Oncology, Centre Hospitalier de l’Université de Montréal, Centre de Recherche de l’Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Vincent Castonguay
- Medical Oncology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Alexander Arkhipov
- Oncology and Chemical Therapy, Medical Rehabilitation Center Under the Ministry of Health of Russian Federation, Moscow, Russian Federation
| | | | - Kan Li
- Oncology, Merck & Co, Inc, Rahway, New Jersey
| | | | | | - Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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Monk BJ, Colombo N, Tewari KS, Dubot C, Caceres MV, Hasegawa K, Shapira-Frommer R, Salman P, Yañez E, Gümüş M, Olivera Hurtado de Mendoza M, Samouëlian V, Castonguay V, Arkhipov A, Tekin C, Li K, Keefe SM, Lorusso D. First-Line Pembrolizumab + Chemotherapy Versus Placebo + Chemotherapy for Persistent, Recurrent, or Metastatic Cervical Cancer: Final Overall Survival Results of KEYNOTE-826. J Clin Oncol 2023; 41:5505-5511. [PMID: 37910822 DOI: 10.1200/jco.23.00914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/29/2023] [Accepted: 09/02/2023] [Indexed: 11/03/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The phase III, double-blind KEYNOTE-826 trial of pembrolizumab 200 mg or placebo once every 3 weeks for up to 35 cycles plus platinum-based chemotherapy, with or without bevacizumab, showed statistically significant survival benefits with the addition of pembrolizumab for patients with persistent, recurrent, or metastatic cervical cancer (primary data cutoff: May 3, 2021). This article reports the protocol-specified final overall survival (OS) results tested in the PD-L1 combined positive score (CPS) ≥1, all-comer, and CPS ≥10 populations. At the final data cutoff (October 3, 2022), the median study follow-up duration was 39.1 months (range, 32.1-46.5 months). In the PD-L1 CPS ≥1 (N = 548), all-comer (N = 617), and CPS ≥10 (N = 317) populations, median OS with pembrolizumab-chemotherapy versus placebo-chemotherapy was 28.6 months versus 16.5 months (hazard ratio [HR] for death, 0.60 [95% CI, 0.49 to 0.74]), 26.4 months versus 16.8 months (HR, 0.63 [95% CI, 0.52 to 0.77]), and 29.6 months versus 17.4 months (HR, 0.58 [95% CI, 0.44 to 0.78]), respectively. The incidence of grade ≥3 adverse events was 82.4% with pembrolizumab-chemotherapy and 75.4% with placebo-chemotherapy. These results show that pembrolizumab plus chemotherapy, with or without bevacizumab, continued to provide clinically meaningful improvements in OS for patients with persistent, recurrent, or metastatic cervical cancer.
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Affiliation(s)
- Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
| | - Nicoletta Colombo
- Gynecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
- Università degli Studi di Milano Bicocca, Milan, Italy
| | | | - Coraline Dubot
- Oncologie Médicale, Institut Curie Saint Cloud, and GINECO, Paris, France
| | - M Valeria Caceres
- Medical Oncology, Instituto de Oncologia Angel H. Roffo, Buenos Aires, Argentina
| | - Kosei Hasegawa
- Gynecologic Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Pamela Salman
- Medical Oncology, Oncovida Cancer Center, Providencia, Santiago, Chile
| | - Eduardo Yañez
- Medical Oncology, Universidad de la Frontera, Temuco, Chile
| | - Mahmut Gümüş
- Medical Oncology, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | - Vanessa Samouëlian
- Gynecologic Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM), Université de Montréal, Montreal, QC, Canada
| | - Vincent Castonguay
- Medical Oncology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Alexander Arkhipov
- Oncology and Chemical Therapy, Medical Rehabilitation Center under the Ministry of Health of Russian Federation, Moscow, Russian Federation
| | | | - Kan Li
- Oncology, Merck & Co, Inc, Rahway, NJ
| | | | - Domenica Lorusso
- Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
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5
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Ledermann JA, Shapira-Frommer R, Santin AD, Lisyanskaya AS, Pignata S, Vergote I, Raspagliesi F, Sonke GS, Birrer M, Provencher DM, Sehouli J, Colombo N, González-Martín A, Oaknin A, Ottevanger PB, Rudaitis V, Kobie J, Nebozhyn M, Edmondson M, Sun Y, Cristescu R, Jelinic P, Keefe SM, Matulonis UA. Molecular determinants of clinical outcomes of pembrolizumab in recurrent ovarian cancer: Exploratory analysis of KEYNOTE-100. Gynecol Oncol 2023; 178:119-129. [PMID: 37862791 DOI: 10.1016/j.ygyno.2023.09.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE This prespecified exploratory analysis evaluated the association of gene expression signatures, tumor mutational burden (TMB), and multiplex immunohistochemistry (mIHC) tumor microenvironment-associated cell phenotypes with clinical outcomes of pembrolizumab in advanced recurrent ovarian cancer (ROC) from the phase II KEYNOTE-100 study. METHODS Pembrolizumab-treated patients with evaluable RNA-sequencing (n = 317), whole exome sequencing (n = 293), or select mIHC (n = 125) data were evaluated. The association between outcomes (objective response rate [ORR], progression-free survival [PFS], and overall survival [OS]) and gene expression signatures (T-cell-inflamed gene expression profile [TcellinfGEP] and 10 non-TcellinfGEP signatures), TMB, and prespecified mIHC cell phenotype densities as continuous variables was evaluated using logistic (ORR) and Cox proportional hazards regression (PFS; OS). One-sided p-values were calculated at prespecified α = 0.05 for TcellinfGEP, TMB, and mIHC cell phenotypes and at α = 0.10 for non-TcellinfGEP signatures; all but TcellinfGEP and TMB were adjusted for multiplicity. RESULTS No evidence of associations between ORR and key axes of gene expression was observed. Negative associations were observed between outcomes and TcellinfGEP-adjusted glycolysis (PFS, adjusted-p = 0.019; OS, adjusted-p = 0.085) and hypoxia (PFS, adjusted-p = 0.064) signatures. TMB as a continuous variable was not associated with outcomes (p > 0.05). Positive associations were observed between densities of myeloid cell phenotypes CD11c+ and CD11c+/MHCII-/CD163-/CD68- in the tumor compartment and ORR (adjusted-p = 0.025 and 0.013, respectively). CONCLUSIONS This exploratory analysis in advanced ROC did not find evidence for associations between gene expression signatures and outcomes of pembrolizumab. mIHC analysis suggests CD11c+ and CD11c+/MHCII-/CD163-/CD68- phenotypes representing myeloid cell populations may be associated with improved outcomes with pembrolizumab in advanced ROC. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02674061.
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Affiliation(s)
- Jonathan A Ledermann
- Department of Oncology, UCL Cancer Institute, University College London, London, United Kingdom.
| | - Ronnie Shapira-Frommer
- The Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, United States
| | - Alla S Lisyanskaya
- Department of Oncogynecology, St. Petersburg City Clinical Oncology Dispensary, St. Petersburg, Russia
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - Ignace Vergote
- Department of Obstetrics and Gynaecology, Division of Gynecologic Oncology, University Hospital Leuven, Leuven, Belgium
| | | | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Birrer
- UAMS Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, United States
| | - Diane M Provencher
- Centre Hospitalier de l'Université de Montréal (CHUM), Institut du Cancer de Montréal, Montreal, Canada
| | - Jalid Sehouli
- Gynecology with Center of Oncological Surgery, Charité-Medical University of Berlin, Berlin, Germany
| | - Nicoletta Colombo
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio González-Martín
- Department of Medical Oncology and Program in Solid Tumors-Cima, Cancer Center Clínica Universidad de Navarra, Madrid, Spain
| | - Ana Oaknin
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P B Ottevanger
- Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Vilius Rudaitis
- Clinic of Obstetrics and Gynecology, Vilnius University Institute of Clinical Medicine, Vilnius, Lithuania
| | - Julie Kobie
- Merck & Co., Inc., Rahway, NJ, United States
| | | | | | - Yuan Sun
- Merck & Co., Inc., Rahway, NJ, United States
| | | | | | | | - Ursula A Matulonis
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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Colombo N, Dubot C, Lorusso D, Caceres MV, Hasegawa K, Shapira-Frommer R, Tewari KS, Salman P, Hoyos Usta E, Yañez E, Gümüş M, Olivera Hurtado de Mendoza M, Samouëlian V, Castonguay V, Arkhipov A, Toker S, Li K, Keefe SM, Monk BJ. Pembrolizumab for Persistent, Recurrent, or Metastatic Cervical Cancer. N Engl J Med 2021; 385:1856-1867. [PMID: 34534429 DOI: 10.1056/nejmoa2112435] [Citation(s) in RCA: 372] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pembrolizumab has efficacy in programmed death ligand 1 (PD-L1)-positive metastatic or unresectable cervical cancer that has progressed during chemotherapy. We assessed the relative benefit of adding pembrolizumab to chemotherapy with or without bevacizumab. METHODS In a double-blind, phase 3 trial, we randomly assigned patients with persistent, recurrent, or metastatic cervical cancer in a 1:1 ratio to receive pembrolizumab (200 mg) or placebo every 3 weeks for up to 35 cycles plus platinum-based chemotherapy and, per investigator discretion, bevacizumab. The dual primary end points were progression-free survival and overall survival, each tested sequentially in patients with a PD-L1 combined positive score of 1 or more, in the intention-to-treat population, and in patients with a PD-L1 combined positive score of 10 or more. The combined positive score is defined as the number of PD-L1-staining cells divided by the total number of viable tumor cells, multiplied by 100. All results are from the protocol-specified first interim analysis. RESULTS In 548 patients with a PD-L1 combined positive score of 1 or more, median progression-free survival was 10.4 months in the pembrolizumab group and 8.2 months in the placebo group (hazard ratio for disease progression or death, 0.62; 95% confidence interval [CI], 0.50 to 0.77; P<0.001). In 617 patients in the intention-to-treat population, progression-free survival was 10.4 months and 8.2 months, respectively (hazard ratio, 0.65; 95% CI, 0.53 to 0.79; P<0.001). In 317 patients with a PD-L1 combined positive score of 10 or more, progression-free survival was 10.4 months and 8.1 months, respectively (hazard ratio, 0.58; 95% CI, 0.44 to 0.77; P<0.001). Overall survival at 24 months was 53.0% in the pembrolizumab group and 41.7% in the placebo group (hazard ratio for death, 0.64; 95% CI, 0.50 to 0.81; P<0.001), 50.4% and 40.4% (hazard ratio, 0.67; 95% CI, 0.54 to 0.84; P<0.001), and 54.4% and 44.6% (hazard ratio, 0.61; 95% CI, 0.44 to 0.84; P = 0.001), respectively. The most common grade 3 to 5 adverse events were anemia (30.3% in the pembrolizumab group and 26.9% in the placebo group) and neutropenia (12.4% and 9.7%, respectively). CONCLUSIONS Progression-free and overall survival were significantly longer with pembrolizumab than with placebo among patients with persistent, recurrent, or metastatic cervical cancer who were also receiving chemotherapy with or without bevacizumab. (Funded by Merck Sharp and Dohme; KEYNOTE-826 ClinicalTrials.gov number, NCT03635567.).
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Affiliation(s)
- Nicoletta Colombo
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Coraline Dubot
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Domenica Lorusso
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - M Valeria Caceres
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Kosei Hasegawa
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Ronnie Shapira-Frommer
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Krishnansu S Tewari
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Pamela Salman
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Edwin Hoyos Usta
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Eduardo Yañez
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Mahmut Gümüş
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Mivael Olivera Hurtado de Mendoza
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Vanessa Samouëlian
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Vincent Castonguay
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Alexander Arkhipov
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Sarper Toker
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Kan Li
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Stephen M Keefe
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
| | - Bradley J Monk
- From the University of Milan-Bicocca and European Institute of Oncology IRCCS, Milan (N.C.), and Fondazione Policlinico Universitario A. Gemelli IRCCS and Catholic University of the Sacred Heart, Rome (D.L.) - both in Italy; Institut Curie Saint-Cloud, Group d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens, Saint-Cloud, France (C.D.); Instituto de Oncología Ángel H. Roffo, Buenos Aires (M.V.C.); Saitama Medical University International Medical Center, Hidaka, Japan (K.H.); Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel (R.S.-F.); the University of California, Irvine, Orange (K.S.T.); Oncovida Cancer Center, Providencia (P.S.), and Universidad de la Frontera, Temuco (E.Y.) - both in Chile; IMAT (Instituto Médico de Alta Tecnología) Oncomedica, Monteria, Colombia (E.H.U.); Istanbul Medeniyet University Hospital, Istanbul, Turkey (M.G.); Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (M.O.H.M.); Centre Hospitalier de l'Université de Montréal, Centre de Recherche de l'Université de Montréal, Université de Montréal, Montreal (V.S.), and Centre Hospitalier Universitaire de Québec, Université Laval, Quebec (V.C.) - both in Quebec, Canada; the Medical Rehabilitation Center of the Ministry of Health of the Russian Federation, Moscow (A.A.); Merck, Kenilworth, NJ (S.T., K.L., S.M.K.); and Arizona Oncology (U.S. Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix (B.J.M.)
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Høgdall E, Høgdall C, Vo T, Zhou W, Huang L, Marton M, Keefe SM, Busch-Sørensen M, Sørensen SM, Georgsen J, Mejlgaard E, Nedergaard L, Steiniche T. Impact of PD-L1 and T-cell inflamed gene expression profile on survival in advanced ovarian cancer. Int J Gynecol Cancer 2020; 30:1034-1042. [PMID: 32527769 DOI: 10.1136/ijgc-2019-001109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/13/2019] [Revised: 04/16/2020] [Accepted: 04/23/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Programmed death ligand 1 (PD-L1) expression affects tumor evasion of immune surveillance. The prognostic value and relationship of PD-L1 expression to T-cell-inflamed immune signatures in ovarian cancer are unclear. The purpose of this study is to evaluate the impact of PD-L1 on overall survival and its correlation with an immune-mediated gene expression profile in patients with advanced ovarian cancer. METHODS PD-L1 expression in tumor and immune cells was assessed by immunohistochemistry, and PD-L1-positive expression was defined as a combined positive score ≥1; a T-cell-inflamed gene expression profile containing interferon γ response genes was evaluated using extracted RNA from surgical samples. Associations between PD-L1 expression, gene expression profile status, and overall survival were analyzed using the Kaplan-Meier method, log-rank test, and multivariate Cox proportional hazards regression models. RESULTS A total of 376 patients with advanced epithelial ovarian, primary peritoneal, or fallopian tube cancer treated by cytoreductive surgery and platinum-based therapy were included. PD-L1-positive expression was observed in 50.5% of patients and associated with more advanced stage (p=0.047), more aggressive histologic subtype (p=0.001), and platinum sensitivity defined by increasing treatment-free interval from first platinum-based chemotherapy to next systemic treatment (p=0.027). PD-L1-positive expression was associated with longer overall survival in multivariate analyses (adjusted HR 0.72, 95% CI 0.56 to 0.93). In subgroup analyses, this association was most pronounced in patients with partially platinum-sensitive disease (treatment-free interval ≥6 to <12 months). T-cell-inflamed gene expression profile status correlated with PD-L1 expression (Spearman, ρ=0.712) but was not an independent predictor of overall survival. CONCLUSION PD-L1 expression is associated with longer overall survival among advanced ovarian cancer patients. PD-L1 expression may be an independent prognostic biomarker.
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Affiliation(s)
- Estrid Høgdall
- Department of Pathology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Claus Høgdall
- Department of Gynecology and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thao Vo
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Wei Zhou
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | | | | | | | | | - Sarah M Sørensen
- Department of Gynecology and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette Georgsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Else Mejlgaard
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Lotte Nedergaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
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Balar AV, Castellano D, O'Donnell PH, Grivas P, Vuky J, Powles T, Plimack ER, Hahn NM, de Wit R, Pang L, Savage MJ, Perini RF, Keefe SM, Bajorin D, Bellmunt J. First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, phase 2 study. Lancet Oncol 2017; 18:1483-1492. [PMID: 28967485 DOI: 10.1016/s1470-2045(17)30616-2] [Citation(s) in RCA: 886] [Impact Index Per Article: 126.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/12/2017] [Accepted: 07/17/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND More than half of all patients with advanced urothelial cancer cannot receive standard, first-line cisplatin-based chemotherapy because of renal dysfunction, poor performance status, or other comorbidities. We assessed the activity and safety of first-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer. METHODS In this multicentre, single-arm, phase 2 study (KEYNOTE-052), cisplatin-ineligible patients with advanced urothelial cancer who had not been previously treated with systemic chemotherapy were recruited from 91 academic medical centres in 20 countries. Enrolled patients received intravenous pembrolizumab 200 mg every 3 weeks. The primary endpoint was objective response (the proportion of patients who achieved complete or partial response) in all patients and by PD-L1 expression status according to the Response Evaluation Criteria in Solid Tumors, version 1.1, as assessed by independent central review. PD-L1 expression was assessed in tumour and inflammatory cells from tumour biopsies provided at study entry. Activity and safety were analysed in all patients who received at least one dose of pembrolizumab (all-patients-treated population). This study is registered with ClinicalTrials.gov, number NCT02335424, and follow-up is ongoing. FINDINGS Between Feb 24, 2015, and Aug 8, 2016, 374 patients were enrolled and 370 patients received at least one dose of pembrolizumab. 89 (24%, 95% CI 20-29) of 370 patients had a centrally assessed objective response, and as of Sept 1, 2016 (data cutoff), 74 (83%) of 89 responses were ongoing. Median follow-up was 5 months (IQR 3·0-8·6). A PD-L1-expression cutoff of 10% was associated with a higher frequency of response to pembrolizumab; 42 (38%, 95% CI 29-48) of 110 patients with a combined positive score of 10% or more had a centrally assessed objective response. The most common grade 3 or 4 treatment-related adverse events were fatigue (eight [2%] of 370 patients), alkaline phosphatase increase (five [1%]), colitis, and muscle weakness (both four [1%]). 36 (10%) of 370 patients had a serious treatment-related adverse event. 17 (5%) of 370 patients died from non-treatment-related adverse events associated with death, and one patient died from treatment-related adverse events (myositis in addition to grade 3 thyroiditis, grade 3 hepatitis, grade 3 pneumonia, and grade 4 myocarditis). INTERPRETATION First-line pembrolizumab has antitumour activity and acceptable tolerability in cisplatin-ineligible patients with urothelial cancer, most of whom were elderly, had poor prognostic factors, or had serious comorbidities. In view of this result, pembrolizumab has become a new treatment option for patients who are cisplatin-ineligible or not suitable candidates for chemotherapy. Pembrolizumab in the first-line setting is being further assessed in the phase 3 KEYNOTE-361 trial (ClinicalTrials.gov, NCT02335424). FUNDING Merck & Co.
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Affiliation(s)
- Arjun V Balar
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, USA.
| | | | | | - Petros Grivas
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Noah M Hahn
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | | | | | | | | | | | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Weber JS, Levit LA, Adamson PC, Bruinooge SS, Burris HA, Carducci MA, Dicker AP, Gönen M, Keefe SM, Postow MA, Thompson MA, Waterhouse DM, Weiner SL, Schuchter LM. Reaffirming and Clarifying the American Society of Clinical Oncology's Policy Statement on the Critical Role of Phase I Trials in Cancer Research and Treatment. J Clin Oncol 2016; 35:139-140. [PMID: 27893329 PMCID: PMC5559890 DOI: 10.1200/jco.2016.70.4692] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Jeffrey S Weber
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Laura A Levit
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Peter C Adamson
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Suanna S Bruinooge
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Howard A Burris
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Michael A Carducci
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Adam P Dicker
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Mithat Gönen
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Stephen M Keefe
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Michael A Postow
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Michael A Thompson
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - David M Waterhouse
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Susan L Weiner
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
| | - Lynn M Schuchter
- Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Laura A. Levit, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, The Children's Hospital of Philadelphia, Philadelphia, PA; Suanna S. Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Howard A. Burris III, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Adam P. Dicker, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Stephen M. Keefe, University of Pennsylvania, Philadelphia, PA; Michael A. Postow, Memorial Sloan Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC; and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA
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Keefe SM, Hoffman-Censits J, Cohen RB, Mamtani R, Heitjan D, Eliasof S, Nixon A, Turnbull B, Garmey EG, Gunnarsson O, Waliki M, Ciconte J, Jayaraman L, Senderowicz A, Tellez AB, Hennessy M, Piscitelli A, Vaughn D, Smith A, Haas NB. Efficacy of the nanoparticle-drug conjugate CRLX101 in combination with bevacizumab in metastatic renal cell carcinoma: results of an investigator-initiated phase I-IIa clinical trial. Ann Oncol 2016; 27:1579-85. [PMID: 27457310 DOI: 10.1093/annonc/mdw188] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 03/18/2016] [Accepted: 04/26/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Anti-angiogenic therapies are effective in metastatic renal cell carcinoma (mRCC), but resistance is inevitable. A dual-inhibition strategy focused on hypoxia-inducible factor (HIF) is hypothesized to be active in this refractory setting. CRLX101 is an investigational camptothecin-containing nanoparticle-drug conjugate (NDC), which durably inhibits HIF1α and HIF2α in preclinical models and in gastric cancer patients. Synergy was observed in the preclinical setting when combining this NDC and anti-angiogenic agents, including bevacizumab. PATIENTS AND METHODS Patients with refractory mRCC were treated every 2 weeks with bevacizumab (10 mg/kg) and escalating doses of CRLX101 (12, 15 mg/m(2)) in a 3 + 3 phase I design. An expansion cohort of 10 patients was treated at the recommended phase II dose (RP2D). Patients were treated until progressive disease or prohibitive toxicity. Adverse events (AEs) were assessed using CTCAE v4.0 and clinical outcome using RECIST v1.1. RESULTS Twenty-two patients were response-evaluable in an investigator-initiated trial at two academic medical centers. RCC histologies included clear cell (n = 12), papillary (n = 5), chromophobe (n = 2), and unclassified (n = 3). Patients received a median of two prior therapies, with at least one prior vascular endothelial tyrosine kinase inhibitor therapy (VEGF-TKI). No dose-limiting toxicities were observed. Grade ≥3 AEs related to CRLX101 included non-infectious cystitis (5 events), fatigue (3 events), anemia (2 events), diarrhea (2 events), dizziness (2 events), and 7 other individual events. Five of 22 patients (23%) achieved partial responses, including 3 of 12 patients with clear cell histology and 2 of 10 patients (20%) with non-clear cell histology. Twelve of 22 patients (55%) achieved progression-free survival (PFS) of >4 months. CONCLUSIONS CRLX101 combined with bevacizumab is safe in mRCC. This combination fulfilled the protocol's predefined threshold for further examination with responses and prolonged PFS in a heavily pretreated population. A randomized phase II clinical trial in mRCC of this combination is ongoing.
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Affiliation(s)
- S M Keefe
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - J Hoffman-Censits
- Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia
| | - R B Cohen
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - R Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - D Heitjan
- Southern Methodist University, Dallas
| | | | - A Nixon
- Duke University School of Medicine, Durham
| | | | | | - O Gunnarsson
- Landspitali University Hospital, Reykjavik, Iceland
| | - M Waliki
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - J Ciconte
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | | | | | | | | | | | - D Vaughn
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - A Smith
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - N B Haas
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
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Gunnarsson O, Pfanzelter NR, Cohen RB, Keefe SM. Evaluating the safety and efficacy of axitinib in the treatment of advanced renal cell carcinoma. Cancer Manag Res 2015; 7:65-73. [PMID: 25709499 PMCID: PMC4334173 DOI: 10.2147/cmar.s74202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Axitinib is a tyrosine kinase inhibitor of vascular endothelial growth factor receptor, platelet-derived growth factor receptor-α, and c-kit. Phase I studies demonstrated 5 mg twice daily as the recommended starting dose with notable effects seen in renal cell carcinoma, an observation confirmed in Phase II trials. The trial of comparative effectivess of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS) was an international randomized Phase III study designed for registration purposes, compared axitinib to sunitinib. This trial randomized 723 patients with metastatic kidney cancer to axitinib or sunitinib in the second-line setting and demonstrated a median progression-free survival of 6.7 months for axitinib versus 4.7 months for sorafenib (P<0.0001). Clinical benefit was detected regardless of prior therapy, but no overall survival benefit has been observed. Axitinib is well tolerated without a significant effect on quality of life. The most common grade 3 toxicities are hypertension (16%), diarrhea (11%), and fatigue (11%), with other notable side effects being anorexia, nausea, hand–foot syndrome, and rash. Patients who developed diastolic blood pressure >90 mmHg were noted to have significantly longer median overall survival and overall response rates when compared to normotensive patients. Therefore, the manufacturer recommends escalating the twice-daily dose to 7 mg and 10 mg, as tolerated, if there is no significant increase in blood pressure on treatment. Currently, axitinib is approved for use in the second-line setting for patients with metastatic renal cell carcinoma. Research is ongoing in other disease settings.
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Affiliation(s)
- Orvar Gunnarsson
- Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nicklas R Pfanzelter
- Department of Medicine, Division of Hematology and Oncology, Rush University Medical Center, Chicago, IL, USA
| | - Roger B Cohen
- Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen M Keefe
- Department of Medicine, Division of Hematology and Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Weber JS, Levit LA, Adamson PC, Bruinooge S, Burris HA, Carducci MA, Dicker AP, Gönen M, Keefe SM, Postow MA, Thompson MA, Waterhouse DM, Weiner SL, Schuchter LM. American Society of Clinical Oncology policy statement update: the critical role of phase I trials in cancer research and treatment. J Clin Oncol 2014; 33:278-84. [PMID: 25512456 DOI: 10.1200/jco.2014.58.2635] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Jeffrey S Weber
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC.
| | - Laura A Levit
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Peter C Adamson
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Suanna Bruinooge
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Howard A Burris
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Michael A Carducci
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Adam P Dicker
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Mithat Gönen
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Stephen M Keefe
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Michael A Postow
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Michael A Thompson
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - David M Waterhouse
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Susan L Weiner
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
| | - Lynn M Schuchter
- Jeffrey S. Weber, H. Lee Moffitt Cancer Center, Tampa, FL; Laura A. Levit and Suanna Bruinooge, American Society of Clinical Oncology, Alexandria, VA; Peter C. Adamson, Children's Hospital of Philadelphia; Adam P. Dicker, Jefferson Medical College, Thomas Jefferson University; Stephen M. Keefe and Lynn M. Schuchter, University of Pennsylvania, Philadelphia, PA; Howard A. Burris IIII, Sarah Cannon Research Institute, Nashville, TN; Michael A. Carducci, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD; Mithat Gönen and Michael A. Postow, Memorial Sloan-Kettering Cancer Center, New York, NY; Michael A. Thompson, Aurora Health Care, Milwaukee, WI; David M. Waterhouse, Oncology Hematology Care, Cincinnati, OH; and Susan L. Weiner, Children's Cause for Cancer Advocacy, Washington, DC
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Mamtani R, Haynes K, Boursi B, Scott FI, Goldberg DS, Keefe SM, Vaughn DJ, Malkowicz SB, Lewis JD. Validation of a coding algorithm to identify bladder cancer and distinguish stage in an electronic medical records database. Cancer Epidemiol Biomarkers Prev 2014; 24:303-7. [PMID: 25389114 DOI: 10.1158/1055-9965.epi-14-0677] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Studies on outcomes in bladder cancer rely on accurate methods to identify patients with bladder cancer and differentiate bladder cancer stage. Medical record and administrative databases are increasingly used to study cancer incidence, but few have distinguished cancer stage, and none have focused on bladder cancer. In this study, we used data from The UK Health Improvement Network (THIN) to identify patients with bladder cancer using at least one diagnostic code for bladder cancer, and distinguish muscle-invasive from non-invasive disease using a subsequent code for cystectomy. Algorithms were validated against a gold standard of physician-completed questionnaires, pathology reports, and consultant letters. Algorithm performance was evaluated by measuring positive predictive value (PPV) and corresponding 95% confidence interval (CI). Among all patients coded with bladder cancer (n = 194), PPV for any bladder cancer was 99.5% (95% CI, 97.2-99.9). PPV for incident bladder cancer was 93.8% (95% CI, 89.4-96.7). PPV for muscle-invasive bladder cancer was 70.1% (95% CI, 59.4-79.5) in patients with cystectomy (n = 95) and 83.9% (95% CI, 66.3-94.5) in those with cystectomy plus additional codes for metastases and death (n = 31). Using our codes for bladder cancer, the age- and sex-standardized incidence rate (SIR) of bladder cancer in THIN approximated that measured by cancer registries (SIR within 20%), suggesting that sensitivity was high as well. THIN is a valid and novel database for the study of bladder cancer. Our algorithm can be used to examine the epidemiology of muscle-invasive bladder cancer or outcomes following cystectomy for patients with muscle invasion.
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Affiliation(s)
- Ronac Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ben Boursi
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Frank I Scott
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Goldberg
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Keefe
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Vaughn
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Bruce Malkowicz
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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Keefe SM, Hennessy M, Gunnarsson O, Mamtani R, Vaughn D, Hoffman-Censits J, Nathanson K, Lal P, Lal P, Pryma D, Eliasof S, Garmey E, Cohen RB, Haas NB. Abstract CT340: Phase 1b/2a study of the nanopharmaceutical CRLX101 with bevacizumab (bev) in the treatment of patients (pts) with refractory metastatic renal cell carcinoma (mRCC): results from the planned interim analysis. Clin Trials 2014. [DOI: 10.1158/1538-7445.am2014-ct340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mamtani R, Pfanzelter N, Haynes K, Finkelman BS, Wang X, Keefe SM, Haas NB, Vaughn DJ, Lewis JD. Incidence of bladder cancer in patients with type 2 diabetes treated with metformin or sulfonylureas. Diabetes Care 2014; 37:1910-7. [PMID: 24496803 PMCID: PMC4067396 DOI: 10.2337/dc13-1489] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous studies evaluating the effect of metformin on cancer risk have been impacted by time-related biases. To avoid these biases, we examined the incidence of bladder cancer in new users of metformin and sulfonylureas (SUs). RESEARCH DESIGN AND METHODS This cohort study included 87,600 patients with type 2 diabetes in The Health Improvement Network database. Use of metformin or an SU was treated as a time-dependent variable. Cox regression-generated hazard ratios (HRs) compared metformin use with SU use, adjusted for age, sex, smoking, obesity, and HbA1c level. RESULTS We identified 196 incident bladder cancers in the metformin cohort and 66 cancers in the SU cohort. Use of metformin was not associated with decreased bladder cancer risk (HR 0.81 [95% CI 0.60-1.09]). This association did not differ by sex (P for interaction = 0.20). We observed no association with duration of metformin relative to SU use (3 to <4 years of use: 0.57 [0.25-1.34]; 4 to <5 years of use: 0.93 [0.30-2.85; ≥5 years of use: 1.18 [0.44-3.19]; P for trend = 0.26). CONCLUSIONS Use of metformin is not associated with a decreased incidence of bladder cancer. Similar methods should be used to study other cancers that have previously been identified as potentially preventable with metformin.
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Affiliation(s)
- Ronac Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Nick Pfanzelter
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Kevin Haynes
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Brian S Finkelman
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Xingmei Wang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Stephen M Keefe
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Naomi B Haas
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - David J Vaughn
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
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Ju M, Kao GD, Steinmetz D, Chandrasekaran S, Keefe SM, Guzzo TJ, Christodouleas JP, Hahn SM, Dorsey JF. Application of a telomerase-based circulating tumor cell (CTC) assay in bladder cancer patients receiving postoperative radiation therapy: a case study. Cancer Biol Ther 2014; 15:683-7. [PMID: 24618718 DOI: 10.4161/cbt.28412] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Muscle invasive bladder carcinoma is an often lethal disease that requires aggressive treatment. Improved assays would contribute to better risk prediction and clinical management of this disease. A telomerase-based assay to detect circulating tumor cells (CTCs) may usefully fulfill this role. METHODS Two patients (C1 and C2) were enrolled onto an IRB-approved bladder biomarker study before initiating post-operative radiation therapy (RT) for muscle invasive bladder carcinoma. Blood samples were taken at predefined intervals: before, during, and after RT and then retrospectively correlated with imaging studies and disease course. RESULTS C1 began RT for positive resection margins on surgical pathology, at which time CTCs were undetectable and pelvic imaging demonstrated no evidence of disease. However, following the completion of treatment, the patient's CTC count was found to have increased to 202 CTCs/mL, and MRI demonstrated new abdominal and pelvic masses consistent with progressive disease. C1 ultimately died of disease with distant and local failure. Conversely, C2 was found to have 632 CTCs/mL before the initiation of RT for positive surgical margins, although imaging demonstrated no visible masses. At the conclusion of RT, repeat imaging showed changes that were indeterminate for either tumor recurrence or post-radiation effects. However, the patient's CTC count had dropped to 184 CTCs/mL. Furthermore, a second follow-up assay performed 6 months later revealed no detectable CTCs and repeat imaging showed complete resolution of worrisome imaging changes, thus excluding tumor progression. CONCLUSIONS To our knowledge this is the first report of a telomerase-based assay to identify CTCs in bladder cancer patients. Further studies are required to fully determine the ultimate clinical utility of this assay. However, the two patient vignettes described here illustrate how serial CTC assays may track the disease course and inform the management of bladder cancer patients undergoing adjuvant RT and potentially chemotherapy.
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Affiliation(s)
- Melody Ju
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Gary D Kao
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - David Steinmetz
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Sanjay Chandrasekaran
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Stephen M Keefe
- Department of Medicine; Division of Hematology/Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Thomas J Guzzo
- Department of Surgery; Division of Urology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - John P Christodouleas
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Stephen M Hahn
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Jay F Dorsey
- Department of Radiation Oncology; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
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Goldsmith B, Baumann BC, He J, Tucker K, Bekelman J, Deville C, Vapiwala N, Vaughn D, Keefe SM, Guzzo T, Malkowicz SB, Christodouleas JP. Occult pelvic lymph node involvement in bladder cancer: implications for definitive radiation. Int J Radiat Oncol Biol Phys 2014; 88:603-10. [PMID: 24411628 DOI: 10.1016/j.ijrobp.2013.11.211] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To inform radiation treatment planning for clinically staged, node-negative bladder cancer patients by identifying clinical factors associated with the presence and location of occult pathologic pelvic lymph nodes. METHODS AND MATERIALS The records of patients with clinically staged T1-T4N0 urothelial carcinoma of the bladder undergoing radical cystectomy and pelvic lymphadenectomy at a single institution were reviewed. Logistic regression was used to evaluate associations between preoperative clinical variables and occult pathologic pelvic or common iliac lymph nodes. Percentages of patient with involved lymph node regions entirely encompassed within whole bladder (perivesicular nodal region), small pelvic (perivesicular, obturator, internal iliac, and external iliac nodal regions), and extended pelvic clinical target volume (CTV) (small pelvic CTV plus common iliac regions) were calculated. RESULTS Among 315 eligible patients, 81 (26%) were found to have involved pelvic lymph nodes at the time of surgery, with 38 (12%) having involved common iliac lymph nodes. Risk of occult pathologically involved lymph nodes did not vary with clinical T stage. On multivariate analysis, the presence of lymphovascular invasion (LVI) on preoperative biopsy was significantly associated with occult pelvic nodal involvement (odds ratio 3.740, 95% confidence interval 1.865-7.499, P<.001) and marginally associated with occult common iliac nodal involvement (odds ratio 2.307, 95% confidence interval 0.978-5.441, P=.056). The percentages of patients with involved lymph node regions entirely encompassed by whole bladder, small pelvic, and extended pelvic CTVs varied with clinical risk factors, ranging from 85.4%, 95.1%, and 100% in non-muscle-invasive patients to 44.7%, 71.1%, and 94.8% in patients with muscle-invasive disease and biopsy LVI. CONCLUSIONS Occult pelvic lymph node rates are substantial for all clinical subgroups, especially patients with LVI on biopsy. Extended coverage of pelvic lymph nodes up to the level of the common iliac nodes may be warranted in subsets of patients.
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Affiliation(s)
- Benjamin Goldsmith
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian C Baumann
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jiwei He
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kai Tucker
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Bekelman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Curtiland Deville
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Vaughn
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Keefe
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Guzzo
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Bruce Malkowicz
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Christodouleas
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Eliasof S, Conley S, Keefe SM, Kerbel R, Krasner CN, Lazarus D, Peters C, Pham E, Wicha MS, Garmey EG. Abstract PR09: Synergistic activity of CRLX101, a nanopharmaceutical in Phase II clinical trials, with antiangiogenic therapies mediated through HIF-1alpha inhibition: A translational research program. Mol Cancer Ther 2013. [DOI: 10.1158/1535-7163.targ-13-pr09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: Antiangiogenic drugs reduce blood flow to tumors and thereby inhibit tumor growth by starving tumors of oxygen and nutrients. However, antiangiogenic drugs have achieved limited success as monotherapies, in part because of their induction of hypoxia and the concomitant up-regulation of hypoxia-inducible factor 1α (HIF-1α), now well implicated in the promotion of tumor angiogenesis, invasion, metastasis, and cancer stem cell formation. We describe here a translational research program to investigate whether the efficacy of antiangiogenic drugs can be improved through combination with CRLX101, a camptothecin (CPT) containing nanopharmaceutical that inhibits both topoisomerase-1 and HIF-1α.
Material and methods: We will present preclinical and clinical projects conducted across several major research institutions intended to demonstrate the anti-HIF-1α activity of CRLX101, the capacity of this drug to block the epithelial-mesenchymal transition (EMT) and the formation of cancer stem cells, and the synergistic activity of CRLX101 given in combination with antiangiogenic drugs. We will further describe two ongoing clinical trials evaluating these hypotheses, one at the University of Pennsylvania in advanced renal cell carcinoma (RCC) and one at the Massachusetts General Hospital in relapsed ovarian cancer following progression through prior platinum-containing chemotherapy.
Results: A single dose of CRLX101 durably inhibits HIF-1α protein levels across multiple tumor types. Evaluation of CRLX101 in combination with bevacizumab, aflibercept or pazopanib in the A2780 ovarian xenograft tumor model demonstrates synergistic inhibition of tumor growth inhibition as well as increases in the rate of long-term survivorship. While all three antiangiogenic drugs alone increased HIF-1α protein levels, levels were inhibited in response to combination with CRLX101. In clinical evaluations, a CRLX101-bevacizumab combination appears safe and well tolerated with no dose limiting toxicities observed to date. Notable tumor decreases and long periods of progression free survival have been noted among patients treated with CRLX101-based mono and combination therapy.
Conclusions: Results generated through this translational research program suggest that CRLX101 can overcome HIF-1α-mediated acquired resistance to antiangiogenic drugs, supporting the use of CRLX101 in combination with antiangiogenic drugs as an exciting new paradigm for the treatment of cancer.
Citation Information: Mol Cancer Ther 2013;12(11 Suppl):PR09.
Citation Format: Scott Eliasof, Sarah Conley, Stephen M. Keefe, Robert Kerbel, Carolyn N. Krasner, Douglas Lazarus, Christian Peters, Elizabeth Pham, Max S. Wicha, Edward G. Garmey. Synergistic activity of CRLX101, a nanopharmaceutical in Phase II clinical trials, with antiangiogenic therapies mediated through HIF-1alpha inhibition: A translational research program. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr PR09.
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Affiliation(s)
| | | | | | - Robert Kerbel
- 4Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | | | | | | | - Elizabeth Pham
- 6Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Max S. Wicha
- 7University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Keefe SM, Cohen RB, Eliasof S, Garmey EG, Hennessy M, Mykulowicz KM, Pryma DA, Haas N. Abstract 2419: A phase Ib-IIa study evaluating the nanopharmaceutical CRLX101 in combination with bevacizumab in the treatment of patients (pts.) with advanced renal cell carcinoma. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2419] [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:
Topoisomerase-1 (topo-1)-inhibiting agents demonstrate activity across multiple cancer types but use of these agents remains limited by insufficient tumor exposure and toxicity. CRLX101, a novel cyclodextrin-containing polymer conjugate of camptothecin (CPT) that self-assembles into nanoparticles, delivers sustained levels of active CPT into cancer cells while substantially reducing systemic exposure. In vitro and in vivo data suggest superior activity of CRLX101 compared to approved agents in multiple animal tumor models. A monotherapy maximum tolerated dose (MTD)/recommended phase 2 dose (RP2D) of 15 mg/m2 IV every 2 weeks (wks.) was reported previously and over 100 cancer pts. have now been treated with CRLX101 across three ongoing phase 2 clinical trials. To be presented separately at this conference, CRLX101 further appears to inhibit HIF1α, a hypoxia-induced transcription factor implicated in tumor angiogenesis, invasion, and metastasis. We hypothesize that observed synergistic activity between CRLX101 and the VEGF-inhibiting monoclonal antibody bevacizumab occurs as a result of overcoming HIF-mediated resistance to VEGF-inhibition. Clear cell renal cell carcinoma (ccRCC), accounting for approximately 85% of RCC, provides an ideal clinical setting in which to evaluate the potential of this drug-drug combination. The most commonly observed genetic abnormality in ccRCC results in higher intracellular levels of HIF1α. Bevacizumab was chosen as a combination partner here because of its proven activity in the treatment of RCC as well as a history of successful combination with chemotherapy partners including topo-1 inhibitors.
Methods:
This clinical trial examines the combination of bevacizumab and CRLX101 in the treatment of pts. with advanced metastatic RCC. The primary objective is to determine the RP2D of CRLX101 administered in ombination with bevacizumab. In a preliminary stage 1b, a standard 3+3 dose-escalation design is being employed and no fewer than 6 pts. will be evaluated at the MTD. A secondary objective is to evaluate progression-free survival (PFS). Based on a preliminary test for futility, the study will be terminated if ≤ 3 of the initial 12 pts. survive without progression to 16 wks. Otherwise, an additional 10 pts. will be enrolled for a total of 22 pts. and the combination will be viewed as active and worthy of further examination if the PFS rate at 16 wks. is ≥ 50%. Additional exploratory endpoints include a comparison of bone marrow histology and molecular features among pts. treated with 12 mg/m2 vs. 15 mg/m2 of CRLX101. Finally, tumor expression of CAIX, a well-studied surrogate for HIF1α activity, will be measured using 124I-cG250, a CAIX antibody, with real-time PET imaging employed to determine the degree of CRLX101-mediated HIF1α modulation.
Citation Format: Stephen M. Keefe, Roger B. Cohen, Scott Eliasof, Edward G. Garmey, Meliessa Hennessy, Kristine M. Mykulowicz, Daniel A. Pryma, Naomi Haas. A phase Ib-IIa study evaluating the nanopharmaceutical CRLX101 in combination with bevacizumab in the treatment of patients (pts.) with advanced renal cell carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2419. doi:10.1158/1538-7445.AM2013-2419
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Affiliation(s)
| | | | | | | | | | | | | | - Naomi Haas
- 1Abramson Cancer Center, Philadelphia, PA
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Baumann BC, Guzzo TJ, He J, Vaughn DJ, Keefe SM, Vapiwala N, Deville C, Bekelman JE, Tucker K, Hwang WT, Malkowicz SB, Christodouleas JP. Bladder Cancer Patterns of Pelvic Failure: Implications for Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys 2013; 85:363-9. [DOI: 10.1016/j.ijrobp.2012.03.061] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/25/2012] [Accepted: 03/28/2012] [Indexed: 10/27/2022]
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Smith ZL, Christodouleas JP, Keefe SM, Malkowicz SB, Guzzo TJ. Bladder preservation in the treatment of muscle-invasive bladder cancer (MIBC): a review of the literature and a practical approach to therapy. BJU Int 2013; 112:13-25. [DOI: 10.1111/j.1464-410x.2012.11762.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zachary L. Smith
- Division of Urology; Hospital of the University of Pennsylvania; Philadelphia; PA; USA
| | - John P. Christodouleas
- Department of Radiation Oncology; Hospital of the University of Pennsylvania; Philadelphia; PA; USA
| | - Stephen M. Keefe
- Department of Medicine; Division of Hematology/Oncology; Hospital of the University of Pennsylvania; Philadelphia; PA; USA
| | - S. Bruce Malkowicz
- Division of Urology; Hospital of the University of Pennsylvania; Philadelphia; PA; USA
| | - Thomas J. Guzzo
- Division of Urology; Hospital of the University of Pennsylvania; Philadelphia; PA; USA
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Keefe SM, Cohen MA, Brose MS. Targeting vascular endothelial growth factor receptor in thyroid cancer: the intracellular and extracellular implications. Clin Cancer Res 2010; 16:778-83. [PMID: 20103668 DOI: 10.1158/1078-0432.ccr-08-2743] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our understanding of the molecular pathophysiology of differentiated thyroid cancer (DTC) has developed considerably over the last 10 years. Aberrant signaling through B-Raf and Akt has been implicated in the tumorigenesis of DTC. Moreover, these highly vascular tumors have proven to be sensitive to the inhibition of vascular endothelial growth factor receptor (VEGFR-2). It is likely that the multikinase inhibitors, sorafenib, sunitinib, axitinib, and motesanib, whose targets include VEGFR-2, exert their effects primarily through inhibition of endothelial cells. However, as VEGFR-2 is expressed on DTC cells, these compounds may have direct antitumor action. This review will discuss the key signaling pathways involved in thyroid cancer and their implications for targeted therapy.
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Affiliation(s)
- Stephen M Keefe
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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Keefe SM, Strom BL. On the importance of heterogeneity in meta-analysis. Clin Trials 2009; 6:443-4; discussion 445. [DOI: 10.1177/1740774509344372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen M Keefe
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Brian L Strom
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA,
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