1
|
Spiliopoulou P, Kazmi F, Aroldi F, Holmes T, Thompson D, Griffiths L, Qi C, Parkes M, Lord S, Veal GJ, Harrison DJ, Coyle VM, Graham J, Jeffry Evans TR, Blagden SP. A phase I open-label, dose-escalation study of NUC-3373, a targeted thymidylate synthase inhibitor, in patients with advanced cancer (NuTide:301). J Exp Clin Cancer Res 2024; 43:100. [PMID: 38566164 PMCID: PMC10986017 DOI: 10.1186/s13046-024-03010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE 5-fluorouracil (5-FU) is inefficiently converted to the active anti-cancer metabolite, fluorodeoxyuridine-monophosphate (FUDR-MP), is associated with dose-limiting toxicities and challenging administration schedules. NUC-3373 is a phosphoramidate nucleotide analog of fluorodeoxyuridine (FUDR) designed to overcome these limitations and replace fluoropyrimidines such as 5-FU. PATIENTS AND METHODS NUC-3373 was administered as monotherapy to patients with advanced solid tumors refractory to standard therapy via intravenous infusion either on Days 1, 8, 15 and 22 (Part 1) or on Days 1 and 15 (Part 2) of 28-day cycles until disease progression or unacceptable toxicity. Primary objectives were maximum tolerated dose (MTD) and recommended Phase II dose (RP2D) and schedule of NUC-3373. Secondary objectives included pharmacokinetics (PK), and anti-tumor activity. RESULTS Fifty-nine patients received weekly NUC-3373 in 9 cohorts in Part 1 (n = 43) and 3 alternate-weekly dosing cohorts in Part 2 (n = 16). They had received a median of 3 prior lines of treatment (range: 0-11) and 74% were exposed to prior fluoropyrimidines. Four experienced dose-limiting toxicities: two Grade (G) 3 transaminitis; one G2 headache; and one G3 transient hypotension. Commonest treatment-related G3 adverse event of raised transaminases occurred in < 10% of patients. NUC-3373 showed a favorable PK profile, with dose-proportionality and a prolonged half-life compared to 5-FU. A best overall response of stable disease was observed, with prolonged progression-free survival. CONCLUSION NUC-3373 was well-tolerated in a heavily pre-treated solid tumor patient population, including those who had relapsed on prior 5-FU. The MTD and RP2D was defined as 2500 mg/m2 NUC-3373 weekly. NUC-3373 is currently in combination treatment studies. TRIAL REGISTRATION Clinicaltrials.gov registry number NCT02723240. Trial registered on 8th December 2015. https://clinicaltrials.gov/study/NCT02723240 .
Collapse
Affiliation(s)
- Pavlina Spiliopoulou
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Farasat Kazmi
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - Francesca Aroldi
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - Thomas Holmes
- Department of Oncology, Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - David Thompson
- Department of Oncology, Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - Lucinda Griffiths
- Department of Oncology, Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - Cathy Qi
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit (OCTRU), Oxford, UK
| | - Matthew Parkes
- Centre for Statistics in Medicine and Oxford Clinical Trials Research Unit (OCTRU), Oxford, UK
| | - Simon Lord
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | - Gareth J Veal
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - David J Harrison
- School of Medicine, University of St Andrews, St Andrews, UK
- NuCana plc, 3 Lochside Way, Edinburgh, UK
| | - Vicky M Coyle
- Patrick G. Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Jill Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Thomas R Jeffry Evans
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Sarah P Blagden
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
- Department of Oncology, Oncology Clinical Trials Office, University of Oxford, Oxford, UK.
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, OX3 7DQ, UK.
| |
Collapse
|
2
|
Larkin J, Marais R, Porta N, Gonzalez de Castro D, Parsons L, Messiou C, Stamp G, Thompson L, Edmonds K, Sarker S, Banerji J, Lorigan P, Evans TRJ, Corrie P, Marshall E, Middleton MR, Nathan P, Nicholson S, Ottensmeier C, Plummer R, Bliss J, Valpione S, Turajlic S. Nilotinib in KIT-driven advanced melanoma: Results from the phase II single-arm NICAM trial. Cell Rep Med 2024; 5:101435. [PMID: 38417447 PMCID: PMC10982988 DOI: 10.1016/j.xcrm.2024.101435] [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: 08/16/2023] [Revised: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 03/01/2024]
Abstract
Mucosal (MM) and acral melanomas (AM) are rare melanoma subtypes of unmet clinical need; 15%-20% harbor KIT mutations potentially targeted by small-molecule inhibitors, but none yet approved in melanoma. This multicenter, single-arm Phase II trial (NICAM) investigates nilotinib safety and activity in KIT mutated metastatic MM and AM. KIT mutations are identified in 39/219 screened patients (18%); of 29/39 treated, 26 are evaluable for primary analysis. Six patients were alive and progression free at 6 months (local radiology review, 25%); 5/26 (19%) had objective response at 12 weeks; median OS was 7.7 months; ddPCR assay correctly identifies KIT alterations in circulating tumor DNA (ctDNA) in 16/17 patients. Nilotinib is active in KIT-mutant AM and MM, comparable to other KIT inhibitors, with demonstrable activity in nonhotspot KIT mutations, supporting broadening of KIT evaluation in AM and MM. Our results endorse further investigations of nilotinib for the treatment of KIT-mutated melanoma. This clinical trial was registered with ISRCTN (ISRCTN39058880) and EudraCT (2009-012945-49).
Collapse
Affiliation(s)
- James Larkin
- Skin and Renal Units, The Royal Marsden Hospital NHS Foundation Trust, London, UK; Melanoma and Kidney Cancer Team, The Institute of Cancer Research, London, UK
| | - Richard Marais
- Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - David Gonzalez de Castro
- Molecular Diagnostics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Lisa Parsons
- University of Edinburgh, Edinburgh, UK; PDD - Thermo Fisher Scientific, Bend, Oregon, USA
| | - Christina Messiou
- Department of Radiology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Gordon Stamp
- Department of Histopathology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Lisa Thompson
- Centre for Molecular Pathology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Kim Edmonds
- Skin and Renal Units, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Sarah Sarker
- Skin and Renal Units, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Jane Banerji
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Paul Lorigan
- Division of Cancer Sciences, Unviersity of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | | | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ernest Marshall
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | | | - Paul Nathan
- Mount Vernon Cancer Centre, East & North Herts NHS Trust, Northwood, UK
| | - Steve Nicholson
- University Hospitals of Leicester NHS Foundation Trust, Leicester, UK
| | | | - Ruth Plummer
- Newcastle University and Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Judith Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Sara Valpione
- Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
| | - Samra Turajlic
- Skin and Renal Units, The Royal Marsden Hospital NHS Foundation Trust, London, UK; Melanoma and Kidney Cancer Team, The Institute of Cancer Research, London, UK; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK.
| |
Collapse
|
3
|
McLaren AS, Spoor JA, Cartwright D, Naylor G, Barclay S, Priest M, Puttagunta S, Armstrong K, Ballantyne S, Stanley A, Jeffry Evans TR. Impact of the COVID-19 pandemic on patients with hepatocellular carcinoma in the West of Scotland: a cohort study. BMJ Open Gastroenterol 2023; 10:e001231. [PMID: 37989352 PMCID: PMC10660158 DOI: 10.1136/bmjgast-2023-001231] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic had an undoubted impact on the provision of elective and emergency cancer care, including the diagnosis and management of patients with hepatocellular carcinoma (HCC). Our aim was to determine the effects of the COVID-19 pandemic on patients with HCC in the West of Scotland. DESIGN This was a retrospective audit of a prospectively collated database of patients presented to the West of Scotland Multidisciplinary Team (MDT) between April and October 2020 (during the pandemic), comparing baseline demographics, characteristics of disease at presentation, diagnostic workup, treatment and outcomes with patients from April to October 2019 (pre pandemic). RESULTS There was a 36.5% reduction in new cases referred to the MDT during the pandemic. Patients presented at a significantly later Barcelona Cancer Liver Clinic stage (24% stage D during the pandemic, 9.5% pre pandemic, p<0.001) and with a significantly higher Child-Pugh Score (46% Child-Pugh B/C during the pandemic vs 27% pre pandemic, p<0.001). We observed a reduction in overall survival (OS) among all patients with a median OS during the pandemic of 6 months versus 17 months pre pandemic (p=0.048). CONCLUSION The impact of the COVID-19 pandemic is likely to have contributed to a reduction in the presentation of new cases and survival among patients with HCC in the West of Scotland. The reason for this is likely multifactorial, but disruption of standard care is likely to have played a significant role. Resources should be provided to address the backlog and ensure there are robust investigation and management pathways going forward.
Collapse
Affiliation(s)
- Alistair Stewart McLaren
- School of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- CRUK Scotland Institute, Glasgow, UK
| | - Johannes A Spoor
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Douglas Cartwright
- Gastrointestinal Cancers, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Gregory Naylor
- Gastrointestinal Cancers, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Matthew Priest
- Department of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Kirsty Armstrong
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Adrian Stanley
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Thomas R Jeffry Evans
- Gastrointestinal Cancers, Beatson West of Scotland Cancer Centre, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
4
|
Yap C, Solovyeva O, de Bono J, Rekowski J, Patel D, Jaki T, Mander A, Evans TRJ, Peck R, Hayward KS, Hopewell S, Ursino M, Rantell KR, Calvert M, Lee S, Kightley A, Ashby D, Chan AW, Garrett-Mayer E, Isaacs JD, Golub R, Kholmanskikh O, Richards D, Boix O, Matcham J, Seymour L, Ivy SP, Marshall LV, Hommais A, Liu R, Tanaka Y, Berlin J, Espinasse A, Dimairo M, Weir CJ. Enhancing reporting quality and impact of early phase dose-finding clinical trials: CONSORT Dose-finding Extension (CONSORT-DEFINE) guidance. BMJ 2023; 383:e076387. [PMID: 37863501 PMCID: PMC10583500 DOI: 10.1136/bmj-2023-076387] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 10/22/2023]
Affiliation(s)
| | | | - Johann de Bono
- Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Jan Rekowski
- Institute of Cancer Research, London SM2 5NG, UK
| | | | - Thomas Jaki
- MRC Biostatistics Unit, Cambridge University, Cambridge, UK
- Computational Statistics Group, University of Regensburg, Regensburg, Germany
| | - Adrian Mander
- Centre For Trials Research, Cardiff University, Heath Park, Cardiff, UK
| | - Thomas R Jeffry Evans
- Institute of Cancer Sciences, CR-UK Beatson Institute, University of Glasgow, Glasgow, UK
| | - Richard Peck
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Hoffmann-La Roche, Basel, Switzerland
| | - Kathryn S Hayward
- Departments of Physiotherapy, and Medicine (Royal Melbourne Hospital), University of Melbourne, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sally Hopewell
- Oxford Clinical Research Unit, NDORMS, University of Oxford, Oxford, UK
| | - Moreno Ursino
- ReCAP/F CRIN, INSERM, Paris, France
- Unit of Clinical Epidemiology, CHU Robert Debré, APHP, URC, INSERM CIC-EC 1426, Reims, France
- INSERM Centre de Recherche des Cordeliers, Sorbonne University, Paris Cité University, Paris, France
- Health data and model driven approaches for Knowledge Acquisition team, Centre Inria, Paris, France
| | | | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
- NIHR Research Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Edgbaston, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, University Hospital NHS Foundation Trust, Birmingham, UK
| | - Shing Lee
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Deborah Ashby
- School of Public Health, Imperial College London, London, UK
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Garrett-Mayer
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Robert Golub
- Department of Medicine, Northwestern University Feinberg School of Medicine, 633 Clark Street, Evanston, IL, USA
| | - Olga Kholmanskikh
- Federal Agency for Medicines and Health Products, Brussels, Belgium
- European Medicines Agency, Amsterdam, Netherlands
| | - Dawn Richards
- Clinical Trials Ontario, MaRS Centre, Toronto, ON, Canada
| | | | - James Matcham
- Strategic Consulting, Cytel (Australia), Perth, WA, Australia
| | - Lesley Seymour
- Investigational New Drug Programme, Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - S Percy Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Institute of Health, Bethesda, MD, USA
| | - Lynley V Marshall
- Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Antoine Hommais
- Department of Clinical Research, National Cancer Institute, Boulogne-Billancourt, France
| | - Rong Liu
- Bristol Myers Squibb, New York, NY, USA
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | - Munyaradzi Dimairo
- Division of Population Health, Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
5
|
Yap C, Rekowski J, Ursino M, Solovyeva O, Patel D, Dimairo M, Weir CJ, Chan AW, Jaki T, Mander A, Evans TRJ, Peck R, Hayward KS, Calvert M, Rantell KR, Lee S, Kightley A, Hopewell S, Ashby D, Garrett-Mayer E, Isaacs J, Golub R, Kholmanskikh O, Richards DP, Boix O, Matcham J, Seymour L, Ivy SP, Marshall LV, Hommais A, Liu R, Tanaka Y, Berlin J, Espinasse A, de Bono J. Enhancing quality and impact of early phase dose-finding clinical trial protocols: SPIRIT Dose-finding Extension (SPIRIT-DEFINE) guidance. BMJ 2023; 383:e076386. [PMID: 37863491 DOI: 10.1136/bmj-2023-076386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
| | - Jan Rekowski
- Institute of Cancer Research, London SM2 5NG, UK
| | - Moreno Ursino
- ReCAP/F CRIN, INSERM, Paris, France
- Unit of Clinical Epidemiology, University Hospital Centre Robert Debré, Reims, France
- INSERM Centre de Recherche des Cordeliers, Sorbonne University, Paris, France
- Health data and model driven approaches for Knowledge Acquisition team, Centre Inria, Paris, France
| | | | | | - Munyaradzi Dimairo
- Division of Population Health, Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Canada
| | - Thomas Jaki
- MRC Biostatistics Unit, Cambridge University, Cambridge, UK
- Computational Statistics Group, University of Regensburg, Regensburg, Germany
| | - Adrian Mander
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | - Thomas R Jeffry Evans
- Institute of Cancer Sciences, CR-UK Beatson Institute, University of Glasgow, Glasgow, UK
| | - Richard Peck
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
- Hoffmann-La Roche, Basel, Switzerland
| | - Kathryn S Hayward
- Departments of Physiotherapy, and Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, NIHR Birmingham Biomedical Research Centre, Institute of Translational Medicine, University Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Shing Lee
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Sally Hopewell
- Oxford Clinical Research Unit, NDORMS, University of Oxford, Oxford, UK
| | - Deborah Ashby
- School of Public Health, Imperial College London, St Mary's Hospital, London, UK
| | - Elizabeth Garrett-Mayer
- Center for Research and Analytics, American Society of Clinical Oncology, Alexandria, VA, USA
| | - John Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Robert Golub
- Department of Medicine, Northwestern University Feinberg School of Medicine, Evanston, IL, USA
| | | | | | | | - James Matcham
- Strategic Consulting, Cytel (Australia), Perth, WA, Australia
| | - Lesley Seymour
- Investigational New Drug Programme, Canadian Cancer Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - S Percy Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Institute of Health, Bethesda, MD, USA
| | - Lynley V Marshall
- Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| | - Antoine Hommais
- Department of Clinical Research, National Cancer Institute, Boulogne-Billancourt, France
| | - Rong Liu
- Bristol Myers Squibb, New York, NY, USA
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | - Johann de Bono
- Institute of Cancer Research, London SM2 5NG, UK
- Royal Marsden NHS Foundation Trust, London, UK
| |
Collapse
|
6
|
Solovyeva O, Dimairo M, Weir CJ, Hee SW, Espinasse A, Ursino M, Patel D, Kightley A, Hughes S, Jaki T, Mander A, Evans TRJ, Lee S, Hopewell S, Rantell KR, Chan AW, Bedding A, Stephens R, Richards D, Roberts L, Kirkpatrick J, de Bono J, Yap C. Development of consensus-driven SPIRIT and CONSORT extensions for early phase dose-finding trials: the DEFINE study. BMC Med 2023; 21:246. [PMID: 37408015 PMCID: PMC10324137 DOI: 10.1186/s12916-023-02937-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Early phase dose-finding (EPDF) trials are crucial for the development of a new intervention and influence whether it should be investigated in further trials. Guidance exists for clinical trial protocols and completed trial reports in the SPIRIT and CONSORT guidelines, respectively. However, both guidelines and their extensions do not adequately address the characteristics of EPDF trials. Building on the SPIRIT and CONSORT checklists, the DEFINE study aims to develop international consensus-driven guidelines for EPDF trial protocols (SPIRIT-DEFINE) and reports (CONSORT-DEFINE). METHODS The initial generation of candidate items was informed by reviewing published EPDF trial reports. The early draft items were refined further through a review of the published and grey literature, analysis of real-world examples, citation and reference searches, and expert recommendations, followed by a two-round modified Delphi process. Patient and public involvement and engagement (PPIE) was pursued concurrently with the quantitative and thematic analysis of Delphi participants' feedback. RESULTS The Delphi survey included 79 new or modified SPIRIT-DEFINE (n = 36) and CONSORT-DEFINE (n = 43) extension candidate items. In Round One, 206 interdisciplinary stakeholders from 24 countries voted and 151 stakeholders voted in Round Two. Following Round One feedback, one item for CONSORT-DEFINE was added in Round Two. Of the 80 items, 60 met the threshold for inclusion (≥ 70% of respondents voted critical: 26 SPIRIT-DEFINE, 34 CONSORT-DEFINE), with the remaining 20 items to be further discussed at the consensus meeting. The parallel PPIE work resulted in the development of an EPDF lay summary toolkit consisting of a template with guidance notes and an exemplar. CONCLUSIONS By detailing the development journey of the DEFINE study and the decisions undertaken, we envision that this will enhance understanding and help researchers in the development of future guidelines. The SPIRIT-DEFINE and CONSORT-DEFINE guidelines will allow investigators to effectively address essential items that should be present in EPDF trial protocols and reports, thereby promoting transparency, comprehensiveness, and reproducibility. TRIAL REGISTRATION SPIRIT-DEFINE and CONSORT-DEFINE are registered with the EQUATOR Network ( https://www.equator-network.org/ ).
Collapse
Affiliation(s)
| | - Munyaradzi Dimairo
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Siew Wan Hee
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- University of Warwick, Coventry, UK
| | | | - Moreno Ursino
- Inserm, Centre de Recherche Des Cordeliers, Sorbonne UniversitéUniversité Paris Cité, 75006, Paris, France
- HeKA, Inria Paris, 75015, Paris, France
- Unit of Clinical Epidemiology, AP-HP, CHU Robert Debré, CIC-EC 1426, Paris, France
- RECaP/F-CRIN, Inserm, 5400, Nancy, France
| | | | - Andrew Kightley
- Patient and Public Involvement and Engagement (PPIE) Lead, Lichfield, UK
| | | | - Thomas Jaki
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
- University of Regensburg, Regensburg, Germany
| | | | | | - Shing Lee
- Columbia University, Mailman School of Public Health, New York, USA
| | - Sally Hopewell
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | | | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Canada
| | | | | | | | | | | | - Johann de Bono
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | |
Collapse
|
7
|
Kristeleit R, Plummer R, Jones R, Carter L, Blagden S, Sarker D, Arkenau T, Evans TRJ, Danson S, Symeonides SN, Veal GJ, Klencke BJ, Kowalski MM, Banerji U. A Phase 1/2 trial of SRA737 (a Chk1 inhibitor) administered orally in patients with advanced cancer. Br J Cancer 2023; 129:38-45. [PMID: 37120671 PMCID: PMC10307885 DOI: 10.1038/s41416-023-02279-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND This was a first-in-human Phase 1/2 open-label dose-escalation study of the novel checkpoint kinase 1 (Chk1) inhibitor SRA737. METHODS Patients with advanced solid tumours enrolled in dose-escalation cohorts and received SRA737 monotherapy orally on a continuous daily (QD) dosing schedule in 28-day cycles. Expansion cohorts included up to 20 patients with prospectively selected, pre-specified response predictive biomarkers. RESULTS In total, 107 patients were treated at dose levels from 20-1300 mg. The maximum tolerated dose (MTD) of SRA737 was 1000 mg QD, the recommended Phase 2 dose (RP2D) was 800 mg QD. Common toxicities of diarrhoea, nausea and vomiting were generally mild to moderate. Dose-limiting toxicity at daily doses of 1000 and 1300 mg QD SRA737 included gastrointestinal events, neutropenia and thrombocytopenia. Pharmacokinetic analysis at the 800 mg QD dose showed a mean Cmin of 312 ng/mL (546 nM), exceeding levels required to cause growth delay in xenograft models. No partial or complete responses were seen. CONCLUSIONS SRA737 was well tolerated at doses that achieved preclinically relevant drug concentrations but single agent activity did not warrant further development as monotherapy. Given its mechanism of action resulting in abrogating DNA damage repair, further clinical development of SRA737 should be as combination therapy. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT02797964.
Collapse
Affiliation(s)
| | - Ruth Plummer
- Newcastle University and Newcastle Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Robert Jones
- Velindre School of Medicine, Cardiff University, and Velindre University NHS Trust, Cardiff, UK
| | - Louise Carter
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Blagden
- Early Phase Clinical Trials Unit, Churchill Hospital, Oxford University Hospital NHS Trust, Oxford, UK
| | | | | | - Thomas R Jeffry Evans
- The Beatson West of Scotland Cancer Centre and the University of Glasgow, Glasgow, UK
| | - Sarah Danson
- Sheffield ECMC, Department of Oncology and Metabolism, University of Sheffield, and Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Stefan N Symeonides
- Edinburgh ECMC, Institute of Genetics & Cancer, University of Edinburgh, Edinburgh Cancer Centre, Edinburgh, UK
| | - Gareth J Veal
- Newcastle University Centre for Cancer, Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | | | | | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital NHS Foundation Trust, London, UK.
| |
Collapse
|
8
|
Hamid O, Hassel JC, Shoushtari AN, Meier F, Bauer TM, Salama AKS, Kirkwood JM, Ascierto PA, Lorigan PC, Mauch C, Orloff M, Evans TRJ, Holland C, Edukulla R, Abedin SE, Middleton MR. Tebentafusp in combination with durvalumab and/or tremelimumab in patients with metastatic cutaneous melanoma: a phase 1 study. J Immunother Cancer 2023; 11:e006747. [PMID: 37286303 PMCID: PMC10254987 DOI: 10.1136/jitc-2023-006747] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors have significantly improved outcomes in first line cutaneous melanoma. However, there is a high unmet need for patients who progress on these therapies and combination therapies are being explored to improve outcomes. Tebentafusp is a first-in-class gp100×CD3 ImmTAC bispecific that demonstrated overall survival (OS) benefit (HR 0.51) in metastatic uveal melanoma despite a modest overall response rate of 9%. This phase 1b trial evaluated the safety and initial efficacy of tebentafusp in combination with durvalumab (anti-programmed death ligand 1 (PDL1)) and/or tremelimumab (anti-cytotoxic T lymphocyte-associated antigen 4) in patients with metastatic cutaneous melanoma (mCM), the majority of whom progressed on prior checkpoint inhibitors. METHODS In this open-label, multicenter, phase 1b, dose-escalation trial, HLA-A*02:01-positive patients with mCM received weekly intravenous tebentafusp with increasing monthly doses of durvalumab and/or tremelimumab starting day 15 of each cycle. The primary objective was to identify the maximum tolerated dose (MTD) or recommended phase 2 dose for each combination. Efficacy analyses were performed in all tebentafusp with durvalumab±tremelimumab treated patients with a sensitivity analysis in those who progressed on prior anti-PD(L)1 therapy. RESULTS 85 patients were assigned to receive tebentafusp in combination with durvalumab (n=43), tremelimumab (n=13), or durvalumab and tremelimumab (n=29). Patients were heavily pretreated with a median of 3 prior lines of therapy, including 76 (89%) who received prior anti-PD(L)1. Maximum target doses of tebentafusp (68 mcg) alone or in combination with durvalumab (20 mg/kg) and tremelimumab (1 mg/kg) were tolerated; MTD was not formally identified for any arm. Adverse event profile was consistent with each individual therapy and there were no new safety signals nor treatment-related deaths. In the efficacy subset (n=72), the response rate was 14%, tumor shrinkage rate was 41% and 1-year OS rate was 76% (95% CI: 70% to 81%). The 1-year OS for triplet combination (79%; 95% CI: 71% to 86%) was similar to tebentafusp plus durvalumab (74%; 95% CI: 67% to 80%). CONCLUSION At maximum target doses, the safety of tebentafusp with checkpoint inhibitors was consistent with safety of each individual therapy. Tebentafusp with durvalumab demonstrated promising efficacy in heavily pretreated patients with mCM, including those who progressed on prior anti-PD(L)1. TRIAL REGISTRATION NUMBER NCT02535078.
Collapse
Affiliation(s)
- Omid Hamid
- The Angeles Clinic and Research Institute, a Cedars-Sinai Affiliate, Los Angeles, California, USA
| | | | - Alexander N Shoushtari
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Friedegund Meier
- Skin Cancer Center at the National Center for Tumor Diseases and University Cancer Centre, Dresden, Germany
- Department of Dermatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | | | - John M Kirkwood
- University of Pittsburgh Medical Center Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | | | - Marlana Orloff
- Sidney Kimmel Cancer Center, Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Mark R Middleton
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Krebs MG, Delord JP, Jeffry Evans TR, De Jonge M, Kim SW, Meurer M, Postel-Vinay S, Lee JS, Angell HK, Rocher-Ros V, Meyer K, Ah-See ML, Herbolsheimer P, Lai Z, Nunes A, Domchek SM. Olaparib and durvalumab in patients with relapsed small cell lung cancer (MEDIOLA): An open-label, multicenter, phase 1/2, basket study. Lung Cancer 2023; 180:107216. [PMID: 37146473 DOI: 10.1016/j.lungcan.2023.107216] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION Preclinical studies have demonstrated increased efficacy with combined DNA damage response inhibition and immune checkpoint blockade compared with either alone. We assessed olaparib in combination with durvalumab in patients with relapsed small cell lung cancer (SCLC). METHODS Patients with previously treated limited or extensive-stage SCLC received oral olaparib 300 mg twice daily, as run-in for 4 weeks, then with durvalumab (1500 mg intravenously every 4 weeks) until disease progression. Primary endpoints were safety, tolerability, and 12-week disease control rate (DCR). Secondary endpoints included 28-week DCR, objective response rate (ORR), duration of response, progression-free survival, overall survival, change in tumor size, and programmed death-ligand 1 (PD-L1) expression subgroup analyses. RESULTS Forty patients were enrolled and analyzed for safety; 38 were analyzed for efficacy. Eleven patients (28.9% [90% confidence interval (CI), 17.2-43.3]) had disease control at 12 weeks. ORR was 10.5% (95% CI, 2.9-24.8). Median progression-free and overall survival were 2.4 (95% CI, 0.9-3.0)months and 7.6(95% CI, 5.6-8.8)months, respectively. The most common adverse events (≥40.0%) were anemia, nausea, and fatigue. Grade ≥ 3 adverse events occurred in 32 patients (80.0%). PD-L1 levels, tumor mutational burden, and other genetic mutations were evaluated, but no significant correlations with clinical outcomes wereobserved. CONCLUSIONS Tolerability of olaparib with durvalumab was consistent with the safety profile of each agent alone. Although the 12-week DCR did not meet the prespecified target (60%), four patients responded, and median overall survival was promising for a pretreated SCLC population. Further analyses are required to identify patients most likely to benefit from this treatment approach.
Collapse
Affiliation(s)
- Matthew G Krebs
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
| | | | | | - Maja De Jonge
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Marie Meurer
- Centre d'Essais Précoces en Cancérologie de Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Sophie Postel-Vinay
- Department of Drug Development, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jong-Seok Lee
- Seoul National University College of Medicine, Bundang Hospital, Seoul, South Korea
| | | | | | | | | | | | | | | | - Susan M Domchek
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
10
|
Ali A, Jamieson NB, Khan IN, Chang D, Giovannetti E, Funel N, Frampton AE, Morton J, Sansom O, Evans TRJ, Duthie F, McKay CJ, Samra J, Gill AJ, Biankin A, Oien KA. Prognostic implications of microRNA-21 overexpression in pancreatic ductal adenocarcinoma: an international multicenter study of 686 patients. Am J Cancer Res 2022; 12:5668-5683. [PMID: 36628279 PMCID: PMC9827095] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/27/2022] [Indexed: 01/12/2023] Open
Abstract
Despite progress in genomic characterization, no single prognostic marker that can be evaluated using an easy-to-perform and relatively inexpensive method is available for pancreatic ductal adenocarcinoma (PDAC). MicroRNAs, which are stable, tumor- and tissue-specific molecules, are potentially ideal biomarkers, and we established an inter-laboratory validated method to investigate miR-21 as a prognostic biomarker in PDAC. The study samples of PDAC patients were recruited from a test cohort of Glasgow (n = 189) and three validation cohorts of Pisa (n = 69), Sydney (n = 249), and International Cancer Genome Consortium (ICGC) (n = 249). Tissue microarrays were used for miR-21 staining by chromogenic in situ hybridization (CISH). The patients were subdivided into no/low and high miR-21 staining groups using a specific histoscore. Furthermore, miR-21 staining was evaluated against clinicopathological variables and follow-up data by Fisher/log-rank test and Cox proportional models. The prognostic variables found to be significant in univariate analysis (P value < 0.10) were included in multivariate analysis in a backward-stepwise fashion. MiR-21 expression was cytoplasmic, with more consistent staining in the malignant ductal epithelium than in the stroma. The expression of miR-21 was significantly associated with tumor size and lymph node metastasis, whereas no association was observed with other clinicopathological variables. High miR-21 staining (histoscore ≥ 45 [median score]) was an independent predictor of survival in the Glasgow test cohort (HR 2.37, 95% CI: 1.42-3.96, P < 0.0001) and three validation cohorts (Pisa, HR 2.03, 95% CI: 1.21-3.39, P = 0.007; Sydney, HR 2.58, 95% CI (1.21-3.39), P < 0.0001; and ICGC, HR 3.34, 95% CI: 2.07-5.84, P = 0.002) when adjusted for clinical variables in a multivariate model. In comparison to the patients with low miR-21, the patients with high miR-21 expression had significant increase in OS as they benefit from gemcitabine-based adjuvant chemotherapy (Glasgow 16.5 months [with chemotherapy] vs 10.5 months [without chemotherapy]); Sydney 25.0 vs 10.6; ICGC 25.2 vs 11.9. These results indicated that miR-21 is a predictor of survival, prompting prospective trials. Evaluation of miR-21 offers new opportunities for the stratification of patients with PDAC and might facilitate the implementation of clinical management and therapeutic interventions for this devastating disease.
Collapse
Affiliation(s)
- Asif Ali
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of GlasgowUK
- Institute of Pathology and Diagnostic Medicine, Khyber Medical UniversityPeshawar, Pakistan
- Gulf Medical UniversityAjman, United Arab Emirates
| | - Nigel Balfour Jamieson
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of GlasgowUK
| | - Ishaq N Khan
- Department of Pharmaceutical Sciences, Texas A&M Health Science Center, Joe H. Reynolds Medical Bld, Texas A&M University, College StationUnited States
- Cancer Cell Culture & Precision Oncomedicine Lab, Institute of Basic Medical Sciences, Khyber Medical UniversityPeshawar, Pakistan
| | - David Chang
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of GlasgowUK
| | - Elisa Giovannetti
- Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical CenterAmsterdam, The Netherlands
- Cancer Pharmacology Lab, AIRC Start-Up Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of PisaPisa, Italy
| | - Nicola Funel
- Cancer Pharmacology Lab, AIRC Start-Up Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of PisaPisa, Italy
| | - Adam E Frampton
- Department of Surgery & Cancer, Imperial College, Hammersmith Hospital CampusDu Cane Road, London, UK
- Department of Hepato-Pancreato-Biliary (HPB) Surgery, Royal Surrey County HospitalEgerton Road, Guildford, Surrey, GU2 7XX, UK
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Science, University of SurreyGuildford, Surrey, UK
| | - Jennifer Morton
- Beatson Institute for Cancer Research, University of GlasgowUK
| | - Owen Sansom
- Beatson Institute for Cancer Research, University of GlasgowUK
| | | | - Fraser Duthie
- Department of Pathology, Laboratory Medicine Building, Queen Elizabeth University HospitalGreater Glasgow & Clyde NHS
| | - Colin J McKay
- West of Scotland Pancreatic Unit and Glasgow Royal InfirmaryAlexandra Parade, Glasgow
| | - Jas Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore HospitalPacific Highway St Leonards, Australia
| | - Anthony J Gill
- Sydney Medical School, University of SydneySydney, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, and Health Pathology Department of Anatomical Pathology, Royal North Shore HospitalSt Leonards, NSW, Australia
- The Kinghorn Cancer Centre, The Garvan Institute of Medical ResearchDarlinghurst, Sydney, Australia
- The Australian Pancreatic Genome InitiativeDarlinghurst NSW 2010, Australia
| | - Andrew Biankin
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of GlasgowUK
| | - Karin A Oien
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of GlasgowUK
- Department of Pathology, Laboratory Medicine Building, Queen Elizabeth University HospitalGreater Glasgow & Clyde NHS
| |
Collapse
|
11
|
Sala A, Cameron JM, Jenkins CA, Barr H, Christie L, Conn JJA, Evans TRJ, Harris DA, Palmer DS, Rinaldi C, Theakstone AG, Baker MJ. Liquid Biopsy for Pancreatic Cancer Detection Using Infrared Spectroscopy. Cancers (Basel) 2022; 14:3048. [PMID: 35804820 PMCID: PMC9264892 DOI: 10.3390/cancers14133048] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/04/2022] Open
Abstract
Pancreatic cancer claims over 460,000 victims per year. The carbohydrate antigen (CA) 19-9 test is the blood test used for pancreatic cancer's detection; however, its levels can be raised in symptomatic patients with other non-malignant diseases, or with other tumors in the surrounding area. Attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy has demonstrated exceptional potential in cancer diagnostics, and its clinical implementation could represent a significant step towards early detection. This proof-of-concept study, investigating the use of ATR-FTIR spectroscopy on dried blood serum, focused on the discrimination of both cancer versus healthy control samples, and cancer versus symptomatic non-malignant control samples, as a novel liquid biopsy approach for pancreatic cancer diagnosis. Machine learning algorithms were applied, achieving results of up to 92% sensitivity and 88% specificity when discriminating between cancers (n = 100) and healthy controls (n = 100). An area under the curve (AUC) of 0.95 was obtained through receiver operating characteristic (ROC) analysis. Balanced sensitivity and specificity over 75%, with an AUC of 0.83, were achieved with cancers (n = 35) versus symptomatic controls (n = 35). Herein, we present these results as demonstration that our liquid biopsy approach could become a simple, minimally invasive, and reliable diagnostic test for pancreatic cancer detection.
Collapse
Affiliation(s)
- Alexandra Sala
- Department of Pure and Applied Chemistry, University of Strathclyde, Thomas Graham Building, Glasgow G1 1XL, UK; (A.S.); (L.C.); (D.S.P.)
- Dxcover Limited, Royal College Building, Glasgow G1 1XW, UK; (J.M.C.); (J.J.A.C.)
| | - James M. Cameron
- Dxcover Limited, Royal College Building, Glasgow G1 1XW, UK; (J.M.C.); (J.J.A.C.)
| | - Cerys A. Jenkins
- Swansea University Medical School, Swansea University, Swansea SA2 8PP, UK;
| | - Hugh Barr
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 2EL, UK;
| | - Loren Christie
- Department of Pure and Applied Chemistry, University of Strathclyde, Thomas Graham Building, Glasgow G1 1XL, UK; (A.S.); (L.C.); (D.S.P.)
- Dxcover Limited, Royal College Building, Glasgow G1 1XW, UK; (J.M.C.); (J.J.A.C.)
| | - Justin J. A. Conn
- Dxcover Limited, Royal College Building, Glasgow G1 1XW, UK; (J.M.C.); (J.J.A.C.)
| | | | - Dean A. Harris
- Singleton Hospital, Swansea Bay University Local Health Board, Swansea SA2 8QA, UK;
| | - David S. Palmer
- Department of Pure and Applied Chemistry, University of Strathclyde, Thomas Graham Building, Glasgow G1 1XL, UK; (A.S.); (L.C.); (D.S.P.)
- Dxcover Limited, Royal College Building, Glasgow G1 1XW, UK; (J.M.C.); (J.J.A.C.)
| | - Christopher Rinaldi
- Department of Pure and Applied Chemistry, University of Strathclyde, The Technology and Innovation Centre, Glasgow G1 1RD, UK; (C.R.); (A.G.T.)
| | - Ashton G. Theakstone
- Department of Pure and Applied Chemistry, University of Strathclyde, The Technology and Innovation Centre, Glasgow G1 1RD, UK; (C.R.); (A.G.T.)
| | - Matthew J. Baker
- Dxcover Limited, Royal College Building, Glasgow G1 1XW, UK; (J.M.C.); (J.J.A.C.)
| |
Collapse
|
12
|
Yoshino T, Ikeda M, Finn RS, Evans TRJ, Weng L, Saito K, Mody K, Tamai T, Paoletti C, Iwasa S. Abstract CT523: An open-label, multicenter, phase 1b/2 Study of E7386 (Wnt/β-catenin pathway inhibitor) + pembrolizumab in patients with pretreated advanced solid tumors. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct523] [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: Development of primary or secondary resistance to anticancer treatments has been a critical challenge since implementation of immune checkpoint inhibitor (ICI) treatments across multiple cancer subtypes. Preclinical studies have indicated that a mechanism of resistance to ICIs, including PD-1/PD-L1 inhibitors, is activation of the Wnt/β-catenin signaling pathway. E7386 is a novel compound that has been shown to modulate this pathway in vivo, by inhibiting the interactions between CREB-binding protein and β-catenin. Preclinical models have also shown that E7386 may be able to eliminate drug-resistant cancer stem cells and resensitize resistant tumors to conventional treatment or therapy with an ICI, such as the PD-1 inhibitor pembrolizumab. There are no expected overlapping clearance, metabolic pathways, nor any known overlapping toxicities between E7386 and pembrolizumab monotherapies. Therefore, this combination may provide a novel anticancer treatment in patients with ICI-resistant tumors. This study aims to determine tolerability and efficacy of E7386 in combination with pembrolizumab in previously treated patients with selected solid tumors.
Methods: This open-label, multicenter, phase 1b/2 study (NCT05091346) will assess E7386 + pembrolizumab in patients with certain pretreated advanced solid tumors. Patients with melanoma, colorectal cancer (CRC), or hepatocellular carcinoma (HCC) are eligible. Patients should be ≥ 18 years of age with measurable lesions as assessed by an investigator by RECIST v1.1. In the phase 1b dose escalation, patients (n=6 per dose level; up to n=18 in total) are treated with E7386 orally + pembrolizumab 200 mg IV Q3W (fixed dose). If the initial starting dose of E7386 100 mg BID is considered tolerable (≤1 patient with a dose-limiting toxicity), E7386 may be escalated to 120 mg BID; if not tolerable, E7386 may be reduced to 80 mg BID. Primary objectives for phase 1b are to assess safety and tolerability, as well as to determine the recommended phase 2 dose (RP2D), of E7386 + pembrolizumab. Upon determination of the RP2D, additional patients will be enrolled (approximately 30 patients in each tumor cohort) at this dose to assess safety, tolerability, and efficacy. The primary objective of phase 2 is to assess objective response rate according to RECIST v1.1. Secondary objectives for phases 1b and 2 include efficacy assessments (duration of response, disease control rate, clinical benefit rate) in each tumor cohort, and pharmacokinetics of E7386 when administered in combination with pembrolizumab. Exploratory objectives include assessment of biomarkers, PFS, and OS. Tumors will be assessed by an investigator based on RECIST v1.1, every 6 weeks, and all adverse events (as graded by CTCAE v5.0) will be monitored and recorded. As of January 6, 2022, 2 patients have been enrolled in phase 1b.
Citation Format: Takayuki Yoshino, Masafumi Ikeda, Richard S. Finn, Thomas R. Jeffry Evans, Lidong Weng, Kenichi Saito, Kalgi Mody, Toshiyuki Tamai, Costanza Paoletti, Satoru Iwasa. An open-label, multicenter, phase 1b/2 Study of E7386 (Wnt/β-catenin pathway inhibitor) + pembrolizumab in patients with pretreated advanced solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT523.
Collapse
Affiliation(s)
| | | | - Richard S. Finn
- 2Geffen School of Medicine, UCLA Medical Center, Santa Monica, CA
| | - Thomas R. Jeffry Evans
- 3University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
13
|
Motzer RJ, Taylor MH, Evans TRJ, Okusaka T, Glen H, Lubiniecki GM, Dutcus C, Smith AD, Okpara CE, Hussein Z, Hayato S, Tamai T, Makker V. Lenvatinib dose, efficacy, and safety in the treatment of multiple malignancies. Expert Rev Anticancer Ther 2022; 22:383-400. [PMID: 35260027 PMCID: PMC9484451 DOI: 10.1080/14737140.2022.2039123] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/03/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Lenvatinib is an oral multitargeted tyrosine kinase inhibitor that has shown efficacy and manageable safety across multiple cancer types. The recommended starting doses for lenvatinib differ across cancer types and indications based on whether it is used as monotherapy or as combination therapy. AREAS COVERED This review covers clinical trials that established the dosing paradigm and efficacy of lenvatinib and defined its adverse-event profile as a monotherapy; or in combination with the mTOR inhibitor, everolimus; or the anti-PD-1 antibody, pembrolizumab; and/or chemotherapy. EXPERT OPINION Lenvatinib has been established as standard-of-care either as a monotherapy or in combination with other anticancer agents for the treatment of radioiodine-refractory differentiated thyroid carcinoma, hepatocellular carcinoma, renal cell carcinoma, and endometrial carcinoma, and is being investigated further across several other tumor types. The dosing and adverse-event management strategies for lenvatinib have been developed through extensive clinical trial experience. Collectively, the data provide the rationale to start lenvatinib at the recommended doses and then interrupt or dose reduce as necessary to achieve required dose intensity for maximized patient benefit. The adverse-event profile of lenvatinib is consistent with that of other tyrosine kinase inhibitors, and clinicians are encouraged to review and adopt relevant symptom-management strategies.
Collapse
Affiliation(s)
- Robert J. Motzer
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY, USA
| | - Matthew H. Taylor
- Division of Hematology and Oncology, Earle A. Chiles Research Institute, Providence Portland Medical Center, Portland, OR, USA
| | - Thomas R. Jeffry Evans
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hilary Glen
- Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Gregory M. Lubiniecki
- Global Clinical Development, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | | | - Ziad Hussein
- Clinical Pharmacology Science, Eisai Europe Ltd., Hatfield, UK
| | - Seiichi Hayato
- Clinical Pharmacology Science, Eisai Co., Ltd., Tokyo, Japan
| | | | - Vicky Makker
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY, USA
| |
Collapse
|
14
|
Glen C, Tan YY, Waterston A, Evans TRJ, Jones RJ, Petrie MC, Lang NN. Mechanistic and Clinical Overview Cardiovascular Toxicity of BRAF and MEK Inhibitors: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2022; 4:1-18. [PMID: 35492830 PMCID: PMC9040125 DOI: 10.1016/j.jaccao.2022.01.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/07/2022] [Indexed: 02/07/2023] Open
Abstract
Rapidly accelerated fibrosarcoma B-type (BRAF) and mitogen-activated extracellular signal-regulated kinase (MEK) inhibitors have revolutionized melanoma treatment. Approximately half of patients with melanoma harbor a BRAF gene mutation with subsequent dysregulation of the RAF-MEK-ERK signaling pathway. Targeting this pathway with BRAF and MEK blockade results in control of cell proliferation and, in most cases, disease control. These pathways also have cardioprotective effects and are necessary for normal vascular and cardiac physiology. BRAF and MEK inhibitors are associated with adverse cardiovascular effects including hypertension, left ventricular dysfunction, venous thromboembolism, atrial arrhythmia, and electrocardiographic QT interval prolongation. These effects may be underestimated in clinical trials. Baseline cardiovascular assessment and follow-up, including serial imaging and blood pressure assessment, are essential to balance optimal anti-cancer therapy while minimizing cardiovascular side effects. In this review, an overview of BRAF/MEK inhibitor-induced cardiovascular toxicity, the mechanisms underlying these, and strategies for surveillance, prevention, and treatment of these effects are provided.
Collapse
Key Words
- ACE, angiotensin-converting enzyme
- AF, atrial fibrillation
- BRAF inhibitor
- BRAF, rapidly accelerated fibrosarcoma B-type
- CVAE, cardiovascular adverse event
- EGFR, epidermal growth factor receptor
- ERK, extracellular signal-regulated kinase
- LVSD, left ventricular systolic dysfunction
- MEK inhibitor
- MEK, mitogen-activated extracellular signal-regulated kinase
- RAF, rapidly accelerated fibrosarcoma
- VEGF, vascular endothelial growth factor
- cardio-oncology
- cardiovascular toxicity
- hypertension
- left ventricular systolic dysfunction
- melanoma
Collapse
Affiliation(s)
- Claire Glen
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Yun Yi Tan
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Ashita Waterston
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Thomas R. Jeffry Evans
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Robert J. Jones
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mark C. Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ninian N. Lang
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| |
Collapse
|
15
|
Finn RS, Kudo M, Cheng AL, Wyrwicz L, Ngan RKC, Blanc JF, Baron AD, Vogel A, Ikeda M, Piscaglia F, Han KH, Qin S, Minoshima Y, Kanekiyo M, Ren M, Dairiki R, Tamai T, Dutcus CE, Ikezawa H, Funahashi Y, Evans TRJ. Pharmacodynamic Biomarkers Predictive of Survival Benefit with Lenvatinib in Unresectable Hepatocellular Carcinoma: From the Phase III REFLECT Study. Clin Cancer Res 2021; 27:4848-4858. [PMID: 34108184 PMCID: PMC9401497 DOI: 10.1158/1078-0432.ccr-20-4219] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/25/2021] [Accepted: 06/02/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE In REFLECT, lenvatinib demonstrated an effect on overall survival (OS) by confirmation of noninferiority to sorafenib in unresectable hepatocellular carcinoma. This analysis assessed correlations between serum or tissue biomarkers and efficacy outcomes from REFLECT. EXPERIMENTAL DESIGN Serum biomarkers (VEGF, ANG2, FGF19, FGF21, and FGF23) were measured by ELISA. Gene expression in tumor tissues was measured by the nCounter PanCancer Pathways Panel. Pharmacodynamic changes in serum biomarker levels from baseline, and associations of clinical outcomes with baseline biomarker levels, were evaluated. RESULTS Four hundred and seven patients were included in the serum analysis set (lenvatinib n = 279, sorafenib n = 128); 58 patients were included in the gene-expression analysis set (lenvatinib n = 34, sorafenib n = 24). Both treatments were associated with increases in VEGF; only lenvatinib was associated with increases in FGF19 and FGF23 at all time points. Lenvatinib-treated responders had greater increases in FGF19 and FGF23 versus nonresponders at cycle 4, day 1 (FGF19: 55.2% vs. 18.3%, P = 0.014; FGF23: 48.4% vs. 16.4%, P = 0.0022, respectively). Higher baseline VEGF, ANG2, and FGF21 correlated with shorter OS in both treatment groups. OS was longer for lenvatinib than sorafenib [median, 10.9 vs. 6.8 months, respectively; HR, 0.53; 95% confidence interval (CI), 0.33-0.85; P-interaction = 0.0397] with higher baseline FGF21. In tumor tissue biomarker analysis, VEGF/FGF-enriched groups showed improved OS with lenvatinib versus the intermediate VEGF/FGF group (HR, 0.39; 95% CI, 0.16-0.91; P = 0.0253). CONCLUSIONS Higher baseline levels of VEGF, FGF21, and ANG2 may be prognostic for shorter OS. Higher baseline FGF21 may be predictive for longer OS with lenvatinib compared with sorafenib, but this needs confirmation.
Collapse
Affiliation(s)
- Richard S Finn
- Division of Hematology/Oncology, Geffen School of Medicine, UCLA Medical Center, Santa Monica, California.
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ann-Lii Cheng
- National Taiwan University Cancer Center, Taipei, Taiwan
| | - Lucjan Wyrwicz
- Centrum Onkologii-Instytut im., M. Sklodowskiej Curie, Warsaw, Poland
| | | | | | - Ari D Baron
- California Pacific Medical Center, San Francisco, California
| | | | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Fabio Piscaglia
- General and University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Kwang-Hyub Han
- Severance Hospital, Yonsei University, Seoul, South Korea
| | - Shukui Qin
- Nanjing Bayi Hospital, Nanjing, Jiangsu, China
| | | | | | - Min Ren
- Eisai Inc., Woodcliff Lake, New Jersey
| | | | | | | | | | | | | |
Collapse
|
16
|
Lei M, Siemers NO, Pandya D, Chang H, Sanchez T, Harbison C, Szabo PM, Janjigian Y, Ott PA, Sharma P, Bendell J, Evans TRJ, de Braud F, Chau I, Boyd Z. Analyses of PD-L1 and Inflammatory Gene Expression Association with Efficacy of Nivolumab ± Ipilimumab in Gastric Cancer/Gastroesophageal Junction Cancer. Clin Cancer Res 2021; 27:3926-3935. [PMID: 33782030 DOI: 10.1158/1078-0432.ccr-20-2790] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/02/2020] [Accepted: 03/24/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE In advanced gastric cancer/gastroesophageal junction cancer (GC/GEJC), there is a need to identify biomarkers of response to therapies, such as immune checkpoint inhibitors. PATIENTS AND METHODS In post hoc exploratory analyses from CheckMate 032 (GC/GEJC cohort), we evaluated associations between nivolumab ± ipilimumab (NIVO ± IPI) efficacy and programmed death ligand 1 (PD-L1) expression, defined by tumor cells (% TC) or combined positive score (CPS; sum of PD-L1-staining TCs + immune cells, divided by total viable TCs, × 100) using the Dako PD-L1 IHC 28-8 pharmDx assay, or inflammatory gene expression. RESULTS There was a trend toward increased efficacy (objective response and overall survival) when PD-L1 expression was determined by CPS compared with % TC at higher cutoffs of ≥5 and ≥10 in the pooled analysis of all treatment regimens. In this analysis, 19% and 26% of patients with PD-L1-positive tumors at a CPS cutoff of ≥5 and ≥10, respectively, had an objective response compared with 8% and 9% of patients at the equivalent % TC cutoffs. Longer survival was demonstrated in patients with PD-L1-positive (defined by CPS cutoffs of ≥5 and ≥10) versus PD-L1-negative status. Similar results were observed in the NIVO 1 mg/kg + IPI 3 mg/kg subgroup. Multiple inflammatory gene signatures/transcripts, including a signature consisting of four genes (CD274, CD8A, LAG3, and STAT1), showed associations with response to NIVO ± IPI. CONCLUSIONS This study suggests a greater association of PD-L1 expression by CPS with NIVO ± IPI efficacy compared with % TC PD-L1 expression in patients with GC/GEJC. Inflammatory signatures were also associated with NIVO ± IPI response, warranting further investigation.See related commentary by Moutafi and Rimm, p. 3812.
Collapse
Affiliation(s)
- Ming Lei
- Bristol Myers Squibb, Princeton, New Jersey.
| | | | | | - Han Chang
- Bristol Myers Squibb, Princeton, New Jersey
| | | | | | | | - Yelena Janjigian
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Padmanee Sharma
- Genitourinary Medical Oncology and Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Johanna Bendell
- Drug Development Unit, Sarah Cannon Research Institute at Tennessee Oncology, Nashville, Tennessee
| | - Thomas R Jeffry Evans
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom
| | - Filippo de Braud
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- University of Milan, Milan, Italy
| | - Ian Chau
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | | |
Collapse
|
17
|
Marks DK, Kucharczyk J, Kim P, Chyong DI, Gartrell RD, Lu Y, Hibshoosh H, Guo H, Evans TRJ, Lopez J, Kristeleit R, Connolly E, Saenger Y, Kalinsky K. Quantitative Multiplex Immunofluorescence Evaluation of the Tumor Microenvironment in Pretreatment Tumors of Patients with Metastatic Breast Cancer and Serous Ovarian Carcinoma Treated with Liposomal Eribulin. Cancer Invest 2021; 39:466-472. [PMID: 34075851 DOI: 10.1080/07357907.2021.1938109] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Eribulin inhibits microtubule polymerization and suppresses epithelial-mesenchymal transition. Conventional pathology approaches have not identified a precise predictive biomarker for Eribulin. We performed qmIF on pre-treatment tissue from 11 patients (6 TNBC, 5 HGSOC) treated with Eribulin-LF. T-lymphocytes were the dominant immune-subset in TME, with higher levels detected in stroma vs tumor (9% vs 2%). Greater density of CD3+ (p = 0.01) and CD3 + CD8+ (p = 0.03) cells and closer proximity between CD3 + CD8+ and tumor cells was observed in the patients with disease control (PR + SD) vs. progressive disease. QmIF identified an association between TIL infiltration and Eribulin-LF sensitivity, which should be evaluated further in prospective studies.
Collapse
Affiliation(s)
- Douglas K Marks
- Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
- NYU Long Island School of Medicine, NYU Langone Health, New York, New York, USA
| | - John Kucharczyk
- NYU Long Island School of Medicine, NYU Langone Health, New York, New York, USA
| | - Pan Kim
- College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Donian I Chyong
- Columbia College, Columbia University, New York, New York, USA
| | - Robyn D Gartrell
- Department of Pediatrics, Pediatric Hematology/Oncology and Medicine, Hematology/Oncology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yan Lu
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
| | - Hanina Hibshoosh
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Hua Guo
- Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | | | - Rebecca Kristeleit
- Department of Oncology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Eileen Connolly
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
- Division of Radiation Oncology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yvonne Saenger
- College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
| | - Kevin Kalinsky
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
18
|
Annese VF, Patil SB, Hu C, Giagkoulovits C, Al-Rawhani MA, Grant J, Macleod M, Clayton DJ, Heaney LM, Daly R, Accarino C, Shah YD, Cheah BC, Beeley J, Evans TRJ, Jones R, Barrett MP, Cumming DRS. A monolithic single-chip point-of-care platform for metabolomic prostate cancer detection. Microsyst Nanoeng 2021; 7:21. [PMID: 34567735 PMCID: PMC8433377 DOI: 10.1038/s41378-021-00243-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/05/2020] [Accepted: 12/15/2020] [Indexed: 05/18/2023]
Abstract
There is a global unmet need for rapid and cost-effective prognostic and diagnostic tools that can be used at the bedside or in the doctor's office to reduce the impact of serious disease. Many cancers are diagnosed late, leading to costly treatment and reduced life expectancy. With prostate cancer, the absence of a reliable test has inhibited the adoption of screening programs. We report a microelectronic point-of-care metabolite biomarker measurement platform and use it for prostate cancer detection. The platform, using an array of photodetectors configured to operate with targeted, multiplexed, colorimetric assays confined in monolithically integrated passive microfluidic channels, completes a combined assay of 4 metabolites in a drop of human plasma in under 2 min. A preliminary clinical study using l-amino acids, glutamate, choline, and sarcosine was used to train a cross-validated random forest algorithm. The system demonstrated sensitivity to prostate cancer of 94% with a specificity of 70% and an area under the curve of 0.78. The technology can implement many similar assay panels and hence has the potential to revolutionize low-cost, rapid, point-of-care testing.
Collapse
Affiliation(s)
- Valerio F. Annese
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - Samadhan B. Patil
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - Chunxiao Hu
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - Christos Giagkoulovits
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - Mohammed A. Al-Rawhani
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - James Grant
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - Martin Macleod
- Beatson West of Scotland Cancer Centre, Glasgow, G12 0YN UK
| | - David J. Clayton
- School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NF UK
| | - Liam M. Heaney
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, LE11 3TU UK
| | - Ronan Daly
- Glasgow Polyomics, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1BD UK
| | - Claudio Accarino
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - Yash D. Shah
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - Boon C. Cheah
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - James Beeley
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| | - Thomas R. Jeffry Evans
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, G12 0YN UK
| | - Robert Jones
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, G12 0YN UK
| | - Michael P. Barrett
- Glasgow Polyomics, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1BD UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8TA UK
| | - David R. S. Cumming
- Electronics and Nanoscale Engineering, James Watt School of Engineering, University of Glasgow, Glasgow, G12 8QQ UK
| |
Collapse
|
19
|
Middleton MR, McAlpine C, Woodcock VK, Corrie P, Infante JR, Steven NM, Evans TRJ, Anthoney A, Shoushtari AN, Hamid O, Gupta A, Vardeu A, Leach E, Naidoo R, Stanhope S, Lewis S, Hurst J, O'Kelly I, Sznol M. Tebentafusp, A TCR/Anti-CD3 Bispecific Fusion Protein Targeting gp100, Potently Activated Antitumor Immune Responses in Patients with Metastatic Melanoma. Clin Cancer Res 2020; 26:5869-5878. [PMID: 32816891 PMCID: PMC9210997 DOI: 10.1158/1078-0432.ccr-20-1247] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/11/2020] [Accepted: 08/14/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Tebentafusp is a first-in-class bispecific fusion protein designed to target gp100 (a melanoma-associated antigen) through a high affinity T-cell receptor (TCR) binding domain and an anti-CD3 T-cell engaging domain, which redirects T cells to kill gp100-expressing tumor cells. Here, we report a multicenter phase I/II trial of tebentafusp in metastatic melanoma (NCT01211262) focusing on the mechanism of action of tebentafusp. PATIENTS AND METHODS Eighty-four patients with advanced melanoma received tebentafusp. Treatment efficacy, treatment-related adverse events, and biomarker assessments were performed for blood-derived and tumor biopsy samples obtained at baseline and on-treatment. RESULTS Tebentafusp was generally well-tolerated and active in both patients with metastatic uveal melanoma and patients with metastatic cutaneous melanoma. A 1-year overall survival rate of 65% was achieved for both patient cohorts. On-treatment cytokine measurements were consistent with the induction of IFNγ pathway-related markers in the periphery and tumor. Notably, tebentafusp induced an increase in serum CXCL10 (a T-cell attractant) and a reduction in circulating CXCR3+ CD8+ T cells together with an increase in cytotoxic T cells in the tumor microenvironment. Furthermore, increased serum CXCL10 or the appearance of rash (likely due to cytotoxic T cells targeting gp100-expressing skin melanocytes) showed a positive association with patient survival. CONCLUSIONS These data suggest that redirecting T cells using a gp100-targeting TCR/anti-CD3 bispecific fusion protein may provide benefit to patients with metastatic melanoma. Furthermore, the activity observed in these two molecularly disparate melanoma classes hints at the broad therapeutic potential of tebentafusp.
Collapse
Affiliation(s)
- Mark R Middleton
- Department of Oncology, Medical Sciences Division, University of Oxford, Headington, Oxford, United Kingdom.
| | | | - Victoria K Woodcock
- Department of Oncology, Medical Sciences Division, University of Oxford, Headington, Oxford, United Kingdom
| | - Pippa Corrie
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Neil M Steven
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Thomas R Jeffry Evans
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Alan Anthoney
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Omid Hamid
- Immunooncology, The Angeles Clinic and Research Institute, Los Angeles, California
| | - Avinash Gupta
- Department of Oncology, Medical Sciences Division, University of Oxford, Headington, Oxford, United Kingdom
| | | | - Emma Leach
- Immunocore Ltd, Abingdon, Oxford, United Kingdom
| | | | | | - Sion Lewis
- Immunocore Ltd, Abingdon, Oxford, United Kingdom
| | - Jacob Hurst
- Immunocore Ltd, Abingdon, Oxford, United Kingdom
| | - Ita O'Kelly
- Immunocore Ltd, Abingdon, Oxford, United Kingdom
| | - Mario Sznol
- Yale Cancer Center, Yale School of Medicine, Yale, Connecticut
| |
Collapse
|
20
|
Briggs A, Daniele B, Dick K, Evans TRJ, Galle PR, Hubner RA, Lopez C, Siebert U, Tremblay G. Covariate-adjusted analysis of the Phase 3 REFLECT study of lenvatinib versus sorafenib in the treatment of unresectable hepatocellular carcinoma. Br J Cancer 2020; 122:1754-1759. [PMID: 32265508 PMCID: PMC7283323 DOI: 10.1038/s41416-020-0817-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/27/2020] [Accepted: 03/11/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the Phase 3 REFLECT trial in patients with unresectable hepatocellular carcinoma (uHCC), the multitargeted tyrosine kinase inhibitor, lenvatinib, was noninferior to sorafenib in the primary outcome of overall survival. Post-hoc review revealed imbalances in prognostic variables between treatment arms. Here, we re-analyse overall survival data from REFLECT to adjust for the imbalance in covariates. METHODS Univariable and multivariable adjustments were undertaken for a candidate set of covariate values that a physician panel indicated could be prognostically associated with overall survival in uHCC. The values included baseline variables observed pre- and post-randomisation. Univariable analyses were based on a stratified Cox model. The multivariable analysis used a "forwards stepwise" Cox model. RESULTS Univariable analysis identified alpha-fetoprotein (AFP) as the most influential variable. The chosen multivariable Cox model analysis resulted in an estimated adjusted hazard ratio for lenvatinib of 0.814 (95% CI: 0.699-0.948) when only baseline variables were included. Adjusting for post-randomisation treatment variables further increased the estimated superiority of lenvatinib. CONCLUSIONS Covariate adjustment of REFLECT suggests that the original noninferiority trial likely underestimated the true effect of lenvatinib on overall survival due to an imbalance in baseline prognostic covariates and the greater use of post-treatment therapies in the sorafenib arm. TRIAL REGISTRATION Trial number: NCT01761266 (Submitted January 2, 2013).
Collapse
Affiliation(s)
- Andrew Briggs
- Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | | | | | | | - Peter R Galle
- Medical Department, University Medical Center Mainz, Mainz, Germany
| | | | - Carlos Lopez
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics, and Technology, Hall i.T., Hall in Tirol, Austria
- Department of Health Policy and Management, Harvard Chan School of Public Health and Dept of Radiology, Harvard Medical School, Boston, MA, USA
- Division of HTA, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Gabriel Tremblay
- Department of Health Economics and HTA, Purple Squirrel Economics, New York, NY, USA
| |
Collapse
|
21
|
Alsina A, Kudo M, Vogel A, Cheng AL, Tak WY, Ryoo BY, Evans TRJ, López López C, Daniele B, Misir S, Ren M, Izumi N, Qin S, Finn RS. Effects of Subsequent Systemic Anticancer Medication Following First-Line Lenvatinib: A Post Hoc Responder Analysis from the Phase 3 REFLECT Study in Unresectable Hepatocellular Carcinoma. Liver Cancer 2020; 9:93-104. [PMID: 32071913 PMCID: PMC7024884 DOI: 10.1159/000504624] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/18/2019] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Understanding the relationship between subsequent-line therapies and overall survival (OS) is important for maximizing OS for patients with hepatocellular carcinoma. OBJECTIVE In this post hoc analysis, we investigated OS in lenvatinib- and sorafenib-treated patients from the REFLECT study, who then received subsequent anticancer medication during the survival follow-up period. METHODS The follow-up period commenced at the first off-treatment visit after stopping the study medication and continued until study termination, withdrawal of consent, or death. OS and objective response rate were calculated for patients who did or did not receive poststudy anticancer medication for both treatment arms, as well as for the overall cohort. We investigated the subset of patients who responded to first-line treatment and subsequently received anticancer medication. RESULTS The OS for patients initially randomized to first-line lenvatinib (versus first-line sorafenib) and who then received any subsequent anticancer medication was 20.8 vs. 17.0 months (hazard ratio [HR] 0.87; 95% CI 0.67-1.14). The OS for patients who initially received first-line lenvatinib (versus first-line sorafenib) and who did not receive any subsequent anticancer medication was 11.5 vs. 9.1 months (HR 0.90; 95% CI 0.75-1.09). Responders to first-line lenvatinib who received subsequent medication had a median OS of 25.7 months (95% CI 18.5-34.6); responders to first line-sorafenib who received subsequent medication had a median OS of 22.3 months (95% CI 14.6-not evaluable). CONCLUSIONS In this post hoc analysis of all patients in the REFLECT study who received subsequent anticancer medication, OS was increased compared with patients who did not receive any subsequent anticancer medication. In a subset analysis of responders who had received subsequent anticancer medication, use of first-line lenvatinib led to a slightly longer median OS; more research is needed on the benefits of using first-line lenvatinib compared with sorafenib.
Collapse
Affiliation(s)
- Angel Alsina
- aTransplant and Specialty Services, Tampa General Hospital, Tampa, Florida, USA,*Angel Alsina, MD, Tampa General Hospital, 409 Bayshore Blvd, Tampa, FL 33606 (USA), E-Mail
| | - Masatoshi Kudo
- bDepartment of Medicine, Kindai University, Osaka, Japan
| | - Arndt Vogel
- cDepartment of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ann-Lii Cheng
- dDepartment of Medical Oncology, National Taiwan University Hospital, and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Won Young Tak
- eDepartment of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Baek-Yeol Ryoo
- fDepartment of Oncology, Asan Medical Center, and University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Thomas R. Jeffry Evans
- gInstitute of Cancer Sciences, Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, United Kingdom
| | - Carlos López López
- hOncology Service, Marqués de Valdecilla University Hospital, IDIVAL, Santander, Spain
| | - Bruno Daniele
- iDepartment of Oncology, Azienda Ospedaliera G. Rummo, Benevento, Italy and Ospedale del Mare, Naples, Italy
| | | | - Min Ren
- kEisai Inc., Woodcliff Lake, New Jersey, USA
| | - Namiki Izumi
- lDepartment of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Shukui Qin
- mPLA Cancer Center, Nanjing Bayi Hospital, Nanjing, Jiangsu, China
| | - Richard S. Finn
- nGeffen School of Medicine, Department of Medicine, UCLA Medical Center, Santa Monica, California, USA
| |
Collapse
|
22
|
Evans TRJ, Kudo M, Finn RS, Han KH, Cheng AL, Ikeda M, Kraljevic S, Ren M, Dutcus CE, Piscaglia F, Sung MW. Correction: Urine protein:creatinine ratio vs 24-hour urine protein for proteinuria management: analysis from the phase 3 REFLECT study of lenvatinib vs sorafenib in hepatocellular carcinoma. Br J Cancer 2019; 121:625. [PMID: 31363170 PMCID: PMC6889263 DOI: 10.1038/s41416-019-0534-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Richard S Finn
- David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Kwang-Hyub Han
- Severance Hospital, Yonsei University, Seoul, South Korea
| | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Min Ren
- Eisai Inc., Woodcliff Lake, NJ, USA
| | | | - Fabio Piscaglia
- Unit of Internal Medicine, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Max W Sung
- Tisch Cancer Institute at Mount Sinai, New York, NY, USA
| |
Collapse
|
23
|
Evans TRJ, Kudo M, Finn RS, Han KH, Cheng AL, Ikeda M, Kraljevic S, Ren M, Dutcus CE, Piscaglia F, Sung MW. Urine protein:creatinine ratio vs 24-hour urine protein for proteinuria management: analysis from the phase 3 REFLECT study of lenvatinib vs sorafenib in hepatocellular carcinoma. Br J Cancer 2019; 121:218-221. [PMID: 31249394 PMCID: PMC6738107 DOI: 10.1038/s41416-019-0506-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/24/2019] [Accepted: 06/05/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Proteinuria monitoring is required in patients receiving lenvatinib, however, current methodology involves burdensome overnight urine collection. METHODS To determine whether the simpler urine protein:creatinine ratio (UPCR) calculated from spot urine samples could be accurately used for proteinuria monitoring in patients receiving lenvatinib, we evaluated the correlation between UPCR and 24-hour urine protein results from the phase 3 REFLECT study. Paired data (323 tests, 154 patients) were analysed. RESULTS Regression analysis showed a statistically significant correlation between UPCR and 24-hour urine protein (R2: 0.75; P < 2 × 10-16). A UPCR cut-off value of 2.4 had 96.9% sensitivity, 82.5% specificity for delineating between grade 2 and 3 proteinuria. Using this UPCR cut-off value to determine the need for further testing could reduce the need for 24-hour urine collection in ~74% of patients. CONCLUSION Incorporation of UPCR into the current algorithm for proteinuria management can enable optimisation of lenvatinib treatment, while minimising patient inconvenience. CLINICAL TRIAL REGISTRATION NCT01761266.
Collapse
Affiliation(s)
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Richard S Finn
- David Geffen School of Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Kwang-Hyub Han
- Severance Hospital, Yonsei University, Seoul, South Korea
| | - Ann-Lii Cheng
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Min Ren
- Eisai Inc., Woodcliff Lake, NJ, USA
| | | | - Fabio Piscaglia
- Unit of Internal Medicine, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Max W Sung
- Tisch Cancer Institute at Mount Sinai, New York, NY, USA
| |
Collapse
|
24
|
Evans TRJ, Van Cutsem E, Moore MJ, Bazin IS, Rosemurgy A, Bodoky G, Deplanque G, Harrison M, Melichar B, Pezet D, Elekes A, Rock E, Lin C, Strauss L, O'Dwyer PJ. Phase 2 placebo-controlled, double-blind trial of dasatinib added to gemcitabine for patients with locally-advanced pancreatic cancer. Ann Oncol 2017; 28:354-361. [PMID: 27998964 DOI: 10.1093/annonc/mdw607] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) has a high mortality rate with limited treatment options. Gemcitabine provides a marginal survival benefit for patients with advanced PDAC. Dasatinib is a competitive inhibitor of Src kinase, which is overexpressed in PDAC tumors. Dasatinib and gemcitabine were combined in a phase 1 clinical trial where stable disease was achieved in two of eight patients with gemcitabine-refractory PDAC. Patients and methods This placebo-controlled, randomized, double-blind, phase II study compared the combination of gemcitabine plus dasatinib to gemcitabine plus placebo in patients with locally advanced, non-metastatic PDAC. Patients received gemcitabine 1000 mg/m2 (30-min IV infusion) on days 1, 8, 15 of a 28-day cycle combined with either 100 mg oral dasatinib or placebo tablets daily. The primary objective was overall survival (OS), with safety and progression-free survival (PFS) as secondary objectives. Exploratory endpoints included overall response rate, freedom from distant metastasis, pain and fatigue progression and response rate, and CA19-9 response rate. Results There was no statistically significant difference in OS between the two treatment groups (HR = 1.16; 95% confidence interval [CI]: 0.81-1.65; P = 0.5656). Secondary and exploratory endpoint analyses also showed no statistically significant differences. The burden of toxicity was higher in the dasatinib arm. Conclusions Dasatinib failed to show increased OS or PFS in patients with locally advanced PDAC. Alternative combinations or trial designs may show a role for src inhibition in PDAC treatment.
Collapse
Affiliation(s)
- T R J Evans
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - E Van Cutsem
- Department of Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - M J Moore
- Princess Margaret Cancer, Toronto, Canada
| | - I S Bazin
- Federal State Budgetary Institution, Dubna, Russia
| | - A Rosemurgy
- Surgery, Florida Hospital, Tampa, Tampa, USA
| | - G Bodoky
- Oncology, St.László Teaching Hospital, Budapest, Hungary
| | - G Deplanque
- Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - M Harrison
- East and North Hertfordshire NHS Trust, Northwood, Middlesex, UK
| | - B Melichar
- Department of Oncology, Lekarska Fakulta Univerzity Palackeho a Fakultni Nemocnice, Olomouc, Czech Republic
| | - D Pezet
- CHU Estaing, Clermont-Ferrand, France
| | - A Elekes
- Otsuka Pharmaceutical Development and Commercialization, Princeton
| | - E Rock
- Otsuka Pharmaceutical Development and Commercialization, Princeton
| | - C Lin
- Otsuka Pharmaceutical Development and Commercialization, Princeton
| | - L Strauss
- Bristol-Myers Squibb Company, Princeton
| | - P J O'Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
25
|
Soria JC, Gan HK, Blagden SP, Plummer R, Arkenau HT, Ranson M, Evans TRJ, Zalcman G, Bahleda R, Hollebecque A, Lemech C, Dean E, Brown J, Gibson D, Peddareddigari V, Murray S, Nebot N, Mazumdar J, Swartz L, Auger KR, Fleming RA, Singh R, Millward M. A phase I, pharmacokinetic and pharmacodynamic study of GSK2256098, a focal adhesion kinase inhibitor, in patients with advanced solid tumors. Ann Oncol 2016; 27:2268-2274. [PMID: 27733373 DOI: 10.1093/annonc/mdw427] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Focal adhesion kinase (FAK) is important in cancer growth, survival, invasion, and migration. The purpose of this study was to determine the maximum tolerated dose (MTD), safety, pharmacokinetics (PK), and pharmacodynamics (PD) of the FAK inhibitor, GSK2256098, in cancer patients. PATIENTS AND METHODS The dose of GSK2256098 was escalated, in cohorts of patients with advanced cancer, from 80 to 1500 mg, oral twice daily (BID), until the MTD was determined. Serial blood samples were obtained from all patients, and the PK was determined. Paired tumor biopsies were obtained in select patients, and the level of phospho-FAK (pFAK) was determined. RESULTS Sixty-two patients (39 males, 23 females; median age 61 y.o., range 21-84) received GSK2256098. Dose-limiting toxicities of grade 2 proteinuria (1000 mg BID), grade 2 fatigue, nausea, vomiting (1250 mg BID), and grade 3 asthenia and grade 2 fatigue (1500 mg BID) were reported with the MTD identified as 1000 mg BID. The most frequent adverse events (AEs) were nausea (76%), diarrhea (65%), vomiting (58%), and decreased appetite (47%) with the majority of AEs being grades 1-2. The PK was generally dose proportional with a geometric mean elimination half-life range of 4-9 h. At the 750, 1000, and 1500 mg BID dose levels evaluated, the pFAK, Y397 autophosphorylation site, was reduced by ∼80% from baseline. Minor responses were observed in a patient with melanoma (-26%) and three patients with mesothelioma (-13%, -15%, and -17%). In the 29 patients with recurrent mesothelioma, the median progression-free survival was 12 weeks with 95% CI 9.1, 23.4 weeks (23.4 weeks merlin negative, n = 14; 11.4 weeks merlin positive, n = 9; 10.9 weeks merlin status unknown, n = 6). CONCLUSIONS GSK2256098 has an acceptable safety profile, has evidence of target engagement at doses at or below the MTD, and has clinical activity in patients with mesothelioma, particularly those with merlin loss.
Collapse
Affiliation(s)
- J C Soria
- Drug Development Department at Gustave Roussy Cancer Campus, University Paris-Sud, Paris, France
| | - H K Gan
- Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
- School of Cancer Medicine, Latrobe University, Melbourne, Australia
| | - S P Blagden
- Imperial College, Hammersmith Hospital, London
| | - R Plummer
- Northern Centre for Cancer Care, Newcastle
| | | | - M Ranson
- University of Manchester, Christie Hospital, Manchester
| | - T R J Evans
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - G Zalcman
- Early Phases Clinical Trials Unit at Caen University Hospital, Caen, France
| | - R Bahleda
- Drug Development Department at Gustave Roussy Cancer Campus, University Paris-Sud, Paris, France
| | - A Hollebecque
- Drug Development Department at Gustave Roussy Cancer Campus, University Paris-Sud, Paris, France
| | - C Lemech
- Sarah Cannon Research Institute, London
| | - E Dean
- University of Manchester, Christie Hospital, Manchester
| | - J Brown
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Gibson
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - V Peddareddigari
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - S Murray
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - N Nebot
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - J Mazumdar
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - L Swartz
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - K R Auger
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - R A Fleming
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - R Singh
- GlaxoSmithKline, Research Triangle Park, NC and Upper Providence, Collegeville, USA
| | - M Millward
- School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia
| |
Collapse
|
26
|
Milojkovic Kerklaan B, Slater S, Flynn M, Greystoke A, Witteveen PO, Megui-Roelvink M, de Vos F, Dean E, Reyderman L, Ottesen L, Ranson M, Lolkema MPJ, Plummer R, Kristeleit R, Evans TRJ, Schellens JHM. A phase I, dose escalation, pharmacodynamic, pharmacokinetic, and food-effect study of α2 integrin inhibitor E7820 in patients with advanced solid tumors. Invest New Drugs 2016; 34:329-37. [PMID: 27039386 DOI: 10.1007/s10637-016-0344-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 01/13/2023]
Abstract
UNLABELLED Introduction E7820 is an orally administered sulfonamide that inhibits alfa-2-integrin mRNA expression. Pre-clinically E7820 showed tumor anti-angiogenic effects in various tumor cell lines and xenograft mouse models. Human daily dosing of 100 mg QD had previously been shown to be safe and tolerable. Methods The study consisted of two parts: Part A (food effect) and Part B (determination of maximum tolerated dose (MTD) for bi-daily (BID) dosing). E7820 dosing started at 50 mg BID with planned escalation to 60, 80 and 100 mg BID every 28 days. Results Fifteen patients were enrolled in Part A and 26 in Part B. The most frequent adverse events of all grades were constipation, diarrhea, nausea, and fatigue while anemia, neutropenia, and fatigue were most frequent grade ≥3 toxicities. At dose-level 60 mg BID, two patients experienced dose-limiting toxicities (grade 3 neutropenic sepsis and grade 4 neutropenia). Therefore the recommended dose (RD) was 50 mg BID. Food had no effect on E7820 exposure. E7820 exposure following twice daily administration was dose-proportional. Expression of platelet integrin-α2 measured as a response biomarker in Part B, generally decreased by a median 7.7 % from baseline following treatment with 50 mg BID E7820. Reduction was most pronounced within 1-week post treatment. The median duration of treatment was median 54, range 20-111 days. The best overall response in any treatment group was stable disease (SD): 23.1 % in Part A (100 mg QD); at the RD 66.7 % (12 of 18 patients) and 40 % in the 60 mg BID group in Part B. CONCLUSIONS Food had no effect on E7820 exposure. A dose of 50 mg BID was considered the MTD. Treatment with E7820 is safe and tolerable with 2/3 of patients (66.7 %) at MTD having SD as their best response.
Collapse
Affiliation(s)
- B Milojkovic Kerklaan
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - S Slater
- The Beatson West of Scotland Cancer Centre, University Glasgow, Glasgow, UK
| | - M Flynn
- University College London Hospital, London, United Kingdom
| | - A Greystoke
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | - P O Witteveen
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Megui-Roelvink
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - F de Vos
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Dean
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | | | | | - M Ranson
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | - M P J Lolkema
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
- Erasmus Medical Center Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Plummer
- Sir Bobby Robson Cancer Trials Research Centre Newcastle, Newcastle, UK
| | - R Kristeleit
- University College London Hospital, London, United Kingdom
| | - T R J Evans
- The Beatson West of Scotland Cancer Centre, University Glasgow, Glasgow, UK
| | - J H M Schellens
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
- Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
| |
Collapse
|
27
|
Venugopal B, Awada A, Evans TRJ, Dueland S, Hendlisz A, Rasch W, Hernes K, Hagen S, Aamdal S. A first-in-human phase I and pharmacokinetic study of CP-4126 (CO-101), a nucleoside analogue, in patients with advanced solid tumours. Cancer Chemother Pharmacol 2015; 76:785-92. [PMID: 26289594 DOI: 10.1007/s00280-015-2846-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND CP-4126 (gemcitabine elaidate, previously CO-101) is a lipid-drug conjugate of gemcitabine designed to circumvent human equilibrative nucleoside transporter1-related resistance to gemcitabine. The purpose of this study was to determine the maximum tolerated dose (MTD) and the recommended phase II dose (RP2D) of CP-4126, and to describe its pharmacokinetic profile. METHODS Eligible patients with advanced refractory solid tumours, and adequate performance status, haematological, renal and hepatic function, were treated with one of escalating doses of CP-4126 administered by a 30-min intravenous infusion on days 1, 8 and 15 of a 28-day cycle. Blood and urine samples were collected to determine the pharmacokinetics (PKs) of CP-4126. RESULTS Forty-three patients, median age 59 years (range 18-76; male = 27, female = 16), received one of ten dose levels (30-1600 mg/m(2)). Dose-limiting toxicities included grade 3 anaemia, grade 3 fatigue and grade 3 elevation of transaminases. The MTD and RP2D were 1250 mg/m(2) on basis of the toxicity and PK data. CP-4126 followed dose-dependent kinetics and maximum plasma concentrations occurred at the end of CP-4126 infusion. Seven patients achieved stable disease sustained for ≥3 months, including two patients with pancreatic cancer who had progressed on or after gemcitabine exposure. CONCLUSIONS CP-4126 was well tolerated with comparable toxicity profile to gemcitabine. Future studies are required to determine its anti-tumour efficacy, either alone or in combination with other cytotoxic chemotherapy regimens.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Antimetabolites, Antineoplastic/administration & dosage
- Antimetabolites, Antineoplastic/adverse effects
- Antimetabolites, Antineoplastic/pharmacokinetics
- Antimetabolites, Antineoplastic/therapeutic use
- Cohort Studies
- Deoxycytidine/administration & dosage
- Deoxycytidine/adverse effects
- Deoxycytidine/analogs & derivatives
- Deoxycytidine/pharmacokinetics
- Deoxycytidine/therapeutic use
- Disease Progression
- Dose-Response Relationship, Drug
- Drug Monitoring
- Drug Resistance, Neoplasm
- Drugs, Investigational/administration & dosage
- Drugs, Investigational/adverse effects
- Drugs, Investigational/pharmacokinetics
- Drugs, Investigational/therapeutic use
- Female
- Half-Life
- Humans
- Male
- Metabolic Clearance Rate
- Middle Aged
- Neoplasms/blood
- Neoplasms/drug therapy
- Neoplasms/metabolism
- Neoplasms/pathology
- Tumor Burden/drug effects
- Young Adult
Collapse
Affiliation(s)
- B Venugopal
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK.
- Institute of Cancer Sciences, University of Glasgow, Switchback Road, Glasgow, G61 1BD, UK.
| | - A Awada
- Institut Jules Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - T R J Evans
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
- Institute of Cancer Sciences, University of Glasgow, Switchback Road, Glasgow, G61 1BD, UK
| | - S Dueland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A Hendlisz
- Institut Jules Bordet, Université Libre de Bruxelles, 121, Boulevard de Waterloo, 1000, Brussels, Belgium
| | - W Rasch
- Clavis Pharma ASA, Parkveien 53 B, 0256, Oslo, Norway
| | - K Hernes
- Clavis Pharma ASA, Parkveien 53 B, 0256, Oslo, Norway
| | - S Hagen
- Clavis Pharma ASA, Parkveien 53 B, 0256, Oslo, Norway
| | - S Aamdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
28
|
Miller BW, Morton JP, Pinese M, Saturno G, Jamieson NB, McGhee E, Timpson P, Leach J, McGarry L, Shanks E, Bailey P, Chang D, Oien K, Karim S, Au A, Steele C, Carter CR, McKay C, Anderson K, Evans TRJ, Marais R, Springer C, Biankin A, Erler JT, Sansom OJ. Targeting the LOX/hypoxia axis reverses many of the features that make pancreatic cancer deadly: inhibition of LOX abrogates metastasis and enhances drug efficacy. EMBO Mol Med 2015; 7:1063-76. [PMID: 26077591 PMCID: PMC4551344 DOI: 10.15252/emmm.201404827] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 05/12/2015] [Accepted: 05/21/2015] [Indexed: 12/20/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer-related mortality. Despite significant advances made in the treatment of other cancers, current chemotherapies offer little survival benefit in this disease. Pancreaticoduodenectomy offers patients the possibility of a cure, but most will die of recurrent or metastatic disease. Hence, preventing metastatic disease in these patients would be of significant benefit. Using principal component analysis (PCA), we identified a LOX/hypoxia signature associated with poor patient survival in resectable patients. We found that LOX expression is upregulated in metastatic tumors from Pdx1-Cre Kras(G12D/+) Trp53(R172H/+) (KPC) mice and that inhibition of LOX in these mice suppressed metastasis. Mechanistically, LOX inhibition suppressed both migration and invasion of KPC cells. LOX inhibition also synergized with gemcitabine to kill tumors and significantly prolonged tumor-free survival in KPC mice with early-stage tumors. This was associated with stromal alterations, including increased vasculature and decreased fibrillar collagen, and increased infiltration of macrophages and neutrophils into tumors. Therefore, LOX inhibition is able to reverse many of the features that make PDAC inherently refractory to conventional therapies and targeting LOX could improve outcome in surgically resectable disease.
Collapse
Affiliation(s)
- Bryan W Miller
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | | | - Mark Pinese
- The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Grazia Saturno
- Cancer Research UK Manchester Institute, Withington Manchester, UK
| | - Nigel B Jamieson
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Ewan McGhee
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | - Paul Timpson
- The Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Joshua Leach
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | - Lynn McGarry
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | - Emma Shanks
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | - Peter Bailey
- Institute of Cancer Sciences University of Glasgow Garscube Estate, Glasgow, UK
| | - David Chang
- Institute of Cancer Sciences University of Glasgow Garscube Estate, Glasgow, UK
| | - Karin Oien
- Institute of Cancer Sciences University of Glasgow Garscube Estate, Glasgow, UK
| | - Saadia Karim
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | - Amy Au
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | - Colin Steele
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | | | - Colin McKay
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Kurt Anderson
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| | - Thomas R Jeffry Evans
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK Institute of Cancer Sciences University of Glasgow Garscube Estate, Glasgow, UK
| | - Richard Marais
- Cancer Research UK Manchester Institute, Withington Manchester, UK
| | | | - Andrew Biankin
- Institute of Cancer Sciences University of Glasgow Garscube Estate, Glasgow, UK
| | - Janine T Erler
- Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen (UCPH), Denmark
| | - Owen J Sansom
- Cancer Research UK Beatson Institute Garscube Estate, Glasgow, UK
| |
Collapse
|
29
|
Cassier PA, Polivka V, Judson I, Soria JC, Penel N, Marsoni S, Verweij J, Schellens JH, Morales-Barrera R, Schöffski P, Voest EE, Gomez-Roca C, Evans TRJ, Plummer R, Gallerani E, Kaye SB, Olmos D. Outcome of patients with sarcoma and other mesenchymal tumours participating in phase I trials: a subset analysis of a European Phase I database. Ann Oncol 2014; 25:1222-8. [PMID: 24608201 DOI: 10.1093/annonc/mdu108] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although sarcomas account for only 1% of all solid tumours, patients with sarcomas comprise a larger proportion of patients entering phase I trials, due to the limited number of registered or active drugs for these diseases. To help in patient selection, we evaluated the utility of the predictive Royal Marsden Score which had been derived in carcinoma patients. In addition, we analysed efficacy and toxicity regarding the sarcoma population enrolled in phase I trials. PATIENTS AND METHODS We used data from a European Database comprising 2182 patients treated in phase I trials in 14 European institutions between 2005 and 2007. RESULTS One hundred and seventy-eight patients diagnosed with advanced sarcoma or other mesenchymal tumours were identified and accounted for 217 phase I trial participations during the study period. Histological type, class of drug, number of metastatic sites, high serum lactate dehydrogenase activity (LDH), low albumin and high white blood cell count were independent prognostic factors. Poor performance status (PS), liver metastases and high leucocyte count were associated with increased risk of early death. The class of drug used was the strongest predictor of progression-free survival (PFS) duration, inhibitors of angiogenesis and histone deacetylase giving the best results. Poor PS, high serum LDH and low lymphocyte count correlated with shorter PFS. In this heterogeneous population, PFS with investigational agents appeared comparable with that previously published for patients receiving standard treatments beyond first line. CONCLUSION Prognostic factors in sarcoma patients do not differ from a broader phase I population. Efficacy measures suggest that some patients with sarcoma derive benefit from therapy in this setting which could therefore be considered for patients with no remaining standard therapeutic option.
Collapse
Affiliation(s)
- P A Cassier
- Drug Development Unit, The Royal Marsden National Health Service Foundation Trust, Sutton The Institute of Cancer Research, Sutton, UK Departments of Medical Oncology
| | - V Polivka
- Biostatistics, Centre Léon Bérard, Lyon
| | - I Judson
- Drug Development Unit, The Royal Marsden National Health Service Foundation Trust, Sutton The Institute of Cancer Research, Sutton, UK
| | - J-C Soria
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - N Penel
- Department of General Cancer, Centre Oscar Lambret, Lille, France
| | - S Marsoni
- Southern Europe New Drug Organization Foundation, Milan, Italy
| | - J Verweij
- Erasmus University Medical Center, Cancer Institute, Rotterdam
| | - J H Schellens
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R Morales-Barrera
- Research Unit for Molecular Therapy of Cancer, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - E E Voest
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Gomez-Roca
- Department of Medicine, Institut Gustave Roussy, Villejuif
| | - T R J Evans
- The Beatson West of UK Cancer Centre, Glasgow
| | - R Plummer
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | - E Gallerani
- Department of Oncology, Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
| | - S B Kaye
- Drug Development Unit, The Royal Marsden National Health Service Foundation Trust, Sutton The Institute of Cancer Research, Sutton, UK
| | - D Olmos
- Drug Development Unit, The Royal Marsden National Health Service Foundation Trust, Sutton The Institute of Cancer Research, Sutton, UK
| |
Collapse
|
30
|
Steele CW, Jamieson NB, Evans TRJ, McKay CJ, Sansom OJ, Morton JP, Carter CR. Exploiting inflammation for therapeutic gain in pancreatic cancer. Br J Cancer 2013; 108:997-1003. [PMID: 23385734 PMCID: PMC3619061 DOI: 10.1038/bjc.2013.24] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/19/2012] [Accepted: 01/03/2013] [Indexed: 12/19/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy associated with <5% 5-year survival, in which standard chemotherapeutics have limited benefit. The disease is associated with significant intra- and peritumoral inflammation and failure of protective immunosurveillance. Indeed, inflammatory signals are implicated in both tumour initiation and tumour progression. The major pathways regulating PDAC-associated inflammation are now being explored. Activation of leukocytes, and upregulation of cytokine and chemokine signalling pathways, both have been shown to modulate PDAC progression. Therefore, targeting inflammatory pathways may be of benefit as part of a multi-target approach to PDAC therapy. This review explores the pathways known to modulate inflammation at different stages of tumour development, drawing conclusions on their potential as therapeutic targets in PDAC.
Collapse
Affiliation(s)
- C W Steele
- The Beatson Institute for Cancer Research, Glasgow G61 1BD, UK
- Department of Surgery, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - N B Jamieson
- Department of Surgery, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - T R J Evans
- The Beatson Institute for Cancer Research, Glasgow G61 1BD, UK
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G61 1BD, UK
| | - C J McKay
- Department of Surgery, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| | - O J Sansom
- The Beatson Institute for Cancer Research, Glasgow G61 1BD, UK
| | - J P Morton
- The Beatson Institute for Cancer Research, Glasgow G61 1BD, UK
| | - C R Carter
- Department of Surgery, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
| |
Collapse
|
31
|
Anthoney DA, Naik J, Macpherson IRJ, Crawford D, Hartley JM, Hartley JA, Saito T, Abe M, Jones K, Miwa M, Twelves C, Evans TRJ. Phase I study of TP300 in patients with advanced solid tumors with pharmacokinetic, pharmacogenetic and pharmacodynamic analyses. BMC Cancer 2012; 12:536. [PMID: 23170896 PMCID: PMC3517777 DOI: 10.1186/1471-2407-12-536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 11/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A Phase I dose escalation first in man study assessed maximum tolerated dose (MTD), dose-limiting toxicity (DLT) and recommended Phase II dose of TP300, a water soluble prodrug of the Topo-1 inhibitor TP3076, and active metabolite, TP3011. METHODS Eligible patients with refractory advanced solid tumors, adequate performance status, haematologic, renal, and hepatic function. TP300 was given as a 1-hour i.v. infusion 3-weekly and pharmacokinetic (PK) profiles of TP300, TP3076 and TP3011 were analysed. Polymorphisms in CYP2D6, AOX1 and UGT1A1 were studied and DNA strand-breaks measured in peripheral blood mononuclear cells (PBMCs). RESULTS 32 patients received TP300 at 1, 2, 4, 6, 8, 10, 12 mg/m(2). MTD was 10 mg/m(2); DLTs at 12 (2/4 patients) and 10 mg/m(2) (3/12) included thrombocytopenia and febrile neutropenia; diarrhoea was uncommon. Six patients (five had received irinotecan), had stable disease for 1.5-5 months. TP3076 showed dose proportionality in AUC and Cmax from 1-10 mg/m(2). Genetic polymorphisms had no apparent influence on exposure. DNA strand-breaks were detected after TP300 infusion. CONCLUSIONS TP300 had predictable hematologic toxicity, and diarrhoea was uncommon. AUC at MTD is substantially greater than for SN38. TP3076 and TP3011 are equi-potent with SN38, suggesting a PK advantage. TRIAL REGISTRATION EU-CTR2006-001345-33.
Collapse
Affiliation(s)
- D Alan Anthoney
- St James Institute of Oncology, University of Leeds & Leeds Teaching Hospitals Trust, Leeds LS9 7TF, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Macpherson IR, Poondru S, Simon GR, Gedrich R, Brock K, Hopkins CA, Stewart K, Stephens A, Evans TRJ. A phase 1 study of OSI-930 in combination with erlotinib in patients with advanced solid tumours. Eur J Cancer 2012; 49:782-9. [PMID: 23099006 DOI: 10.1016/j.ejca.2012.09.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
AIM To determine the maximum tolerated dose (MTD) of OSI-930 that can be combined with erlotinib, and establish recommended phase 2 doses when both agents are administered daily in patients with advanced solid tumours. PATIENTS AND METHODS Eligible patients with advanced solid tumours were enrolled into this standard "three+three" dose escalation study. Study treatment commenced on day 1 with OSI-930, and erlotinib was introduced on day 8. PK profiles of OSI-930, erlotinib and its active metabolite, OSI-420, were determined. Changes in sVEGFR2 as a pharmacodynamic biomarker of OSI-930 activity were assessed. RESULTS Twenty one patients were enrolled to 1 of 3 cohorts: 200 mg OSI-930 BID+100 mg erlotinib QD; 200 mg OSI-930 BID+150 mg erlotinib QD; 300 mg OSI-930 BID+150 mg erlotinib QD. The most common adverse events were anorexia (85%), diarrhoea (75%), rash (70%) and lethargy (65%). The MTD was not reached but the onset of cumulative toxicity necessitating dose modification after the 28-d DLT assessment period was common at the highest dose level. A PK interaction was identified with co-administration of both agents resulting in a two-fold increase in OSI-930 exposure. Pharmacodynamic activity was observed with a decline in sVEGFR levels detected in all patients. Ten patients had disease stabilization (median duration 119 d). CONCLUSIONS 200 mg OSI-930 BID+150 mg erlotinib QD were the recommended doses for further evaluation of this combination.
Collapse
Affiliation(s)
- I R Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Boss DS, Glen H, Beijnen JH, Keesen M, Morrison R, Tait B, Copalu W, Mazur A, Wanders J, O'Brien JP, Schellens JHM, Evans TRJ. A phase I study of E7080, a multitargeted tyrosine kinase inhibitor, in patients with advanced solid tumours. Br J Cancer 2012; 106:1598-604. [PMID: 22516948 PMCID: PMC3349182 DOI: 10.1038/bjc.2012.154] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: The objectives of this phase I study were to assess the safety and tolerability of E7080 in patients with advanced, refractory solid tumours; to determine the maximum tolerated dose (MTD) and pharmacokinetics profile of E7080; and to explore preliminary evidence of its anti-tumour efficacy. Methods: E7080 was administered orally in escalating doses on a once-daily continuous schedule in 28-day cycles to eligible patients. Samples for pharmacokinetic analyses were collected on days 1, 8, 15 and 22 of cycle 1 and day 1 of cycle 2. Anti-tumour efficacy was assessed every two cycles. Results: Eighty-two patients received E7080 in dose cohorts from 0.2 to 32 mg. Dose-limiting toxicities were grade 3 proteinuria (two patients) at 32 mg, and the MTD was defined as 25 mg. The most frequently observed cumulative toxicities (all grades) were hypertension (40% of patients), diarrhoea (45%), nausea (37%), stomatitis (32%) and vomiting (23%). Seven patients (9%) had a partial response and 38 patients (46%) had stable disease as best response. E7080 has dose-linear kinetics with no drug accumulation after 4 weeks’ administration. Conclusion: E7080 is well tolerated at doses up to 25 mg per day. Encouraging anti-tumour efficacy was observed in patients with melanoma and renal cell carcinoma.
Collapse
Affiliation(s)
- D S Boss
- Division of Medical Oncology, Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Holmes WM, Maclellan S, Condon B, Dufès C, Evans TRJ, Uchegbu IF, Schätzlein AG. High-resolution 3D isotropic MR imaging of mouse flank tumours obtainedin vivowith solenoid RF micro-coil. Phys Med Biol 2007; 53:505-13. [DOI: 10.1088/0031-9155/53/2/015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
35
|
Guo X, Evans TRJ, Somanath S, Armesilla AL, Darling JL, Schatzlein A, Cassidy J, Wang W. In vitro evaluation of cancer-specific NF-kappaB-CEA enhancer-promoter system for 5-fluorouracil prodrug gene therapy in colon cancer cell lines. Br J Cancer 2007; 97:745-54. [PMID: 17687334 PMCID: PMC2360387 DOI: 10.1038/sj.bjc.6603930] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nuclear factor-kappa B (NF-κB) is a transcription factor with high transcriptional activity in cancer cells. In this study, we developed a novel enhancer–promoter system, κB4-CEA205, in which the basal carcinoembryonic antigen (CEA) promoter sequence (CEA205) was placed downstream of the four tandem-linked NF-κB DNA-binding sites (κB4). In combination with a κB4 enhancer, the transcriptional activity of the CEA promoter was significantly enhanced (three- to eight-fold) in cancer cell lines but not in normal cells. In cancer cell lines, the transcriptional activity of κB4-CEA205 was comparable with that of the SV40 promoter. We also constructed vectors in which the thymidine phosphorylase (TP) cDNA was under the control of CEA205, κB4, κB4-CEA205 and CMV promoters, respectively. TP protein and enzyme activity were detected at comparable levels in κB4-CEA205- and CMV-driven TP cDNA-transfected cancer cell lines (H630 and RKO). The κB4-TP and CEA205-TP-transfected cell lines, respectively, only demonstrated negligible and low levels of TP protein and enzyme activity. Both CMV- and κB4-CEA205-driven TP cDNA transiently transfected cells were 8- to 10-fold sensitised to 5-fluorouracil (5-FU) prodrug, 5′-deoxy-5-fluorouradine (5′-DFUR), in contrast to only 1.5- to 2-fold sensitised by the κB4- and CEA205-driven TP cDNA-transfected cells. The bystander killing effect of CMV- and κB4-CEA205-driven TP cDNA-transfected cells was comparable. This is the first report that indicates that the NF-κB DNA-binding site could be used as a novel cancer-specific enhancer to improve cancer-specific promoter activity in gene-directed enzyme prodrug therapy.
Collapse
Affiliation(s)
- X Guo
- Oncology Group, Research Institute in Healthcare Science, School of Applied Sciences, University of Wolverhampton, Wolverhampton WV1 1SB, UK
| | - T R J Evans
- Cancer Research UK Beatson Laboratories, Centre for Oncology and Applied Pharmacology, University of Glasgow, Glasgow G61 1BD, UK
| | - S Somanath
- Oncology Group, Research Institute in Healthcare Science, School of Applied Sciences, University of Wolverhampton, Wolverhampton WV1 1SB, UK
| | - A L Armesilla
- Pharmacology Group, Research Institute in Healthcare Science, School of Applied Sciences, University of Wolverhampton, Wolverhampton WV1 1SB, UK
| | - J L Darling
- Oncology Group, Research Institute in Healthcare Science, School of Applied Sciences, University of Wolverhampton, Wolverhampton WV1 1SB, UK
| | - A Schatzlein
- The School of Pharmacy, University of London, London WC1N 1AX, UK
| | - J Cassidy
- Cancer Research UK Beatson Laboratories, Centre for Oncology and Applied Pharmacology, University of Glasgow, Glasgow G61 1BD, UK
| | - W Wang
- Oncology Group, Research Institute in Healthcare Science, School of Applied Sciences, University of Wolverhampton, Wolverhampton WV1 1SB, UK
- E-mail:
| |
Collapse
|
36
|
Evans TRJ, Keith WN. Intra-peritoneal administration of genetic therapies: promises and pitfalls. Minerva Ginecol 2004; 56:529-38. [PMID: 15729205] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Rapid advances in our understanding of the molecular basis of cancer development and progression over the past 3 decades have led to the design of new potential cancer therapies based on the expression of introduced genes into a tumor or its host. In an attempt to overcome the limitations of direct intratumoral administration of genetic therapies in patients with advanced malignant disease, loco-regional routes of delivery have been explored including the intraperitoneal route. This review highlights the potential of replication-competent oncolytic viruses, virus-mediated gene replacement, and gene-directed enzyme-prodrug strategies, as novel cancer therapies. The potential of exploiting the selectivity of the telomerase gene within cancer cells to develop gene therapy strategies is discussed and the promises and pitfalls in translating these novel therapeutics from the laboratory to the clinic are reviewed.
Collapse
Affiliation(s)
- T R J Evans
- Centre for Oncology and Applied Pharmacology, University of Glasgow, Cancer Research, UK Beatson Laboratories, Glasgow, UK.
| | | |
Collapse
|
37
|
Jodrell DI, Evans TRJ, Steward W, Cameron D, Prendiville J, Aschele C, Noberasco C, Lind M, Carmichael J, Dobbs N, Camboni G, Gatti B, De Braud F. Phase II studies of BBR3464, a novel tri-nuclear platinum complex, in patients with gastric or gastro-oesophageal adenocarcinoma. Eur J Cancer 2004; 40:1872-7. [PMID: 15288289 DOI: 10.1016/j.ejca.2004.04.032] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [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: 02/13/2004] [Revised: 04/22/2004] [Accepted: 04/29/2004] [Indexed: 11/20/2022]
Abstract
BBR3464, a novel tri-nuclear platinum complex, forms long-range DNA adducts and is highly potent when compared with cisplatin in vitro. Preclinical studies demonstrated activity in cisplatin-resistant tumours and tumours with mutated p53 status. Phase I & II clinical studies gave preliminary indications of activity in melanoma, pancreatic, lung and ovarian cancers. The aim of this study was to determine the efficacy and confirm the toxicity of BBR3464 when given either as first- or second-line treatment for advanced disease in patients with gastric and gastro-oesphageal adenocarcinoma. Two multicentre, open label, Gehan design studies were conducted; one study used BBR3464 as first-line and the other as second-line treatment for metastatic or locally advanced disease. Nineteen first-line and 26 second-line patients were enrolled receiving a total of 74 and 53 infusions, respectively. Initially, seven patients in the second-line study received BBR3464 using the planned schedule of 1.1 mg/m2 every 4 weeks; however, 5 of these patients experienced dose-limiting grade 3 or 4 febrile neutropenia; subsequent patients in both studies were treated using the modified schedule of 0.9 mg/m2, every 21 days. In 1 of 17 evaluable, previously untreated patients, regression of multiple skin lesions was noted with stabilisation of lung metastases and maxillary sinus mass, lasting 155 days. In the first-line study, the median time to progression was 85 days [95% Confidence Interval (CI): 42, 127] (2.8 months) and in the second-line study, the median time to progression was 71 days [95% CI: 42, 109] and 38 days [95% CI: 32, 73] in the 1.1 and 0.9 mg/m2 dose level groups, respectively. Toxicity data were available for 45 patients. Neutropenia was the main toxicity seen (G3: 40%, G4: 40%). Febrile neutropenia was observed in six patients (15%) treated with 0.9 mg/m2 compared with five patients (71%) treated with 1.1 mg/m2 BBR3464. Other drug-related toxicities (G3/4) included: anaemia, thrombocytopenia, nausea, vomiting, diarrhoea, mucositis and fatigue. Diarrhoea and nausea/ vomiting were adequately controlled by the use of loperamide and antiemetics, respectively. Recruitment to the second-line study was closed early due to the poor response rate (1/17 evaluable, 6%; 95% CI: 1%, 27%) and short time to progression noted in the first-line study. Further studies with BBR3464 in this tumour type are not recommended.
Collapse
Affiliation(s)
- D I Jodrell
- Western General Hospital, Department of Medical Oncology, Crewe Road, Edinburgh EH4 2XR, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
White JD, Marshall DAS, Seywright MM, Evans TRJ. Primary amyloidosis of the breast associated with invasive breast cancer. Oncol Rep 2004; 11:761-3. [PMID: 15010869] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Amyloidosis is usually a systemic disorder. A localised form can involve the breast and may mimic breast cancer. We report a case of primary amyloid deposit confirmed by immunohistochemistry, occurring in a patient with early breast cancer and review other cases of breast involvement with various types of amyloid.
Collapse
Affiliation(s)
- J D White
- Department of Medical Oncology, Cancer Research UK, Beatson Oncology Centre, Western Infirmary, Glasgow, G11 6NT, UK.
| | | | | | | |
Collapse
|
39
|
Johnston SRD, Gumbrell LA, Evans TRJ, Coleman RE, Smith IE, Twelves CJ, Soukop M, Rea DW, Earl HM, Howell A, Jones A, Canney P, Powles TJ, Haynes BP, Nutley B, Grimshaw R, Jarman M, Halbert GW, Brampton M, Haviland J, Dowsett M, Coombes RC. A Cancer Research (UK) randomized phase II study of idoxifene in patients with locally advanced/metastatic breast cancer resistant to tamoxifen. Cancer Chemother Pharmacol 2004; 53:341-8. [PMID: 14722733 DOI: 10.1007/s00280-003-0733-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2003] [Accepted: 10/09/2003] [Indexed: 11/27/2022]
Abstract
Idoxifene is a novel selective oestrogen receptor modulator (SERM) which had greater binding affinity for the oestrogen receptor (ER) and reduced agonist activity compared with tamoxifen in preclinical studies. In a randomized phase II trial in 56 postmenopausal patients with progressive locally advanced/metastatic breast cancer we assessed whether idoxifene showed evidence of activity compared with an increased 40 mg/day dose of tamoxifen in patients who had previously demonstrated resistance to the standard 20 mg/day dose of tamoxifen. Of 47 patients eligible for response (25 idoxifene, 22 tamoxifen), two partial responses and two disease stabilizations (SD) for >6 months were seen with idoxifene (overall clinical benefit rate 16%, 95% CI 4.5-36.1%). The median duration of clinical benefit was 9.8 months. In contrast, no objective responses were seen with the increased 40 mg/day dose of tamoxifen, although two patients had SD for 7 and 14 months (clinical benefit rate 9%, 95% CI 1.1-29.2%). Idoxifene was well tolerated and the reported possible drug-related toxicities were similar in frequency to those with tamoxifen (hot flushes 13% vs 15%, mild nausea 20% vs 15%). Endocrine and lipid analysis in both groups showed a similar significant fall in serum follicle-stimulating hormone and luteinizing hormone after 4 weeks, together with a significant rise in sex hormone binding globulin levels and 11% reduction in serum cholesterol levels. In conclusion, while idoxifene was associated with only modest evidence of clinical activity in patients with tamoxifen-resistant breast cancer, its toxicity profile and effects on endocrine/lipid parameters were similar to those of tamoxifen.
Collapse
Affiliation(s)
- S R D Johnston
- Cancer Research UK, Lincoln's Inn Fields, London, WC2A 3PX, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Dalhoff K, Dancey J, Astrup L, Skovsgaard T, Hamberg KJ, Lofts FJ, Rosmorduc O, Erlinger S, Bach Hansen J, Steward WP, Skov T, Burcharth F, Evans TRJ. A phase II study of the vitamin D analogue Seocalcitol in patients with inoperable hepatocellular carcinoma. Br J Cancer 2003; 89:252-7. [PMID: 12865912 PMCID: PMC2394267 DOI: 10.1038/sj.bjc.6601104] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common malignant tumour, which has a poor prognosis. Surgical resection can be curative but most patients are inoperable and most chemotherapy agents have minimal activity in this disease. Seocalcitol, a vitamin D analogue, induces differentiation and inhibits growth in cancer cell lines and in vivo. The vitamin D receptor is expressed in hepatocytes and more abundantly in HCC cells. In total, 56 patients with inoperable advanced HCC were included in an uncontrolled study of oral Seocalcitol treatment for up to 1 year (with possible extension for responders). The dose was titrated according to serum calcium levels. The treatment effect was evaluated by regular CT scans. Out of 33 patients evaluable for tumour response, two had complete response (CR), 12 stable disease and 19 progressive disease. The CRs appeared after 6 and 24 months of treatment, and lasted for 29 and at least 36 months (patient still in remission when data censored). Seocalcitol was well tolerated; the most frequent toxicity was hypercalcaemia and related symptoms. Most patients tolerated a daily dose of 10 micro g of Seocalcitol. This is the first study showing activity, by reduction in tumour dimensions, of a differentiating agent in patients with an advanced bulky, solid tumour. Seocalcitol may have an effect in the treatment of HCC, especially in early disease when a prolonged treatment can be instituted. The survival benefit with or without tumour response should be determined in controlled studies.
Collapse
Affiliation(s)
- K Dalhoff
- Department of Clinical Pharmacology, Rigshospitalet, Denmark [2] 2Department of Hepatology, Rigshospitalet, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
White JD, MacPherson IRJ, Evans TRJ. Auto-immune neutropenia occurring in association with malignant melanoma. Oncol Rep 2003; 10:249-51. [PMID: 12469177] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Neutropenia is frequently observed in the practice of oncology, usually resulting from the use of cytotoxic drugs. Less frequently, neutropenia is due to infiltration of the bone marrow by malignant disease. Both of these usually cause some depletion of all haematopoietic linages. True isolated neutropenia is, in contrast, a less frequent phenomenon. We report a case of auto-immune neutropenia occurring in a patient with metastatic melanoma, and discuss the differential diagnosis and implications for patient management.
Collapse
Affiliation(s)
- J D White
- Cancer Research UK Department of Medical Oncology, Beatson Oncology Centre, Western Infirmary, Glasgow, G11 6NT, UK.
| | | | | |
Collapse
|
42
|
Cameron DA, Anderson A, Toy E, Evans TRJ, Le Vay JH, Kennedy ICS, Grieve RJ, Perren TJ, Jones A, Mansi J, Crown J, Leonard RCF. Block sequential adriamycin CMF--optimal non-myeloablative chemotherapy for high risk adjuvant breast cancer? Br J Cancer 2002; 87:1365-9. [PMID: 12454763 PMCID: PMC2376297 DOI: 10.1038/sj.bjc.6600660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2002] [Accepted: 09/23/2002] [Indexed: 11/12/2022] Open
Abstract
After the publication of the 10-year survival data from Milan on the adjuvant use of the block sequential regimen consisting of four cycles of adriamycin followed by eight cycles of intravenous CMF, many centres adopted this as standard of care for high risk, multiple node-positive breast cancer. For this reason it was identified as the standard arm for the Anglo-Celtic adjuvant high-dose chemotherapy trial. This study reports on the experience of this regimen in 329 women with early breast cancer involving at least four axillary nodes, who were treated outside any adjuvant chemotherapy trial. At a median follow-up of 3 years, the overall 5-year disease-free survival is 61%, and the overall survival is 70%. These data confirm the efficacy of this regimen in non-trial patients, and, for the same high risk subgroup, indicate that this approach offers an outcome at least as good as that seen in the CALGB 9344 AC-Taxol arm, and the NCIC days 1 and 8 CEF.
Collapse
Affiliation(s)
- D A Cameron
- Department of Oncology, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, Scotland, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Evans TRJ, Pentheroudakis G, Paul J, McInnes A, Blackie R, Raby N, Morrison R, Fullarton GM, Soukop M, McDonald AC. A phase I and pharmacokinetic study of capecitabine in combination with epirubicin and cisplatin in patients with inoperable oesophago-gastric adenocarcinoma. Ann Oncol 2002; 13:1469-78. [PMID: 12196374 DOI: 10.1093/annonc/mdf243] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [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: 12/15/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the dose-limiting toxicity (DLT) and maximum tolerated dose of capecitabine when used in combination with epirubicin and cisplatin (ECC) in patients with oesophageal or gastric adenocarcinoma. Response rate, progression-free survival (PFS) and overall survival were also determined, and the effect of previous oesophago-gastric surgery or concurrent oesophago-gastric cancer on the absorption and metabolism of capecitabine was evaluated. PATIENTS AND METHODS Patients with inoperable oesophago-gastric adenocarcinoma received up to six cycles of epirubicin (50 mg/m(2) i.v., 3-weekly), cisplatin (60 mg/m(2) i.v., 3-weekly) and capecitabine, the latter administered orally in an intermittent schedule (14 days treatment; 7-day rest period) at 3-weekly intervals. Patients were recruited into one of four escalating dose cohorts (500, 825, 1000 and 1250 mg/m(2) bd). Dose escalation occurred after six patients had completed at least one cycle of chemotherapy at the previous dose level, with DLT assessed on the toxicity of the first cycle only. Blood sampling for pharmacokinetic analyses was performed over the first 10 h of day 1 of cycle 1. RESULTS Thirty-two patients, median age 63 years (range 32-76 years), ECOG performance status < or =2 with locally advanced (10) or metastatic (22) disease were recruited and were evaluable for toxicity. Two of five patients experienced DLT at 1250 mg/m(2) bd with grade II stomatitis (one patient) and grade III diarrhoea with febrile neutropenia (one patient). Cumulative toxicity for all cycles (n = 140) (worst grade per patient) includes grade IV oesophagitis (one patient), grade III diarrhoea (five), grade IV neutropenia with infection (seven), grade II stomatitis (four) and grade IV thrombocytopenia (one). Of 29 patients with evaluable disease, there was one complete response and six partial responses [24% response rate [95% confidence interval (CI) 10% to 44%]], a median PFS of 22 weeks (95% CI 17-27 weeks) and median overall survival of 34 weeks (95% CI 19-49 weeks). Capecitabine was rapidly absorbed after oral administration, with a t(max) of 1-2 h for capecitabine, DFCR (5'-deoxy-5-fluorocytidine) and DFUR (5'-deoxy-5-fluorouridine). The C(max) and AUC(0-)( infinity ) for capecitabine, DFCR and DFUR were similar to those observed in previous monotherapy studies of capecitabine taken after food. CONCLUSION A dose of 1000 mg/m(2) bd of capecitabine is recommended for use on an intermittent schedule in combination with these doses and schedule of epirubicin and cisplatin. This regimen is tolerable and active in oesophago-gastric adenocarcinoma. A randomised phase III comparison with ECF is justified.
Collapse
Affiliation(s)
- T R J Evans
- CRC Dept of Medical Oncology, University of Glasgow, Beatson Oncology Centre, Western Infirmary, Glasgow, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Díaz-Rubio E, Evans TRJ, Tabemero J, Cassidy J, Sastre J, Eatock M, Bisset D, Regueiro P, Baselga J. Capecitabine (Xeloda) in combination with oxaliplatin: a phase I, dose-escalation study in patients with advanced or metastatic solid tumors. Ann Oncol 2002; 13:558-65. [PMID: 12056706 DOI: 10.1093/annonc/mdf065] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This phase I, dose-escalation study was conducted to determine the recommended dose of intermittent oral capecitabine in combination with a fixed dose of i.v. oxaliplatin. Secondary objectives included evaluation of the safety profile and antitumor activity. PATIENTS AND METHODS Twenty-three patients with advanced or metastatic solid tumors received a 21-day regimen of oral capecitabine (500, 825, 1000 or 1250 mg/m2 twice daily, days 1-14) in combination with oxaliplatin (130 mg/m2, 2-h i.v. infusion, day 1). Dose-limiting toxicities were determined during the first treatment cycle, and safety and efficacy were evaluated throughout treatment. RESULTS The recommended dosing schedule is oral capecitabine 1000 mg/m2 twice daily (days 1-14) with i.v. oxaliplatin 130 mg/m2 (day 1) in a 21-day treatment cycle. The principal dose-limiting toxicity was diarrhea. The most frequent treatment-related adverse events occurring during the study were gastrointestinal (nausea/vomiting, diarrhea) and neurological (dysesthesia, paresthesia). The majority of treatment-related adverse events were mild to moderate in intensity, and no grade 4 adverse events occurred in the 15 patients treated at or below the recommended dose. The most common grade 3/4 laboratory abnormalities were lymphocytopenia (52% of patients), thrombocytopenia (22%; grade 3 only), neutropenia (17%) and hyperbilirubinemia (17%). Among patients treated at or below the recommended dose level (n = 15), only two patients experienced grade 3 neutropenia and no patients experienced grade 4 neutropenia. Partial tumor responses occurred in six patients (26%), including five of nine patients (55%) with colorectal cancer. All responding patients were pretreated with 5-fluorouracil and four responders had received prior irinotecan. CONCLUSIONS Oral capecitabine with i.v. oxaliplatin is a feasible combination regimen that shows promising antitumor activity in patients with colorectal cancer. There is an ongoing, phase II study to further characterize the safety and efficacy of this combination as first-line therapy for metastatic colorectal cancer, using the recommended dose identified in this study.
Collapse
Affiliation(s)
- E Díaz-Rubio
- Department of Oncology, Hospital Clínico Universitario San Carlos, Madrid, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Evans TRJ, Colston KW, Lofts FJ, Cunningham D, Anthoney DA, Gogas H, de Bono JS, Hamberg KJ, Skov T, Mansi JL. A phase II trial of the vitamin D analogue Seocalcitol (EB1089) in patients with inoperable pancreatic cancer. Br J Cancer 2002; 86:680-5. [PMID: 11875725 PMCID: PMC2375305 DOI: 10.1038/sj.bjc.6600162] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2001] [Revised: 12/07/2001] [Accepted: 12/28/2001] [Indexed: 02/07/2023] Open
Abstract
Inoperable cancer of the exocrine pancreas responds poorly to most conventional anti-cancer agents, and new agents are required to palliate this disease. Seocalcitol (EB1089), a vitamin D analogue, can inhibit growth, induce differentiation and induce apoptosis of cancer cell lines in vitro and can also inhibit growth of pancreatic cancer xenografts in vivo. Thirty-six patients with advanced pancreatic cancer received once daily oral treatment with seocalcitol with dose escalation every 2 weeks until hypercalcaemia occurred, following which patients continued with maintenance therapy. The most frequent toxicity was the anticipated dose-dependent hypercalcaemia, with most patients tolerating a dose of 10-15 microg per day in chronic administration. Fourteen patients completed at least 8 weeks of treatment and were evaluable for efficacy, whereas 22 patients were withdrawn prior to completing 8 weeks' treatment and in 20 of these patients withdrawal was due to clinical deterioration as a result of disease progression. No objective responses were observed, with five of 14 patients having stable disease in whom the duration of stable disease was 82-532 days (median=168 days). The time to treatment failure (n=36) ranged from 22 to 847 days, and with a median survival of approximately 100 days. Seocalcitol is well tolerated in pancreatic cancer but has no objective anti-tumour activity in advanced disease. Further studies are necessary to determine if this agent has any cytostatic activity in this malignancy in minimal disease states.
Collapse
Affiliation(s)
- T R J Evans
- CRC Department of Medical Oncology, Beatson Oncology Centre, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Evans TRJ, Harper C, Beveridge IG, Wasinage R, Delginish AG, Mansi JL. The use of routine magnesium supplements with a cisplatin-containing chemotherapy regimen. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91201-u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|