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Morris RT, Joyrich RN, Naumann RW, Shah NP, Maurer AH, Strauss HW, Uszler JM, Symanowski JT, Ellis PR, Harb WA. Phase II study of treatment of advanced ovarian cancer with folate-receptor-targeted therapeutic (vintafolide) and companion SPECT-based imaging agent (99mTc-etarfolatide). Ann Oncol 2014; 25:852-858. [PMID: 24667717 DOI: 10.1093/annonc/mdu024] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [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] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND This report examines (99m)Tc-etarfolatide imaging to identify the presence of folate receptor (FR) on tumors of women with recurrent/refractory ovarian or endometrial cancer and correlates expression with response to FR-targeted therapy (vintafolide). PATIENTS AND METHODS In this phase II, single-arm, multicenter study, patients with advanced ovarian cancer were imaged with (99m)Tc-etarfolatide before vintafolide treatment. Up to 10 target lesions (TLs) were selected based on Response Evaluation Criteria In Solid Tumors criteria using computed tomography scans. Single-photon emission computed tomography images of TLs were assessed for (99m)Tc-etarfolatide uptake as either FR positive or negative. Patients were categorized by percentage of TLs positive and grouped as FR(100%), FR(10%-90%), and FR(0%). Lesion and patient response were correlated with etarfolatide uptake. RESULTS Forty-nine patients were enrolled; 43 were available for analysis. One hundred thirty-nine lesions were (99m)Tc-etarfolatide evaluable: 110 FR positive and 29 FR negative. Lesion disease control rate (DCR = stable or response) was observed in 56.4% of FR-positive lesions versus 20.7% of FR-negative lesions (P < 0.001). Patient DCR was 57%, 36%, and 33% in FR(100%), FR(10%-90%), and FR(0%) patients, respectively. Median overall survival was 14.6, 9.6, and 3.0 months in FR(100%), FR(10%-90%), and FR(0%) patients, respectively. CONCLUSIONS Overall response to FR-targeted therapy and DCR correlate with FR positivity demonstrated by (99m)Tc-etarfolatide imaging. CLINICAL TRIAL NUMBER NCT00507741.
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Affiliation(s)
| | - R N Joyrich
- Detroit Medical Center, Wayne State University, Detroit
| | | | - N P Shah
- Charlotte Radiology, Carolinas Medical Center, Charlotte
| | - A H Maurer
- Temple University Hospital, Philadelphia
| | - H W Strauss
- Memorial Sloan-Kettering Cancer Center, New York
| | - J M Uszler
- Saint John's Health Center, Santa Monica
| | | | | | - W A Harb
- Horizon Oncology Research, Lafayette, USA
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Morris RT, Joyrich RN, Naumann RW, Shah NP, Maurer AH, Strauss HW, Uszler JM, Symanowski JT, Ellis PR, Harb WA. Phase II study of treatment of advanced ovarian cancer with folate-receptor-targeted therapeutic (vintafolide) and companion SPECT-based imaging agent (99mTc-etarfolatide). Ann Oncol 2014. [PMID: 24667717 DOI: 10.1093/annonc/mdu024] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This report examines (99m)Tc-etarfolatide imaging to identify the presence of folate receptor (FR) on tumors of women with recurrent/refractory ovarian or endometrial cancer and correlates expression with response to FR-targeted therapy (vintafolide). PATIENTS AND METHODS In this phase II, single-arm, multicenter study, patients with advanced ovarian cancer were imaged with (99m)Tc-etarfolatide before vintafolide treatment. Up to 10 target lesions (TLs) were selected based on Response Evaluation Criteria In Solid Tumors criteria using computed tomography scans. Single-photon emission computed tomography images of TLs were assessed for (99m)Tc-etarfolatide uptake as either FR positive or negative. Patients were categorized by percentage of TLs positive and grouped as FR(100%), FR(10%-90%), and FR(0%). Lesion and patient response were correlated with etarfolatide uptake. RESULTS Forty-nine patients were enrolled; 43 were available for analysis. One hundred thirty-nine lesions were (99m)Tc-etarfolatide evaluable: 110 FR positive and 29 FR negative. Lesion disease control rate (DCR = stable or response) was observed in 56.4% of FR-positive lesions versus 20.7% of FR-negative lesions (P < 0.001). Patient DCR was 57%, 36%, and 33% in FR(100%), FR(10%-90%), and FR(0%) patients, respectively. Median overall survival was 14.6, 9.6, and 3.0 months in FR(100%), FR(10%-90%), and FR(0%) patients, respectively. CONCLUSIONS Overall response to FR-targeted therapy and DCR correlate with FR positivity demonstrated by (99m)Tc-etarfolatide imaging. CLINICAL TRIAL NUMBER NCT00507741.
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Affiliation(s)
| | - R N Joyrich
- Detroit Medical Center, Wayne State University, Detroit
| | | | - N P Shah
- Charlotte Radiology, Carolinas Medical Center, Charlotte
| | - A H Maurer
- Temple University Hospital, Philadelphia
| | - H W Strauss
- Memorial Sloan-Kettering Cancer Center, New York
| | - J M Uszler
- Saint John's Health Center, Santa Monica
| | | | | | - W A Harb
- Horizon Oncology Research, Lafayette, USA
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Myre B, Yu M, Picus J, Bufill JA, Harb WA, Burns M, Spittler AJ, Zeng Y, Currie CR, Chiorean EG. Phase I study of everolimus (RAD001) with irinotecan (Iri) and cetuximab (C) in second-line metastatic colorectal cancer: Hoosier Oncology Group GI05-102. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
523 Background: Preclinically, mTOR and EGFR inhibitors are synergistic. We hypothesize that the mTOR inhibitor RAD001 would enhance efficacy and prevent resistance when added to an anti-EGFR agent. The purpose of the phase I portion of this study was to determine the safety and maximum tolerated dose (MTD) of daily RAD001 combined with weekly Iri and C in mCRC. Methods: Pts who failed first-line therapy, including an Iri-regimen, were treated with Iri 125 mg/m2 weekly x 2 every 3 weeks, C 400 mg/m2 loading dose, then 250 mg/m2 weekly, and escalating doses of RAD001 orally: 5 mg qod, 5 mg qd and 10 mg qd during 21-day cycles, with a “3+3” design. The study was amended after the first 9 pts enrolled, to include stopping rules for excessive toxicity beyond what was expected for diarrhea, nausea/vomiting and febrile neutropenia due to Iri, and skin rash due to C. Enrollment excluded pts with UGT1A1*28, but allowed KRAS mutated mCRC. RAD001 PK was done on C2D1, and archival tumors were analyzed for pharmacodynamic markers. Results: 28 pts were enrolled, median age 61 y (25-77), 15 male, ECOG PS 0/1 (19/9). Reasons for treatment discontinuation were: PD (7), adverse events (AEs) (6), pt withdrawal, symptomatic deterioration and non-compliance (1 each). Prior to study's amendment* (n=9), 3 pts were not evaluable for DLT due to: Iri intolerance after one dose (1), non-compliance (1) and gr 3 C infusion reaction (1). DLTs and number of cycles are listed in Table. Following protocol amendment, 2 pts had DLT in cohort 3 (gr 3 mucositis), thus the MTD was 5 mg RAD001. The most common grade 3/4 AEs were: diarrhea (10), neutropenia (5), fatigue (4), acne-rash (4), mucositis (2), nausea (2), vomiting (1). Among 19 pts evaluable for response, there were 1 CR, 2 PR, (RR 16%), 9 SD (47%), 7 PD (37%). PK and pharmacodynamic data is ongoing. Conclusions: The MTD of RAD001 of 5 mg QD with Iri/C weekly is safe and clinically active. A randomized phase II study is near starting accrual. [Table: see text] [Table: see text]
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Affiliation(s)
- B. Myre
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - M. Yu
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - J. Picus
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - J. A. Bufill
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - W. A. Harb
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - M. Burns
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - A. J. Spittler
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - Y. Zeng
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - C. R. Currie
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
| | - E. G. Chiorean
- Indiana University School of Medicine, Indianapolis, IN; Washington University School of Medicine, St. Louis, MO; Michiana Hematology Oncology PC, South Bend, IN; Horizon Oncology Center, Lafayette, IN; Indiana University Simon Cancer Center, Indianapolis, IN; Hoosier Oncology Group, Indianapolis, IN
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