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Yu S, Yu M, Keane B, Mauro DM, Helft PR, Harris WP, Sanoff HK, Johnson MS, O’Neil B, McRee AJ, Somasundaram A. A Pilot Study of Pembrolizumab in Combination With Y90 Radioembolization in Subjects With Poor Prognosis Hepatocellular Carcinoma. Oncologist 2024; 29:270-e413. [PMID: 38325328 PMCID: PMC10911903 DOI: 10.1093/oncolo/oyad331] [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: 08/06/2023] [Accepted: 11/21/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Combination checkpoint inhibition therapy with yttrium-90 (Y90) radioembolization represents an emerging area of interest in the treatment of advanced hepatocellular carcinoma (HCC). HCRN GI15-225 is an open-label, single-arm multicenter, pilot study (NCT03099564). METHODS Eligible patients had poor prognosis, localized HCC defined as having portal vein thrombus, multifocal disease, and/or diffuse disease that were not eligible for liver transplant or surgical resection. Patients received pembrolizumab 200 mg intravenously every 3 weeks in conjunction with glass yttrium-90 (Y90) radioembolization TheraSphere. Primary endpoint was 6-month progression-free survival (PFS6) per RECIST 1.1. Secondary endpoints included time to progression (TTP), objective response rate (ORR), overall survival (OS), and safety/tolerability. RESULTS Between October 23, 2017 and November 24, 2020, 29 patients were enrolled: 2 were excluded per protocol. Fifteen of the remaining 27 patients were free of progression at 6 months (55.6%; 95% CI, 35.3-74.5) with median PFS 9.95 months (95% CI, 4.14-15.24) and OS 27.30 months (95% CI, 10.15-39.52). One patient was not evaluable for response due to death; among the remaining 26 patients, ORR was 30.8% (95% CI, 14.3-51.8) and DCR was 84.6% (95% CI, 65.1-95.6). CONCLUSION In patients with localized, poor prognosis HCC, pembrolizumab in addition to glass Y90 radioembolization demonstrated promising efficacy and safety consistent with prior observations (ClinicalTrials.gov Identifier: NCT03099564; IRB Approved: 16-3255 approved July 12, 2016).
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Affiliation(s)
- Shawn Yu
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Menggang Yu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Barry Keane
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David M Mauro
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul R Helft
- Department of Medicine, Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - William P Harris
- Department of Medicine, University of Washington/FHCC, Seattle, WA, USA
| | - Hanna K Sanoff
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew S Johnson
- Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, IN, USA
| | - Bert O’Neil
- Community Health Network, Indianapolis, IN, USA
| | | | - Ashwin Somasundaram
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Harris WP, Salem R. The EPOCH trial: Identifying key patient subgroups to optimize treatment planning. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.130] [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: 01/25/2023] Open
Abstract
130 Background: The primary objective of the original EPOCH trial was to evaluate the potential benefit of adding transarterial radioembolization (TARE) with yttrium-90 glass microspheres to second-line chemotherapy (chemo) versus chemo alone in patients with liver-dominant metastatic colorectal cancer (mCRC). Randomization was stratified by key prognostic factors, including KRAS status; however, it did not account for ECOG status and baseline CEA levels. We present post-hoc analyses investigating the impact of prognostic factors on primary and secondary endpoints to help optimize patient selection. Methods: EPOCH was a 1:1 randomized, open-label, global, multicenter Phase 3 trial. Primary endpoints were progression-free survival (PFS) and hepatic PFS (hPFS). Overall survival (OS) and time to deterioration of quality of life (TTDQOL) were secondary. Post-hoc analyses of the following subgroups were performed: Subgroup A (excluding patients with both ECOG=1 and CEA≥35ng/mL) and Subgroup B (patients with KRAS wild-type and either ECOG=0 or CEA<35ng/mL). Kaplan-Meier analyses, hazard ratios (HRs) and log-rank tests were used to compare outcomes between TARE plus chemo and chemo only groups. Results: In Subgroup A, 160 (75.1%) patients were randomized to chemo only, versus 143 (66.5%) to the TARE arm. In Subgroup B, 91 (42.7%) patients were randomized to chemo only, versus 77 (35.8%) to the TARE arm. Results are shown for PFS, hPFS, OS, and TTDQOL in the intent-to-treat population. In both subgroups A and B, PFS, hPFS, and TTDQOL were significantly improved for the TARE plus chemo arm as compared to the chemo only arm; no OS difference was found. Conclusions: Careful patient selection using multiple prognostic factors is necessary to identify those who will benefit most from TARE with second-line chemo. Prognostic factors were important in identifying the level of benefit seen in patients treated with TARE and chemo versus chemo alone. Clinical trial information: NCT01483027 . [Table: see text]
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Affiliation(s)
| | - Riad Salem
- Northwestern University Feinberg School of Medicine, Chicago, IL
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3
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Diehl AC, Hannan LM, Zhen DB, Coveler AL, King G, Cohen SA, Harris WP, Shankaran V, Wong KM, Green S, Ng N, Pillarisetty VG, Sham JG, Park JO, Reddi D, Konnick EQ, Pritchard CC, Baker K, Redman M, Chiorean EG. KRAS Mutation Variants and Co-occurring PI3K Pathway Alterations Impact Survival for Patients with Pancreatic Ductal Adenocarcinomas. Oncologist 2022; 27:1025-1033. [PMID: 36124727 DOI: 10.1093/oncolo/oyac179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/29/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND KRAS variant alleles may have differential biological properties which impact prognosis and therapeutic options in pancreatic ductal adenocarcinomas (PDA). MATERIALS AND METHODS We retrospectively identified patients with advanced PDA who received first-line therapy and underwent blood and/or tumor genomic sequencing at the University of Washington between 2013 and 2020. We examined the incidence of KRAS mutation variants with and without co-occurring PI3K or other genomic alterations and evaluated the association of these mutations with clinicopathological characteristics and survival using a Cox proportional hazards model. RESULTS One hundred twenty-six patients had genomic sequencing data; KRAS mutations were identified in 111 PDA and included the following variants: G12D (43)/G12V (35)/G12R (23)/other (10). PI3K pathway mutations (26% vs. 8%) and homologous recombination DNA repair (HRR) defects (35% vs. 12.5%) were more common among KRAS G12R vs. non-G12R mutated cancers. Patients with KRAS G12R vs. non-G12R cancers had significantly longer overall survival (OS) (HR 0.55) and progression-free survival (PFS) (HR 0.58), adjusted for HRR pathway co-mutations among other covariates. Within the KRAS G12R group, co-occurring PI3K pathway mutations were associated with numerically shorter OS (HR 1.58), while no effect was observed on PFS. CONCLUSIONS Patients with PDA harboring KRAS G12R vs. non-G12R mutations have longer survival, but this advantage was offset by co-occurring PI3K alterations. The KRAS/PI3K genomic profile could inform therapeutic vulnerabilities in patients with PDA.
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Affiliation(s)
- Adam C Diehl
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lindsay M Hannan
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David B Zhen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Andrew L Coveler
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Gentry King
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Stacey A Cohen
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - William P Harris
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Veena Shankaran
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kit M Wong
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Natasha Ng
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Jonathan G Sham
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - James O Park
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Deepti Reddi
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Eric Q Konnick
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Colin C Pritchard
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.,Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | | | - Mary Redman
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - E Gabriela Chiorean
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Center, Seattle, WA, USA
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4
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Mulcahy MF, Mahvash A, Pracht M, Montazeri AH, Bandula S, Martin RCG, Herrmann K, Brown E, Zuckerman D, Wilson G, Kim TY, Weaver A, Ross P, Harris WP, Graham J, Mills J, Yubero Esteban A, Johnson MS, Sofocleous CT, Padia SA, Lewandowski RJ, Garin E, Sinclair P, Salem R. Radioembolization With Chemotherapy for Colorectal Liver Metastases: A Randomized, Open-Label, International, Multicenter, Phase III Trial. J Clin Oncol 2021; 39:3897-3907. [PMID: 34541864 PMCID: PMC8660005 DOI: 10.1200/jco.21.01839] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To study the impact of transarterial Yttrium-90 radioembolization (TARE) in combination with second-line systemic chemotherapy for colorectal liver metastases (CLM). METHODS In this international, multicenter, open-label phase III trial, patients with CLM who progressed on oxaliplatin- or irinotecan-based first-line therapy were randomly assigned 1:1 to receive second-line chemotherapy with or without TARE. The two primary end points were progression-free survival (PFS) and hepatic PFS (hPFS), assessed by blinded independent central review. Random assignment was performed using a web- or voice-based system stratified by unilobar or bilobar disease, oxaliplatin- or irinotecan-based first-line chemotherapy, and KRAS mutation status. RESULTS Four hundred twenty-eight patients from 95 centers in North America, Europe, and Asia were randomly assigned to chemotherapy with or without TARE; this represents the intention-to-treat population and included 215 patients in the TARE plus chemotherapy group and 213 patients in the chemotherapy alone group. The hazard ratio (HR) for PFS was 0.69 (95% CI, 0.54 to 0.88; 1-sided P = .0013), with a median PFS of 8.0 (95% CI, 7.2 to 9.2) and 7.2 (95% CI, 5.7 to 7.6) months, respectively. The HR for hPFS was 0.59 (95% CI, 0.46 to 0.77; 1-sided P < .0001), with a median hPFS of 9.1 (95% CI, 7.8 to 9.7) and 7.2 (95% CI, 5.7 to 7.6) months, respectively. Objective response rates were 34.0% (95% CI, 28.0 to 40.5) and 21.1% (95% CI, 16.2 to 27.1; 1-sided P = .0019) for the TARE and chemotherapy groups, respectively. Median overall survival was 14.0 (95% CI, 11.8 to 15.5) and 14.4 months (95% CI, 12.8 to 16.4; 1-sided P = .7229) with a HR of 1.07 (95% CI, 0.86 to 1.32) for TARE and chemotherapy groups, respectively. Grade 3 adverse events were reported more frequently with TARE (68.4% v 49.3%). Both groups received full chemotherapy dose intensity. CONCLUSION The addition of TARE to systemic therapy for second-line CLM led to longer PFS and hPFS. Further subset analyses are needed to better define the ideal patient population that would benefit from TARE.
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Affiliation(s)
- Mary F Mulcahy
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Armeen Mahvash
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX
| | - Marc Pracht
- Centre Eugene Marquis, Medical Oncology, Rennes, France
| | - Amir H Montazeri
- Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, United Kingdom
| | - Steve Bandula
- University College London Hospital, London, United Kingdom
| | | | | | - Ewan Brown
- Western General Hospital, Edinburgh, Scotland
| | | | - Gregory Wilson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Tae-You Kim
- Seoul National University, Seoul, South Korea
| | - Andrew Weaver
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Paul Ross
- Guy's Hospital, London, United Kingdom
| | | | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jamie Mills
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | | | | | | | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Etienne Garin
- Centre Eugene Marquis, Nuclear Medicine, Rennes, France
| | | | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
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5
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Zhu AX, Macarulla T, Javle MM, Kelley RK, Lubner SJ, Adeva J, Cleary JM, Catenacci DVT, Borad MJ, Bridgewater JA, Harris WP, Murphy AG, Oh DY, Whisenant JR, Lowery MA, Goyal L, Shroff RT, El-Khoueiry AB, Chamberlain CX, Aguado-Fraile E, Choe S, Wu B, Liu H, Gliser C, Pandya SS, Valle JW, Abou-Alfa GK. Final Overall Survival Efficacy Results of Ivosidenib for Patients With Advanced Cholangiocarcinoma With IDH1 Mutation: The Phase 3 Randomized Clinical ClarIDHy Trial. JAMA Oncol 2021; 7:1669-1677. [PMID: 34554208 PMCID: PMC8461552 DOI: 10.1001/jamaoncol.2021.3836] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Question Does ivosidenib treatment improve overall survival outcomes vs placebo among patients with chemotherapy-refractory cholangiocarcinoma with IDH1 mutation? Findings In this phase 3 randomized clinical trial including 187 previously treated patients with advanced cholangiocarcinoma with IDH1 mutation, ivosidenib treatment resulted in numerically improved overall survival benefits vs placebo, despite a high rate of crossover. Ivosidenib preserved certain quality of life subscales and was well tolerated. Meaning The combined efficacy data and tolerable safety profile, as well as corroborating quality of life data, support the clinical benefit of ivosidenib relative to placebo in cholangiocarcinoma with IDH1 mutation, which has an unmet need for new treatments. Importance Isocitrate dehydrogenase 1 (IDH1) variations occur in up to approximately 20% of patients with intrahepatic cholangiocarcinoma. In the ClarIDHy trial, progression-free survival as determined by central review was significantly improved with ivosidenib vs placebo. Objective To report the final overall survival (OS) results from the ClarIDHy trial, which aimed to demonstrate the efficacy of ivosidenib (AG-120)—a first-in-class, oral, small-molecule inhibitor of mutant IDH1—vs placebo for patients with unresectable or metastatic cholangiocarcinoma with IDH1 mutation. Design, Setting, and Participants This multicenter, randomized, double-blind, placebo-controlled, clinical phase 3 trial was conducted from February 20, 2017, to May 31, 2020, at 49 hospitals across 6 countries among patients aged 18 years or older with cholangiocarcinoma with IDH1 mutation whose disease progressed with prior therapy. Interventions Patients were randomized 2:1 to receive ivosidenib, 500 mg, once daily or matched placebo. Crossover from placebo to ivosidenib was permitted if patients had disease progression as determined by radiographic findings. Main Outcomes and Measures The primary end point was progression-free survival as determined by blinded independent radiology center (reported previously). Overall survival was a key secondary end point. The primary analysis of OS followed the intent-to-treat principle. Other secondary end points included objective response rate, safety and tolerability, and quality of life. Results Overall, 187 patients (median age, 62 years [range, 33-83 years]) were randomly assigned to receive ivosidenib (n = 126; 82 women [65%]; median age, 61 years [range, 33-80 years]) or placebo (n = 61; 37 women [61%]; median age, 63 years [range, 40-83 years]); 43 patients crossed over from placebo to ivosidenib. The primary end point of progression-free survival was reported elsewhere. Median OS was 10.3 months (95% CI, 7.8-12.4 months) with ivosidenib vs 7.5 months (95% CI, 4.8-11.1 months) with placebo (hazard ratio, 0.79 [95% CI, 0.56-1.12]; 1-sided P = .09). When adjusted for crossover, median OS with placebo was 5.1 months (95% CI, 3.8-7.6 months; hazard ratio, 0.49 [95% CI, 0.34-0.70]; 1-sided P < .001). The most common grade 3 or higher treatment-emergent adverse event (≥5%) reported in both groups was ascites (11 patients [9%] receiving ivosidenib and 4 patients [7%] receiving placebo). Serious treatment-emergent adverse events considered ivosidenib related were reported in 3 patients (2%). There were no treatment-related deaths. Patients receiving ivosidenib reported no apparent decline in quality of life compared with placebo. Conclusions and Relevance This randomized clinical trial found that ivosidenib was well tolerated and resulted in a favorable OS benefit vs placebo, despite a high rate of crossover. These data, coupled with supportive quality of life data and a tolerable safety profile, demonstrate the clinical benefit of ivosidenib for patients with advanced cholangiocarcinoma with IDH1 mutation. Trial Registration ClinicalTrials.gov Identifier: NCT02989857
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Affiliation(s)
- Andrew X Zhu
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston.,Jiahui International Cancer Center, Jiahui Health, Shanghai, China
| | | | - Milind M Javle
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - R Kate Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - Sam J Lubner
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison
| | - Jorge Adeva
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - James M Cleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Mitesh J Borad
- Department of Hematology-Oncology, Mayo Clinic, Scottsdale, Arizona
| | - John A Bridgewater
- Department of Medical Oncology, University College London Cancer Institute, London, United Kingdom
| | | | - Adrian G Murphy
- Department of Oncology-Gastrointestinal Cancer, Johns Hopkins University, Baltimore, Maryland
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea
| | | | - Maeve A Lowery
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston.,Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Lipika Goyal
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - Rachna T Shroff
- Department of Medicine, University of Arizona Cancer Center, Tucson
| | - Anthony B El-Khoueiry
- Department of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles
| | - Christina X Chamberlain
- Agios Pharmaceuticals Inc, Cambridge, Massachusetts.,Now with Servier Pharmaceuticals, LLC, Boston, Massachusetts
| | - Elia Aguado-Fraile
- Agios Pharmaceuticals Inc, Cambridge, Massachusetts.,Repare Therapeutics, Cambridge, Massachusetts
| | - Sung Choe
- Agios Pharmaceuticals Inc, Cambridge, Massachusetts.,Now with Servier Pharmaceuticals, LLC, Boston, Massachusetts
| | - Bin Wu
- Agios Pharmaceuticals Inc, Cambridge, Massachusetts.,Bristol Myers Squibb, Cambridge, Massachusetts
| | - Hua Liu
- Agios Pharmaceuticals Inc, Cambridge, Massachusetts.,Now with Servier Pharmaceuticals, LLC, Boston, Massachusetts
| | - Camelia Gliser
- Agios Pharmaceuticals Inc, Cambridge, Massachusetts.,Now with Servier Pharmaceuticals, LLC, Boston, Massachusetts
| | - Shuchi S Pandya
- Agios Pharmaceuticals Inc, Cambridge, Massachusetts.,Now with Servier Pharmaceuticals, LLC, Boston, Massachusetts
| | - Juan W Valle
- Division of Cancer Sciences, University of Manchester, Department of Medical Oncology, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Medical College at Cornell University, New York, New York
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Ojeda PI, Hannan LM, Mieloszyk RJ, Hall CS, Mileto A, Harris WP, Park JO, Baheti AD, Hippe DS, Bhargava P. Is There a Difference Between LI-RADS 3 to LI-RADS 5 Progression Assessment Using CT Versus MR? A Retrospective, Single-Center, Longitudinal Study of Patients Who Underwent 5082 Radiologic Examinations for Surveillance of Hepatocellular Carcinoma Over a 43-Month Period. Curr Probl Diagn Radiol 2021; 51:176-180. [PMID: 33980417 DOI: 10.1067/j.cpradiol.2021.03.016] [Citation(s) in RCA: 1] [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: 03/09/2021] [Accepted: 03/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The Liver Imaging Reporting and Data System (LI-RADS) has been widely applied to CT and MR liver observations in patients at high-risk for hepatocellular carcinoma (HCC). We investigated the impact of CT vs MR in upgrading LI-RADS 3 to LI-RADS 5 observations using a large cohort of high-risk patients. METHODS We performed a retrospective, longitudinal study of CT and MR radiographic reports (June 2013 - February 2017) with an assigned LI-RADS category. A final population of 757 individual scans and 212 high-risk patients had at least one LI-RADS 3 observation. Differences in observation time to progression between modalities were determined using uni- and multivariable analysis. RESULTS Of the 212 patients with a LI-RADS 3 observation, 52 (25%) had progression to LI-RADS 5. Tp ranged from 64 - 818 days (median: 196 days). One hundred and three patients (49%) had MR and 109 patients (51%) had CT as their index study. Twenty-four patients with an MR index exam progressed to LI-RADS 5 during the follow-up interval, with progression rates of 22% (CI:13%-30%) at 1 year and 29% (CI:17%-40%) at 2 years. Twenty-eight patients with a CT index exam progressed to LI-RADS 5 during follow-up, with progression rates of 26% (CI:16%-35%) at 1 year and 31% (CI:19%-41%) at 2 years. Progression rates were not significantly different between patients whose LI-RADS 3 observation was initially diagnosed on MR vs CT (HR: 0.81, P = 0.44). DISCUSSION MR and CT modalities are comparable for demonstrating progression from LI-RADS 3 to 5 for high risk patients.
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Affiliation(s)
- Patricia I Ojeda
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Lindsay M Hannan
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Rebecca J Mieloszyk
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Microsoft Research, Redmond, WA
| | - Christopher S Hall
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Achille Mileto
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - William P Harris
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - James O Park
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Akshay D Baheti
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Department of Radiology, Tata Memorial Center, Mumbai, India; Department of Radiology, Homi Bhabha National Institute, Mumbai, India
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Puneet Bhargava
- Department of Radiology, University of Washington School of Medicine, Seattle, WA.
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7
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Mathai AM, Alexander J, Huang HY, Li CF, Jeng YM, Fung KM, Harris WP, Swanson PE, Truong C, Yeh MM. S100P as a marker for poor survival and advanced stage in gallbladder carcinoma. Ann Diagn Pathol 2021; 52:151736. [PMID: 33798925 DOI: 10.1016/j.anndiagpath.2021.151736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
AIMS Gallbladder carcinomas usually present in advanced stages and has a dismal prognosis despite modern imaging techniques and aggressive surgical intervention. Identification of biologic markers for early diagnosis and improved therapeutic strategies is thus of paramount importance. S100P has been identified in a variety of malignant neoplasms of the gastrointestinal and pancreaticobiliary systems, but it is not yet known if S100P expression is associated with clinically-relevant characteristics of gall bladder carcinoma. The aims of the present study were: 1) to investigate the relationship between S100P expression and histological type, grade, tumor-node-metastasis stage, presence of vascular invasion, perineural invasion and necrosis; and 2) to evaluate for any S100P-defined difference in the risk for tumor recurrence or death. METHOD Immunostains for S100P were performed on 4 tissue microarray blocks containing 91 cases of gall bladder carcinoma. RESULT The intensity of S100P staining was significantly associated with pathological T stage 4 (p = 0. 0238). Staining intensity ≥3 in ≥25% tumor cells was associated with pathological T stage 4 (p = 0.0005). A higher S100P immunoreactivity score (IRS) was significantly associated with higher TNM stage (p = 0.0341). Age (p = 0.0485), presence of vascular invasion (p = 0.0359), pathological T stage (p = 0.0291) and TNM stage (p = 0.0153) were significantly associated with tumor recurrence. Intense S100P reactivity was associated with decreased overall survival [hazard ratio = 9.614; 95% confidence interval (CI), 1.873-49.338; p = 0.0067]. CONCLUSION Our findings indicate that S100P over-expression is a potential prognostic marker for gall bladder carcinoma and is significantly associated with advanced tumor stage and poorer survival.
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Affiliation(s)
- Alka Mary Mathai
- Department of Pathology, Sree Uthradom Thirunal Academy of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - Jacob Alexander
- Department of Medicine, University of Massachusetts Medical School - Baystate Health, Springfield, MA, United States
| | - Hsuan-Ying Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Feng Li
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yung-Ming Jeng
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma, Oklahoma City, OK, United States
| | - William P Harris
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Paul E Swanson
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Camtu Truong
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Matthew M Yeh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States.
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Kim RD, Harris WP, Sung MW, Waldschmidt DT, Cabrera R, Mueller U, Menezes F, Ishida T, Galle PR, El-Khoueiry AB. Results of a phase Ib study of regorafenib (REG) 80 mg/day plus pembrolizumab (PEMBRO) for first-line treatment of advanced hepatocellular carcinoma (HCC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
323 Background: In a phase Ib study, REG 120 mg/day plus PEMBRO for first-line treatment of advanced HCC showed no unexpected safety signals and encouraging anti-tumor activity. At the maximum tolerated dose (MTD) of REG (120 mg/day), approximately three-quarters of patients (pts) had a REG dose reduction or interruption due to a treatment-emergent adverse event (TEAE). Here, we present preliminary data for the REG 80 mg/day cohort. Methods: This is an ongoing, dose-finding study in pts who had no prior systemic therapy. In the first cohort, pts received REG 120 mg/day orally for 3 weeks on/1 week off plus PEMBRO 200 mg intravenously q 3 weeks. In later cohorts, the REG dose could be escalated (160 mg/day) or reduced (80 mg/day); the PEMBRO dose is fixed. The primary objective is safety and tolerability. Secondary objectives are to define the MTD and recommended phase II dose and assess anti-tumor activity. Results: By July 24, 2020, 16 pts were treated with REG 80 mg/day. Median age was 67 years (range 56–79), 25%/75% were Barcelona Clinic Liver Cancer stage B/C, 100% Child–Pugh A, and 69%/31% had Eastern Cooperative Oncology Group performance status 0/1. Grade (Gr) 3 TEAEs occurred in 8/16 pts (50%) and there were no Gr 4 TEAEs (Table); one pt experienced Gr 5 pneumonitis (not drug related). There were no reports of Gr 3 hand–foot skin reaction or Gr 3 maculopapular rash, and one report (6%) of Gr 3 rash. TEAEs led to a REG dose reduction or interruption in 50% of pts and to a PEMBRO dose interruption in 25% of pts. Median treatment duration (range) including pts ongoing was 4.1 months (0.4–7.1) for REG and 3.8 months (0.03–7.2) for PEMBRO. Of 13 evaluable pts, 2 (15%) had a partial response and 9 (69%) had stable disease (Response Evaluation Criteria in Solid Tumors v1.1); disease control rate was 85%. Conclusions: These preliminary results for the combination of REG 80 mg/day plus PEMBRO for first-line treatment of advanced HCC were consistent with the REG 120 mg/day cohort. The combination showed no unexpected safety signals and encouraging anti-tumor activity. Assessment of REG 80 mg/day plus PEMBRO is ongoing. Clinical trial information: NCT03347292. [Table: see text]
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Affiliation(s)
| | - William P. Harris
- University of Washington/Seattle Cancer Care Alliance (SCCA), Seattle, WA
| | - Max W. Sung
- Tisch Cancer Institute at Mount Sinai, New York, NY
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9
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Gordan JD, Kennedy EB, Abou-Alfa GK, Beg MS, Brower ST, Gade TP, Goff L, Gupta S, Guy J, Harris WP, Iyer R, Jaiyesimi I, Jhawer M, Karippot A, Kaseb AO, Kelley RK, Knox JJ, Kortmansky J, Leaf A, Remak WM, Shroff RT, Sohal DPS, Taddei TH, Venepalli NK, Wilson A, Zhu AX, Rose MG. Systemic Therapy for Advanced Hepatocellular Carcinoma: ASCO Guideline. J Clin Oncol 2020; 38:4317-4345. [PMID: 33197225 DOI: 10.1200/jco.20.02672] [Citation(s) in RCA: 319] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To develop an evidence-based clinical practice guideline to assist in clinical decision making for patients with advanced hepatocellular carcinoma (HCC). METHODS ASCO convened an Expert Panel to conduct a systematic review of published phase III randomized controlled trials (2007-2020) on systemic therapy for advanced HCC and provide recommended care options for this patient population. RESULTS Nine phase III randomized controlled trials met the inclusion criteria. RECOMMENDATIONS Atezolizumab + bevacizumab (atezo + bev) may be offered as first-line treatment of most patients with advanced HCC, Child-Pugh class A liver disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1, and following management of esophageal varices, when present, according to institutional guidelines. Where there are contraindications to atezolizumab and/or bevacizumab, tyrosine kinase inhibitors sorafenib or lenvatinib may be offered as first-line treatment of patients with advanced HCC, Child-Pugh class A liver disease, and ECOG PS 0-1. Following first-line treatment with atezo + bev, and until better data are available, second-line therapy with a tyrosine kinase inhibitor may be recommended for appropriate candidates. Following first-line therapy with sorafenib or lenvatinib, second-line therapy options for appropriate candidates include cabozantinib, regorafenib for patients who previously tolerated sorafenib, or ramucirumab (for patients with α-fetoprotein ≥ 400 ng/mL), or atezo + bev where patients did not have access to this option as first-line therapy. Pembrolizumab or nivolumab are also reasonable options for appropriate patients following sorafenib or lenvatinib. Consideration of nivolumab + ipilimumab as an option for second-line therapy and third-line therapy is discussed. Further guidance on choosing between therapy options is included within the guideline. Additional information is available at www.asco.org/gastrointestinal-cancer-guidelines.
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Affiliation(s)
- John D Gordan
- University of California, San Francisco, San Francisco, CA
| | | | - Ghassan K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, Weill Medical College at Cornell University, New York, NY
| | | | - Steven T Brower
- Lefcourt Family Cancer Treatment and Wellness Center, Englewood, NJ
| | | | - Laura Goff
- Vanderbilt Ingram Cancer Center, Nashville, TN
| | | | | | | | - Renuka Iyer
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | | | - R Kate Kelley
- University of California, San Francisco, San Francisco, CA
| | | | | | - Andrea Leaf
- VA New York Harbor Healthcare System, Brooklyn, NY
| | - William M Remak
- California Hepatitis C Task Force, California Chronic Care Coalition, FAIR Foundation, San Francisco, CA
| | | | | | - Tamar H Taddei
- Yale University School of Medicine and VA Connecticut Healthcare System, West Haven, CT
| | | | - Andrea Wilson
- Blue Faery: The Adrienne Wilson Liver Cancer Association, Birmingham, AL
| | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Michal G Rose
- Yale Cancer Center and VA Connecticut Healthcare System, West Haven, CT
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10
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Abou-Alfa GK, Macarulla T, Javle MM, Kelley RK, Lubner SJ, Adeva J, Cleary JM, Catenacci DV, Borad MJ, Bridgewater J, Harris WP, Murphy AG, Oh DY, Whisenant J, Lowery MA, Goyal L, Shroff RT, El-Khoueiry AB, Fan B, Wu B, Chamberlain CX, Jiang L, Gliser C, Pandya SS, Valle JW, Zhu AX. Ivosidenib in IDH1-mutant, chemotherapy-refractory cholangiocarcinoma (ClarIDHy): a multicentre, randomised, double-blind, placebo-controlled, phase 3 study. Lancet Oncol 2020; 21:796-807. [PMID: 32416072 PMCID: PMC7523268 DOI: 10.1016/s1470-2045(20)30157-1] [Citation(s) in RCA: 531] [Impact Index Per Article: 132.8] [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: 12/20/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Isocitrate dehydrogenase 1 (IDH1) mutations occur in approximately 13% of patients with intrahepatic cholangiocarcinoma, a relatively uncommon cancer with a poor clinical outcome. The aim of this international phase 3 study was to assess the efficacy and safety of ivosidenib (AG-120)-a small-molecule targeted inhibitor of mutated IDH1-in patients with previously treated IDH1-mutant cholangiocarcinoma. METHODS This multicentre, randomised, double-blind, placebo-controlled, phase 3 study included patients from 49 hospitals in six countries aged at least 18 years with histologically confirmed, advanced, IDH1-mutant cholangiocarcinoma who had progressed on previous therapy, and had up to two previous treatment regimens for advanced disease, an Eastern Cooperative Oncology Group performance status score of 0 or 1, and a measurable lesion as defined by Response Evaluation Criteria in Solid Tumors version 1.1. Patients were randomly assigned (2:1) with a block size of 6 and stratified by number of previous systemic treatment regimens for advanced disease to oral ivosidenib 500 mg or matched placebo once daily in continuous 28-day cycles, by means of an interactive web-based response system. Placebo to ivosidenib crossover was permitted on radiological progression per investigator assessment. The primary endpoint was progression-free survival by independent central review. The intention-to-treat population was used for the primary efficacy analyses. Safety was assessed in all patients who had received at least one dose of ivosidenib or placebo. Enrolment is complete; this study is registered with ClinicalTrials.gov, NCT02989857. FINDINGS Between Feb 20, 2017, and Jan 31, 2019, 230 patients were assessed for eligibility, and as of the Jan 31, 2019 data cutoff date, 185 patients were randomly assigned to ivosidenib (n=124) or placebo (n=61). Median follow-up for progression-free survival was 6·9 months (IQR 2·8-10·9). Progression-free survival was significantly improved with ivosidenib compared with placebo (median 2·7 months [95% CI 1·6-4·2] vs 1·4 months [1·4-1·6]; hazard ratio 0·37; 95% CI 0·25-0·54; one-sided p<0·0001). The most common grade 3 or worse adverse event in both treatment groups was ascites (four [7%] of 59 patients receiving placebo and nine [7%] of 121 patients receiving ivosidenib). Serious adverse events were reported in 36 (30%) of 121 patients receiving ivosidenib and 13 (22%) of 59 patients receiving placebo. There were no treatment-related deaths. INTERPRETATION Progression-free survival was significantly improved with ivosidenib compared with placebo, and ivosidenib was well tolerated. This study shows the clinical benefit of targeting IDH1 mutations in advanced, IDH1-mutant cholangiocarcinoma. FUNDING Agios Pharmaceuticals.
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Affiliation(s)
- Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Medical College at Cornell University, New York, NY, USA
| | - Teresa Macarulla
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Milind M Javle
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Robin K Kelley
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Sam J Lubner
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Jorge Adeva
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - James M Cleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daniel V Catenacci
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Mitesh J Borad
- Department of Hematology-Oncology, Mayo Clinic Cancer Center, Phoenix, AZ, USA
| | - John Bridgewater
- Department of Medical Oncology, UCL Cancer Institute, London, UK
| | - William P Harris
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Adrian G Murphy
- Department of Oncology-Gastrointestinal Cancer, Johns Hopkins University, Baltimore, MD, USA
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jonathan Whisenant
- Medical Oncology and Hematology, Utah Cancer Specialists, Salt Lake City, UT, USA
| | - Maeve A Lowery
- Trinity St James Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Lipika Goyal
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Rachna T Shroff
- Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA
| | - Anthony B El-Khoueiry
- Department of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Bin Fan
- Agios Pharmaceuticals, Cambridge, MA, USA
| | - Bin Wu
- Agios Pharmaceuticals, Cambridge, MA, USA
| | | | | | | | | | - Juan W Valle
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew X Zhu
- Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA; Jiahui International Cancer Center, Jiahui Health, Shanghai, China.
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11
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Goyal L, Lamarca A, Strickler JH, Cecchini M, Ahn DH, Baiev I, Boileve A, Tazdait M, Hannan LM, Jia J, Marble HD, Barzi A, Sahai V, Lennerz JK, Kelley RK, Bekaii-Saab TS, Javle MM, Uboha NV, Harris WP, Hollebecque A. The natural history of fibroblast growth factor receptor (FGFR)-altered cholangiocarcinoma (CCA). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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
e16686 Background: Genetic alterations in the FGFR pathway are emerging as promising therapeutic targets in CCA. The clinical and molecular features of patients (pts) with CCA harboring FGFR genetic alterations are reported here. Methods: A retrospective chart review was performed in pts with CCA who were found to have an FGFR alteration on tumor molecular profiling as part of routine care between 9/2007 and 12/2019. Data on demographics, risk factors, pathology, molecular characteristics, systemic therapies, radiographical response, time on treatment, and overall survival (OS) were collected in a multi-center collaborative effort across seven academic centers. Results: Among 135 pts with FGFR-altered CCA, the median age at diagnosis was 57 years old (range = 25-92 years), and 80 (59.3%) pts were female, 129 (95.6%) had intrahepatic CCA, and 6 (5.6%) had chronic HBV. At presentation, 28.2% of pts had resectable disease, including 65.0% with Stage I-II, 22.5% with Stage III, and 5.0% with Stage IV. At the time of initial diagnosis, CA19-9 was < 35U/mL in 42.6% of pts. Bone metastases were observed in 41 (30.6%) pts with advanced disease. FGFR2 fusions were the most common FGFR alteration (68.2%), followed by FGFR2 mutations (21.5%), FGFR3 mutations (3.7%), FGFR2 rearrangements (1.5%), FGFR1 amplification (1.5%), and FGFR2 amplification (1.5%). The most common FGFR2 fusion partners were BICC1 (28.3%), SORBS1 (4.4%), POC1B (3.3%), and TACC2 (3.3%). The median lines of palliative systemic therapies received was 3 (range = 0-8), and 40/135 (29.6%) pts received a liver-directed therapy. For the 55 (59.8%) pts with FGFR2 fusions who received gemcitabine/cisplatin as first-line palliative systemic therapy, the median time on treatment was 6.2 months (95% CI: 4.1-9.3). The median OS from time of initial diagnosis was 36.1 months (95% CI: 28.3-51.6) in the FGFR2 fusion positive cohort. Among the 92 pts with FGFR2 fusions, 70 (76.1%) pts received an FGFR inhibitor on a clinical trial; 12 (17.1%) were subsequently treated with a second FGFR inhibitor, and 58.3% stayed on the second FGFR inhibitor for ≥4 months. Pts with a BICC1 fusion partner (n = 16) had an overall response rate of 42.9% on FGFR-selective inhibitors compared to 30.8% in non-BICC1 fusion partners (n = 54). Conclusions: Pts with CCA harboring FGFR alterations were found to have a high rate of normal CA19-9, high rate of bone metastases, and short median time on treatment on first-line palliative gemcitabine/cisplatin. Additional comparative studies are necessary to evaluate these findings.
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Affiliation(s)
- Lipika Goyal
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust / Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | | | | | - Daniel H. Ahn
- Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | | | | | | | | | | | | | - Afsaneh Barzi
- University of Southern California Norris Cancer Hospital Outpatient Clinic, Los Angeles, CA
| | | | | | | | | | - Milind M. Javle
- The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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El-Khoueiry AB, Kim RD, Harris WP, Sung MW, Waldschmidt D, Iqbal S, Zhang X(A, Nakajima K, Galle PR. Phase Ib study of regorafenib (REG) plus pembrolizumab (PEMBRO) for first-line treatment of advanced hepatocellular carcinoma (HCC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.564] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
564 Background: REG is a multikinase inhibitor with immunomodulatory activity and PEMBRO is an anti-PD-1 monoclonal antibody. Both are approved as monotherapy for patients (pts) with HCC previously treated with sorafenib. Based on their potential synergistic effects, we conducted a phase 1b study of REG plus PEMBRO for first-line treatment of advanced HCC. Methods: This is an ongoing, open-label, dose-escalation study in pts with advanced HCC who had no prior systemic therapy. In the first cohort, pts received REG 120 mg/day PO for 3 weeks on/1 week off plus PEMBRO 200 mg IV q 3 weeks. In later cohorts, the REG dose could be escalated (160 mg) or reduced (80 mg) based on the modified toxicity probability interval design; the PEMBRO dose is fixed. The primary objective is safety and tolerability. Secondary objectives are to define the maximum tolerated dose (MTD) and recommended phase 2 dose, and to assess antitumor activity. Results: As of August 23, 2019, 29 pts have been treated at the REG 120 mg level. Median age is 65 years (range 32–81); 41%/55% of pts are BCLC stage B/C; 100% are Child–Pugh A; ECOG status 0/1 is 72%/28%. Dose-limiting toxicities occurred in 4/18 evaluable pts: grade (Gr) 3 increased ALT/AST with Gr 2 increased bilirubin (n = 2); Gr 3 rash (n = 2). The MTD of REG in the combination was 120 mg. Most common Gr 3 or 4 treatment-emergent adverse events (TEAEs) are shown (n = 29). There were no Gr 5 TEAEs. 59%/31% of pts had REG/PEMRO-related Gr 3 or 4 TEAEs. Dose modifications (reductions or interruptions) of REG/PEMBRO for drug-related TEAEs occurred in 59%/31% of pts. Of 23 evaluable pts, 7 (30%) had a partial response (PR) and 14 (61%) had stable disease (RECIST v1.1); 1 additional pt had PR by mRECIST. Conclusions: The combination of REG plus PEMBRO for first-line treatment of advanced HCC showed no unexpected safety signals and encouraging antitumor activity. Accrual is continuing at REG 120 mg dose and an expansion cohort evaluating REG 80 mg plus PEMBRO is planned. Clinical trial information: NCT03347292. [Table: see text]
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Affiliation(s)
| | | | - William P. Harris
- University of Washington/Seattle Cancer Care Alliance (SCCA), Seattle, WA
| | - Max W. Sung
- Tisch Cancer Institute at Mount Sinai, New York, NY
| | | | - Syma Iqbal
- University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
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13
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Abou-Alfa GK, Qin S, Ryoo BY, Lu SN, Yen CJ, Feng YH, Lim HY, Izzo F, Colombo M, Sarker D, Bolondi L, Vaccaro G, Harris WP, Chen Z, Hubner RA, Meyer T, Sun W, Harding JJ, Hollywood EM, Ma J, Wan PJ, Ly M, Bomalaski J, Johnston A, Lin CC, Chao Y, Chen LT. Phase III randomized study of second line ADI-PEG 20 plus best supportive care versus placebo plus best supportive care in patients with advanced hepatocellular carcinoma. Ann Oncol 2019; 29:1402-1408. [PMID: 29659672 DOI: 10.1093/annonc/mdy101] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Arginine depletion is a putative target in hepatocellular carcinoma (HCC). HCC often lacks argininosuccinate synthetase, a citrulline to arginine-repleting enzyme. ADI-PEG 20 is a cloned arginine degrading enzyme-arginine deiminase-conjugated with polyethylene glycol. The goal of this study was to evaluate this agent as a potential novel therapeutic for HCC after first line systemic therapy. Methods and patients Patients with histologically proven advanced HCC and Child-Pugh up to B7 with prior systemic therapy, were randomized 2 : 1 to ADI-PEG 20 18 mg/m2 versus placebo intramuscular injection weekly. The primary end point was overall survival (OS), with 93% power to detect a 4-5.6 months increase in median OS (one-sided α = 0.025). Secondary end points included progression-free survival, safety, and arginine correlatives. Results A total of 635 patients were enrolled: median age 61, 82% male, 60% Asian, 52% hepatitis B, 26% hepatitis C, 76% stage IV, 91% Child-Pugh A, 70% progressed on sorafenib and 16% were intolerant. Median OS was 7.8 months for ADI-PEG 20 versus 7.4 for placebo (P = 0.88, HR = 1.02) and median progression-free survival 2.6 months versus 2.6 (P = 0.07, HR = 1.17). Grade 3 fatigue and decreased appetite occurred in <5% of patients. Two patients on ADI-PEG 20 had ≥grade 3 anaphylactic reaction. Death rate within 30 days of end of treatment was 15.2% on ADI-PEG 20 versus 10.4% on placebo, none related to therapy. Post hoc analyses of arginine assessment at 4, 8, 12 and 16 weeks, demonstrated a trend of improved OS for those with more prolonged arginine depletion. Conclusion ADI-PEG 20 monotherapy did not demonstrate an OS benefit in second line setting for HCC. It was well tolerated. Strategies to enhance prolonged arginine depletion and synergize the effect of ADI-PEG 20 are underway. Clinical Trial number www.clinicaltrials.gov (NCT 01287585).
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Affiliation(s)
- G K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, USA.
| | - S Qin
- Department of Oncology, The Chinese People's Liberation Army 81 Hospital, Nanjing, China
| | - B-Y Ryoo
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - S-N Lu
- Department of Medical Oncology, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Taiwan
| | - C-J Yen
- Department of Oncology, National Cheng Kung University Hospital, Taiwan
| | - Y-H Feng
- Department of Oncology, Chi Mei Medical Center-Yong Kang, Taiwan
| | - H Y Lim
- Department of Medical Oncology, Samsung Medical Center, Seoul, South Korea
| | - F Izzo
- Department of Medicine, Fondazione Giovanni Pascale, Napoli
| | - M Colombo
- Department of Medicine, Fondazione IRCCS Ca, Milan, Italy
| | - D Sarker
- Department of Medicine, King's College Hospital, London, UK
| | - L Bolondi
- Department of Medicine, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - G Vaccaro
- Department of Medicine, Oregon Health Sciences University, Portland
| | - W P Harris
- Department of Medicine, University of Washington Medical Center, Seattle, USA
| | - Z Chen
- Department of Oncology, 2nd Hospital of Anhui Medical University, Hefei, China
| | - R A Hubner
- Department of Medicine, The Christie NHS Foundation Trust, Manchester, UK
| | - T Meyer
- Department of Medicine, Royal Free Hospital and UCL Cancer Institute, London, UK
| | - W Sun
- Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - J J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medical College, New York, USA
| | - E M Hollywood
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Ma
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - P J Wan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Ly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bomalaski
- Department of Research and Development, Polaris Pharmaceuticals, Inc., San Diego, USA
| | - A Johnston
- Department of Research and Development, Polaris Pharmaceuticals, Inc., San Diego, USA
| | - C-C Lin
- Department of Medical Oncology, Chang Gung Medical Foundation LK, Taipei, Tainan
| | - Y Chao
- Department of Medicine, Veterans General Hospital-Taipei, Taipei, Tainan
| | - L-T Chen
- Chang Gung University College of Medicine, Taiwan; Department of Medical Oncology, National Institute of Cancer Research, National Health Research Institutes, Tainan; Department of Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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14
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Apodaca MC, Wright AE, Riggins AM, Harris WP, Yeung RS, Yu L, Morishima C. Characterization of a whole blood assay for quantifying myeloid-derived suppressor cells. J Immunother Cancer 2019; 7:230. [PMID: 31462270 PMCID: PMC6714080 DOI: 10.1186/s40425-019-0674-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023] Open
Abstract
Background Myeloid-derived suppressor cells (MDSC) have been found to play an important role in limiting immune responses in cancer. Higher circulating MDSC levels have been associated with greater tumor burden, poorer response to immunotherapy, and poorer survival. Optimal measurement of MDSC levels could provide clinicians with a useful prognostic and/or management tool. Methods A whole blood (WB) nine color, 11 parameter flow cytometric assay was designed, utilizing fluorescently-labeled antibodies against CD45, CD3, CD19, CD20, CD56, CD16, HLA-DR, CD33, CD11b, CD14 and CD15, and BD Trucount beads for quantitation. Total MDSC were defined as CD45 + CD3−CD19−CD20−CD56−CD16−HLA-DR−CD33 + CD11b + cells, while the monocytic (M-MDSC) and polymorphonuclear subsets were defined as CD14+ or CD15+, respectively. Results A novel gating strategy was devised to eliminate granulocytes and improve consistency in gating. Several pre-analytical variables were found to significantly affect MDSC quantitation, including collection tube type and time elapsed between blood collection and testing. Total and M-MDSC levels were a mean of 63% and 73% greater, respectively, with K2EDTA compared to Na+heparin collection tubes (N = 5). In addition, time elapsed at room temperature prior to cell labeling affected MDSC quantitation; by 24 h after blood collection, total and M-MDSC levels were a mean of 26% and 57% lower compared to testing as soon as possible after collection (N = 6). Refrigeration of samples at 4 °C ameliorated time-dependent effects at both 4 and 8 h, but not 24 h after blood collection. To establish normal ranges for this assay, MDSC levels were quantified in 67 healthy subjects (30 male, 37 female) ages 20–93. No significant differences in total or M-MDSC levels were detected for ages ≤60 compared to > 60 (p = 0.5 and p = 0.8, respectively). Finally, assay results demonstrated significantly higher MDSC levels among patients with hepatocellular carcinoma (N = 55) compared to age-matched healthy controls (N = 27) for total and M-MDSC (p = 0.006 and 0.004, respectively). Conclusions MDSC are a heterogenous group of cells, and their quantitation in WB can be affected by a number of pre-analytical variables. Consideration of these factors, and measurement using a material type that has not been manipulated, such as whole blood, is likely to yield the most accurate results. Electronic supplementary material The online version of this article (10.1186/s40425-019-0674-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minjun C Apodaca
- Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Amy E Wright
- Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Angela M Riggins
- Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - William P Harris
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA
| | - Raymond S Yeung
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Lei Yu
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, WA, USA
| | - Chihiro Morishima
- Department of Laboratory Medicine, University of Washington, Box 357110, 1959 NE Pacific St, Seattle, WA, 98195, USA.
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Mazzaferro V, El-Rayes BF, Droz Dit Busset M, Cotsoglou C, Harris WP, Damjanov N, Masi G, Rimassa L, Personeni N, Braiteh F, Zagonel V, Papadopoulos KP, Hall T, Wang Y, Schwartz B, Kazakin J, Bhoori S, de Braud F, Shaib WL. Derazantinib (ARQ 087) in advanced or inoperable FGFR2 gene fusion-positive intrahepatic cholangiocarcinoma. Br J Cancer 2019; 120:165-171. [PMID: 30420614 PMCID: PMC6342954 DOI: 10.1038/s41416-018-0334-0] [Citation(s) in RCA: 251] [Impact Index Per Article: 50.2] [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: 06/29/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Next-generation sequencing has identified actionable genetic aberrations in intrahepatic cholangiocarcinomas (iCCA), including the fibroblast growth factor receptor 2 (FGFR2) fusions. Derazantinib (ARQ 087), an orally bioavailable, multi-kinase inhibitor with potent pan-FGFR activity, has shown preliminary therapeutic activity against FGFR2 fusion-positive iCCA. METHODS This multicentre, phase 1/2, open-label study enrolled adult patients with unresectable iCCA with FGFR2 fusion, who progressed, were intolerant or not eligible to first-line chemotherapy (NCT01752920). Subjects received derazantinib in continuous daily doses. Tumour response was assessed according to RECIST 1.1 every 8 weeks. RESULTS Twenty-nine patients (18 women/11 men; median age, 58.7 years), 2 treatment-naive and 27 who progressed after at least one prior systemic therapy, were enrolled. Overall response rate was 20.7%, disease control rate was 82.8%. Estimated median progression-free survival was 5.7 months (95% CI: 4.04-9.2 months). Treatment-related adverse events (AE) were observed in 27 patients (93.1%, all grades), including asthenia/fatigue (69.0%), eye toxicity (41.4%), and hyperphosphatemia (75.9%). Grade ≥ 3 AEs occurred in 8 patients (27.6%). CONCLUSION Derazantinib demonstrated encouraging anti-tumour activity and a manageable safety profile in patients with advanced, unresectable iCCA with FGFR2 fusion who progressed after chemotherapy. A pivotal trial of derazantinib in iCCA is ongoing (NCT03230318).
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Affiliation(s)
- Vincenzo Mazzaferro
- Department of Surgery and Oncology, Istituto Nazionale Tumori IRCCS, Milan, Italy.
- University of Milan, Milan, Italy.
| | | | | | - Christian Cotsoglou
- Department of Surgery and Oncology, Istituto Nazionale Tumori IRCCS, Milan, Italy
| | | | - Nevena Damjanov
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Gianluca Masi
- Department of Oncology, Pisa University Hospital, Pisa, Italy
| | - Lorenza Rimassa
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Nicola Personeni
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
- Department of Medical Biosciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Fadi Braiteh
- Medical Oncology, Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA
| | | | | | | | | | | | | | - Sherrie Bhoori
- Department of Surgery and Oncology, Istituto Nazionale Tumori IRCCS, Milan, Italy
| | - Filippo de Braud
- Department of Surgery and Oncology, Istituto Nazionale Tumori IRCCS, Milan, Italy
- University of Milan, Milan, Italy
| | - Walid L Shaib
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Hall T, Mazzaferro V, El-Rayes B, Cotsoglou C, Harris WP, Damjanov N, Masi G, Rimassa L, Personeni N, Zagonel V, Papadopoulos KP, Bhoori S, Droz-Dit-Busset M, Shaib W, Lamar M, Kazakin J, Schwartz B, Wang Y, Savage RE. Abstract LB-232: Derazantinib (ARQ 087) pharmacodynamics: Alterations in FGF19/21/23 and phosphate in patients with cholangiocarcinoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-lb-232] [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: Fibroblast growth factors (FGFs) and their receptors (FGFRs) play important roles in cell proliferation, cell differentiation, cell migration, cell survival, protein synthesis, and angiogenesis. The FGFR family consist of four genes encoding tyrosine kinase receptors (FGFR1, FGFR2, FGFR3, and FGFR4). Dysregulation of FGFR signaling has been implicated in a number of developmental syndromes as well as cancers, e.g., intrahepatic cholangiocarcinoma (iCCA), squamous non-small cell lung cancer, small cell lung cancer, gastric, liver, breast, ovarian, endometrial, and bladder carcinomas, fueling significant interest in FGFRs as targets for therapeutic intervention. In human cancers, FGFRs have been found to be dysregulated by multiple mechanisms, including aberrant expression, mutations, chromosomal rearrangements, and amplifications. Members of the FGF19 ligand subfamily, FGFs 19, 21 and 23, are involved in the regulation of bile acid synthesis, glucose and lipid metabolism, and phosphate homeostasis, respectively. Unlike other FGFR ligands that act locally, the FGF19 subfamily circulate throughout the body, and can act as endocrine hormones at organs distant from their site of synthesis. The wide circulation of FGFs 19, 21, 23 makes them excellent potential biomarkers for FGFR inhibition.
Study Design: 29 patients (18 women, 11 men, median age 58.7 years, all white) with FGFR2 gene positive fusion iCCA were enrolled and treated with derazantinib (dose range 300-400mg QD) at eight sites in the United States and Italy between August 2014 and October 2017 as part of clinical trial ARQ 087-101 [NCT01752920]. Patients' plasma samples were collected (on Day 1, 8, 15, 22 of Cycle 1 and Day 1 of Cycles 2-6) and analyzed for levels of FGF & phosphate. FGF levels were quantified using commercially available ELISA kits for FGF-19 and 21 (R&D Systems, Minneapolis, MN), and FGF-23 (EMD-Millipore, Billerica, MA).
Results: Preliminary data analysis showed clear increase in mean FGF19, 23, and phosphate levels in iCCa patients treated with derazantinib. On Cycle 2 Day 1, phosphate levels on average increased by 40% over baseline. FGF19 and FGF23 increased by 300% and 140%, respectively. Final results and any additional findings will be presented at the meeting.
Conclusions: The changes in FGF19, FGF23, and phosphate observed during treatment suggest that at the recommended phase II dose of derazantinib (300 mg QD), clinical signs of target engagement are detectable. Additional data to demonstrate potential correlation between FGFs/phosphate levels and clinical outcomes, including response and toxicity will be presented. DeLIVERr, a pivotal study of derazantinib in patients with FGFR2 gene fusion positive iCCA is ongoing (NCT03230318).
Citation Format: Terence Hall, Vincenzo Mazzaferro, Bassel El-Rayes, Christian Cotsoglou, William P. Harris, Nevana Damjanov, Gianluca Masi, Lorenza Rimassa, Nicola Personeni, Vittorina Zagonel, Kyriakos P. Papadopoulos, Sherrie Bhoori, Michele Droz-Dit-Busset, Walid Shaib, Maria Lamar, Julia Kazakin, Brian Schwartz, Yunxia Wang, Ronald E. Savage. Derazantinib (ARQ 087) pharmacodynamics: Alterations in FGF19/21/23 and phosphate in patients with cholangiocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-232.
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Affiliation(s)
| | | | | | | | | | | | | | - Lorenza Rimassa
- 7Humanitas Cancer Center, Humanitas Clinical and Research Center, Milano, Italy
| | - Nicola Personeni
- 8Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | | | | | | | | | - Walid Shaib
- 3Winship Cancer Institute, Emory University, Atlanta, GA
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Wong KM, Horton KJ, Coveler AL, Hingorani SR, Harris WP. Targeting the Tumor Stroma: the Biology and Clinical Development of Pegylated Recombinant Human Hyaluronidase (PEGPH20). Curr Oncol Rep 2018; 19:47. [PMID: 28589527 DOI: 10.1007/s11912-017-0608-3] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [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: 01/04/2023]
Abstract
The tumor stroma is increasingly recognized as a key player in tumorigenesis through its effects on cell signaling, immune responses, and access of therapeutic agents. A major component of the extracellular matrix is hyaluronic acid (HA), which raises the interstitial gel fluid pressure within tumors and reduces drug delivery to malignant cells, and has been most extensively studied in pancreatic ductal adenocarcinoma (PDA). Pegylated recombinant human hyaluronidase (PEGPH20) is a novel agent that degrades HA and normalizes IFP to enhance the delivery of cytotoxic agents. It has demonstrated promising preclinical results and early clinical evidence of efficacy in the first-line treatment of metastatic PDA with acceptable tolerability. Moreover, intratumoral HA content appears to be a predictive biomarker of response. Phase 2 and 3 trials of PEGPH20 plus chemotherapy are ongoing in metastatic PDA, and it is also being evaluated in other malignancies and in combination with radiation and immunotherapy.
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Affiliation(s)
- Kit Man Wong
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kathryn J Horton
- Department of Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 354760, Seattle, WA, USA
| | - Andrew L Coveler
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sunil R Hingorani
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M5-C800, Seattle, WA, 98109-1024, USA
| | - William P Harris
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Harris WP, Wong KM, Saha S, Dika IE, Abou-Alfa GK. Biomarker-Driven and Molecular Targeted Therapies for Hepatobiliary Cancers. Semin Oncol 2018; 45:116-123. [PMID: 30348531 DOI: 10.1053/j.seminoncol.2018.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/29/2017] [Accepted: 03/07/2018] [Indexed: 12/18/2022]
Abstract
The recent accumulation of molecular profiling data for primary hepatobiliary malignancies, including hepatocellular carcinoma and biliary tract cancers, has led to a proliferation of promising therapeutic investigations in recent years. Treatment with pathway-specific targeted inhibitors and immunotherapeutic agents have demonstrated promising early clinical results. Key molecular alterations in common hepatobiliary cancers and ongoing interventional clinical trials of molecularly targeted systemic agents focusing on hepatocellular carcinoma and biliary tract cancer are reviewed.
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Affiliation(s)
- William P Harris
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Kit Man Wong
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Supriya Saha
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle WA; Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Imane El Dika
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Medical College at Cornell University, New York, NY.
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Hingorani SR, Zheng L, Bullock AJ, Seery TE, Harris WP, Sigal DS, Braiteh F, Ritch PS, Zalupski MM, Bahary N, Oberstein PE, Wang-Gillam A, Wu W, Chondros D, Jiang P, Khelifa S, Pu J, Aldrich C, Hendifar AE. HALO 202: Randomized Phase II Study of PEGPH20 Plus Nab-Paclitaxel/Gemcitabine Versus Nab-Paclitaxel/Gemcitabine in Patients With Untreated, Metastatic Pancreatic Ductal Adenocarcinoma. J Clin Oncol 2017; 36:359-366. [PMID: 29232172 DOI: 10.1200/jco.2017.74.9564] [Citation(s) in RCA: 306] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose Metastatic pancreatic ductal adenocarcinoma is characterized by excessive hyaluronan (HA) accumulation in the tumor microenvironment, elevating interstitial pressure and impairing perfusion. Preclinical studies demonstrated pegvorhyaluronidase alfa (PEGPH20) degrades HA, thereby increasing drug delivery. Patients and Methods Patients with previously untreated metastatic pancreatic ductal adenocarcinoma were randomly assigned to treatment with PEGPH20 plus nab-paclitaxel/gemcitabine (PAG) or nab-paclitaxel/gemcitabine (AG). Tumor HA levels were measured retrospectively using a novel affinity histochemistry assay. Primary end points were progression-free survival (PFS; overall) and thromboembolic (TE) event rate. Secondary end points included overall survival, PFS by HA level, and objective response rate. An early imbalance in TE events in the PAG arm led to a clinical hold; thereafter, patients with TE events were excluded and enoxaparin prophylaxis was initiated. Results A total of 279 patients were randomly assigned; 246 had HA data; 231 were evaluable for efficacy; 84 (34%) had HA-high tumors (ie, extracellular matrix HA staining ≥ 50% of tumor surface at any intensity). PFS was significantly improved with PAG treatment overall (hazard ratio [HR], 0.73; 95% CI, 0.53 to 1.00; P = .049) and for patients with HA-high tumors (HR, 0.51; 95% CI, 0.26 to 1.00; P = .048). In patients with HA-high tumors (PAG v AG), the objective response rate was 45% versus 31%, and median overall survival was 11.5 versus 8.5 months (HR, 0.96; 95% CI, 0.57 to 1.61). The most common treatment-related grade 3/4 adverse events with significant differences between arms (PAG v AG) included muscle spasms (13% v 1%), neutropenia (29% v 18%), and myalgia (5% v 0%). TE events were comparable after enoxaparin initiation (14% PAG v 10% AG). Conclusion This study met its primary end points of PFS and TE event rate. The largest improvement in PFS was observed in patients with HA-high tumors who received PAG. A similar TE event rate was observed between the treatment groups in stage 2 of the trial.
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Affiliation(s)
- Sunil R Hingorani
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Lei Zheng
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Andrea J Bullock
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Tara E Seery
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - William P Harris
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Darren S Sigal
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Fadi Braiteh
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Paul S Ritch
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Mark M Zalupski
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Nathan Bahary
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Paul E Oberstein
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Andrea Wang-Gillam
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Wilson Wu
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Dimitrios Chondros
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Ping Jiang
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Sihem Khelifa
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Jie Pu
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Carrie Aldrich
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
| | - Andrew E Hendifar
- Sunil R. Hingorani, Fred Hutchinson Cancer Research Center; William P. Harris, University of Washington, School of Medicine, Seattle, WA; Lei Zheng, Johns Hopkins University School of Medicine, Baltimore, MD; Andrea J. Bullock, Beth Israel Deaconess Medical Center, Boston, MA; Tara E. Seery, Chan Soon-Shiong Institute for Medicine, El Segundo; Darren S. Sigal, Scripps Cancer Center, La Jolla; Wilson Wu, Dimitrios Chondros, and Ping Jiang, Halozyme Therapeutics, San Diego; Andrew E. Hendifar, Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, Los Angeles, CA; Fadi Braiteh, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Paul S. Ritch, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, WI; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Nathan Bahary, University of Pittsburgh Medical Center Cancer Pavilion, Pittsburgh, PA; Paul E. Oberstein, Columbia University Medical Center, New York, NY; Andrea Wang-Gillam, Washington University, St Louis, MO; and Sihem Khelifa, Jie Pu, and Carrie Aldrich, Ventana Medical Systems, Tucson, AZ
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Chapman TR, Bowen SR, Schaub SK, Yeung RH, Kwan SW, Park JO, Yu L, Harris WP, Johnson GE, Liou IW, Nyflot MJ, Apisarnthanarax S. Toward consensus reporting of radiation-induced liver toxicity in the treatment of primary liver malignancies: Defining clinically relevant endpoints. Pract Radiat Oncol 2017; 8:157-166. [PMID: 29426691 DOI: 10.1016/j.prro.2017.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/03/2017] [Accepted: 10/25/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Our purpose was to define the most clinically relevant "nonclassic" radiation-induced liver disease (RILD) endpoints in cirrhotic patients receiving stereotactic body radiation therapy or proton beam therapy for primary liver cancer. METHODS AND MATERIALS We retrospectively collected pretreatment, detailed toxicity (≤6 months posttreatment), and outcomes data from 48 patients. Deaths were examined for association with RILD. Univariate and multivariate Cox models defined significant predictors of overall survival (OS)/RILD-specific survival (RILD-SS). RESULTS With median follow-up of 13 months, 23 patients (48%) had an increase in Child-Pugh (CP) score (≥2, 25%) and 3 (6%) had ≥G3 transaminase elevation. Of 18 deaths, 6 were potentially ascribed to RILD. Univariate analysis showed that CP score increases of ≥1 and ≥2 and CP class change predicted OS, as did ≥G3 aspartate transaminase (AST) elevation and ≥1 Common Terminology Criteria for Adverse Events (CTCAE) AST toxicity grade change. On multivariate analysis, CP score increase of ≥2 and ≥1 CTCAE AST toxicity grade change were the strongest independent nonclassic RILD predictors of OS. For RILD-SS, CP score increases of ≥2, ≥grade 3 CTCAE alanine transaminase, and ≥grade 2 bilirubin elevations were predictive. CONCLUSIONS Increased CP score ≥2 strongly predicts for both OS and RILD-SS and should be reported in future studies along with transaminase elevations, which are also predictive of outcomes.
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Affiliation(s)
- Tobias R Chapman
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen R Bowen
- Department of Radiation Oncology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington
| | - Stephanie K Schaub
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Rosanna H Yeung
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Sharon W Kwan
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington
| | - James O Park
- Department of Surgery, University of Washington, Seattle, Washington
| | - Lei Yu
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington
| | - William P Harris
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington
| | - Guy E Johnson
- Department of Radiology, University of Washington, Seattle, Washington
| | - Iris W Liou
- Department of Surgery, University of Washington, Seattle, Washington
| | - Matthew J Nyflot
- Department of Radiation Oncology, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington
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21
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Zheng L, Hendifar AE, Reni M, Harris WP, Ducreux M, Bullock AJ, Corrie PG, Seery T, Chondros D, Cutsem EV. Abstract CT066: Global phase 3, randomized, double-blind, placebo-controlled study evaluating PEGylated recombinant human hyaluronidase PH20 (PEGPH20) plus nab-paclitaxel and gemcitabine in patients with previously untreated, hyaluronan (HA)-high, stage IV pancreatic ductal adenocarcinoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct066] [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: Poor outcome in pancreatic ductal adenocarcinoma (PDA) is associated partly with stromal hyaluronan (HA) accumulation, which may compromise chemotherapy access to tumors. In animal models, PEGPH20 degrades HA in tumors. Key endpoint data from a phase 2 study showed that PEGPH20 plus chemotherapy improved efficacy over chemotherapy alone in tumors retrospectively identified to accumulate HA (“HA-High”). The objectives of this phase 3 study are to compare efficacy and safety of standard-dose nab-paclitaxel (NAB) and gemcitabine (GEM) combined with either PEGPH20 or placebo in patients with HA-High, previously untreated, Stage IV PDA. Primary endpoints are progression-free survival (PFS) and overall survival (OS). Secondary endpoints are objective response rate, duration of response, and safety.
Methods: 420 patients ≥18 years with untreated HA-High metastatic PDA, ECOG PS 0-1 will be randomized (stratified by geographic region: North America/Europe/Other) 2:1 to NAB 125 mg/m2 + GEM 1000 mg/m2 + PEGPH20 3.0 μg/kg or to placebo. Patients with HA-High tumors will be prospectively identified by the co-developed VENTANA HA RxDx Assay, which indicates HA in the extracellular matrix. HA-High status (indicating patients who may achieve clinical benefit) was determined by Halozyme to be ≥50% staining based on clinical outcome data from a phase 2 study. Treatment will be provided in 4 week cycles (Wk 13, Wk 4 rest) until disease progression, unacceptable toxicity, death, or consent withdrawal. PEGPH20 or placebo will be given twice weekly (Cycle 1) then weekly (Cycles 2+), NAB + GEM once weekly for all cycles. Dexamethasone will be given before and after PEGPH20 administrations to reduce treatment related musculoskeletal symptoms and enoxaparin will be given to minimize thromboembolic events. Tumor response will be assessed by an independent central imaging vendor using RECIST v1.1. Adverse events will be graded per NCI CTCAE v4.03. An independent Data Monitoring Committee will evaluate safety and data for PFS and OS. Trial initiated Q12016 (EudraCT 2015-004068-13; NCT02715804).
Citation Format: Lei Zheng, Andrew E. Hendifar, Michele Reni, William P. Harris, Michel Ducreux, Andrea J. Bullock, Pippa G. Corrie, Tara Seery, Dimitrios Chondros, Eric Van Cutsem. Global phase 3, randomized, double-blind, placebo-controlled study evaluating PEGylated recombinant human hyaluronidase PH20 (PEGPH20) plus nab-paclitaxel and gemcitabine in patients with previously untreated, hyaluronan (HA)-high, stage IV pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT066. doi:10.1158/1538-7445.AM2017-CT066
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Affiliation(s)
- Lei Zheng
- 1The Johns Hopkins University Hospital, Baltimore, MD
| | - Andrew E. Hendifar
- 2Samuel Oschin Cancer Center-Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | - Pippa G. Corrie
- 7Cambridge Cancer Centre, Addenbrooke's Hospital, Cambridge, United Kingdom
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Abstract
IMPORTANCE Natural language processing (NLP) has the potential to accelerate translation of cancer treatments from the laboratory to the clinic and will be a powerful tool in the era of personalized medicine. This technology can harvest important clinical variables trapped in the free-text narratives within electronic medical records. OBSERVATIONS Natural language processing can be used as a tool for oncological evidence-based research and quality improvement. Oncologists interested in applying NLP for clinical research can play pivotal roles in building NLP systems and, in doing so, contribute to both oncological and clinical NLP research. Herein, we provide an introduction to NLP and its potential applications in oncology, a description of specific tools available, and a review on the state of the current technology with respect to cancer case identification, staging, and outcomes quantification. CONCLUSIONS AND RELEVANCE More automated means of leveraging unstructured data from daily clinical practice is crucial as therapeutic options and access to individual-level health information increase. Research-minded oncologists may push the avenues of evidence-based research by taking advantage of the new technologies available with clinical NLP. As continued progress is made with applying NLP toward oncological research, incremental gains will lead to large impacts, building a cost-effective infrastructure for advancing cancer care.
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Affiliation(s)
- Wen-Wai Yim
- Departments of Biomedical and Health Informatics, University of Washington Medical Center, Seattle
| | - Meliha Yetisgen
- Departments of Biomedical and Health Informatics, University of Washington Medical Center, Seattle2Departments of Linguistics, University of Washington Medical Center, Seattle
| | - William P Harris
- Division of Oncology, Departments of Medicine, University of Washington Medical Center, Seattle
| | - Sharon W Kwan
- Department of Radiology, University of Washington Medical Center, Seattle
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Hingorani SR, Harris WP, Beck JT, Berdov BA, Wagner SA, Pshevlotsky EM, Tjulandin SA, Gladkov OA, Holcombe RF, Korn R, Raghunand N, Dychter S, Jiang P, Shepard HM, Devoe CE. Phase Ib Study of PEGylated Recombinant Human Hyaluronidase and Gemcitabine in Patients with Advanced Pancreatic Cancer. Clin Cancer Res 2016; 22:2848-54. [PMID: 26813359 DOI: 10.1158/1078-0432.ccr-15-2010] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/24/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE This phase Ib study evaluated the safety and tolerability of PEGylated human recombinant hyaluronidase (PEGPH20) in combination with gemcitabine (Gem), and established a phase II dose for patients with untreated stage IV metastatic pancreatic ductal adenocarcinoma (PDA). Objective response rate and treatment efficacy using biomarker and imaging measurements were also evaluated. EXPERIMENTAL DESIGN Patients received escalating intravenous doses of PEGPH20 in combination with Gem using a standard 3+3 dose-escalation design. In cycle 1 (8 weeks), PEGPH20 was administrated twice weekly for 4 weeks, then once weekly for 3 weeks; Gem was administrated once weekly for 7 weeks, followed by 1 week off treatment. In each subsequent 4-week cycle, PEGPH20 and Gem were administered once weekly for 3 weeks, followed by 1 week off. Dexamethasone (8 mg) was given pre- and post-PEGPH20 administration. Several safety parameters were evaluated. RESULTS Twenty-eight patients were enrolled and received PEGPH20 at 1.0 (n = 4), 1.6 (n = 4), or 3.0 μg/kg (n = 20), respectively. The most common PEGPH20-related adverse events were musculoskeletal and extremity pain, peripheral edema, and fatigue. The incidence of thromboembolic events was 29%. Median progression-free survival (PFS) and overall survival (OS) rates were 5.0 and 6.6 months, respectively. In 17 patients evaluated for pretreatment tissue hyaluronan (HA) levels, median PFS and OS rates were 7.2 and 13.0 months for "high"-HA patients (n = 6), and 3.5 and 5.7 months for "low"-HA patients (n = 11), respectively. CONCLUSIONS PEGPH20 in combination with Gem was well tolerated and may have therapeutic benefit in patients with advanced PDA, especially in those with high HA tumors. Clin Cancer Res; 22(12); 2848-54. ©2016 AACR.
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Affiliation(s)
- Sunil R Hingorani
- Fred Hutchinson Cancer Research Center, Seattle, Washington. University of Washington School of Medicine, Seattle, Washington.
| | - William P Harris
- Fred Hutchinson Cancer Research Center, Seattle, Washington. University of Washington School of Medicine, Seattle, Washington
| | | | - Boris A Berdov
- Medical Radiological Research Center, Obninsk, Russian Federation
| | - Stephanie A Wagner
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | - Eduard M Pshevlotsky
- Omsk Regional Budget Medical Institution: Clinical Oncological Center, Omsk, Russian Federation
| | - Sergei A Tjulandin
- Russian Oncology Research Center n.a. N.N. Blokhin, Moscow, Russian Federation
| | - Oleg A Gladkov
- Chelyabinsk Regional Clinical Oncology Center, Chelyabinsk, Russian Federation
| | | | | | | | | | - Ping Jiang
- Halozyme Therapeutics, San Diego, California
| | | | - Craig E Devoe
- Hofstra North Shore-LIJ School of Medicine, Hempstead, New York
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Yeh MM, Yeung RS, Apisarnthanarax S, Bhattacharya R, Cuevas C, Harris WP, Hon TLK, Padia SA, Park JO, Riggle KM, Daoud SS. Multidisciplinary perspective of hepatocellular carcinoma: A Pacific Northwest experience. World J Hepatol 2015; 7:1460-83. [PMID: 26085907 PMCID: PMC4462686 DOI: 10.4254/wjh.v7.i11.1460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/03/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most rapidly increasing type of cancer in the United States. HCC is a highly malignant cancer, accounting for at least 14000 deaths in the United States annually, and it ranks third as a cause of cancer mortality in men. One major difficulty is that most patients with HCC are diagnosed when the disease is already at an advanced stage, and the cancer cannot be surgically removed. Furthermore, because almost all patients have cirrhosis, neither chemotherapy nor major resections are well tolerated. Clearly there is need of a multidisciplinary approach for the management of HCC. For example, there is a need for better understanding of the fundamental etiologic mechanisms that are involved in hepatocarcinogenesis, which could lead to the development of successful preventive and therapeutic modalities. It is also essential to define the cellular and molecular bases for malignant transformation of hepatocytes. Such knowledge would: (1) greatly facilitate the identification of patients at risk; (2) prompt efforts to decrease risk factors; and (3) improve surveillance and early diagnosis through diagnostic imaging modalities. Possible benefits extend also to the clinical management of this disease. Because there are many factors involved in pathogenesis of HCC, this paper reviews a multidisciplinary perspective of recent advances in basic and clinical understanding of HCC that include: molecular hepatocarcinogenesis, non-invasive diagnostics modalities, diagnostic pathology, surgical modality, transplantation, local therapy and oncological/target therapeutics.
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Affiliation(s)
- Matthew M Yeh
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - Raymond S Yeung
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - Smith Apisarnthanarax
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - Renuka Bhattacharya
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - Carlos Cuevas
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - William P Harris
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - Tony Lim Kiat Hon
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - Siddharth A Padia
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - James O Park
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - Kevin M Riggle
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
| | - Sayed S Daoud
- Matthew M Yeh, Raymond S Yeung, Department of Pathology, University of Washington School of Medicine, Seattle, WA 99210, United States
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Riehle KJ, Yeh MM, Yu JJ, Kenerson HL, Harris WP, Park JO, Yeung RS. mTORC1 and FGFR1 signaling in fibrolamellar hepatocellular carcinoma. Mod Pathol 2015; 28:103-10. [PMID: 24925055 DOI: 10.1038/modpathol.2014.78] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 03/30/2014] [Accepted: 03/31/2014] [Indexed: 02/06/2023]
Abstract
Fibrolamellar hepatocellular carcinoma, or fibrolamellar carcinoma, is a rare form of primary liver cancer that afflicts healthy young men and women without underlying liver disease. There are currently no effective treatments for fibrolamellar carcinoma other than resection or transplantation. In this study, we sought evidence of mechanistic target of rapamycin complex 1 (mTORC1) activation in fibrolamellar carcinoma, based on anecdotal reports of tumor response to rapamycin analogs. Using a tissue microarray of 89 primary liver tumors, including a subset of 10 fibrolamellar carcinomas, we assessed the expression of phosphorylated S6 ribosomal protein (P-S6), a downstream target of mTORC1, along with fibroblast growth factor receptor 1 (FGFR1). These results were extended and confirmed using an additional 13 fibrolamellar carcinomas, whose medical records were reviewed. In contrast to weak staining in normal livers, all fibrolamellar carcinomas on the tissue microarray showed strong immunostaining for FGFR1 and P-S6, whereas only 13% of non-fibrolamellar hepatocellular carcinomas had concurrent activation of FGFR1 and mTORC1 signaling (P<0.05). When individual samples were stratified according to staining intensity (scale 0-4), the average score in fibrolamellar carcinomas was 2.46 for FGFR1 and 3.77 for P-S6, compared with 0 and 0, respectively, in non-tumor liver. Immunoblot analyses of fibrolamellar carcinomas revealed high mTORC1 activities relative to AKT activities accompanied by reduced TSC2 expression, which was not observed in non-fibrolamellar hepatocellular carcinomas. Our findings provide evidence for mTORC1 activation and FGFR1 overexpression in human fibrolamellar carcinoma, and support the use of FGFR1 inhibitors and rapamycin analogs in the treatment of patients with unresectable fibrolamellar carcinoma.
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Affiliation(s)
- Kimberly J Riehle
- 1] The Northwest Liver Research Program, University of Washington, Seattle, WA, USA [2] Department of Pathology, University of Washington, Seattle, WA, USA [3] Department of Surgery, University of Washington, Seattle, WA, USA [4] Seattle Children's Hospital, Seattle, WA, USA
| | - Matthew M Yeh
- 1] The Northwest Liver Research Program, University of Washington, Seattle, WA, USA [2] Department of Pathology, University of Washington, Seattle, WA, USA
| | - Jeannette J Yu
- 1] The Northwest Liver Research Program, University of Washington, Seattle, WA, USA [2] Seattle Children's Hospital, Seattle, WA, USA
| | - Heidi L Kenerson
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - William P Harris
- 1] The Northwest Liver Research Program, University of Washington, Seattle, WA, USA [2] Department of Medicine, University of Washington, Seattle, WA, USA
| | - James O Park
- 1] The Northwest Liver Research Program, University of Washington, Seattle, WA, USA [2] Department of Surgery, University of Washington, Seattle, WA, USA
| | - Raymond S Yeung
- 1] The Northwest Liver Research Program, University of Washington, Seattle, WA, USA [2] Department of Pathology, University of Washington, Seattle, WA, USA [3] Department of Surgery, University of Washington, Seattle, WA, USA
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Gordon RR, Wu M, Huang CY, Harris WP, Sim HG, Lucas JM, Coleman I, Higano CS, Gulati R, True LD, Vessella R, Lange PH, Garzotto M, Beer TM, Nelson PS. Chemotherapy-induced monoamine oxidase expression in prostate carcinoma functions as a cytoprotective resistance enzyme and associates with clinical outcomes. PLoS One 2014; 9:e104271. [PMID: 25198178 PMCID: PMC4157741 DOI: 10.1371/journal.pone.0104271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 03/10/2014] [Accepted: 07/01/2014] [Indexed: 01/26/2023] Open
Abstract
To identify molecular alterations in prostate cancers associating with relapse following neoadjuvant chemotherapy and radical prostatectomy patients with high-risk localized prostate cancer were enrolled into a phase I-II clinical trial of neoadjuvant chemotherapy with docetaxel and mitoxantrone followed by prostatectomy. Pre-treatment prostate tissue was acquired by needle biopsy and post-treatment tissue was acquired by prostatectomy. Prostate cancer gene expression measurements were determined in 31 patients who completed 4 cycles of neoadjuvant chemotherapy. We identified 141 genes with significant transcript level alterations following chemotherapy that associated with subsequent biochemical relapse. This group included the transcript encoding monoamine oxidase A (MAOA). In vitro, cytotoxic chemotherapy induced the expression of MAOA and elevated MAOA levels enhanced cell survival following docetaxel exposure. MAOA activity increased the levels of reactive oxygen species and increased the expression and nuclear translocation of HIF1α. The suppression of MAOA activity using the irreversible inhibitor clorgyline augmented the apoptotic responses induced by docetaxel. In summary, we determined that the expression of MAOA is induced by exposure to cytotoxic chemotherapy, increases HIF1α, and contributes to docetaxel resistance. As MAOA inhibitors have been approved for human use, regimens combining MAOA inhibitors with docetaxel may improve clinical outcomes.
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Affiliation(s)
- Ryan R. Gordon
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Mengchu Wu
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Chung-Ying Huang
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - William P. Harris
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Hong Gee Sim
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Jared M. Lucas
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Ilsa Coleman
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Celestia S. Higano
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Urology, University of Washington, Seattle, Washington, United States of America
| | - Roman Gulati
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Lawrence D. True
- Department of Pathology, University of Washington, Seattle, Washington, United States of America
- Department of Urology, University of Washington, Seattle, Washington, United States of America
| | - Robert Vessella
- Department of Urology, University of Washington, Seattle, Washington, United States of America
| | - Paul H. Lange
- Department of Urology, University of Washington, Seattle, Washington, United States of America
| | - Mark Garzotto
- Department of Urology and Cancer Institute, Oregon Health and Sciences University, Portland, Oregon, United States of America
- Section of Urology, Portland VA Medical Center, Portland, Oregon, United States of America
| | - Tomasz M. Beer
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon, United States of America
| | - Peter S. Nelson
- Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Pathology, University of Washington, Seattle, Washington, United States of America
- Department of Urology, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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Padia SA, Kwan SW, Roudsari B, Monsky WL, Coveler A, Harris WP. Superselective yttrium-90 radioembolization for hepatocellular carcinoma yields high response rates with minimal toxicity. J Vasc Interv Radiol 2014; 25:1067-73. [PMID: 24837982 DOI: 10.1016/j.jvir.2014.03.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 03/23/2014] [Accepted: 03/28/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess the safety and efficacy of yttrium-90 ((90)Y) radioembolization when performed in a superselective fashion for patients with unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS This retrospective study included 20 patients with unresectable HCC. Median Model for End-Stage Liver Disease score was 10.5 (range, 6-25), with 8 of 20 patients (40%) classified Child-Pugh class B and 1 of 20 patients (5%) classified class C cirrhosis. Segmental tumor-associated portal vein thrombus was present in 12 patients (60%), and a transjugular intrahepatic portosystemic shunt was present in 4 patients (20%). Median tumor diameter was 3.9 cm (range, 2.5-7.1 cm). All patients underwent superselective (90)Y radioembolization targeted to a single liver segment using glass microspheres. RESULTS Median dose to the treated segment was 254 Gy, and median dose to the tumor was 536 Gy. No grade 3-4 hepatotoxicity occurred. The most common clinical toxicities were fatigue (30%), abdominal pain (10%), and postembolization syndrome (10%). Follow-up imaging demonstrated complete European Association for the Study of the Liver response of the index tumor in 19 of 20 patients (95%) and stable disease in 1 of 20 patients (5%). In patients with complete response, local tumor recurrence rate was 5.3% (1 of 19 patients). Median time to progression was 319 days. Overall survival was 90% (18 of 20 patients) with a median follow-up period of 275 days (range, 32-677 d). CONCLUSIONS When performed in a segmental fashion, (90)Y radioembolization demonstrates high response rates and low local tumor recurrence rates. Complete imaging response can be achieved in patients with locally aggressive disease. This study demonstrates no clinically significant hepatotoxicity, despite moderate liver dysfunction in many patients.
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Affiliation(s)
- Siddharth A Padia
- Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119.
| | - Sharon W Kwan
- Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119
| | - Bahman Roudsari
- Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119
| | - Wayne L Monsky
- Section of Interventional Radiology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98119
| | - Andrew Coveler
- Department of Radiology, and Department of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195
| | - William P Harris
- Department of Radiology, and Department of Medical Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Box 357115, 1959 NE Pacific Street, Seattle, WA 98195
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James AC, Lee FC, Izard JP, Harris WP, Cheng HH, Zhao S, Gore JL, Lin DW, Porter MP, Yu EY, Wright JL. Role of maximal endoscopic resection before cystectomy for invasive urothelial bladder cancer. Clin Genitourin Cancer 2014; 12:287-91. [PMID: 24560087 DOI: 10.1016/j.clgc.2014.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/02/2014] [Accepted: 01/02/2014] [Indexed: 02/01/2023]
Abstract
INTRODUCTION/BACKGROUND The aim of this study was to examine whether TUR of all visible endophytic tumors performed before RC, with or without NC, affects final pathologic staging. PATIENTS AND METHODS We retrospectively reviewed data from patients with clinical T2-T4N0-1 urothelial carcinoma of the bladder who underwent RC at our institution between July 2005 and November 2011. Degree of TUR was derived from review of operative reports. We used multivariate logistic regression to assess the association of maximal TUR on pT0 status at time of RC. RESULTS Of 165 eligible RC patients, 81 received NC. Reported TUR of all visible tumors was performed in 38% of patients who did not receive NC and 48% of NC patients (P = .19). Nine percent of patients who underwent maximal TUR and did not receive NC were pT0, whereas among NC patients, pT0 was seen in 39% and 19% of those with and without maximal TUR, respectively (P = .05). On multivariate analysis in all patients, maximal TUR was associated with a nonsignificant increased likelihood of pT0 status (odds ratio [OR], 2.03; 95% confidence interval [CI], 0.84-4.94), which was significant when we restricted the analysis to NC patients (OR, 3.17; 95% CI, 1.02-9.83). CONCLUSION Maximal TUR of all endophytic tumors before NC is associated with complete pathologic tumor response at RC. Candidates for NC before RC should undergo resection of all endophytic tumors when feasible. Larger series are warranted to see if maximal TUR leads to improved overall and disease-specific survival.
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Affiliation(s)
- Andrew C James
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
| | - Franklin C Lee
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Jason P Izard
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - William P Harris
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Song Zhao
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Michael P Porter
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA
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Murugappan S, Harris WP, Willett CG, Lin E. Multidisciplinary Management of Locally Advanced Rectal Cancer: Neoadjuvant Approaches. J Natl Compr Canc Netw 2013; 11:548-57. [DOI: 10.6004/jnccn.2013.0071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Padia SA, Shivaram G, Bastawrous S, Bhargava P, Vo NJ, Vaidya S, Valji K, Harris WP, Hippe DS, Kogut MJ. Safety and Efficacy of Drug-eluting Bead Chemoembolization for Hepatocellular Carcinoma: Comparison of Small-versus Medium-size Particles. J Vasc Interv Radiol 2013; 24:301-6. [DOI: 10.1016/j.jvir.2012.11.023] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 11/22/2012] [Accepted: 11/26/2012] [Indexed: 12/13/2022] Open
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Kogut MJ, Chewning RH, Harris WP, Hippe DS, Padia SA. Postembolization syndrome after hepatic transarterial chemoembolization: effect of prophylactic steroids on postprocedure medication requirements. J Vasc Interv Radiol 2013; 24:326-31. [PMID: 23380736 DOI: 10.1016/j.jvir.2012.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/20/2012] [Accepted: 11/20/2012] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the impact of prophylactic use of dexamethasone and scopolamine on analgesic and antiemetic agent requirements after transarterial chemoembolization. MATERIALS AND METHODS A total of 148 patients underwent 316 rounds of chemoembolization for hepatocellular carcinoma at a single institution over a 17-month period. Patient charts were retrospectively reviewed for demographic data, procedural technique, and use of analgesic and antiemetic medications. Patients were grouped into three categories: group A received steroid prophylaxis before and after the procedure, group B received steroid prophylaxis before the procedure only, and group C received no steroid prophylaxis. RESULTS Analysis was performed on 125 patients undergoing 252 procedures. Demographics were similar among groups. Overall, 86 (68.8%) were male, and mean age was 62 years (range, 39-82 y). Ninety-one patients (75%) had Child-Pugh class A cirrhosis and 25% had Child-Pugh class B cirrhosis. Dexamethasone was not significantly associated with decreased analgesic agent use (P = .6). Group A patients used significantly fewer antiemetic agents (Δ = 0.89; P = .007) compared with group C. A transdermal scopolamine patch was not associated with reduced use of antiemetic agents (P = .3). Age was inversely associated with analgesic (P <.001) and antiemetic agent use (P = .004). Men received significantly fewer antiemetic agents than women (P = .002), whereas there was no significant difference in analgesic agent use (P = .7). CONCLUSIONS The use of steroids did not affect analgesic agent use and had a minor effect on antiemetic requirements. The use of a scopolamine patch was not associated with reduced antiemetic agent use.
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Affiliation(s)
- Matthew J Kogut
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Harris WP, Mostaghel EA, Nelson PS, Montgomery B. Androgen deprivation therapy: progress in understanding mechanisms of resistance and optimizing androgen depletion. Nat Clin Pract Urol 2009; 6:76-85. [PMID: 19198621 PMCID: PMC2981403 DOI: 10.1038/ncpuro1296] [Citation(s) in RCA: 590] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 12/12/2008] [Indexed: 11/08/2022]
Abstract
Androgen deprivation therapy remains a critical component of treatment for men with advanced prostate cancer, and data support its use in metastatic disease and in conjunction with surgery or radiation in specific settings. Alternatives to standard androgen deprivation therapy, such as intermittent androgen suppression and estrogen therapy, hold the potential to improve toxicity profiles while maintaining clinical benefit. Current androgen deprivation strategies seem to incompletely suppress androgen levels and androgen-receptor-mediated effects at the tissue level. Advances in the understanding of mechanisms that contribute to castration-resistant prostate cancer are leading to rationally designed therapies targeting androgen metabolism and the androgen receptor. The results of large trials investigating the optimization of primary androgen deprivation therapy, including evaluation of intermittent androgen suppression and phase III studies of novel androgen synthesis inhibitors, such as abiraterone acetate, are eagerly awaited.
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Affiliation(s)
- William P Harris
- Medical Oncology Fellow at Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, Seattle, WA, USA
| | - Elahe A Mostaghel
- Assistant Member in the Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center and Assistant Professor in the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Peter S Nelson
- Member in the Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center and Professor in the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Bruce Montgomery
- Associate Member in the Divisions of Human Biology and Clinical Research, Fred Hutchinson Cancer Research Center and Associate Professor in the Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Chickering DE, Harris WP, Mathiowitz E. A microtensiometer for the analysis of bioadhesive microspheres. Biomed Instrum Technol 1995; 29:501-12. [PMID: 8574265] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bioadhesive polymer microspheres are potential vehicles for the delivery of bioactive agents to mucosal tissues. Bioadhesive delivery devices could improve drug absorption, enhance bioavailability, and increase patient compliance by minimizing dosing regimens. Identification of bioadhesive materials is the first phase in developing bioadhesive drug delivery systems. Additionally, quantification and analysis of the bioadhesive event are essential to successful development of a new generation of adhesive delivery systems. A unique, microbalance-based instrument was developed to analyze bioadhesive forces between polymer microspheres and mucosal tissue segments. A contact angle analyzer, with a custom-made physiologic tissue chamber, was linked to a computer via the serial port. Software was used to modify the microbalance operation to behave as a microtensiometer with a sensitivity of 0.1 microN. After mounting a microsphere and tissue segment in the balance and adjusting the experimental settings, the instrument performs a tensile experiment and automatically determines the following parameters: compressive deformation, peak compressive load, compressive work, yield point, deformation to yield, returned work, peak tensile load, deformation to peak tensile load, fracture strength, deformation to failure, and tensile work. Using this device the authors identified several bioadhesive materials ideally suited for orally-delivered, controlled-release systems. GI-transit studies in rats showed strong correlation between increased GI-residence time and strong bioadhesive interactions.
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Affiliation(s)
- D E Chickering
- Department of Molecular Pharmacology and Biotechnology, Brown University, Providence, Rhode Island 02912, USA
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Abstract
Colchicine, a drug used for centuries in the treatment of gout, has been reported to be effective for low-back pain due to disc disorders. A prospective, randomized, double-blind study evaluating the therapeutic effect of intravenous colchicine was conducted in a group of patients with low-back pain with symptoms originating less than 6 months previously. Each patient completed a questionnaire and a pain drawing. Laboratory studies including uric acid and sedimentation rate were performed, as was a detailed physical examination and lumbar thermography. All treatment parameters (including physical therapy, anti-inflammatory medications, and instructions) were constant except that each patient received either intravenous colchicine or intravenous saline. Results indicate a significant difference between the two groups, the intravenous colchicine group showing improvement in symptoms for a few hours or days over a 3-week course of treatment. However, the relief was often of short duration.
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Affiliation(s)
- J W Simmons
- Alamo Bone & Joint Clinic, San Antonio, Texas
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Yngve DA, Harris WP, Herndon WA, Sullivan JA, Gross RH. Spinal cord injury without osseous spine fracture. J Pediatr Orthop 1988; 8:153-9. [PMID: 3350948] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sixteen patients with spinal cord injury without osseous spine fracture and 55 patients with spinal cord injury with osseous spine fracture aged from birth through 18 years were studied. Those without osseous fracture were younger (mean age 6 years) than were those with osseous fracture (mean age 16 years). Extravasation of myelographic dye from the spinal canal was a poor prognostic sign. All three in the group with this finding without osseous fracture had complete spinal cord lesions. Those without osseous fracture should be followed for the development of late spinal deformity that may require orthotic support or surgical stabilization.
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Affiliation(s)
- D A Yngve
- University of Oklahoma Health Sciences Center, Oklahoma City
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Meyer D, Harris WP, Fine SL, Green WR. Clinicopathologic correlation of argon-laser photocoagulation of an idiopathic choroidal neovascular membrane in the macula. Retina 1984; 4:107-14. [PMID: 6205429 DOI: 10.1097/00006982-198400420-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The clinicopathologic features of an idiopathic choroidal neovascular membrane treated by argon laser photocoagulation are presented. The area of treatment is characterized microscopically by a proliferation of fibrocytes and retinal pigment epithelial cells. No choroidal vascular membrane was identified. Capillaries were present in the scar but not internal to the level of Bruch's membrane.
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Cooter IL, Harris WP. Investigation of an alternating-current bridge for the measurement of core losses in ferromagnetic materials at high flux densities. J Res Natl Bur Stand (1977) 1956. [DOI: 10.6028/jres.057.013] [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: 11/04/2022] Open
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Parker HC, Ellarson RS, Hickey JJ, Wilber CG, Howard WE, Smith ME, Frings H, Frings M, van Gelder RG, Goodpaster WW, Cockrum EL, Hansen RM, Quick HF, Baker RH, Childs HE, Doran DJ, Gunderson HL, Beltz A, Booth ES, Huey LM, Prychodko W, Edwards RY, Durham FE, Harris WP, de Paula Couto C. General Notes. J Mammal 1952. [DOI: 10.2307/1376022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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40
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Harris WP, Young JZ. The Life of Vertebrates. J Mammal 1951. [DOI: 10.2307/1375670] [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: 11/10/2022] Open
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41
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Guilday JE, Sherman HB, George JL, Stitt M, Mangold RE, Marshall WH, Davis WB, Shadle AR, Norris-Elye LTS, Moore JC, Dusi JL, Jones TS, Pengelly WL, Cook AH, Schantz VS, Behle WH, Hansen RM, Manville RH, Koopman KF, Hibbard CW, Romer AS, de la Torre L, Po-Chedley DS, Schwartz A, Harris WP. General Notes. J Mammal 1951. [DOI: 10.2307/1375379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Harris WP, Wender L. Animal Encyclopaedia. J Mammal 1950. [DOI: 10.2307/1375482] [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: 11/10/2022] Open
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Gordon K, Blossom PM, Dunn ER, Campbell B, Tinklepaugh OL, Harris WP, von Bloeker JC, von Bloeker JC, Miller FW, Whitney LF. General Notes. J Mammal 1931. [DOI: 10.2307/1373774] [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: 11/10/2022] Open
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