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Couban S, Benevolo G, Donnellan W, Cultrera J, Koschmieder S, Verstovsek S, Hooper G, Hertig C, Tandon M, Dimier N, Malhi V, Passamonti F. A phase Ib study to assess the efficacy and safety of vismodegib in combination with ruxolitinib in patients with intermediate- or high-risk myelofibrosis. J Hematol Oncol 2018; 11:122. [PMID: 30249277 PMCID: PMC6154811 DOI: 10.1186/s13045-018-0661-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/04/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The JAK inhibitor (JAKi) ruxolitinib is standard treatment for myelofibrosis (MF), but some patients are unresponsive. Pre-clinical and clinical data suggest that addition of a Hedgehog pathway inhibitor (HPI) to ruxolitinib might improve response. Vismodegib is an HPI approved for treatment of locally advanced and metastatic basal cell carcinoma. The MYLIE study assessed the safety and efficacy of combining ruxolitinib with vismodegib in ruxolitinib-naive patients with MF and characterized the pharmacokinetics (PK) of vismodegib in this setting. METHODS In this phase Ib study, ten patients with intermediate- or high-risk primary or secondary MF received open-label vismodegib (150 mg/day orally) and ruxolitinib (15 or 20 mg orally twice daily, depending on baseline platelet count) for up to 48 weeks, or until withdrawal or discontinuation. PK samples were collected throughout the study for comparison with other patient populations. Efficacy outcomes at week 24 included spleen response (≥ 35% reduction in volume by imaging) and improvement in bone marrow fibrosis by central and investigator assessment, symptom response (≥ 50% reduction in Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom score), and anemia response (per International Working Group for Myeloproliferative Neoplasms Research and Treatment revised response criteria). RESULTS As of November 17, 2017, eight patients had completed 48 weeks of treatment with vismodegib and ruxolitinib; two discontinued treatment early. At week 24 (± 1 week), three patients experienced a spleen response by central review and no patients showed a 1-grade improvement in bone marrow fibrosis by central review. Five patients experienced symptom response at week 24, and no patients experienced an anemia response. The most common adverse events were muscle spasm (100% of patients), alopecia (70%), dysgeusia (50%), thrombocytopenia (50%), and nausea (40%); these events were predominantly grade 1/2. Three patients experienced a total of six serious adverse events. CONCLUSIONS The combination of vismodegib and ruxolitinib was tolerable and no new safety signals were seen, but there was no evidence that the addition of vismodegib to ruxolitinib improved any of the efficacy outcome measures assessed. Further evaluation of this combination will not be pursued. TRIAL REGISTRATION ClinicalTrials.gov, NCT02593760 . Registered November 2, 2015.
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Affiliation(s)
- Stephen Couban
- Queen Elizabeth II Health Sciences Centre, 1278 Tower Road, Room 420, Halifax, Nova Scotia B3H 2V7 Canada
- Queen Elizabeth II Health Sciences Centre, Room 430, Bethune Building, VG Site, 126 South Park Street, Halifax, Nova Scotia B3H 2V9 Canada
| | - Giulia Benevolo
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, San Giovanni Battista, Corso Bramante 88/90, 10126, Torino, Italy
| | - William Donnellan
- Sarah Cannon Research Institute, 250 25th Ave North, Suite 412, Nashville, TN 37203 USA
| | - Jennifer Cultrera
- Florida Cancer Specialists, 1400 North US Highway 441, Suite 540, The Villages, FL 32159 USA
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and SCT, Faculty of Medicine, Rheinisch-Westfälische Technische Hochschule Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd., Unit 428, Houston, TX 77030 USA
| | - Gregory Hooper
- Roche Products Ltd, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW UK
| | - Christian Hertig
- Roche Clinical Science, F. Hoffmann-La Roche Ltd., Bldg. 001, Room 07.S373, CH-4070 Basel, Switzerland
| | - Maneesh Tandon
- Roche Products Ltd, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW UK
| | - Natalie Dimier
- Roche Products Ltd, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW UK
| | - Vikram Malhi
- Genentech Research and Early Development, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080 USA
| | - Francesco Passamonti
- Università degli Studi dell’Insubria, Viale Luigi Borri, 57, 21100 Varese, VA Italy
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Ai L, Mu S, Hu Y. Prognostic role of RDW in hematological malignancies: a systematic review and meta-analysis. Cancer Cell Int 2018; 18:61. [PMID: 29713244 PMCID: PMC5914059 DOI: 10.1186/s12935-018-0558-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 03/19/2018] [Accepted: 04/16/2018] [Indexed: 01/28/2023] Open
Abstract
Background Red blood cell distribution width (RDW), a biomarker for discrimination of anemia, has been recently identified as a prognostic factor in various types of cancer. Here we performed a meta-analysis in order to assess the correlation between RDW and the survival outcomes in patients with hematologic malignances. Patients/methods We systematically searched PubMed, Embase, and ISI Web of Science for relevant studies, to investigate the prognostic significance of RDW in hematological malignancies. Odds ratios or hazards ratios (HRs) with corresponding 95% confidence intervals (CIs) are pooled to estimate the association between RDW and clinicopathological parameters of patients with hematologic malignances. Results Seven trials with 1031 patients suffering from hematological malignancies were included in the meta-analysis, and the results indicated that increased pretreatment RDW predicted poor overall survival (HR = 2.35, 95% CI 1.70–3.24), poor progress-free survival (HR = 2.44, 95% CI 1.70–3.49) and poor event-free survival (EFS) (HR = 3.15, 95% CI 1.59–6.25). Furthermore, the similar results were observed in subgroup analysis stratified by cancer type, such as multiple myeloma, and diffuse large B cell lymphoma, etc. Conclusions As for hematologic malignances, patients with higher RDW are more likely to have poorer prognosis than those with lower RDW.
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Affiliation(s)
- Lisha Ai
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Shidai Mu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 China
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