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Gouda MA, Janku F, Wahida A, Buschhorn L, Schneeweiss A, Abdel Karim N, De Miguel Perez D, Del Re M, Russo A, Curigliano G, Rolfo C, Subbiah V. Liquid Biopsy Response Evaluation Criteria in Solid Tumors (LB-RECIST). Ann Oncol 2024; 35:267-275. [PMID: 38145866 DOI: 10.1016/j.annonc.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/17/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023] Open
Abstract
Current evaluation of treatment response in solid tumors depends on dynamic changes in tumor diameters as measured by imaging. However, these changes can only be detected when there are enough macroscopic changes in tumor volume, which limits the usability of radiological response criteria in evaluating earlier stages of disease response and necessitates much time to lapse for gross changes to be notable. One promising approach is to incorporate dynamic changes in circulating tumor DNA (ctDNA), which occur early in the course of therapy and can predict tumor responses weeks before gross size changes manifest. However, several issues need to be addressed before recommending the implementation of ctDNA response criteria in daily clinical practice such as clinical, biological, and regulatory challenges and, most importantly, the need to standardize/harmonize detection methods and ways to define ctDNA response and/or progression for precision oncology. Herein, we review the use of liquid biopsy (LB) to evaluate response in solid tumors and propose a plan toward standardization of LB-RECIST.
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Affiliation(s)
- M A Gouda
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston
| | - F Janku
- Monte Rosa Therapeutics, Boston, USA
| | - A Wahida
- Division of Gynecological Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - L Buschhorn
- Division of Gynecological Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - A Schneeweiss
- Division of Gynecological Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - N Abdel Karim
- Inova Schar Cancer Institute, Fairfax, (5)University of Virginia, Charlottesville
| | - D De Miguel Perez
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - M Del Re
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - A Russo
- Medical Oncology Unit, Papardo Civil Hospital and Department of Human Pathology, University of Messina, Messina
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milano; Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milano, Italy
| | - C Rolfo
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - V Subbiah
- Sarah Cannon Research Institute, Nashville, USA.
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Sherman E, Tsai F, Janku F, Allen C, Yaeger R, Ammakkanavar N, Butowski N, Michelson G, Paz M, Tussay-Lindenberg A, Wang K, Shepherd S, Dehan E, de la Fuente M, Rodon J. 466P Efficacy of BRAF inhibitor FORE8394 in BRAF V600+ patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.595] [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: 11/01/2022] Open
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3
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Janku F, Bauer S, Shoumariyeh K, Jones RL, Spreafico A, Jennings J, Psoinos C, Meade J, Ruiz-Soto R, Chi P. Efficacy and safety of ripretinib in patients with KIT-altered metastatic melanoma. ESMO Open 2022; 7:100520. [PMID: 35753087 PMCID: PMC9434165 DOI: 10.1016/j.esmoop.2022.100520] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Ripretinib, a broad-spectrum KIT and platelet-derived growth factor receptor A switch-control tyrosine kinase inhibitor, is approved for the treatment of adult patients with advanced gastrointestinal stromal tumor as ≥ fourth-line therapy. We present the efficacy and safety of ripretinib in patients with KIT-altered metastatic melanoma enrolled in the expansion phase of the ripretinib phase I study. PATIENTS AND METHODS Patients with KIT-altered metastatic melanoma were enrolled and treated with ripretinib at the recommended phase II dose of 150 mg once daily in 28-day cycles. Investigator-assessed responses according to Response Evaluation Criteria In Solid Tumors version 1.1 were carried out on day 1 of cycles 3, 5, 7, every three cycles thereafter, and at a final study visit. RESULTS A total of 26 patients with KIT-altered metastatic melanoma (25 with KIT mutations, 1 with KIT-amplification) were enrolled. Patients had received prior immunotherapy (n = 23, 88%) and KIT inhibitor therapy (n = 9, 35%). Confirmed objective response rate (ORR) was 23% [95% confidence interval (CI) 9%-44%; one complete and five partial responses] with a median duration of response of 9.1 months (range, 6.9-31.3 months). Median progression-free survival (mPFS) was 7.3 months (95% CI 1.9-13.6 months). Patients without prior KIT inhibitor therapy had a higher ORR and longer mPFS (n = 17, ORR 29%, mPFS 10.2 months) than those who had received prior KIT inhibitor treatment (n = 9, ORR 11%, mPFS 2.9 months). The most common treatment-related treatment-emergent adverse events (TEAEs) of any grade in ≥15% of patients were increased lipase, alopecia, actinic keratosis, myalgia, arthralgia, decreased appetite, fatigue, hyperkeratosis, nausea, and palmar-plantar erythrodysesthesia syndrome. There were no grade ≥4 treatment-related TEAEs. CONCLUSIONS In this phase I study, ripretinib demonstrated encouraging efficacy and a well-tolerated safety profile in patients with KIT-altered metastatic melanoma, suggesting ripretinib may have a clinically meaningful role in treating these patients.
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Affiliation(s)
- F Janku
- Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - S Bauer
- Department of Medical Oncology, Sarcoma Center/West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - K Shoumariyeh
- Department of Medicine I, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - R L Jones
- Medical Oncology, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - A Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, and Department of Medicine, University of Toronto, Toronto, Canada
| | - J Jennings
- Deciphera Pharmaceuticals, LLC, Waltham, USA
| | - C Psoinos
- Deciphera Pharmaceuticals, LLC, Waltham, USA
| | - J Meade
- Deciphera Pharmaceuticals, LLC, Waltham, USA
| | - R Ruiz-Soto
- Deciphera Pharmaceuticals, LLC, Waltham, USA
| | - P Chi
- Human Oncology and Pathogenesis Program/Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
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Gouda MA, Polivka J, Huang HJ, Treskova I, Pivovarcikova K, Fikrle T, Woznica V, Dustin DJ, Call SG, Meric-Bernstam F, Pesta M, Janku F. Ultrasensitive detection of BRAF mutations in circulating tumor DNA of non-metastatic melanoma. ESMO Open 2022; 7:100357. [PMID: 34942440 PMCID: PMC8695283 DOI: 10.1016/j.esmoop.2021.100357] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/11/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022] Open
Abstract
Background Implementation of adjuvant therapies in non-metastatic melanoma improved treatment outcomes in some patients; however, adjuvant therapy can be associated with significant cost and risk of toxicity. Therefore, there is an unmet need to better identify patients at high risk of recurrence. Patients and methods We carried out an ultrasensitive droplet digital PCR (ddPCR)-based detection of BRAFV600E-mutated circulating tumor DNA (ctDNA) from blood samples prospectively collected before surgery, 1 hour after surgery, and then serially during follow-up. Results In 80 patients (stages ≤III), BRAFV600E mutations were detected in 47.2% of tissue, in 37.7% of ctDNA samples collected before surgery, and in 25.9% of ctDNA samples collected 1 hour after surgery. Patients with detected ctDNA in blood collected 1 hour after surgery compared to patients without detected ctDNA had higher likelihood of melanoma recurrence (P < 0.001) and shorter median disease-free survival (P = 0.001) and overall survival (P = 0.003). Conclusions Ultrasensitive ddPCR can detect ctDNA in pre- and post-surgical blood samples from patients with resectable melanoma. Detection of ctDNA in post-surgical samples is associated with inferior treatment outcomes. Ultrasensitive ddPCR can detect ctDNA in pre- and post-surgical samples. Detection of ctDNA 1 hour after surgery is associated with inferior treatment outcomes. There were no associations between ctDNA detection at other timepoints and clinical outcomes.
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Affiliation(s)
- M A Gouda
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Polivka
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Department of Neurology, University Hospital Pilsen, Pilsen, Czech Republic
| | - H J Huang
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - I Treskova
- Department of Plastic Surgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - K Pivovarcikova
- Department of Pathology, University Hospital Pilsen, Pilsen, Czech Republic
| | - T Fikrle
- Department of Dermatovenerology, University Hospital Pilsen, Pilsen, Czech Republic
| | - V Woznica
- Department of Plastic Surgery, University Hospital Pilsen, Pilsen, Czech Republic
| | - D J Dustin
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S G Call
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Pesta
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic; Department of Biology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - F Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Dumbrava EE, Call SG, Huang HJ, Stuckett AL, Madwani K, Adat A, Hong DS, Piha-Paul SA, Subbiah V, Karp DD, Fu S, Naing A, Tsimberidou AM, Moulder SL, Koenig KH, Barcenas CH, Kee BK, Fogelman DR, Kopetz ES, Meric-Bernstam F, Janku F. PIK3CA mutations in plasma circulating tumor DNA predict survival and treatment outcomes in patients with advanced cancers. ESMO Open 2021; 6:100230. [PMID: 34479035 PMCID: PMC8414046 DOI: 10.1016/j.esmoop.2021.100230] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/08/2021] [Accepted: 07/09/2021] [Indexed: 12/13/2022] Open
Abstract
Background Oncogenic mutations in PIK3CA are prevalent in diverse cancers and can be targeted with inhibitors of the phosphoinositide-3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) pathway. Analysis of circulating tumor DNA (ctDNA) provides a minimally invasive approach to detect clinically actionable PIK3CA mutations. Patients and methods We analyzed PIK3CA hotspot mutation frequency by droplet digital PCR (QX 200; BioRad) using 16 ng of unamplified plasma-derived cell-free DNA from 68 patients with advanced solid tumors (breast cancer, n = 41; colorectal cancer, n = 13; other tumor types, n = 14). Results quantified as variant allele frequencies (VAFs) were compared with previous testing of archival tumor tissue and with patient outcomes. Results Of 68 patients, 58 (85%) had PIK3CA mutations in tumor tissue and 43 (74%) PIK3CA mutations in ctDNA with an overall concordance of 72% (49/68, κ = 0.38). In a subset analysis, which excluded samples from 26 patients known not to have disease progression at the time of sample collection, we found an overall concordance of 91% (38/42; κ = 0.74). PIK3CA-mutated ctDNA VAF of ≤8.5% (5% trimmed mean) showed a longer median survival compared with patients with a higher VAF (15.9 versus 9.4 months; 95% confidence interval 6.7-17.1 months; P = 0.014). Longitudinal analysis of ctDNA in 18 patients with serial plasma collections (range 2-22 time points, median 5) showed that those with a decrease in PIK3CA VAF had a longer time to treatment failure (TTF) compared with patients with an increase or no change (10.7 versus 2.6 months; P = 0.048). Conclusions Detection of PIK3CA mutations in ctDNA is concordant with testing of archival tumor tissue. Low quantity of PIK3CA-mutant ctDNA is associated with longer survival and a decrease in PIK3CA-mutant ctDNA on therapy is associated with longer TTF. Testing for PIK3CA mutations in ctDNA is concordant with testing of tumor tissue. High PIK3CA-mutant abundance in ctDNA was associated with shorter survival. Increasing PIK3CA-mutant abundance in serial blood samples was associated with shorter TTF. Longitudinal monitoring of PIK3CA-mutant ctDNA tracked with cancer clinical course.
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Affiliation(s)
- E E Dumbrava
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S G Call
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H J Huang
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A L Stuckett
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K Madwani
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Adat
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - D S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S A Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - V Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - D D Karp
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Fu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A M Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K H Koenig
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - B K Kee
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - D R Fogelman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E S Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA; Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Janku F, Bauer S, Shoumariyeh K, Jones R, Spreafico A, Jennings J, Psoinos C, Meade J, Ruiz-Soto R, Chi P. 1082P Phase I study of ripretinib, a broad-spectrum KIT and PDGFRA inhibitor, in patients with KIT-mutated or KIT-amplified melanoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Gouda M, Overman M, Huang H, Thomas J, Dasari N, Meric-Bernstam F, Kopetz S, Janku F. 91P Liquid biopsy for detection of minimal residual disease after liver metastasectomy in stage IV colorectal cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.371] [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: 10/20/2022] Open
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Hamilton E, Goel S, Arend R, Chu C, Richardson D, Corr B, John V, Janku F, Hays J, Michenzie M, Reichmann W, Achour H, Sherman M, Ruiz-Soto R, Mathews C. 728P A phase Ib/II study of rebastinib and paclitaxel in advanced/metastatic platinum-resistant ovarian cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1171] [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: 11/29/2022] Open
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Piha-Paul S, Tsimberidou A, Janku F, Raghav K, Wolff R, Huey R, Peng P, Levin W, Ngo B, Wang H, Sun C, Ru Q, Wu F, Javle M. P-261 Phase I study of multiple kinase inhibitor, TT-00420, in advanced, refractory cholangiocarcinoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.315] [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: 10/20/2022] Open
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Rodon J, Demanse D, Rugo H, André F, Janku F, Mayer I, Burris H, Simo R, Farooki A, Hu H, Lorenzo I, Quadt C, Juric D. 96MO A risk analysis of alpelisib (ALP)-induced hyperglycemia (HG) using baseline factors in patients (pts) with advanced solid tumours and breast cancer (BC): A pooled analysis of X2101 and SOLAR-1. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.110] [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: 10/21/2022] Open
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Cascone T, Sacks RL, Subbiah IM, Drobnitzky N, Piha-Paul SA, Hong DS, Hess KR, Amini B, Bhatt T, Fu S, Naing A, Janku F, Karp D, Falchook GS, Conley AP, Sherman SI, Meric-Bernstam F, Ryan AJ, Heymach JV, Subbiah V. Safety and activity of vandetanib in combination with everolimus in patients with advanced solid tumors: a phase I study. ESMO Open 2021; 6:100079. [PMID: 33721621 PMCID: PMC7973128 DOI: 10.1016/j.esmoop.2021.100079] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Preclinical studies suggest that combining vandetanib (VAN), a multi-tyrosine kinase inhibitor of rearranged during transfection (RET) proto-oncogene, vascular endothelial growth factor receptor (VEGFR), and epidermal growth factor receptor (EGFR), with everolimus (EV), a mammalian target of rapamycin (mTOR) inhibitor, may improve antitumor activity. We determined the safety, maximum tolerated dose (MTD), recommended phase II dose (RP2D), and dose-limiting toxicities (DLTs) of VAN + EV in patients with advanced solid cancers and the effect of combination therapy on cancer cell proliferation and intracellular pathways. Patients and methods Patients with refractory solid tumors were enrolled in a phase I dose-escalation trial testing VAN (100-300 mg orally daily) + EV (2.5-10 mg orally daily). Objective responses were evaluated using RECIST v1.1. RET mutant cancer cell lines were used in cell-based studies. Results Among 80 patients enrolled, 72 (90%) patients were evaluable: 7 achieved partial response (PR) (10%) and 37 had stable disease (SD) (51%; duration range: 1-27 cycles). Clinical benefit (SD or PR ≥ 6 months) was observed in 26 evaluable patients [36%, 95% confidence intervals (CI) (25% to 49%)]. In 80 patients, median overall survival (OS) was 10.5 months [95% CI (8.5-16.1)] and median progression-free survival (PFS) 4.1 months [95% CI (3.4-7.3)]. Six patients (7.5%) experienced DLTs and 20 (25%) required dose modifications. VAN + EV was safe, with fatigue, rash, diarrhea, and mucositis being the most common toxicities. In cell-based studies, combination therapy was superior to monotherapy at inhibiting cancer cell proliferation and intracellular signaling. Conclusions The MTDs and RP2Ds of VAN + EV are 300 mg and 10 mg, respectively. VAN + EV combination is safe and active in refractory solid tumors. Further investigation is warranted in RET pathway aberrant tumors. VAN + EV is safe, active and provides clinical benefit in some patients with refractory solid cancers. Dual therapy is superior to monotherapy at inhibiting proliferation and intracellular signaling of RET mutant cancer cells. This study highlights the importance of identifying novel combination therapies to overcome therapeutic resistance. Next-generation sequencing of advanced solid tumors may inform treatment strategies and guide future drug development.
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Affiliation(s)
- T Cascone
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - R L Sacks
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - I M Subbiah
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N Drobnitzky
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - S A Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - D S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - B Amini
- Department of Musculoskeletal Radiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - T Bhatt
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Fu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - D Karp
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G S Falchook
- Sarah Cannon Research Institute at HealthONE, Denver, USA
| | - A P Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S I Sherman
- Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A J Ryan
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - J V Heymach
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - V Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA.
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Wu J, Liu D, Offin M, Lezcano C, Torrisi JM, Brownstein S, Hyman DM, Gounder MM, Abida W, Drilon A, Harding JJ, Sullivan RJ, Janku F, Welsch D, Varterasian M, Groover A, Li BT, Lacouture ME. Characterization and management of ERK inhibitor associated dermatologic adverse events: analysis from a nonrandomized trial of ulixertinib for advanced cancers. Invest New Drugs 2021; 39:785-795. [PMID: 33389388 DOI: 10.1007/s10637-020-01035-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/22/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022]
Abstract
Background Ulixertinib is the first-in-class ERK1/2 kinase inhibitor with encouraging clinical activity in BRAF- and NRAS-mutant cancers. Dermatologic adverse events (dAEs) are common with ulixertinib, so management guidelines like those established for epidermal growth factor receptor inhibitor (EGFRi)-associated dAEs are needed. Patients and Methods This was an open-label, multicenter, phase I dose escalation and expansion trial of ulixertinib evaluating data from 135 patients with advanced malignancies enrolled between March 2013 and July 2017. Histopathological features, management, and dAEs in 34 patients are also reported. Twice daily oral ulixertinib was administered at 10 to 900 mg in the dose escalation cohort (n = 27) and at 600 mg in 21-day cycles in the expansion cohort (n = 108). Results The incidence of ulixertinib-induced dAEs and combined rash were 79% (107/135) and 76% (102/135). The most common dAEs included acneiform rash (45/135, 33%), maculopapular rash (36/135, 27%), and pruritus (34/135, 25%). Grade 3 dAEs were observed in 19% (25/135) of patients; no grade 4 or 5 dAEs were seen. The presence of at least 1 dAE was associated with stable disease (SD) or partial response (PR) (OR = 3.64, 95% CI 1.52-8.72; P = .003). Acneiform rash was associated with a PR (OR = 10.19, 95% CI 2.67-38.91; P < .001). Conclusion The clinical spectrum of ulixertinib-induced dAEs was similar to EGFR and MEK inhibitors; dAEs may serve as a surrogate marker of tumor response. We propose treatment algorithms for common ERK inhibitor-induced dAEs to maintain patients' quality of life and dose intensity for maximal clinical benefit. Clinical Trial Registration: NCT01781429.
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Affiliation(s)
- J Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Linkou, Taipei, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - D Liu
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - M Offin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - C Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - J M Torrisi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - S Brownstein
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - D M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - M M Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - W Abida
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - A Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.,Thoracic Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA
| | - J J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - R J Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, 02114, USA
| | - F Janku
- MD Anderson Cancer Center, The University of Texas, Houston, TX, 77030, USA
| | - D Welsch
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - M Varterasian
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - A Groover
- BioMed Valley Discoveries, Kansas City, MO, 64111, USA
| | - B T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Medicine, Weill Cornell Medicine, New York, NY, 10065, USA. .,Thoracic Oncology and Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA.
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA. .,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medicine, 530 East 74th Street, New York, NY, 10021, USA.
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Thein K, Tsimberidou A, Piha-Paul S, Janku F, Karp D, Fu S, Zarifa A, Gong J, Hong D, Yap T, Subbiah V, Pant S, Meric-Bernstam F, Naing A. 72MO Selinexor in combination with standard chemotherapy in patients with advanced solid tumours: Results of an open label, single-center, multi-arm phase Ib study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.092] [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: 10/22/2022] Open
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14
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Thein K, Tsimberidou A, Piha-Paul S, Janku F, Karp D, Fu S, Zarifa A, Gong J, Yap T, Hong D, Subbiah V, Pant S, Meric-Bernstam F, Naing A. 73P Selinexor in combination with carboplatin and pemetrexed (CP) in patients with advanced or metastatic solid tumors: Results of an open label, single-center, multi-arm phase Ib study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.093] [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: 10/22/2022] Open
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15
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Janku F, Abdul-Karim R, Azad A, Bendell J, Gan H, Sen S, Tan T, Wang J, Marina N, Baker L, Ma L, Mooney J, Luo D, Leveque J, Milla M, Meniawy T. Preliminary results from an open-label, multicenter phase 1/2 dose escalation and expansion study of THOR-707, a novel not-Alpha IL-2, as a single agent in adult subjects with advanced or metastatic solid tumors. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31094-7] [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: 10/23/2022]
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Hamilton E, Goel S, Arend R, Chu C, Richardson D, Diamond J, John V, Janku F, Matthews C, JeBailey L, Kuida K, Achour H, Ruiz-Soto R, Hays J. 839P A phase Ib/II study of rebastinib and paclitaxel in advanced or metastatic platinum-resistant ovarian cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.978] [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: 11/28/2022] Open
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Janku F, Chi P, Heinrich M, von Mehren M, Jones R, Ganjoo K, Trent J, Gelderblom H, Razak AA, Gordon M, Somaiah N, Jennings J, Shi K, Ruiz-Soto R, George S. 1623MO Ripretinib intra-patient dose escalation (IPDE) following disease progression provides clinically meaningful progression-free survival (PFS) in gastrointestinal stromal tumor (GIST) in phase I study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Thein K, Tsimberidou A, Piha-Paul S, Janku F, Karp D, Fu S, Zarifa A, Gong J, Hong D, Yap T, Subbiah V, Pant S, Meric-Bernstam F, Naing A. 565P Selinexor in combination with topotecan in patients with advanced or metastatic solid tumours: Results of an open label, single-center, multi-arm phase Ib study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Alhalabi O, Hahn A, Msaouel P, Meric-Bernstam F, Naing A, Piha-Paul S, Janku F, Pant S, Yap T, Hong D, Fu S, Karp D, Campbell E, Campbell M, Shah A, Tannir N, Siefker-Radtke A, Gao J, Roszik J, Subbiah V. 779P Validation of prognostic scores in patients with metastatic bladder carcinoma (mBC) enrolled in early phase clinical trials. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.851] [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: 10/23/2022] Open
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Lakhani N, Spreafico A, Tolcher A, Rodon J, Janku F, Chandana S, Oliva M, Sharma M, Abdul-Karim R, Hansen U, Hansen L, Skartved N, Poulsen T, Nadal R, Lantto J, Wood D, Nadler P, Siu L. 1019O Phase I studies of Sym021, an anti-PD-1 antibody, alone and in combination with Sym022 (anti-LAG-3) or Sym023 (anti-TIM-3). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1139] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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21
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Spreafico A, Janku F, Rodon J, Tolcher A, Chandana S, Oliva M, Musalli S, Knauss L, Kragh M, Alifrangis L, Fröhlich C, Melander M, Blondal T, Pedersen M, Lantto J, Wood D, Nadler P, Horak I, Siu L, Lakhani N. A phase I study of Sym021, an anti-PD-1 antibody (Ab), alone and in combination with Sym022 (anti-LAG-3) or Sym023 (anti-TIM-3). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Naing A, Meric-Bernstam F, Karp D, Rodon J, Piha-Paul S, Subbiah V, Hong D, Pant S, Fu S, Janku F, Yap T, Tsimberidou A, Dumbrava EEI, Colen R, Hess K, Campbell M, Tu SM, Jimenez C, Habra M, Varadhachary G. Pembrolizumab in advanced rare cancers. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.095] [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: 11/14/2022] Open
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Tsimberidou A, Hong D, Fu S, Karp D, Piha-Paul S, Kies M, Ravi V, Subbiah V, Patel S, Tu SM, Janku F, Heymach J, Johnson A, Zhang J, Berry D, Vining D, Futreal A, Miller V, Meric-Bernstam F, Zhao L. Precision medicine: Preliminary results from the initiative for molecular profiling and advanced cancer therapy 2 (IMPACT 2) study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.011] [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: 11/12/2022] Open
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Janku F, Huang H, Treskova I, Pivovarcikova K, Call S, Meric-Bernstam F, Pesta M, Polivka J. Ultra-sensitive detection of circulating tumor DNA identifies patients in high risk of recurrence in early stages melanoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wick W, Tabatabai G, Schuler M, Rorhberg K, Chawla S, Janku F, Schiff D, Heinemann V, Narita Y, Ando Y, Lenz H, Ikeda M, Genvresse I, Rentzsch C, Reschke S, Cyris C, Cai C, Jeffers M, Peña C, Bähr O. Safety, efficacy, PK and PD biomarker results of the first-in-human study of mutant isocitrate dehydrogenase 1 (mIDH1) inhibitor BAY 1436032 in patients (pts) with mIDH1 advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Camidge D, Janku F, Bueno AM, Catenacci D, Lee J, Lee SH, Chung H, Dowlati A, Rohrberg K, Felip Font E, Garralda E, Kang YK, Moon Y, López Criado M, Chiu CF, Poulsen T, Rudbæk H, Alifrangis L, Dalal R, Patnaik A. A phase Ia/IIa trial of Sym015, a MET antibody mixture, in patients with advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Li BT, Janku F, Jung B, Hou C, Madwani K, Alden R, Razavi P, Reis-Filho JS, Shen R, Isbell JM, Blocker AW, Eattock N, Gnerre S, Satya RV, Xu H, Zhao C, Hall MP, Hu Y, Sehnert AJ, Brown D, Ladanyi M, Rudin CM, Hunkapiller N, Feeney N, Mills GB, Paweletz CP, Janne PA, Solit DB, Riely GJ, Aravanis A, Oxnard GR. Ultra-deep next-generation sequencing of plasma cell-free DNA in patients with advanced lung cancers: results from the Actionable Genome Consortium. Ann Oncol 2019; 30:597-603. [PMID: 30891595 PMCID: PMC6503621 DOI: 10.1093/annonc/mdz046] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Noninvasive genotyping using plasma cell-free DNA (cfDNA) has the potential to obviate the need for some invasive biopsies in cancer patients while also elucidating disease heterogeneity. We sought to develop an ultra-deep plasma next-generation sequencing (NGS) assay for patients with non-small-cell lung cancers (NSCLC) that could detect targetable oncogenic drivers and resistance mutations in patients where tissue biopsy failed to identify an actionable alteration. PATIENTS AND METHODS Plasma was prospectively collected from patients with advanced, progressive NSCLC. We carried out ultra-deep NGS using cfDNA extracted from plasma and matched white blood cells using a hybrid capture panel covering 37 lung cancer-related genes sequenced to 50 000× raw target coverage filtering somatic mutations attributable to clonal hematopoiesis. Clinical sensitivity and specificity for plasma detection of known oncogenic drivers were calculated and compared with tissue genotyping results. Orthogonal ddPCR validation was carried out in a subset of cases. RESULTS In 127 assessable patients, plasma NGS detected driver mutations with variant allele fractions ranging from 0.14% to 52%. Plasma ddPCR for EGFR or KRAS mutations revealed findings nearly identical to those of plasma NGS in 21 of 22 patients, with high concordance of variant allele fraction (r = 0.98). Blinded to tissue genotype, plasma NGS sensitivity for de novo plasma detection of known oncogenic drivers was 75% (68/91). Specificity of plasma NGS in those who were driver-negative by tissue NGS was 100% (19/19). In 17 patients with tumor tissue deemed insufficient for genotyping, plasma NGS identified four KRAS mutations. In 23 EGFR mutant cases with acquired resistance to targeted therapy, plasma NGS detected potential resistance mechanisms, including EGFR T790M and C797S mutations and ERBB2 amplification. CONCLUSIONS Ultra-deep plasma NGS with clonal hematopoiesis filtering resulted in de novo detection of targetable oncogenic drivers and resistance mechanisms in patients with NSCLC, including when tissue biopsy was inadequate for genotyping.
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Affiliation(s)
- B T Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York.
| | - F Janku
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston
| | - B Jung
- Illumina, Inc., San Francisco
| | - C Hou
- Illumina, Inc., San Francisco
| | - K Madwani
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston
| | - R Alden
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston
| | - P Razavi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | | | - R Shen
- Epidemiology and Biostatistics
| | - J M Isbell
- Surgery, Memorial Sloan Kettering Cancer Center, New York
| | | | | | | | | | - H Xu
- Illumina, Inc., San Francisco
| | - C Zhao
- Illumina, Inc., San Diego
| | | | - Y Hu
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston
| | | | | | | | - C M Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | | | - N Feeney
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston
| | - G B Mills
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston
| | - C P Paweletz
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston
| | - P A Janne
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston; Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston
| | - D B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Human Oncology and Pathogenesis Program, Memorial Sloan Cancer Center, New York, USA
| | - G J Riely
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| | | | - G R Oxnard
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston
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Owusu-Brackett N, Zhao M, Akcakanat A, Evans KW, Yuca E, Tapia C, Ileana-Dumbrava E, Janku F, Meric-Bernstam F. Abstract P6-21-04: Targeting PI3Kβ alone and in combination with chemotherapy or immunotherapy in tumors with PTEN loss. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-21-04] [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: PTEN functions as a negative regulator of the phosphatidylinositol 3-kinase (PI3K)/AKT/mTOR pathway to promote balanced cell proliferation, survival and differentiation. PTEN loss occurs across a variety of cancer subtypes; PTEN-deficient tumors are dependent on PI3Kβ activity, making PI3Kβ a compelling target. We evaluated the efficacy of PI3Kβ inhibitor AZD8186 as a single agent and in combination with standard chemotherapy and immune checkpoint inhibitors focused on tumors with loss of PTEN function.
Methods: In vitro, cell proliferation assays were performed to determine the half maximal inhibitory concentration (IC50) after 3 days of treatment and to test the effects in combination with standard chemotherapy. Colony formation assays were performed to confirm efficacy of AZD8186 in PTEN-deficient cell lines. Western blot analysis was performed to assess PTEN protein expression and to evaluate effects of AZD8186 on PI3K signaling. In vivo, antitumor efficacy of AZD8186 as a single agent as well as in combination with paclitaxel and anti-PD1 was evaluated.
Results: AZD8186 inhibited the cell proliferation of three of ten TNBC cell lines in vitro; PTEN loss was significantly correlated with AZD8186 sensitivity (p= 0.008). Colony formation assay confirmed sensitivity of PTEN-deficient cell lines to AZD8186. AZD8186 inhibited PI3K signaling with decreased expression of pAKT, pGSK3β, pPRAS40 and pS6. AZD8186 treatment of PTEN-deficient cell lines, MDA-MB-436 and MDA-MB-468, resulted in increased apoptosis. Cell proliferation assays demonstrated additive effect of the combination of paclitaxel with AZD8186. AZD8186 significantly enhanced antitumor activity of paclitaxel in MDA-MB-436 and MDA-MB-468 cell-line-derived xenografts, with disease stabilization in the latter. In syngeneic models, AZD8186 enhanced antitumor efficacy of anti-PD1 antibodies in PTEN-deficient BP murine melanoma xenograft (p=0.0073), but not in PTEN-wildtype colon carcinoma, CT26.
Conclusion: AZD8186 has single agent efficacy in PTEN-deficient triple negative breast cancer cell lines in vitro, with modest single agent efficacy in vivo. AZD8186 enhanced the antitumor efficacy of paclitaxel and of Anti-PD1 antibodies in vivo. Further study is needed to determine optimal combination therapies for PTEN-deficient solid tumors.
Citation Format: Owusu-Brackett N, Zhao M, Akcakanat A, Evans KW, Yuca E, Tapia C, Ileana-Dumbrava E, Janku F, Meric-Bernstam F. Targeting PI3Kβ alone and in combination with chemotherapy or immunotherapy in tumors with PTEN loss [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-21-04.
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Affiliation(s)
| | - M Zhao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A Akcakanat
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - KW Evans
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E Yuca
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C Tapia
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - F Janku
- The University of Texas MD Anderson Cancer Center, Houston, TX
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George S, Heinrich M, Chi P, Razak A, von Mehren M, Gordon M, Ganjoo K, Somaiah N, Trent J, Rodon Ahnert J, Wolf J, Ruiz-Soto R, Rosen O, Janku F. Initial results of phase I study of DCC-2618, a broad-spectrum KIT and PDGFRa inhibitor, in patients (pts) with gastrointestinal stromal tumor (GIST) by number of prior regimens. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy299.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Janku F, Jegede O, Puhalla S, Konstantinopoulos P, Meric-Bernstam F, Mitchell E, Zwiebel J, McShane L, Li S, Rubinstein L, Doyle L, Patton D, Conley B, O’Dwyer P, Harris L, Arteaga C, Williams P, Hamilton S, Chen A, Flaherty K. NCI-MATCH Arms N & P: Phase II study of PI3K beta inhibitor GSK2636771 in patients (pts) with cancers (ca) with PTEN mutation/deletion (mut/del) or PTEN protein loss. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy279.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Liu L, Toung JM, Jassowicz AF, Vijayaraghavan R, Kang H, Zhang R, Kruglyak KM, Huang HJ, Hinoue T, Shen H, Salathia NS, Hong DS, Naing A, Subbiah V, Piha-Paul SA, Bibikova M, Granger G, Barnes B, Shen R, Gutekunst K, Fu S, Tsimberidou AM, Lu C, Eng C, Moulder SL, Kopetz ES, Amaria RN, Meric-Bernstam F, Laird PW, Fan JB, Janku F. Targeted methylation sequencing of plasma cell-free DNA for cancer detection and classification. Ann Oncol 2018; 29:1445-1453. [PMID: 29635542 PMCID: PMC6005020 DOI: 10.1093/annonc/mdy119] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Targeted methylation sequencing of plasma cell-free DNA (cfDNA) has a potential to expand liquid biopsies to patients with tumors without detectable oncogenic alterations, which can be potentially useful in early diagnosis. Patients and methods We developed a comprehensive methylation sequencing assay targeting 9223 CpG sites consistently hypermethylated according to The Cancer Genome Atlas. Next, we carried out a clinical validation of our method using plasma cfDNA samples from 78 patients with advanced colorectal cancer, non-small-cell lung cancer (NSCLC), breast cancer or melanoma and compared results with patients' outcomes. Results Median methylation scores in plasma cfDNA samples from patients on therapy were lower than from patients off therapy (4.74 versus 85.29; P = 0.001). Of 68 plasma samples from patients off therapy, methylation scores detected the presence of cancer in 57 (83.8%), and methylation-based signatures accurately classified the underlying cancer type in 45 (78.9%) of these. Methylation scores were most accurate in detecting colorectal cancer (96.3%), followed by breast cancer (91.7%), melanoma (81.8%) and NSCLC (61.1%), and most accurate in classifying the underlying cancer type in colorectal cancer (88.5%), followed by NSCLC (81.8%), breast cancer (72.7%) and melanoma (55.6%). Low methylation scores versus high were associated with longer survival (10.4 versus 4.4 months, P < 0.001) and longer time-to-treatment failure (2.8 versus 1.6 months, P = 0.016). Conclusions Comprehensive targeted methylation sequencing of 9223 CpG sites in plasma cfDNA from patients with common advanced cancers detects the presence of cancer and underlying cancer type with high accuracy. Methylation scores in plasma cfDNA correspond with treatment outcomes.
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Affiliation(s)
- L Liu
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - J M Toung
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A F Jassowicz
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Vijayaraghavan
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H Kang
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Zhang
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K M Kruglyak
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H J Huang
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - T Hinoue
- Van Andel Research Institute, Grand Rapids, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - H Shen
- Van Andel Research Institute, Grand Rapids, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N S Salathia
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - D S Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - V Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S A Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Bibikova
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Granger
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - B Barnes
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Shen
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K Gutekunst
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S Fu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A M Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C Lu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S L Moulder
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - E S Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA
| | - P W Laird
- Van Andel Research Institute, Grand Rapids, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J-B Fan
- Illumina, Inc., San Diego, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, USA.
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Janku F, Johnson LK, Karp DD, Atkins JT, Singleton PA, Moss J. Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer. Ann Oncol 2018; 29:1076. [PMID: 29253076 DOI: 10.1093/annonc/mdx776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jassowicz A, Liu L, Huang H, Hong D, Naing A, Subbiah V, Piha-Paul S, Toung J, Vijayaraghavan R, Zhang R, Kang H, Fu S, Tsimberiodou A, Lu C, Eng C, Moulder S, Kopetz S, Amaria R, Meric-Bernstam F, Janku F. Targeted methylation sequencing of plasma cell-free DNA identifies patients with advanced breast, colorectal, non-small cell lung cancer, melanoma with poor outcomes. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.041] [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: 11/13/2022] Open
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Janku F, Razak A, Gordon M, Flynn D, Kaufman M, Pitman J, Smith B, Somaiah N, Jennings J, Salah S, Westwood D, Greensmith D, Jacobson J, Rosen O, George S. Encouraging activity of novel pan-KIT and PDGFRα inhibitor DCC-2618 in patients (pts) with Gastrointestinal Stromal Tumor (GIST). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sakamuri D, Kato S, Huang H, Naing A, Holley V, Patel S, Piha-Paul S, Tsimberidou A, Hong D, Meric-Bernstam F, Janku F. Dose escalation study of vemurafenib with crizotinib or sorafenib in patient with BRAF-mutated advance cancers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.037] [Citation(s) in RCA: 1] [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: 11/12/2022] Open
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Janku F, Huang HJ, Fujii T, Shelton DN, Madwani K, Fu S, Tsimberidou AM, Piha-Paul SA, Wheler JJ, Zinner RG, Naing A, Hong DS, Karp DD, Cabrilo G, Kopetz ES, Subbiah V, Luthra R, Kee BK, Eng C, Morris VK, Karlin-Neumann GA, Meric-Bernstam F. Multiplex KRASG12/G13 mutation testing of unamplified cell-free DNA from the plasma of patients with advanced cancers using droplet digital polymerase chain reaction. Ann Oncol 2017; 28:642-650. [PMID: 27993791 PMCID: PMC5834133 DOI: 10.1093/annonc/mdw670] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Cell-free DNA (cfDNA) from plasma offers easily obtainable material for KRAS mutation analysis. Novel, multiplex, and accurate diagnostic systems using small amounts of DNA are needed to further the use of plasma cfDNA testing in personalized therapy. Patients and methods Samples of 16 ng of unamplified plasma cfDNA from 121 patients with diverse progressing advanced cancers were tested with a KRASG12/G13 multiplex assay to detect the seven most common mutations in the hotspot of exon 2 using droplet digital polymerase chain reaction (ddPCR). The results were retrospectively compared to mutation analysis of archival primary or metastatic tumor tissue obtained at different points of clinical care. Results Eighty-eight patients (73%) had KRASG12/G13 mutations in archival tumor specimens collected on average 18.5 months before plasma analysis, and 78 patients (64%) had KRASG12/G13 mutations in plasma cfDNA samples. The two methods had initial overall agreement in 103 (85%) patients (kappa, 0.66; ddPCR sensitivity, 84%; ddPCR specificity, 88%). Of the 18 discordant cases, 12 (67%) were resolved by increasing the amount of cfDNA, using mutation-specific probes, or re-testing the tumor tissue, yielding overall agreement in 115 patients (95%; kappa 0.87; ddPCR sensitivity, 96%; ddPCR specificity, 94%). The presence of ≥ 6.2% of KRASG12/G13 cfDNA in the wild-type background was associated with shorter survival (P = 0.001). Conclusion(s) Multiplex detection of KRASG12/G13 mutations in a small amount of unamplified plasma cfDNA using ddPCR has good sensitivity and specificity and good concordance with conventional clinical mutation testing of archival specimens. A higher percentage of mutant KRASG12/G13 in cfDNA corresponded with shorter survival.
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Affiliation(s)
- F. Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - H. J. Huang
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - T. Fujii
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | | | - K. Madwani
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - S. Fu
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - A. M. Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - S. A. Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - J. J. Wheler
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - R. G. Zinner
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - A. Naing
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - D. S. Hong
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - D. D. Karp
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - G. Cabrilo
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - E. S. Kopetz
- Departments of Gastrointestinal Medical Oncology
| | - V. Subbiah
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - R. Luthra
- Hematopathology, Molecular Diagnostic Laboratory, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - B. K. Kee
- Departments of Gastrointestinal Medical Oncology
| | - C. Eng
- Departments of Gastrointestinal Medical Oncology
| | - V. K. Morris
- Departments of Gastrointestinal Medical Oncology
| | | | - F. Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
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Paez Arango N, Evans KW, Zhao M, Yuca E, Scott SM, Janku F, Ueno NT, Tripathy D, Kim C, Naing A, Funda MB. Abstract P3-07-01: Selinexor, a selective inhibitor of nuclear export, demonstrates efficacy in preclinical models of triple negative breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-07-01] [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: Approximately 15% of all breast cancers are categorized as triple negative (TNBC) for which the only chemotherapy is known to be effective, yet often fails to achieve remission. Nuclear exporter XPO1 (Exportin1 or CRM1) is a promising target for cancer therapy that mediates the transport of multiple tumor suppressors and cell cycle regulators that have been known to be relevant predictors in the mechanism and severity of TNBC. Given the pressing need for novel therapies for this disease, we sought to determine the antitumor effects of selinexor, a novel inhibitor of nuclear export, on triple negative breast cancers in vitro and in vivo as well as to address its mechanism of action.
Methods: 26 breast cancer cell lines of different breast cancer subtypes were treated with selinexor in vitro. Using cell proliferation assays the half maximal inhibitory concentration (IC50) was calculated using isobologram curves after 3 days of treatment; sensitivity was defined as IC50 <1000nM. We then assessed mechanistic effects on apoptosis and cell proliferation using flow cytometry analysis with annexin V and propidium iodide and using western blot analysis we also studied its effects on markers of inhibition of apoptosis. In vivo efficacy was studied as single agent and in combination with standard chemotherapy agents in TNBC patient derived xenografts (PDXs) with varying levels of sensitivity to chemotherapy as well as with varying statuses of TP53 and PIK3CA, and gene expression subtypes.
Results: Selinexor demonstrated growth inhibition in all fourteen TNBC cell lines tested; TNBC cell lines were more sensitive to selinexor (median IC50 44nM, range 11 - 550nM), compared to ER+ cells lines (median IC50 of 13000 nM, range of 40nM - > 1000 nM; P=0.017). Treatment with selinexor decreased expression levels of XPO1, as well as survivin and XIAP, and induced apoptosis. In multiple TNBC cell lines selinexor was synergistic with paclitaxel, carboplatin, eribulin and doxorubicin in vitro (median combination index 0.6, range 0.5-0.8). Selinexor as a single agent reduced tumor growth in vivo in 4 of 5 different TNBC PDX models with a median tumor growth inhibition ratio score (T/C) of 48% (range 34-59%) and demonstrated greater antitumor efficacy in combination with paclitaxel or eribulin with an average T/C score of 27% and 12% respectively.
Conclusions: Selinexor is a promising therapeutic agent for triple negative breast cancer and it has potential as a combination agent with standard chemotherapy.
Citation Format: Paez Arango N, Evans KW, Zhao M, Yuca E, Scott SM, Janku F, Ueno NT, Tripathy D, Kim C, Naing A, Funda M-B. Selinexor, a selective inhibitor of nuclear export, demonstrates efficacy in preclinical models of triple negative breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-07-01.
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Affiliation(s)
| | - KW Evans
- MD Anderson Cancer Center, Houston, TX
| | - M Zhao
- MD Anderson Cancer Center, Houston, TX
| | - E Yuca
- MD Anderson Cancer Center, Houston, TX
| | - SM Scott
- MD Anderson Cancer Center, Houston, TX
| | - F Janku
- MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- MD Anderson Cancer Center, Houston, TX
| | | | - C Kim
- MD Anderson Cancer Center, Houston, TX
| | - A Naing
- MD Anderson Cancer Center, Houston, TX
| | - M-B Funda
- MD Anderson Cancer Center, Houston, TX
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Janku F, Vergilio J, Salhia B, Fanale M, Oki Y, Huang H, Westin J, He J, Nahas M, Mughal T, Miller V, Stephens P, Raina A, Garrido-Laguna I, Meric-Bernstam F, Ross J, Liang W. Comprehensive genomic profiling reveals recurrent XPO1 mutations and other alterations in archival samples of patients with Hodgkin lymphoma. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32705-8] [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: 11/25/2022]
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Janku F, Murthy R, Wang-Gillam A, Shepard D, Helgason T, Henry T, Rudin C, Huang S, Sakamuri D, Solomon S, Collins A, Kreider B, Miller M, Saha S, Tung D, Varterasian M, Zhang L, Zhang H, Gounder M. Phase I clinical study of intratumoral injection of oncolytic Clostridium novyi-NT spores in patients with advanced cancers. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32878-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Dembla V, Ray D, Lockett P, Fullmer C, Subramanian H, Subbiah V, Fu S, Janku F, Tsimberidou A, Naing A, Piha-Paul S, Hong D, Pant S, Miller V, Lim J, Le H, Karp D. Drug development in the MD Anderson Cancer Center (MDACC) Clinical Translational Research Center (CTRC) – 2011–2015: The challenge of precision medicine in a very broad playing field. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)33011-8] [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: 11/25/2022]
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Janku F, Johnson LK, Karp DD, Atkins JT, Singleton PA, Moss J. Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer. Ann Oncol 2016; 27:2032-2038. [PMID: 27573565 DOI: 10.1093/annonc/mdw317] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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: 05/13/2016] [Accepted: 07/28/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Methylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy. PATIENTS AND METHODS Pooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization. RESULTS In two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43-109 versus 56 days, 95% CI 43-69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59-177 versus 55 days, 95% CI 40-70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29-0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30-0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88). CONCLUSION This unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy. CLINICAL TRIALS NUMBER NCT00401362, NCT00672477.
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Affiliation(s)
- F Janku
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | | | - D D Karp
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - J T Atkins
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston
| | - P A Singleton
- Department of Medicine, Section of Pulmonary and Critical Care.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, The University of Chicago, Chicago, USA
| | - J Moss
- Department of Anesthesia and Critical Care, Pritzker School of Medicine, The University of Chicago, Chicago, USA
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Basho RK, Gilcrease M, Murthy RK, Helgason T, Booser DJ, Karp DD, Meric-Bernstam F, Wheler JJ, Valero V, Albarracin C, Litton J, Chavez-MacGregor M, Ibrahim NK, Murray JL, Koenig KB, Hong D, Subbiah V, Kurzrock R, Janku F, Moulder S. Abstract P3-14-02: Targeting the PI3K/AKT/mTOR pathway for the treatment of mesenchymal triple-negative breast cancer (TNBC): Evidence of efficacy and proof of concept from a phase I trial with dose expansion of mTOR inhibition in combination with liposomal doxorubicin and bevacizumab. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-14-02] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Approximately 30% of TNBCs are characterized by microarray as claudin-low, mesenchymal or mesenchymal stem cell-like and, unlike basal TNBCs, these tumors frequently harbor aberrations in the PI3K/AKT/mTOR axis, raising the possibility of targeting this axis to enhance chemotherapy response. Assays to clinically identify mesenchymal TNBCs are under development, but published results confirm that up to 30% are metaplastic breast cancers (MpBCs), a chemo-refractory group of tumors that contain a mixture of epithelial and mesenchymal components, making them identifiable by microscopy. As such, MpBCs serve as surrogates of response for potential regimens to treat mesenchymal TNBC.
Methods: Patients (pts) with advanced TNBC (N=64) were treated with liposomal doxorubicin (D), bevacizumab (A) and the mTOR inhibitors temsirolimus (T) or everolimus (E). D and A were administered IV on day 1 with T (IV on days 1, 8 and 15) or E (continuous daily oral administration) using 21 day cycles. Response was assessed every 6 weeks using RECIST. When available, archived tissue was evaluated for aberrations in the PI3K pathway using standard assays.
Results: Fifty-two MpBC pts were treated with DAT (N=39) or DAE (N=13). Median age was 58 (range 37-79); median # of prior regimens for metastatic disease was 1 (range 0-5). The objective response rate (ORR) was 21% [complete response (CR)=4 (8%); partial response (PR)=7 (13%)] and 10 (19%) pts had stable disease (SD)≥6 months for a clinical benefit rate (CBR) of 40%. Tissue was available for testing in 43 pts and 32 (74%) had a PI3K pathway activating aberration (Table 1).
Response According to PI3K Pathway AberrationPI3K Pathway AberrationN (%)CRPRSD≥6monthsCBRORRAny PI3K Pathway Aberration*32 (74)46444%31%PIK3CA Mutation19 (59)23447%26%p.H1047R12 (38)21350%25%p.E545K6 (19)02150%33%p.G1007R1 (3)010100%100%p.E545A1 (3)0000%0%p.H1047Y1 (3)0000%0%p.K111E1 (3)0000%0%p.E542K1 (3)0000%0%PIK3CA Amplification1 (3)010100%100%PTEN Mutation5 (16)0000%0%PTEN Loss5 (16)02040%40%AKT1 p.E17K Mutation2 (6)0000%0%AKT2 Amplification1 (3)100100%100%PIK3R1 Mutation2 (6)01050%50%NF2 Mutation1 (3)100100%100%No PI3K Pathway Aberration11 (26)00545%0%*Some tumors had >1 aberration detected
PI3K pathway activation was associated with a significant improvement in ORR (31 vs 0%; P=0.043) but not CBR (44 vs 45%; P=1.000) or progression-free survival (median 5.1 vs 2.9 months; P=0.352). A pt with 5 year+ durable CR (on maintenance everolimus) had a mutation in NF2. To emphasize the importance of pt selection, it is notable that 12 pts with non-metaplastic TNBC were also treated with DAT, and only 1 pt had a response (CR/PR=1; SD≥6 months=0), for a CBR that was significantly worse than pts with MpBC (8 vs 40%; P=0.045).
Conclusions: Using MpBC as a surrogate of response, DAT/DAE has significantly better activity in mesenchymal compared to non-selected TNBC. Response is enhanced in pts with PI3K pathway activation. DAT/DAE should be tested in non-metaplastic, mesenchymal TNBC once a diagnostic assay is available.
Citation Format: Basho RK, Gilcrease M, Murthy RK, Helgason T, Booser DJ, Karp DD, Meric-Bernstam F, Wheler JJ, Valero V, Albarracin C, Litton J, Chavez-MacGregor M, Ibrahim NK, Murray JL, Koenig KB, Hong D, Subbiah V, Kurzrock R, Janku F, Moulder S. Targeting the PI3K/AKT/mTOR pathway for the treatment of mesenchymal triple-negative breast cancer (TNBC): Evidence of efficacy and proof of concept from a phase I trial with dose expansion of mTOR inhibition in combination with liposomal doxorubicin and bevacizumab. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-14-02.
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Affiliation(s)
- RK Basho
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - M Gilcrease
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - RK Murthy
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - T Helgason
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - DJ Booser
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - DD Karp
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - F Meric-Bernstam
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - JJ Wheler
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - V Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - C Albarracin
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - J Litton
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - M Chavez-MacGregor
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - NK Ibrahim
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - JL Murray
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - KB Koenig
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - D Hong
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - V Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - R Kurzrock
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - F Janku
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
| | - S Moulder
- The University of Texas MD Anderson Cancer Center, Houston, TX; UC San Diego Moores Cancer Center, La Jolla, CA
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Meric-Bernstam F, Brusco L, Daniels M, Wathoo C, Bailey AM, Strong L, Shaw K, Lu K, Qi Y, Zhao H, Lara-Guerra H, Litton J, Arun B, Eterovic AK, Aytac U, Routbort M, Subbiah V, Janku F, Davies MA, Kopetz S, Mendelsohn J, Mills GB, Chen K. Incidental germline variants in 1000 advanced cancers on a prospective somatic genomic profiling protocol. Ann Oncol 2016; 27:795-800. [PMID: 26787237 DOI: 10.1093/annonc/mdw018] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [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: 11/17/2015] [Accepted: 01/08/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Next-generation sequencing in cancer research may reveal germline variants of clinical significance. We report patient preferences for return of results and the prevalence of incidental pathogenic germline variants (PGVs). PATIENTS AND METHODS Targeted exome sequencing of 202 genes was carried out in 1000 advanced cancers using tumor and normal DNA in a research laboratory. Pathogenic variants in 18 genes, recommended for return by The American College of Medical Genetics and Genomics, as well as PALB2, were considered actionable. Patient preferences of return of incidental germline results were collected. Return of results was initiated with genetic counseling and repeat CLIA testing. RESULTS Of the 1000 patients who underwent sequencing, 43 had likely PGVs: APC (1), BRCA1 (11), BRCA2 (10), TP53 (10), MSH2 (1), MSH6 (4), PALB2 (2), PTEN (2), TSC2 (1), and RB1 (1). Twenty (47%) of 43 variants were previously known based on clinical genetic testing. Of the 1167 patients who consented for a germline testing protocol, 1157 (99%) desired to be informed of incidental results. Twenty-three previously unrecognized mutations identified in the research environment were confirmed with an orthogonal CLIA platform. All patients approached decided to proceed with formal genetic counseling; in all cases where formal genetic testing was carried out, the germline variant of concern validated with clinical genetic testing. CONCLUSIONS In this series, 2.3% patients had previously unrecognized pathogenic germline mutations in 19 cancer-related genes. Thus, genomic sequencing must be accompanied by a plan for return of germline results, in partnership with genetic counseling.
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Affiliation(s)
- F Meric-Bernstam
- Department of Investigational Cancer Therapeutics Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy Department of Surgical Oncology
| | - L Brusco
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy
| | - M Daniels
- Department of Gynecologic Oncology and Reproductive Medicine Program of Clinical Cancer Genetics
| | - C Wathoo
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy
| | - A M Bailey
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy
| | - L Strong
- Program of Clinical Cancer Genetics
| | - K Shaw
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy
| | - K Lu
- Department of Gynecologic Oncology and Reproductive Medicine Program of Clinical Cancer Genetics
| | - Y Qi
- Department of Bioinformatics and Computational Biology
| | - H Zhao
- Department of Bioinformatics and Computational Biology
| | - H Lara-Guerra
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy Department of RedSky/Biomedical Institute of the Americas, El Paso, USA
| | - J Litton
- Department of Breast Medical Oncology
| | - B Arun
- Department of Breast Medical Oncology Program of Clinical Cancer Genetics
| | | | - U Aytac
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy
| | | | - V Subbiah
- Department of Investigational Cancer Therapeutics
| | - F Janku
- Department of Investigational Cancer Therapeutics
| | - M A Davies
- Department of Systems Biology Department of Melanoma Medical Oncology
| | - S Kopetz
- Department of Gastrointestinal (GI) Medical Oncology, MD Anderson Cancer Center, Houston
| | - J Mendelsohn
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy Department of Genomic Medicine
| | - G B Mills
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy Department of Systems Biology
| | - K Chen
- Department of Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy Department of Bioinformatics and Computational Biology
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Liu X, George GC, Tsimberidou AM, Naing A, Wheler JJ, Kopetz S, Fu S, Piha-Paul SA, Eng C, Falchook GS, Janku F, Garrett C, Karp D, Kurzrock R, Zinner R, Raghav K, Subbiah V, Hess K, Meric-Bernstam F, Hong DS, Overman MJ. Retreatment with anti-EGFR based therapies in metastatic colorectal cancer: impact of intervening time interval and prior anti-EGFR response. BMC Cancer 2015; 15:713. [PMID: 26474549 PMCID: PMC4609167 DOI: 10.1186/s12885-015-1701-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 10/07/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This retrospective study aims to investigate the activity of retreatment with anti-EGFR-based therapies in order to explore the concept of clonal evolution by evaluating the impact of prior activity and intervening time interval. METHODS Eighty-nine KRAS exon 2-wild-type metastatic colorectal patients were retreated on phase I/II clinical trials containing anti-EGFR therapies after progressing on prior cetuximab or panitumumab. Response on prior anti-EGFR therapy was defined retrospectively per physician-records as response or stable disease ≥6 months. Multivariable statistical methods included a multiple logistic regression model for response, and Cox proportional hazards model for progression-free survival. RESULTS Retreatment anti-EGFR agents were cetuximab (n = 76) or cetuximab plus erlotinib (n = 13). The median interval time between prior and retreatment regimens was 4.57 months (range: 0.46-58.7). Patients who responded to the prior cetuximab or panitumumab were more likely to obtain clinical benefit to the retreatment compared to the non-responders in both univariate (p = 0.007) and multivariate analyses (OR: 3.38, 95 % CI: 1.27, 9.31, p = 0.019). The clinical benefit rate on retreatment also showed a marginally significant association with interval time between the two anti-EGFR based therapies (p = 0.053). Median progression-free survival on retreatment was increased in prior responders (4.9 months, 95 % CI: 3.6, 6.2) compared to prior non-responders (2.5 months, 95 % CI, 1.58, 3.42) in univariate (p = 0.064) and multivariate analysis (HR: 0.70, 95 % CI: 0.43-1.15, p = 0.156). CONCLUSION Our data lends support to the concept of clonal evolution, though the clinical impact appears less robust than previously reported. Further work to determine which patients benefit from retreatment post progression is needed.
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Affiliation(s)
- X Liu
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - G C George
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - A M Tsimberidou
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - A Naing
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - J J Wheler
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - S Kopetz
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
| | - S Fu
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - S A Piha-Paul
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - C Eng
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
| | - G S Falchook
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - F Janku
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - C Garrett
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
| | - D Karp
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - R Kurzrock
- Division of Hematology and Oncology, University of California San Diego Moores Cancer Center, San Diego, CA, USA.
| | - R Zinner
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - K Raghav
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
| | - V Subbiah
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - K Hess
- Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - F Meric-Bernstam
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - D S Hong
- Department of Investigational Cancer Therapeutics (Phase 1 Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Unit 455, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - M J Overman
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit # 426, Houston, TX, 77030, USA.
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Basho R, Janku F, Helgason T, Gilcrease M, Booser D, Karp D, Meric-Bernstam F, Wheler J, Valero V, Albarracin C, Litton J, Chavez-MacGregor M, Ibrahim N, Murray J, Koenig K, Hong D, Subbiah V, Kurzrock R, Moulder S. 1871 Inhibition of mTOR in combination with chemotherapy and angiogenic blockade shows activity in metaplastic breast cancer, an aggressive, chemo-refractory subtype of triple-negative breast cancer (TNBC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30821-8] [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: 10/22/2022]
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Moulder S, Helgason T, Janku F, Wheler J, Moroney J, Booser D, Albarracin C, Morrow PK, Atkins J, Koenig K, Gilcrease M, Kurzrock R. Inhibition of the phosphoinositide 3-kinase pathway for the treatment of patients with metastatic metaplastic breast cancer. Ann Oncol 2015; 26:1346-52. [PMID: 25878190 DOI: 10.1093/annonc/mdv163] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 03/16/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mesenchymal/metaplastic breast cancers (MpBCs) are often triple-negative (TNBC), and chemo-refractory, and can harbor phosphoinositide 3-kinase (PI3kinase) alterations; thus, therapy with mTor inhibitors may demonstrate activity. PATIENTS AND METHODS Patients with mesenchymal/MpBC treated with temsirolimus-based regimens were evaluated. Mutational analyses [polymerase chain reaction (PCR)-based DNA sequencing method, mass spectrometric detection (Sequenom MassARRAY), or next-generation sequencing] as well as loss of phosphatase and tensin homolog (PTEN) (immunohistochemistry) were performed (archived tissue when available). RESULTS Twenty-three patients (one of whom was on two separate trials) were treated using temsirolimus-containing regimens: temsirolimus alone (n = 1 patient) or combined with the following: liposomal doxorubicin and bevacizumab (DAT, n = 18); liposomal doxorubicin (DT, n = 1); paclitaxel and bevacizumab (TAT, n = 2); paclitaxel (TT, n = 1); carboplatin and bevacizumab (CAT, n = 1). Response rate [complete response (CR) + partial response (PR)] was 25% across all regimens; 32% in the anthracycline-based regimens [DAT and DT (CR = 2, PR = 4; N = 19)]. An additional two patients achieved stable disease (SD) ≥6 months [total SD ≥6 months/CR/PR = 8 (33%)]. Molecular aberrations in the PI3K pathway were common: PIK3CA mutation = 6/15 (40%), PTEN mutation = 3/11 (27%), and PTEN loss = 2/11 (18%). A point mutation in the NF2 gene (K159fs*16; NF2 alterations can activate mTor) was found in one patient who attained CR (3+ years). Of the eight patients who achieved SD ≥6 months/CR/PR, all 4 patients with available tissue had a molecular aberration that activate the PIK3CA/Akt/mTOR axis: PIK3CA mutation = 2; PTEN loss = 1; NF2 aberration = 1. CONCLUSIONS DAT has activity in MpBCs including complete CRs. Molecular aberrations that can activate the PI3 K/Akt/mTOR axis are common in MpBC.
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Affiliation(s)
- S Moulder
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston Department of Breast Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - T Helgason
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - F Janku
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - J Wheler
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - J Moroney
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - D Booser
- Department of Breast Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - C Albarracin
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - P K Morrow
- Department of Breast Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - J Atkins
- Department of Investigational Cancer Therapeutics (Phase I), The University of Texas, M.D. Anderson Cancer Center, Houston
| | - K Koenig
- Department of Breast Medical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - M Gilcrease
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston
| | - R Kurzrock
- Department of Hematology and Oncology, UCSD Moores Cancer Center, San Diego, USA
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Morelli MP, Overman MJ, Dasari A, Kazmi SMA, Mazard T, Vilar E, Morris VK, Lee MS, Herron D, Eng C, Morris J, Kee BK, Janku F, Deaton FL, Garrett C, Maru D, Diehl F, Angenendt P, Kopetz S. Characterizing the patterns of clonal selection in circulating tumor DNA from patients with colorectal cancer refractory to anti-EGFR treatment. Ann Oncol 2015; 26:731-736. [PMID: 25628445 PMCID: PMC4374387 DOI: 10.1093/annonc/mdv005] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION KRAS and EGFR ectodomain-acquired mutations in patients with metastatic colorectal cancer (mCRC) have been correlated with acquired resistance to anti-EGFR monoclonal antibodies (mAbs). We investigated the frequency, co-occurrence, and distribution of acquired KRAS and EGFR mutations in patients with mCRC refractory to anti-EGFR mAbs using circulating tumor DNA (ctDNA). PATIENTS AND METHODS Sixty-two post-treatment plasma and 20 matching pretreatment archival tissue samples from KRAS (wt) mCRC patients refractory to anti-EGFR mAbs were evaluated by high-sensitivity emulsion polymerase chain reaction for KRAS codon 12, 13, 61, and 146 and EGFR 492 mutations. RESULTS Plasma analyses showed newly detectable EGFR and KRAS mutations in 5/62 [8%; 95% confidence interval (CI) 0.02-0.18] and 27/62 (44%; 95% CI 0.3-0.56) samples, respectively. KRAS codon 61 and 146 mutations were predominant (33% and 11%, respectively), and multiple EGFR and/or KRAS mutations were detected in 11/27 (41%) cases. The percentage of mutant allele reads was inversely correlated with time since last treatment with EGFR mAbs (P = 0.038). In the matching archival tissue, these mutations were detectable as low-allele-frequency clones in 35% of patients with plasma mutations after treatment with anti-EGFR mAbs and correlated with shorter progression-free survival (PFS) compared with the cases with no new mutations (3.0 versus 8.0 months, P = 0.0004). CONCLUSION Newly detected KRAS and/or EGFR mutations in plasma ctDNA from patients refractory to anti-EGFR treatment appear to derive from rare, pre-existing clones in the primary tumors. These rare clones were associated with shorter PFS in patients receiving anti-EGFR treatment. Multiple simultaneous mutations in KRAS and EGFR in the ctDNA and the decline in allele frequency after discontinuation of anti-EGFR therapy in a subset of patients suggest that several resistance mechanisms can co-exist and that relative clonal burdens may change over time. Monitoring treatment-induced genetic alterations by sequencing ctDNA could identify biomarkers for treatment screening in anti-EGFR-refractory patients.
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Affiliation(s)
- M P Morelli
- Department of Gastrointestinal Medical Oncology
| | - M J Overman
- Department of Gastrointestinal Medical Oncology
| | - A Dasari
- Department of Gastrointestinal Medical Oncology
| | - S M A Kazmi
- Department of Gastrointestinal Medical Oncology
| | - T Mazard
- Department of Gastrointestinal Medical Oncology
| | - E Vilar
- Department of Gastrointestinal Medical Oncology; Clinical Cancer Prevention
| | - V K Morris
- Department of Gastrointestinal Medical Oncology
| | - M S Lee
- Department of Gastrointestinal Medical Oncology
| | - D Herron
- Department of Gastrointestinal Medical Oncology
| | - C Eng
- Department of Gastrointestinal Medical Oncology
| | - J Morris
- Investigational Cancer Therapeutics
| | - B K Kee
- Department of Gastrointestinal Medical Oncology
| | | | - F L Deaton
- Department of Gastrointestinal Medical Oncology
| | - C Garrett
- Department of Gastrointestinal Medical Oncology
| | - D Maru
- Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - F Diehl
- Sysmex Inostics, Hamburg, Germany
| | | | - S Kopetz
- Department of Gastrointestinal Medical Oncology.
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Janku F, Gounder M, Murthy R, Rudin C, Helgason T, Hong D, Benjamin R, Meyer L, Zinner R, Meric-Bernstam F, Masters T. Phase I clinical study of intratumoral injection of Clostridium novyi-NT spores in patients with advanced cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv090.9] [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: 11/12/2022] Open
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49
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Fu S, Hou MM, Naing A, Janku F, Hess K, Zinner R, Subbiah V, Hong D, Wheler J, Piha-Paul S, Tsimberidou A, Karp D, Araujo D, Kee B, Hwu P, Wolff R, Kurzrock R, Meric-Bernstam F. Phase I study of pazopanib and vorinostat: a therapeutic approach for inhibiting mutant p53-mediated angiogenesis and facilitating mutant p53 degradation. Ann Oncol 2015; 26:1012-1018. [PMID: 25669829 DOI: 10.1093/annonc/mdv066] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/29/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We carried out a phase I trial of the vascular endothelial growth factor inhibitor pazopanib and the histone deacetylase inhibitor vorinostat to determine the safety and efficacy. Because these agents are known to target factors activated by TP53 mutation and facilitate mutant p53 degradation, a subgroup analysis may be interesting in patients with TP53 mutant malignancies. PATIENTS AND METHODS Patients with advanced solid tumors (n = 78) were enrolled following a 3 + 3 design, with dose expansion for those with responsive tumors. Hotspot TP53 mutations were tested when tumor specimens were available. RESULTS Adverse events of ≥grade 3 included thrombocytopenia, neutropenia, fatigue, hypertension, diarrhea and vomiting. Overall, the treatment produced stable disease for at least 6 months or partial response (SD ≥6 months/PR) in 19% of the patients, median progression-free survival (PFS) of 2.2 months, and median overall survival (OS) of 8.9 months. In patients with detected hotspot TP53 mutant advanced solid tumors (n = 11), the treatment led to a 45% rate of SD ≥6 months/PR (1 PR and 3 SD ≥6 months), median PFS of 3.5 months, and median OS of 12.7 months, compared favorably with the results for patients with undetected hotspot TP53 mutations (n = 25): 16% (1 PR and 3 SD ≥6 months, P = 0.096), 2.0 months (P = 0.042), and 7.4 months (P = 0.1), respectively. CONCLUSION The recommended phase II dosage was oral pazopanib at 600 mg daily plus oral vorinostat at 300 mg daily. The preliminary evidence supports further evaluation of the combination in cancer patients with mutated TP53, especially in those with metastatic sarcoma or metastatic colorectal cancer. CLINICAL TRIAL REGISTRATION www.clinicaltrials.gov, NCT01339871.
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Affiliation(s)
- S Fu
- Departments of Investigational Cancer Therapeutics.
| | - M M Hou
- Departments of Investigational Cancer Therapeutics; Division of Hematology-Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - A Naing
- Departments of Investigational Cancer Therapeutics
| | - F Janku
- Departments of Investigational Cancer Therapeutics
| | | | - R Zinner
- Departments of Investigational Cancer Therapeutics
| | - V Subbiah
- Departments of Investigational Cancer Therapeutics
| | - D Hong
- Departments of Investigational Cancer Therapeutics
| | - J Wheler
- Departments of Investigational Cancer Therapeutics
| | - S Piha-Paul
- Departments of Investigational Cancer Therapeutics
| | | | - D Karp
- Departments of Investigational Cancer Therapeutics
| | | | - B Kee
- GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | | | - R Wolff
- GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - R Kurzrock
- University of California San Diego, Moores Cancer Center, La Jolla, USA
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Murthy R, Huang S, Thorunn H, Janku F. Phase 1 Trial of Image-Guided Oncolysis by Clostridium Novyi-NT Spore Inoculation: Early Technical Insights. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.10.042] [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: 10/24/2022] Open
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