A Phase I Study Investigating AZD8186, a Potent and Selective Inhibitor of PI3Kβ/δ, in Patients with Advanced Solid Tumors

PURPOSE

To characterize safety and tolerability of the selective PI3Kβ inhibitor AZD8186, identify a recommended phase II dose (RP2D), and assess preliminary efficacy in combination with abiraterone acetate or vistusertib.

PATIENTS AND METHODS

This phase I open-label study included patients with advanced solid tumors, particularly prostate cancer, triple-negative breast cancer, and squamous non-small cell lung cancer. The study comprised four arms: (i) AZD8186 monotherapy dose finding; (ii) monotherapy dose expansion; (iii) AZD8186/abiraterone acetate (with prednisone); and (iv) AZD8186/vistusertib. The primary endpoints were safety, tolerability, and identification of the RP2D of AZD8186 monotherapy and in combination. Secondary endpoints included pharmacokinetics (PK), pharmacodynamics, and tumor and prostate-specific antigen (PSA) responses.

RESULTS

In total, 161 patients were enrolled. AZD8186 was well tolerated across all study arms, the most common adverse events being gastrointestinal symptoms. In the monotherapy dose-finding arm, four patients experienced dose-limiting toxicities (mainly rash). AZD8186 doses of 60-mg twice daily [BID; 5 days on, 2 days off (5:2)] and 120-mg BID (continuous and 5:2 dosing) were taken into subsequent arms. The PKs of AZD8186 were dose proportional, without interactions with abiraterone acetate or vistusertib, and target inhibition was observed in plasma and tumor tissue. Monotherapy and combination therapy showed preliminary evidence of limited antitumor activity by imaging and, in prostate cancer, PSA reduction.

CONCLUSIONS

AZD8186 monotherapy had an acceptable safety and tolerability profile, and combination with abiraterone acetate/prednisone or vistusertib was also tolerated. There was preliminary evidence of antitumor activity, meriting further exploration of AZD8186 in subsequent studies in PI3Kβ pathway-dependent cancers.

SAVANNAH: A Phase II trial of osimertinib plus savolitinib for patients (pts) with EGFR-mutant, MET-driven (MET+), locally advanced or metastatic non-small cell lung cancer (NSCLC), following disease progression on osimertinib

TPS9119

Background: The toxicity profile of the third-generation EGFR-tyrosine kinase inhibitor (TKI) osimertinib makes it an attractive backbone for combination with other targeted agents, possibly overcoming acquired resistance mechanisms. Combination with a MET-inhibitor is an intuitive approach as MET-amplification was identified as the most common mechanism of resistance to osimertinib in preliminary ctDNA data from the Phase III FLAURA (15% of pts) and AURA3 (19% of pts) studies. Savolitinib (AZD6094, HMPL-504, volitinib) is an oral, potent and highly selective MET-TKI that had an acceptable safety profile when combined with osimertinib in the Phase Ib TATTON study, providing the basis for this Phase II SAVANNAH study (NCT03778229). Other mechanisms of acquired resistance to osimertinib, including secondary EGFR mutations (e.g. C797S), RAS/RAF activation, and oncogenic gene fusions, provide additional opportunities for developing osimertinib-based combinations. Methods: Eligible pts will have histologically/cytologically confirmed EGFR-mutant NSCLC, and MET+ disease by central FISH, central IHC, or local NGS (retrospectively confirmed by central FISH/IHC). Pts must have documented radiological progression following 1–3 lines of prior therapy (must include osimertinib). Pts will receive osimertinib 80 mg plus weight-based dosing with savolitinib 300 or 600 mg PO QD, in 28-day cycles. The primary objective is efficacy (RECIST 1.1) by overall response rate (ORR) in pts who are MET+ by central FISH. Secondary endpoints include: ORR ( MET+ by central IHC and all pts); progression-free survival, overall survival, duration of response, percent change in tumor size, HRQoL, and EGFR mutation ctDNA clearance ( MET+ by central FISH, central IHC, and all pts); safety, and pharmacokinetics (all pts). Based on the TATTON study, we anticipate enrolling ~172 MET+ pts to include ≥117 pts with MET+ disease by central FISH. Enrolment began in Q1 2019. Ongoing development of complementary trials targeting other osimertinib resistance mechanisms will also be discussed. Clinical trial information: NCT03778229.

Randomised crossover trial of telemonitoring in chronic respiratory patients (TeleCRAFT trial)

Objective

To assess the impact of home telemonitoring on health service use and quality of life in patients with severe chronic lung disease.

Design

Randomised crossover trial with 6 months of standard best practice clinical care (control group) and 6 months with the addition of telemonitoring.

Participants

68 patients with chronic lung disease (38 with COPD; 30 with chronic respiratory failure due to other causes), who had a hospital admission for an exacerbation within 6 months of randomisation and either used long-term oxygen therapy or had an arterial oxygen saturation (SpO₂) of <90% on air during the previous admission. Individuals received telemonitoring (second-generation system) via broadband link to a hospital-based care team.

Outcome measures

Primary outcome measure was time to first hospital admission for an acute exacerbation. Secondary outcome measures were hospital admissions, general practitioner (GP) consultations and home visits by nurses, quality of life measured by EuroQol-5D and hospital anxiety and depression (HAD) scale, and self-efficacy score (Stanford).

Results

Median (IQR) number of days to first admission showed no difference between the two groups—77 (114) telemonitoring, 77.5 (61) control (p=0.189). Hospital admission rate at 6 months increased (0.63 telemonitoring vs 0.32 control p=0.026). Home visits increased during telemonitoring; GP consultations were unchanged. Self-efficacy fell, while HAD depression score improved marginally during telemonitoring.

Conclusions

Telemonitoring added to standard care did not alter time to next acute hospital admission, increased hospital admissions and home visits overall, and did not improve quality of life in chronic respiratory patients.

Trial registration number

NCT02180919 (ClinicalTrials.gov).

Hepatitis B prevention, diagnosis, treatment and care: a review

Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality worldwide. Chronic hepatitis B (CHB) infection is associated with an increased risk of cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC). The likelihood of developing CHB is related to the age at which infection is acquired; the risk being lowest in adults and >90% in neonates whose mothers are hepatitis B e antigen positive. Treatment of CHB infection aims to clear HBV DNA and prevent the development of complications. There are currently seven drugs available for the treatment of CHB: five nucleos(t)ide analogues and two interferon-based therapies. Long-term treatment is often required, and the decision to treat is based on clinical assessment including the phase of CHB infection and the presence and extent of liver damage. A safe and effective HBV vaccine has been available since the early 1980s. Vaccination plays a central role in HBV prevention strategies worldwide, and a decline in the incidence and prevalence of HBV infection following the introduction of universal HBV vaccination programmes has been observed in many countries including the USA and parts of South East Asia and Europe. Post-exposure prophylaxis (PEP) with HBV vaccine +/- hepatitis B immunoglobulin is highly effective in preventing mother to child transmission and in preventing transmission following sharps injuries, sexual contact and other exposures to infected blood and body fluids. Transmission of HBV in the health care setting has become an increasingly rare event in developed nations. However, it remains a significant risk in developing countries reflecting the higher prevalence of CHB, limited access to HBV vaccination and PEP and a lack of adherence to standard infection control precautions.

Should healthcare workers be screened routinely for meticillin-resistant Staphylococcus aureus? A review of the evidence

Meticillin-resistant Staphylococcus aureus (MRSA) is considered endemic in the UK National Health Service (NHS), and routine MRSA screening of hospital inpatients has recently been introduced in both Scotland and England. The UK National Screening Committee states that public pressure for widening the eligibility criteria of a proposed screening programme should be anticipated and any related decisions scientifically justifiable. A literature review was conducted to examine whether MRSA screening in Scotland should be expanded to include the routine screening of healthcare workers (HCWs). There are no published prevalence studies reporting the overall MRSA carriage rate in HCWs in NHS hospitals. Estimates of HCW carriage from the worldwide literature vary widely depending on the country, hospital specialty and setting (endemic, non-endemic or outbreak). Recent studies conducted in endemic hospital settings report non-outbreak carriage rates of 0-15%. The role of HCW carriage in the transmission of MRSA is not well understood. Persistent carriage could act as a reservoir for infection and HCWs have been implicated as the source in a number of published outbreak reports. There are no published controlled trials examining the impact of routine HCW screening as an intervention in the prevention and control of MRSA infections in the endemic hospital setting. Most of the evidence for HCW screening comes from outbreak reports where the outbreak was brought to an end following the introduction of staff screening as part of a suite of infection control measures. Further research is required before a recommendation could be made to introduce routine MRSA screening of HCWs in the NHS in Scotland.

An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland

An investigation is currently underway to explore and control an outbreak of Bacillus anthracis among drug users (mainly injecting) in Scotland. Contaminated heroin or a contaminated cutting agent mixed with the heroin is considered to be the most likely source and vehicle of infection. Heroin users have been advised of the risk. The risk to the general public is regarded as very low.

Transcutaneous oximetry in clinical practice: consensus statements from an expert panel based on evidence

Transcutaneous oximetry (PtcO2) is finding increasing application as a diagnostic tool to assess the peri-wound oxygen tension of wounds, ulcers, and skin flaps. It must be remembered that PtcO2 measures the oxygen partial pressure in adjacent areas of a wound and does not represent the actual partial pressure of oxygen within the wound, which is extremely difficult to perform. To provide clinical practice guidelines, an expert panel was convened with participants drawn from the transcutaneous oximetry workshop held on June 13, 2007, in Maui, Hawaii. Important consensus statements were (a) tissue hypoxia is defined as a PtcO2 <40 mm Hg; (b) in patients without vascular disease, PtcO2 values on the extremity increase to a value >100 mm Hg when breathing 100% oxygen under normobaric pressures; (c) patients with critical limb ischemia (ankle systolic pressure of < or =50 mm Hg or toe systolic pressure of < or =30 mm Hg) breathing air will usually have a PtcO2 <30 mm Hg; (d) low PtcO2 values obtained while breathing normobaric air can be caused by a diffusion barrier; (e) a PtcO2 <40 mm Hg obtained while breathing normobaric air is associated with a reduced likelihood of amputation healing; (f) if the baseline PtcO2 increases <10 mm Hg while breathing 100% normobaric oxygen, this is at least 68% accurate in predicting failure of healing post-amputation; (g) an increase in PtcO2 to >40 mm Hg during normobaric air breathing after revascularization is usually associated with subsequent healing, although the increase in PtcO2 may be delayed; (h) PtcO2 obtained while breathing normobaric air can assist in identifying which patients will not heal spontaneously.

Efficacy of tetrachlorvinphos insecticide dust against darkling beetles in commercial broiler chicken barns

Residual application of tetrachlorvinphos dust (Debantic 50WP) was evaluated against darkling beetles in commercial broiler chicken barns. The dust formulation was applied using an electrostatic duster after clean out of old litter at the start of a new broiler cycle. Tetrachlorvinphos dust provided adequate control of beetle larvae and adults up to 5 wk. One time of application is adequate for one commercial broiler chicken production cycle only. Key words: Darkling beetle, Alphitobius diaperinus,tetrachlorvinphos, chicken, electrostatic duster

Steroidogenesis-inducing protein, isolated from human ovarian follicular fluid, is a potent mitogen for cell lines derived from ovarian surface epithelial carcinomas

The majority of human ovarian cancers originate from the surface epithelial (OSE) cells that surround the ovary. The incidence of OSE cancer is correlated with the number of ovulations that occur during fertile life. OSE cells remain quiescent but undergo rapid mitotic activity after ovulation to repair the wound. This increase in mitotic activity following each ovulation may give rise to mutations that make the OSE susceptible to malignant transformation. Steroidogenesis-inducing protein (SIP), a protein isolated from human follicular fluid obtained from hyperstimulated ovaries, is a potent mitogen for several gonadal cells. To investigate the possibility that SIP may be involved in the proliferation of OSE cells, we have studied its effects on DNA synthesis in seven cell lines derived from OSE carcinomas (HEY, MLS, SKA, OW-1, SAU, NIH:OVCAR-3, and Caov-3). The cells were cultured in serum-free medium in the presence of SIP for 18 hr, followed by incubation with [3H]thymidine for 4 hr. The radioactivity incorporated into the DNA was measured. SIP stimulated DNA synthesis in six of the cell lines. HEY, SKA, MLS, and OVCAR3 were most responsive to SIP. Interactions between SIP and other growth factors and cytokines known to be present in follicular fluid (EGF/TGFalpha, TGFbeta, FGF, IGF-1, IL-1beta, and TNFalpha) were also investigated in HEY and SKA cells. EGF/TGFalpha and IGF-1 potentiated the effects of SIP. TGFbeta had no effect on SIP, and/or EGF/TGFalpha stimulated DNA synthesis. Other growth factors which were tested in this study had no effect on DNA synthesis in SKA cells. Dibutyryl cyclic-AMP blocked the effects of SIP on DNA synthesis. We conclude that SIP is a potent mitogen for OSE cell lines and together with TGFalpha and IGF-1 may be involved in the proliferation of normal OSE cells after ovulation. Since SIP is obtained from the preovulatory follicle, it may represent a link between the number of ovulations and the increased incidence of OSE cancers.

Infrared filters and dichroics for the advanced along-track scanning radiometer

The design and manufacture of the band-defining filters and their associated dichroic beam splitter for the 11- and the 12-μm infrared channels of the advanced along-track scanning radiometer are described. The filter requirements that have led to the choice of coating designs, coating materials, disposition of coatings, and effects of polarization are discussed. Overall spectral throughputs of the filter and dichroic interaction for the two channels are also presented.

Congenital cytomegalovirus infection: a cause of sensorineural hearing loss

Prospective studies have suggested that about 108 children with congenital cytomegalovirus (CMV) infection and bilateral sensorineural hearing loss are born each year in England and Wales; this represents about 12% of all children with congenital sensorineural hearing loss. Over a nine year period 1644 children aged between 6 months and 4 years who were attending the Nuffield Hearing and Speech Centre were screened for CMV infection. The prevalence of CMV in the urine of children with sensorineural hearing loss but no immediate family history of deafness was nearly twice that (13%) found in other children with impaired hearing and those with normal hearing (7%). These findings indicate the importance of CMV as a cause of hearing loss.