A first-in-human phase 1 study of nofazinlimab, an anti-PD-1 antibody, in advanced solid tumors and in combination with regorafenib in metastatic colorectal cancer

BACKGROUND

We assessed nofazinlimab, an anti-PD-1 antibody, in solid tumors and combined with regorafenib in metastatic colorectal cancer (mCRC).

METHODS

This phase 1 study comprised nofazinlimab dose escalation (phase 1a) and expansion (phase 1b), and regorafenib dose escalation (80 or 120 mg QD, days 1-21 of 28-day cycles) combined with 300-mg nofazinlimab Q4W (part 2a) to determine safety, efficacy, and RP2D.

RESULTS

In phase 1a (N = 21), no dose-limiting toxicity occurred from 1 to 10 mg/kg Q3W, with 200 mg Q3W determined as the monotherapy RP2D. In phase 1b (N = 87), 400-mg Q6W and 200-mg Q3W regimens were found comparable. In part 2a (N = 14), both regimens were deemed plausible RP2Ds. Fatigue was the most frequent treatment-emergent adverse event (AE) in this study. Any-grade and grade 3/4 nofazinlimab-related AEs were 71.4% and 14.3%, 56.3% and 5.7%, and 57.1% and 21.4% in phases 1a, 1b, and part 2a, respectively. ORRs were 14.3% and 25.3% in phases 1a and 1b, respectively. In part 2a, no patients had radiological responses.

CONCLUSIONS

Nofazinlimab monotherapy was well tolerated and demonstrated preliminary anti-tumor activity in multiple tumor types. Regorafenib plus nofazinlimab had a manageable safety profile but was not associated with any response in mCRC.

CLINICAL TRIAL REGISTR ATION

Clinicaltrials.gov (NCT03475251).

KRASG12C Inhibition with Sotorasib in Advanced Solid Tumors

BACKGROUND

No therapies for targeting KRAS mutations in cancer have been approved. The KRAS p.G12C mutation occurs in 13% of non-small-cell lung cancers (NSCLCs) and in 1 to 3% of colorectal cancers and other cancers. Sotorasib is a small molecule that selectively and irreversibly targets KRASG12C.

METHODS

We conducted a phase 1 trial of sotorasib in patients with advanced solid tumors harboring the KRAS p.G12C mutation. Patients received sotorasib orally once daily. The primary end point was safety. Key secondary end points were pharmacokinetics and objective response, as assessed according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1.

RESULTS

A total of 129 patients (59 with NSCLC, 42 with colorectal cancer, and 28 with other tumors) were included in dose escalation and expansion cohorts. Patients had received a median of 3 (range, 0 to 11) previous lines of anticancer therapies for metastatic disease. No dose-limiting toxic effects or treatment-related deaths were observed. A total of 73 patients (56.6%) had treatment-related adverse events; 15 patients (11.6%) had grade 3 or 4 events. In the subgroup with NSCLC, 32.2% (19 patients) had a confirmed objective response (complete or partial response) and 88.1% (52 patients) had disease control (objective response or stable disease); the median progression-free survival was 6.3 months (range, 0.0+ to 14.9 [with + indicating that the value includes patient data that were censored at data cutoff]). In the subgroup with colorectal cancer, 7.1% (3 patients) had a confirmed response, and 73.8% (31 patients) had disease control; the median progression-free survival was 4.0 months (range, 0.0+ to 11.1+). Responses were also observed in patients with pancreatic, endometrial, and appendiceal cancers and melanoma.

CONCLUSIONS

Sotorasib showed encouraging anticancer activity in patients with heavily pretreated advanced solid tumors harboring the KRAS p.G12C mutation. Grade 3 or 4 treatment-related toxic effects occurred in 11.6% of the patients. (Funded by Amgen and others; CodeBreaK100 ClinicalTrials.gov number, NCT03600883.).

A randomized trial of the electronic Lung Cancer Symptom Scale for quality-of-life assessment in patients with advanced non-small-cell lung cancer

Introduction

Improving health-related quality of life (hrqol) is a key goal of systemic therapy in advanced lung cancer, although routine assessment remains challenging. We analyzed the impact of a real-time electronic hrqol tool, the electronic Lung Cancer Symptom Scale (elcss-ql), on palliative care (pc) referral rates, patterns of chemotherapy treatment, and use of other supportive interventions in patients with advanced non-small-cell lung cancer (nsclc) receiving first-line chemotherapy.

Methods

Patients with advanced nsclc starting first-line chemotherapy were randomized to their oncologist receiving or not receiving their elcss-ql data before each clinic visit. Patients completed the elcss-ql at baseline, before each chemotherapy cycle, and at subsequent follow-up visits until disease progression. Prospective data about the pc referral rate, hrqol, and use of other supportive interventions were collected.

Results

For the 95 patients with advanced nsclc who participated, oncologists received real-time elcss-ql data for 44 (elcss-ql arm) and standard clinical assessment alone for 51 (standard arm). The primary endpoint, the pc referral rate, was numerically higher, but statistically similar, for patients in the elcss-ql and standard arms. The hrqol scores over time were not significantly different between the two study arms.

Conclusions

The elcss-ql is feasible as a tool for use in routine clinical practice, although no statistically significant effect of its use was demonstrated in our study. Improving access to supportive care through the collection of patient-reported outcomes and hrqol should be an important component of care for patients with advanced lung cancer.

Immune checkpoint inhibitors in the treatment of advanced mucosal melanoma

Immunotherapy with immune checkpoint inhibitors is the standard of care in the treatment of advanced melanoma. Treatment outcome of these agents is less defined for the rare subtype of mucosal melanoma. In this single-institutional case series, the objective response rate was low at 11.8%, but durable response was seen, including a complete response to first-line ipilimumab and to second-line pembrolizumab. Survival remained poor; at the median follow-up of 10.1 months, the median progression-free survival and overall survival were 3.1 and 8.8 months respectively. Nevertheless, among the few responders, survival of up to 56+ months was observed. Other treatment strategies need to be explored to improve treatment outcome for this rare subtype.

Application of hypersensitivity skin testing in chemotherapy-induced pneumonitis

Skin testing has been utilised to determine the culprit allergenic agent in drug reactions. Its application in the setting of hypersensitivity reaction relating to combination chemotherapeutic regimens may help identify the causative drug, allowing drug that is safe to be continued and avoiding limiting treatment options for patients. We report what we believe to be the first published case of hypersensitivity skin testing for gemcitabine-induced pneumonitis in a patient with metastatic leiomyosarcoma and another case of docetaxel-induced pneumonitis in a patient with metastatic HER2-positive breast cancer.

Serious hepatic complications of selective internal radiation therapy with yttrium-90 microsphere radioembolization for unresectable liver tumors

AIM

Selective internal radiation therapy with yttrium-90 microsphere radioembolization has been used to treat unresectable liver tumors and its acute toxicity has been well described. Subacute and long-term hepatic complications related to radioembolization however may be underreported in the literature. This retrospective study describes the incidence and sequelae of serious hepatic complications in patients who underwent radioembolization for unresectable liver tumors.

METHODS

A retrospective review of clinical notes of patients who received radioembolization for unresectable liver tumors from 2001 to 2011 at two Australian institutions was performed to identify those who developed clinically significant hepatic complications. Relevant clinical data were obtained and analyzed to determine their incidence and sequelae.

RESULTS

A total of 205 patients were identified, of whom 10 (4.9%) developed serious hepatic complications with 7 (3.4%) attributable to radioembolization-induced liver disease. None had preexisting underlying liver disease or progressive hepatic metastases at the time of developing hepatic complication. The median time to the onset of hepatic complications was 3.5 months (range 1-67 months); six patients had a complete resolution eventually, including one patient who subsequently underwent hepatic metastasectomy safely. Three patients died as a result of fulminant hepatic failure.

CONCLUSION

Selective internal radiation therapy with radioembolization was associated with serious hepatic complications with an incidence of 4.9% and a mortality rate of 1.5% in 205 patients from two Australian institutions. The risk of serious hepatic toxicity therefore needs to be discussed when counseling patients regarding this potential treatment option.

Regorafenib-induced hyperammonemic encephalopathy

WHAT IS KNOWN AND OBJECTIVE

Regorafenib improves progression-free survival as a late-line treatment for patients with metastatic gastrointestinal stromal tumour (GIST). As a multitargeted tyrosine kinase inhibitor (TKI), the expected adverse events of regorafenib are similar to those reported with imatinib, sunitinib or sorafenib. We report the first case of hyperammonemic encephalopathy related to regorafenib in a patient with metastatic GIST.

CASE SUMMARY

A 61-year-old man maintained on regorafenib for metastatic GIST presented with acute confusion. Discontinuation of regorafenib led to complete resolution of confusion, which later recurred with hyperammonemia on recommencing regorafenib. Cessation of regorafenib and normalization of hyperammonemia then resulted in resolution of confusion.

WHAT IS NEW AND CONCLUSIONS

Regorafenib withdrawal and recommencement had influenced the confusional state and hyperammonemia in this patient. There is a probable relationship between regorafenib and metabolic encephalopathy. There are case reports of similar encephalopathy thought to be induced by other multitargeted TKI, and, as such, a class effect could be postulated.

ARL4, an ARF-like protein that is developmentally regulated and localized to nuclei and nucleoli

ADP-ribosylation factors (ARFs) are highly conserved approximately 20-kDa guanine nucleotide-binding proteins that participate in both exocytic and endocytic vesicular transport pathways via mechanisms that are only partially understood. Although several ARF-like proteins (ARLs) are known, their biological functions remain unclear. To characterize its molecular properties, we cloned mouse and human ARL4 (mARL4 and hARL4) cDNA. The appearance of mouse ARL4 mRNA during embryonic development coincided temporally with the sequential formation of somites and the establishment of brain compartmentation. Using ARL4-specific antibody for immunofluorescence microscopy, we observed that endogenous mARL4 in cultured Sertoli and neuroblastoma cells was mainly concentrated in nuclei. When expressed in COS7 cells, ARL4-T34N mutant, predicted to exist with GDP bound, was concentrated in nucleoli. Yeast two-hybrid screening and in vitro protein-interaction assays showed that hARL4 interacted with importin-alpha through its C-terminal NLS region and that the interaction was not nucleotide-dependent. Like ARL2 and -3, recombinant hARL4 did not enhance cholera toxin-catalyzed auto-ADP-ribosylation. Its binding of guanosine 5'-O-(thiotriphosphate) was modified by phospholipid and detergent, and the N terminus of hARL4, like that of ARF, was myristoylated. Our findings suggest that ARL4, with its distinctive nuclear/nucleolar localization and pattern of developmental expression, may play a unique role(s) in neurogenesis and somitogenesis during embryonic development and in the early stages of spermatogenesis in adults.

Concentrations and antioxidative activity of anserine and carnosine in poultry meat extracts treated with demineralization and papain

Anserine and carnosine found in animal skeletal muscle are capable of inhibiting the catalysis of lipid oxidation by heme and non-heme iron. A demineralization technique and a proteolytic enzyme (papain) were used in this research in order to reduce the levels of proxidants while maintaining high levels of anserine and camosine in poultry (chicken, duck and turkey) meat extracts. Undemineralized poultry meat extracts contained larger amounts of anserine, camosine, heme and non-heme iron (p < 0.05) than did demineralized poultry meat extracts. Both undemineralized and demineralized breast meat extracts of chicken, duck and turkey contained higher concentrations of anserine and camosine, but lower amounts of heme and non-heme iron than did thigh meat extracts. In chicken, duck and turkey meat (breast and thigh) extracts (undemineralized and demineralized), the anserine concentrations were greater (p < 0.05) than the camosine concentrations. The hydrogen-donating ability of undemineralized and demineralized chicken breast meat extracts was not significantly different (p > 0.05): however, demineralized chicken breast meat extracts showed higher (p < 0.05) ferrous chelating ability than did undemineralized meat extracts. The concentrations of anserine, camosine, heme and non-heme iron in chicken breast meat extracts increased (p < 0.05) with the addition of papain (1%) to the meat mixture before extraction. Heme and non-heme iron in the chicken breast meat extracts increased as the reaction time for papain increased from 30 to 120 min, but the concentrations of anserine and camosine were not significantly affected by the longer reaction time for papain. The hydrogen-donating ability and ferrous chelating ability of demineralized chicken breast meat extracts were not significantly affected by papain. The ratios of carnosine/anserine were very specific in the chicken, duck and turkey meat extracts (breast and thigh); and the turkey meat extracts had lower (p < 0.05) camosine/anserine ratios than did the chicken and duck meat extracts. The camosine/anserine ratios of undemineralized and demineralized poultry meat extracts were not significantly different (p > 0.05). This suggests that the carnosine/anserine ratios of undemineralized chicken (0.62 - 0.80), duck (0.75 - 0.77) and turkey (0.15 - 0.16) meat extracts could be used to estimate the single meat species in uncooked or cooked meat products.

Ultrasensitive reverse transcription-PCR assay for quantitation of human immunodeficiency virus type 1 RNA in plasma

With the recent introduction of combination therapy, human immunodeficiency virus type 1 (HIV-1) RNA levels in plasma have been dramatically reduced, frequently to below the limit of quantitation (400 copies/ml of plasma) of the AMPLICOR HIV-1 MONITOR Test (Roche Diagnostic Systems). To achieve enhanced sensitivity of the AMPLICOR HIV-1 MONITOR Test, a modified specimen preparation procedure that allows input of RNA from 10-fold more plasma per amplification reaction was developed. This "ultrasensitive" method allows the accurate quantitation of plasma HIV-1 RNA levels as low as 50 copies/ml. A precision study yielded average within-run and between-run coefficients of variation (CV) of 24.8 and 9.6%, respectively. A multicenter reproducibility study demonstrated that the laboratory-to-laboratory reproducibility of this assay is good, with an average CV of 32%. The linear range of this test is between 50 and 50,000 copies/ml of plasma. RNA concentrations measured by the ultrasensitive and standard HIV-1 MONITOR tests exhibited good agreement within the shared linear range of the two methods. The two measurements were within a factor of 2 for 91% of the specimens tested, with the concentration measured by the ultrasensitive method being only slightly lower (median, 22% lower). Preliminary studies suggest that this assay will prove to be useful for predicting the stability of viral suppression in patients whose RNA levels drop below 400 copies/ml in response to highly active antiretroviral therapy.

The quality of ultrasonic root-end preparation: a quantitative study

Ultrasonic root-end preparation techniques have recently been introduced and revolutionized the field of endodontic surgery. The purpose of this study was to compare quantitatively the quality of root-end preparation techniques prepared by a specially designed ultrasonic retrotip with those prepared in a traditional manner by a microhandpiece bur. Twenty roots with two canals and an isthmus from extracted maxillary human molars were selected for this study. After instrumentation, obturation, and root-end resection, root-end preparations were made using either an ultrasonic retrotip or a conventional microhandpiece bur. With the aid of the image processing and analysis system, the specimens were inspected under a stereomicroscope for further evaluation of the quality of the shape and size of preparation. The results of this investigation showed that the ultrasonic root-end preparations produced more conservative and less perforated cavities than those made with conventional microhandpiece bur preparations.

Scanning electron microscopic evaluation of the cleanliness of a new ultrasonic root end preparation

Recently introduced ultrasonic instrumentation techniques for root end preparation have revolutionized the field of endodontic surgery. The specially designed tips offer improved access to the root end and create more conservative root and preparations while decreasing the amount of retained debris. This study compared the cleanliness of root end preparations made using ultrasonic instrumentation with that of those prepared in a traditional manner using a microhandpiece bur. We used 10 extracted maxillary human premolars and molars. After cleaning, shaping, and obturation of the root canals, a 3 mm root end resection perpendicular to the long axis of the root was performed with a carbide fissure bur. The roots were randomly divided into two groups and root end preparations were made using the two aforementioned techniques. The roots were longitudinally split and sputter-coated with gold for scanning electron microscopic study. Three independent dentists used a standardized grading system to evaluate the cleanliness of the root end preparations. The ultrasonic preparation had significantly less superficial debris and a thinner smear layer than the microhandpiece preparation (p < 0.05). There were no significant differences between the canal and isthmus portions of the root end preparations within each group in either superficial debris or smear layer. This indicates that cleaner surfaces for root end cavities are created using ultrasonic retrotips than using microhandpiece burs.

Long-term followup of and patient satisfaction with the Dynaflex self-contained inflatable penile prosthesis

PURPOSE

We analyzed our experience with the Dynaflex* self-contained inflatable penile prosthesis to define specific complication rates and patient satisfaction in the long term.

MATERIALS AND METHODS

From October 1990 through October 1994, 62 men underwent implantation of a Dynaflex prosthesis. Mean and median time since implantation was 50 and 53 months, respectively (minimum 24). In addition to standard followup and tabulation of complications, patients were contacted and interviewed regarding satisfaction with the prosthesis.

RESULTS

Mechanical device failures occurred in 9.7% of cases with a mean time to failure of 40 months in 6 prostheses. An additional 16.1% of patients had an unsuccessful outcome due to dissatisfaction with the Dynaflex. Of the patients with a functional Dynaflex prosthesis contacted at the time of this review 88.1% expressed satisfaction.

CONCLUSIONS

Mechanical failure rates for the Dynaflex prosthesis are comparable to those previously reported for multicomponent inflatable penile prostheses. Patient dissatisfaction, mainly due to difficulty in operating the Dynaflex inflation and deflation mechanisms, is much higher than for multicomponent inflatable penile prostheses. However, in patients who are successful in mastering operation of the Dynaflex satisfaction rates are high. Careful patient selection, and extended training and education efforts are the keys to maximizing successful outcomes with the Dynaflex prosthesis.

Optimization of the solubilization and renaturation of fish growth hormone produced by Escherichia coli

Growth hormone (GH) enhances the growth rate of aquacultured fish and shellfish, but it is difficult to extract native GH from fish pituitary glands. However, fish recombinant GH (rGH) can be efficiently synthesized by Escherichia coli cells, although it exists in denatured form in inclusion bodies (IB). We studied the solubilization of IB and the renaturation of rGH to help facilitate the production of a large amount of biologically active rGH. A 100-ml sample of rGH-producing E. coli produced 73.43 +/- 5.47 mg IB (dry weight, n = 3) after 20 h induction by 1 mM isopropyl beta-o-thiogalactopyranoside. Interestingly, if the bacteria were induced by 0.1 mM beta-lactose, 95.3 +/- 3.43 mg of IB was obtained. The optimal conditions for denaturation and renaturation of rGH were when IB were solubilized in 6 M guanidine hydrochloride and then dialysed against pH 10 dialysis buffer (50 mM ammonium bicarbonate and 2 mM EDTA) containing 100 mM L-arginine, 2 mM oxidized glutathione and 2 mM reduced glutathione for 24 h at 4 degrees C in a volume ratio of 3 to 500. At least 20% of the denaturated rGH in IB was renatured. Juvenile black sea bream injected with 0.05 microgram/g resultant rGH once every 2 weeks exhibited significant increases (P < 0.05) in weight gain (84%) relative to fish in the control group over a 16-week period. This process is an economical and effective way to obtain an active form of rGH biosynthesized by a prokaryotic system.

Highly efficient expression of fish growth hormone by Escherichia coli cells

A PCR product encoding the mature segment of fish pregrowth hormone (pre-GH) was inserted into an Escherichia coli expression vector, pET, in which the ori site was replaced by that of pUC19. The yield of recombinant GH (rGH) was as high as 44 to 47% of total protein. This rGH was immunoreactive to GH antibody. After renaturation, rGH was used to inject fish with 0.1 microgram of rGH per g once every 2 weeks, and this resulted in increases in weight (65%), percent weight gain (165%), and length (22%) relative to those of an untreated control group at week 16 and onward.

Buildup of steady-state picosecond pulses in an actively mode-locked laser-diode array

We have studied experimentally the temporal and spectral characteristics of an actively mode-locked laserdiode array in an external cavity as it evolves to the steady state. It is found that the buildup time to steadystate picosecond pulses takes less than 45 round trips. The number of clusters of the longitudinal-mode spectrum reduces during the evolution and finally approaches a steady-state spectral distribution with the pulse energy mainly distributed among a few clusters near the line center.

Buildup of steady-state subpicosecond and femtosecond pulses in a colliding-pulse mode-locked ring dye laser

We show for the first time, to our knowledge, that the buildup time to steady-state femtosecond pulses in a typical colliding-pulse mode-locked dye laser (lambda = 620 nm) with compensating prisms is 15 microsec after the pulses have been completely modulated. For a similar laser without the compensating prisms, the buildup time is 40 microsec and exhibits interesting oscillatory behavior in the initial stage.

Effects of Rigor State, Salt Level and Storage Time on Chemical and Sensory Traits of Frozen and Freeze-Dried Ground Beef

Both pre- and post-rigor beef semimembranosus muscles were ground with salt (0, 2 and 4%) and then subdivided into two treatment groups (freezing and freeze drying) and evaluated during storage of 0, 5, 10 and 15 wk for chemical and sensory traits. Rehydration ratios of pre-rigor freeze-dried beef (salted or unsalted) were not significantly changed during a 15-wk storage period at 25°C. With the addition of 2 and 4% salt, pre-rigor freeze-dried beef was less susceptible (P<0.05) to lipid oxidation (lower TBA values) than post-rigor, freeze-dried beef. Pre-rigor, freeze-dried beef was superior to post-rigor, freeze-dried meat in all sensory traits studied. Differences in TBA values were not significant between pre-rigor and post-rigor, frozen beef treatments at any salt level (0, 2 and 4%). Pre-rigor, frozen beef samples were superior (P<0.05) to conventional post-rigor, frozen meat in panel tenderness and acceptability scores. The TBA values of pre- and post-rigor beef (frozen or freeze dried), in general, increased with increased salt level (0, 2 and 4%). Freeze-dried beef samples (pre- or post-rigor) were less (P<0.05) tender, cohesive, acceptable and more rancid and/or off-flavor than frozen meat (pre- or post-rigor).

Effects of Rigor, Salt, Freezing, Lyophilization and Storage Time on pH, Water-Holding Capacity and Soluble Protein Nitrogen in Beef Muscle 1

The water-holding capacity (WHC) of frozen and reconstituted lyophilized (freeze-dried) beef (both pre- and post-rigor) increased (P<0.05) with the increase in salt levels (0, 2 and 4%). Freeze-dried and reconstituted beef had lower (P<0.05) WHC than the frozen control at all salt levels tested. The freeze-drying process may damage some of the beef muscle proteins. The WHC of the freeze-dried beef (both pre- and post-rigor) decreased (P<0.05) with the increase of storage time (10 weeks). Salt (2 and 4%) retarded the glycolysis process in the pre-rigor frozen and freeze-dried beef as indicated by higher (P<0.05) pH values than the post-rigor frozen and freeze-dried beef. The addition of salt (0, 2 and 4%) increased (P<0.05) the extractable soluble protein nitrogen content in the prerigor frozen beef and decreased (P<0.05) the soluble protein nitrogen content in the post-rigor frozen beef. The pre-rigor freeze-dried beef with 2% salt contained (P<0.05) more extractable soluble protein nitrogen than the other two pre-rigor freeze-dried groups (0 and 4% salt). The pre-rigor beef contained more (P<0.05) extractable soluble protein nitrogen than the post-rigor beef at the three different salt levels (0, 2 and 4%) during the 15 weeks of storage.

Determination of carbohydrates in urine by high-performance liquid chromatography and optical activity detection

Improvements in a detector for liquid chromatography based on optical activity of the components have led to a detectability of 100 ng. This allows the simultaneous determination of six naturally occurring carbohydrates in 100-microliters samples of human urine, which is injected directly except for a simple deionization step. The reproducibility and reliability of this method should allow better insight into the relation between urinary sugars and physiological conditions.