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Sweeney CJ, Hainsworth JD, Bose R, Burris HA, Kurzrock R, Swanton C, Friedman CF, Spigel DR, Szado T, Schulze K, Price R, Malato J, Lo AA, Levy J, Wang Y, Yu W, Meric-Bernstam F. MyPathway Human Epidermal Growth Factor Receptor 2 Basket Study: Pertuzumab + Trastuzumab Treatment of a Tissue-Agnostic Cohort of Patients With Human Epidermal Growth Factor Receptor 2-Altered Advanced Solid Tumors. J Clin Oncol 2024; 42:258-265. [PMID: 37793085 PMCID: PMC10824375 DOI: 10.1200/jco.22.02636] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/31/2023] [Accepted: 08/01/2023] [Indexed: 10/06/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The MyPathway multiple-basket study (ClinicalTrials.gov identifier: NCT02091141) is evaluating targeted therapies in nonindicated tumors with relevant molecular alterations. We assessed pertuzumab + trastuzumab in a tissue-agnostic cohort of adult patients with human epidermal growth factor receptor 2 (HER2)-amplified and/or -overexpressed and/or -mutated solid tumors. The primary end point was objective response rate (ORR); secondary end points included survival and safety. At data cutoff (March 2022), 346 patients with HER2 amplification and/or overexpression with/without HER2 mutations (n = 263), or HER2 mutations alone (n = 83) had been treated. Patients with HER2 amplification and/or overexpression had an ORR of 25.9% (68/263, 95% CI, 20.7 to 31.6), including five complete responses (urothelial [n = 2], salivary gland [n = 2], and colon [n = 1] cancers). Activity was higher in those with wild-type (ORR, 28.1%) versus mutated KRAS (ORR, 7.1%). Among patients with HER2 amplification, ORR was numerically higher in patients with immunohistochemistry (IHC) 3+ (41.0%; 32/78) or 2+ (21.9%; 7/32), versus 1+ (8.3%; 1/12) or no expression (0%; 0/20). In patients with HER2 mutations alone, ORR was 6.0% (5/83, 95% CI, 2.0 to 13.5). Pertuzumab + trastuzumab showed activity in various HER2-amplified and/or -overexpressed tumors with wild-type KRAS, with the range of activity dependent on tumor type, but had limited activity in the context of KRAS mutations, HER2 mutations alone, or 0-1+ HER2 expression.
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Affiliation(s)
- Christopher J. Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - John D. Hainsworth
- Sarah Cannon Research Institute, Nashville, TN
- Tennessee Oncology, PLLC, Nashville, TN
| | - Ron Bose
- Washington University School of Medicine, St Louis, MO
| | - Howard A. Burris
- Sarah Cannon Research Institute, Nashville, TN
- Tennessee Oncology, PLLC, Nashville, TN
| | | | - Charles Swanton
- Francis Crick Institute, London, United Kingdom
- UCL Hospitals, London, United Kingdom
| | - Claire F. Friedman
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Medical College at Cornell University, New York, NY
| | - David R. Spigel
- Sarah Cannon Research Institute, Nashville, TN
- Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | | | - Amy A. Lo
- Genentech, Inc, South San Francisco, CA
| | | | - Yong Wang
- Genentech, Inc, South San Francisco, CA
| | - Wei Yu
- Genentech, Inc, South San Francisco, CA
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Friedman CF, Hainsworth JD, Kurzrock R, Spigel DR, Burris HA, Sweeney CJ, Meric-Bernstam F, Wang Y, Levy J, Grindheim J, Shames DS, Schulze K, Patel A, Swanton C. Atezolizumab Treatment of Tumors With High Tumor Mutational Burden From MyPathway, a Multicenter, Open-label, Phase 2a Multiple Basket Study. Cancer Discov 2021; 12:654-669. [PMID: 34876409 PMCID: PMC9394388 DOI: 10.1158/2159-8290.cd-21-0450] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/13/2021] [Revised: 10/15/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022]
Abstract
High tumor mutational burden (TMB-H) correlates with improved immunotherapy response. We assessed atezolizumab 1,200 mg every 3 weeks for TMB-H tumors from MyPathway (NCT02091141), a phase IIa multibasket study. One hundred twenty-one patients had advanced solid tumors with TMB ≥10 mut/Mb by any Clinical Laboratory Improvement Amendments (CLIA)–certified assay. The preplanned primary endpoint was objective response rate (ORR) in patients with TMB ≥16 mut/Mb tumors by FoundationOne TMB testing [F1(CDx)]. Patients with F1(CDx) TMB ≥10 and <16 mut/Mb were also evaluated. Ninety patients with 19 tumor types and F1(CDx) TMB ≥10 mut/Mb were efficacy evaluable. In 42 patients with F1(CDx) TMB ≥16 mut/Mb, confirmed ORR was 38.1% [16/42; 95% confidence interval (CI), 23.6–54.4], and disease control rate was 61.9% (26/42; 95% CI, 45.6–76.4) versus 2.1% (1/48; 95% CI, 0.1–11.1) and 22.9% (11/48; 95% CI, 12.0–37.3) for 48 patients with TMB ≥10 and <16 mut/Mb. Responses were observed in nine different tumor types (47%; 9/19).
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Affiliation(s)
- Claire F Friedman
- Early Drug Development Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Medical College at Cornell University
| | - John D Hainsworth
- Chief Scientific Officer, Sarah Cannon Research Institute/Tennessee Oncology, PLLC
| | - Razelle Kurzrock
- Worldwide Innovative Network (WIN) for Personalized Cancer Therapy, Worldwide Innovative Network (WIN) for Personalized Cancer Therapy
| | | | - Howard A Burris
- Department of Medicine/Medical Oncology, Sarah Cannon Research Institute
| | | | - Funda Meric-Bernstam
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center
| | | | | | | | | | | | | | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute
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Yardley DA, Young RR, Adelson KB, Silber AL, Najera JE, Daniel DB, Peacock N, Finney L, Hoekstra SJ, Shastry M, Hainsworth JD, Burris HA. A Phase II Study Evaluating Orteronel, an Inhibitor of Androgen Biosynthesis, in Patients With Androgen Receptor (AR)-Expressing Metastatic Breast Cancer (MBC). Clin Breast Cancer 2021; 22:269-278. [PMID: 34824002 DOI: 10.1016/j.clbc.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AR is a targetable pathway with AR modulation inhibiting estrogen- and androgen-mediated cell proliferation. Orteronel is an oral, selective, nonsteroidal inhibitor of 17, 20-lyase, a key enzyme in androgen biosynthesis. This study evaluated single-agent orteronel in AR+ metastatic breast cancer (MBC). METHODS Male/female patients with AR+ MBC were grouped in Cohort 1: AR+ TNBC with l-3 prior chemotherapy regimens or Cohort 2: AR+ HR+ (estrogen [ER+]/ progesterone receptor [PR+] positive) HER2+/- with 1 to 3 prior hormonal and at least 1 prior chemotherapy regimen. Patients with HER2+ MBC must have received at least 2 lines of HER2-targeted therapy. Orteronel was administered at 300 mg BID; response rate was the primary endpoint. RESULTS Seventy patients were enrolled (Cohort 1, n = 26 and Cohort 2, n = 44). Median treatment duration was 7.1 weeks. Seven patients were on treatment for ≥6 months. One of the 21 evaluated patients in Cohort 1 (4.8%) had an objective response. In Cohort 2, none of the first 23 patients to be evaluated had a response and accrual was stopped. Median progression-free and overall survival were 1.8 and 8.3 months, respectively. Toxicities were predominantly Grade 1 or 2 nausea/vomiting (36%) and fatigue (31%). Grade 3 or 4 events in ≥5% of patients included increased amylase/lipase (10%) and hypertension (6%). CONCLUSIONS Orteronel demonstrated limited clinical activity in heavily pre-treated AR+ MBC. Further development of orteronel in MBC is not recommended. Further efforts to validate the AR as a therapeutic target should focus on identifying new markers predictive of sensitivity to AR-targeted agents.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN.
| | - Robyn R Young
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | | | | | | | - Davey B Daniel
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Chattanooga, TN
| | - Nancy Peacock
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN
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Halabi S, Yang Q, Carmack A, Zhang S, Foo WC, Eisen T, Stadler WM, Jones RJ, Garcia JA, Vaishampayan UN, Picus J, Hawkins RE, Hainsworth JD, Kollmannsberger CK, Logan TF, Puzanov I, Pickering LM, Ryan CW, Protheroe A, George DJ, Armstrong AJ. Tissue based biomarkers in non-clear cell RCC: Correlative analysis from the ASPEN clinical trial. Kidney Cancer J 2021; 19:64-72. [PMID: 34765076 PMCID: PMC8580377 DOI: 10.52733/kcj19n3-a1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Biomarkers are needed in patients with non-clear cell renal cell carcinomas (NC-RCC), particularly papillary renal cell carcinoma, in order to inform on initial treatment selection and identify potentially novel targets for therapy. We enrolled 108 patients in ASPEN, an international randomized open-label phase 2 trial of patients with metastatic papillary, chromophobe, or unclassified NC-RCC treated with the mTOR inhibitor everolimus (n=57) or the vascular endothelial growth factor (VEGF) receptor inhibitor sunitinib (n=51), stratified by MSKCC risk and histology. The primary endpoint was overall survival (OS) and secondary efficacy endpoints for this exploratory biomarker analysis were radiographic progression-free survival (rPFS) defined by intention-to-treat using the RECIST 1.1 criteria and radiographic response rates. Tissue biomarkers (n=78) of mTOR pathway activation (phospho-S6 and -Akt, c-kit) and VEGF pathway activation (HIF-1α, c-MET) were prospectively explored in tumor tissue by immunohistochemistry prior to treatment and associated with clinical outcomes. We found that S6 activation was more common in poor risk NC-RCC tumors and S6/Akt activation was associated with worse PFS and OS outcomes with both everolimus and sunitinib, while c-kit was commonly expressed in chromophobe tumors and associated with improved outcomes with both agents. C-MET was commonly expressed in papillary tumors and was associated with lower rates of radiographic response but did not predict PFS for either agent. In multivariable analysis, both pAkt and c-kit were statistically significant prognostic biomarkers of OS. No predictive biomarkers of treatment response were identified for clinical outcomes. Most biomarker subgroups had improved outcomes with sunitinib as compared to everolimus.
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Affiliation(s)
- Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham NC
| | - Qian Yang
- Department of Biostatistics and Bioinformatics, Duke University, Durham NC
| | - Andrea Carmack
- Department of Biostatistics and Bioinformatics, Duke University, Durham NC
| | - Shiqi Zhang
- Department of Biostatistics and Bioinformatics, Duke University, Durham NC
| | - Wen-Chi Foo
- Department of Biostatistics and Bioinformatics, Duke University, Durham NC
| | - Tim Eisen
- University of Cambridge, Cambridge, United Kingdom
| | | | - Robert J. Jones
- University of Glasgow, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Ulka N. Vaishampayan
- University of Michigan, Ann Arbor/Karmanos Cancer Institute, Wayne State University, Detroit, MI USA
| | - Joel Picus
- Washington University in St. Louis, St. Louis, MO USA
| | | | | | | | - Theodore F. Logan
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN USA
| | - Igor Puzanov
- Vanderbilt University Medical Center, Nashville, TN USA
| | | | - Christopher W. Ryan
- Oregon Health & Science University, OHSU Knight Cancer Institute, Portland, OR USA
| | - Andrew Protheroe
- University of Oxford Medical Oncology Department, Oxford, United Kingdom
| | - Daniel J. George
- Duke University and the Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | - Andrew J. Armstrong
- Duke University and the Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
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Armstrong AJ, Nixon AB, Carmack A, Yang Q, Eisen T, Stadler WM, Jones RJ, Garcia JA, Vaishampayan UN, Picus J, Hawkins RE, Hainsworth JD, Kollmannsberger CK, Logan TF, Puzanov I, Pickering LM, Ryan CW, Protheroe A, George DJ, Halabi S. Angiokines Associated with Targeted Therapy Outcomes in Patients with Non-Clear Cell Renal Cell Carcinoma. Clin Cancer Res 2021; 27:3317-3328. [PMID: 33593885 DOI: 10.1158/1078-0432.ccr-20-4504] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/11/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Biomarkers are needed in patients with non-clear cell renal cell carcinomas (NC-RCC) to inform treatment selection but also to identify novel therapeutic targets. We thus sought to profile circulating angiokines in the context of a randomized treatment trial of everolimus versus sunitinib. PATIENTS AND METHODS ASPEN (NCT01108445) was an international, randomized, open-label phase II trial of patients with metastatic papillary, chromophobe, or unclassified NC-RCC with no prior systemic therapy. Patients were randomized to everolimus or sunitinib and treated until disease progression or unacceptable toxicity. The primary endpoint was radiographic progression-free survival (PFS) defined by RECIST 1.1. Plasma angiokines were collected at baseline, cycle 3, and progression and associated with PFS and overall survival (OS). RESULTS We enrolled 108 patients, 51 received sunitinib and 57 everolimus; of these, 99 patients had evaluable plasma for 23 angiokines. At the final data cutoff, 94 PFS and 64 mortality events had occurred. Angiokines that were independently adversely prognostic for OS were osteopontin (OPN), TIMP-1, thrombospondin-2 (TSP-2), hepatocyte growth factor (HGF), and VCAM-1, and these were also associated with poor-risk disease. Stromal derived factor 1 (SDF-1) was associated with improved survival. OPN was also significantly associated with worse PFS. No statistically significant angiokine-treatment outcome interactions were observed for sunitinib or everolimus. Angiopoeitin-2 (Ang-2), CD-73, HER-3, HGF, IL6, OPN, PIGF, PDGF-AA, PDGF-BB, SDF-1, TGF-b1-b2, TGFb-R3, TIMP-1, TSP-2, VCAM-1, VEGF, and VEGF-R1 levels increased with progression on everolimus, while CD-73, ICAM-1, IL6, OPN, PlGF, SDF-1, TGF-b2, TGFb-R3, TIMP-1, TSP-2, VEGF, VEGF-D, and VCAM-1 increased with progression on sunitinib. CONCLUSIONS In patients with metastatic NC-RCC, we identified several poor prognosis angiokines and immunomodulatory chemokines during treatment with sunitinib or everolimus, particularly OPN.
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Affiliation(s)
- Andrew J Armstrong
- Duke University Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina.
| | - Andrew B Nixon
- Duke University Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina
| | - Andrea Carmack
- Duke University Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina
| | - Qian Yang
- Duke University Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina
| | - Tim Eisen
- University of Cambridge, Cambridge, United Kingdom
| | | | - Robert J Jones
- University of Glasgow, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Ulka N Vaishampayan
- University of Michigan/Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Joel Picus
- Washington University in St. Louis, St. Louis, Missouri
| | | | | | | | - Theodore F Logan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Christopher W Ryan
- Oregon Health & Science University, OHSU Knight Cancer Institute, Portland, Oregon
| | - Andrew Protheroe
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Daniel J George
- Duke University Department of Medicine, Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, North Carolina
| | - Susan Halabi
- Department of Biostatistics, Duke University, Durham, North Carolina
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Armstrong AJ, Nixon AB, Carmack A, Yang Q, Eisen T, Stadler WM, Jones RJ, Garcia JA, Vaishampayan UN, Picus J, Hawkins RE, Hainsworth JD, Kollmannsberger CK, Logan TF, Puzanov I, Pickering LM, Ryan CW, Protheroe A, George DJ, Halabi S. Correction: Angiokines Associated with Outcomes after Sunitinib or Everolimus Treatment in Patients with Non-Clear Cell Renal Cell Carcinoma. Clin Cancer Res 2021; 27:3503. [PMID: 34117029 DOI: 10.1158/1078-0432.ccr-21-1636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yardley DA, Young RR, Adelson KB, Silber AL, Kommor MD, Najera JE, Daniel DB, Peacock NW, Shastry M, Hainsworth JD, Burris HA. Abstract PS11-29: A phase 2 study evaluating orteronel, an inhibitor of androgen biosynthesis, in patients with androgen receptor (AR)-expressing metastatic triple-negative breast cancer (TNBC). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps11-29] [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: Treatment options for TNBC are limited by the lack of estrogen and progesterone receptors as well as the absence of HER2 overexpression. AR is present in all breast cancer subtypes and up to 40% of TNBC have AR overexpression (AR+). Thus AR positivity in TNBC represents a potential targetable signaling pathway. Preclinical studies demonstrated that AR modulation inhibits cell proliferation, and clinical activity with anti-androgen monotherapy has been reported in breast cancer. Orteronel is a novel, oral, selective, nonsteroidal inhibitor of 17, 20-lyase, a key enzyme in androgen biosynthesis under evaluation as a potential therapeutic strategy in hormone-sensitive cancers. In this phase 2 study, we evaluated androgen blockade with single agent orteronel in AR+ metastatic breast cancer (MBC). Methods: Male or female pts with AR+ MBC (≥10% staining by central immunohistochemistry) were eligible. Pts were grouped into 2 cohorts for analysis: Cohort 1-TNBC (AR+/ER-/PR-/HER2-) and Cohort 2-ER+ (AR+/ER+/HER2 +/-). Results in Cohort 2 (ER+) have been previously reported; here we report results in the AR+ TNBC cohort. TNBC pts must have been previously treated with standard therapy (1-3 chemotherapy regimens for MBC). All pts received 300 mg orteronel PO BID over a 4 week cycle and underwent response assessment every 2 cycles. Treatment continued until disease progression or unacceptable toxicity. The hypothesized response rate for pts with previously treated metastatic AR+ TNBC was 11%. Results: From 7/2014 to 2/2019 a total of 26 AR+ TNBC pts were enrolled on cohort 1. The trial closed early due to slow accrual. Median age was 57 years (range, 33-92); 96% ECOG 0-1; all pts had ≥ 1 prior chemotherapy; 42% prior targeted therapy; 8% prior immunotherapy. All tumors were ER and PR negative per institutional standards. PI3K was mutated in 16% (3/19) tumors tested and 65% (13/20) were PTEN-negative. Median duration of treatment was 8 weeks (range 0.7-35.7) with 15% of pts on treatment ≥ 6 months (mo). All pts have discontinued treatment, 85% due to disease progression, and 15% due to AEs. Nausea and fatigue [8 pts each (31%)] were the most common AEs noted. G 3/4 AEs included hypertension, increased amylase and lipase [2 pts each (8%)] with 4 patients reporting SAEs (G2 pneumonitis, G2 chest pain and G2 peripheral edema, G4 prolonged QT and G4 hypokalemia). The ORR was 4% and DCR was 15%. Median PFS was 2.0 mo and median OS was 10.2 mo. Conclusions: Orteronel monotherapy was well tolerated but demonstrated limited clinical activity in this heavily pre-treated metastatic AR+ TNBC patient population. As novel AR targeting agents are being developed, future studies are needed to identify AR+ breast cancer patients most likely to benefit from AR inhibition.
Citation Format: Denise A Yardley, Robyn R Young, Kerin B Adelson, Andrea L Silber, Michael D Kommor, Jose E Najera, Davey B Daniel, Nancy W Peacock, Mythili Shastry, John D Hainsworth, Howard A Burris, III. A phase 2 study evaluating orteronel, an inhibitor of androgen biosynthesis, in patients with androgen receptor (AR)-expressing metastatic triple-negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-29.
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Affiliation(s)
- Denise A Yardley
- 1Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Robyn R Young
- 2The Center for Cancer and Blood Disorders, Forth Worth, TX
| | | | | | | | | | - Davey B Daniel
- 6Sarah Cannon Research Institute/Tennessee Oncology, Chattanooga, TN
| | - Nancy W Peacock
- 1Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | | | - Howard A Burris
- 1Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
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Yardley DA, Peacock N, Daniel B, Anz B, Molthrop DC, Shroff SK, Young R, Jankov A, Vander Woude A, Shastry M, Pasek J, DeBusk LM, Hainsworth JD. Phase II trial of eribulin in patients who do not achieve pathologic complete response (pCR) following neoadjuvant chemotherapy. Breast Cancer Res Treat 2020; 180:647-655. [PMID: 32060783 DOI: 10.1007/s10549-020-05563-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/08/2019] [Accepted: 01/31/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Women with residual invasive breast cancer at the primary site or axillary lymph nodes following neoadjuvant chemotherapy have a high risk of recurrence. Eribulin improves survival in patients with metastatic breast cancer who progress after anthracycline and taxane therapy. This phase 2 trial assessed the efficacy of postoperative eribulin in breast cancer patients who did not achieve a pCR following standard neoadjuvant chemotherapy. METHODS Women with localized breast cancer who had residual invasive cancer following ≥ 4 cycles of standard anthracycline and/or taxane-containing neoadjuvant chemotherapy received adjuvant eribulin treatment. HER2-positive patients also received trastuzumab for 1 year. Adjuvant hormonal therapy and locoregional radiotherapy were administered as per institutional guidelines. Primary endpoint was the 2-year DFS rate. Three patient cohorts were analyzed: TNBC (Cohort A), HR+/HER2- (Cohort B), and HER2+ (Cohort C). RESULTS One hundred twenty-six patients (Cohort A-53, Cohort B-42, and Cohort C-31) were enrolled. Neoadjuvant chemotherapy included a taxane and an anthracycline in 70%. Eribulin was well tolerated; 84% of patients received the planned 6 cycles. After a median follow-up of 28 months, the 24-month DFS rates were 56% (95% CI 42, 69), 83% (95% CI 67, 91), and 73% (95% CI 53, 86) for Cohorts A, B, and C, respectively. The most common grade 3/4 treatment-related adverse events were neutropenia (26%), leukopenia (13%), and neuropathy (7%). CONCLUSION Administration of adjuvant eribulin after neoadjuvant chemotherapy was feasible and well tolerated. The 24-month DFS rate did not reach the study target levels in any of the cohorts and was similar to DFS previously described in these cohorts following neoadjuvant chemotherapy alone.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, Nashville, TN, USA. .,Tennessee Oncology, PLLC, Nashville, TN, USA. .,Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA.
| | - Nancy Peacock
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology, PLLC, Nashville, TN, USA
| | - Brooke Daniel
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology, PLLC, Chattanooga, TN, USA
| | - Betrand Anz
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology, PLLC, Chattanooga, TN, USA
| | | | | | - Robyn Young
- The Center for Cancer and Blood Disorders, Fort Worth, TX, USA
| | | | - Amy Vander Woude
- Cancer Research Consortium of West Michigan, Grand Rapids, MI, USA
| | | | | | | | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, TN, USA.,Tennessee Oncology, PLLC, Nashville, TN, USA
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Pavel ME, Baudin E, Öberg KE, Hainsworth JD, Voi M, Rouyrre N, Peeters M, Gross DJ, Yao JC. Efficacy of everolimus plus octreotide LAR in patients with advanced neuroendocrine tumor and carcinoid syndrome: final overall survival from the randomized, placebo-controlled phase 3 RADIANT-2 study. Ann Oncol 2019; 30:2010. [PMID: 31406974 PMCID: PMC8902958 DOI: 10.1093/annonc/mdz222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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10
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Spigel DR, Shipley DL, Waterhouse DM, Jones SF, Ward PJ, Shih KC, Hemphill B, McCleod M, Whorf RC, Page RD, Stilwill J, Mekhail T, Jacobs C, Burris HA, Hainsworth JD. A Randomized, Double-Blinded, Phase II Trial of Carboplatin and Pemetrexed with or without Apatorsen (OGX-427) in Patients with Previously Untreated Stage IV Non-Squamous-Non-Small-Cell Lung Cancer: The SPRUCE Trial. Oncologist 2019; 24:e1409-e1416. [PMID: 31420467 DOI: 10.1634/theoncologist.2018-0518] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/20/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This randomized, double-blinded, phase II trial evaluated the efficacy of carboplatin and pemetrexed plus either apatorsen, an antisense oligonucleotide targeting heat shock protein (Hsp) 27 mRNA, or placebo in patients with previously untreated metastatic nonsquamous non-small cell lung cancer (NSCLC). METHODS Patients were randomized 1:1 to Arm A (carboplatin/pemetrexed plus apatorsen) or Arm B (carboplatin/pemetrexed plus placebo). Treatment was administered in 21-day cycles, with restaging every two cycles, until progression or intolerable toxicity. Serum Hsp27 levels were analyzed at baseline and during treatment. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS), objective response rate, and toxicity. RESULTS The trial enrolled 155 patients (median age 66 years; 44% Eastern Cooperative Oncology Group performance status 0). Toxicities were similar in the 2 treatment arms; cytopenias, nausea, vomiting, and fatigue were the most frequent treatment-related adverse events. Median PFS and OS were 6.0 and 10.8 months, respectively, for Arm A, and 4.9 and 11.8 months for Arm B (differences not statistically significant). Overall response rates were 27% for Arm A and 32% for Arm B. Sixteen patients (12%) had high serum levels of Hsp27 at baseline. In this small group, patients who received apatorsen had median PFS of 10.8 months, and those who received placebo had median PFS 4.8 months. CONCLUSION The addition of apatorsen to carboplatin and pemetrexed was well tolerated but did not improve outcomes in patients with metastatic nonsquamous NSCLC cancer in the first-line setting. IMPLICATIONS FOR PRACTICE This randomized, double-blinded, phase II trial evaluated the efficacy of carboplatin and pemetrexed plus either apatorsen, an antisense oligonucleotide targeting heat shock protein 27 mRNA, or placebo in patients with previously untreated metastatic nonsquamous non-small cell lung cancer (NSCLC). The addition of apatorsen to carboplatin and pemetrexed was well tolerated but did not improve outcomes in patients with metastatic nonsquamous NSCLC cancer in the first-line setting.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennessee, USA
| | - Dianna L Shipley
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennessee, USA
| | - David M Waterhouse
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Oncology Hematology Care, Cincinnati, Ohio, USA
| | | | - Patrick J Ward
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Oncology Hematology Care, Cincinnati, Ohio, USA
| | - Kent C Shih
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennessee, USA
| | - Brian Hemphill
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennessee, USA
| | - Michael McCleod
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Florida Cancer Specialists, Ft. Myers Florida, USA
| | - Robert C Whorf
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Florida Cancer Specialists, Bradenton, Florida, USA
| | - Ray D Page
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Center for Cancer and Blood Disorders, Ft. Worth, Texas, USA
| | - Joseph Stilwill
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Research Medical Center, Kansas City, Missouri, USA
| | - Tarek Mekhail
- Florida Hospital Cancer Institute, Orlando, Florida, USA
| | | | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennessee, USA
| | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennessee, USA
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11
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Hainsworth JD, Greco FA. Cancer of Unknown Primary Site: New Treatment Paradigms in the Era of Precision Medicine. Am Soc Clin Oncol Educ Book 2018; 38:20-25. [PMID: 30231392 DOI: 10.1200/edbk_100014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- John D Hainsworth
- From the Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | - F Anthony Greco
- From the Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
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12
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Hainsworth JD, Meric-Bernstam F, Swanton C, Hurwitz H, Spigel DR, Sweeney C, Burris H, Bose R, Yoo B, Stein A, Beattie M, Kurzrock R. Reply to J.J. Tao et al. J Clin Oncol 2018; 36:2451. [PMID: 29856693 DOI: 10.1200/jco.2018.78.6392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- John D Hainsworth
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Funda Meric-Bernstam
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Charles Swanton
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Herbert Hurwitz
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - David R Spigel
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Christopher Sweeney
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Howard Burris
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Ron Bose
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Bongin Yoo
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Alisha Stein
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Mary Beattie
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
| | - Razelle Kurzrock
- John D. Hainsworth, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Funda Meric-Bernstam, The University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Genentech, South San Francisco, CA; David R. Spigel, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN; Christopher Sweeney, Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco, CA; and Razelle Kurzrock, Moores Cancer Center, University of California, San Diego, San Diego, CA
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13
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Spigel DR, Burris HA, Greco FA, Shih KC, Gian VG, Lipman AJ, Daniel DB, Waterhouse DM, Finney L, Heymach JV, Hainsworth JD. Erlotinib plus either pazopanib or placebo in patients with previously treated advanced non-small cell lung cancer: A randomized, placebo-controlled phase 2 trial with correlated serum proteomic signatures. Cancer 2018; 124:2355-2364. [PMID: 29645086 DOI: 10.1002/cncr.31290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/06/2017] [Accepted: 11/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study compared the efficacy and safety of treatment with erlotinib plus pazopanib versus erlotinib plus placebo in patients with previously treated advanced non-small cell lung cancer (NSCLC). METHODS Patients with progressive-stage IV NSCLC after either 1 or 2 previous chemotherapy regimens were randomized to receive erlotinib (150 mg by mouth daily) with either pazopanib (600 mg by mouth daily) or placebo. During treatment, patients were evaluated every 8 weeks until disease progression or unacceptable toxicity. After a study amendment, pretreatment serum specimens for the VeriStrat assay were collected. The predictive value of the VeriStrat score (good vs poor) for progression-free survival (PFS) and overall survival (OS) was assessed in the overall population and in each treatment group. RESULTS One hundred ninety-two eligible patients were randomized between February 2010 and February 2011. PFS was prolonged with erlotinib plus pazopanib versus erlotinib plus placebo (median, 2.6 vs 1.8 months; hazard ratio, 0.58; P = .001). There was no difference in the OS of the 2 groups. A good VeriStrat score predicted longer PFS and OS in the entire group and predicted longer PFS in the subgroup receiving erlotinib plus pazopanib. The addition of pazopanib increased toxicity, and this was consistent with the known toxicity profile. CONCLUSIONS The addition of pazopanib to erlotinib in an unselected group of patients with previously treated NSCLC improved PFS and increased treatment-related toxicity, but it had no influence on OS. The efficacy of both regimens was modest. Patients receiving erlotinib plus pazopanib had longer PFS if they had a good VeriStrat score versus a poor one. Cancer 2018;124:2355-64. © 2018 American Cancer Society.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - F Anthony Greco
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Kent C Shih
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Victor G Gian
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Andrew J Lipman
- Sarah Cannon Research Institute, Nashville, Tennessee.,Florida Cancer Specialists, Naples, Florida
| | - Davey B Daniel
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Chattanooga, Tennessee
| | | | | | - John V Heymach
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
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14
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Hainsworth JD, Waterhouse DM, Shih KC, Boccia RV, Priego VM, McCleod MJ, Kudrik FJ, Mitchell RB, Burris HA, Greco FA, Spigel DR. Phase II trial of preoperative pemetrexed plus carboplatin in patients with stage IB-III nonsquamous non-small cell lung cancer (NSCLC). Lung Cancer 2018; 118:6-12. [DOI: 10.1016/j.lungcan.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/13/2017] [Accepted: 01/16/2018] [Indexed: 11/26/2022]
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15
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Yardley DA, Hart LL, Ward PJ, Wright GL, Shastry M, Finney L, DeBusk LM, Hainsworth JD. Cabazitaxel Plus Lapatinib as Therapy for HER2 + Metastatic Breast Cancer With Intracranial Metastases: Results of a Dose-finding Study. Clin Breast Cancer 2018; 18:e781-e787. [PMID: 29678476 DOI: 10.1016/j.clbc.2018.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 10/10/2017] [Revised: 01/18/2018] [Accepted: 03/05/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Lapatinib is an oral small molecule tyrosine kinase epidermal growth factor receptor-1/HER2 inhibitor that crosses the blood-brain barrier and is active against central nervous system (CNS) metastases. Cabazitaxel is a taxoid that is effective against taxane-resistant metastatic breast cancer (MBC) and has distinguished itself by its ability to cross the blood-brain barrier. The present phase II study (ClinicalTrials.gov identifier, NCT01934894) evaluated the combination of these agents to treat HER2+ MBC patients with CNS metastases. MATERIALS AND METHODS Patients with HER2+ MBC and ≥ 1 untreated or progressive, measurable CNS metastasis were eligible. Using a 3+3 dose escalation design, patients were treated with escalating doses of intravenous cabazitaxel every 21 days and oral lapatinib daily in 21-day treatment cycles. Intracranial disease restaging was performed every 2 cycles for the first 8 cycles and then every 3 cycles until progression or unacceptable toxicity. RESULTS Eleven patients were treated at 2 dose levels. Six patients were treated at dose level 1 (intravenous cabazitaxel 20 mg/m2 plus oral lapatinib 1000 mg daily), and five were treated at dose level 2 (intravenous cabazitaxel 25 mg/m2 plus oral lapatinib 1000 mg daily). The most common treatment-related adverse events were myelosuppression, diarrhea, fatigue, and skin toxicity. A total of 5 dose-limiting toxicity events occurred. No intra- or extracranial objective responses were observed. CONCLUSION The combination of cabazitaxel plus lapatinib was not feasible because of toxicity and because no objective CNS activity was seen in the 5 evaluable patients. The role of cabazitaxel to treat breast cancer patients with CNS metastases remains undefined.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN.
| | - Lowell L Hart
- Sarah Cannon Research Institute, Nashville, TN; Florida Cancer Specialists, Fort Myers, FL
| | | | - Gail L Wright
- Sarah Cannon Research Institute, Nashville, TN; Florida Cancer Specialists, Fort Myers, FL
| | | | | | | | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN
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16
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Spigel DR, Hainsworth JD, Shipley DL, Mekhail TM, Zubkus JD, Waterhouse DM, Daniel DB, Burris HA, Greco FA. Amrubicin and carboplatin with pegfilgrastim in patients with extensive stage small cell lung cancer: A phase II trial of the Sarah Cannon Oncology Research Consortium. Lung Cancer 2018; 117:38-43. [PMID: 29496254 DOI: 10.1016/j.lungcan.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/26/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE First-line treatment for patients with extensive-stage small cell lung cancer (SCLC) includes treatment with platinum-based combination chemotherapy. Amrubicin is a synthetic anthracycline with single-agent activity in relapsed/refractory SCLC. In an attempt to improve treatment efficacy, we evaluated amrubicin/carboplatin as first-line therapy for extensive-stage SCLC. PATIENTS AND METHODS In this multicenter phase II trial, patients received amrubicin (30 mg/m2 daily on Days 1, 2, and 3) and carboplatin (AUC = 5 on Day 1); cycles were repeated every 21 days for 4 cycles. Pegfilgrastim (6 mg subcutaneously) was administered on Day 4 of all cycles. Overall survival (OS) proportion at 1 year was the primary endpoint. The target 1-year OS rate was 47%, an improvement of 35% from historical results with carboplatin/etoposide. RESULTS Eighty patients received study treatment, and 62% completed the planned 4 courses. The overall response rate was 74% (13% complete responses). The 1-year survival rate was 38% (95% CI: 25, 50). The median survival was 10 months. Myelosuppression was severe but manageable. CONCLUSIONS The combination of amrubicin/carboplatin was an active first-line treatment for extensive stage SCLC, but showed no indication of increased efficacy compared to standard treatments. Severe myelosuppression was common with this regimen, in spite of prophylactic pegfilgrastim. These results are consistent with those of other trials in showing no role for amrubicin in the first-line treatment of SCLC.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
| | | | - Dianna L Shipley
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
| | | | - John D Zubkus
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
| | | | - Davey B Daniel
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Chattanooga Oncology Hematology Associates, Chattanooga, TN, 37404, USA.
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
| | - F Anthony Greco
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
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17
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Spigel DR, Hainsworth JD, Joseph MJ, Shipley DL, Hagan MK, Thompson DS, Burris HA, Greco FA. Randomized phase 2 trial of pemetrexed, pemetrexed/bevacizumab, and pemetrexed/carboplatin/bevacizumab in patients with stage IIIB/IV non-small cell lung cancer and an Eastern Cooperative Oncology Group performance status of 2. Cancer 2018; 124:1982-1991. [PMID: 29451696 DOI: 10.1002/cncr.30986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/02/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The best treatment for patients with advanced non-small cell lung cancer (NSCLC) and a poor performance status is not well defined. In this phase 2 trial, patients were randomized to receive treatment with either single-agent pemetrexed or 1 of 2 combination regimens. METHODS Patients with newly diagnosed, histologically confirmed nonsquamous NSCLC and an Eastern Cooperative Oncology Group (ECOG) performance status of 2 were stratified by age and serum albumin level and were randomized (1:1:1) to 1 of 3 regimens: pemetrexed (arm 1), pemetrexed and bevacizumab (arm 2), or pemetrexed, carboplatin, and bevacizumab (arm 3). The response to treatment was assessed every 2 cycles; responding and stable patients continued treatment until progression or unacceptable toxicity. RESULTS One hundred seventy-two patients were randomized, 162 patients began the study treatment, and 146 patients completed 2 cycles and were evaluated for their response. The median progression-free survival (PFS) was 2.8 months in arm 1, 4.0 months in arm 2, and 4.8 months in arm 3. The overall response rates were 15% in arm 1, 31% in arm 2, and 44% in arm 3. The overall survival was similar in the 3 treatment arms. All 3 regimens were relatively well tolerated. Patients receiving bevacizumab had an increased incidence of hypertension, proteinuria, and bleeding episodes, but most events were mild or moderate. CONCLUSIONS All 3 regimens were feasible for patients with advanced NSCLC and an ECOG performance status of 2. The addition of bevacizumab to pemetrexed increased the overall response rate. The efficacy of pemetrexed/carboplatin/bevacizumab (median PFS, 4.8 months) approached the prespecified study PFS goal of 5 months. Larger studies will be necessary to define the role of bevacizumab in addition to standard pemetrexed and carboplatin in this population. Cancer 2018;124:1982-91. © 2018 American Cancer Society.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
| | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
| | - Mathew J Joseph
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
| | - Dianna L Shipley
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
| | | | - Dana S Thompson
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
| | - F Anthony Greco
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, PLLC, Nashville, Tennessee
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Hainsworth JD, Meric-Bernstam F, Swanton C, Hurwitz H, Spigel DR, Sweeney C, Burris H, Bose R, Yoo B, Stein A, Beattie M, Kurzrock R. Targeted Therapy for Advanced Solid Tumors on the Basis of Molecular Profiles: Results From MyPathway, an Open-Label, Phase IIa Multiple Basket Study. J Clin Oncol 2018; 36:536-542. [PMID: 29320312 DOI: 10.1200/jco.2017.75.3780] [Citation(s) in RCA: 317] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Detection of specific molecular alterations in tumors guides the selection of effective targeted treatment of patients with several types of cancer. These molecular alterations may occur in other tumor types for which the efficacy of targeted therapy remains unclear. The MyPathway study evaluates the efficacy and safety of selected targeted therapies in tumor types that harbor relevant genetic alterations but are outside of current labeling for these treatments. Methods MyPathway ( ClinicalTrials.gov identifier: NCT02091141) is a multicenter, nonrandomized, phase IIa multiple basket study. Patients with advanced refractory solid tumors harboring molecular alterations in human epidermal growth factor receptor-2, epidermal growth factor receptor, v-raf murine sarcoma viral oncogene homolog B1, or the Hedgehog pathway are treated with pertuzumab plus trastuzumab, erlotinib, vemurafenib, or vismodegib, respectively. The primary end point is investigator-assessed objective response rate within each tumor-pathway cohort. Results Between April 1, 2014 and November 1, 2016, 251 patients with 35 different tumor types received study treatment. The efficacy population contains 230 treated patients who were evaluated for response or discontinued treatment before evaluation. Fifty-two patients (23%) with 14 different tumor types had objective responses (complete, n = 4; partial, n = 48). Tumor-pathway cohorts with notable objective response rates included human epidermal growth factor receptor-2-amplified/overexpressing colorectal (38% [14 of 37]; 95% CI, 23% to 55%) and v-raf murine sarcoma viral oncogene homolog B1 V600-mutated non-small-cell lung cancer (43% [six of 14]; 95% CI, 18% to 71%). Conclusion The four currently approved targeted therapy regimens in the MyPathway study produced meaningful responses when administered without chemotherapy in several refractory solid tumor types not currently labeled for these agents.
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Affiliation(s)
- John D Hainsworth
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Funda Meric-Bernstam
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Charles Swanton
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Herbert Hurwitz
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - David R Spigel
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Christopher Sweeney
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Howard Burris
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Ron Bose
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Bongin Yoo
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Alisha Stein
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Mary Beattie
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Razelle Kurzrock
- John D. Hainsworth, David R. Spigel, and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Funda Meric-Bernstam, University of Texas MD Anderson Cancer Center, Houston, TX; Charles Swanton, Francis Crick Institute, London, United Kingdom; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Christopher Sweeney, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; Ron Bose, Washington University School of Medicine, St Louis, MO; Bongin Yoo, Alisha Stein, and Mary Beattie, Genentech, South San Francisco; and Razelle Kurzrock, Moores Cancer Center, University of California San Diego, San Diego, CA
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Spigel DR, Mekhail TM, Waterhouse D, Hadley T, Webb C, Burris HA, Hainsworth JD, Greco FA. First-Line Carboplatin, Pemetrexed, and Panitumumab in Patients with Advanced Non-Squamous KRAS Wild Type (WT) Non-Small-Cell Lung Cancer (NSCLC). Cancer Invest 2017; 35:541-546. [PMID: 28762849 DOI: 10.1080/07357907.2017.1344698] [Citation(s) in RCA: 5] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND We added panitumumab to standard combination chemotherapy as first-line treatment for patients with advanced KRAS WT non-squamous NSCLC. METHODS Patients received panitumumab 9 mg/kg IV, pemetrexed 500 mg/m2 IV, and carboplatin AUC = 6 IV every 21 days. After 6 cycles, maintenance therapy with panitumumab and pemetrexed was administered every 21 days until progressive disease or unacceptable toxicity. RESULTS 29 of 66 patients (44%) had objective responses. The median TTP was 6 months; median overall survival (OS) was 17 months. Panitumumab increased treatment-related toxicity, notably skin rash. CONCLUSIONS The addition of panitumumab increased toxicity, and had no discernible impact on efficacy.
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Affiliation(s)
- David R Spigel
- a Sarah Cannon Research Institute/Tennessee Oncology, PLLC , Nashville , Tennessee , USA
| | - Tarek M Mekhail
- b Florida Hospital Cancer Institute , Orlando , Florida , USA
| | - David Waterhouse
- c Oncology Hematology Care/US Oncology , Cincinnati , Ohio , USA
| | | | - Charles Webb
- e Baptist Hospital East , Louisville , Kentucky , USA
| | - Howard A Burris
- a Sarah Cannon Research Institute/Tennessee Oncology, PLLC , Nashville , Tennessee , USA
| | - John D Hainsworth
- a Sarah Cannon Research Institute/Tennessee Oncology, PLLC , Nashville , Tennessee , USA
| | - F Anthony Greco
- a Sarah Cannon Research Institute/Tennessee Oncology, PLLC , Nashville , Tennessee , USA
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Pavel ME, Baudin E, Öberg KE, Hainsworth JD, Voi M, Rouyrre N, Peeters M, Gross DJ, Yao JC. Efficacy of everolimus plus octreotide LAR in patients with advanced neuroendocrine tumor and carcinoid syndrome: final overall survival from the randomized, placebo-controlled phase 3 RADIANT-2 study. Ann Oncol 2017; 28:1569-1575. [PMID: 28444114 DOI: 10.1093/annonc/mdx193] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [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: 01/03/2017] [Indexed: 01/12/2023] Open
Abstract
Background In the phase 3 RADIANT-2 study, everolimus plus octreotide long-acting repeatable (LAR) showed improvement of 5.1 months in median progression-free survival versus placebo plus octreotide LAR among patients with advanced neuroendocrine tumors associated with carcinoid syndrome. The progression-free survival P-value was marginally above the prespecified threshold for statistical significance. Here, we report final overall survival (OS) and key safety update from RADIANT-2. Patients and methods The RADIANT-2 trial compared everolimus (10 mg/day, orally; n = 216) versus placebo (n = 213), both in conjunction with octreotide LAR (30 mg, intramuscularly, every 28 days). Patients, unblinded at the time of progression or after end of double-blind core phase following primary analysis, were offered open-label everolimus with octreotide LAR (open-label phase). In the open-label phase, patients had similar safety and efficacy assessments as those in the core phase. For OS, hazard ratios (HRs) with 95% CIs using unadjusted Cox model and a Cox model adjusted for prespecified baseline covariates were calculated. Results A total of 170 patients received open-label everolimus (143 crossed over from the placebo arm; 27 in the everolimus arm continued to receive the same treatment after unblinding). The median OS (95% CI) after 271 events was 29.2 months (23.8-35.9) for the everolimus arm and 35.2 months (30.0-44.7) for the placebo arm (HR, 1.17; 95% CI, 0.92-1.49). HR adjusted for baseline covariates was 1.08 (95% CI, 0.84-1.38). The most frequent drug-related grade 3 or 4 AEs reported during the open-label phase were diarrhea (5.3%), fatigue (4.7%), and stomatitis (4.1%). Deaths related to pulmonary or cardiac failure were observed more frequently in the everolimus arm. Conclusion No significant difference in OS was observed for the everolimus plus octreotide LAR and placebo plus octreotide LAR arms of the RADIANT-2 study, even after adjusting for imbalances in the baseline covariates. Clinical Trial Number NCT00412061, www.clinicaltrials.gov.
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Affiliation(s)
- M E Pavel
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - E Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave-Roussy, Villejuif Cedex, France
| | - K E Öberg
- Department of Endocrine Oncology, University Hospital, Uppsala, Sweden
| | | | - M Voi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - N Rouyrre
- Novartis International AG, Basel, Switzerland
| | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - D J Gross
- Neuroendocrine Tumor Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - J C Yao
- Division of Cancer Medicine, Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Atkins MB, McDermott DF, Powles T, Motzer RJ, Rini BI, Fong L, Joseph RW, Pal SK, Sznol M, Hainsworth JD, Stadler WM, Hutson TE, Ravaud A, Bracarda S, Suarez C, Choueiri TK, Qiu J, Huseni MA, Schiff C, Escudier BJ. IMmotion150: A phase II trial in untreated metastatic renal cell carcinoma (mRCC) patients (pts) of atezolizumab (atezo) and bevacizumab (bev) vs and following atezo or sunitinib (sun). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4505] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4505 Background: While inhibiting VEGF improves outcomes in mRCC pts, most develop resistance, often within a year. Here, we report results from a Ph II study of atezo (anti–PD-L1) and bev (anti-VEGF) vs and following atezo or sun (TKI) in mRCC pts. Methods: Pts with untreated mRCC were enrolled in the hypothesis generating IMmotion150 study (NCT01984242) and randomized to atezo 1200 mg IV q3w + bev 15 mg/kg IV q3w, atezo alone or sun 50 mg PO QD 4 wk on/2 wk off. After progression on atezo or sun, crossover to atezo + bev was allowed. PD-L1 status was scored on tumor-infiltrating immune cells (IC, SP142 IHC assay). The primary analysis was modified prior to final analysis to reflect the coprimary endpoints of IRF-assessed PFS (RECIST v1.1) in ITT pts and pts with PD-L1 expression on ≥ 1% of IC (PD-L1+). Results: 54% of pts were PD-L1+. In PD-L1+ pts 1L treatment resulted in a PFS hazard ratio (HR) of 0.64 for atezo + bev vs sun (table). After 1L treatment, 78% of sun and 60% of atezo pts who progressed subsequently received atezo + bev and achieved ORRs of 28% and 24%, respectively (table). Safety was comparable to the known individual profiles of atezo and bev. Additional clinical, safety and biomarker data will be presented. Conclusions: Atezo + bev resulted in encouraging antitumor activity in 1L pts with PD-L1+ mRCC. Preliminary activity in the 2L setting was demonstrated in pts who crossed over to atezo + bev, regardless of prior therapy. 1L atezo + bev vs sun is being evaluated in the ongoing Ph III study IMmotion151 (NCT02420821). Clinical trial information: NCT01984242. [Table: see text]
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Affiliation(s)
- Michael B. Atkins
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
| | | | | | | | - Brian I. Rini
- Cleveland Clinic Taussig Cancer Insitute, Cleveland, OH
| | - Lawrence Fong
- University of California, San Francisco, San Francisco, CA
| | | | | | - Mario Sznol
- Yale School of Medicine and Yale Cancer Center, New Haven, CT
| | - John D. Hainsworth
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | | | | | - Alain Ravaud
- Groupe Hospitalier Saint Andre - Hopital Saint Andre, Bordeaux Cedex, France
| | | | - Cristina Suarez
- Vall d’Hebron University Hospital Institute of Oncology (VHIO), Barcelona, Spain
| | - Toni K. Choueiri
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
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Kurzrock R, Meric-Bernstam F, Hurwitz H, Hainsworth JD, Spigel DR, Bose R, Swanton C, Burris HA, Sweeney C, Yoo B, Beattie MS, Patel R, Schulze K, Lam ET. Targeted therapy for advanced salivary cancer with HER2 or hedgehog alterations: Interim data from MyPathway. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6086 Background: Salivary gland cancers comprise <1% of cancers. Advanced cases have a 40% 5-year survival rate. Due to their rarity, no standard treatment guidelines exist. However, salivary duct carcinomas have morphological and gene expression profiles similar to breast cancers, and 20–40% of this subset have HER2 alterations. MyPathway (NCT02091141) is an ongoing, phase 2, multi-basket study evaluating the efficacy of targeted treatments in nonindicated tumor types with alterations in the HER2, BRAF, Hedgehog (Hh), or EGFR pathways. We present interim data for patients with salivary cancer. Methods: Patients had advanced salivary cancer with HER2 (amplification, overexpression, and/or mutation) or Hh (SMO or PTCH-1) alterations, locally assessed by gene sequencing, FISH, or IHC, as applicable. Patients received standard doses of pertuzumab + trastuzumab or vismodegib, respectively, until disease progression or unacceptable toxicity. The primary endpoint is investigator-assessed objective response rate (ORR) by RECIST v1.1. Results: As of Nov 30, 2016, 8 patients had been treated for salivary cancer, all carcinomas (7 had HER2 alterations; 1 had an Hh alteration). One HER2 patient without a post-baseline tumor assessment by data cut-off was not evaluable for efficacy. Characteristics and outcomes are shown (Table). Of 6 patients with a complete response (CR) or partial response (PR), 5 patients were still receiving study treatment by the data cut-off, with a median time on treatment of 4.6 months (range 1.4–12.5). There were no new safety signals. Conclusions: Six of 7 patients (86%) with advanced salivary carcinoma achieved CR or PR by targeting HER2 (n=5) or Hh (n=1) alterations. These promising results merit study of these treatments in additional patients. Accrual to MyPathway is ongoing. Clinical trial information: NCT02091141. [Table: see text]
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Affiliation(s)
- Razelle Kurzrock
- Moores Cancer Center, University of California San Diego School of Medicine, San Diego, CA
| | | | | | - John D. Hainsworth
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - David R. Spigel
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Ron Bose
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | - Howard A. Burris
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | | | | | - Elaine Tat Lam
- University of Colorado Comprehensive Cancer Center, Aurora, CO
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Hainsworth JD, Bose R, Sweeney C, Meric-Bernstam F, Hurwitz H, Swanton C, Burris HA, Kurzrock R, Yoo B, Beattie MS, Gupta R, Patel RD, Schulze K, Spigel DR. Targeted therapy for non-small cell lung cancer (NSCLC) with HER2, BRAF, or hedgehog alterations: Interim data from MyPathway. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9073 Background: Treatments targeting critical molecular alterations (EGFR, ALK, and ROS1) in NSCLC are highly effective. MyPathway (NCT02091141) is an ongoing, phase 2, multi-basket study evaluating the efficacy of targeted treatment in non-indicated tumor types harboring alterations in the HER2, BRAF, Hedgehog (Hh), or EGFR pathways. Interim results in NSCLC are presented. Methods: Patients with previously treated advanced NSCLC and alterations in the HER2 (amplification and/or mutation), BRAF (V600E or other mutations), Hh (SMO or PTCH-1 mutations), or EGFR (mutations other than known activating mutations) pathways received standard doses of pertuzumab + trastuzumab, vemurafenib, vismodegib, or erlotinib, respectively, until disease progression or unacceptable toxicity. The HER2, BRAF, and Hh cohorts are included in this analysis. The primary endpoint is investigator-assessed objective response rate (ORR, defined as complete response [CR] + partial response [PR]) by RECIST v1.1. Results: As of November 30, 2016, 61 patients with NSCLC and HER2 (n = 36), BRAF (n = 22), or Hh (n = 3) alterations have been treated (median age of 64 years, 49% male, 85% adenocarcinoma, and a median of 2 previous regimens). Median treatment duration was 1.8 (range, 0–21.4) months. Efficacy in the 55 patients with the minimum required follow-up for efficacy analysis is summarized in the table. Conclusions: Targeted therapy is active in patients with previously treated NSCLC harboring BRAF V600E mutations or HER2 alterations (amplifications and/or mutations). These cohorts have been expanded as MyPathway accrual continues. Additional efficacy data and details regarding molecular alterations will be presented. Clinical trial information: NCT02091141. [Table: see text]
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Affiliation(s)
- John D. Hainsworth
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Ron Bose
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | | | - Howard A. Burris
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Razelle Kurzrock
- Moores Cancer Center, University of California San Diego School of Medicine, San Diego, CA
| | | | | | | | | | | | - David R. Spigel
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
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Yardley DA, Arrowsmith ER, Daniel BR, Eakle J, Brufsky A, Drosick DR, Kudrik F, Bosserman LD, Keaton MR, Goble SA, Bubis JA, Priego VM, Pendergrass K, Manalo Y, Bury M, Gravenor DS, Rodriguez GI, Inhorn RC, Young RR, Harwin WN, Silver C, Hainsworth JD, Burris HA. TITAN: phase III study of doxorubicin/cyclophosphamide followed by ixabepilone or paclitaxel in early-stage triple-negative breast cancer. Breast Cancer Res Treat 2017; 164:649-658. [PMID: 28508185 DOI: 10.1007/s10549-017-4285-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/05/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Ixabepilone is a microtubule stabilizer with activity in taxane-refractory metastatic breast cancer and low susceptibility to taxane-resistance mechanisms including multidrug-resistant phenotypes and high β-III tubulin expression. Since these resistance mechanisms are common in triple-negative breast cancer (TNBC), ixabepilone may have particular advantages in this patient population. This study evaluated the substitution of ixabepilone for paclitaxel following doxorubicin/cyclophosphamide (AC) in the adjuvant treatment of early-stage TNBC. METHODS Patients with operable TNBC were eligible following definitive breast surgery. Patients were randomized (1:1) to receive four cycles of AC followed by either four cycles (12 weeks) of ixabepilone or 12 weekly doses of paclitaxel. RESULTS 614 patients were randomized: 306 to AC/ixabepilone and 308 to AC/paclitaxel. At a median follow-up of 48 months, 59 patients had relapsed (AC/ixabepilone, 29; AC/paclitaxel, 30). The median time from diagnosis to relapse was 20.8 months. The 5-year disease-free survival (DFS) rates of the two groups were similar [HR 0.92; ixabepilone 87.1% (95% CI 82.6-90.5) vs. paclitaxel 84.7% (95% CI 79.7-88.6)]. The estimated 5-year overall survival (OS) rates were also similar [HR 1.1; ixabepilone 89.7% (95% CI 85.5-92.7) vs. paclitaxel 89.6% (95% CI 85.0-92.9)]. Peripheral neuropathy was the most common grade 3/4 event. Dose reductions and treatment discontinuations occurred more frequently during paclitaxel treatment. CONCLUSIONS Treatment with AC/ixabepilone provided similar DFS and OS in patients with operable TNBC when compared to treatment with AC/paclitaxel. The two regimens had similar toxicity, although treatment discontinuation, dose modifications, and overall peripheral neuropathy were more frequent with AC/paclitaxel. TRIAL REGISTRATION Clinical Trials.gov Identifier, NCT00789581.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA.
- Tennessee Oncology, Nashville, TN, USA.
| | - Edward R Arrowsmith
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- Tennessee Oncology, Chattanooga, TN, USA
| | - Brooke R Daniel
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- Tennessee Oncology, Chattanooga, TN, USA
| | - Janice Eakle
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- Florida Cancer Specialists, Fort Meyers, FL, USA
| | - Adam Brufsky
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David R Drosick
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- Oncology Hematology Care, Cincinnati, OH, USA
| | - Fred Kudrik
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- South Carolina Oncology Associates, Columbia, SC, USA
| | | | | | | | - Jeffrey A Bubis
- ICON/Cancer Specialists of North Florida, Jacksonville, FL, USA
| | | | | | | | - Martin Bury
- Cancer Research Consortium of West Michigan, Grand Rapids, MI, USA
| | | | | | | | - Robyn R Young
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- The Center for Cancer and Blood Disorders, Ft Worth, TX, USA
| | - William N Harwin
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- Florida Cancer Specialists, Fort Meyers, FL, USA
| | - Caryn Silver
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- Florida Cancer Specialists, Fort Meyers, FL, USA
| | - John D Hainsworth
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- Tennessee Oncology, Nashville, TN, USA
| | - Howard A Burris
- Sarah Cannon Research Institute, 250 25th Avenue North, Suite 100, Nashville, TN, 37203, USA
- Tennessee Oncology, Nashville, TN, USA
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Bryce AH, Kurzrock R, Meric-Bernstam F, Hurwitz H, Hainsworth JD, Spigel DR, Bose R, Swanton C, Burris HA, Guo S, Yoo B, Beattie MS, Tayama D, Sweeney C. Pertuzumab plus trastuzumab for HER2-positive metastatic urothelial cancer (mUC): Preliminary data from MyPathway. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.348] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
348 Background: Patients (pts) with mUC have few treatment options beyond the second-line setting. HER2 gene amplification has been reported in a minority of pts with UC, but there have been anecdotal reports of the activity of HER2-targeted agents. MyPathway is a multi-basket study evaluating the efficacy and safety of targeted therapies in non-indicated tumor types harboring relevant molecular alterations. We present preliminary data for pts with HER2-positive mUC receiving HER2-targeted treatment with pertuzumab + trastuzumab. Methods: MyPathway (NCT02091141) is an open-label, multicenter, phase IIA study. Pts in this subset analysis had refractory mUC with HER2 amplification or putative activating mutations by gene sequencing, FISH, or IHC. Pts received standard doses of pertuzumab + trastuzumab without chemotherapy until disease progression or unacceptable toxicity. The primary endpoint is investigator-assessed overall response rate (RECIST v1.1). Results: As of July 31, 2016, 12 pts with platinum-resistant HER2-positive mUC (HER2-amplified, n=9; HER2-mutated, n=3) have been enrolled. At a median follow-up of 5.4 (range 0.9–14.5) mos, 1 pt had complete response (CR, ongoing at 12.5 mos), 2 had partial responses (PR; duration of response, 3.7 and 5.5 mos), and 2 had stable disease (SD) for >4 mos (Table). Safety was consistent with the product labels. Conclusions: Preliminary results indicate that the combination of pertuzumab + trastuzumab has activity in previously treated HER2-amplified mUC, including a durable CR in a pt with peritoneal metastases. Accrual to MyPathway is ongoing. Clinical trial information: NCT02091141. [Table: see text]
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Affiliation(s)
| | - Razelle Kurzrock
- Moores Cancer Center, University of California, San Diego, San Diego, CA
| | | | | | | | - David R. Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | - Ron Bose
- Washington University School of Medicine, St. Louis, MO
| | | | - Howard A. Burris
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | | | - Bongin Yoo
- Genentech, Inc., South San Francisco, CA
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McDermott DF, Atkins MB, Motzer RJ, Rini BI, Escudier BJ, Fong L, Joseph RW, Pal SK, Sznol M, Hainsworth JD, Stadler WM, Hutson TE, Ravaud A, Bracarda S, Suarez C, Choueiri TK, Choi Y, Huseni MA, Fine GD, Powles T. A phase II study of atezolizumab (atezo) with or without bevacizumab (bev) versus sunitinib (sun) in untreated metastatic renal cell carcinoma (mRCC) patients (pts). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.431] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
431 Background: While targeting VEGF improves outcomes for mRCC pts, resistance invariably develops, often within the first year. Here, we describe the efficacy and safety of atezo (anti-PD-L1) with bev (anti-VEGF) and atezo monotherapy vs sun (TKI) in first-line mRCC. Methods: Treatment-naïve mRCC pts were enrolled in a hypothesis generating Ph II study (IMmotion150; NCT01984242) and randomized to atezo 1200 mg IV q3w + bev 15 mg/kg IV q3w, atezo alone or sun 50 mg PO QD 4 wk on/2 wk off. Crossover to atezo + bev after disease progression was allowed for pts receiving atezo or sun. PD-L1 expression was scored on tumor-infiltrating immune cells (IC, SP142 IHC assay). Coprimary endpoints were PFS (RECIST v1.1 by independent review [IRF]) in ITT pts and pts with PD-L1 expression on ≥ 1% of IC (PD-L1+). Results: Baseline characteristics were comparable across arms and between ITT and PD-L1+ pts. The majority of sun and atezo pts subsequently received atezo + bev. Median survival follow up was 20.7 mo. The PFS HR in ITT pts for atezo + bev vs sun was 1.00 and 1.19 for atezo vs sun. In PD-L1+ pts, the PFS HR for atezo + bev vs sun was 0.64 and 1.03 for atezo vs sun (table). Tx-related Gr 3-4 AEs were seen in 40%, 16% and 57% of pts in the atezo + bev, atezo and sun arms, respectively. AEs leading to death occurred in 3%, 2% and 2% of pts, respectively. Conclusion: Atezo + bev resulted in encouraging antitumor activity in the PD-L1+ subgroup of first-line RCC pts. Atezo + bev safety is consistent with the known profile of atezo and bev individually. The clinical benefit of atezo + bev vs sun will be evaluated in the ongoing Ph III study IMmotion151 (NCT02420821). Clinical trial information: NCT01984242. [Table: see text]
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Affiliation(s)
| | | | | | - Brian I. Rini
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | | | - Lawrence Fong
- University of California, San Francisco, San Francisco, CA
| | | | | | - Mario Sznol
- Yale University School of Medicine, New Haven, CT
| | | | | | | | - Alain Ravaud
- Groupe Hospitalier Saint Andre - Hopital Saint Andre, Bordeaux Cedex, France
| | | | - Cristina Suarez
- Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | | | | | | | - Thomas Powles
- Barts Cancer Institute-Queen Mary University of London, London, United Kingdom
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Yardley DA, Blakely L, Hemphill B, Joseph M, Liggett W, Daniel B, Castrellon A, Shastry M, Finney L, DeBusk L, Hainsworth JD, Burris HA. Abstract P4-22-09: A phase 2 open label study of everolimus in combination with endocrine therapy in resistant hormone receptor-positive HER2-negative advanced breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-09] [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: Therapies targeting estrogen receptor (ER) signaling are standard for patients (pts) with hormone receptor positive (HR+) (ER and/or progesterone receptor [PR] positive) metastatic breast cancer (MBC). Dysregulation of the mammalian target of rapamycin (mTOR) pathway has been associated with endocrine therapy (ET) resistance. BOLERO-2 demonstrated that the addition of the mTOR inhibitor, everolimus (EVE), to exemestane doubled the PFS in HR+ HER2- MBC pts who previously progressed on nonsteroidal aromatase inhibitor therapy.The premise of this phase 2 trial in HR+ MBC is that the addition of EVE to the last ET on which the disease progressed may restore sensitivity to ET and extend the benefit of the anti-estrogen therapy.
Methods: Pts ≥18 yrs with HR+, HER2- unresectable, locally recurrent, or MBC refractory to ET in either the adjuvant or advanced/metastatic setting. 0-1 chemotherapy (chemo) regimens for MBC were permitted. Post-/ pre-/peri-menopausal women were eligible with ovarian function suppression permitted. Additional eligibility requirements include: no prior mTOR inhibitor therapy, measurable or evaluable disease, ECOG ≤2, adequate bone marrow and organ function. EVE (10 mg PO daily) was administered on a 4-wk cycle in combination with the same dose and schedule of the last ET to which their disease became resistant. Disease assessments were performed every 2 cycles and treatment continued until disease progression or unacceptable toxicity. Blood samples and archival tumor were collected respectively for the VeriStrat Assay and for the Foundation One molecular profiling platform.
Results: 48 pts were enrolled; data from 26 pts is presented. Median age 63.5 yrs (range, 36-81) with 46% ≥ 65 yrs. 14 (54%) pts had received chemo in the adjuvant setting, 9 pts (35%) received chemo for MBC, and 4 pts (15%) received chemo in both settings. All pts had at least 1 prior hormonal therapy; 9 pts received ≥ 3 hormonal agents. EVE was combined with tamoxifen (27%), AIs (61%), and fulvestrant (12%). Median time on treatment was 18.6 wks (range 1-48.9 weeks). 5 pts (19%) remain on treatment and 21 (81%) have discontinued therapy due to: disease progression - 17, toxicity -2, and other causes - 2. 23 pts were evaluable for response. 1 pt on fulvestrant plus EVE had a PR and 18 pts (78%) had SD as best response, with SD > 6 mos in 7 pts, for a clinical benefit rate (CR+PR+ SD ≥ 6 months) of 35%. With a median follow up of 11 mos (range 2-16 mos), the median PFS was 6.6 months (range 3.6-9.4); the median OS has not been reached. Treatment-related adverse events consisted mostly of stomatitis, rash and fatigue with few G3 events: stomatitis 3 pts, rash 2 pts, and 1 each of fatigue, edema, and neutropenia. G1 pneumonitis was present in 2 pts. There were no G4 events or treatment related deaths.
Conclusions: In HR+ HER2- advanced/MBC patients who progressed on prior ET, the addition of EVE to the ET to which their disease became resistant, resulted in 1 PR and 7 pts with SD > 6 mos. The results of the full study population will be presented. Modulation of the mTOR/AKT/PI3K pathway with EVE may extend the benefit of ET, even after tumor progression on ET alone.
Citation Format: Yardley DA, Blakely L, Hemphill B, Joseph M, Liggett W, Daniel B, Castrellon A, Shastry M, Finney L, DeBusk L, Hainsworth JD, Burris III HA. A phase 2 open label study of everolimus in combination with endocrine therapy in resistant hormone receptor-positive HER2-negative advanced 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 P4-22-09.
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Affiliation(s)
- DA Yardley
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - L Blakely
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - B Hemphill
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - M Joseph
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - W Liggett
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - B Daniel
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - A Castrellon
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - M Shastry
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - L Finney
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - L DeBusk
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - JD Hainsworth
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - HA Burris
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
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Javle MM, Hainsworth JD, Swanton C, Burris HA, Kurzrock R, Sweeney C, Meric-Bernstam F, Spigel DR, Bose R, Guo S, Bernaards C, Beattie MS, Scappaticci FA, Hurwitz H. Pertuzumab + trastuzumab for HER2-positive metastatic biliary cancer: Preliminary data from MyPathway. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.402] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
402 Background: Biliary cancers have a high mortality rate, with limited treatment options. While HER2 is overexpressed in 9-20% of biliary cancers, it has not been fully explored as a therapeutic target. MyPathway is a multi-basket study evaluating the efficacy and safety of targeted therapies in non-indicated tumor types harboring relevant genetic alterations. We present preliminary data for patients with HER2-positive metastatic biliary cancer receiving HER2-targeted treatment with pertuzumab + trastuzumab. Methods: MyPathway (NCT02091141) is an open-label, multicenter, phase IIA study. Patients in this subset analysis had refractory metastatic biliary cancer with HER2 amplification/overexpression or putative activating mutations by gene sequencing, FISH, or IHC. Patients received standard doses of pertuzumab + trastuzumab until disease progression or unacceptable toxicity. The primary endpoint is investigator-assessed overall response rate (RECIST v1.1). Results: As of July 31, 2016, 11 patients with HER2-positive biliary cancer (HER2-amplified/overexpressed, n = 8; HER2-mutated, n = 3 [D277Y, S310F, and A775-G776insYVMA]) have been enrolled. At a median follow-up of 4.2 (range 2.0–12.0) months, 4 patients had partial responses (PR) and 3 had stable disease (SD) for > 4 months (Table). Safety was consistent with the package inserts. Conclusions: Preliminary results indicate that pertuzumab + trastuzumab has activity in HER2 amplified/overexpressed/mutated metastatic biliary tumors, suggesting HER2 as a therapeutic target for these rare cancers. Accrual to MyPathway is ongoing. Clinical trial information: NCT02091141. [Table: see text]
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Affiliation(s)
- Milind M. Javle
- Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John D. Hainsworth
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | | | - Howard A. Burris
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Razelle Kurzrock
- Moores Cancer Center, University of California, San Diego, San Diego, CA
| | | | | | - David R. Spigel
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Ron Bose
- Washington University School of Medicine, St. Louis, MO
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29
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Hurwitz H, Raghav KPS, Burris HA, Kurzrock R, Sweeney C, Meric-Bernstam F, Vanderwalde AM, Spigel DR, Bose R, Fakih M, Swanton C, Guo S, Bernaards C, Beattie MS, Sommer N, Hainsworth JD. Pertuzumab + trastuzumab for HER2-amplified/overexpressed metastatic colorectal cancer (mCRC): Interim data from MyPathway. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.676] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
676 Background: Among recent advances in precision medicine, HER2 has emerged as a potential therapeutic target for advanced colon cancer. MyPathway is a multi-basket study evaluating the efficacy and safety of targeted therapies in non-indicated tumor types harboring relevant genetic alterations. We present updated data for an expanded cohort of patients with HER2-amplified/overexpressed mCRC receiving HER2-targeted therapy with pertuzumab + trastuzumab. Methods: MyPathway (NCT02091141) is a multicenter, open-label, phase IIA study. Patients in this analysis had treatment-refractory HER2-amplified/overexpressed mCRC by gene sequencing, FISH, or IHC. Patients received standard doses of pertuzumab + trastuzumab until disease progression or unacceptable toxicity. The primary endpoint is investigator-assessed overall response rate. The cutoff date was July 31, 2016. Results: Of 34 patients with mCRC enrolled, 32 have had ≥1 tumor assessment. At a median follow-up of 5.2 (range 0.7–18.3) months from treatment initiation, 12 patients had partial responses (PR), with stable disease (SD) for >4 months in 3 additional patients (Table). The safety profiles were consistent with the product labels. Conclusions: Interim data show that HER2-targeted therapy with pertuzumab + trastuzumab, a chemotherapy-free regimen, is active in heavily pretreated HER2-amplified/overexpressed mCRC. The ORR was 37.5%, responses were durable (median 11.1 months), and the CBR was 46.9%. Accrual to MyPathway is ongoing. Clinical trial information: NCT02091141. [Table: see text]
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Affiliation(s)
| | | | - Howard A. Burris
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Razelle Kurzrock
- Moores Cancer Center, University of California, San Diego, San Diego, CA
| | | | | | | | - David R. Spigel
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
| | - Ron Bose
- Washington University School of Medicine, St. Louis, MO
| | - Marwan Fakih
- City of Hope National Medical Center, Duarte, CA
| | | | | | | | | | | | - John D. Hainsworth
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
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30
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Pal SK, Drabkin HA, Reeves JA, Hainsworth JD, Hazel SE, Paggiarino DA, Wojciak J, Woodnutt G, Bhatt RS. A phase 2 study of the sphingosine-1-phosphate antibody sonepcizumab in patients with metastatic renal cell carcinoma. Cancer 2016; 123:576-582. [PMID: 27727447 DOI: 10.1002/cncr.30393] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 08/30/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Upregulation of sphingosine-1-phosphate (S1P) may mediate resistance to vascular endothelial growth factor (VEGF)-directed therapies and inhibit antitumor immunity. Antagonism of S1P in preclinical models appears to overcome this resistance. In this phase 2 study, the authors assessed the activity of sonepcizumab, a first-in-class inhibitor of S1P, in patients with metastatic renal cell carcinoma (mRCC) with a history of prior VEGF-directed therapy. METHODS Patients were required to have clear cell mRCC and to have received treatment with at least 1 prior VEGF-directed agent. Prior treatment with immunotherapeutic agents and ≤1 mammalian target of rapamycin inhibitors was permitted. The primary endpoint of the study was progression-free survival. Additional endpoints included response rate and safety, and overall survival (OS) performed post hoc. RESULTS A total of 40 patients were enrolled with a median of 3 prior therapies (range, 1-5 prior therapies), 78% of whom had intermediate-risk disease by second-line International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria. Although the current study did not achieve its primary endpoint based on the 2-month progression-free survival, a median OS of 21.7 months was observed. Four patients (10%) demonstrated a partial response, with a median duration of response of 5.9 months. No grade 3/4 treatment-related adverse events were observed in >5% of patients (adverse events were graded and recorded for each patient using Common Terminology Criteria for Adverse Events [version 4.0]); the most frequent grade 1/2 treatment-related adverse events were fatigue (30%), weight gain (18%), constipation (15%), and nausea (15%). Biomarker studies demonstrated an increase in S1P concentrations with therapy. Comprehensive genomic profiling of 3 patients with a clinical benefit of >24 months indicated von Hippel-Lindau (VHL) and polybromo-1 (PBRM1) alterations. CONCLUSIONS The encouraging OS and favorable safety profile observed with sonepcizumab should prompt further investigation of the agent in combination with VEGF-directed agents or checkpoint inhibitors. Cancer 2017;123:576-582. © 2016 American Cancer Society.
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Affiliation(s)
- Sumanta K Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Harry A Drabkin
- Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | | | | | | | | | | | - Rupal S Bhatt
- Department of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Vogelzang NJ, Fizazi K, Burke JM, De Wit R, Bellmunt J, Hutson TE, Crane E, Berry WR, Doner K, Hainsworth JD, Wiechno PJ, Liu K, Waldman MF, Gandhi A, Barton D, Jungnelius U, Fandi A, Sternberg CN, Petrylak DP. Circulating Tumor Cells in a Phase 3 Study of Docetaxel and Prednisone with or without Lenalidomide in Metastatic Castration-resistant Prostate Cancer. Eur Urol 2016; 71:168-171. [PMID: 27522164 DOI: 10.1016/j.eururo.2016.07.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 12/31/2015] [Accepted: 07/29/2016] [Indexed: 01/29/2023]
Abstract
Elevated circulating tumor cell (CTC) blood levels (≥5 cells/7.5ml) convey a negative prognosis in metastatic castration-resistant prostate cancer but their prognostic significance in patients receiving chemotherapy is uncertain. The association between CTC counts (at baseline or after treatment), overall survival (OS), and response to docetaxel with lenalidomide was evaluated in a 208-patient subset from the MAINSAIL trial, which compared docetaxel-prednisone-lenalidomide and docetaxel-prednisone-placebo in metastatic castration-resistant prostate cancer patients. Baseline CTCs were <5 cells/7.5ml blood in 87 (42%) patients and ≥5 cells/7.5ml in 121 (58%) patients. Neither tumor response nor prostate-specific antigen response correlated with baseline CTCs. However, CTC count ≥5 cells/7.5ml was significantly associated with lower OS (hazard ratio: 3.23, p = 0.0028). Increases in CTCs from <5 cells/7.5ml to ≥5 cells/7.5ml after three cycles were associated with significantly shorter OS (hazard ratio: 5.24, p=0.025), whereas CTC reductions from ≥5 cells/7.5ml to <5 cells/7.5ml were associated with the best prognosis (p=0.003). PATIENT SUMMARY Our study in metastatic castration-resistant prostate cancer patients treated with docetaxel chemotherapy, with or without lenalidomide, showed that patient survival was best predicted by circulating tumor cell count at the start of treatment. A rising circulating tumor cell count after three cycles of therapy predicted poor survival, while a decline predicted good survival.
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Affiliation(s)
- Nicholas J Vogelzang
- US Oncology Research, Houston, TX, USA; Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA.
| | - Karim Fizazi
- Institut Gustave Roussy, Department of Cancer Medicine, University of Paris Sud, Villejuif, France
| | - John M Burke
- US Oncology Research, Houston, TX, USA; Rocky Mountain Cancer Centers, Aurora, CO, USA
| | - Ronald De Wit
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joaquim Bellmunt
- University Hospital del Mar-IMIM, Barcelona, Spain; Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas E Hutson
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, Dallas, TX, USA
| | - Edward Crane
- Oncology Hematology Care, Inc., Cincinnati, OH, USA
| | - William R Berry
- US Oncology, Cancer Centers of North Carolina, Raleigh, NC, USA
| | | | | | - Pawel J Wiechno
- Department of Uro-Oncology, Centrum Onkologii - Instytut im Marii Sklodowskiej-Curie, Warsaw, Poland
| | | | | | | | | | | | | | - Cora N Sternberg
- San Camillo and Forlanini Hospitals, Department of Medical Oncology, Rome, Italy
| | - Daniel P Petrylak
- Yale Cancer Center, Department of Medicine Division of Oncology, New Haven, CT, USA
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Hainsworth JD, Meric-Bernstam F, Swanton C, Hurwitz H, Spigel DR, Sweeney C, Burris HA, Bose R, Guo S, Bernaards C, Beattie MS, Stein A, Brammer M, Kurzrock R. Targeted therapy for advanced solid tumors based on molecular profiles: Early results from MyPathway, an open-label, phase IIa umbrella basket study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.18_suppl.lba11511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
LBA11511 Background: The MyPathway study (NCT02091141) evaluates agents targeting the HER2, BRAF, Hedgehog (Hh), or EGFR pathways in non-indicated tumors with relevant genetic abnormalities. Early results from MyPathway merit pre-planned tumor-cohort expansion. Methods: Eligible pts had advanced solid tumors with no curative therapy and molecular alterations in HER2, BRAF, Hh, or EGFR. Pts received standard doses of trastuzumab + pertuzumab (for the HER2 pathway), vemurafenib (BRAF), vismodegib (Hh), or erlotinib (EGFR) based on alteration. The primary endpoint is investigator-evaluated response rate within a tumor-pathway cohort (RECIST 1.1). Cohort size and expansion is determined by Simon’s two-stage design criteria. Results: By December 14, 2015, MyPathway included 129 pts with available baseline assessments and alterations in HER2 (n = 82; 53 amplifications, 23 mutations, 5 both, 1 RBMS-NRG1 fusion), BRAF (n = 33; 18 V600E, 15 other), Hh (n = 8; 7 PTCH1, 1 SMO), or EGFR (n = 6). Pts had a median of 3 (range, 0–10) prior lines of therapy. Best responses (n = 118) are shown below; 11 pts had insufficient follow-up for reevaluation and were not analyzed. 22 pts had PR/CR (1 CR); current response durations were up to 11 months. Conclusions: Targeted therapy produced responses in pts with 9 different tumor types outside of current drug indications. As enrollment increases for all tumor-pathway cohorts, analyses of tumor responses based on specific alterations (eg, HER2 amplifications vs. mutations) are planned. The HER2 amplified colorectal, bladder, and biliary, and the BRAF lung cohorts will be expanded based on observed activity. Clinical trial information: NCT02091141. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - Ron Bose
- Washington University School of Medicine, St. Louis, MO
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Shipley D, Waterhouse DM, Jones SF, Stults DM, Ward PJ, Shih KC, Hemphill MB, McCleod M, Whorf RC, Page RD, Stilwell J, Mekhail T, Anderson K, Jacobs C, Hainsworth JD, Spigel DR. The Spruce clinical trial: Double-blind randomized phase II trial of carboplatin and pemetrexed +/- apatorsen in patients with previously untreated stage IV non-squamous non-small-cell lung cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dianna Shipley
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | - Patrick J. Ward
- Oncology Hematology Care/Sarah Cannon Research Institute, Cincinnati, OH
| | - Kent C. Shih
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | | | - Michael McCleod
- Florida Cancer Specialists/Sarah Cannon Research Institute, Ft Myer, FL
| | - Robert C. Whorf
- Florida Cancer Specialists/Sarah Cannon Research Institute, Bradenton, FL
| | - Ray D. Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
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Hainsworth JD, Meric-Bernstam F, Swanton C, Hurwitz H, Spigel DR, Sweeney C, Burris HA, Bose R, Guo S, Bernaards C, Beattie MS, Stein A, Brammer M, Kurzrock R. Targeted therapy for advanced solid tumors based on molecular profiles: Early results from MyPathway, an open-label, phase IIa umbrella basket study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.lba11511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Ron Bose
- Washington University School of Medicine, St. Louis, MO
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Hainsworth JD, Reeves JA, Mace JR, Crane EJ, Hamid O, Stille JR, Flynt A, Roberson S, Polzer J, Arrowsmith ER. A Randomized, Open-Label Phase 2 Study of the CXCR4 Inhibitor LY2510924 in Combination with Sunitinib Versus Sunitinib Alone in Patients with Metastatic Renal Cell Carcinoma (RCC). Target Oncol 2016; 11:643-653. [DOI: 10.1007/s11523-016-0434-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Hainsworth JD, Anthony Greco F. Lung Adenocarcinoma with Anaplastic Lymphoma Kinase (ALK) Rearrangement Presenting as Carcinoma of Unknown Primary Site: Recognition and Treatment Implications. Drugs Real World Outcomes 2016; 3:115-120. [PMID: 27747807 PMCID: PMC4819469 DOI: 10.1007/s40801-016-0064-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Molecular cancer classifier assays are being used with increasing frequency to predict tissue of origin and direct site-specific therapy for patients with carcinoma of unknown primary site (CUP). Objective We postulated some CUP patients predicted to have non-small-cell lung cancer (NSCLC) by molecular cancer classifier assay may have anaplastic lymphoma kinase (ALK) rearranged tumors, and benefit from treatment with ALK inhibitors. Methods We retrospectively reviewed CUP patients who had the 92-gene molecular cancer classifier assay (CancerTYPE ID; bioTheranostics, Inc.) performed on tumor biopsies to identify patients predicted to have NSCLC. Beginning in 2011, we have tested these patients for ALK rearrangements and epidermal growth factor receptor (EGFR) activating mutations, based on the proven therapeutic value of these targets in NSCLC. We identified CUP patients with predicted NSCLC who were subsequently found to have ALK rearrangements. Results NSCLC was predicted by the molecular cancer classifier assay in 37 of 310 CUP patients. Twenty-one of these patients were tested for ALK rearrangements, and four had an EML4-ALK fusion gene detected. The diagnosis of lung cancer was strongly suggested in only one patient prior to molecular testing. One patient received ALK inhibitor treatment and has had prolonged benefit. Conclusions We report on patients with lung adenocarcinoma and ALK rearrangements originally diagnosed as CUP who were identified using a molecular cancer classifier assay. Although ALK inhibitors treatment experience is limited, this newly identifiable group of lung cancer patients should be considered for therapy according to guidelines for stage IV ALK-positive NSCLC.
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Affiliation(s)
- John D Hainsworth
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, 3322 West End Avenue, Suite 900, Nashville, TN, 37203, USA.
| | - F Anthony Greco
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, 3322 West End Avenue, Suite 900, Nashville, TN, 37203, USA
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Yardley DA, Chandra P, Hart L, Wright GS, Ward P, Mani A, Shastry M, Finney L, Guo S, DeBusk LM, Hainsworth JD, Burris III HA. Abstract P1-14-06: A phase II randomized study with eribulin/cyclophosphamide (ErC) and docetaxel/cyclophosphamide (TC) as neoadjuvant therapy in HER2-negative breast cancer- Final analysis of primary endpoint and correlative analysis results. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: Eribulin mesylate (Er) is a non-taxane inhibitor of microtubule growth that results in G2-M cell cycle arrest, disruption of normal mitotic spindles and apoptosis. Er demonstrated an overall survival (OS) but not progression free survival (PFS) advantage in anthracycline and taxane refractory breast cancer pts. This OS rather than PFS benefit has been attributed to Er's potential to suppress new metastases through its effects on the epithelial mesenchymal transition (EMT) pathway, even in the absence of an effect on the primary tumor or established metastases. In this study ErC was compared to TC, a standard regimen for (neo) adjuvant treatment. A companion exploratory analysis examined the EMT markers E-cadherin and vimentin, as well as the endothelial marker CD-31 assessing tumor vasculature. Final assessments of the primary endpoint of pathological complete response (pCR) and results of the correlative studies will be presented.
Methods: Women with histologically confirmed invasive HER2-negative (IHC 0-1+ or FISH/SISH negative), cT1-3, cN0-2, M0 (pN3a disease allowed) adenocarcinoma of the breast were eligible. Following a 10 pt lead-in to confirm the safety/feasibility of ErC, pts were randomized 2:1. Arm 1, Er 1.4 mg/m2 IV (Days 1 & 8) and C 600 mg/m2 IV (Day 1); Arm 2, T 75 mg/m2 IV and C 600 mg/m2 IV on Day 1, both regimens administered q 21 days x 6 cycles followed by surgery. Tumor samples were collected at baseline and from residual breast cancer at the time of surgery. Samples were assayed for E-cadherin, vimentin, and CD-31 expression by immunohistochemistry.
Results: Enrollment was completed 4/2014 (76 pts); 10 pts in lead-in phase, 66 pts were randomized (Arm 1, 44; Arm 2, 22). In the randomized population, 77% had invasive ductal adenocarcinoma; median tumor size 3.1 cm (range, 0.4-10cm; 29.5% were T3); axillary nodes clinically positive in 52%. 34% of pts were triple negative (TN). 59 pts (89%) underwent surgery after receiving neoadjuvant chemotherapy (NAC) on study. pCR rates were 9% and 18% on the TC and ErC arms respectively. 4/7 pts with pCR on the ErC arm were TN. tumor samples were analyzed from 69 pts (including lead-in pts) for expression of the EMT biomarkers. Of these, 40 pts had paired pre- and post-treatment samples, and 29 pts had either a pre- or post-treatment sample (including 8 pre-treatment samples from pts who achieved pCR). In pre-treatment tumor specimens (61 samples), E-cadherin levels were modest-high in 80%, vimentin expression was seen in 39%, and CD-31 expression observed in 21% of the samples. Analysis of pre- and post-treatment paired specimens and differential effects according to treatment regimen will be presented.
Conclusion: The observed pCR rate of 18% with ErC in this HER2- pt population was comparable with other NAC regimens. Correlative evaluation of EMT markers and tumor vascular density with response is ongoing and will be presented.
Citation Format: Yardley DA, Chandra P, Hart L, Wright GS, Ward P, Mani A, Shastry M, Finney L, Guo S, DeBusk LM, Hainsworth JD, Burris III HA. A phase II randomized study with eribulin/cyclophosphamide (ErC) and docetaxel/cyclophosphamide (TC) as neoadjuvant therapy in HER2-negative breast cancer- Final analysis of primary endpoint and correlative analysis results. [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 P1-14-06.
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Affiliation(s)
- DA Yardley
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - P Chandra
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - L Hart
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - GS Wright
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - P Ward
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - A Mani
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - M Shastry
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - L Finney
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - S Guo
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - LM DeBusk
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - JD Hainsworth
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
| | - HA Burris III
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; PathGroup, Brentwood, TN; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, New Port Richey, FL; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Memorial Cancer Institute, Hollywood, FL; Sarah Cannon Research Institute, Nashville, TN
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Yardley DA, Peacock N, Shroff S, Molthrop DC, Anz B, Daniel BR, Young RR, Weaver R, Harwin W, Webb CD, Ward P, Shastry M, DeBusk LM, Midha R, Hainsworth JD, Burris III HA. Abstract P1-12-04: A phase 2 study of eribulin in breast cancer not achieving a pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-12-04] [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: Residual breast cancer after NAC is associated with a high risk of recurrence. Little evidence supports the use of further chemotherapy in this setting. Eribulin, an inhibitor of microtubule dynamics, demonstrated a survival advantage in patients with metastatic breast cancer who had progressed after previous anthracycline and taxane therapy. This phase 2 trial assessed the efficacy of eribulin (2-yr disease-free survival) administered postoperatively to breast cancer pts not achieving a pCR following standard NAC.
Methods: Women with invasive breast cancer (stage T1-4b, N0-2, M0 at diagnosis) and evidence of residual cancer (>5 mm) in the breast or axillary lymph nodes (LN) following ≥4 cycles of standard anthracycline and/or taxane-containing NAC were eligible. Additional eligibility criteria: age ≥18 yrs, peripheral neuropathy < 1, adequate hematologic, hepatic, and renal function. 3 groups were studied: Cohort A-triple negative (TN), Cohort B-HR+/HER2-, Cohort C-HER2+. After recovery from definitive surgery, all pts received eribulin mesylate 1.4mg/m2 IV on days 1 and 8 every 21 days for 6 cycles. Cohort C pts also received trastuzumab 6mg/kg IV day 1 every 21 days for a total of 1 yr from start of NAC. Adjuvant hormonal therapy and loco-regional radiotherapy were administered per institutional guidelines. We hypothesized post-operative eribulin would result in a 40% increase over the reported 40% 2 yr DFS for TN, and a 15% increase over the reported 80% 2 yr DFS for HR+/HER2- pts who did not achieve pCR following standard NAC.
Results: 127 pts were enrolled (54, Cohort A; 42, Cohort B; 31, Cohort C). Pts on Cohort C continue with study treatment. Here, we present the results of 95 pts treated on Cohorts A and B. Median age-52 yrs (range, 27-74). 87 pts (92%) had invasive ductal adenocarcinoma, 6 (6%) invasive lobular, 1 (1%) mucinous, and 1 (1 %) unknown; 34 pts (36%) had T3 or T4 tumors and 65 (68%) had N1-2 disease at diagnosis. NAC with anthracyclines was administered to 74 pts (78%), taxanes to 88 (93%), and 72 (76%) received both. 71 pts (75%) had mastectomies, 24 (25%) had breast conserving surgery. Median residual tumor was 17.5 mm (range 0.1 to 80); 60 pts (63%) were LN+. 78 pts (81%) completed the planned 6 cycles of eribulin. Adjuvant radiation was administered in 28 pts (30%). 3 pts discontinued treatment due to toxicity (1 each with G3 neutropenia, G3 nausea, and unknown grade neuropathy). The most common treatment-related G3/4 adverse events were neutropenia [29 pts (31%)] and leukopenia [10 pts (11%)]. 3 pts (3%) had G3/4 febrile neutropenia and 2 pts (2%) had G3/4 neuropathy. Growth factors were administered to 22 pts (24%). There were no treatment-related deaths. With a median follow up of 19.2 and 14.9 months for Cohorts A and B respectively, the 2 yr DFS probabilities calculated from date of surgery were 61.1 % (95% CI-41.2-76.0) for Cohort A; 82.2% (95% CI-60.2-92.7) for Cohort B.
Conclusions: The addition of eribulin is safe and feasible in pts who do not achieve pCR following anthracycline and/or taxane based NAC. At a median follow up of 19.2 months, a statistically significant improvement in the estimated 2 yr DFS was evident in the TN (Cohort A) pts.
Citation Format: Yardley DA, Peacock N, Shroff S, Molthrop, Jr DC, Anz B, Daniel BR, Young RR, Weaver R, Harwin W, Webb CD, Ward P, Shastry M, DeBusk LM, Midha R, Hainsworth JD, Burris III HA. A phase 2 study of eribulin in breast cancer not achieving a pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC). [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 P1-12-04.
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Affiliation(s)
- DA Yardley
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - N Peacock
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - S Shroff
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - DC Molthrop
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - B Anz
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - BR Daniel
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - RR Young
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - R Weaver
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - W Harwin
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - CD Webb
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - P Ward
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - M Shastry
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - LM DeBusk
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - R Midha
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - JD Hainsworth
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
| | - HA Burris III
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; Florida Hospital Cancer Institute, Orlando, FL; Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Chattanooga, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Sarah Cannon Research Institute/Florida Cancer Specialists, St Petersburg, FL; Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, FL; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute/Oncology Hematology Care, Inc, Cincinnati, OH; Sarah Cannon Research Institute, Nashville, TN
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Yardley DA, Peacock N, Young RR, Silber A, Chung G, Webb CD, Jones SF, Shastry M, Midha R, DeBusk LM, Hainsworth JD, Burris HA. Abstract P5-14-04: A phase 2 study evaluating orteronel, an inhibitor of androgen biosynthesis, in patients with androgen receptor (AR)-expressing metastatic breast cancer: Interim analysis. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-14-04] [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: The frequency of AR expression varies in the different breast cancer subtypes with 88%, 59%, and 32% expression reported in ER+, HER2+, and triple negative tumors, respectively. AR expression is associated with resistance to endocrine therapy in ER+ breast cancer. Androgen levels frequently increase following treatment with aromatase inhibitors suggesting a role for androgen synthesis inhibitors in ER+ breast cancer. AR signaling and expression are seen in triple negative breast cancer (TNBC), and a distinct AR TNBC subtype can be identified by gene expression profiling. AR expression in TNBC offers a potential therapeutic target. Preclinical and clinical studies demonstrated anti-androgen agent activity in breast cancer cell lines; preliminary clinical data suggests activity in TNBC. Orteronel is a novel, oral, selective, nonsteroidal inhibitor of 17, 20-lyase, a key enzyme in androgen biosynthesis that is being evaluated as endocrine therapy in various hormone-sensitive cancers. In this phase 2 study we are evaluating single agent orteronel in AR+ MBC.
Methods: Pts with AR expressing MBC (≥10% staining by central immunohistochemistry) were eligible. Pts were grouped into 2 cohorts for analysis: Cohort 1-TNBC and Cohort 2-ER+ (HER2 could be +/- in this cohort). Pts must have been previously treated with standard therapy for MBC (1-3 chemotherapy regimens for TNBC, 1-3 hormonal therapies + 1 chemotherapy for ER+ patients, ≥2 HER2-targeted regimens for HER2+ patients). A 6 pt lead-in for safety and tolerability of orteronel in AR+ female MBC pts was followed by open enrollment to either cohort. All pts received 300 mg orteronel PO BID over a 4 week cycle and underwent response assessment every 2 cycles. Treatment was continued until disease progression or unacceptable toxicity. The hypothesized response rate for Cohort 1 was 10% and 13% for Cohort 2. We present the results of a protocol-specified interim analysis of the ER+ MBC pts (Cohort 2).
Results: From 3/2014 to 4/2015, a total of 29 pts were enrolled on cohort 2. Median age was 65 years (range, 39-79); 90% ECOG ≤1; 90% HER2-/10% HER2+; median of 7 prior therapies (range 3-11). 93% had prior chemotherapy. Pts received a median of 2 cycles of orteronel treatment (range 1-4) and 3 pts (10%) are still on treatment. Of the 26 pts (90%) pts that have discontinued, 19 (66%) discontinued due to disease progression, 4 (14%) due to pt decision, 2 (7%) due to adverse event (AE), and 1 (3%) due to non-compliance. The most common treatment-related G 3/4 AEs were increased lipase [3 pts (10%)] and hypertension [2 pts (7%)]. There were no treatment-related SAEs or deaths on study. Three pts (10%) had stable disease as their best response. Further response evaluation is underway.
Conclusions: Orteronel monotherapy was well tolerated but appears to have limited single-agent activity in this heavily pre-treated ER+ MBC pt population. The full results from this interim analysis will be presented.
Citation Format: Yardley DA, Peacock N, Young RR, Silber A, Chung G, Webb CD, Jones SF, Shastry M, Midha R, DeBusk LM, Hainsworth JD, Burris HA. A phase 2 study evaluating orteronel, an inhibitor of androgen biosynthesis, in patients with androgen receptor (AR)-expressing metastatic breast cancer: Interim analysis. [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 P5-14-04.
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Affiliation(s)
- DA Yardley
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - N Peacock
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - RR Young
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - A Silber
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - G Chung
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - CD Webb
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - SF Jones
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - M Shastry
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - R Midha
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - LM DeBusk
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - JD Hainsworth
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
| | - HA Burris
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN; The Center for Cancer and Blood Disorders, Fort Worth, TX; Yale School of Medicine, New Haven, CT; Baptist Health Louisville, Louisville, KY; Sarah Cannon Research Institute, Nashville, TN
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Yardley DA, Dickson N, Drosick D, Earwood C, Inhorn R, Murphy P, Hainsworth JD. Sorafenib Plus Ixabepilone as First-Line Treatment of Metastatic HER2-Negative Breast Cancer: A Sarah Cannon Research Institute Phase I/II Trial. Clin Breast Cancer 2016; 16:180-7. [PMID: 26943991 DOI: 10.1016/j.clbc.2016.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 09/23/2015] [Revised: 12/23/2015] [Accepted: 02/03/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The purposes of the present phase I/II trial were (1) to define tolerable doses of ixabepilone and sorafenib when used in combination and (2) to evaluate the efficacy and toxicity of this combination in the treatment of patients with human epidermal growth factor receptor-negative metastatic breast cancer (MBC). PATIENTS AND METHODS The eligible patients had human epidermal growth factor receptor-negative MBC and had not received previous chemotherapy in the metastatic setting. All patients received ixabepilone intravenously on day 1 of each 21-day treatment cycle; sorafenib was administered orally twice daily. Patients in phase II received the maximum doses identified in phase I. The patients were reevaluated after the completion of 3 treatment cycles; treatment continued until disease progression or intolerable toxicity. A total of 67 patients were required in phase II to demonstrate increased median progression-free survival from 4.2 to 6.2 months (90% power, α = 0.05). RESULTS Ten patients entered the phase I portion; the maximum tolerated doses were ixabepilone 32 mg/m(2) and sorafenib 400 mg orally twice daily. A total of 76 patients were treated at the phase II dose. The median progression-free survival was 4.8 months (95% confidence interval, 3.5-6.3 months). The overall response rate was 37%. The regimen was difficult to tolerate for many patients; 20 patients discontinued because of toxicity, and dose reductions were frequent. The common toxicities included neutropenia, fatigue, rash, and neuropathy. CONCLUSION The combination of ixabepilone and sorafenib was poorly tolerated as first-line treatment of patients with MBC. The activity of the combination was similar to the activity previously reported with single-agent ixabepilone or taxanes. Further development of this combination is not recommended.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN.
| | | | | | | | | | | | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN
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Bose R, Ali S, Jain N, Gowen K, Bertotti A, Murray E, Ross JS, Beattie MS, Hurwitz H, Hainsworth JD. Frequency of HER2 mutations and amplification in GI malignancies and ability of pertuzumab to overcome neuregulin1 mediated drug resistance to a HER2 tyrosine kinase inhibitor in colon cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.630] [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: 11/20/2022] Open
Abstract
630 Background: HER2 amplifications and activating mutations are an emerging drug target in the treatment of colorectal cancer (CRC). Ongoing studies, such as MyPathway (Clinicaltrials.gov NCT02091141), include basket trials of targeted therapies for multiple solid tumor types. The frequency of HER2 mutations in GI cancers and a drug resistance mechanism to the HER2 kinase inhibitor, afatinib, are presented here. Methods: The Foundation Medicine database of 53,126 cases was searched and clinical data from patients with GI tumors enrolled in the HER2 basket of MyPathway was included. Results: 10,358 patients with GI cancers and FoundationOne (FO) testing were identified and compared to the HER2 mutation frequency reported by The Cancer Genome Atlas (TCGA). In MyPathway, 28 GI tumors with HER2 alterations are enrolled: CRC (n = 13, all amplified), liver/biliary (n = 5), pancreatic (n =4), small intestine (n = 3), and esophageal (n = 2). Several CRC patients demonstrated responses to trastuzumab/pertuzumab (reported separately). The HER2 mutant CRC cell lines, CW-2 and CCK-81, are highly sensitive to afatinib (IC50=7-20 nM). Addition of the HER3 ligand, neuregulin1 caused afatinib resistance, but pertuzumab prevented HER3/HER2 activation and reversed this drug resistance. Conclusions: HER2 mutations or amplifications are commonly found in a wide range of GI cancers. Pre-clinical data provide rationale for inclusion of pertuzumab in the treatment strategy for these cancers. The MyPathway Trial is testing this approach. [Table: see text]
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Affiliation(s)
- Ron Bose
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Siraj Ali
- Foundation Medicine, Inc., Cambridge, MA
| | - Naveen Jain
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kyle Gowen
- Foundation Medicine, Inc., Cambridge, MA
| | - Andrea Bertotti
- Istituto di Candiolo, Fondazione del Piemonte per l'Oncologia, IRCCS, Candiolo, Italy
| | - Elisa Murray
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | - John D. Hainsworth
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
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Hurwitz H, Hainsworth JD, Swanton C, Perez EA, Sweeney C, Burris HA, Spigel D, Meric-Bernstam F, Strickland DK, Leon L, Brammer M, Beattie MS, Bose R. Targeted therapy for gastrointestinaI (GI) tumors based on molecular profiles: Early results from MyPathway, an open-label phase IIa basket study in patients with advanced solid tumors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.653] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
653 Background: Next-generation sequencing often reveals potentially actionable molecular alterations; however, data on approved targeted therapies in non-indicated tumors are limited. MyPathway (NCT02091141) evaluates agents targeting the HER2, EGFR, BRAF, or Hedgehog (Hh) pathways in tumors for which these therapies are not currently indicated. Here, we present early response data for patients with GI tumors. Methods: Eligible patients had metastatic tumors with potentially actionable genomic alterations, identified by a CLIA-certified lab, and progression on standard therapy. Based on the identified alteration, patients received standard doses of trastuzumab + pertuzumab (HER2), erlotinib (EGFR), vemurafenib (BRAF), or vismodegib (Hh). Response was evaluated by the investigator using RECIST v1.1. Results: As of Aug 21, 2015, 96 patients had enrolled, 36 of whom (38%) had GI tumors with the following alterations: HER2 (n=28 [22 amplifications, 5 activating mutations, 1 both]), BRAF (n=4), Hh (n=2 [2 PTCH-1 mutations]), and EGFR (n=2). Patients had a median of 4 (range, 1–8) prior lines of therapy. Tumor types and interim best response data are shown below. Among all evaluable patients with GI tumors (n=26), 5 have had a PR to targeted therapy (duration 3–10+ months). Conclusions: Targetable molecular alterations were found in a variety of GI tumors, resulting in clinical benefit from targeted treatments that would not have otherwise been realized. These early results support this molecular testing strategy. Accrual to the trial continues; based on activity observed, the HER2-positive colorectal cancer cohort will be expanded to ≥30 patients. Additional data will be presented at the meeting. Clinical trial information: NCT02091141. [Table: see text]
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Affiliation(s)
| | - John D. Hainsworth
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
| | - Charles Swanton
- Sarah Cannon Research Institute, University College London Cancer Institute, London, England
| | | | | | - Howard A. Burris
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
| | - David Spigel
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN
| | | | | | - Larry Leon
- Genentech, Inc., South San Francisco, CA
| | | | | | - Ron Bose
- Washington University School of Medicine in St. Louis, St. Louis, MO
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Greco FA, Lennington WJ, Spigel DR, Hainsworth JD. Poorly differentiated neoplasms of unknown primary site: diagnostic usefulness of a molecular cancer classifier assay. Mol Diagn Ther 2016; 19:91-7. [PMID: 25758902 DOI: 10.1007/s40291-015-0133-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Definition of the lineage of poorly differentiated neoplasms (PDNs) presenting as cancer of unknown primary site (CUP) is important since many of these tumors are treatment-sensitive. Gene expression profiling and a molecular cancer classifier assay (MCCA) may provide a new method of diagnosis when standard pathologic evaluation and immunohistochemical (IHC) staining is unsuccessful. PATIENTS AND METHODS Thirty of 751 CUP patients (4%) seen from 2000-2012 had PDNs without a definitive lineage diagnosed by histology or IHC (median 18 stains, range 9-46). Biopsies from these 30 patients had MCCA (92-gene reverse transcriptase-polymerase chain reaction mRNA) performed. Additional IHC, gene sequencing, fluorescent in situ hybridization for specific genetic alterations, and repeat biopsies were performed to support MCCA diagnoses, and clinical features correlated. Seven patients had MCCA performed initially and received site-specific therapy. RESULTS Lineage diagnoses were made by MCCA in 25 of 30 (83 %) patients, including ten carcinomas (three germ cell, two neuroendocrine, five others), eight sarcomas [three peritoneal mesotheliomas, one primitive neuroectodermal tumor (PNET), four others], five melanomas, and two lymphomas. Additional IHC and genetic testing [BRAF, i(12)p] supported the MCCA diagnoses in 11 of 16 tumors. All seven patients (two germ cell, two neuroendocrine, two mesothelioma, one lymphoma) responded to site-specific therapy based on the MCCA diagnosis, and remain alive (five progression-free) from 25+ to 72+ months. CONCLUSION The MCCA provided a specific lineage diagnosis and tissue of origin in most patients with PDNs unclassifiable by standard pathologic evaluation. Earlier use of MCCA will expedite diagnosis and direct appropriate first-line therapy, which is potentially curative for several of these tumor types.
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Affiliation(s)
- F Anthony Greco
- Sarah Cannon Research Institute and Cancer Center, Tennessee Oncology, PLLC, Suite 100, 250 25th Avenue North, Nashville, TN, 37203, USA,
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Strosberg JR, Yao JC, Bajetta E, Aout M, Bakker B, Hainsworth JD, Ruszniewski PB, Van Cutsem E, Öberg K, Pavel ME. Efficacy of octreotide long-acting repeatable in neuroendocrine tumors: RADIANT-2 placebo arm post hoc analysis. Endocr Relat Cancer 2015; 22:933-40. [PMID: 26373569 PMCID: PMC4609826 DOI: 10.1530/erc-15-0314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/18/2022]
Abstract
Somatostatin analogues (SSA) have demonstrated antiproliferative activity in addition to efficacy for carcinoid symptom control in functional neuroendocrine tumors (NET). A post hoc analysis of the placebo arm of the RAD001 In Advanced Neuroendocrine Tumors-2 (RADIANT-2) study was conducted to assess the efficacy of octreotide long-acting repeatable (LAR) on progression-free survival (PFS) and overall survival (OS) estimated using the Kaplan-Meier method. Out of 213 patients randomized to placebo plus octreotide LAR in RADIANT-2, 196 patients with foregut, midgut, or hindgut NET were considered for present analysis. Of these, 41 patients were SSA-treatment naïve and 155 had received SSA therapy before study entry. For SSA-naïve patients, median PFS by adjudicated central review was 13.6 (95% CI 8.2-22.7) months. For SSA-naïve patients with midgut NET (n=24), median PFS was 22.2 (95% CI 8.3-29.5) months. For patients who had received SSA previously, the median PFS was 11.1 (95% CI 8.4-14.3) months. Among the SSA-pretreated patients who had midgut NET (n=119), the median PFS was 12.0 (95% CI 8.4-19.3) months. Median OS was 35.8 (95% CI 32.5-48.9) months for patients in the placebo plus octreotide LAR arm; 50.6 (36.4 - not reached) months for SSA-naïve patients and 33.5 (95% CI 27.5-44.7) months for those who had received prior SSA. This post hoc analysis of the placebo arm of the large phase 3 RADIANT-2 study provides data on PFS and OS among patients with progressive NET treated with octreotide therapy.
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Affiliation(s)
- Jonathan R Strosberg
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - James C Yao
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Emilio Bajetta
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Mounir Aout
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Bert Bakker
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - John D Hainsworth
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Philippe B Ruszniewski
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Eric Van Cutsem
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Kjell Öberg
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Marianne E Pavel
- Department of MedicineMoffitt Cancer Center, Tampa, Florida, USADivision of Cancer MedicineDepartment of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAIstituto di OncologiaPoliclinico di Monza, Monza, ItalyNovartis International AGBasel, SwitzerlandNovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USASarah Cannon Research InstituteNashville, Tennessee, USAUniversity of Paris VII and Beaujon HospitalParis, FranceDigestive OncologyUniversity Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, BelgiumUppsala University HospitalUppsala, SwedenDepartment of Hepatology and GastroenterologyCharité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
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Yardley DA, Bosserman LD, O'Shaughnessy JA, Harwin WN, Morgan SK, Priego VM, Peacock NW, Bass JD, Burris HA, Hainsworth JD. Paclitaxel, bevacizumab, and everolimus/placebo as first-line treatment for patients with metastatic HER2-negative breast cancer: a randomized placebo-controlled phase II trial of the Sarah Cannon Research Institute. Breast Cancer Res Treat 2015; 154:89-97. [PMID: 26456573 DOI: 10.1007/s10549-015-3599-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/23/2015] [Accepted: 10/06/2015] [Indexed: 12/27/2022]
Abstract
Amplified PI3K/Akt/mTOR signaling is common in metastatic breast cancer (MBC). The mTOR inhibitor everolimus improves progression-free survival (PFS) when added to steroidal aromatase inhibitor therapy. This randomized phase II trial compares the efficacy of paclitaxel/bevacizumab/everolimus and paclitaxel/bevacizumab/placebo as first-line treatment for MBC. Patients with untreated HER2-negative MBC were randomized (1:1) to receive 28-day cycles of paclitaxel 90 mg/m(2) IV (days 1, 8, and 15) and bevacizumab 10 mg/kg IV (days 1, 15) with either everolimus 10 mg (Arm 1) or placebo (Arm 2) daily. Treatment continued (evaluation every 8 weeks) until progression or unacceptable toxicity. Treatment of 110 patients allowed detection of an improvement in median PFS from 11 to 16 months (70 % power, α = 0.10). Between August 2009 and June 2011, 113 patients (median age 58 years; 88 % ER or PR positive) were randomized (Arm 1, 56; Arm 2, 57). Patients in both arms received a median of six treatment cycles. Median PFS (95 % CI) was 9.1 months (6.8-18.8) for Arm 1, and 7.1 months (5.6-10.8) for Arm 2 (p = 0.89). Comparisons of other efficacy endpoints were also similar in the two treatment arms. Patients receiving everolimus had more anemia, stomatitis, diarrhea, rash, and arthralgia/myalgia, although the overall incidence of severe (grade 3/4) toxicity was similar. The addition of everolimus did not improve the efficacy of weekly paclitaxel/bevacizumab as first-line treatment for patients with HER2-negative MBC. These results contrast with the demonstrated efficacy of adding everolimus to either hormonal or HER2-targeted therapy in previously treated patients.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, 3322 West End Ave, Suite 900, Nashville, TN, 37203, USA. .,Tennessee Oncology, PLLC, 250 25th Avenue North, Nashville, TN, 37203, USA.
| | | | | | - William N Harwin
- Sarah Cannon Research Institute, 3322 West End Ave, Suite 900, Nashville, TN, 37203, USA.,Florida Cancer Specialists, Fort Myers, FL, USA
| | - Susan K Morgan
- Sarah Cannon Research Institute, 3322 West End Ave, Suite 900, Nashville, TN, 37203, USA.,Florida Cancer Specialists, Fort Myers, FL, USA
| | - Victor M Priego
- The Center for Cancer and Blood Disorders, Bethesda, MD, USA
| | - Nancy W Peacock
- Sarah Cannon Research Institute, 3322 West End Ave, Suite 900, Nashville, TN, 37203, USA.,Tennessee Oncology, PLLC, 250 25th Avenue North, Nashville, TN, 37203, USA
| | - J David Bass
- Sarah Cannon Research Institute, 3322 West End Ave, Suite 900, Nashville, TN, 37203, USA
| | - Howard A Burris
- Sarah Cannon Research Institute, 3322 West End Ave, Suite 900, Nashville, TN, 37203, USA.,Tennessee Oncology, PLLC, 250 25th Avenue North, Nashville, TN, 37203, USA
| | - John D Hainsworth
- Sarah Cannon Research Institute, 3322 West End Ave, Suite 900, Nashville, TN, 37203, USA. .,Tennessee Oncology, PLLC, 250 25th Avenue North, Nashville, TN, 37203, USA.
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Hainsworth JD, Arrowsmith ER, McCleod M, Hsi ED, Hamid O, Shi P, Lin BK, Fayad LE. A randomized, phase 2 study of R-CHOP plus enzastaurin vs R-CHOP in patients with intermediate- or high-risk diffuse large B-cell lymphoma. Leuk Lymphoma 2015; 57:216-8. [DOI: 10.3109/10428194.2015.1045898] [Citation(s) in RCA: 21] [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: 11/13/2022]
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Casulo C, Day B, Dawson KL, Zhou X, Flowers CR, Farber CM, Hainsworth JD, Cerhan JR, Link BK, Zelenetz AD, Friedberg JW. Disease characteristics, treatment patterns, and outcomes of follicular lymphoma in patients 40 years of age and younger: an analysis from the National Lymphocare Study†. Ann Oncol 2015; 26:2311-7. [PMID: 26362568 DOI: 10.1093/annonc/mdv375] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 04/15/2015] [Accepted: 09/04/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma, with median age at diagnosis in the seventh decade. FL in young adults (YAs), defined as diagnosis at ≤40 years, is uncommon. No standard approaches exist guiding the treatment of YA FL, and little is known about their disease characteristics and outcomes. To gain further insights into YA FL, we analyzed the National LymphoCare Study (NLCS) to describe characteristics, initial treatments, and outcomes in this population versus patients aged >40 years. PATIENTS AND METHODS Using the NLCS database, we stratified FL patients by age: 18-40 (YA), 41-60, 61-70, 71-80, and >80 years. Survival probability was estimated using Kaplan-Meier methodology. We examined associations between age and survival using hazard ratios and 95% confidence intervals (CIs) from multivariable Cox models. RESULTS Of 2652 eligible FL patients in the NLCS, 164 (6%) were YAs. Of YA patients, 69% had advanced disease, 80% had low-grade histology, and 50% had good-risk disease according to the Follicular Lymphoma International Prognostic Index (FLIPI). Nineteen percent underwent observation, 12% received rituximab monotherapy, and 46% received chemoimmunotherapy [in 59% of these: R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone)]. With a median follow-up of 8 years, overall survival (OS) at 2, 5, and 8 years was 98% (95% CI 93-99), 94% (95% CI 89-97), and 90% (95% CI 83-94), respectively. Median progression-free survival (PFS) was 7.3 years (95% CI 5.6-not reached). CONCLUSIONS In one of the largest cohorts of YA FL patients treated in the rituximab era, disease characteristics and outcomes were similar to patients aged 41-60 years, with favorable OS and PFS in YAs. Longer-term outcomes and YA-specific survivorship concerns should be considered when defining management. These data may not support the need for more aggressive therapies in YA FL. CLINICAL TRIAL NUMBER Roche/Genentech ML01377 (U2963n).
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Affiliation(s)
- C Casulo
- James P. Wilmot Cancer Center, University of Rochester, Rochester
| | - B Day
- Genentech, Inc., South San Francisco
| | | | - X Zhou
- RTI Health Solutions, Research Triangle Park, Durham
| | - C R Flowers
- Department of Medicine, Emory University, Atlanta
| | - C M Farber
- Carol G. Simon Cancer Center, Morristown
| | | | - J R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester
| | | | - A D Zelenetz
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - J W Friedberg
- James P. Wilmot Cancer Center, University of Rochester, Rochester
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Mudigonda TV, Wyman K, Spigel DR, Dahlman KB, Greco FA, Puzanov I, Kelley MC, Hainsworth JD, Sosman JA, Johnson DB. A phase II trial of erlotinib and bevacizumab for patients with metastatic melanoma. Pigment Cell Melanoma Res 2015; 29:101-3. [PMID: 26176864 DOI: 10.1111/pcmr.12394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tejaswi V Mudigonda
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth Wyman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David R Spigel
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN, USA
| | - Kimberly B Dahlman
- Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - F Anthony Greco
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN, USA
| | - Igor Puzanov
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mark C Kelley
- Division of Surgical Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John D Hainsworth
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Nashville, TN, USA
| | - Jeffrey A Sosman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Yardley DA, Zubkus JD, Eakle JF, Bechhold RG, Finney L, Daniel D, Daniel B, Hainsworth JD. Neoadjuvant Ixabepilone/Carboplatin/Trastuzumab in HER2-Positive Operable Breast Cancer: A Phase II Trial of the Sarah Cannon Research Institute. Clin Breast Cancer 2015; 15:251-8. [DOI: 10.1016/j.clbc.2014.09.007] [Citation(s) in RCA: 3] [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] [Received: 06/20/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
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Yardley DA, Shipley DL, Peacock NW, Shastry M, Midha R, Priego VM, Hainsworth JD. Phase I/II trial of neoadjuvant sunitinib administered with weekly paclitaxel/carboplatin in patients with locally advanced triple-negative breast cancer. Breast Cancer Res Treat 2015; 152:557-67. [PMID: 26155975 DOI: 10.1007/s10549-015-3482-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
The purpose of the study is to evaluate the feasibility and efficacy of adding sunitinib to paclitaxel/carboplatin in the neoadjuvant therapy of patients with triple-negative breast cancer (TNBC). Patients had histologically proven, previously untreated, triple-negative adenocarcinoma, with disease limited to the breast and axilla (clinical T1-T3, N0-N2, M0; T1N1M0 excluded). Following determination of the maximum tolerated doses in the phase I portion, patients in the phase II study received paclitaxel 70 mg/m(2) IV days 1, 8, and 15; carboplatin AUC 5.0 IV day 1; sunitinib 25 mg orally daily; treatment was administered for six 28-day cycles followed by definitive surgery. Sunitinib was resumed postoperatively to complete a 52-week course. Pathologic complete response (pCR) rate was the primary endpoint. Fifty-four patients enrolled; 41 received treatment in the phase II study. Sixteen patients (39 %) were able to complete six cycles of neoadjuvant therapy; 18 additional patients had surgery after completing 2-5 cycles of treatment. The pCR rate in these 34 evaluable patients was 35 %. The toxicity of the regimen was considerable, with myelosuppression resulting in numerous dose reductions and/or omissions of paclitaxel and carboplatin. Eleven patients (27 %) discontinued sunitinib during neoadjuvant therapy, and six patients (14 %) completed 52 weeks of single-agent sunitinib. In the neoadjuvant treatment of patients with TNBC, the combination of paclitaxel, carboplatin, and sunitinib was difficult to administer, and produced a pCR rate comparable to other less toxic regimens. This combination is not recommended for further evaluation. At present, sunitinib has no defined role in the treatment of breast cancer.
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