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Pilbeam KL, Pradhan K, Croop J, Minard CG, Liu X, Voss SD, Isikwei E, Berg SL, Reid JM, Fox E, Weigel BJ. A phase 1 trial utilizing a pharmacokinetic endpoint to determine the optimal dose of ramucirumab in children and adolescents with relapsed or refractory solid tumors, including central nervous system tumors. Pediatr Blood Cancer 2024; 71:e30817. [PMID: 38189770 DOI: 10.1002/pbc.30817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Ramucirumab is a monoclonal antibody that binds the extracellular domain of vascular endothelial growth factor receptor (VEGFR-2) and prevents binding of VEGF ligands. Based on population pharmacokinetic (PK) analysis and correlation with efficacy in adults, a target steady state trough concentration (Css,min ) ≥ 50 µg/mL was established. PROCEDURES This phase 1 trial (ADVL1416) used a rolling six design and a PK primary endpoint to define the recommended phase 2 dose (RP2D) of ramucirumab in children with recurrent/refractory solid tumors. Two dose levels (DL) were planned (DL1: 8 mg/kg, DL2: 12 mg/kg administered intravenously [IV] every 2 weeks). Toxicity during the initial 6 weeks was used to assess maximum tolerated dose (MTD). Cycle 1 Day 42 trough (Cmin ) ≥ 50 µg/mL was the target concentration for the PK endpoint. At the RP2D, cohorts for PK expansion and children with central nervous tumors were planned. RESULTS Twenty-nine patients were enrolled; 28 were eligible; median age [range] = 13.5 [1-21] years; 22 were evaluable for the PK endpoint. Dose-limiting proteinuria occurred at both DLs; however, the MTD was not exceeded. At DL2 (12 mg/kg), the median Day 42 Cmin (n = 16) was 87.8 µg/mL; 15 of 16 patients achieved a Cmin ≥ 50 µg/mL. CONCLUSION Ramucirumab was well tolerated in children and adolescents with solid tumors. The RP2D for ramucirumab was 12 mg/kg IV every 2 weeks. This trial demonstrates the feasibility of incorporating a primary PK endpoint to determine dose escalation and the RP2D in children. Studies of ramucirumab in children with selected solid tumors are ongoing.
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Affiliation(s)
- Kristy L Pilbeam
- Spectrum Health, Pediatric Hematology Oncology, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | | | - James Croop
- Pediatric Hematology Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Charles G Minard
- Baylor College of Medicine, Dan Duncan Cancer Institute, Houston, Texas, USA
| | - Xiaowei Liu
- Children's Oncology Group, Monrovia, California, USA
| | - Stephan D Voss
- Department Radiology, Dana-Farber/Harvard Cancer center, Boston, Massachusetts, USA
| | | | | | - Joel M Reid
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth Fox
- Clinical Trials Administration, Saint Jude Children's Research Hospital Cancer Center, Memphis, Tennessee, USA
| | - Brenda J Weigel
- Pediatric Hematology Oncology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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Chi SN, Yi JS, Williams PM, Roy-Chowdhuri S, Patton DR, Coffey BD, Reid JM, Piao J, Saguilig L, Alonzo TA, Berg SL, Ramirez NC, Jaju A, Mhlanga JC, Fox E, Hawkins DS, Mooney MM, Takebe N, Tricoli JV, Janeway KA, Seibel NL, Parsons DW. Tazemetostat for tumors harboring SMARCB1/SMARCA4 or EZH2 alterations: results from NCI-COG pediatric MATCH APEC1621C. J Natl Cancer Inst 2023; 115:1355-1363. [PMID: 37228094 PMCID: PMC11009504 DOI: 10.1093/jnci/djad085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND National Cancer Institute-Children's Oncology Group Pediatric Molecular Analysis for Therapy Choice assigns patients aged 1-21 years with refractory solid tumors, brain tumors, lymphomas, and histiocytic disorders to phase II trials of molecularly targeted therapies based on detection of predefined genetic alterations. Patients whose tumors harbored EZH2 mutations or loss of SMARCB1 or SMARCA4 by immunohistochemistry were treated with EZH2 inhibitor tazemetostat. METHODS Patients received tazemetostat for 28-day cycles until disease progression or intolerable toxicity (max 26 cycles). The primary endpoint was objective response rate; secondary endpoints included progression-free survival and tolerability of tazemetostat. RESULTS Twenty patients (median age = 5 years) enrolled, all evaluable for response and toxicities. The most frequent diagnoses were atypical teratoid rhabdoid tumor (n = 8) and malignant rhabdoid tumor (n = 4). Actionable alterations consisted of SMARCB1 loss (n = 16), EZH2 mutation (n = 3), and SMARCA4 loss (n = 1). One objective response was observed in a patient with non-Langerhans cell histiocytosis with SMARCA4 loss (26 cycles, 1200 mg/m2/dose twice daily). Four patients with SMARCB1 loss had a best response of stable disease: epithelioid sarcoma (n = 2), atypical teratoid rhabdoid tumor (n = 1), and renal medullary carcinoma (n = 1). Six-month progression-free survival was 35% (95% confidence interval [CI] = 15.7% to 55.2%) and 6-month overall survival was 45% (95% CI = 23.1% to 64.7%). Treatment-related adverse events were consistent with prior tazemetostat reports. CONCLUSIONS Although tazemetostat did not meet its primary efficacy endpoint in this population of refractory pediatric tumors (objective response rate = 5%, 90% CI = 1% to 20%), 25% of patients with multiple histologic diagnoses experienced prolonged stable disease of 6 months and over (range = 9-26 cycles), suggesting a potential effect of tazemetostat on disease stabilization.
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Affiliation(s)
- Susan N Chi
- Department of Pediatrics, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Joanna S Yi
- Department of Pediatrics, Texas Children’s Cancer and Hematology Center, Baylor College of Medicine, Houston, TX, USA
| | - P Mickey Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David R Patton
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brent D Coffey
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel M Reid
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Jin Piao
- Department of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lauren Saguilig
- Children’s Oncology Group Statistical Center, Monrovia, CA, USA
| | - Todd A Alonzo
- Department of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stacey L Berg
- Department of Pediatrics, Texas Children’s Cancer and Hematology Center, Baylor College of Medicine, Houston, TX, USA
| | - Nilsa C Ramirez
- Biopathology Center, Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Alok Jaju
- Department of Radiology, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Joyce C Mhlanga
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Elizabeth Fox
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Douglas S Hawkins
- Department of Hematology-Oncology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
| | - Margaret M Mooney
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Cancer Therapy Evaluation Program, Bethesda, MD, USA
| | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Cancer Therapy Evaluation Program, Bethesda, MD, USA
| | - James V Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Katherine A Janeway
- Department of Pediatrics, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Nita L Seibel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Cancer Therapy Evaluation Program, Bethesda, MD, USA
| | - D Williams Parsons
- Department of Pediatrics, Texas Children’s Cancer and Hematology Center, Baylor College of Medicine, Houston, TX, USA
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Unguru Y, Bernhardt MB, Berg SL, Marie-Johnson L, Grimm KP, Woodman C, Fernandez CV. Essential medicines for childhood cancer in Europe. Lancet Oncol 2023; 24:e67. [PMID: 36725147 DOI: 10.1016/s1470-2045(23)00009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Yoram Unguru
- Division of Pediatric Hematology/Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, MD 21215-5271, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.
| | | | - Stacey L Berg
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Kim Pyke Grimm
- Department of Nursing Research and Evidence-Based Practice, Stanford Medicine Children's Health, Stanford, CA, USA; Division of Pediatric Hematology/Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Conrad V Fernandez
- Pediatric Hematology-Oncology, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
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Davis KL, Fox E, Isikwei E, Reid JM, Liu X, Minard CG, Voss S, Berg SL, Weigel BJ, Mackall CL. A Phase I/II Trial of Nivolumab plus Ipilimumab in Children and Young Adults with Relapsed/Refractory Solid Tumors: A Children's Oncology Group Study ADVL1412. Clin Cancer Res 2022; 28:5088-5097. [PMID: 36190525 PMCID: PMC10597535 DOI: 10.1158/1078-0432.ccr-22-2164] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/11/2022] [Revised: 08/29/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE In many cancers, nivolumab in combination with ipilimumab improves response rates compared with either agent alone, but the combination has not been evaluated in childhood cancer. We conducted a phase I/II trial of nivolumab plus ipilimumab in children and young adults with recurrent/refractory solid tumors. PATIENTS AND METHODS ADVL1412, Part C assessed safety of nivolumab plus ipilimumab at two dose levels (DL): DL1 1 mg/kg of each drug and DL2 3 mg/kg nivolumab plus 1 mg/kg ipilimumab. Part D evaluated response at the recommended phase II dose (RP2D) in Ewing sarcoma, rhabdomyosarcoma, and osteosarcoma. Part E tested DL3 (1 mg/kg nivolumab plus 3 mg/kg ipilimumab) in Ewing sarcoma and rhabdomyosarcoma. Tumor response was measured using RECIST v1.1. Pharmacokinetics and PD-L1 expression on archival tissues were assessed. RESULTS Fifty-five eligible patients enrolled. Based on safety, tolerability, and similar drug exposure to the same doses administered in adults, DL2 was defined as the pediatric RP2D. Among 41 patients treated at the RP2D, 2 patients experienced dose-limiting toxicities during cycle 1, and 4 patients experienced toxicities beyond that period. Two patients had clinically significant sustained partial responses (1 rhabdomyosarcoma, 1 Ewing sarcoma) and 4 had stable disease. Among 8 patients treated at DL3, 3 dose-limiting toxicities (DLT) occurred, all immune-related adverse events; no objective responses were observed. CONCLUSIONS The RP2D of nivolumab (3 mg/kg) plus ipilimumab (1 mg/kg) is well tolerated in children and young adults with solid tumors and shows some clinical activity. Increased dose of ipilimumab (3 mg/kg) plus nivolumab (1 mg/kg) was associated with increased toxicity without clinical benefit.
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Affiliation(s)
- Kara L. Davis
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Dept. of Pediatrics, Stanford University, Stanford, CA
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford CA
| | | | | | | | | | | | - Stephan Voss
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Crystal L. Mackall
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Dept. of Pediatrics, Stanford University, Stanford, CA
- Division of Blood and Marrow Transplantation and Cell Therapy, Dept. of Medicine, Stanford University, Stanford, California
- Center for Cancer Cell Therapy, Stanford Cancer Institute, Stanford CA
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5
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Eckstein OS, Allen CE, Williams PM, Roy-Chowdhuri S, Patton DR, Coffey B, Reid JM, Piao J, Saguilig L, Alonzo TA, Berg SL, Ramirez NC, Jaju A, Mhlanga J, Fox E, Hawkins DS, Mooney MM, Takebe N, Tricoli JV, Janeway KA, Seibel NL, Parsons DW. Phase II Study of Selumetinib in Children and Young Adults With Tumors Harboring Activating Mitogen-Activated Protein Kinase Pathway Genetic Alterations: Arm E of the NCI-COG Pediatric MATCH Trial. J Clin Oncol 2022; 40:2235-2245. [PMID: 35363510 PMCID: PMC9273373 DOI: 10.1200/jco.21.02840] [Citation(s) in RCA: 4] [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: 12/14/2022] Open
Abstract
PURPOSE The NCI-COG Pediatric MATCH trial assigns patients age 1-21 years with relapsed or refractory solid tumors, lymphomas, and histiocytic disorders to phase II studies of molecularly targeted therapies on the basis of detection of predefined genetic alterations. Patients with tumors harboring mutations or fusions driving activation of the mitogen-activated protein kinase (MAPK) pathway were treated with the MEK inhibitor selumetinib. METHODS Patients received selumetinib twice daily for 28-day cycles until disease progression or intolerable toxicity. The primary end point was objective response rate; secondary end points included progression-free survival and tolerability of selumetinib. RESULTS Twenty patients (median age: 14 years) were treated. All were evaluable for response and toxicities. The most frequent diagnoses were high-grade glioma (HGG; n = 7) and rhabdomyosarcoma (n = 7). Twenty-one actionable mutations were detected: hotspot mutations in KRAS (n = 8), NRAS (n = 3), and HRAS (n = 1), inactivating mutations in NF1 (n = 7), and BRAF V600E (n = 2). No objective responses were observed. Three patients had a best response of stable disease including two patients with HGG (NF1 mutation, six cycles; KRAS mutation, 12 cycles). Six-month progression-free survival was 15% (95% CI, 4 to 34). Five patients (25%) experienced a grade 3 or higher adverse event that was possibly or probably attributable to study drug. CONCLUSION A national histology-agnostic molecular screening strategy was effective at identifying children and young adults eligible for treatment with selumetinib in the first Pediatric MATCH treatment arm to be completed. MEK inhibitors have demonstrated promising responses in some pediatric tumors (eg, low-grade glioma and plexiform neurofibroma). However, selumetinib in this cohort with treatment-refractory tumors harboring MAPK alterations demonstrated limited efficacy, indicating that pathway mutation status alone is insufficient to predict response to selumetinib monotherapy for pediatric cancers.
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Affiliation(s)
- Olive S. Eckstein
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX
| | - Carl E. Allen
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX,Carl E. Allen, MD, PhD, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, 1102 Bates Ave, Suite 1025, Houston, TX 77030; e-mail:
| | | | | | - David R. Patton
- Center for Biomedical Informatics and Information Technology, NCI, NIH, Bethesda, MD
| | - Brent Coffey
- Center for Biomedical Informatics and Information Technology, NCI, NIH, Bethesda, MD
| | | | - Jin Piao
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Todd A. Alonzo
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stacey L. Berg
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX
| | - Nilsa C. Ramirez
- Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Alok Jaju
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL
| | - Joyce Mhlanga
- Washington University School of Medicine, St Louis, MO
| | | | | | - Margaret M. Mooney
- Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - James V. Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Nita L. Seibel
- Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - D. Williams Parsons
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, TX
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Vo KT, Sabnis AJ, Williams PM, Roy-Chowdhuri S, Patton DR, Coffey B, Reid JM, Piao J, Saguilig L, Alonzo TA, Berg SL, Jaju A, Fox E, Hawkins DS, Mooney MM, Takebe N, Tricoli JV, Janeway KA, Seibel N, Parsons DW. Ulixertinib in patients with tumors with MAPK pathway alterations: Results from NCI-COG Pediatric MATCH trial Arm J (APEC1621J). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3009] [Citation(s) in RCA: 1] [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: 11/20/2022] Open
Abstract
3009 Background: The NCI-Children’s Oncology Group (COG) Pediatric Molecular Analysis for Therapy Choice (MATCH) trial assigns patients age 1 to 21 years with relapsed or refractory solid tumors, lymphomas, and histiocytic disorders to phase 2 treatment arms of molecularly-targeted therapies based on genetic alterations detected in their tumor. Arm J evaluated the ERK1/2 inhibitor ulixertinib (BVD-523FB) in patients whose tumors harbored activating alterations in the MAPK pathway ( ARAF, BRAF, HRAS, KRAS, NRAS, MAPK1, MAP2K1, GNA11, GNAQ hotspot mutations; NF1inactivating mutations; BRAF fusions). Methods: As there were no prior pediatric data, ulixertinib was initially tested in a dose escalation cohort using a rolling 6 design to establish the recommended phase 2 dose (RP2D) before proceeding with enrollment to the phase 2 cohort. Ulixertinib was administered at 260 mg/m2/dose PO BID (dose level 1, DL1, n = 15) or 350 mg/m2/dose PO BID (dose level 2, DL2, n = 5). Patients were treated on continuous 28-day cycles for up to 2 years, until disease progression or intolerable toxicity; response assessment occurred every 2-3 cycles. The primary endpoint was objective response rate; secondary endpoints included safety/tolerability and progression-free survival (PFS). Results: Twenty patients (median age 12 years; range 5-20) were enrolled between November 2018 and March 2021. All patients were evaluable for response. High-grade glioma (HGG, n = 7) was most common, with CNS tumors comprising 55% (11/20) of diagnoses; all CNS tumors except one (HGG with KRAS and NF1 mutations) harbored BRAF fusions or V600 mutations. Rhabdomyosarcoma (n = 5) was the most frequent non-CNS diagnosis, with NRAS mutations detected in 4 tumors. DL1 was declared the RP2D after first-cycle dose limiting toxicities (DLTs) occurred in 1/6 DLT-evaluable patients at DL1 and 2/5 patients at DL2 in the dose escalation cohort. Any-cycle DLTs in 8 patients in the dose escalation and primary cohorts included fatigue, anorexia, rash, nausea, vomiting, diarrhea, dehydration, increased creatinine, hypoalbuminemia, hypernatremia, and hip fracture. No objective responses were observed. Six-month PFS was 37% (95% CI: 17%, 58%). Three patients with CNS tumors achieved stable disease > 6 months (HGG with BRAF fusion, 15 cycles; glioneuronal tumor with BRAF V600E, 9 cycles; low-grade glioma with BRAF fusion, 7 cycles). Analyses of correlative studies, including pharmacokinetics and circulating tumor DNA, are ongoing. Conclusions: The pediatric RP2D of ulixertinib was established as 260 mg/m2/dose PO BID. There were no objective responses in this cohort of children and young adults with treatment-refractory tumors with activating MAPK alterations. Clinical benefit of prolonged disease control was observed in 3 patients with BRAF-altered gliomas and glioneuronal tumors. Clinical trial information: NCT03698994.
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Affiliation(s)
| | - Amit J. Sabnis
- University of California San Francisco, Benioff Children’s Hospital, San Francisco, CA
| | - Paul M. Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - David R. Patton
- Center for Biomedical Informatics & Information Technology, NCI, NIH, Bethedsa, MD
| | - Brent Coffey
- Essex Management, Center for Biomedical Informatics & Information Technology, NCI, NIH, Bethesda, MD
| | | | - Jin Piao
- Children's Oncology Group, Monrovia, CA
| | | | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | | | - Alok Jaju
- Ann and Robert H Lurie Children’s Hospital, Chicago, IL
| | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Douglas S. Hawkins
- Seattle Children’s Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | | | - Nita Seibel
- Cancer Therapy Evaluation Program, DCTD, NCI, NIH, Bethesda, MD
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Chi SN, Yi JS, Williams PM, Roy-Chowdhuri S, Patton DR, Coffey B, Reid JM, Piao J, Saguilig L, Alonzo TA, Berg SL, Mhlanga J, Fox E, Hawkins DS, Mooney MM, Takebe N, Tricoli JV, Janeway KA, Seibel N, Parsons DW. Tazemetostat in patients with tumors with alterations in EZH2 or the SWI/SNF complex: Results from NCI-COG Pediatric MATCH trial Arm C (APEC1621C). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10009] [Citation(s) in RCA: 1] [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: 11/20/2022] Open
Abstract
10009 Background: The NCI-Children’s Oncology Group (COG) Pediatric Molecular Analysis for Therapy Choice (MATCH) trial assigns patients, age 1-21 years, with relapsed or refractory solid tumors, lymphomas, and histiocytic disorders to phase 2 treatment arms based on genetic alterations detected in their tumor. Arm C evaluated the EZH2 inhibitor tazemetostat in patients whose tumors harbored EZH2 hotspot mutations or SMARCB1 or SMARCA4 loss by immunohistochemistry. Methods: Tazemetostat 1200 mg/m2/dose PO BID was administered to the first 13 patients; after study amendment due to second malignancy noted in the pediatric phase 1 trial, the dose for patients with non-CNS tumors was reduced to 520 mg/m2/dose PO BID. Patients were treated for 28-day cycles until PD or intolerable toxicity (max 26 cycles); response assessments occurred every 2-3 cycles. Primary and secondary endpoints were ORR and PFS, respectively. Results: Twenty eligible and evaluable patients (median age 5 years; range 1-21) were enrolled between Nov 2017 and Sept 2020. SMARCB1 loss was detected in 16/20 (80%) tumors: atypical teratoid rhabdoid tumor (ATRT, n = 8), malignant rhabdoid tumor (MRT, n = 4), epithelioid sarcoma (ES, n = 2), renal medullary carcinoma (RMC, n = 1) and hepatocellular carcinoma (HCC, n = 1). EZH2 mutations were identified in 3/20 (15%) tumors: Ewing sarcoma (n = 2), ependymoma (n = 1). One patient with Langerhans cell histiocytosis (LCH) had SMARCA4 loss. Centrally reviewed, one objective response (PR) was observed (LCH [SMARCA4], 26 cycles at 1200 mg/m2/dose BID). Five other patients had a best response of stable disease (ES [SMARCB1], 26 cycles, 520 mg/m2/dose BID; ATRT [SMARCB1], 13 cycles,1200 mg/m2/dose BID; RMC [SMARCB1], 12 cycles, 520 mg/m2/dose BID; ES [SMARCB1], 9 cycles,1200 mg/m2/dose BID; ATRT [SMARCB1], 6 cycles, 1200 mg/m2/dose BID). No other patients received > 2 cycles. Six-month PFS was 35% (95% CI 15.7%, 55.2%); OS was 45% (95% CI 23.1%, 64.7%). Treatment-related adverse events were consistent with AEs previously reported with tazemetostat, including anemia, thrombocytopenia, elevated LFTs, abdominal pain, dyspnea, infection, and intracranial hemorrhage. Three patients had bromide elevations. Conclusions: In this cohort of children with relapsed tumors harboring EZH2 mutations or loss of SMARCB1 or SMARCA4, tazemetostat did not produce significant objective responses (ORR: 5%, 90% CI 1%, 20%). However, we observed prolonged stable disease of > 6 months (range: 6-26 cycles) in 33% of patients across different histologic diagnoses, including two patients who received the full two years of study therapysuggesting a potential effect of tazemetostat on disease stabilization. Future studies will incorporate tazemetostat in combination with chemotherapy or immunologic agents for patients with these aggressive and difficult to treat tumors. Clinical trial information: NCT03213665.
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Affiliation(s)
- Susan N. Chi
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Joanna S. Yi
- Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | | | | | - David R. Patton
- Center for Biomedical Informatics & Information Technology, NCI, NIH, Bethedsa, MD
| | - Brent Coffey
- Essex Management, Center for Biomedical Informatics & Information Technology, NCI, NIH, Bethesda, MD
| | | | - Jin Piao
- Children's Oncology Group, Monrovia, CA
| | | | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | | | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Douglas S. Hawkins
- Seattle Children’s Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | | | - Nita Seibel
- Cancer Therapy Evaluation Program, DCTD, NCI, NIH, Bethesda, MD
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Cramer S, Gilger EA, Burlingame S, Militano O, Liu X, Minard CG, Reddy AT, Voss SD, Berg SL, Reid JM, Fox E, Weigel B. ADVL1514, a phase 1 study of ABI-009 (nab-sirolimus) in pediatric patients with recurrent or refractory solid tumors, including CNS tumors as a single agent and in combination with temozolomide and irinotecan: A Children’s Oncology Group pediatric early-phase clinical trial network study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10022] [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: 11/20/2022] Open
Abstract
10022 Background: nab-Sirolimus (formerly know ABI-009 and nab-rapamycin) is a novel human albumin-bound preparation of sirolimus, a potent mTOR inhibitor. We report results of a Phase I study of ABI-009 alone and in combination with irinotecan and temozolomide in children with relapsed/refractory solid or CNS tumors. Methods: Patients (age 1-21 years) with relapsed/refractory solid or CNS tumors were eligible. Using a rolling 6 design, ABI-009 was administered intravenously as a single agent on Days 1 and 8 of cycle 1 (cycle = 21d), then subsequent cycles ABI-009 was administered in combination with temozolomide (125 mg/m2/dose, maximum 250 mg/dose) orally once daily x 5 on Days 1-5 and irinotecan 90 mg/m2/dose orally once daily x 5 on Days 1-5. Three dose levels (DL) of ABI-009 were investigated (DL1: 35mg/m2/dose, DL-1: 20mg/m2/dose, and DL-2: 15mg/m2/dose). The maximum tolerated dose (MTD) or Recommended Phase 2 Dose (RP2D) was established based on dose limiting toxicity (DLT) observed during Cycle 1 and 2. At the RP2D, additional patients were enrolled for pharmacokinetics (PK). Results: 33 patients were enrolled (32 eligible and 1 ineligible); 11 did not experience DLT but were not evaluable for toxicity due to progressive disease or physician decision to discontinue protocol therapy prior to completion of cycle 2; 17 [median age 13 (2-20) years] were evaluable for determination of MTD during dose escalation, 6 were enrolled on the PK cohort, of which 3 were evaluable to toxicity. At DL1, 2/5 patients experienced DLT (thrombocytopenia during cycle 1 (n = 1) and cycle 2 (n = 1)); at DL-1, 2/6 patients experienced DLT (thrombocytopenia in cycle 1); at DL-2, 1/6 patients experienced DLT (thrombocytopenia in cycle 1). PK expansion enrolled at DL-2 and 1/3 participants evaluable for toxicity had a DLT (mucositis). Overall, at DL-2, 2/9 patients (22%) had DLT. One patient with Ewing Sarcoma had a partial response and remained on study for 35 cycles; Patients (one each) with Ewing Sarcoma, Wilms Tumor, and Pineoblastoma had stable disease, ranging from 3-6 cycles. Conclusions: Thrombocytopenia was dose limiting for ABI-009 alone and in combination with temozolomide and irinotecan. The MTD for ABI-009 is 15mg/m2/dose days 1 and 8 in combination with 5 daily doses of temozolomide 125 mg/m2/dose and oral irinotecan 90 mg/m2/dose. One patient had a partial response, 3 patients had prolonged stable disease. Pharmacokinetics and pharmacodynamics are pending and will inform future trials. Clinical trial information: NCT02975882.
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Affiliation(s)
- Stuart Cramer
- Prisma Health Children’s Hospital- Midlands, Columbia, SC
| | | | - Susan Burlingame
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brenda Weigel
- Department of Pediatrics, University of Minnesota Masonic Cancer Center, Minneapolis, MN
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9
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Parsons DW, Janeway KA, Patton DR, Winter CL, Coffey B, Williams PM, Roy-Chowdhuri S, Tsongalis GJ, Routbort M, Ramirez NC, Saguilig L, Piao J, Alonzo TA, Berg SL, Fox E, Hawkins DS, Abrams JS, Mooney M, Takebe N, Tricoli JV, Seibel NL. Actionable Tumor Alterations and Treatment Protocol Enrollment of Pediatric and Young Adult Patients With Refractory Cancers in the National Cancer Institute-Children's Oncology Group Pediatric MATCH Trial. J Clin Oncol 2022; 40:2224-2234. [PMID: 35353553 PMCID: PMC9273376 DOI: 10.1200/jco.21.02838] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The National Cancer Institute-Children's Oncology Group Pediatric MATCH trial aimed to facilitate evaluation of molecular-targeted therapies in biomarker-selected cohorts of childhood and young adult patients with cancer by screening tumors for actionable alterations. PATIENTS AND METHODS Tumors from patients age 1-21 years with refractory solid tumors, lymphomas, or histiocytic disorders were subjected to cancer gene panel sequencing and limited immunohistochemistry to identify actionable alterations for assignment to phase II treatment arms. The rates of treatment arm assignment and enrollment were compared between clinical and demographic groups. RESULTS Testing was completed for 94.7% of tumors submitted. Actionable alterations were detected in 31.5% of the first 1,000 tumors screened, with treatment arm assignment and enrollment occurring in 28.4% and 13.1% of patients, respectively. Assignment rates varied by tumor histology and were higher for patients with CNS tumors or enrolled at Pediatric Early Phase Clinical Trials Network sites. A reported history of prior clinical molecular testing was associated with higher assignment and enrollment rates. Actionable alterations in the mitogen-activated protein kinase signaling pathway were most frequent (11.2%). The most common reasons provided for not enrolling on treatment arms were patients receiving other treatment or poor clinical status. CONCLUSION The Pediatric MATCH trial has proven the feasibility of a nationwide screening Protocol for identification of actionable genetic alterations and assignment of pediatric and young adult patients with refractory cancers to trials of molecularly targeted therapies. These data support the early use of tumor molecular screening for childhood patients with cancer whose tumors have not responded to standard treatments.
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Affiliation(s)
- D Williams Parsons
- Texas Children's Cancer and Hematology Center, Baylor College of Medicine, Houston, TX
| | | | - David R Patton
- Center for Biomedical Informatics and Information Technology, NCI, NIH, Bethesda, MD
| | - Cynthia L Winter
- Center for Biomedical Informatics and Information Technology, NCI, NIH, Bethesda, MD
| | - Brent Coffey
- Center for Biomedical Informatics and Information Technology, NCI, NIH, Bethesda, MD
| | | | | | - Gregory J Tsongalis
- Geisel School of Medicine at Dartmouth, Hanover, NH.,Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Mark Routbort
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nilsa C Ramirez
- Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH
| | | | - Jin Piao
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Todd A Alonzo
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Stacey L Berg
- Texas Children's Cancer and Hematology Center, Baylor College of Medicine, Houston, TX
| | | | - Douglas S Hawkins
- Seattle Children's Hospital and University of Washington, Seattle, WA
| | - Jeffrey S Abrams
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Margaret Mooney
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - James V Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
| | - Nita L Seibel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD
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10
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Allen CE, Eckstein O, Williams PM, Roy-Chowdhuri S, Patton DR, Coffey B, Reid JM, Piao J, Saguilig L, Alonzo TA, Berg SL, Jaju A, Fox E, Hawkins DS, Mooney MM, Takebe N, Tricoli JV, Janeway KA, Seibel N, Parsons DW. Selumetinib in patients with tumors with MAPK pathway alterations: Results from Arm E of the NCI-COG pediatric MATCH trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10008 Background: The NCI-Children’s Oncology Group (COG) Pediatric Molecular Analysis for Therapy Choice (MATCH) trial assigns patients age 1 to 21 years with relapsed or refractory solid tumors, lymphomas, and histiocytic disorders to phase 2 treatment arms of molecularly-targeted therapies based on genetic alterations detected in their tumor. Arm E evaluated the MEK inhibitor selumetinib (ARRY-142886) in patients whose tumors harbored activating alterations in the MAPK pathway ( ARAF, BRAF, HRAS, KRAS, NRAS, MAP2K1, GNA11, GNAQ hotspot mutations; NF1 inactivating mutations; BRAF fusions). Methods: Patients received selumetinib 25 mg/m2/dose (max 75 mg/dose) PO BID for 28-day cycles until disease progression or intolerable toxicity with response assessments obtained every 2-3 cycles. The primary endpoint was objective response rate (ORR); secondary endpoints included progression-free survival (PFS). Patients with low grade glioma were excluded. Results: A total of 21 patients (median age 14 years; range 5-21) were enrolled between 10/2017 and 8/2019, with 20 patients evaluable for response. Diagnoses were high grade glioma (HGG; n = 8), rhabdomyosarcoma (n = 7), adenocarcinoma (n = 2), and one each of MPNST, endodermal sinus/yolk sac tumor, plexiform neurofibroma (PN), and neuroblastoma. MAPK pathway alterations detected consisted of inactivating NF1 mutations (n = 8), hotspot mutations in KRAS (n = 8), NRAS (n = 3), and HRAS (n = 1), and BRAF V600E (n = 2). No objective responses were observed. Three patients had a best response of stable disease (HGG with NF1 mutation, 6 cycles; HGG with KRAS mutation, 12 cycles; PN with NF1 mutation, 13 cycles prior to removal for dose-limiting toxicity). Six-month PFS was 15% (95% CI: 4%, 34%). Adverse events that were deemed possibly, probably, or definitely attributable to study drug included one case each of grade 3 uveitis, lymphopenia, and thromboembolic event; one grade 4 CPK elevation; and one grade 5 thromboembolic event. Conclusions: Selumetinib did not result in tumor regression in this cohort of children and young adults with treatment-refractory tumors with activating MAPK pathway alterations. Of note, two patients with HGG initially had stable disease, but ultimately progressed after 6 and 12 cycles, respectively. Selumetinib has previously demonstrated activity in low grade glioma and PN and is now FDA-approved for PN. The results of our study indicate that MAPK pathway mutation status alone is insufficient to predict response to selumetinib monotherapy. It is likely that selumetinib and other MEK inhibitors will require combination with targeted or cytotoxic agents for optimal efficacy in children with persistent or progressive cancers after front-line chemotherapy. Clinical trial information: NCT03213691. Clinical trial information: NCT03155620.
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Affiliation(s)
- Carl E. Allen
- Baylor College of Medicine Texas Children's Cancer Center, Houston, TX
| | | | - Paul M. Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - David R Patton
- National Cancer Institute/Center for Biomedical Informatics & Information Technology, Rockville, MD
| | | | | | - Jin Piao
- Children's Oncology Group, Monrovia, CA
| | | | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | | | - Alok Jaju
- Ann and Robert H Lurie Children’s Hospital, Chicago, IL
| | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Douglas S. Hawkins
- Seattle Children’s Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Naoko Takebe
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
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11
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Parsons DW, Janeway KA, Patton DR, Lee J, Coffey B, Williams PM, Roy-Chowdhuri S, Tsongalis GJ, Routbort M, Ramirez NC, Saguilig L, Piao J, Alonzo TA, Berg SL, Fox E, Hawkins DS, Mooney MM, Takebe N, Tricoli JV, Seibel N. Factors impacting enrollment on NCI-COG Pediatric MATCH trial treatment protocols. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10007 Background: The NCI-Children’s Oncology Group (COG) Pediatric Molecular Analysis for Therapy Choice (MATCH) trial assigns patients age 1 to 21 years with relapsed or refractory solid tumors, lymphomas, and histiocytic disorders to phase 2 treatment arms of molecularly-targeted therapies based on the genetic alterations detected in their tumor. Treatment arm assignments and enrollment decisions have now been made for 1000 study participants: we report here match and enrollment data and factors affecting treatment protocol enrollment. Methods: Patients enrolled in the Pediatric MATCH screening protocol were assigned to an open treatment protocol if an actionable mutation (aMOI) was detected by tumor DNA and RNA-based cancer gene panel sequencing. After a match, treatment protocol enrollment must occur within 8-12 weeks. Patient demographic data, reasons for not enrolling on treatment protocol (if applicable), and prior history of molecular testing were reported by study sites. The Fisher exact test was used to compare protocol enrollment rates between groups. Results: Results were analyzed for the first 1000 patients with testing completed (enrolled between July 2017 and October 2020). At least one tumor aMOI was detected in 310 (31%) patients and treatment protocol slots were available for 284 patients (28%). A total of 131 patients (46% of those matched) enrolled on a treatment arm. No difference in treatment protocol match or enrollment rate was observed for gender, race, or ethnicity. Both treatment protocol match rate (105/275, 38% vs 86/394, 22%) and enrollment rate (56/275, 20% vs 33/394, 8%) were significantly more frequent in patients with a reported history of prior molecular testing (p<0.0001). The most common reasons provided for not enrolling on a treatment protocol were: patient receiving other treatment (32% of responses), poor clinical status (16%), lack of measurable disease (11%), or ineligible diagnosis for that treatment arm (10%). Ineligibility due to history of excluded prior targeted therapy (6%) or inability to swallow capsules (4%) was less frequent. Conclusions: The rate of Pediatric MATCH treatment protocol enrollment has exceeded pre-study projections, due to more frequent actionable mutation detection and treatment assignment than anticipated (28% observed, 10% projected). This may in part reflect an increased number of targetable events in recurrent or refractory pediatric cancers. Correlative studies analyzing pre-treatment tumors from MATCH study patients are underway and will address this hypothesis. Prior history of molecular testing was associated with higher match and enrollment rate and poor clinical status was a common reason for not enrolling on a treatment protocol, suggesting that early molecular screening of children with solid malignancies may facilitate enrollment to biomarker-selected trials of targeted therapies. Clinical trial information: NCT03155620.
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Affiliation(s)
| | | | - David R Patton
- National Cancer Institute/Center for Biomedical Informatics & Information Technology, Rockville, MD
| | | | | | - Paul M. Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Gregory J. Tsongalis
- The Geisel School of Medicine at Dartmouth and Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Mark Routbort
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nilsa C. Ramirez
- Gynecologic Oncology Group Tissue Bank, Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH
| | | | - Jin Piao
- Children's Oncology Group, Monrovia, CA
| | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Douglas S. Hawkins
- Seattle Children’s Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Naoko Takebe
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
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12
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Foster J, Reid JM, Minard CG, Isikwei E, Liu X, Berg SL, Injac SG, Fox E, Weigel B. Phase 1 study of pevonedistat (MLN4924) a NEDD8 activating enzyme inhibitor, in combination with temozolomide (TMZ) and irinotecan (IRN) in pediatric patients with recurrent or refractory solid tumors (ADVL1615). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10019] [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: 11/20/2022] Open
Abstract
10019 Background: Pevonedistat (PEV), a first in class inhibitor of NEDD8 activating enzyme (NAE), prevents the activation of Cullin-RING ligases (CRL) necessary for proteasome mediated degradation of key regulatory proteins important in cell survival. In adults with solid tumors, the maximum tolerated dose (MTD) in combination with chemotherapy is 20-25 mg/m2. Antitumor activity of PEV has been demonstrated in preclinical models of childhood cancer. In vivo additive activity has been demonstrated for PEV in combination with IRN and alkylating agents. The objectives of this study are to determine the MTD and recommended Phase 2 dose of PEV in combination with IRN and TMZ and describe the toxicities, pharmacokinetic (PK), and pharmacodynamics (PD) properties of this combination. Methods: We conducted a phase 1 trial of PEV in combination with IRN and TMZ in pediatric patients (pts) with recurrent or refractory solid tumors and brain tumors. During cycle 1, PEV was administered intravenously on days 1, 8, 10, and 12, with IRN (IV, 50mg/m2) and TMZ (orally, 100mg/m2), on days 8-12 of a 28 day cycle. In subsequent cycles, PEV was administered on days 1, 3, and 5, with IRN and TMZ on days 1-5 of a 21 day cycle. Dose escalation was determined using the Rolling 6 Design. Results: 30 pts enrolled. All pts were eligible and evaluable for cycle 1 dose limiting toxicity (DLT) assessment. Median (range) age was 13 (1-21) years; 19 (63%) were male. Eleven pts had brain tumors, and 19 pts had solid tumors. Six pts each enrolled on PEV dose levels (DL) 1 (15mg/m2), 2 (20mg/m2), 3 (25mg/m2) and 4 (35mg/m2) as well as an expanded PK cohort at DL4. Cycle 1 grade 3/4 toxicities include lymphopenia (n = 5), leukopenia (n = 4), neutropenia (n = 2), elevated ALT (n = 2), elevated AST (n = 1), diarrhea (n = 1), flu-like symptoms (n = 1). The most frequent non-dose limiting AEs in cycle 1 were anemia (87%), WBC decreased (77%), nausea (57%), diarrhea (53%), ALT increased (50%), AST increased (50%), and vomiting (50%). PK analyses showed the mean area under the curve at the 25 mg/m2 dose level on day 8 (in combination with irinotecan and temozolomide) was 1300 hr•ng/mL, half-life (T ½) was 5-6 hours, time to maximum concentration (Tmax) was 1 hour, and mean clearance was 20 L/hr/m2. There were 3 DLTs, 2 of which were related to protocol therapy (diarrhea and thrombocytopenia), among 12 patients on DL4. Thus the MTD was not exceeded at any dose level. PK at the 25 mg/m2 dose level are comparable to those in adult patients. PK from the 12 patients on DL4 (35mg/m2) as well as responses of all patients are pending. Conclusions: PEV in combination with IRN and TMZ is well tolerated in children with solid or brain tumors. PEV PK was not altered by the addition of irinotecan and temozolomide. Further PK and PD analyses are ongoing to establish the recommended phase 2 dose. Clinical trial information: NCT03323034.
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Affiliation(s)
| | | | | | | | | | | | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
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13
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Foster JH, Voss SD, Hall DC, Minard CG, Balis FM, Wilner K, Berg SL, Fox E, Adamson PC, Blaney SM, Weigel BJ, Mossé YP. Activity of Crizotinib in Patients with ALK-Aberrant Relapsed/Refractory Neuroblastoma: A Children's Oncology Group Study (ADVL0912). Clin Cancer Res 2021; 27:3543-3548. [PMID: 33568345 DOI: 10.1158/1078-0432.ccr-20-4224] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/18/2020] [Accepted: 02/04/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Anaplastic lymphoma kinase (ALK) aberrations are a promising target for patients with neuroblastoma. We assessed the activity of first-generation ALK inhibitor crizotinib in patients with no known curative treatments and whose tumors harbored an activating ALK alteration. PATIENTS AND METHODS Twenty patients with relapsed/refractory ALK-positive neuroblastoma received crizotinib at the recommended phase II dose of 280 mg/m2/dose. A Simon two-stage design was used to evaluate the antitumor activity of crizotinib monotherapy. Response evaluation occurred after cycles 1, 3, 5, 7, and then every 3 cycles. Correlation of ALK status and response was a secondary aim of the study. RESULTS The objective response rate for patients with neuroblastoma was 15% [95% confidence interval (CI): 3.3%-34.3%]: two with partial responses and 1 with a complete response. All three patients had a somatic ALK Arg1275Gln mutation, the most common ALK hotspot mutation observed in neuroblastoma and the only mutation predicted to be sensitive to ALK inhibition with crizotinib. Two patients had prolonged stable disease (10 and 13 cycles, respectively); both harbored an ALK Arg1275Gln mutation. Three patients with ALK Phe1174Leu mutations progressed during cycle 1 of therapy, and one patient with an ALK Phe1174Val received three cycles before disease progression. The two patients with ALK amplification had no response. The most common adverse event was a decrease in neutrophil count. CONCLUSIONS Despite limited activity seen in this trial, we conclude that this is more likely due to an inability to reach the higher concentrations of crizotinib needed to overcome the competing ATP affinity.See related commentary by Schulte and Eggert, p. 3507.
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Affiliation(s)
- Jennifer H Foster
- Baylor College of Medicine; Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Stephan D Voss
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | - Charles G Minard
- Baylor College of Medicine; Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Frank M Balis
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Stacey L Berg
- Baylor College of Medicine; Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Elizabeth Fox
- St Jude Children's Research Hospital, Memphis, Tennessee
| | - Peter C Adamson
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan M Blaney
- Baylor College of Medicine; Texas Children's Cancer and Hematology Centers, Houston, Texas
| | | | - Yael P Mossé
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. .,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Geller JI, Pressey JG, Smith MA, Kudgus RA, Cajaiba M, Reid JM, Hall D, Barkauskas DA, Voss SD, Cho SY, Berg SL, Dome JS, Fox E, Weigel BJ. ADVL1522: A phase 2 study of lorvotuzumab mertansine (IMGN901) in children with relapsed or refractory wilms tumor, rhabdomyosarcoma, neuroblastoma, pleuropulmonary blastoma, malignant peripheral nerve sheath tumor, or synovial sarcoma-A Children's Oncology Group study. Cancer 2020; 126:5303-5310. [PMID: 32914879 DOI: 10.1002/cncr.33195] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 02/04/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Lorvotuzumab mertansine (IMGN901) is an antibody-drug conjugate linking an antimitotic agent (DM1) to an anti-CD56 antibody (lorvotuzumab). Preclinical efficacy has been noted in Wilms tumor, rhabdomyosarcoma, and neuroblastoma. Synovial sarcoma, malignant peripheral nerve sheath tumor (MPNST), and pleuropulmonary blastoma also express CD56. A phase 2 trial of lorvotuzumab mertansine was conducted to assess its efficacy, recommended phase 2 dose, and toxicities. METHODS Eligible patients had relapsed after or progressed on standard therapy for their tumor type. Lorvotuzumab mertansine (110 mg/m2 per dose) was administered at the adult recommended phase 2 dose intravenously on days 1 and 8 of 21-day cycles. Dexamethasone premedication was used. Pharmacokinetic samples, peripheral blood CD56-positive cell counts, and tumor CD56 expression were assessed. RESULTS Sixty-two patients enrolled. The median age was 14.3 years (range, 2.8-29.9 years); 35 were male. Diagnoses included Wilms tumor (n = 17), rhabdomyosarcoma (n = 17), neuroblastoma (n = 12), synovial sarcoma (n = 10), MPNST (n = 5), and pleuropulmonary blastoma (n = 1). Five patients experienced 9 dose-limiting toxicities: hyperglycemia (n = 1), colonic fistula (n = 1) with perforation (n = 1), nausea (n = 1) with vomiting (n = 1), increased alanine aminotransferase in cycle 1 (n = 2), and increased alanine aminotransferase in cycle 2 (n = 1) with increased aspartate aminotransferase (n = 1). Non-dose-limiting toxicities (grade 3 or higher) attributed to lorvotuzumab mertansine were rare. The median values of the maximum concentration, half-life, and area under the curve from zero to infinity for DM1 were 0.87 µg/mL, 35 hours, and 27.9 µg/mL h, respectively. Peripheral blood CD56+ leukocytes decreased by 71.9% on day 8. One patient with rhabdomyosarcoma had a partial response, and 1 patient with synovial sarcoma achieved a delayed complete response. CONCLUSIONS Lorvotuzumab mertansine (110 mg/m2 ) is tolerated in children at the adult recommended phase 2 dose; clinical activity is limited.
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Affiliation(s)
- James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Joseph G Pressey
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Institutes of Health, Bethesda, Maryland
| | - Rachel A Kudgus
- Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | | | - Joel M Reid
- Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota
| | - David Hall
- Children's Oncology Group, Monrovia, California
| | - Donald A Barkauskas
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Steve Y Cho
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Stacey L Berg
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brenda J Weigel
- University of Minnesota Medical Center, Minneapolis, Minnesota
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15
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Mangum R, Bernhardt MB, Cheng WS, Schafer ES, Berg SL, Foster JH. Do intravenous fluid substitutions influence methotrexate clearance? An unanticipated impact of an intravenous sodium bicarbonate drug shortage. Pediatr Blood Cancer 2020; 67:e28334. [PMID: 32608575 DOI: 10.1002/pbc.28334] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND National drug shortages of essential medications for childhood cancer have increasingly posed a challenge in the treatment of patients. The efficacy of standardized supportive care practices to avoid treatment-related toxicities may be limited during these drug shortages. High-dose methotrexate (HDMTX) plays a critical role in modern treatment protocols for acute lymphoblastic leukemia and requires stringent supportive care measures to mitigate toxicity. As the result of a national intravenous (IV) sodium bicarbonate shortage, institutional standard HDMTX supportive care guidelines had to be modified. We describe the unanticipated consequences on HDMTX clearance. METHODS We performed a retrospective chart review assessing the impact of alternative compositions of IV fluids on the mean 24-h methotrexate levels (Cpss ) of 25 patients receiving 76 total HDMTX infusions at Texas Children's Hospital Cancer Center from March to October 2017. During the sodium bicarbonate drug shortage, all patients received IV hydration consisting of either dextrose 5%, 0.45% normal saline (D5 ½ NS-Group A) or dextrose 5%, 0.2% normal saline (D5 ¼ NS-Group B). RESULTS Patients receiving a higher total sodium dose demonstrated significantly lower Cpss (25.36 ± 16.6 μMol) compared to patients receiving less sodium (53.9 ± 37.9 μMol; P < .001). CONCLUSIONS Our report shows that in the setting of IV sodium bicarbonate shortage, the composition of hydration IV fluids may affect methotrexate clearance. Patient who received a higher sodium load had a lower 24-h methotrexate level. This demonstrates the potential for unanticipated outcomes resulting from national drug shortages.
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Affiliation(s)
- Ross Mangum
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - M Brooke Bernhardt
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - W Susan Cheng
- Department of Public Heath, Benedictine University, Lisle, Illinois
| | - Eric S Schafer
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - Stacey L Berg
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - Jennifer H Foster
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
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Davis KL, Fox E, Merchant MS, Reid JM, Kudgus RA, Liu X, Minard CG, Voss S, Berg SL, Weigel BJ, Mackall CL. Nivolumab in children and young adults with relapsed or refractory solid tumours or lymphoma (ADVL1412): a multicentre, open-label, single-arm, phase 1-2 trial. Lancet Oncol 2020; 21:541-550. [PMID: 32192573 DOI: 10.1016/s1470-2045(20)30023-1] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors targeting PD-1 have shown clinical benefit in adults with cancer, but data on these drugs in children are scarce. We did a phase 1-2 study of nivolumab, a PD-1 blocking monoclonal antibody, to determine its safety, pharmacokinetics, and antitumour activity in children and young adults with recurrent or refractory non-CNS solid tumours or lymphoma. METHODS We did a multicentre, open-label, single-arm, dose-confirmation and dose-expansion, phase 1-2 trial in 23 hospitals in the USA. Eligible patients for part A (dose-confirmation phase) of the study were aged 1-18 years with solid tumours with measurable or evaluable disease (by Response Evaluation Criteria in Solid Tumors [RECIST] version 1.1) regardless of histology. Eligible patients for part B (dose-expansion phase) were aged 1-30 years with measurable disease (by RECIST criteria) in the following disease cohorts: rhabdomyosarcoma, Ewing sarcoma, osteosarcoma, neuroblastoma, Hodgkin lymphoma, non-Hodgkin lymphoma, and melanoma. Patients in part A and were given nivolumab 3 mg/kg intravenously over 60 min on days 1 and 15 of a 28-day cycle in a rolling 6 study design with de-escalation upon dose-limiting toxicities to establish the recommended phase 2 dose. Patients in part B were given the recommended phase 2 dose. The primary outcomes were the tolerability, systemic exposure, maximum tolerated dose, and the antitumour activity of nivolumab at the adult recommended dose in children and young adults. This trial is registered with ClinicalTrials.gov, NCT02304458, with follow-up ongoing and is closed to new participants. FINDINGS 85 patients were enrolled between Feb 22, 2015, and Dec 31, 2018, and 75 patients were fully evaluable for toxicity. Median follow-up was 30 days (IQR 27-83). In part A, 13 patients were enrolled and 12 were evaluable for toxicity. There were no dose de-escalations or dose-limiting toxicities and nivolumab 3 mg/kg was confirmed as the paediatric recommended phase 2. 72 patients were enrolled in part B and 63 were evaluable for toxicity. Five (7%) patients in part B had dose-limiting toxicities. The most common overall toxicity was anaemia (35 [47%] of 75 patients; five patients had grade 3 or grade 4) and non-haematological toxicity was fatigue (28 [37%] patients; none had grade 3 or grade 4). Responses were observed in patients with lymphoma (three [30%] of ten with Hodgkin lymphoma and one [10%] of ten with non-Hodgkin lymphoma; all responders had PD-L1 expression). Objective responses were not observed in other tumour types. INTERPRETATION Nivolumab was safe and well tolerated in children and young adults and showed clinical activity in lymphoma. Nivolumab showed no significant single-agent activity in the common paediatric solid tumours. This study defines the recommended phase 2 dose and establishes a favourable safety profile for nivolumab in children and young adults, which can serve as the basis for its potential study in combinatorial regimens for childhood cancer. FUNDING Bristol-Myers Squibb, Children's Oncology Group, National Institutes of Health, Cookies for Kids Cancer Foundation.
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Affiliation(s)
- Kara L Davis
- Department of Pediatrics, Division of Hematology and Oncology, Stanford University, Stanford, CA, USA
| | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA, USA; Clinical Trials Administration, Cancer Center, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Melinda S Merchant
- Pediatric Oncology, National Institutes of Health, Bethesda, MD, USA; Epizyme, Cambridge, MA, USA
| | - Joel M Reid
- Department of Oncology and Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Rachel A Kudgus
- Department of Oncology and Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Xiaowei Liu
- Children's Oncology Group, Monrovia, CA, USA
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Stephan Voss
- Department of Radiology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Stacey L Berg
- Pediatric Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Brenda J Weigel
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Crystal L Mackall
- Department of Pediatrics, Division of Hematology and Oncology, Stanford University, Stanford, CA, USA.
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17
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Schafer ES, Rau RE, Berg SL, Liu X, Minard CG, Bishop AJR, Romero JC, Hicks MJ, Nelson MD, Voss S, Reid JM, Fox E, Weigel BJ, Blaney SM. Phase 1/2 trial of talazoparib in combination with temozolomide in children and adolescents with refractory/recurrent solid tumors including Ewing sarcoma: A Children's Oncology Group Phase 1 Consortium study (ADVL1411). Pediatr Blood Cancer 2020; 67:e28073. [PMID: 31724813 PMCID: PMC9134216 DOI: 10.1002/pbc.28073] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/17/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023]
Abstract
PURPOSE We conducted a phase 1/2 trial of the poly(ADP-ribose) polymerase 1/2 inhibitor talazoparib in combination with low-dose temozolomide (TMZ) to determine the dose-limiting toxicities (DLTs), recommended phase 2 dose (RP2D), and pharmacokinetics of this combination in children with recurrent/refractory solid tumors; and to explore clinical activity in Ewing sarcoma (EWS) (NCT02116777). METHODS Talazoparib (400-600 µg/m2 /dose, maximum daily dose 800-1000 µg) was administered q.d. or b.i.d. orally on day 1 followed by q.d. dosing concomitant with q.d. dosing of oral TMZ (20-55 mg/m2 /day) on days 2 to 6, every 28 days. RESULTS Forty patients, aged 4 to 25 years, were enrolled. Talazoparib was increased to 600 µg/m2 /dose b.i.d. on day 1, and q.d. thereafter, with 20 mg/m2 /day of TMZ, without DLTs. TMZ was subsequently increased, during which dose-limiting neutropenia and thrombocytopenia occurred in two of three subjects at 55 mg/m2 /day, two of six subjects at 40 mg/m2 /day, and one of six subjects at 30 mg/m2 /day. During dose-finding, two of five EWS and four of 25 non-EWS subjects experienced prolonged stable disease (SD), and one subject with malignant glioma experienced a partial response. In phase 2, 0 of 10 EWS subjects experienced an objective response; two experienced prolonged SD. CONCLUSIONS Talazoparib and low-dose TMZ are tolerated in children with recurrent/refractory solid tumors. Reversible neutropenia and thrombocytopenia were dose limiting. The RP2D is talazoparib 600 µg/m2 b.i.d. on day 1 followed by 600 µg/m2 q.d. on days 2 to 6 (daily maximum 1000 µg) in combination with temozolomide 30 mg/m2 /day on days 2 to 6. Antitumor activity was not observed in EWS, and limited antitumor activity was observed in central nervous system tumors.
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Affiliation(s)
- Eric S. Schafer
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | - Rachel E. Rau
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | - Stacey L. Berg
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | | | | | - Alexander J. R. Bishop
- Greehey Children’s Cancer Research Institute, UT Health San Antonio, San Antonio, TX,Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX
| | - J. Carolina Romero
- Greehey Children’s Cancer Research Institute, UT Health San Antonio, San Antonio, TX
| | | | | | | | | | - Elizabeth Fox
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Susan M. Blaney
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
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18
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Cole KA, Pal S, Kudgus RA, Ijaz H, Liu X, Minard CG, Pawel BR, Maris JM, Haas-Kogan DA, Voss SD, Berg SL, Reid JM, Fox E, Weigel BJ. Phase I Clinical Trial of the Wee1 Inhibitor Adavosertib (AZD1775) with Irinotecan in Children with Relapsed Solid Tumors: A COG Phase I Consortium Report (ADVL1312). Clin Cancer Res 2019; 26:1213-1219. [PMID: 31857431 DOI: 10.1158/1078-0432.ccr-19-3470] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/06/2019] [Accepted: 12/13/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Adavosertib (AZD1775), an inhibitor of WEE1 kinase, potentiates replicative stress induced by oncogenes or chemotherapy. Antitumor activity of adavosertib has been demonstrated in preclinical models of pediatric cancer. This phase I trial was performed to define dose-limiting toxicities (DLT), recommended phase II dose (RP2D), and pharmacokinetics of adavosertib in combination with irinotecan in children and adolescents with relapsed or refractory solid tumors or primary central nervous system tumors. PATIENTS AND METHODS Using a 3+3 escalation design, five dose cohorts of the combination of adavosertib and irinotecan (50/70; 65/70; 65/90; 85/90; 110/90 mg/m2/day) delivered on days 1-5 of a 21-day cycle were studied. Pharmacokinetics and analysis of peripheral blood γH2AX was performed. RESULTS Thirty-seven patients were enrolled; 27 were evaluable. The median (range) age was 14 (2-20) years. Twenty-five (93%) received prior chemotherapy (median, three regimens) and 21 (78%) received prior radiotherapy. Eleven patients had a primary central nervous system (CNS) malignancy. Common toxicities were hematologic and gastrointestinal. Two patients receiving adavosertib (110 mg/m2) in combination with irinotecan (90 mg/m2) experienced dose-limiting grade 3 dehydration. A patient with Ewing sarcoma had a confirmed partial response and 2 patients (ependymoma and neuroblastoma) had prolonged stable disease (≥ 6 cycles). Pharmacokinetics of adavosertib were variable but generally dose proportional and clearance was lower in younger patients. CONCLUSIONS Adavosertib (85 mg/m2) in combination with irinotecan (90 mg/m2) administered orally for 5 days was the MTD in children and adolescents with solid and CNS tumors.
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Affiliation(s)
- Kristina A Cole
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Sharmistha Pal
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Heba Ijaz
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xiaowei Liu
- Children's Oncology Group, Monravia, California
| | | | - Bruce R Pawel
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - John M Maris
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Stephan D Voss
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | - Elizabeth Fox
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
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19
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Childerhose JE, Finnila CH, Yu JH, Koenig BA, McEwen J, Berg SL, Wilfond BS, Appelbaum PS, Brothers KB. Participant Engagement in Translational Genomics Research: Respect for Persons-and Then Some. Ethics Hum Res 2019; 41:2-15. [PMID: 31541538 PMCID: PMC7199158 DOI: 10.1002/eahr.500029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The expansion of both formal and informal frameworks of "engaged" research in translational research settings raises emerging and substantial normative concerns. In this article, we draw on findings from a focus group study with members of a national consortium of translational genomic research sites. The goals were to catalog informal participant engagement practices, to explore the perceived roots of these practices and the motivations of research staff members for adopting them, and to reflect on their ethical implications. We learned that participant engagement is a deliberate strategy by research staff members both to achieve instrumental research goals and to "do research differently" in response to past research injustices. While many of the participant engagement practices used in translational genomic research are not new, important insights can be gained through a closer examination of the specific contours of participant engagement in this context. These practices appear to have been shaped by the professional training of genetic counselors and by the interests and needs of participants who enroll in clinical genomics studies. The contours of this contemporary application of engaged research principles have relevance not only to clinical genomics research but also to translational research broadly, particularly for how communities of clinical researchers are interpreting the principle of respect for persons. Our findings invite normative questions about the governance of these practices and sociological questions about whether and how clinical researchers in other professions are also engaging participants in translational research settings.
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Affiliation(s)
- Janet E. Childerhose
- Division of Pediatric Clinical and Translational Research, University of Louisville School of Medicine, 231 East Chestnut Street, N-97, Louisville, KY 40202
| | - Candice H. Finnila
- HudsonAlpha Institute for Biotechnology, 601 Genome Way, Huntsville, AL 35806
| | - Joon-Ho Yu
- Department of Pediatrics, University of Washington School of Medicine, Box 357371, 1959 NE Pacific St. HSB I607Q, Seattle, WA 98195
| | - Barbara A. Koenig
- Institute for Health and Aging, University of California San Francisco, 3333 California St., Suite 340, San Francisco, CA 94118
| | - Jean McEwen
- The Ethical, Legal and Social Implications Research Program, National Human Genome Research Institute, National Institutes of Health, 5635 Fishers Lane, Suite 4076, MSC 9305, Bethesda, MD 20892
| | - Stacey L. Berg
- Texas Children’s Cancer Center, Department of Pediatrics, Baylor College of Medicine, 6701 Fannin St #1400, Houston, Texas 77030
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Suite 450A, Houston, Texas 77030
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital, 1900 Ninth Ave., M/S JMB-6, Seattle, WA 98101
| | - Paul S. Appelbaum
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY 10032
| | - Kyle B. Brothers
- Division of Pediatric Clinical and Translational Research, University of Louisville School of Medicine, 231 East Chestnut Street, N-97, Louisville, KY 40202
- Institute for Bioethics, Health Policy, and Law, University of Louisville, 501 E. Broadway, Ste 310, Louisville, KY 40202
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20
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Mossé YP, Fox E, Teachey DT, Reid JM, Safgren SL, Carol H, Lock RB, Houghton PJ, Smith MA, Hall D, Barkauskas DA, Krailo M, Voss SD, Berg SL, Blaney SM, Weigel BJ. A Phase II Study of Alisertib in Children with Recurrent/Refractory Solid Tumors or Leukemia: Children's Oncology Group Phase I and Pilot Consortium (ADVL0921). Clin Cancer Res 2019; 25:3229-3238. [PMID: 30777875 PMCID: PMC6897379 DOI: 10.1158/1078-0432.ccr-18-2675] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/20/2018] [Accepted: 02/14/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE Aurora A kinase (AAK) plays an integral role in mitotic entry, DNA damage checkpoint recovery, and centrosome and spindle maturation. Alisertib (MLN8237) is a potent and selective AAK inhibitor. In pediatric preclinical models, antitumor activity was observed in neuroblastoma, acute lymphoblastic leukemia, and sarcoma xenografts. We conducted a phase 2 trial of alisertib in pediatric patients with refractory or recurrent solid tumors or acute leukemias (NCT01154816). PATIENTS AND METHODS Alisertib (80 mg/m2/dose) was administered orally, daily for 7 days every 21 days. Pharmacogenomic (PG) evaluation for polymorphisms in the AURK gene and drug metabolizing enzymes (UGT1A1*28), and plasma pharmacokinetic studies (PK) were performed. Using a 2-stage design, patients were enrolled to 12 disease strata (10 solid tumor and 2 acute leukemia). Response was assessed after cycle 1, then every other cycle. RESULTS A total of 139 children and adolescents (median age, 10 years) were enrolled, 137 were evaluable for response. Five objective responses were observed (2 complete responses and 3 partial responses). The most frequent toxicity was myelosuppression. The median alisertib trough concentration on day 4 was 1.3 μmol/L, exceeding the 1 μmol/L target trough concentration in 67% of patients. No correlations between PG or PK and toxicity were observed. CONCLUSIONS Despite alisertib activity in pediatric xenograft models and cogent pharmacokinetic-pharmacodynamic relationships in preclinical models and adults, the objective response rate in children and adolescents receiving single-agent alisertib was less than 5%.
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Affiliation(s)
- Yael P Mossé
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Pennsylvania.
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Fox
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David T Teachey
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Hernan Carol
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, Australia
| | - Richard B Lock
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Sydney, Sydney, Australia
| | - Peter J Houghton
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | | | - David Hall
- Children's Oncology Group, Monrovia, California
| | | | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Stephan D Voss
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Stacey L Berg
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Susan M Blaney
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Brenda J Weigel
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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Foster J, Muscal JA, Minard CG, Liu X, Reid JM, Berg SL, Fox E, Weigel B. Phase 1 study of pevonedistat (MLN4924) in combination with temozolomide (TMZ) and irinotecan (IRN) in pediatric patients with recurrent or refractory solid tumors (ADVL1615). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
e21521 Background: Pevonedistat, a first in class inhibitor of NEDD8 activating enzyme (NAE), prevents the activation of Cullin-RING ligases (CRL) necessary for proteasome mediated degradation of key regulatory proteins important in cell survival. In adults with solid tumors, the maximum tolerated dose (MTD) in combination with chemotherapy is 20-25 mg/m2. Antitumor activity of pevonedistat has been demonstrated in preclinical models of childhood cancer. In vivo additive activity has been demonstrated for pevonedistat in combination with IRN and alkylating agents. The objectives of this study are to determine the MTD and recommended phase 2 dose of pevonedistat in combination with IRN and TMZ and describe the toxicities, pharmacokinetic (PK), and pharmacodynamics (PD) properties of this combination. Methods: Using a rolling six design, we conducted a phase 1 trial of pevonedistat in combination with IRN and TMZ in pediatric patients (pts) with recurrent or refractory solid tumors and brain tumors. During cycle 1, pevonedistat was administered intravenously on days 1, 8, 10, and 12, with IRN (IV, 50mg/m2) and TMZ (orally, 100mg/m2), on days 8-12 of a 28 day cycle. In subsequent cycles, pevonedistat was administered on days 1, 3, and 5, with IRN and TMZ on days 1-5 of a 21 day cycle. Results: 18 pts enrolled. All pts were eligible and evaluable for cycle 1 dose limiting toxicity (DLT) assessment. Median (range) age was 13 (1-21) years; 11 (61%) were male. Six pts had brain tumors, and 12 pts had solid tumors. Six pts each enrolled on pevonedistat dose levels 1 (15mg/m2), 2 (20mg/m2), and 3 (25mg/m2). There were no DLTs; DLT assessment is pending for 1 pt on dose level 3. Grade 3/4 toxicities included grade 4 lymphocyte count decreased (n = 2), grade 3 white blood cell decreased (n = 2), and 1 pt each with grade 3 anemia, elevated AST, and elevated ALT. The most frequent AEs were anemia (83%), nausea (61%), elevated AST (61%), and diarrhea (61%). Pharmacokinetic analysis is pending. Conclusions: Pevonedistat in combination with IRN and TMZ is well tolerated in pts with solid or brain tumors. PK and PD analyses are ongoing to establish the recommended dose. Clinical trial information: NCT03323034.
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Affiliation(s)
| | - Jodi Ann Muscal
- Baylor College of Medicine Texas Children's Hospital, Bellaire, TX
| | | | | | - Joel M. Reid
- Department of Oncology, Mayo Clinic, Rochester, MN
| | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
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22
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Greengard EG, Williams RL, Liu X, Militano O, Fisher TL, Evans EE, Minard CG, Reid JM, Voss SD, Berg SL, Fox E, Weigel B. A phase I/II trial of VX15/2503 in children, adolescents, and young adults with relapsed or refractory solid tumors (ADVL1614). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
e21519 Background: Semaphorins regulate tumor progression, immune responses, and angiogenesis. SEMA4D was identified as a candidate proto-oncogene by a Sleeping Beauty forward genetic screen that induced osteosarcoma in mice. SEMA4D is expressed on tumors, including osteosarcoma, and in the tumor microenvironment. VX15/2503, a humanized IgG4 monoclonal antibody, binds SEMA4D, blocks receptor interaction and enhances the anti-tumor immune response in preclinical studies. This trial aimed to determine the tolerability and recommended dose of VX15/2503 in patients with relapsed/refractory solid tumors and activity in patients with osteosarcoma. Methods: Part A enrolled patients age≤ 21y with refractory solid tumors to assess the tolerability of VX15/2503 (20 mg/kg) IV every 14 days x 2 doses/cycle. The recommended dose was one that was tolerated and achieved sustained target saturation. Up to 6 additional children were enrolled to assess pharmacokinetics (PK). In part B, a two-stage design was used to assess the activity of VX15/2503 in patients with measurable, relapsed /refractory osteosarcoma. In part B1 patients > 21-30y accrued concurrently with part A; Part B2 (patients £ 21y) was initiated after the pediatric recommended dose was determined. Correlative studies including target saturation by VX15/2503 were required. Results: 18 eligible patients enrolled, 16 evaluable for toxicity. In part A (n = 12) the median (range) age was 12.5 (1-20) y. Diagnoses included osteosarcoma (8), neuroblastoma (2), other (2). No dose limiting toxicities (DLTs) were observed. In Part B1, (n = 6) median (range) age was 22.5 (22-30) y; one patient had cycle 1 DLTs (grade 3 acute kidney injury, creatinine increase, arthralgia and myalgia); a second patient had a later cycle DLT (grade 4 pericardial effusion). Given only 1/18 had a cycle 1 DLT, this did not impact dose selection. T-cell saturation by VX15/2503 was adequate and sustained in all patients. Conclusions: VX15/2503 was well tolerated at 20 mg/kg IV every 2 weeks and is the recommended dose in children, adolescents and young adults. The activity in osteosarcoma is under evaluation. Future trials combining VX15/2503 with novel agents are in development. Clinical trial information: NCT03320330.
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Affiliation(s)
| | | | | | | | | | | | | | - Joel M. Reid
- Department of Oncology, Mayo Clinic, Rochester, MN
| | | | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
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Parsons DW, Janeway KA, Patton D, Coffey B, Williams PM, Hamilton SR, Purkayastha A, Tsongalis GJ, Routbort M, Gastier-Foster JM, Saguilig L, Piao J, Alonzo TA, Berg SL, Fox E, Adamson PC, Mooney MM, Takebe N, Tricoli JV, Seibel N. Identification of targetable molecular alterations in the NCI-COG Pediatric MATCH trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.10011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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
10011 Background: The screening protocol for the NCI-Children’s Oncology Group (COG) Pediatric Molecular Analysis for Therapy Choice (MATCH) trial detects tumor alterations that are used to assign patients with treatment-refractory or recurrent cancers to phase 2 treatment arms of molecularly-targeted therapies. Methods: Patients age 1 to 21 years old with treatment-refractory or recurrent solid tumors, non-Hodgkin lymphomas, or histiocytic disorders treated at U.S. based COG sites are eligible. DNA and RNA extracted from FFPE tumor samples are sequenced using an Oncomine cancer gene panel for detection of mutations, amplifications, and fusions. Loss of SMARCB1, SMARCA4, and PTEN expression is detected by immunohistochemistry. Lists of actionable mutations (aMOIs) based upon available clinical and pre-clinical data are used a priori to determine eligibility for treatment arms. Results: Between 7/24/17 and 12/31/18, 422 patients with a median age of 13 years (range 1-21) were enrolled from 93 COG sites. Solid tumors comprised 71% (n = 300) of diagnoses, CNS tumors 24% (n = 101) and lymphomas/histiocytoses 5% (n = 21). A tumor sample was submitted for 390 patients, sequencing was attempted for 370 (95%), and results were confirmed for 357 (92%). Median turn-around time was 15 days. An aMOI for at least one of the 10 current treatment arms was identified in 112 patients (29%, 95% CI 24%-33%); 95 patients (24%, 95% CI 20%-29%) were assigned to a treatment arm with 39 patients (10%, 95% CI 7%-13%) enrolled to date. The aMOI rate was similar in patients less than 12 years of age (35%) compared to patients 12 years and older (25%). Actionable MAPK pathway alterations were found in 11% of patients (n = 41), most often HRAS/ KRAS/ NRAS mutations (n = 16), BRAF mutations or fusions (n = 14), or NF1 mutations (n = 11). Other genes with recurrent aMOIs included SMARCB1 (n = 14), ALK (n = 8), CDK4 (n = 8), PIK3CA (n = 7), PTEN (n = 7), FGFR1 (n = 5), and BRCA1/BRCA2 (n = 5). Conclusions: Approximately one-quarter of patients with tumor submitted for Pediatric MATCH screening have been assigned to an investigational therapy, facilitating the evaluation of molecularly-targeted agents in biomarker-positive pediatric cohorts through a collaborative nationwide study. Clinical trial information: NCT03155620.
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Affiliation(s)
| | | | - David Patton
- National Cancer Institute/Center for Biomedical Informatics & Information Technology, Rockville, MD
| | | | - Paul M. Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | - Gregory J. Tsongalis
- The Geisel School of Medicine at Dartmouth and Dartmouth Hitchcock Medical Center, Lebanon, NH
| | - Mark Routbort
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Jin Piao
- Children's Oncology Group, Monrovia, CA
| | - Todd Allen Alonzo
- University of Southern California Children's Oncology Group, Arcadia, CA
| | | | - Elizabeth Fox
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Naoko Takebe
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD
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Unguru Y, Bernhardt MB, Berg SL, Johnson LM, Pyke-Grimm K, Woodman C, Fernandez CV. Chemotherapy and Supportive Care Agents as Essential Medicines for Children With Cancer. JAMA Pediatr 2019; 173:477-484. [PMID: 30830204 DOI: 10.1001/jamapediatrics.2019.0070] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In resource-rich countries, 5-year survival rates for children with cancer approach 85%. This impressive statistic is largely the result of integrating research with clinical care. At the core of this endeavor are multiagent combination chemotherapy and supportive care agents (CASCA). Most CASCAs belong to the class of sterile injectable drugs, which make up the backbone of many proven and life-saving pediatric oncology regimens. There are few if any alternative agents available to treat most life-threatening childhood cancers. In the United States, shortages of CASCAs are now commonplace. The consequences of drug shortages are far reaching. Beyond the economic costs, these shortages directly affect patients' lives, and this is especially true for children with cancer. Drug shortages in general and shortages of CASCAs specifically result in increased medication errors, delayed administration of life-saving therapy, inferior outcomes, and patient deaths. One way to mitigate drug shortages is to adopt an essential medicines list and ensure that these medications remain in adequate supply at all times. We argue for creation of a CASCA-specific essential medicines list for childhood cancer and provide ethical and policy-based reasoning for this approach. We recognize that such a call has implications beyond pediatric cancer, in that children with other serious disease should have an equal claim to access to guaranteed evidence-based medicines. We provide these arguments as an example of what should be claimed for medical indications that are deemed essential to preserve life and function.
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Affiliation(s)
- Yoram Unguru
- Division of Pediatric Hematology-Oncology, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, Maryland.,Johns Hopkins University, Berman Institute of Bioethics, Baltimore, Maryland
| | - Melanie Brooke Bernhardt
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Stacey L Berg
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | | | - Kimberly Pyke-Grimm
- Bass Center for Childhood Cancer and Blood Diseases, Lucile Packard Children's Hospital, Stanford, California
| | | | - Conrad V Fernandez
- Pediatric Hematology-Oncology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Geller JI, Fox E, Turpin BK, Goldstein SL, Liu X, Minard CG, Kudgus RA, Reid JM, Berg SL, Weigel BJ. A study of axitinib, a VEGF receptor tyrosine kinase inhibitor, in children and adolescents with recurrent or refractory solid tumors: A Children's Oncology Group phase 1 and pilot consortium trial (ADVL1315). Cancer 2018; 124:4548-4555. [PMID: 30394521 DOI: 10.1002/cncr.31725] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 05/10/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Axitinib is an oral small molecule that inhibits receptor tyrosine kinases vascular endothelial growth factor receptors 1 to 3. A phase 1 and pharmacokinetic (PK) trial evaluating axitinib was conducted in children with refractory solid tumors. METHODS Axitinib was administered orally twice daily in continuous 28-day cycles. Dose levels (2.4 mg/m2 /dose and 3.2 mg/m2 /dose) were evaluated using a rolling 6 design. Serial PKs (cycle 1, days 1 and 8) and exploratory biomarkers were analyzed. RESULTS A total of 19 patients were enrolled; 1 patient was ineligible due to inadequate time having elapsed from prior therapy. The median age of the patients was 13.5 years (range, 5-17 years). Two of 5 patients who were treated at dose level 2 experienced dose-limiting toxicities (palmar-plantar erythryodysesthesia syndrome in 1 patient and intratumoral hemorrhage in 1 patient). Frequent (>20%) grade 1 to 2 toxicities during cycle 1 included anemia, anorexia, fatigue, diarrhea, nausea, and hypertension. Nonhematological toxicities of grade ≥3 in subsequent cycles included hypertension and elevated serum lipase. PK analysis demonstrated variability in axitinib exposure, the median time to peak plasma concentration was 2 hours, and the half-life ranged from 0.7 to 5.2 hours. Exposure and dose were not found to be significantly associated with hypertension. Five patients achieved stable disease for ≤6 cycles as their best response, including patients with malignant peripheral nerve sheath tumor (1 patient), Ewing sarcoma (1 patient), hepatocellular carcinoma (1 patient), and osteosarcoma (2 patients). One patient with alveolar soft part sarcoma achieved a partial response. Kidney injury biomarkers were found to be elevated at baseline; no trends were identified. CONCLUSIONS In children with refractory solid tumors, the maximum tolerated and recommended dose of axitinib appears to be 2.4 mg/m2 /dose, which provides PK exposures similar to those of adults.
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Affiliation(s)
- James I Geller
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth Fox
- Developmental Therapeutics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian K Turpin
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Stuart L Goldstein
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Xiaowei Liu
- Children's Oncology Group, Monrovia, California
| | - Charles G Minard
- Dan L, Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Rachel A Kudgus
- Department of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Joel M Reid
- Department of Oncology Research, Mayo Clinic, Rochester, Minnesota
| | - Stacey L Berg
- Dan L, Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Brenda J Weigel
- Department of Pediatrics, Masonic Children's Hospital, University of Minnesota Medical Center, Minneapolis, Minnesota
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Pradhan K, Berg SL, Liu X, Minard CG, Croop J, Reid JM, Fox E, Weigel BJ. Abstract CT054: A dose escalation and toxicity study using pre-determined target concentration of Ramucirumab, a novel anti-angiogenic agent in children with recurrent / refractory solid tumors: A report from the children's oncology group phase I/ pilot consortium (ADVL1416). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct054] [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
Ramucirumab (RAM) is a high affinity, humanized, monoclonal antibody that binds to the extra-cellular domain of the vascular endothelial growth factor receptor (VEGFR). RAM prevents the binding of VEGF ligands with VEGFR-2, the most potent receptor of the VEGF tumor angiogenesis pathway. RAM is FDA approved for adults with NSCLC, as well as for gastric and colorectal adenocarcinoma where higher exposure was associated with better outcomes. Based on population pharmacokinetic (PK) analysis of the adult data, a minimum steady state concentration (Cmin ss) of ≥ 50 µg/ml of RAM was considered the target concentration for pediatrics. The Children's Oncology Group (COG) conducted a phase 1 study using a rolling six design to define the maximum tolerated dose (MTD) and /or a recommended phase 2 dose (RP2D), evaluate toxicities and explore circulating angiogenic cells as a biomarker for RAM monotherapy in children with recurrent/refractory solid tumors. The starting dose of 8 mg/kg IV q2 weeks (DL1) was chosen based on the adult safety profile and effective Cmin ss. Since adult data suggested that lower body weight was associated with lower Cmin ss, dose escalation to 12 mg/kg IV q2 weeks (DL2) was planned provided the MTD was not exceeded in DL1 and up to 16 mg/kg IV q2 weeks (DL3) if Cmin ss was < 50 µg/ml in 1 of 6 subjects on DL2 without exceeding the MTD. An expansion cohort was planned at the lowest dose where at least 5 of 6 subjects exceeded the target in order to generate PK data in at least 6 additional subjects < 12 years of age. In the absence of an MTD, the RP2D was defined as the dose achieving Cmin ss ≥ 50 µg/ml on day 42 ± 2, after 3 doses of RAM administered IV every 2 weeks, in at least 10 of 12 subjects. Sixteen subjects (15 eligible; 7 females), median age of 14 years (3-21 yrs.) have been enrolled. Of the 7 subjects on DL1, two had insufficient PK sampling to establish Cmin ss, including 1 who experienced grade 2 proteinuria (DLT). In the remaining 5, the median (range) Cmin ss was 66 (40-136) µg/ml; 2/5 did not achieve the target of ≥ 50 µg/ml. Of the 8 subjects on DL2, two had insufficient PK sampling, including 1 with grade 2 proteinuria (DLT). In the remaining 6, the median (range) Cmin ss was 64 (51-101) µg/ml, all ≥ 50 µg/ml; thus 12mg/kg IV q2 weeks was identified for the expansion cohort. The most common RAM related non-DLT toxicities were grade 1/2 headache in 6 subjects, grade 1/2 elevation in aspartate aminotransferase in 7 subjects and grade 2/3 hypertension in 2 subjects. Due to low participation, circulating angiogenic cells could not be analyzed. This is the first COG study in which dose escalation and RP2D for a targeted agent incorporated a primary PK endpoint (Cmin ss) based upon efficacy data from adult studies and paves the way for similar study design for future phase-1 studies.
Citation Format: Kamnesh Pradhan, Stacey L. Berg, Xiaowei Liu, Charles G. Minard, James Croop, Joel M. Reid, Elizabeth Fox, Brenda J. Weigel. A dose escalation and toxicity study using pre-determined target concentration of Ramucirumab, a novel anti-angiogenic agent in children with recurrent / refractory solid tumors: A report from the children's oncology group phase I/ pilot consortium (ADVL1416) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT054.
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Desai AV, Brodeur GM, Foster J, Berg SL, Basu EM, Shusterman S, Sabnis AJ, Macy M, Yoon J, Gauvain K, Esquibel V, Chow Maneval E, Multani PS, Fox E. Phase 1 study of entrectinib (RXDX-101), a TRK, ROS1, and ALK inhibitor, in children, adolescents, and young adults with recurrent or refractory solid tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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)
- Ami Vijay Desai
- University of Chicago Medical Center, Comer Children’s Hospital, Chicago, IL
| | | | | | | | - Ellen M. Basu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Amit J. Sabnis
- UCSF Benioff Children’s Hospital San Francisco, San Francisco, CA
| | | | | | | | | | | | | | - Elizabeth Fox
- The Children's Hospital of Pennsylvania, Philadelphia, PA
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28
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Lin FY, Bergstrom K, Person R, Bavle A, Ballester LY, Scollon S, Raesz-Martinez R, Jea A, Birchansky S, Wheeler DA, Berg SL, Chintagumpala MM, Adesina AM, Eng C, Roy A, Plon SE, Parsons DW. Integrated tumor and germline whole-exome sequencing identifies mutations in MAPK and PI3K pathway genes in an adolescent with rosette-forming glioneuronal tumor of the fourth ventricle. Cold Spring Harb Mol Case Stud 2016; 2:a001057. [PMID: 27626068 PMCID: PMC5002928 DOI: 10.1101/mcs.a001057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The integration of genome-scale studies such as whole-exome sequencing (WES) into the clinical care of children with cancer has the potential to provide insight into the genetic basis of an individual's cancer with implications for clinical management. This report describes the results of clinical tumor and germline WES for a patient with a rare tumor diagnosis, rosette-forming glioneuronal tumor of the fourth ventricle (RGNT). Three pathogenic gene alterations with implications for clinical care were identified: somatic activating hotspot mutations in FGFR1 (p.N546K) and PIK3CA (p.H1047R) and a germline pathogenic variant in PTPN11 (p.N308S) diagnostic for Noonan syndrome. The molecular landscape of RGNT is not well-described, but these data are consistent with prior observations regarding the importance of the interconnected MAPK and PI3K/AKT/mTOR signaling pathways in this rare tumor. The co-occurrence of FGFR1, PIK3CA, and PTPN11 alterations provides further evidence for consideration of RGNT as a distinct molecular entity from pediatric low-grade gliomas and suggests potential therapeutic strategies for this patient in the event of tumor recurrence as novel agents targeting these pathways enter pediatric clinical trials. Although RGNT has not been definitively linked with cancer predisposition syndromes, two prior cases have been reported in patients with RASopathies (Noonan syndrome and neurofibromatosis type 1 [NF1]), providing an additional link between these tumors and the mitogen-activated protein kinase (MAPK) signaling pathway. In summary, this case provides an example of the potential for genome-scale sequencing technologies to provide insight into the biology of rare tumors and yield both tumor and germline results of potential relevance to patient care.
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Affiliation(s)
- Frank Y Lin
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Katie Bergstrom
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Richard Person
- Department of Molecular and Human Genetics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Abhishek Bavle
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Leomar Y Ballester
- Department of Pathology, Texas Children's Hospital Baylor College of Medicine, Houston, Texas 77030, USA
| | - Sarah Scollon
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Robin Raesz-Martinez
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Andrew Jea
- Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Sherri Birchansky
- Department of Pediatric Radiology, Texas Children's Hospital Baylor College of Medicine, Houston, Texas 77030, USA
| | - David A Wheeler
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA;; Department of Molecular and Human Genetics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Stacey L Berg
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Murali M Chintagumpala
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Adekunle M Adesina
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA;; Department of Pathology, Texas Children's Hospital Baylor College of Medicine, Houston, Texas 77030, USA
| | - Christine Eng
- Department of Molecular and Human Genetics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Angshumoy Roy
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA;; Department of Pathology, Texas Children's Hospital Baylor College of Medicine, Houston, Texas 77030, USA
| | - Sharon E Plon
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA;; Department of Molecular and Human Genetics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - D Williams Parsons
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA;; Department of Molecular and Human Genetics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA;; Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
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Balis FM, Womer RB, Berg SL, Adamson PC, Fox E. Current approach and recommendations for standardized dosing of anticancer drugs in infants. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10546] [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
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30
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Minard CG, Seibel N, Berg SL, Fox E, Weigel B. Impact of the pediatric central institutional review board (PedCIRB) in Children's Oncology Group Phase 1 Consortium dose escalation studies. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18050] [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
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Parsons DW, Roy A, Yang Y, Wang T, Scollon S, Bergstrom K, Kerstein RA, Gutierrez S, Petersen AK, Bavle A, Lin FY, López-Terrada DH, Monzon FA, Hicks MJ, Eldin KW, Quintanilla NM, Adesina AM, Mohila CA, Whitehead W, Jea A, Vasudevan SA, Nuchtern JG, Ramamurthy U, McGuire AL, Hilsenbeck SG, Reid JG, Muzny DM, Wheeler DA, Berg SL, Chintagumpala MM, Eng CM, Gibbs RA, Plon SE. Diagnostic Yield of Clinical Tumor and Germline Whole-Exome Sequencing for Children With Solid Tumors. JAMA Oncol 2016; 2:616-624. [PMID: 26822237 DOI: 10.1001/jamaoncol.2015.5699] [Citation(s) in RCA: 327] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Whole-exome sequencing (WES) has the potential to reveal tumor and germline mutations of clinical relevance, but the diagnostic yield for pediatric patients with solid tumors is unknown. Objective To characterize the diagnostic yield of combined tumor and germline WES for children with solid tumors. Design Unselected children with newly diagnosed and previously untreated central nervous system (CNS) and non-CNS solid tumors were prospectively enrolled in the BASIC3 study at a large academic children's hospital during a 23-month period from August 2012 through June 2014. Blood and tumor samples underwent WES in a certified clinical laboratory with genetic results categorized on the basis of perceived clinical relevance and entered in the electronic health record. Main Outcomes and Measures Clinical categorization of somatic mutations; frequencies of deleterious germline mutations related to patient phenotype and incidental medically-actionable mutations. Results Of the first 150 participants (80 boys and 70 girls, mean age, 7.4 years), tumor samples adequate for WES were available from 121 patients (81%). Somatic mutations of established clinical utility (category I) were reported in 4 (3%) of 121 patients, with mutations of potential utility (category II) detected in an additional 29 (24%) of 121 patients. CTNNB1 was the gene most frequently mutated, with recurrent mutations in KIT, TSC2, and MAPK pathway genes (BRAF, KRAS, and NRAS) also identified. Mutations in consensus cancer genes (category III) were found in an additional 24 (20%) of 121 tumors. Fewer than half of somatic mutations identified were in genes known to be recurrently mutated in the tumor type tested. Diagnostic germline findings related to patient phenotype were discovered in 15 (10%) of 150 cases: 13 pathogenic or likely pathogenic dominant mutations in adult and pediatric cancer susceptibility genes (including 2 each in TP53, VHL, and BRCA1), 1 recessive liver disorder with hepatocellular carcinoma (TJP2), and 1 renal diagnosis (CLCN5). Incidental findings were reported in 8 (5%) of 150 patients. Most patients harbored germline uncertain variants in cancer genes (98%), pharmacogenetic variants (89%), and recessive carrier mutations (85%). Conclusions and Relevance Tumor and germline WES revealed mutations in a broad spectrum of genes previously implicated in both adult and pediatric cancers. Combined reporting of tumor and germline WES identified diagnostic and/or potentially actionable findings in nearly 40% of newly diagnosed pediatric patients with solid tumors.
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Affiliation(s)
- D Williams Parsons
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston2Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas3The Human Genome Sequencing Center, Baylor College of Medicine, Houston, T
| | - Angshumoy Roy
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston4The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas5Department of Pathology, Texas Children's Hospital, Houston6Department of Pathology a
| | - Yaping Yang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Tao Wang
- The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Sarah Scollon
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston
| | - Katie Bergstrom
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston
| | - Robin A Kerstein
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston
| | - Stephanie Gutierrez
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston
| | - Andrea K Petersen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Abhishek Bavle
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston
| | - Frank Y Lin
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston4The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Dolores H López-Terrada
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston4The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas5Department of Pathology, Texas Children's Hospital, Houston6Department of Pathology a
| | - Federico A Monzon
- Department of Pathology, Texas Children's Hospital, Houston6Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - M John Hicks
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston4The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas5Department of Pathology, Texas Children's Hospital, Houston6Department of Pathology a
| | - Karen W Eldin
- Department of Pathology, Texas Children's Hospital, Houston6Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Norma M Quintanilla
- Department of Pathology, Texas Children's Hospital, Houston6Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Adekunle M Adesina
- The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas5Department of Pathology, Texas Children's Hospital, Houston6Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Carrie A Mohila
- Department of Pathology, Texas Children's Hospital, Houston6Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - William Whitehead
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas8Department of Surgery, Texas Children's Hospital, Houston
| | - Andrew Jea
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas8Department of Surgery, Texas Children's Hospital, Houston
| | - Sanjeev A Vasudevan
- The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas8Department of Surgery, Texas Children's Hospital, Houston9Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jed G Nuchtern
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston4The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas8Department of Surgery, Texas Children's Hospital, Houston9Michael E. DeBakey Departme
| | - Uma Ramamurthy
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Amy L McGuire
- The Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas11Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Susan G Hilsenbeck
- The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G Reid
- The Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Donna M Muzny
- The Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - David A Wheeler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas3The Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas4The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Stacey L Berg
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston4The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Murali M Chintagumpala
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston4The Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Christine M Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas3The Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Sharon E Plon
- Texas Children's Cancer Center, Department of Pediatrics, Baylor College of Medicine, Houston2Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas3The Human Genome Sequencing Center, Baylor College of Medicine, Houston, T
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Bavle A, Wang T, Lin FY, Roy A, Kerstein RA, Scollon S, Bergstrom K, Gutierrez S, Ramamurthy U, Yang Y, Eng CM, Gibbs RA, Chintagumpala MM, Hilsenbeck SG, Plon SE, Berg SL, Parsons. DW. Abstract 04: Impact of whole exome sequencing results on clinical decision making for pediatric solid tumor patients in the hypothetical scenario of tumor relapse: A survey of pediatric oncologists. Clin Cancer Res 2016. [DOI: 10.1158/1557-3265.pmsclingen15-04] [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 development of molecularly-targeted agents has made it possible to personalize therapy for patients by targeting the specific mutations in their tumor. Pediatric clinical trials utilizing such strategies are being planned but little is known about the opinions of pediatric oncologists regarding the utility of genomic data for guiding treatment decisions. The goals of this study were to (1) characterize those opinions in the context of children with relapsed/refractory solid tumors and (2) assess the potential impact of clinical whole exome sequencing (WES) data on medical decision-making in that context.
Methods: As part of the ongoing BASIC3 clinical sequencing study at Texas Children's Cancer Center, clinical germline and tumor (if sample available) WES were performed for unselected newly-diagnosed pediatric CNS and non-CNS solid tumor patients. The primary oncologist for each (n=17) received online surveys for each study patient before and after review of WES reports. The pre- and post-WES surveys asked oncologists to rank options for off-study systemic chemotherapy (of any type) for their patient in the hypothetical scenario of tumor relapse. Oncologists were then asked if they would consider using a molecularly-targeted agent in the context of a clinical trial, and if so, which agents (from a representative list), their rank order and the rationale for those choices. Post-WES surveys also included questions regarding perceived utility of the tumor WES results for patient care. Pre-WES surveys were analyzed for baseline oncologist responses regarding these hypothetical treatment decisions. When available, pre- and post-WES surveys were analyzed as pairs as an initial assessment of the influence of the WES results on the oncologist's choice of therapy.
Results: 177/189 (94%) of pre-WES surveys and 111/161 (69%) post-WES surveys were available for analysis. Analysis of pre-exome surveys revealed that oncologists would recommend systemic chemotherapy for 127/177 (72%) patients in the hypothetical event of tumor relapse but would consider a molecularly-targeted agent off-study as their first option in only 8/177 (4%) cases. In contrast, oncologists indicated that they would consider targeted therapies in the context of a clinical trial for 99/177 (56%) patients, most commonly sorafenib (n=21), cixutumumab (n=17), and crizotinib (n=13). There were 26 cases in which somatic mutations were identified in genes categorized as having established or potential clinical relevance, and for which both pre- and post-WES surveys were available. A corresponding targeted agent was ranked for consideration in the hypothetical scenario of relapse on the post-WES survey for 8/26 (31%) of these patients (somatic mutations in MET, JAK2, HRAS, NRAS X 2, ALK, BRAF, KIT), having only been chosen on the pre-WES survey in 2 of those cases. On 8 of 111 (7%) post-WES surveys, the oncologist removed a targeted agent that had been prioritized on the pre-WES survey after no relevant mutation was detected, including the Sonic Hedgehog inhibitor GDC-0449 in 5 cases.
Conclusion: Although genomic tests such as WES have the potential to identify molecular targets for therapy in children with relapsed tumors, a survey of pediatric oncologists revealed that most consider such therapies as options only in the context of a clinical trial. These findings support the potential utility of WES in precision oncology approaches as well as the need for clinical trials evaluating the use of integrated genomic testing to guide treatment of children with relapsed solid tumors.
Citation Format: Abhishek Bavle, Tao Wang, Frank Y. Lin, Angshumoy Roy, Robin A. Kerstein, Sarah Scollon, Katie Bergstrom, Stephanie Gutierrez, Uma Ramamurthy, Yaping Yang, Christine M. Eng, Richard A. Gibbs, Murali M. Chintagumpala, Susan G. Hilsenbeck, Sharon E. Plon, Stacey L. Berg, D. Williams Parsons. Impact of whole exome sequencing results on clinical decision making for pediatric solid tumor patients in the hypothetical scenario of tumor relapse: A survey of pediatric oncologists. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Integrating Clinical Genomics and Cancer Therapy; Jun 13-16, 2015; Salt Lake City, UT. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(1_Suppl):Abstract nr 04.
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Affiliation(s)
- Abhishek Bavle
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Tao Wang
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Frank Y. Lin
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Angshumoy Roy
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Robin A. Kerstein
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Sarah Scollon
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Katie Bergstrom
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | | | - Uma Ramamurthy
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Yaping Yang
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Christine M. Eng
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Richard A. Gibbs
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | | | | | - Sharon E. Plon
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Stacey L. Berg
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
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Parsons DW, Roy A, Yang Y, Wang T, Scollon S, Bergstrom K, Kerstein RA, Gutierrez S, Bavle A, Lin FY, López-Terrada DH, Monzon FA, Nuchtern JG, Ramamurthy U, McGuire AL, Hilsenbeck SG, Reid JG, Muzny DM, Wheeler DA, Berg SL, Chintagumpala MM, Eng CM, Gibbs RA, Plon SE. Abstract IA16: Clinical genomics for children with solid tumors: Current realities and future opportunities. Clin Cancer Res 2016. [DOI: 10.1158/1557-3265.pmsclingen15-ia16] [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
Genome-scale sequencing methods such as whole exome sequencing (WES) have provided significant insight into the pathogenesis of cancer. However, experience with the use of these tests in the clinical care of cancer patients remains limited. Sequencing of tumor and matched normal samples can reveal multiple types of results with implications for clinical practice. The identification of somatic (tumor-specific) mutations has the potential to offer diagnostic and prognostic information and inform selection of therapies. Detection of germline mutations in cancer susceptibility genes may prompt further genetic testing and guide cancer surveillance strategies for both the patient and family members. Germline mutations may also explain non-cancer phenotypes, predict drug responses, or provide reproductive counseling information for parents. The goal of the BASIC3 (Baylor College of Medicine Advancing Sequencing into Childhood Cancer Care) study is to determine the clinical impact of incorporating clinical tumor and constitutional WES into the care of children with newly diagnosed solid tumors. This study follows pediatric patients with newly diagnosed CNS and non-CNS solid tumors at Texas Children's Cancer Center for two years after performing CLIA-certified WES of blood and frozen tumor samples. Results are deposited into the electronic health record and disclosed to families by their oncologist and a genetic counselor. The potential impact of tumor exome findings on clinical decision-making is assessed through review of the medical record over the two year follow-up period as well as through surveys of the oncologists regarding prioritization of treatment options in the hypothetical event of tumor recurrence before and after receiving tumor exome results. Preferences of patient families and oncologists for reporting this complex information are obtained by interviews and audio recording of the WES result disclosure visits. Since the study opened in August 2012, more than 210 subjects have been enrolled (~80% of potentially eligible patients), representing the expected distribution of both CNS and non-CNS tumors. WES results have been reported for 170 subjects, revealing potentially-clinically relevant germline and somatic mutations in cancer genes known to be related to pediatric solid tumors as well as others known to be mutated primarily in adult cancer patients. Data will be presented regarding the diagnostic yield of combined tumor and germline WES for children with newly-diagnosed solid tumors. These results demonstrate the feasibility of routine tumor WES in the pediatric oncology clinic and a significant level of parental interest in receiving WES results and have significant implications for the treatment of children with relapsed and refractory solid tumors and the design of clinical trials using precision oncology approaches for these patients. Further analyses of the clinical utility of the WES data and the preferences of oncologists and parents for reporting of these results are under study. The BASIC3 study is a Clinical Sequencing Exploratory Research (CSER) program project supported by NHGRI/NCI 1U01HG006485.
Citation Format: D. William Parsons, Angshumoy Roy, Yaping Yang, Tao Wang, Sarah Scollon, Katie Bergstrom, Robin A. Kerstein, Stephanie Gutierrez, Abhishek Bavle, Frank Y. Lin, Dolores H. López-Terrada, Federico A. Monzon, Jed G. Nuchtern, Uma Ramamurthy, Amy L. McGuire, Susan G. Hilsenbeck, Jeffrey G. Reid, Donna M. Muzny, David A. Wheeler, Stacey L. Berg, Murali M. Chintagumpala, Christine M. Eng, Richard A. Gibbs, Sharon E. Plon. Clinical genomics for children with solid tumors: Current realities and future opportunities. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Integrating Clinical Genomics and Cancer Therapy; Jun 13-16, 2015; Salt Lake City, UT. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(1_Suppl):Abstract nr IA16.
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Affiliation(s)
- D. William Parsons
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Angshumoy Roy
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Yaping Yang
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Tao Wang
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Sarah Scollon
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Katie Bergstrom
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Robin A. Kerstein
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | | | - Abhishek Bavle
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Frank Y. Lin
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | | | - Federico A. Monzon
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Jed G. Nuchtern
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Uma Ramamurthy
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Amy L. McGuire
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | | | - Jeffrey G. Reid
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Donna M. Muzny
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - David A. Wheeler
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Stacey L. Berg
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | | | - Christine M. Eng
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Richard A. Gibbs
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
| | - Sharon E. Plon
- Texas Children's Cancer Center and Baylor College of Medicine, Houston, TX
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Affiliation(s)
- Stacey L. Berg
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston
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Plon SE, Scollon S, Bergstrom K, Kerstein RA, Chintagumpala M, Berg SL, Hilsenbeck SG, Wang T, Rednam S, Wheeler D, McCullough L, Street R, McGuire AL, Jeffrey RG, Muzny DM, Eng CM, Yang Y, Gibbs RA, Parsons DW. Abstract 11: Evaluating cancer susceptibility mutations and incidental findings from whole exome sequencing of sequentially diagnosed pediatric solid and brain tumor patients: Early results of the BASIC3 study. Cancer Res 2014. [DOI: 10.1158/1538-7445.cansusc14-11] [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
Advances in sequencing technologies allow for provision of genome-scale data to oncologists and geneticists caring for pediatric cancer patients but current experience with the clinical application of genomic sequencing is limited. The goal of the BASIC3 (Baylor Advancing Sequencing into Childhood Cancer Care) study is to determine the clinical impact of incorporating tumor and constitutional whole exome sequencing (WES) into the care of children with newly diagnosed solid tumors at Texas Children's Cancer Center (target enrollment n=280). WES of patient blood and frozen tumor samples was conducted in the CLIA-certified Whole Genome Laboratory at Baylor College of Medicine using the vCrome 2.1 capture platform and Illumina paired-end sequencing. Reported WES germline findings were validated by a second platform and evaluated in parental blood samples if available, then deposited into the electronic medical record and disclosed to families by their oncologist and a genetic counselor. These disclosure visits are audio recorded and transcribed for analysis of the communication of WES results between parents and oncologists; in addition, the parents and oncologists are serially interviewed to determine preferences for reporting this complex information. Since the study opened in August 2012, 80% of 145 potentially eligible families have consented to enrollment. The first 100 patients comprise a diverse representation of diagnoses, including 32 with CNS tumors (32%) and 68 with non-CNS tumors (68%). The germline WES results (n=85 reported to date) included diagnostic findings in 10 cases including 7 patients with pathogenic mutations in dominant cancer susceptibility genes (all singletons except TP53 mutations identified in 2 patients). Only 3 of these 7 patients had genetic testing recommended clinically. There were 2 patients with mutations which identified the genetic cause of other (non-cancer) medical problems, and 1 study patient with mutations which explained both liver disease and hepatocellular carcinoma. Downstream testing of at-risk relatives has occurred rapidly in several families and cancer screening recommendations implemented in patients and family members. Seven medically actionable incidental findings unrelated to clinical phenotype have also been reported, predominantly in cardiovascular genes and mitochondrial DNA. The BASIC3 study demonstrates the feasibility of routine germline WES in the pediatric oncology clinic and a significant level of parental interest in receiving WES results. Early results suggest that clinically relevant susceptibility mutations can be identified in approximately 10% of unselected pediatric solid and brain tumor patients. This is a conservative estimate, as the WES data analysis does not currently report copy number variation in cancer susceptibility genes. A similar proportion of patients had incidental medically actionable mutations reported. The clinical utility of the germline WES data and the preferences of oncologists and parents for reporting of these results are under study. Supported by NHGRI/NCI 1U01HG006485.
Citation Format: Sharon E. Plon, Sarah Scollon, Katie Bergstrom, Robin A. Kerstein, Murali Chintagumpala, Stacey L. Berg, Susan G. Hilsenbeck, Tao Wang, Surya Rednam, David Wheeler, Laurence McCullough, Richard Street, Amy L. McGuire, Reid G. Jeffrey, Donna M. Muzny, Christine M. Eng, Yaping Yang, Richard A. Gibbs, Donald W. Parsons. Evaluating cancer susceptibility mutations and incidental findings from whole exome sequencing of sequentially diagnosed pediatric solid and brain tumor patients: Early results of the BASIC3 study. [abstract]. In: Proceedings of the AACR Special Conference: Cancer Susceptibility and Cancer Susceptibility Syndromes; Jan 29-Feb 1, 2014; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(23 Suppl):Abstract nr 11. doi:10.1158/1538-7445.CANSUSC14-11
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Affiliation(s)
| | | | | | | | | | | | | | - Tao Wang
- Baylor College of Medicine, Houston, TX
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Parsons DW, Roy A, Monzon FA, Yang Y, López-Terrada DH, Chintagumpala MM, Berg SL, Hilsenbeck SG, Wang T, Kerstein RA, Scollon S, Bergstrom K, Street RL, McCullough LB, McGuire AL, Ramamurthy U, Reid JG, Muzny DM, Wheeler DA, Eng CM, Gibbs RA, Plon SE. Abstract 5169: Diagnostic yield of clinical tumor and germline exome sequencing for newly diagnosed children with solid tumors. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-5169] [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: Advances in sequencing technologies allow for provision of genome-scale data to physicians caring for pediatric cancer patients but current experience with the clinical application of genomic sequencing is limited and the diagnostic yield of these methods is unclear.
Methods: The goal of the BASIC3 (Baylor Advancing Sequencing into Childhood Cancer Care) study is to determine the clinical impact of incorporating tumor and constitutional whole exome sequencing (WES) into the care of children with newly diagnosed solid tumors at Texas Children's Cancer Center (target enrollment n=280). WES of patient blood and frozen tumor samples is being conducted in the CLIA-certified Whole Genome Laboratory at Baylor College of Medicine using the VCRome 2.1 capture reagent and Illumina paired-end sequencing with reports incorporated in the medical record.
Results: 120 patients have enrolled to date, including 39 (33%) and 81 (67%) with CNS and non-CNS tumors, respectively. Despite limited diagnostic biopsies in many patients, tumor samples adequate for WES have been obtained from 97 subjects (81%). WES results have been reported for 89 patients. Tumor WES (n=73) revealed 20 of 73 tumors (27%) to contain mutations classified as having proven or potential clinical utility, including recurrent alterations of CTNNB1, BRAF, KIT, and NRAS/KRAS. Notably, less than 50% of somatic mutations would have been detected on an adult-focused cancer panel, BCM Cancer Gene Mutation Panel v.2. Germline WES (n=89) identified diagnostic findings in 11 cases (12%) including 8 patients with pathogenic mutations in dominant cancer susceptibility genes (singletons except for 2 patients with TP53 mutations). Four of these 8 patients had genetic testing recommended clinically. There were 2 patients with mutations providing the genetic cause of non-cancer medical problems and 1 patient with a mutation which explained both liver disease and hepatocellular carcinoma. Downstream testing of at-risk relatives has occurred rapidly in several families and cancer screening recommendations implemented. Seven (8%) medically actionable incidental findings unrelated to phenotype were reported, predominantly in cardiovascular genes and mitochondrial DNA.
Conclusions: These data demonstrate the feasibility of routine WES in the pediatric oncology setting. Early results demonstrate that clinically relevant findings are identified by tumor and germline WES in 38% of pediatric solid tumor patients. The yield of clinically relevant somatic and germline alterations would likely increase further by incorporation of complementary genomic methods (e.g. RNA-seq or copy number analysis). Assessment of the clinical utility of the tumor and germline exomes and preferences for reporting of these results to physicians and parents are under study. Supported by NHGRI/NCI 1U01HG006485.
Citation Format: Donald W. Parsons, Angshumoy Roy, Federico A. Monzon, Yaping Yang, Dolores H. López-Terrada, Murali M. Chintagumpala, Stacey L. Berg, Susan G. Hilsenbeck, Tao Wang, Robin A. Kerstein, Sarah Scollon, Katie Bergstrom, Richard L. Street, Laurence B. McCullough, Amy L. McGuire, Uma Ramamurthy, Jeff G. Reid, Donna M. Muzny, David A. Wheeler, Christine M. Eng, Richard A. Gibbs, Sharon E. Plon. Diagnostic yield of clinical tumor and germline exome sequencing for newly diagnosed children with solid tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5169. doi:10.1158/1538-7445.AM2014-5169
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Affiliation(s)
| | | | | | | | | | | | | | | | - Tao Wang
- 1Baylor College of Medicine, Houston, TX
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Scollon S, Bergstrom K, Kerstein RA, Wang T, Hilsenbeck SG, Ramamurthy U, Gibbs RA, Eng CM, Chintagumpala MM, Berg SL, McCullough LB, McGuire AL, Plon SE, Parsons DW. Obtaining informed consent for clinical tumor and germline exome sequencing of newly diagnosed childhood cancer patients. Genome Med 2014; 6:69. [PMID: 25317207 PMCID: PMC4195891 DOI: 10.1186/s13073-014-0069-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [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: 04/25/2014] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effectively educating families about the risks and benefits of genomic tests such as whole exome sequencing (WES) offers numerous challenges, including the complexity of test results and potential loss of privacy. Research on best practices for obtaining informed consent (IC) in a variety of clinical settings is needed. The BASIC3 study of clinical tumor and germline WES in an ethnically diverse cohort of newly diagnosed pediatric cancer patients offers the opportunity to study the IC process in the setting of critical illness. We report on our experience for the first 100 families enrolled, including study participation rates, reasons for declining enrollment, assessment of clinical and demographic factors that might impact study enrollment, and preferences of parents for participation in optional genomics study procedures. METHODS A specifically trained IC team offered study enrollment to parents of eligible children for procedures including clinical tumor and germline WES with results deposited in the medical record and disclosure of both diagnostic and incidental results to the family. Optional study procedures were also offered, such as receiving recessive carrier status and deposition of data into research databases. Stated reasons for declining participation were recorded. Clinical and demographic data were collected and comparisons made between enrolled and non-enrolled patients. RESULTS Over 15 months, 100 of 121 (83%) eligible families elected to enroll in the study. No significant differences in enrollment were detected based on factors such as race, ethnicity, use of Spanish interpreters and Spanish consent forms, and tumor features (central nervous system versus non-central nervous system, availability of tumor for WES). The most common reason provided for declining enrollment (10% of families) was being overwhelmed by the new cancer diagnosis. Risks specific to clinical genomics, such as privacy concerns, were less commonly reported (5.5%). More than 85% of parents consented to each of the optional study procedures. CONCLUSIONS An IC process was developed that utilizes a specialized IC team, active communication with the oncology team, and an emphasis on scheduling flexibility. Most parents were willing to participate in a clinical germline and tumor WES study as well as optional procedures such as genomic data sharing independent of race, ethnicity or language spoken.
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Affiliation(s)
- Sarah Scollon
- Texas Children's Cancer Center, 6701 Fannin Street #1400, Houston, TX 77030 USA ; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Katie Bergstrom
- Texas Children's Cancer Center, 6701 Fannin Street #1400, Houston, TX 77030 USA ; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Robin A Kerstein
- Texas Children's Cancer Center, 6701 Fannin Street #1400, Houston, TX 77030 USA ; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Tao Wang
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Susan G Hilsenbeck
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Uma Ramamurthy
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Christine M Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Murali M Chintagumpala
- Texas Children's Cancer Center, 6701 Fannin Street #1400, Houston, TX 77030 USA ; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Stacey L Berg
- Texas Children's Cancer Center, 6701 Fannin Street #1400, Houston, TX 77030 USA ; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Laurence B McCullough
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Amy L McGuire
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Human Genome Sequencing Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - Sharon E Plon
- Texas Children's Cancer Center, 6701 Fannin Street #1400, Houston, TX 77030 USA ; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Human Genome Sequencing Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
| | - D Williams Parsons
- Texas Children's Cancer Center, 6701 Fannin Street #1400, Houston, TX 77030 USA ; Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Human Genome Sequencing Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA ; Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA
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Thompson P, Wheeler HE, Delaney SM, Lorier R, Broeckel U, Devidas M, Reaman GH, Scorsone K, Sung L, Dolan ME, Berg SL. Pharmacokinetics and pharmacogenomics of daunorubicin in children: a report from the Children's Oncology Group. Cancer Chemother Pharmacol 2014; 74:831-8. [PMID: 25119182 DOI: 10.1007/s00280-014-2535-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 07/09/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE We explored the impact of obesity, body composition, and genetic polymorphisms on the pharmacokinetics (PK) of daunorubicin in children with cancer. PATIENTS AND METHODS Patients ≤21 years receiving daunorubicin as an infusion of any duration <24 h for any type of cancer were eligible. Plasma drug concentrations were measured by high-performance liquid chromatography. Body composition was measured by dual-energy X-ray absorptiometry. Obesity was defined as a BMI >95% for age or as body fat >30%. NONMEM was used to perform PK model fitting. The Affymetrix DMET chip was used for genotyping. The impact of genetic polymorphisms was investigated using SNP/haplotype association analysis with estimated individual PK parameters. RESULTS A total of 107 subjects were enrolled, 98 patients had PK sampling, and 50 patients underwent DNA analysis. Population estimates for daunorubicin clearance and volume of distribution were 116 L/m(2)/h ± 14% and 68.1 L/m(2) ± 24%, respectively. Apparent daunorubicinol clearance and volume of distribution were 26.8 L/m(2)/h ± 5.6% and 232 L/m(2) ± 10%, respectively. No effect of body composition or obesity was observed on PK. Forty-four genes with variant haplotypes were tested for association with PK. FMO3-H1/H3 genotype was associated with lower daunorubicin clearance than FMO3-H1/H1, p = 0.00829. GSTP1*B/*B genotype was also associated with lower daunorubicin clearance compared to GSTP1*A/*A, p = 0.0347. However, neither of these associations was significant after adjusting for multiple testing by either Bonferroni or false discovery rate correction. CONCLUSIONS We did not detect an effect of body composition or obesity on daunorubicin PK. We found suggestive associations between FMO3 and GSTP1 haplotypes with daunorubicin PK that could potentially affect efficacy and toxicity.
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Affiliation(s)
- Patrick Thompson
- Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates Ave., Suite 1570, Houston, TX, 77030, USA
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Parsons DW, Roy A, Monzon FA, Yang Y, López-Terrada DH, Chintagumpala MM, Berg SL, Nuchtern JG, Hilsenbeck SG, Wang T, Kerstein RA, Scollon S, Bergstrom K, Ramamurthy U, Reid JG, Muzny DM, Wheeler DA, Eng CM, Gibbs RA, Plon SE. What’s in an exome? Diversity of diagnostic and incidental findings revealed by clinical tumor and germline sequencing of 100 children with solid tumors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | | | | | - Yaping Yang
- Department of Molecular and Human Genetics, Houston, TX
| | | | | | | | | | | | - Tao Wang
- Dan L. Duncan Cancer Center, Houston, TX
| | | | | | | | - Uma Ramamurthy
- Department of Pediatrics and Dan L. Duncan Institute for Clinical & Translational Research, Houston, TX
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Ryu RJ, Eyal S, Kaplan HG, Akbarzadeh A, Hays K, Puhl K, Easterling TR, Berg SL, Scorsone KA, Feldman EM, Umans JG, Miodovnik M, Hebert MF. Pharmacokinetics of doxorubicin in pregnant women. Cancer Chemother Pharmacol 2014; 73:789-97. [PMID: 24531558 DOI: 10.1007/s00280-014-2406-z] [Citation(s) in RCA: 24] [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] [Received: 08/08/2013] [Accepted: 01/29/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Our objective was to evaluate the pharmacokinetics (PK) of doxorubicin during pregnancy compared to previously published data from non-pregnant subjects. METHODS During mid- to late-pregnancy, serial blood and urine samples were collected over 72 h from seven women treated with doxorubicin for malignancies. PK parameters were estimated using non-compartmental techniques. Pregnancy parameters were compared to those previously reported non-pregnant subjects. RESULTS During pregnancy, mean (±SD) doxorubicin PK parameters utilizing 72 h sampling were: clearance (CL), 412 ± 80 mL/min/m(2); steady-state volume of distribution (Vss), 1,132 ± 476 L/m(2); and terminal half-life (T1/2), 40.3 ± 8.9 h. The BSA-adjusted CL was significantly decreased (p < 0.01) and T1/2 was not different compared to non-pregnant women. Truncating our data to 48 h, PK parameters were: CL, 499 ± 116 ml/min/m(2); Vss, 843 ± 391 L/m(2); and T1/2, 24.8 ± 5.9 h. The BSA-adjusted CL in pregnancy compared to non-pregnant data was significantly decreased in 2 of 3 non-pregnant studies (p < 0.05, < 0.05, NS). Vss and T1/2 were not significantly different. CONCLUSIONS In pregnant subjects, we observed significantly lower doxorubicin CL in our 72 h and most of our 48 h sampling comparisons with previously reported non-pregnant subjects. However, the parameters were within the range previously reported in smaller studies. At this time, we cannot recommend alternate dosage strategies for pregnant women. Further research is needed to understand the mechanism of doxorubicin pharmacokinetic changes during pregnancy and optimize care for pregnant women.
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Affiliation(s)
- Rachel J Ryu
- Department of Pharmacy, University of Washington, 1959 NE Pacific Street, H-375 Health Sciences Center, Box 357630, Seattle, WA, 98195-7630, USA
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Parsons DW, Chintagumpala MM, Berg SL, López-Terrada DH, Roy A, Kerstein RA, Scollon S, Hilsenbeck SG, Ramamurthy U, Eng CM, Yang Y, Gibbs RA, Wheeler DA, Street RL, McCullough LB, McGuire AL, Monzon FA, Plon SE. Implementation and evaluation of clinical exome sequencing in childhood cancer care: The BASIC 3 study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.10023] [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: 11/20/2022] Open
Abstract
10023 Background: Advances in sequencing technologies allow for provision of genome-scale data to oncologists and geneticists caring for pediatric cancer patients. The goal of the BASIC3 (Baylor Advancing Sequencing into Childhood Cancer Care) study is to determine the clinical impact of incorporating CLIA-certified tumor and constitutional exome sequencing into the care of children with newly diagnosed solid tumors. Methods: Blood and frozen tumor samples obtained at initial surgery are submitted for clinical exome sequencing (target enrollment 280 patients). Results are deposited into the electronic medical record and disclosed to families by their oncologist and a genetic counselor. Identification of germline cancer susceptibility mutations is compared with standard testing practices. Oncologists are surveyed on prioritization of treatment options in the hypothetical event of tumor recurrence before and after receiving tumor exome results. Patients will be followed for two years to assess the clinical utility of exome data. Preferences for reporting this complex information are obtained by interviews and audiorecording of disclosure visits. Results: Initial results reveal that41 of 49 (84%) ethnically diverse families have consented to enroll on study. Adequate tumor samples were available from 35 of 41 patients (85%), including 11 of 15 (73%) patients with CNS tumors and 24 of 26 (92%) with non-CNS tumors. Pathogenic germline cancer susceptibility mutations (TP53, MSH2) were reported in 2 of the first 11 patients, with a medically-actionable mutation in a gene (SCN5A) unrelated to cancer in 1 patient and 0-4 (median of 2) recessive carrier mutations per patient. Between 9 and 33 protein altering mutations (median of 11) have been identified in tumors, including known cancer genes such as TP53 and others with no known link to pediatric cancer. Conclusions: A robust clinical pipeline for exome sequencing of blood and tumor samples has been successfully developed with significant parental interest. Data assessing the clinical utility of both the tumor and constitutional exomes and the preferences of oncologists and parents for reporting of these results are under study. Supported by NHGRI 1U01HG006485.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Uma Ramamurthy
- Department of Pediatrics and Dan L. Duncan Institute for Clinical & Translational Research, Houston, TX
| | | | - Yaping Yang
- Department of Molecular and Human Genetics, Houston, TX
| | | | | | - Richard L. Street
- Department of Communication, Texas A&M University and Houston Center for Quality of Care and Utilization Studies, Houston, TX
| | | | - Amy L. McGuire
- Center for Medical Ethics and Health Policy, Houston, TX
| | | | - Sharon E. Plon
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
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Blaney SM, Tagen M, Onar-Thomas A, Berg SL, Gururangan S, Scorsone K, Su J, Goldman S, Kieran MW, Kun L, Boyett J, Stewart C. A phase-1 pharmacokinetic optimal dosing study of intraventricular topotecan for children with neoplastic meningitis: a Pediatric Brain Tumor Consortium study. Pediatr Blood Cancer 2013; 60:627-32. [PMID: 23002039 PMCID: PMC3573253 DOI: 10.1002/pbc.24309] [Citation(s) in RCA: 19] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/09/2012] [Indexed: 11/09/2022]
Abstract
PURPOSE We performed a phase-1 pharmacokinetic optimal dosing study of intraventricular topotecan (IT), administered daily 5×, to determine whether, the maximum tolerated dose of IT topotecan was also the pharmacokinetic optimal dose. PATIENTS AND METHODS Patients received topotecan administered through an intraventricular access device (0.1 or 0.2 mg/dose), daily × 5 every other week 2× (Induction); every 3 weeks × 2 (Consolidation); then every 4 weeks for up to 11 courses (Maintenance). Ventricular CSF pharmacokinetic studies were performed on day 1, week 1 of induction, and in a subset of patients after a single intralumbar topotecan dose on day 1, week 3. RESULTS Nineteen patients were enrolled. All were evaluable for toxicity and 18 were assessable for pharmacokinetics. Arachnoiditis requiring corticosteroid therapy occurred in or one of three patients at the 0.1 mg dose level and two of the initial three patients enrolled at the 0.2 mg dose level. All subsequent patients were therefore treated with concomitant dexamethasone. Pharmacokinetic evaluation after accrual of the first seven patients revealed that a topotecan lactone concentration >1 ng/ml for 8 hours was attained in all patients and thus, further dose escalation was not pursued. Results of simulation studies showed that at the dose levels evaluated, >99.9% of patients are expected to achieve CSF topotecan lactone concentrations >1 ng/ml for at least 8 hours. CONCLUSION Intraventricular topotecan, 0.2 mg, administered daily for 5 days with concomitant dexamethasone is well tolerated and was defined to be the pharmacokinetic optimal dose in this trial.
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Affiliation(s)
- Susan M. Blaney
- Texas Children’s Cancer Center/Baylor College of Medicine, Houston, TX 77030
| | - Michael Tagen
- St. Jude Children’s Research Hospital, Memphis, TN 38105
| | | | - Stacey L. Berg
- Texas Children’s Cancer Center/Baylor College of Medicine, Houston, TX 77030
| | - Sri Gururangan
- Duke University Medical Center, Durham North Carolina 27710
| | - Kathleen Scorsone
- Texas Children’s Cancer Center/Baylor College of Medicine, Houston, TX 77030
| | - Jack Su
- Texas Children’s Cancer Center/Baylor College of Medicine, Houston, TX 77030
| | | | - Mark W. Kieran
- Dana-Farber Children’s Hospital Cancer Center, Boston, MA 02215
| | - Larry Kun
- St. Jude Children’s Research Hospital, Memphis, TN 38105
| | - Jim Boyett
- St. Jude Children’s Research Hospital, Memphis, TN 38105
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Muscal JA, Sun Y, Nuchtern JG, Dauser RC, McGuffey LH, Gibson BW, Berg SL. Plasma and cerebrospinal fluid pharmacokinetics of thalidomide and lenalidomide in nonhuman primates. Cancer Chemother Pharmacol 2011; 69:943-7. [PMID: 22109830 DOI: 10.1007/s00280-011-1781-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/07/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Thalidomide, originally developed as a sedative, was subsequently identified to have antiangiogenic properties. Lenalidomide is an antiangiogenic and immunomodulatory agent that has been utilized in the treatment of patients with brain tumors. We studied the pharmacokinetics and cerebrospinal fluid (CSF) penetration of thalidomide and lenalidomide in a nonhuman primate model. METHODS A dose of 50 mg of thalidomide or 20 mg of lenalidomide was administered once orally to each of three rhesus monkeys. Plasma and CSF samples were obtained at specified intervals, and the thalidomide or lenalidomide concentrations were determined by high-performance liquid chromatography with tandem mass spectrometry. Pharmacokinetic parameters were estimated using noncompartmental methods. CSF penetration was calculated as area under the concentration-time curve (AUC) CSF/AUC plasma. RESULTS For thalidomide, the median apparent clearance (Cl/F) was 2.9 mL/min/kg, the median plasma AUC was 80 μM h, and the median terminal half-life (t(½)) was 13.3 h. For lenalidomide, the median Cl/F was 8.7 mL/min/kg, the median AUC was 9 μM h, and the median t(½) was 5.6 h. Thalidomide was detected in the CSF of all animals, with a median penetration of 42%. Lenalidomide was detected in the CSF of 2 of 3 animals, with a CSF penetration of 11% in each. CONCLUSION Thalidomide and lenalidomide penetrate into the CSF after oral administration of clinically relevant doses. Plasma exposure to lenalidomide was similar in our model to that observed in studies involving children who have brain tumors. These results support further development of lenalidomide for the treatment of central nervous system malignancies.
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Affiliation(s)
- Jodi A Muscal
- Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates Street, Suite 1220, Houston, TX 77030, USA
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Warren KE, Gururangan S, Geyer JR, McLendon RE, Poussaint TY, Wallace D, Balis FM, Berg SL, Packer RJ, Goldman S, Minturn JE, Pollack IF, Boyett JM, Kun LE. A phase II study of O6-benzylguanine and temozolomide in pediatric patients with recurrent or progressive high-grade gliomas and brainstem gliomas: a Pediatric Brain Tumor Consortium study. J Neurooncol 2011; 106:643-9. [PMID: 21968943 DOI: 10.1007/s11060-011-0709-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 09/12/2011] [Indexed: 11/29/2022]
Abstract
To estimate the sustained (≥8 weeks) objective response rate in pediatric patients with recurrent or progressive high-grade gliomas (HGG, Stratum A) or brainstem gliomas (BSG, Stratum B) treated with the combination of O6-benzylguanine (O6BG) and temozolomide(®) (TMZ). Patients received O6BG 120 mg/m(2)/d IV followed by TMZ 75 mg/m(2)/d orally daily for 5 consecutive days of each 28-day course. The target objective response rate to consider the combination active was 17%. A two-stage design was employed. Forty-three patients were enrolled; 41 were evaluable for response, including 25 patients with HGG and 16 patients with BSG. The combination of O6BG and TMZ was tolerable, and the primary toxicities were myelosuppression and gastrointestinal symptoms. One sustained (≥8 weeks) partial response was observed in the HGG cohort; no sustained objective responses were observed in the BSG cohort. Long-term (≥6 courses) stable disease (SD) was observed in 4 patients in Stratum A and 1 patient in Stratum B. Of the 5 patients with objective response or long-term SD, 3 underwent central review with 2 reclassified as low-grade gliomas. The combination of O6BG and TMZ did not achieve the target response rate for activity in pediatric patients with recurrent or progressive HGG and BSG.
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Affiliation(s)
- Katherine E Warren
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
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Berg SL, Cairo MS, Russell H, Ayello J, Ingle AM, Lau H, Chen N, Adamson PC, Blaney SM. Safety, pharmacokinetics, and immunomodulatory effects of lenalidomide in children and adolescents with relapsed/refractory solid tumors or myelodysplastic syndrome: a Children's Oncology Group Phase I Consortium report. J Clin Oncol 2010; 29:316-23. [PMID: 21149673 DOI: 10.1200/jco.2010.30.8387] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine the maximum-tolerated or recommended phase II dose, dose-limiting toxicities (DLTs), pharmacokinetics (PK), and immunomodulatory effects of lenalidomide in children with recurrent or refractory solid tumors or myelodysplastic syndrome (MDS). PATIENTS AND METHODS Cohorts of children with solid tumors received lenalidomide once daily for 21 days, every 28 days at dose levels of 15 to 70 mg/m(2)/dose. Children with MDS received a fixed dose of 5 mg/m(2)/dose. Specimens for PK and immune modulation were obtained in the first cycle. RESULTS Forty-nine patients (46 solid tumor, three MDS), median age 16 years (range, 1 to 21 years), were enrolled, and 42 were fully assessable for toxicity. One patient had a cerebrovascular ischemic event of uncertain relationship to lenalidomide. DLTs included hypercalcemia at 15 mg/m(2); hypophosphatemia/hypokalemia, neutropenia, and somnolence at 40 mg/m(2); and urticaria at 55 mg/m(2). At the highest dose level evaluated (70 mg/m(2)), zero of six patients had DLT. A maximum-tolerated dose was not reached. No objective responses were observed. PK studies (n = 29) showed that clearance is faster in children younger than 12 years of age. Immunomodulatory studies (n = 26) showed a significant increase in serum interleukin (IL) -2, IL-15, granulocyte-macrophage colony-stimulating factor, natural killer (NK) cells, NK cytotoxicity, and lymphokine activated killer (LAK) cytoxicity, and a significant decrease in CD4(+)/CD25(+) regulatory T cells. CONCLUSION Lenalidomide is well-tolerated at doses up to 70 mg/m(2)/d for 21 days in children with solid tumors. Drug clearance in children younger than 12 years is faster than in adolescents and young adults. Lenalidomide significantly upregulates cellular immunity, including NK and LAK activity.
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Affiliation(s)
- Stacey L Berg
- Texas Children's Cancer Center, 6621 Fannin St, MC3-3320, Houston, TX 77030, USA.
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Berg SL, Winick N, Ingle AM, Adamson PC, Blaney SM. Reasons for participation in optional pharmacokinetic studies in children with cancer: a Children's Oncology Group phase 1 consortium study. Pediatr Blood Cancer 2010; 55:119-22. [PMID: 20486176 PMCID: PMC2911979 DOI: 10.1002/pbc.22529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Pharmacokinetic (PK) studies provide critical information about the disposition of anticancer drugs in children. In the Children's Oncology Group (COG) Phase 1 Consortium, pharmacokinetic studies are usually optional. We surveyed the attitudes towards PK studies among subjects in phase 1 trials at COG institutions. METHODS Subjects were eligible if they participated in a phase 1 anticancer drug study with optional PK studies within the 4 weeks, regardless of whether they agreed to participate in the PK studies. Staff provided demographics; subjects/parents completed a questionnaire. RESULTS Fifty eligible subjects enrolled. Thirty-six (72%) of the 50 eligible subjects consented to participate in PK studies; 14 (25%) declined. The most common reasons for participating were "the results might help researchers learn more about the drug" and "results from the pharmacokinetic studies might help other children." The most common reasons for not participating were "having the samples drawn would mean spending extra time in the hospital," and "my child might have needed a separate IV catheter in order to participate." CONCLUSIONS The majority of subjects identified altruistic motives for participation in PK studies. Subjects who did not participate in PK studies identified extra time and need for an extra IV as important concerns. Simple interventions like sending staff to the subjects' home to draw PK samples or drawing samples from existing catheters could increase the number of subjects who are willing to participate in PK studies.
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Affiliation(s)
- Stacey L. Berg
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Naomi Winick
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Susan M. Blaney
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
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Horton TM, Jenkins G, Pati D, Zhang L, Dolan ME, Ribes-Zamora A, Bertuch AA, Blaney SM, Delaney SL, Hegde M, Berg SL. Poly(ADP-ribose) polymerase inhibitor ABT-888 potentiates the cytotoxic activity of temozolomide in leukemia cells: influence of mismatch repair status and O6-methylguanine-DNA methyltransferase activity. Mol Cancer Ther 2009; 8:2232-42. [PMID: 19671751 PMCID: PMC3741063 DOI: 10.1158/1535-7163.mct-09-0142] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The poly(ADP-ribose) polymerase (PARP) inhibitor ABT-888 potentiates the antitumor activity of temozolomide (TMZ). TMZ resistance results from increased O(6)-methylguanine-DNA methyltransferase (MGMT) activity and from mismatch repair (MMR) system mutations. We evaluated the relative importance of MGMT activity, MMR deficiency, nonhomologous end joining (NHEJ), and PARP activity in ABT-888 potentiation of TMZ. MMR-proficient and MMR-deficient leukemia cells with varying MGMT activity, as well as primary leukemia samples, were used to determine TMZ IC(50) alone and with ABT-888. ABT-888 effectively inhibited PARP activity and enhanced TMZ growth inhibition in most leukemia cells. ABT-888 potentiation was most effective in MMR-deficient cells with low MGMT activity [potentiation factor (PF) = 21]. ABT-888 also potentiated TMZ activity in MMR-deficient cells with elevated MGMT activity. Unexpectedly, ABT-888 also enhanced TMZ activity in MMR-proficient cells (PF = 3-7). ABT-888 potentiation was unrelated to NHEJ activity. ABT-888 potentiated TMZ (PF = 2-5) in two of four acute myeloid leukemia patient samples but showed little potentiation in primary acute lymphoblastic leukemia. In conclusion, although ABT-888 potentiation of TMZ was most pronounced in MMR-deficient cells with low MGMT activity, neither MMR proficiency nor MGMT overexpression completely abrogated ABT-888 potentiation of TMZ.
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Affiliation(s)
- Terzah M Horton
- Texas Children's Cancer Center/Baylor College of Medicine, Houston, Texas 77030, USA.
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Affiliation(s)
- Stacey L Berg
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas 77030, USA.
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Thompson PA, Rosner GL, Matthay KK, Moore TB, Bomgaars LR, Ellis KJ, Renbarger J, Berg SL. Impact of body composition on pharmacokinetics of doxorubicin in children: a Glaser Pediatric Research Network study. Cancer Chemother Pharmacol 2008; 64:243-51. [DOI: 10.1007/s00280-008-0854-z] [Citation(s) in RCA: 66] [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] [Received: 02/19/2008] [Accepted: 10/07/2008] [Indexed: 01/02/2023]
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