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Ulys A, Jankevicus F, Jievaltas M, Venckus R, Auskalnis S, Kardelis Z, Barisiene M, MacLean CM, van Os S, Larsen F. Efficacy, tolerability, and safety of teverelix DP in patients with advanced prostate cancer: A multicenter, open-label, phase 2 trial. Prostate 2024; 84:584-598. [PMID: 38311868 DOI: 10.1002/pros.24674] [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: 12/03/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Teverelix drug product (DP) is a novel injectable gonadotropin-releasing hormone antagonist. METHODS An adaptive phase 2, open-label, multicenter trial was conducted in patients with advanced prostate cancer to evaluate the efficacy and safety of a combined subcutaneous (SC) and intramuscular (IM) loading dose regimen of teverelix DP of 120 mg SC + 120 mg IM (Group 1; N = 9) or 180 mg SC + 180 mg IM (Group 2; N = 41) administered at a single visit, followed by 6-weekly SC maintenance doses of 120 mg (Group 1) or 180 mg (Group 2), up to Day 168. The primary endpoint was the proportion of patients achieving castration levels with serum testosterone <0.5 ng/mL at Day 28 with a target castration rate of 90%. Injection sites were inspected by the investigator at every visit and reactions (ISRs) were proactively recorded. RESULTS The target castration rate was reached in Group 2 (97.5%) but not in Group 1 (62.5%). The castration rates were not maintained to Day 42 (Group 2: 82.5%; Group 1: 50.0%). Suppression of testosterone to castrate levels occurred rapidly (median time: 2 days for both groups). Suppression of testosterone, prostate-specific antigen, follicle-stimulating hormone, and luteinizing hormone was sustained throughout the treatment period, being more prominent with the higher dose. The adverse event (AE) profile was similar between groups. The most common AEs were injection-site induration (n = 40: 80.0%), injection-site erythema (n = 35: 70.0%), and hot flush (n = 21: 42.0%). Most ISRs were Grade 1. CONCLUSION Overall, the teverelix DP doses were generally well-tolerated but did not adequately maintain castration levels.
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Affiliation(s)
- Albertas Ulys
- Departments of Urology, National Cancer Institute, Vilnius, Lithuania
| | - Feliksas Jankevicus
- Faculty of Medicine, Departments of Urology, Vilnius University, Vilnius, Lithuania
| | - Mindaugas Jievaltas
- Urology Department, Medicine Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimundas Venckus
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
| | - Stasys Auskalnis
- Urology Department, Medicine Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Marija Barisiene
- Faculty of Medicine, Departments of Urology, Vilnius University, Vilnius, Lithuania
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Barsotti GC, Luciano R, Kumar A, Meliambro K, Kakade V, Tokita J, Naik A, Fu J, Peck E, Pell J, Reghuvaran A, Tanvir E, Patel P, Zhang W, Li F, Moeckel G, Perincheri S, Cantley L, Moledina DG, Wilson FP, He JC, Menon MC. Rationale and Design of a Phase 2, Double-blind, Placebo-Controlled, Randomized Trial Evaluating AMP Kinase-Activation by Metformin in Focal Segmental Glomerulosclerosis. Kidney Int Rep 2024; 9:1354-1368. [PMID: 38707807 PMCID: PMC11068976 DOI: 10.1016/j.ekir.2024.02.006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Focal segmental glomerulosclerosis (FSGS), the most common primary glomerular disease leading to end-stage kidney disease (ESKD), is characterized by podocyte injury and depletion, whereas minimal change disease (MCD) has better outcomes despite podocyte injury. Identifying mechanisms capable of preventing podocytopenia during injury could transform FSGS to an "MCD-like" state. Preclinical data have reported conversion of an MCD-like injury to one with podocytopenia and FSGS by inhibition of AMP-kinase (AMPK) in podocytes. Conversely, in FSGS, AMPK-activation using metformin (MF) mitigated podocytopenia and azotemia. Observational studies also support beneficial effects of MF on proteinuria and chronic kidney disease (CKD) outcomes in diabetes. A randomized controlled trial (RCT) to test MF in podocyte injury with FSGS has not yet been conducted. Methods We report the rationale and design of phase 2, double-blind, placebo-controlled RCT evaluating the efficacy and safety of MF as adjunctive therapy in FSGS. By randomizing 30 patients with biopsy-confirmed FSGS to MF or placebo (along with standard immunosuppression), we will study mechanistic biomarkers that correlate with podocyte injury or depletion and evaluate outcomes after 6 months. We specifically integrate novel urine, blood, and tissue markers as surrogates for FSGS progression along with unbiased profiling strategies. Results and Conclusion Our phase 2 trial will provide insight into the potential efficacy and safety of MF as adjunctive therapy in FSGS-a crucial step to developing a larger phase 3 study. The mechanistic assays here will guide the design of other FSGS trials and contribute to understanding AMPK activation as a potential therapeutic target in FSGS. By repurposing an inexpensive agent, our results will have implications for FSGS treatment in resource-poor settings.
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Affiliation(s)
- Gabriel C. Barsotti
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Randy Luciano
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ashwani Kumar
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kristin Meliambro
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vijayakumar Kakade
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Joji Tokita
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Abhijit Naik
- Division of Nephrology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Jia Fu
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth Peck
- Clinical Research Coordinator, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Pell
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anand Reghuvaran
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - E.M. Tanvir
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Prashant Patel
- Investigational Drug Service, Department of Pharmacy Services, Yale New Haven Hospital, Connecticut, USA
| | - Weijia Zhang
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Gilbert Moeckel
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sudhir Perincheri
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lloyd Cantley
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dennis G. Moledina
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - F. Perry Wilson
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John C. He
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhav C. Menon
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Kus T, Cicin I. A perspective: the integration of ctDNA into Response Evaluation Criteria in Solid Tumours 1.1 for phase II immunotherapy clinical trials. Immunotherapy 2024; 16:319-329. [PMID: 38197142 DOI: 10.2217/imt-2023-0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
A consensus guideline, iRECIST, was developed by the Response Evaluation Criteria in Solid Tumours (RECIST) working group for the use of the modified RECIST version 1.1 in cancer immunotherapy trials. iRECIST was designed to separate pseudoprogression from real progression. However, this is not the only ambiguous situation. In clinical immunotherapy trials, stable disease may reflect three tumor responses, including real stable disease, progressive disease and responsive disease. The prediction of a "true complete/partial response" is also important. Much data has accumulated showing that ctDNA can guide decisions at this point; thus, integrating ctDNA into the RECIST 1.1 criteria may help to distinguish a true tumor response type earlier in patients treated with immunotherapy; however, prospectively designed validation studies are needed.
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Affiliation(s)
- Tulay Kus
- School of Medicine, Department of Medical Oncology, Gaziantep University, Gaziantep, 27310, Turkey
| | - Irfan Cicin
- Department of Medical Oncology, Istinye University Topkapı Health Sciences Campus, Istanbul, 34295, Turkey
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Symington E, Rangarajan S, Lester W, Madan B, Pierce GF, Raheja P, Robinson TM, Osmond D, Russell CB, Vettermann C, Agarwal SK, Li M, Wong WY, Laffan M. Long-term safety and efficacy outcomes of valoctocogene roxaparvovec gene transfer up to 6 years post-treatment. Haemophilia 2024; 30:320-330. [PMID: 38317480 DOI: 10.1111/hae.14936] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Valoctocogene roxaparvovec uses an adeno-associated virus serotype 5 (AAV5) vector to transfer a factor VIII (FVIII) coding sequence to individuals with severe haemophilia A, providing bleeding protection. AIM To assess safety and efficacy of valoctocogene roxaparvovec 5-6 years post-treatment. METHODS In a phase 1/2 trial, adult male participants with severe haemophilia A (FVIII ≤1 IU/dL) without FVIII inhibitors or anti-AAV5 antibodies received valoctocogene roxaparvovec and were followed for 6 (6 × 1013 vg/kg; n = 7) and 5 (4 × 1013 vg/kg; n = 6) years. Safety, including investigation of potential associations between a malignancy and gene therapy, and efficacy are reported. RESULTS No new treatment-related safety signals emerged. During year 6, a participant in the 6 × 1013 vg/kg cohort was diagnosed with grade 2 parotid gland acinar cell carcinoma; definitive treatment was uncomplicated parotidectomy with lymph node dissection. Target enrichment sequencing of tumour and adjacent healthy tissue revealed low vector integration (8.25 × 10-5 per diploid cell). Integrations were not elevated in tumour samples, no insertions appeared to drive tumorigenesis, and no clonal expansion of integration-containing cells occurred. During all follow-ups, >90% decreases from baseline in annualised treated bleeds and FVIII infusion rates were maintained. At the end of years 6 and 5, mean FVIII activity (chromogenic assay) was 9.8 IU/dL (median, 5.6 IU/dL) and 7.6 IU/dL (median, 7.1 IU/dL) for the 6 × 1013 and 4 × 1013 vg/kg cohorts, respectively, representing proportionally smaller year-over-year declines than earlier timepoints. CONCLUSIONS Valoctocogene roxaparvovec safety and efficacy profiles remain largely unchanged; genomic investigations showed no association with a parotid tumour.
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Affiliation(s)
- Emily Symington
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Will Lester
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bella Madan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Priyanka Raheja
- Haemophilia Centre Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Dane Osmond
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | | | | | | | - Mingjin Li
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Wing Yen Wong
- BioMarin Pharmaceutical Inc., Novato, California, USA
| | - Michael Laffan
- Centre for Haematology, Imperial College London, London, UK
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Rewerska B, Sher LD, Alpizar S, Pauser S, Pulka G, Mozaffarian N, Salhi Y, Martinet C, Jabert W, Gudi G, CA V, GN S, Macoin J, Anstett V, Turrini R, Doucey MA, Blein S, Konto C, Machkova M. Phase 2b randomized trial of OX40 inhibitor telazorlimab for moderate-to-severe atopic dermatitis. J Allergy Clin Immunol Glob 2024; 3:100195. [PMID: 38187863 PMCID: PMC10770725 DOI: 10.1016/j.jacig.2023.100195] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 01/09/2024]
Abstract
Background Telazorlimab is a humanized anti-OX40 monoclonal antibody being studied for treatment of T-cell-mediated diseases. Objective This randomized, placebo-controlled, phase 2b dose-range finding study investigated efficacy, safety, pharmacokinetics, and immunogenicity of telazorlimab in subjects with atopic dermatitis. Methods In this 2-part study (NCT03568162), adults (≥18 years) with moderate-to-severe disease were randomized to various regimens of subcutaneous telazorlimab or placebo for 16 weeks' blinded treatment, followed by 38 weeks' open-label treatment and 12 weeks' drug-free follow-up. Telazorlimab treatment groups (following a loading dose) in part 1 were 300 mg every 2 weeks; 300 mg every 4 weeks; or 75 mg every 4 weeks. Part 2 evaluated telazorlimab 600 mg every 2 weeks. The primary end point was percentage change from baseline in Eczema Area and Severity Index (EASI) at week 16. Safety assessments included incidence of treatment-emergent adverse events. Results The study randomized 313 subjects in part 1 and 149 in part 2. At 16 weeks, the least squares mean percentage change from baseline in EASI was significantly greater in subjects receiving telazorlimab 300 mg every 2 weeks (part 1) and 600 mg every 2 weeks (part 2) versus placebo (-54.4% vs -34.2% for part 1 and -59.0% vs -41.8% for part 2, P = .008 for both). Telazorlimab was well tolerated, with similar distribution of adverse events between telazorlimab- and placebo-treated subjects in both part 1 and part 2. Conclusion Telazorlimab, administered subcutaneously at 300 mg every 2 weeks or 600 mg every 2 weeks following a loading dose, was well tolerated and induced significant and progressive clinical improvement in adults with moderate-to-severe atopic dermatitis.
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Affiliation(s)
| | | | - Sady Alpizar
- Clinical Research Trials of Florida Inc, Tampa, Fla
| | - Sylvia Pauser
- KliFOs—Klinische Forschung Osnabrück, Osnabrück, Germany
| | - Grazyna Pulka
- School of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | | | | | | | | | - Vinu CA
- Ichnos Sciences, New York, NY
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6
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Stratigos AJ, Sekulic A, Peris K, Bechter O, Prey S, Lewis KD, Basset-Seguin N, Chang ALS, Dalle S, Fernández Orland A, Licitra L, Robert C, Ulrich C, Hauschild A, Migden MR, Dummer R, Yoo SY, Okoye E, Bassukas I, Loquai C, De Giorgi V, Eroglu Z, Gutzmer R, Ulrich J, Puig S, Inocencio TJ, Chen CI, LaFontaine PR, Seebach F, Lowy I, Fury MG. Phase 2 open-label, multicenter, single-arm study of cemiplimab in patients with locally advanced basal cell carcinoma after hedgehog inhibitor therapy: Extended follow-up. J Am Acad Dermatol 2024; 90:414-418. [PMID: 37839734 DOI: 10.1016/j.jaad.2023.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/11/2023] [Accepted: 08/01/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Alexander J Stratigos
- Department of Dermatology-Venereology, Andreas Sygros Hospital-National and Kapodistrian University of Athens, Athens, Greece.
| | | | - Ketty Peris
- Dipartimento di Scienze Mediche e Chirurgiche, UOC di Dermatologia, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Oliver Bechter
- Department of General Medical Oncology, University Hospitals, Leuven, Belgium
| | - Sorilla Prey
- Department of Dermatology, Bordeaux University Hospital, Bordeaux, France
| | - Karl D Lewis
- School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Anne Lynn S Chang
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Stéphane Dalle
- Department of Dermatology, Centre Hospitalier Lyon-Sud, Lyon, France
| | | | - Lisa Licitra
- Medical Oncology Head and Neck Cancer Department, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - Caroline Robert
- Dermatology Unit, Gustave Roussy Cancer Center and Paris-Saclay University, Villejuif, France
| | - Claas Ulrich
- Skin Cancer Centre, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Hauschild
- Department of Dermatology, University of Kiel, Kiel, Germany
| | - Michael R Migden
- Departments of Dermatology and Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Ioannis Bassukas
- Faculty of Medicine, Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Vincenzo De Giorgi
- Departments of Dermatology, Human Pathology, and Oncology, University of Florence, Florence, Italy
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ralf Gutzmer
- Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
| | - Jens Ulrich
- Academic Teaching Hospital of the University Otto von Guericke Magdeburg, Quedlinburg, Germany
| | - Susana Puig
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
| | | | | | - Israel Lowy
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York
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Zhou C, Yang X, Yang B, Yan G, Dong X, Ding Y, Fan W, Li L, Yang D, Fang H, Ji C, Cheng H, Zhang S, Goh AH, Liu R, Gu X, Weng Z, Foley P, Sinclair R, Zhang J. A randomized, double-blind, placebo-controlled phase II study to evaluate the efficacy and safety of ivarmacitinib (SHR0302) in adult patients with moderate-to-severe alopecia areata. J Am Acad Dermatol 2023; 89:911-919. [PMID: 37019385 DOI: 10.1016/j.jaad.2023.02.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Alopecia areata (AA) is a CD8+ T cell-mediated autoimmune disease characterized by nonscarring hair loss. Ivarmacitinib, which is a selective oral Janus kinase 1 inhibitor, may interrupt certain cytokine signaling implicated in the pathogenesis of AA. OBJECTIVE To evaluate the efficacy and safety of ivarmacitinib in adult patients with AA who have ≥25% scalp hair loss. METHODS Eligible patients were randomized 1:1:1:1 to receive ivarmacitinib 2, 4, or 8 mg once daily or placebo for 24 weeks. The primary end point was the percentage change from baseline in the Severity of Alopecia Tool score at week 24. RESULTS A total of 94 patients were randomized. At week 24, the least squares mean difference in the percentage change from baseline in the Severity of Alopecia Tool score for ivarmacitinib 2, 4, and 8 mg and placebo groups were -30.51% (90% CI, -45.25, -15.76), -56.11% (90% CI, -70.28, -41.95), -51.01% (90% CI, -65.20, -36.82), and -19.87% (90% CI, -33.99, -5.75), respectively. Two serious adverse events-follicular lymphoma and COVID-19 pneumonia-were reported. LIMITATIONS A small sample size limits the generalizability of the results. CONCLUSION Treatment with ivarmacitinib 4 and 8 mg doses in patients with moderate and severe AA for 24 weeks was efficacious and generally tolerated.
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Affiliation(s)
- Cheng Zhou
- Peking University People's Hospital, Beijing
| | | | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou
| | - Guofu Yan
- Chongqing Traditional Chinese Medicine Hospital, Chongqing
| | - Xiuqin Dong
- Guangdong Provincial People's Hospital, Guangzhou
| | | | - Weixin Fan
- Jiangsu Province Hospital, The First Affiliated Hospital with Nanjing Medical University, Nanjing
| | - Linfeng Li
- Beijing Friendship Hospital, Capital Medical University, Beijing
| | | | - Hong Fang
- First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Chao Ji
- First Affiliated Hospital of Fujian Medical University, Fuzhou
| | - Hao Cheng
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou
| | | | | | | | | | | | - Peter Foley
- University of Melbourne, Skin & Cancer Foundation Inc., Melbourne
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8
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Siddiqui S, Wenzel SE, Bozik ME, Archibald DG, Dworetzky SI, Mather JL, Killingsworth R, Ghearing N, Schwartz JT, Ochkur SI, Jacobsen EA, Busse WW, Panettieri RA, Prussin C. Safety and Efficacy of Dexpramipexole in Eosinophilic Asthma (EXHALE): A randomized controlled trial. J Allergy Clin Immunol 2023; 152:1121-1130.e10. [PMID: 37277072 DOI: 10.1016/j.jaci.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a need for new and effective oral asthma therapies. Dexpramipexole, an oral eosinophil-lowering drug, has not previously been studied in asthma. OBJECTIVE We sought to evaluate the safety and efficacy of dexpramipexole in lowering blood and airway eosinophilia in subjects with eosinophilic asthma. METHODS We performed a randomized, double-blind, placebo-controlled proof-of-concept trial in adults with inadequately controlled moderate to severe asthma and blood absolute eosinophil count (AEC) greater than or equal to 300/μL. Subjects were randomly assigned (1:1:1:1) to dexpramipexole 37.5, 75, or 150 mg BID (twice-daily) or placebo. The primary end point was the relative change in AEC from baseline to week 12. Prebronchodilator FEV1 week-12 change from baseline was a key secondary end point. Nasal eosinophil peroxidase was an exploratory end point. RESULTS A total of 103 subjects were randomly assigned to dexpramipexole 37.5 mg BID (N = 22), 75 mg BID (N = 26), 150 mg BID (N = 28), or placebo (N = 27). Dexpramipexole significantly reduced placebo-corrected AEC week-12 ratio to baseline, in both the 150-mg BID (ratio, 0.23; 95% CI, 0.12-0.43; P < .0001) and the 75-mg BID (ratio, 0.34; 95% CI, 0.18-0.65; P = .0014) dose groups, corresponding to 77% and 66% reductions, respectively. Dexpramipexole reduced the exploratory end point of nasal eosinophil peroxidase week-12 ratio to baseline in the 150-mg BID (median, 0.11; P = .020) and the 75-mg BID (median, 0.17; P = .021) groups. Placebo-corrected FEV1 increases were observed starting at week 4 (nonsignificant). Dexpramipexole displayed a favorable safety profile. CONCLUSIONS Dexpramipexole demonstrated effective eosinophil lowering and was well tolerated. Additional larger clinical trials are needed to understand the clinical efficacy of dexpramipexole in asthma.
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Affiliation(s)
- Salman Siddiqui
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Sally E Wenzel
- University of Pittsburgh School of Public Health, Environmental & Occupational Health, Pittsburgh, Pa
| | | | | | | | | | | | - Natasha Ghearing
- Division of Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Justin T Schwartz
- Division of Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sergei I Ochkur
- Division of Allergy, Asthma and Clinical Immunology, Scottsdale, Ariz; Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz
| | - Elizabeth A Jacobsen
- Division of Allergy, Asthma and Clinical Immunology, Scottsdale, Ariz; Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz
| | - William W Busse
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, The State University of New Jersey, New Brunswick, NJ
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9
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Jilg N, Chew KW, Giganti MJ, Daar ES, Wohl DA, Javan AC, Kantor A, Moser C, Coombs RW, Neytman G, Hoover K, Jana A, Hart PA, Greninger AL, Szurgot B, Eron JJ, Currier JS, Hughes MD, Smith DM, Li JZ. One Week of Oral Camostat Versus Placebo in Nonhospitalized Adults With Mild-to-Moderate Coronavirus Disease 2019: A Randomized Controlled Phase 2 Trial. Clin Infect Dis 2023; 77:941-949. [PMID: 37279602 PMCID: PMC10552586 DOI: 10.1093/cid/ciad342] [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] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Camostat inhibits severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in vitro. We studied the safety and efficacy of camostat in ACTIV-2/A5401, a phase 2/3 platform trial of therapeutics for COVID-19 in nonhospitalized adults. METHODS We conducted a phase 2 study in adults with mild-to-moderate COVID-19 randomized to oral camostat for 7 days or a pooled placebo arm. Primary outcomes were time to improvement in COVID-19 symptoms through day 28, proportion of participants with SARS-CoV-2 RNA below the lower limit of quantification (LLoQ) from nasopharyngeal swabs through day 14, and grade ≥3 treatment-emergent adverse events (TEAEs) through day 28. RESULTS Of 216 participants (109 randomized to camostat, 107 to placebo) who initiated study intervention, 45% reported ≤5 days of symptoms at study entry and 26% met the protocol definition of higher risk of progression to severe COVID-19. Median age was 37 years. Median time to symptom improvement was 9 days in both arms (P = .99). There were no significant differences in the proportion of participants with SARS-CoV-2 RNA CONCLUSIONS In a phase 2 study of nonhospitalized adults with mild-to-moderate COVID-19, oral camostat did not accelerate viral clearance or time to symptom improvement, or reduce hospitalizations or deaths. Clinical Trials Registration. ClinicalTrials.gov identifier: NCT04518410.
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Affiliation(s)
- Nikolaus Jilg
- Department of Medicine, Massachusetts General Hospital and Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kara W Chew
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Mark J Giganti
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eric S Daar
- Department of Medicine, University of California Los Angeles Center, Torrance, California, USA
| | - David A Wohl
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Amy Kantor
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carlee Moser
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Robert W Coombs
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Gene Neytman
- Quantum Clinical Trials, Miami Beach, Florida, USA
| | | | - Atasi Jana
- Sagent Pharmaceuticals, Schaumburg, Illinois, USA
| | - Phil A Hart
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Bob Szurgot
- Sagent Pharmaceuticals, Schaumburg, Illinois, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Judith S Currier
- Department of Medicine, University of Los Angeles, Los Angeles, California, USA
| | - Michael D Hughes
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Davey M Smith
- Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Jonathan Z Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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10
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Kato M, Nakagome K, Baba T, Sonoyama T, Okutsu D, Yamanaka H, Shimizu R, Motomiya T, Inoue T. Efficacy and safety of zuranolone in Japanese adults with major depressive disorder: A double-blind, randomized, placebo-controlled, phase 2 clinical trial. Psychiatry Clin Neurosci 2023; 77:497-509. [PMID: 37252829 DOI: 10.1111/pcn.13569] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 02/13/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/01/2023]
Abstract
AIM To evaluate the efficacy and safety of an oral, once-daily, 14-day treatment course of zuranolone in Japanese patients with major depressive disorder (MDD). METHODS This multicenter, randomized, double-blind, placebo-controlled study randomized eligible patients (1:1:1) to receive oral zuranolone 20 mg, zuranolone 30 mg, or placebo once daily for 14 days (treatment-period), followed by two 6-week follow-up periods. The primary endpoint was change from baseline in the 17-item Hamilton Depression Rating Scale (HAMD-17) total score on Day 15. RESULTS Overall, 250 patients (enrolled: 07/07/2020-05/26/2021) were randomized to receive placebo (n = 83), zuranolone 20 mg (n = 85), or zuranolone 30 mg (n = 82). The demographic and baseline characteristics were balanced between groups. The adjusted mean (standard error) change from baseline in the HAMD-17 total score on Day 15 was -6.22 (0.62), -8.14 (0.62), and - 8.31 (0.63) in the placebo, zuranolone 20-mg, and zuranolone 30-mg groups, respectively. Significant differences in the adjusted mean (95% confidence interval [CI]) for zuranolone 20 mg versus placebo (-1.92; [-3.65, -0.19]; P = 0.0296) and zuranolone 30 mg versus placebo (-2.09; [-3.83, -0.35]; P = 0.0190) groups were observed on Day 15, and also as early as Day 3. A nonsignificant yet distinct drug-placebo separation was observed during follow-up. Somnolence (placebo [3.7%], zuranolone 20 mg [10.6%], and zuranolone 30 mg [20.7%]) and dizziness (3.7%, 9.4%, and 9.8%, respectively) were more common with zuranolone. CONCLUSION Oral zuranolone was safe and demonstrated significant improvements in depressive symptoms, as assessed by HAMD-17 total score change from baseline over 14 days in Japanese patients with MDD.
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Affiliation(s)
- Masaki Kato
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Takamichi Baba
- Biostatistics Center, Drug Development and Regulatory Science Division, Shionogi & Co., Ltd., Osaka, Japan
| | - Takuhiro Sonoyama
- Medical Science Department, Drug Development and Regulatory Science Division, Shionogi & Co., Ltd., Osaka, Japan
| | - Daiki Okutsu
- Clinical Research Department, Drug Development and Regulatory Science Division, Shionogi & Co., Ltd., Osaka, Japan
| | - Hideki Yamanaka
- Clinical Research Department, Drug Development and Regulatory Science Division, Shionogi & Co., Ltd., Osaka, Japan
| | - Ryosuke Shimizu
- Clinical Pharmacology & Pharmacokinetics, Drug Development and Regulatory Science Division, Shionogi & Co., Ltd., Osaka, Japan
| | - Tomoko Motomiya
- Project Management Department, Drug Development and Regulatory Science Division, Shionogi & Co., Ltd., Osaka, Japan
| | - Takeshi Inoue
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
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11
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Fox E, Parsons DW, Weigel BJ. Children's Oncology Group's 2023 blueprint for research: Developmental therapeutics. Pediatr Blood Cancer 2023; 70 Suppl 6:e30563. [PMID: 37430453 DOI: 10.1002/pbc.30563] [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: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023]
Abstract
The Developmental Therapeutics Committee (DVL) identifies and develops new agents and treatment strategies for children/adolescents with cancer, through clinical and translational research. DVL has focused on evaluating the activity of targeted therapy and has evolved from trials with multiple histology strata to biomarker-selected phase 2 trials. These trials have included single-agent studies to evaluate agents such as cabozantinib in multi-disease cohorts, to trametinib, larotrectinib, and lorvotuzumab in disease-specific cohorts, as well as the pediatric Molecular Analysis for Therapy Choice (MATCH) study including multiple single agents targeted for biomarker-selected pediatric tumors. The ongoing vision and direction of DVL is to support the disease committees of COG to develop novel agents and combinations to advance the care of children with cancer.
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Affiliation(s)
- Elizabeth Fox
- St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - D Williams Parsons
- Texas Children's Cancer and Hematology Center, Baylor College of Medicine, Houston, Texas, USA
| | - Brenda J Weigel
- Division of Pediatric Hematology and Oncology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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12
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Cakir Cetin A, Tuncok Y, Keskinoglu P, Arici MA, Onen F, Ecevit MC. Methotrexate for recurrent chronic rhinosinusitis with nasal polyps: A randomized, controlled, phase 2 clinical trial. Int Forum Allergy Rhinol 2023; 13:1592-1602. [PMID: 36575820 DOI: 10.1002/alr.23131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/06/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This randomized, controlled, open-label, phase 2 clinical trial aimed to assess the efficacy and safety of low-dose methotrexate as maintenance therapy for recurrent postoperative chronic rhinosinusitis with nasal polyps (CRSwNPs). METHODS Forty-one patients with CRSwNPs who experienced postoperative polyp recurrence(s) were randomly divided into three groups to receive one of the following treatments for 8 weeks: daily intranasal mometasone furoate monohydrate 200 mcg (control [intranasal corticosteroids (INCS)] arm, n = 13]); daily per oral methylprednisolone 8 mg (oral corticosteroids [OCS] arm, n = 14); and once weekly per oral 10 mg methotrexate (MTX arm, n = 14). All patients were assessed at three clinical visits according to the Lund-Kennedy endoscopic grading system (LKES), visual analog scale (VAS), Turkish version of the Sinonasal Outcome Test-22 (SNOT-22), peak nasal inspiratory flow (PNIF), butanol olfactory threshold test (BuOT), serum total IgE level, presence of peripheral eosinophilia, serum biochemical assays, and adverse events. RESULTS All efficacy outcome measures significantly improved in all three groups, except for the nonrecovery of peripheral eosinophilia in the INCS group. There was no significant difference among the groups in terms of LKES scores. Scores for the Turkish version of the SNOT-22, PNIF, BuOT, and serum IgE levels were also similar among the groups. However, total VAS scores recovered significantly better in the INCS group than in the MTX group. Serum biochemical assays remained normal in all groups. Adverse events were minor and observed only in the OCS group. CONCLUSION Low-dose MTX was a safe and effective maintenance therapy for patients with recurrent postoperative CRSwNPs.
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Affiliation(s)
- Asli Cakir Cetin
- Department of Otorhinolaryngology, Dokuz Eylul University Medical School, Izmir, Turkey
| | - Yesim Tuncok
- Department of Medical Pharmacology, Dokuz Eylul University Medical School, Izmir, Turkey
| | - Pembe Keskinoglu
- Department of Biostatistics and Informatics, Dokuz Eylul University Medical School, Izmir, Turkey
| | - Mualla Aylin Arici
- Department of Medical Pharmacology, Dokuz Eylul University Medical School, Izmir, Turkey
| | - Fatos Onen
- Department of Rheumatology and Immunology, Dokuz Eylul University Medical School, Izmir, Turkey
| | - Mustafa Cenk Ecevit
- Department of Otorhinolaryngology, Dokuz Eylul University Medical School, Izmir, Turkey
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13
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Doggrell SA. Retatrutide showing promise in obesity (and type 2 diabetes). Expert Opin Investig Drugs 2023; 32:997-1001. [PMID: 37947489 DOI: 10.1080/13543784.2023.2283020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/09/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Obesity is a major risk factor for cardiovascular disease, diabetes, osteoarthritis, and some cancers. Retatrutide stimulates Glucagon-like peptide 1 (GLP-1), Glucose-dependent insulinotropic polypeptide (GIP) receptors, and glucagon receptors, and is being developed for the treatment of obesity and type 2 diabetes. AREAS COVERED A phase 2 clinical trial of retatrutide (LY3437943) in the treatment of obesity. The primary end point was percentage change in weight from baseline to 24 weeks, which ranged from -7.2% to -~18% as the dose of retatrutide increased from 1 mg to 12 mg. The most frequent adverse events were gastrointestinal (nausea, diarrhea, vomiting). EXPERT OPINION The results for retatrutide in phase 2 for obesity (and diabetes) are mostly encouraging. Consistent with being a GLP-1 receptor agonist, heart rate was increased by up to 6.7 beats/min by retatrutide, which may be detrimental and offset some of the benefits of weight loss. Presumably, retatrutide is being developed as a challenger to the recently developed weight loss medicines; semaglutide and/or tirzepatide. Thus, comparator studies are needed between retatrutide and these drugs, but none are ongoing and, in my opinion, this lack is a major omission in the development of retatrutide.
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Affiliation(s)
- Sheila A Doggrell
- School of Pharmacy and Medical Sciences, Gold Coast Campus, Griffith University, Queensland, Australia
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14
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Ciardiello F, Bang YJ, Cervantes A, Dvorkin M, Lopez CD, Metges JP, Sánchez Ruiz A, Calvo M, Strickland AH, Kannourakis G, Muro K, Kawakami H, Wei J, Borg C, Zhu Z, Gupta N, Pelham RJ, Shen L. Efficacy and safety of maintenance therapy with pamiparib versus placebo for advanced gastric cancer responding to first-line platinum-based chemotherapy: Phase 2 study results. Cancer Med 2023. [PMID: 37260158 DOI: 10.1002/cam4.5997] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/29/2023] [Accepted: 04/15/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi) are approved for the treatment of various solid tumors. In gastric cancer, genes commonly harbor mutations in the homologous recombination DNA repair pathway, potentially increasing sensitivity to PARPi. Pamiparib (BGB-290) is a small molecule inhibitor of PARP1 and PARP2. METHODS The PARALLEL-303 study (NCT03427814) investigated the efficacy and safety of pamiparib 60 mg orally (PO) twice daily (BID) versus placebo PO BID as maintenance therapy in patients with inoperable locally advanced or metastatic gastric cancer that responded to platinum-based first-line chemotherapy. The primary endpoint of this double-blind, randomized, global phase 2 study was progression-free survival (PFS) (RECIST version 1.1; per investigator assessment). Secondary endpoints included overall survival (OS) and safety. RESULTS In total, 136 patients were randomized 1:1 to receive pamiparib (n = 71) or placebo (n = 65). Median PFS was numerically longer with pamiparib versus placebo but did not reach statistical significance (3.7 months [95% confidence interval (CI): 1.9, 5.3] vs. 2.1 months [95% CI: 1.9, 3.8]; hazard ratio 0.8 [95% CI: 0.5, 1.2]; p = 0.1428). Median OS was 10.2 months (95% CI: 8.7, 16.3) in the pamiparib arm versus 12.0 months (95% CI: 8.2, not estimable) in the placebo arm. Overall, 8 patients (11.3%) in the pamiparib arm and 2 patients (3.1%) in the placebo arm experienced ≥1 TEAE leading to treatment discontinuation. CONCLUSIONS Maintenance pamiparib did not meet statistical significance for superiority versus placebo for PFS, but was well tolerated with few treatment discontinuations; no unexpected safety signals were identified.
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Affiliation(s)
- Fortunato Ciardiello
- Dipartimento di Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Andrés Cervantes
- Department of Medical Oncology, Biomedical Research Institute INCLIVA, CiberOnc, University of Valencia, Valencia, Spain
| | - Mikhail Dvorkin
- Algorithmic Biology Laboratory, St. Petersburg Academic University, Russian Academy of Sciences, St. Petersburg, Russia
| | - Charles D Lopez
- Department of Medicine, Knight Cancer Institute/Oregon Health and Science University, Portland, Oregon, USA
| | - Jean-Philippe Metges
- Institute of Oncology and Haematology, CHU Morvan, Arpego Network, Brest, France
| | | | - Mariona Calvo
- Department of Medical Oncology, ONCOBELL Program (IDIBELL), Institut Català d'Oncologia-L'Hospitalet, Barcelona, Spain
| | - Andrew H Strickland
- Department of Medical Oncology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - George Kannourakis
- Ballarat Oncology & Haematology Services, Wendouree, Victoria, Australia
- The Fiona Elsey Cancer Research Institute, Ballarat, Victoria, Australia
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hisato Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Jia Wei
- The Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University & Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Christophe Borg
- University Hospital of Besançon, Medical Oncology Department, CIC-BT1431, Besançon, France
- UMR1098, Molecular and Cellular Immune Therapies of Cancers, INSERM, Besançon, France
| | - Zhaoyin Zhu
- Clinical Development, BeiGene Ltd, Cambridge, Massachusetts, USA
| | - Neal Gupta
- Clinical Development, BeiGene Ltd, Cambridge, Massachusetts, USA
| | - Robert J Pelham
- Clinical Development, BeiGene Ltd, Cambridge, Massachusetts, USA
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
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15
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Hirata K, Matsumori Y, Tanji Y, Khanna R, Ozeki A, Komori M. Safety profile of lasmiditan in patients with migraine in an Asian population. Expert Opin Drug Saf 2023; 22:91-101. [PMID: 35736027 DOI: 10.1080/14740338.2022.2087630] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND MONONOFU, a multicenter, randomized, double-blind, placebo-controlled phase 2 study of Japanese patients with migraine, was pivotal for lasmiditan approval in Japan. However, treatment-emergent adverse events (TEAEs) were more common than in global studies. A detailed safety profile would assist patient management. RESEARCH DESIGN AND METHODS Safety assessments in MONONOFU included specific terms reported, frequency, severity, time to onset, duration, TEAE management, common TEAE risk factors, and TEAE-efficacy associations. RESULTS Of 846 participants, 691 were assessed for safety. The proportion of participants reporting ≥1 TEAE was 23.4% with placebo and 70.9% with lasmiditan; 87.3% of TEAEs with lasmiditan were mild. The most frequent TEAEs with lasmiditan, dizziness (39.4%) and somnolence (19.3%), started ≤1 hour postdose (median durations: 2.5 and 3.3 hours, respectively). Higher lasmiditan dose, but not patient factors including body size, was identified as a clinically meaningful predictor of dizziness and somnolence. There were no adverse consequences of neurological TEAEs, which did not appear to adversely affect lasmiditan efficacy. CONCLUSIONS In the MONONOFU study, TEAEs appeared typically mild, transient, and self-limiting. Lasmiditan may represent a useful and well-tolerated acute treatment option for smaller (body mass index <30 kg/m2) patients and Asian patients with migraine.
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Affiliation(s)
- Koichi Hirata
- Headache Center, Dokkyo Medical University, Mibu, Japan
| | | | - Yuka Tanji
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Rashna Khanna
- Global Patient Safety, Eli Lilly and Company Limited, Bracknell, UK
| | - Akichika Ozeki
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
| | - Mika Komori
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., Kobe, Japan
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16
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Baker BF, Xia S, Partridge W, Kwoh TJ, Tsimikas S, Bhanot S, Geary RS. Integrated Assessment of Phase 2 Data on GalNAc 3-Conjugated 2'- O-Methoxyethyl-Modified Antisense Oligonucleotides. Nucleic Acid Ther 2023; 33:72-80. [PMID: 36454263 PMCID: PMC10623620 DOI: 10.1089/nat.2022.0044] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/16/2022] [Indexed: 12/03/2022] Open
Abstract
Receptor-mediated delivery of an antisense oligonucleotide (ASO) using the ligand-conjugated antisense technology is establishing a new benchmark for antisense therapeutics. The triantennary N-acetylgalactosamine (GalNAc3) cluster is the first conjugated ligand to yield a marked increase in ASO potency for RNA targets expressed by hepatocytes, compared to the unconjugated form. In this study, we present an integrated safety assessment of data available from randomized, placebo-controlled, phase 2 studies for six GalNAc3-conjugated 2'-O-methoxyethyl (2'MOE)-modified ASOs. The total study population included 642 participants (130 placebo; 512 ASO) with up to 1 year of exposure. The primary measures were the incidence of signals from standardized laboratory tests and the mean test results over time. The GalNAc3-conjugated ASOs were well tolerated with no class effect identified across all doses tested compared to placebo. These results extend prior observations from phase 1 studies, now with treatment up to 1 year.
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Affiliation(s)
- Brenda F. Baker
- Department of Drug Development, Ionis Pharmaceuticals, Carlsbad, California, USA
| | - Shuting Xia
- Department of Drug Development, Ionis Pharmaceuticals, Carlsbad, California, USA
| | - Wesley Partridge
- Department of Drug Development, Ionis Pharmaceuticals, Carlsbad, California, USA
| | - T. Jesse Kwoh
- Department of Drug Development, Ionis Pharmaceuticals, Carlsbad, California, USA
| | - Sotirios Tsimikas
- Department of Drug Development, Ionis Pharmaceuticals, Carlsbad, California, USA
- Department of Vascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Sanjay Bhanot
- Department of Drug Development, Ionis Pharmaceuticals, Carlsbad, California, USA
| | - Richard S. Geary
- Department of Drug Development, Ionis Pharmaceuticals, Carlsbad, California, USA
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17
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Nistor GI, Dillman RO, Robles RM, Langford JL, Poole AJ, Sofro MAU, Nency YM, Jonny J, Yana ML, Karyana M, Lestari ES, Triwardhani R, Mujahidah M, Sari RK, Soetojo NA, Wibisono D, Tjen D, Ikrar T, Sarkissian G, Winarta H, Putranto TA, Keirstead HS. A personal COVID-19 dendritic cell vaccine made at point-of-care: Feasibility, safety, and antigen-specific cellular immune responses. Hum Vaccin Immunother 2022; 18:2100189. [PMID: 36018753 DOI: 10.1080/21645515.2022.2100189] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a world-wide pandemic. Internationally, because of availability, accessibility, and distribution issues, there is a need for additional vaccines. This study aimed to: establish the feasibility of personal dendritic cell vaccines to the SARS-CoV-2 spike protein, establish the safety of a single subcutaneous vaccine injection, and determine the antigen-specific immune response following vaccination. In Phase 1, 31 subjects were assigned to one of nine formulations of autologous dendritic cells and lymphocytes (DCL) incubated with 0.10, 0.33, or 1.0 µg of recombinant SARS-CoV-2 spike protein, and admixed with saline or 250 or 500 µg of granulocyte-macrophage colony-stimulating factor (GM-CSF) prior to injection, then assessed for safety and humoral response. In Phase 2, 145 subjects were randomized to one of three formulations defined by incubation with the same three quantities of spike protein without GM-CSF, then assessed for safety and cellular response. Vaccines were successfully manufactured for every subject at point-of-care. Approximately 46.4% of subjects had a grade 1 adverse event (AE); 6.5% had a grade 2 AE. Among 169 evaluable subjects, there were no acute allergic, grade 3 or 4, or serious AE. In Phase 1, anti-receptor binding domain antibodies were increased in 70% of subjects on day-28. In Phase 2, in the 127 subjects who did not have high levels of gamma interferon-producing cells at baseline, 94.4% had increased by day 14 and 96.8% by day 28. Point-of-care personal vaccine manufacturing was feasible. Further development of such subject-specific vaccines is warranted.
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Affiliation(s)
| | | | | | | | | | | | - Yetty M Nency
- Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Jonny Jonny
- Gatot Soebroto Army Hospital (RSPAD), Jakarta, Indonesia
| | - Martina L Yana
- Gatot Soebroto Army Hospital (RSPAD), Jakarta, Indonesia
| | | | | | | | | | - Retty K Sari
- Gatot Soebroto Army Hospital (RSPAD), Jakarta, Indonesia
| | | | - Djoko Wibisono
- Gatot Soebroto Army Hospital (RSPAD), Jakarta, Indonesia
| | - Daniel Tjen
- Gatot Soebroto Army Hospital (RSPAD), Jakarta, Indonesia
| | - Taruna Ikrar
- Ministry of Health Republic of Indonesia, Jakarta, Indonesia
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18
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Sulkowski MS, Agarwal K, Ma X, Nguyen TT, Schiff ER, Hann HL, Dieterich DT, Nahass RG, Park JS, Chan S, Han SB, Gane EJ, Bennett M, Alves K, Evanchik M, Yan R, Huang Q, Lopatin U, Colonno R, Ma J, Knox SJ, Stamm LM, Bonacini M, Jacobson IM, Ayoub WS, Weilert F, Ravendhran N, Ramji A, Kwo PY, Elkhashab M, Hassanein T, Bae HS, Lalezari JP, Fung SK, Yuen MF. Safety and efficacy of vebicorvir administered with entecavir in treatment-naïve patients with chronic hepatitis B virus infection. J Hepatol 2022; 77:1265-75. [PMID: 35697332 DOI: 10.1016/j.jhep.2022.05.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/20/2022] [Accepted: 05/17/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND & AIMS Nucleos(t)ide reverse transcriptase inhibitors do not completely suppress HBV DNA in chronic HBV infection (cHBV). Vebicorvir (VBR) is an investigational core inhibitor that interferes with multiple aspects of HBV replication. This phase II trial evaluated the safety and efficacy of VBR in combination with entecavir (ETV) in treatment-naïve patients with cHBV. METHODS HBeAg-positive, treatment-naïve patients without cirrhosis were randomised 1:1 in a double-blind manner to once-daily VBR 300 mg+ETV 0.5 mg or placebo (PBO)+ETV 0.5 mg for 24 weeks. The primary endpoint was change in mean log10 HBV DNA from Baseline to Week 12 and 24. RESULTS All patients in both treatment groups (PBO+ETV: 12/12; VBR+ETV: 13/13) completed the study. At Week 12, VBR+ETV led to a greater mean (SD) reduction from Baseline in log10 IU/ml HBV DNA (-4.45 [1.03]) vs. PBO+ETV (-3.30 [1.18]; p = 0.0077). At Week 24, VBR+ETV led to a greater reduction from Baseline in log10 IU/ml HBV DNA (-5.33 [1.59]) vs. PBO+ETV (-4.20 [0.98]; p = 0.0084). Greater mean reductions in pregenomic RNA were observed at Week 12 and 24 in patients receiving VBR+ETV vs. PBO+ETV (p <0.0001 and p <0.0001). Changes in viral antigens were similar in both groups. No drug interaction between VBR and ETV was observed. Two patients experienced HBV DNA rebound during treatment, with no resistance breakthrough detected. The safety of VBR+ETV was similar to PBO+ETV. All treatment-emergent adverse events and laboratory abnormalities were Grade 1/2. There were no deaths, serious adverse events, or evidence of drug-induced liver injury. CONCLUSIONS In this 24-week study, VBR+ETV provided additive antiviral activity over PBO+ETV in treatment-naïve patients with cHBV, with a favourable safety and tolerability profile. CLINICAL TRIAL NUMBER NCT03577171 LAY SUMMARY: Hepatitis B is a long-lasting viral infection of the liver. Current treatments can suppress hepatitis B virus but do not offer the opportunity of cure, hence, new treatment approaches are required. Herein, we show that the combination of the novel core inhibitor vebicorvir with an existing antiviral (entecavir) in treatment-naïve patients chronically infected with hepatitis B virus demonstrated greater antiviral activity than entecavir alone. Additionally, vebicorvir was safe and well tolerated. Thus, further studies evaluating its potential role in the treatment of chronic hepatitis B are warranted.
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Vieujean S, D’Amico F, Netter P, Danese S, Peyrin‐Biroulet L. Landscape of new drugs and targets in inflammatory bowel disease. United European Gastroenterol J 2022; 10:1129-1166. [PMID: 36112543 PMCID: PMC9752289 DOI: 10.1002/ueg2.12305] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/22/2022] [Indexed: 01/13/2023] Open
Abstract
Although the therapeutic armamentarium of Inflammatory bowel diseases (IBD) physicians has expanded rapidly in recent years, a proportion of patients remain with a suboptimal response to medical treatment due to primary no response, loss of response or intolerance to currently available drugs. Our growing knowledges of IBD pathophysiology has led to the development of a multitude of new therapies over time, which may, 1 day, be able to address this unmet medical need. This review aims to provide physicians an update of emerging therapies in IBD by focusing on drugs currently in phase 3 clinical trials. Among the most promising molecules are anti-IL-23, JAK-inhibitors, anti-integrins and S1P modulators. While the results in terms of efficacy and safety are fairly clear for some classes, the question of safety remains more uncertain for other classes. Molecules at a more preliminary stage of development (phase 1 and 2), one of which may 1 day offer an optimal benefit-risk ratio, will also be presented as well as their respective mechanisms of action.
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Affiliation(s)
- Sophie Vieujean
- Hepato‐Gastroenterology and Digestive OncologyUniversity Hospital CHU of LiègeLiègeBelgium
| | - Ferdinando D’Amico
- Department of Gastroenterology and EndoscopyIRCCS San Raffaele Hospital and Vita‐Salute San Raffaele UniversityMilanItaly,Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanItaly
| | | | - Silvio Danese
- Department of Gastroenterology and EndoscopyIRCCS San Raffaele Hospital and Vita‐Salute San Raffaele UniversityMilanItaly
| | - Laurent Peyrin‐Biroulet
- Department of GastroenterologyUniversity of LorraineCHRU‐NancyNancyFrance,University of LorraineInserm, NGERENancyFrance
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20
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Watson JA, Kissler SM, Day NPJ, Grad YH, White NJ. Characterizing SARS-CoV-2 Viral Clearance Kinetics to Improve the Design of Antiviral Pharmacometric Studies. Antimicrob Agents Chemother 2022;:e0019222. [PMID: 35736134 DOI: 10.1128/aac.00192-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A consensus methodology for the pharmacometric assessment of candidate SARS-CoV-2 antiviral drugs would be useful for comparing trial results and improving trial design. The time to viral clearance, assessed by serial qPCR of nasopharyngeal swab samples, has been the most widely reported measure of virological response in clinical trials, but it has not been compared formally with other metrics, notably model-based estimates of the rate of viral clearance. We analyzed prospectively gathered viral clearance profiles from 280 infection episodes in vaccinated and unvaccinated individuals. We fitted different phenomenological pharmacodynamic models (single exponential decay, bi-exponential, penalized splines) and found that the clearance rate, estimated from a mixed effects single exponential decay model, is a robust pharmacodynamic summary of viral clearance. The rate of viral clearance, estimated from viral densities during the first week following peak viral load, provides increased statistical power (reduced type 2 error) compared with time to clearance. Antiviral effects approximately equivalent to those with currently used and recommended SARS-CoV-2 antiviral treatments, notably nirmatrelvir and molnupiravir, can be detected from randomized trials with sample sizes of only 35 to 65 patients per arm. We recommend that pharmacometric antiviral assessments should be conducted in early COVID-19 illness with serial qPCR samples taken over 1 week.
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21
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Eguchi Y, Takahashi H, Mappa S, Santagostino E. Phase 2 study of avatrombopag in Japanese patients with chronic liver disease and thrombocytopenia. Hepatol Res 2022; 52:371-380. [PMID: 35134259 DOI: 10.1111/hepr.13755] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/07/2022] [Accepted: 01/15/2022] [Indexed: 12/13/2022]
Abstract
AIM Avatrombopag, a thrombopoietin receptor agonist, can reduce the need for platelet transfusions or rescue interventions for bleeding in patients with chronic liver disease (CLD) and thrombocytopenia undergoing scheduled procedures. A model analysis indicated that the effect of avatrombopag on platelet production was reduced in East Asian versus non-East Asian patients; however, the difference was deemed not clinically significant. Furthermore, a subgroup analysis of pooled Phase 3 trials showed similar avatrombopag efficacy across racial subgroups. The aim of this Phase 2 study was to corroborate the efficacy and safety of avatrombopag in Japanese patients with thrombocytopenia due to CLD. METHODS Japanese patients with CLD and thrombocytopenia were randomized to receive placebo or avatrombopag 20, 40, or 60 mg daily for 5 days. The primary endpoint was responder rate in platelet counts at Visit 4 (10-13 days after treatment initiation), defined as the proportion of patients with platelet count ≥50 × 109 /L and ≥20 × 109 /L increase from baseline. RESULTS Thirty-nine patients were randomized and completed the study (placebo, n = 11; avatrombopag 20 mg, n = 7; 40 mg, n = 11; 60 mg, n = 10). Avatrombopag treatment was associated with significant increases in responder rate at Visit 4 in the 40 mg (63.6%; p = 0.004) and 60 mg (40%; p = 0.024) groups versus placebo (9.1%). Avatrombopag was well tolerated and no new safety signals were detected. CONCLUSIONS Efficacy and safety results from this study were consistent with previous studies in patients with CLD and thrombocytopenia undergoing elective procedures, supporting treatment with avatrombopag in the Japanese population. CLINICALTRIALS gov identifier: NCT02227693.
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Affiliation(s)
| | - Hirokazu Takahashi
- Liver Center, Saga University Hospital, Faculty of Medicine, Saga University, Saga, Japan
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22
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Ashmawy R, Hamdy NA, Elhadi YAM, Alqutub ST, Esmail OF, Abdou MSM, Reyad OA, El-Ganainy SO, Gad BK, Nour El-Deen AES, Kamal A, ElSaieh H, Elrewiny E, Shaaban R, Ghazy RM. A Meta-Analysis on the Safety and Immunogenicity of Covid-19 Vaccines. J Prim Care Community Health 2022; 13:21501319221089255. [PMID: 35400233 PMCID: PMC8998390 DOI: 10.1177/21501319221089255] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: The presented meta-analysis (MA) aims at identifying the vaccine safety and immunogenicity in published trials about SARS-CoV-2 vaccines. Methods: All relevant publications were systematically searched and collected from different databases (Embase, Scopus, EBSCO, MEDLINE central/PubMed, Science Direct, Cochrane Central Register for Clinical Trials (CENTRAL), Clinical Trials.gov, WHO International Clinical Trials Registry Platform (ICTRP), COVID Trial, COVID Inato, Web of Science, ProQuest Thesis, ProQuest Coronavirus Database, SAGE Thesis, Google Scholar, Research Square, and Medxriv) up to January 10, 2021. The pooled vaccine safety and immunogenicity following vaccination in phase 1 and 2 vaccine clinical trials, as well as their 95% confidence intervals (CI), were estimated using the random-effects model. Results: The predefined inclusion criteria were met in 22 out of 8592 articles. The proportion of anti-severe acute respiratory distress coronavirus 2 (SARS-CoV-2) antibody responses after 7 days among 72 vaccinated persons included in 1 study was 81% (95% CI: 70-89), after 14 days among 888 vaccinated persons included in 6 studies was 80% (95% CI: 58-92), after 28 days among 1589 vaccinated persons included in 6 studies was 63% (95% CI: 59-67), after 42 days among 478 vaccinated persons included in 5 studies was 93% (95% CI: 80-98), and after 56 days among 432 vaccinated persons included in 2 studies was 93% (95% CI: 83-97). Meta regression explains more than 80% of this heterogeneity, where the main predictors were; the inactivated vaccine type (β = 2.027, P = 0.0007), measurement of antibodies at week 1 (β = −4.327, P < 0.0001) and at week 3 of the first dose (β = −2.02, P = 0.0025). Furthermore, the pooled proportion adverse effects 7 days after vaccination was 0.01 (0.08-0.14) for fever, headache 0.23 (0.19-0.27), fatigue 0.10 (0.07-0.13), and 0.18 (0.14-0.23) for muscle pain. Conclusion: Immunogenicity following vaccination ranged from 63% to 93% depending on the time at which the antibody levels were measured.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Basma Khairy Gad
- Ministry of Health and Population, Preventive Medicine Sector, South Sinai, Egypt
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23
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Peeva E, Guttman-Yassky E, Banerjee A, Sinclair R, Cox LA, Zhu L, Zhu H, Vincent M, King B. Maintenance, withdrawal, and re-treatment with ritlecitinib and brepocitinib in patients with alopecia areata in a single-blind extension of a phase 2a randomized clinical trial. J Am Acad Dermatol 2021; 87:390-393. [PMID: 34915057 DOI: 10.1016/j.jaad.2021.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Brett King
- Yale University School of Medicine, New Haven, Connecticut
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24
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Harding JJ, Yang TS, Chen YY, Feng YH, Yen CJ, Ho CL, Huang WT, El Dika I, Akce M, Tan B, Cohen SA, Meyer T, Sarker D, Lee DW, Ryoo BY, Lim HY, Johnston A, Bomalaski JS, O'Reilly EM, Qin S, Abou-Alfa GK. Assessment of pegylated arginine deiminase and modified FOLFOX6 in patients with advanced hepatocellular carcinoma: Results of an international, single-arm, phase 2 study. Cancer 2021; 127:4585-4593. [PMID: 34415578 DOI: 10.1002/cncr.33870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Arginine starvation depletes the micronutrients required for DNA synthesis and interferes with both thymidylate synthetase activity and DNA repair pathways in preclinical models of hepatocellular carcinoma (HCC). Pegylated arginine deiminase (ADI-PEG 20), an arginine degrader, potentiates the cytotoxic activity of platinum and pyrimidine antimetabolites in HCC cellular and murine models. METHODS This was a global, multicenter, open-label, single-arm, phase 2 trial of ADI-PEG 20 and modified 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) in patients who had HCC with Child-Pugh A cirrhosis and disease progression on ≥2 prior lines of treatment. The primary objective was the objective response rate assessed according to Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary objectives were to estimate progression-free survival, overall survival, safety, and tolerability. Eligible patients were treated with mFOLFOX6 intravenously biweekly at standard doses and ADI-PEG-20 intramuscularly weekly at 36 mg/m2 . RESULTS In total, 140 patients with advanced HCC were enrolled. The median patient age was 62 years (range, 30-85 years), 83% of patients were male, 76% were of Asian race, 56% had hepatitis B viremia, 10% had hepatitis C viremia, 100% had received ≥2 prior lines of systemic therapy, and 39% had received ≥3 prior lines of systemic therapy. The objective response rate was 9.3% (95% confidence interval [CI], 5.0%-15.4%), with a median response duration of 10.2 months (95% CI, 5.8 months to not reached). The median progression-free survival was 3.8 months (95% CI, 1.8-6.3 months), and the median overall survival was 14.5 months (95% CI, 13.6-20.9 months). The most common grade ≥3 treatment-related events were neutropenia (32.9%), white blood cell count decrease (20%), platelet count decrease (19.3%), and anemia (9.3%). CONCLUSIONS Concurrent mFOLFOX6 plus ADI-PEG 20 exhibited limited antitumor activity in patients with treatment-refractory HCC. The study was terminated early, and no further evaluation of the combination will be pursued. LAY SUMMARY Arginine is an important nutrient for hepatocellular carcinoma (HCC). The depletion of arginine with pegylated arginine deiminase (ADI-PEG 20), an arginine degrader, appeared to make chemotherapy (FOLFOX) work better in animal models of HCC and in patients with HCC on an early phase clinical trial. To formally test this hypothesis in the clinical setting, a large, global, phase 2 clinical trial was conducted of ADI-PEG 20 and FOLFOX in the treatment of patients with refractory HCC. The study showed limited activity of ADI-PEG 20 and FOLFOX in advanced HCC and was stopped early.
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Affiliation(s)
- James J Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Tsai-Sheng Yang
- Internal Medicine, Linkou Chang Gung Medical Foundation, Taoyuan City, Taiwan
| | - Yen-Yang Chen
- College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Yin-Hsun Feng
- Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chia-Jui Yen
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ching-Liang Ho
- Division of Hematology, Department of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei City, Taiwan
| | - Wen-Tsung Huang
- Department of Medicine, Chi Mei Medical Center-Liouying, Tainan City, Taiwan
| | - Imane El Dika
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Mehmet Akce
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin Tan
- Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Timothy Meyer
- Oncology, Royal Free Hospital, London, United Kingdom
| | - Debashis Sarker
- Department of Medicine, Guys Hospital, London, United Kingdom
| | - Dae-Won Lee
- Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Baek-Yeol Ryoo
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Yeong Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul, Korea
| | | | | | - Eileen M O'Reilly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Shukui Qin
- Cancer Center, Bayi Hospital of Nanjing Chinese Medicine University, Nanjing, China
| | - Ghassan K Abou-Alfa
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Weill Cornell Medical College, New York, New York
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25
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Evans R, Kohan A, Moldwin R, Radecki D, Geib T, Peters KM. Safety, tolerability, and efficacy of LiRIS 400 mg in women with interstitial cystitis/bladder pain syndrome with or without Hunner lesions. Neurourol Urodyn 2021; 40:1730-1739. [PMID: 34288094 DOI: 10.1002/nau.24702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 01/23/2023]
Abstract
AIMS Two phase 2 studies were conducted to assess the efficacy and safety of lidocaine-releasing intravesical system (LiRIS) in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) with (Study 001; NCT02395042) or without, (Study 002; NCT02411110) Hunner lesions (HL). METHODS Both were multicenter, randomized, double-blind, placebo-controlled, and enrolled women aged ≥18 years. In Study 001, patients were randomized 2:1:1 to LiRIS 400 mg/LiRIS 400 mg, placebo/LiRIS 400 mg, or placebo/placebo for a continuous 28 (2 × 14)-day period. In Study 002, patients were randomized 1:1 to LiRIS 400 mg or placebo for a continuous (single treatment) 14-day period. RESULTS In total, 59 and 131 patients received treatment in Studies 001 and 002, respectively. There was no statistically significant difference in the primary endpoint, the change from baseline to Week 4 of follow-up post-removal in mean daily average bladder numeric rating scale (NRS) pain score in either study (Study 001: placebo/placebo, -1.6; LiRIS/LiRIS, -2.7, p = 0.142; placebo/LiRIS, -2.5, p = 0.319; Study 002: LiRIS -1.2; placebo, -1.5, p = 0.505). There was no statistically significant difference between groups in daily worst NRS pain score, number of micturitions/day or urgency episodes/day. There was no clear trend for reduction in number of HL for LiRIS vs placebo. The frequency of treatment-emergent adverse events was similar between treatment groups in both studies; most were mild or moderate intensity. CONCLUSION These studies did not demonstrate a treatment effect of LiRIS 400 mg compared with placebo, either in patients with IC/BPS with HL, or in those without HL.
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Affiliation(s)
- Robert Evans
- Urology, Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Alfred Kohan
- Bethpage Division, Advanced Urology Centers of New York, Bethpage, New York, USA
| | - Robert Moldwin
- Urologic Infectious/Inflammatory Diseases, The Arthur Smith Institute for Urology, Lake Success, New York, USA
| | | | - Till Geib
- Specialty Development, AbbVie, Irvine, California, USA
| | - Kenneth M Peters
- Urology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.,Urology, Beaumont Health, Royal Oak, Michigan, USA
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Sakai F, Takeshima T, Homma G, Tanji Y, Katagiri H, Komori M. Phase 2 randomized placebo-controlled study of lasmiditan for the acute treatment of migraine in Japanese patients. Headache 2021; 61:755-765. [PMID: 33990951 PMCID: PMC8252620 DOI: 10.1111/head.14122] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/21/2021] [Accepted: 03/15/2021] [Indexed: 12/17/2022]
Abstract
Objective To evaluate the efficacy and safety of lasmiditan in Japanese adults with migraine. Background Global clinical studies have demonstrated the efficacy and safety of lasmiditan in the acute treatment of migraine. Methods This was a multicenter, randomized, double‐blind, placebo‐controlled, phase 2 study in Japan (NCT03962738), which enrolled adults with migraine with or without aura. Participants were randomized 7:3:7:6 to placebo, lasmiditan 50 mg, 100 mg, or 200 mg to be self‐administered orally within 4 h of onset of a single moderate‐to‐severe migraine attack. Participants recorded their response to treatment prior to dosing and for 48 h postdose. The primary endpoint was headache pain freedom at 2 h postdose. Results Participants (N = 846) were randomized and treated (N = 691, safety; N = 682, modified intent‐to‐treat). At 2 h postdose, a significantly higher proportion of participants were headache pain‐free in the lasmiditan 200 mg (40.8%, 73/179; odds ratio 3.46 [95% confidence interval 2.17 to 5.54]; p < 0.001; primary objective) and 100 mg groups (32.4%, 67/207; odds ratio 2.41 [1.51 to 3.83]; p < 0.001) compared with the placebo group (16.6%, 35/211), whereas the lasmiditan 50 mg group had a numerically higher proportion of participants headache pain‐free (23.5%, 20/85; odds ratio 1.55 [0.83 to 2.87]; p = 0.167) compared with placebo. A statistically significant linear dose–response relationship for pain freedom was achieved at 2 h by a Cochran–Armitage trend test (p < 0.001). Lasmiditan treatment was also associated with headache pain relief, most bothersome symptom freedom, and improvement on disability and Patient Global Impression of Change outcomes. The majority of treatment‐emergent adverse events were mild and of short duration, the most common of which were dizziness (39.4%; 188/477), somnolence (19.3%; 92/477), and malaise (10.5%; 50/477) in all lasmiditan groups, with no serious adverse events reported. Conclusions Lasmiditan was well tolerated and effective for the acute treatment of Japanese patients with migraine, consistent with global phase 3 studies.
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Affiliation(s)
- Fumihiko Sakai
- Saitama International Headache Center, Saitama Neuropsychiatric Institute, Saitama, Japan
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27
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de Vos S, Leonard JP, Friedberg JW, Zain J, Dunleavy K, Humerickhouse R, Hayslip J, Pesko J, Wilson WH. Safety and efficacy of navitoclax, a BCL-2 and BCL-X L inhibitor, in patients with relapsed or refractory lymphoid malignancies: results from a phase 2a study. Leuk Lymphoma 2021; 62:810-818. [PMID: 33236943 PMCID: PMC9257998 DOI: 10.1080/10428194.2020.1845332] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023]
Abstract
Navitoclax, a novel BCL-2 and BCL-XL inhibitor, demonstrated promising antitumor activity in the dose-escalation part of a phase 1/2a study (NCT00406809) in lymphoid tumors. Herein, we report the continued safety and efficacy results of the phase 2a portion. Twenty-six adult patients with relapsed/refractory follicular lymphoma (n = 11, Arm A) and other relapsed/refractory lymphoid malignancies (n = 15, Arm B) were enrolled. Navitoclax administration schedule consisted of a 150-mg 7-day lead-in dose followed by 250-mg daily dosing with the option to further increase to 325 mg after 14 days if the 250-mg dose was tolerated. All patients experienced at least 1 treatment-related adverse event (TRAE). Seventeen (65.4%) patients reported grade 3/4 TRAEs; thrombocytopenia (38.5%) and neutropenia (30.8%) were the most common. Two patients reported serious AEs; none were fatal (no deaths occurred within 30 days of last dose of study drug). The objective response rate (complete and partial) was 23.1% (6/26; Arm A: 9.1%, Arm B: 33.3%). Median progression-free survival and time to progression were identical: 4.9 months (95% CI: 3.0, 8.2); median overall survival: 24.8 months (95% CI could not be computed). Navitoclax monotherapy has an acceptable safety profile and meaningful clinical activity in a minority of patients with relapsed/refractory lymphoid malignancies.
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Affiliation(s)
- Sven de Vos
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John P. Leonard
- Weill Cornell Medicine and New York-Presbyterian Hospital, New York, NY, USA
| | | | - Jasmine Zain
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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28
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King B, Guttman-Yassky E, Peeva E, Banerjee A, Sinclair R, Pavel AB, Zhu L, Cox LA, Craiglow B, Chen L, Banfield C, Page K, Zhang W, Vincent MS. A phase 2a randomized, placebo-controlled study to evaluate the efficacy and safety of the oral Janus kinase inhibitors ritlecitinib and brepocitinib in alopecia areata: 24-week results. J Am Acad Dermatol 2021; 85:379-87. [PMID: 33757798 DOI: 10.1016/j.jaad.2021.03.050] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an autoimmune form of hair loss with limited treatments. OBJECTIVE To evaluate the efficacy and safety of the Janus kinase inhibitors ritlecitinib and brepocitinib in patients who have AA with ≥ 50% scalp hair loss. METHODS Patients were randomized to once-daily ritlecitinib, brepocitinib, or placebo. The primary efficacy endpoint was a 24-week change from baseline in the Severity of Alopecia Tool (SALT) score. The key secondary efficacy endpoint was the proportion of patients achieving 30% improvement in SALT score (SALT30). RESULTS The ritlecitinib, brepocitinib, and placebo groups included 48, 47, and 47 patients, respectively. At week 24, least-squares mean difference from placebo in SALT score change from baseline was 31.1 (95% confidence interval [CI], 18.8-43.5) for ritlecitinib and 49.2 (95% CI, 36.6-61.7) for brepocitinib (P < .0001 for both comparisons with placebo). SALT30 was achieved by 50% (90% CI, 38%-62%) of patients receiving ritlecitinib, 64% (90% CI, 51%-75%) receiving brepocitinib, and 2% (90% CI, 0%-9%) receiving placebo. Two patients experienced a serious adverse event (rhabdomyolysis) in the brepocitinib group only. LIMITATIONS Only a single-dosage regimen of each study drug was included. CONCLUSION Treatment with ritlecitinib or brepocitinib for 24 weeks was efficacious and generally well tolerated.
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Reinisch W, Sandborn WJ, Danese S, Hébuterne X, Kłopocka M, Tarabar D, Vaňásek T, Greguš M, Hellstern PA, Kim JS, Sparrow MP, Gorelick KJ, Hoy M, Goetsch M, Bliss C, Gupta C, Cataldi F, Vermeire S. Long-term Safety and Efficacy of the Anti-MAdCAM-1 Monoclonal Antibody Ontamalimab [SHP647] for the Treatment of Ulcerative Colitis: The Open-label Study TURANDOT II. J Crohns Colitis 2021; 15:938-949. [PMID: 33599720 PMCID: PMC8218706 DOI: 10.1093/ecco-jcc/jjab023] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Ontamalimab, a fully-human monoclonal antibody targeting MAdCAM-1, induced remission in patients with moderate-to-severe ulcerative colitis [UC] in the TURANDOT study. We aimed to assess long-term safety, tolerability, and efficacy of ontamalimab in TURANDOT II. METHODS TURANDOT II was a phase 2, multicentre, open-label [OL] study in patients with moderate-to-severe UC who completed TURANDOT on placebo or ontamalimab (NCT01771809). Patients were randomised to 75 mg or 225 mg ontamalimab every 4 weeks for 72 weeks [OL1]. The dosage could be increased to 225 mg from Week 8 at the investigator's discretion. All patients then received 75 mg every 4 weeks for 72 weeks [OL2], followed by 6-month safety follow-up. The primary objective was safety, measured by adverse events [AEs], serious AEs [SAEs], and AEs leading to withdrawal. Mucosal healing [MH; centrally read endoscopy] was assessed. RESULTS Of 330 patients, 180 completed OL1; 94 escalated to 225 mg; 127 completed OL2. Overall, 36.1% experienced drug-related AEs. The most common SAE [10.0%] was worsening/ongoing UC; 5.5% of patients had serious infections, the most common being gastroenteritis [0.9%]. One death and four cancers [all unrelated to ontamalimab] occurred. No PML [progressive multifocal leukoencephalopathy]/lymphoproliferative disorders occurred. Geometric mean high-sensitivity C-reactive protein [hsCRP] and faecal calprotectin decreased across OL1 in both dose groups. The proportion of patients assigned to placebo in TURANDOT achieving MH increased from 8.8% [6/68] at baseline to 35.3% at Week 16 [24/68; non-responder imputation]. The corresponding increase in the ontamalimab group was from 23.3% [61/262] to 26.7% [70/262]. CONCLUSIONS Ontamalimab was well tolerated up to 144 weeks in patients with moderate-to-severe UC, with good safety and efficacy.
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Affiliation(s)
- Walter Reinisch
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria,Corresponding author: Professor Walter Reinisch, MD, PhD , Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria. Tel.: +43 699 1952 7983;
| | - William J Sandborn
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Silvio Danese
- Inflammatory Bowel Diseases Center, Humanitas University, Milan, Italy
| | | | - Maria Kłopocka
- Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Dino Tarabar
- Clinic of Gastroenterology and Hepatology, Military Medical Academy, Belgrade, Serbia
| | - Tomáš Vaňásek
- Faculty of Medicine, Charles University Hospital, Hradec Králové, Czech Republic
| | | | - Paul A Hellstern
- Gastroenterology, Nature Coast Clinical Research, Inverness, FL, USA
| | - Joo Sung Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Miles P Sparrow
- Inflammatory Bowel Disease Clinic, Alfred Hospital, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
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Wright KD, Yao X, London WB, Kao PC, Gore L, Hunger S, Geyer R, Cohen KJ, Allen JC, Katzenstein HM, Smith A, Boklan J, Nazemi K, Trippett T, Karajannis M, Herzog C, Destefano J, Direnzo J, Pietrantonio J, Greenspan L, Cassidy D, Schissel D, Perentesis J, Basu M, Mizuno T, Vinks AA, Prabhu SP, Chi SN, Kieran MW. A POETIC Phase II study of continuous oral everolimus in recurrent, radiographically progressive pediatric low-grade glioma. Pediatr Blood Cancer 2021; 68:e28787. [PMID: 33140540 PMCID: PMC9161236 DOI: 10.1002/pbc.28787] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/02/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND To evaluate efficacy, pharmacokinetics (PK) and pharmacodynamics of single-agent everolimus in pediatric patients with radiographically progressive low-grade glioma (LGG). METHODS Everolimus was administered at 5 mg/m2 once daily as a tablet or liquid for a planned 48-week duration or until unacceptable toxicity or disease progression. Patients with neurofibromatosis type 1 were excluded. PK and pharmacodynamic endpoints were assessed in consenting patients. RESULTS Twenty-three eligible patients (median age 9.2 years) were enrolled. All patients received prior chemotherapy (median number of prior regimens two) and/or radiotherapy (two patients). By week 48, two patients had a partial response, 10 stable disease, and 11 clinical or radiographic progression; two discontinued study prior to 1 year (toxicity: 1, physician determination: 1). With a median follow up of 1.8 years (range 0.2-6.7 years), the 2-, 3-, and 5-year progression-free survivals (PFS) were 39 ± 11%, 26 ± 11%, and 26 ± 11%, respectively; two patients died of disease. The 2-, 3-, and 5-year overall survival (OS) were all 93 ± 6%. Grade 1 and 2 toxicities predominated; two definitively related grade 3 toxicities (mucositis and neutropenia) occurred. Grade 4 elevation of liver enzymes was possibly related in one patient. Predose blood levels showed substantial variability between patients with 45.5% below and 18.2% above the target range of 5-15 ng/mL. Pharmacodynamic analysis demonstrated significant inhibition in phospho-S6, 4E-BP1, and modulation of c-Myc expression. CONCLUSION Daily oral everolimus provides a well-tolerated, alternative treatment for multiple recurrent, radiographically progressive pediatric LGG. Based on these results, everolimus is being investigated further for this patient population.
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Affiliation(s)
- Karen D. Wright
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Xiaopan Yao
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Wendy B. London
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Pei-Chi Kao
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Lia Gore
- Children’s Hospital Colorado, Aurora, CO (current affiliation Children’s Hospital of Philadelphia, Philadelphia, PA)
| | - Stephen Hunger
- Children’s Hospital Colorado, Aurora, CO (current affiliation Children’s Hospital of Philadelphia, Philadelphia, PA)
| | - Russ Geyer
- Seattle Children’s Hospital, Seattle, WA
| | - Kenneth J. Cohen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore MD
| | | | - Howard M. Katzenstein
- Children’s Healthcare of Atlanta; Atlanta GA (current affiliation Nemours Children’s Specialty Care, Jacksonville, FL)
| | - Amy Smith
- University of Florida, Gainesville, FL (current affiliation Arnold Palmer Hospital for Children, Orlando, FL)
| | | | | | | | | | | | | | | | - Jay Pietrantonio
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Lianne Greenspan
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Danielle Cassidy
- Children’s Hospital Colorado, Aurora, CO (current affiliation Children’s Hospital of Philadelphia, Philadelphia, PA)
| | - Debra Schissel
- Children’s Hospital Colorado, Aurora, CO (current affiliation Children’s Hospital of Philadelphia, Philadelphia, PA)
| | - John Perentesis
- Cincinnati Children’s Hospital Medical Center, Cancer and Blood Diseases Institute and
| | - Mitali Basu
- Cincinnati Children’s Hospital Medical Center, Cancer and Blood Diseases Institute and
| | | | | | - Sanjay P. Prabhu
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Susan N. Chi
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | - Mark W. Kieran
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
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Abstract
Introduction: With a large percentage of patients having an incomplete response or intolerance to current FDA approved medications, new therapies for the treatment of primary biliary cholangitis are in great demand. Areas covered: In this review, we assess currently available drugs as well as promising new therapies for the treatment of primary biliary cholangitis. A literature search was performed with the following search terms: 'PBC treatment,' 'PBC therapeutics,' 'PBC clinical trials,' and included original articles, meta-analyses, and systematic reviews from 1 January 1981, to 1 January 2020. ClinicalTrials.gov was accessed for data from ongoing trials. Expert opinion: Targeted drug therapies offer an alternative for patients who are unable to meet their therapeutic goals with either of the two currently approved treatment options. Specifically, new drugs targeting bile-acid regulation, immune-modulation, and fibrogenic pathways are currently in development with multiple agents showing encouraging early results with the ultimate goal of developing therapies that will achieve high rates of biochemical remission, will be well tolerated, and improve symptoms and quality of life in patients with primary biliary cholangitis. Based on a review of the current literature, PPAR agonists appear to be promising agents, along with FGF19 analogs and FXR agonists.
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Roofeh D, Lescoat A, Khanna D. Emerging drugs for the treatment of scleroderma: a review of recent phase 2 and 3 trials. Expert Opin Emerg Drugs 2020; 25:455-466. [PMID: 33054463 PMCID: PMC7770026 DOI: 10.1080/14728214.2020.1836156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Systemic sclerosis (SSc) has the highest case-specific mortality of all connective tissue diseases. Its underlying disease mechanism affects several organs and remains incompletely understood. Ongoing work clarifying its etiopathogenesis is helping to develop targeted therapy. AREAS COVERED Several clinical trials have evaluated the safety and efficacy of agents targeting different mechanisms of this disease. This review article reviews those mechanisms and surveys four key recent phase II or III clinical trials that are contributing to the landscape of SSc therapy. The reported trials primarily focus on patients with systemic sclerosis in the early phase of disease. EXPERT OPINION Traditional therapies for SSc center on immunosuppressive and cytotoxic agents. A new cadre of therapies is borne from improved understandings of SSc pathobiology and target the inflammatory-fibrotic pathways. Scleroderma trials have entered the initial phase of personalized medicine, recognizing molecular subsets that will improve upon cohort enrichment and maximize the measurable benefit of future therapies.
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Affiliation(s)
| | - Alain Lescoat
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
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Iwasa S, Okita N, Kuchiba A, Ogawa G, Kawasaki M, Nakamura K, Shoji H, Honma Y, Takashima A, Kato K, Hamaguchi T, Boku N, Yamada Y. Phase II study of lenvatinib for metastatic colorectal cancer refractory to standard chemotherapy: the LEMON study (NCCH1503). ESMO Open 2020; 5:e000776. [PMID: 32817132 PMCID: PMC7440718 DOI: 10.1136/esmoopen-2020-000776] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lenvatinib inhibits tyrosine kinases, including vascular endothelial growth factor (VEGF) receptor, fibroblast growth factor receptor, platelet-derived growth factor receptor alpha, RET proto-oncogene and KIT proto-oncogene, receptor tyrosine kinase. We assessed the efficacy and safety of lenvatinib in patients with metastatic colorectal cancer after failure of standard chemotherapies. PATIENTS AND METHODS This was an open-label, single centre, single-arm, phase 2 study. Eligible patients had unresectable metastatic colorectal adenocarcinoma, refractory or intolerant to fluoropyrimidine, irinotecan, oxaliplatin, trifluridine/tipiracil, anti-VEGF therapy and anti-epidermal growth factor receptor therapy (for tumours with wild-type RAS). Patients were treated with oral lenvatinib at 24 mg one time a day in 28-day cycles until disease progression or unacceptable toxicity. The primary endpoint was centrally assessed disease control rate. Secondary endpoints included safety, response rate, progression-free survival and overall survival. The planned sample size was 30 patients to expect a disease control rate of 60% with a threshold disease control rate of 35%, one-sided alpha of 5% and power of 80% RESULTS: Between 24 October 2016 and 23 January 2018, 30 patients were enrolled; 11 (37%) and 19 (63%) had received 3 or ≥4 lines of prior chemotherapy for metastatic disease, respectively. The median number of lenvatinib cycles was 4 (range 1-13). The centrally assessed disease control rate was 70.0% (21/30, 90% CI 53.5% to 83.4%, one-sided p=0.0001); 2 patients had a partial response and 19 had a stable disease. Median progression-free survival was 3.6 months (95% CI 2.6 to 3.7). Median overall survival was 7.4 months (95% CI 6.4 to 10.8). The most common grade ≥3 adverse events were hypertension (53%), thrombocytopenia (10%), increased alanine aminotransferase and anorexia (7% each). CONCLUSIONS Lenvatinib showed promising clinical activity and was tolerated in patients with metastatic colorectal cancer after failure of standard chemotherapies. TRIAL REGISTRATION NUMBER UMIN-CTR, UMIN000023446 and JAMCCT-CTR, JMA-IIA00261.
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Affiliation(s)
- Satoru Iwasa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Natsuko Okita
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Aya Kuchiba
- Biostatistics Section, Clinical Research Support Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Gakuto Ogawa
- Biostatistics Section, Clinical Research Support Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Mamiko Kawasaki
- Clinical Trial Support Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Kenichi Nakamura
- Clinical Trial Support Office, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hirokazu Shoji
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yoshitaka Honma
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Atsuo Takashima
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Ken Kato
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Narikazu Boku
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yasuhide Yamada
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
- Comprehensive Cancer Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
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Iskierka-Jażdżewska E, Robak T. Investigational treatments for chronic lymphocytic leukemia: a focus on phase 1 and 2 clinical trials. Expert Opin Investig Drugs 2020; 29:709-722. [PMID: 32407139 DOI: 10.1080/13543784.2020.1770225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Introduction: During recent years, the introduction of novel drugs, particularly small molecule inhibitors, has led to remarkable progress in both previously untreated and relapsed/refractory (RR) patients in chronic lymphocytic leukemia (CLL). However, further research is necessary to find an optimal cure that responds to the individual needs of the patient. Areas covered: This review discusses new agents in phase 1 and 2 clinical trials currently underway in CLL patients. A literature review of the MEDLINE database for articles in English concerning novel drugs, clinical trials, phase 1, phase 2 and CLL was conducted via PubMed. Publications from 2000 through January 2020 were scrutinized. Conference proceedings from the previous five years of the American Society of Hematology, European Hematology Association and American Society of Clinical Oncology were searched manually. Additional relevant publications were obtained by reviewing the references from the chosen articles. The search also included clinical trials registered in clinicaltrials.gov. Expert opinion: The use of BTK and PI3Kδ inhibitors and BCL-2 antagonist have changed the treatment strategy of CLL. Several clinical trials with novel, unapproved agents are currently ongoing. Their findings should define the role of these novel drugs in the treatment of patients with previously untreated and RR CLL.
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Affiliation(s)
| | - Tadeusz Robak
- Department of Hematology, Copernicus Memorial Hospital, Lodz, Medical University of Lodz , Lodz, Poland
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Abstract
Background orthostatic hypotension (OH) is highly prevalent in older populations and is associated with reduced quality of life and increased mortality. Although non-pharmacologic therapies are recommended first-line, evidence for their use is lacking. Objective determine the efficacy of combination non-pharmacologic therapy for OH in older people. Methods a total of 111 orthostatic BP responses were evaluated in this prospective phase 2 efficacy study in 37 older people (≥60 years) with OH. Primary outcome was the proportion of participants whose systolic BP drop improved by ≥10 mmHg. Secondary outcomes include standing BP and symptoms. Comparison is made to the response rate of the most efficacious single therapy (bolus water drinking 56%). Therapeutic combinations were composed of interventions with known efficacy and tolerability: Therapy A- Bolus water drinking + physical counter-manoeuvres (PCM); Therapy B- Bolus water drinking + PCM + abdominal compression. Results the response rate to therapy A was 38% (95% confidence interval – CI 24, 63), with standing systolic BP increasing by 13 mmHg (95% CI 4, 22). Therapy B was efficacious in 46% (95% CI 31, 62), increasing standing systolic BP by 20 mmHg (95% CI 12, 29). Neither therapy had a significant effect on symptoms. There were no adverse events. Conclusions in comparison to single therapy, there is little additional benefit to be gained from combination non-pharmacologic therapy. Focussing on single, efficacious therapies, such as bolus water drinking or PCM, should become standard first-line therapy.
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Affiliation(s)
- James Frith
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- The Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Julia L Newton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- The Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
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Juntas-Morales R, Pageot N, Bendarraz A, Alphandéry S, Sedel F, Seigle S, Camu W. High-dose pharmaceutical grade biotin (MD1003) in amyotrophic lateral sclerosis: A pilot study. EClinicalMedicine 2020; 19:100254. [PMID: 32140672 PMCID: PMC7046518 DOI: 10.1016/j.eclinm.2019.100254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Oligodendrocytes (OGs) provide metabolic support to motor neurons (MNs) and are implicated in the pathophysiology of amyotrophic lateral sclerosis (ALS). MD1003, or high-dose Pharmaceutical grade Biotin (hdPB), may improve disability in progressive multiple sclerosis patients via augmentation of OG or MN energy levels. Here, we assessed the safety and efficacy of MD1003 in ALS patients. METHODS This single centre, randomised, double-blind, placebo-controlled trial included patients aged 25-80 years with probable or definite ALS. Patients were assigned (2:1), using a computer-generated randomisation list, to receive oral MD1003 (300 mg/day) or placebo treatment for 24 weeks. The primary outcome, safety, was analysed in all patients who received at least one dose of study drug. This study, registered with ClinicalTrials.gov, NCT03114215, has been completed. FINDINGS Between June and December 2016, 30 patients were enrolled (MD1003, n = 20; placebo, n = 10). Baseline characteristics were representative of the ALS population. MD1003 and placebo groups were not well balanced at screening, with the MD1003-treated group having a higher rate of ALSFRS-R decline prior to screening versus placebo (-6·0 IQR [-8·5, -5·0] vs. -5·0 IQR [-5·0, -3·0]) and a predominance of ALS with upper limb onset compared to placebo (35% vs. 10%). MD1003 had a favourable safety profile and was well tolerated. The occurrence of adverse events was similar in both groups (60%). Two deaths occurred in the MD1003 group versus 1 in the placebo group. ALSFRS-R median change from baseline to month 6 was not significantly different between the two groups (p = 0·49); the mean difference between groups was -1·6 (SEM=3·3). INTERPRETATION MD1003 treatment was safe and well tolerated. It was not possible to establish MD1003 efficacy in this relatively small study. Given the favourable safety profile of MD1003 and an imbalance between treatment groups favouring placebo, additional, larger studies in ALS are warranted. FUNDING MedDay Pharmaceuticals.
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Affiliation(s)
- Raul Juntas-Morales
- Clinique du motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | - Nicolas Pageot
- Clinique du motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | | | - Sébastien Alphandéry
- Clinique du motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
| | | | | | - William Camu
- Clinique du motoneurone, Explorations Neurologiques, CHU Gui de Chauliac, Montpellier, France
- Corresponding author.
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Sugawara S, Inui N, Kanehara M, Morise M, Yoshimori K, Kumagai T, Fukui T, Minato K, Iwashima A, Takeda Y, Kubota K, Saeki T, Tamura T. Multicenter, placebo-controlled, double-blind, randomized study of fosnetupitant in combination with palonosetron for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Cancer 2019; 125:4076-4083. [PMID: 31381152 PMCID: PMC6900104 DOI: 10.1002/cncr.32429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 11/26/2022]
Abstract
Background The current randomized, double‐blind, phase 2 study assessed the efficacy and safety profile of a single intravenous administration of fosnetupitant, a neurokinin 1 receptor antagonist prodrug, for the prevention of chemotherapy‐induced nausea and vomiting in Japanese patients receiving cisplatin‐based chemotherapy. Methods Patients scheduled to receive cisplatin (at a dose of ≥70 mg/m2)‐based regimens were randomly assigned to receive fosnetupitant at a dose of 81 mg or 235 mg or placebo in combination with palonosetron at a dose of 0.75 mg and dexamethasone. The primary endpoint was complete response (CR; no vomiting and no rescue medication) during the overall phase (0‐120 hours). The overall CR rate was compared between each dose of fosnetupitant and the placebo group adjusting for the stratification factors of sex and age class (age <55 years vs age ≥55 years). Safety was assessed, with special attention given to events that potentially were suggestive of infusion site reactions. Results A total of 594 patients were randomized. Of these, 194 patients, 195 patients, and 195 patients, respectively, in the placebo and fosnetupitant 81‐mg and 235‐mg dose groups were evaluable for efficacy. The overall CR rate was 54.7% for the placebo group, 63.8% for the fosnetupitant 81‐mg dose group (adjusted difference, 9.1%; 95% CI, ‐0.4% to 18.6% [P = .061]), and 76.8% for the fosnetupitant 235‐mg dose group (adjusted difference, 22.0%; 97.5% CI, 11.7% to 32.3% [P < .001]). Safety profiles were comparable between the 3 groups. The incidence of infusion site reactions related to fosnetupitant was ≤1% in each dose group. Conclusions Fosnetupitant at a dose of 235 mg provided superior prevention of chemotherapy‐induced nausea and vomiting among patients receiving cisplatin‐based chemotherapy compared with the control group, and with a satisfactory safety profile. Fosnetupitant at a dose of 235 mg combined with palonosetron and dexamethasone was demonstrated to be effective in the prevention of emesis during the first 0 to 120 hours after the administration of cisplatin. The results of the current study suggest that fosnetupitant at a dose of 235 mg also may improve the percentage of patients with no nausea in the delayed phase (24 ‐ 120 hours after cisplatin administration), which is an unmet medical need of patients with cancer who are receiving chemotherapy.
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Affiliation(s)
- Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Miyagi, Japan
| | - Naoki Inui
- Respiratory Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Masashi Kanehara
- Department of Respiratory Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masahiro Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kozo Yoshimori
- Department of Clinical Oncology, Fukujuji Hospital, Tokyo, Japan
| | - Toru Kumagai
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Akira Iwashima
- Department of Respiratory Medicine, Nagaoka Chuo General Hospital, Niigata, Japan
| | - Yuichiro Takeda
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomohide Tamura
- Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
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38
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McCarty MF, Iloki-Assanga S. Co-administration of Phycocyanobilin and/or Phase 2-Inducer Nutraceuticals for Prevention of Opiate Tolerance. Curr Pharm Des 2019; 24:2250-2254. [PMID: 30039753 DOI: 10.2174/1381612824666180723162730] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/08/2018] [Accepted: 07/17/2018] [Indexed: 11/22/2022]
Abstract
Chronic use of opiates for control of chronic pain is complicated by the development of tolerance and hyperalgesia, and hence usually entails dose escalation and diminished efficacy. Our evolving understanding of the mechanisms mediating induction of morphine tolerance may enable discovery of adjunct measures which can prevent this tolerance; this essay proposes that certain nutraceuticals may have utility in this regard. Considerable evidence now points to an obligate role for production of peroxynitrite and other oxidants in the dorsal horn in development of morphine tolerance. Various isoforms of NADPH oxidase are the chief source of the superoxide which gives rise to these oxidants. Since heme oxygenase, via its products bilirubin and carbon monoxide, functions as a physiological inhibitor of various isoforms of NADPH oxidase, phase 2-inducing nutraceuticals with blood brain-barrier permeability such as lipoic acid, an effective inducer of heme oxygenase-1, may have potential for prevention of morphine tolerance; indeed, this has been demonstrated in a mouse study. The phycocyanobilin (PhyCB) chromophore of spirulina, a structural analog of biliverdin, shares bilirubin's ability to inhibit NAPDH oxidase complexes; hence, administration of spirulina or of PhyCB-enriched spirulina extracts merits evaluation in rodent models of morphine tolerance. Uric acid quenches peroxynitrite-derived radicals, and its plasma level can be boosting via supplementation with inosine; indeed, administration of inosine has been shown to counteract development of hyperalgesia in rodents. If practical doses of these agents can be shown to prevent morphine tolerance and hyperalgesia in rodents, their use as adjuvants to clinical opiate therapy should be assessed.
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Affiliation(s)
- Mark F McCarty
- Catalytic Longevity, 811 B Nahant Ct., San Diego, CA 92109, United States
| | - Simon Iloki-Assanga
- Departamento de Ciencias Quimico Biologicas, Universidad de Sonora, Hermosillo, Mexico
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39
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Chow W, Frankel P, Ruel C, Araujo DM, Milhem M, Okuno S, Hartner L, Undevia S, Staddon A. Results of a prospective phase 2 study of pazopanib in patients with surgically unresectable or metastatic chondrosarcoma. Cancer 2019; 126:105-111. [PMID: 31509242 DOI: 10.1002/cncr.32515] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/17/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This single-arm, multicenter, phase 2 study evaluated the safety and antitumor activity of pazopanib in patients with unresectable or metastatic conventional chondrosarcoma. METHODS Eligible patients had conventional chondrosarcoma of any grade with measurable tumors that were unresectable or metastatic. Patients with mesenchymal, dedifferentiated, and extraskeletal myxoid chondrosarcoma subtypes and patients who received prior tyrosine kinase inhibitor therapy were excluded. Pazopanib at 800 mg once daily was administered for 28-day cycles. Tumor responses were evaluated by local radiology assessments every 2 cycles. The primary endpoint was the disease control rate (DCR) at week 16 (4 cycles). RESULTS Forty-seven patients were enrolled. The DCR at 16 weeks was 43% (95% confidence interval [CI], 28%-58%), which was superior to the null hypothesis rate of 30%, but the 2-sided P value (exact test) was .09 (1-sided P = .045). One patient had a partial response. The median overall survival was 17.6 months (95% CI, 11.3-35.0 months), and the median progression-free survival was 7.9 months (95% CI, 3.7-12.6 months). Grade 3 or higher adverse events were infrequent; hypertension (26%) and elevated alanine aminotransferase (9%) were most common. CONCLUSIONS This study provides evidence of positive drug activity for pazopanib in conventional chondrosarcoma.
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Affiliation(s)
- Warren Chow
- Department of Medical Oncology and Therapeutics Research, City of Hope Medical Center, Duarte, California
| | - Paul Frankel
- Division of Biostatistics, Department of Information Sciences, City of Hope Medical Center, Duarte, California
| | - Chris Ruel
- Division of Biostatistics, Department of Information Sciences, City of Hope Medical Center, Duarte, California
| | - Dejka M Araujo
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mohammed Milhem
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Scott Okuno
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Lee Hartner
- Pennsylvania Oncology Hematology Associates, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samir Undevia
- Edward Hematology Oncology Group, Edward Hospital, Naperville, Illinois
| | - Arthur Staddon
- Pennsylvania Oncology Hematology Associates, University of Pennsylvania, Philadelphia, Pennsylvania
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40
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Inoue M, Kusumoto H, Shiono H, Shintani Y, Ose N, Sakamaki Y, Okami J, Higashiyama M, Takeuchi Y. Feasibility of postoperative adjuvant chemotherapy using carboplatin plus S-1 in completely resected non-small cell lung cancer patients. J Chemother 2019; 31:343-348. [PMID: 31409216 DOI: 10.1080/1120009x.2019.1651002] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Feasibility is one of the major concerns during adjuvant chemotherapy in patients with completely resected non-small cell lung cancer. A phase II clinical trial of adjuvant chemotherapy with four courses of carboplatin (AUC 5 at day 1) and S-1 (80 mg/m2/day for 2 weeks followed by a 2-week rest) was performed to evaluate the feasibility (UMIN 9101). The primary endpoint was the completion rate and the secondary endpoints were adverse events, 2-year overall survival and disease-free rates. Thirty-five non-small cell lung cancer patients were enrolled. The adjuvant chemotherapy completion rate was 85.3% (29/34); 17/34 (50%) patients completed 4 courses without dose reduction. There were no treatment-related deaths, and Grade 3/4 adverse events included neutropenia (38.2%), leukocytopenia (14.7%), anemia (20.6%), thrombocytopenia (20.6%), anorexia (5.9%), fatigue (5.9%), and oral mucositis (2.9%). Two-year overall and disease-free survival rates were 96.3% and 53.3%, respectively. Adjuvant chemotherapy with carboplatin plus S-1 is safe and feasible.
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Affiliation(s)
- Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Hidenori Kusumoto
- General Thoracic Surgery , Nara Hospital, Kindai University School of Medicine , Osaka , Japan
| | - Hiroyuki Shiono
- General Thoracic Surgery , Nara Hospital, Kindai University School of Medicine , Osaka , Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Naoko Ose
- Department of General Thoracic Surgery , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Yasushi Sakamaki
- Department of Chest Surgery , Osaka Police Hospital , Osaka , Japan
| | - Jiro Okami
- Department of General Thoracic Surgery , Osaka International Cancer Institute , Osaka , Japan
| | - Masahiko Higashiyama
- Department of General Thoracic Surgery , Osaka International Cancer Institute , Osaka , Japan
| | - Yukiyasu Takeuchi
- Department of General Thoracic Surgery , Toneyama National Hospital , Osaka , Japan
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41
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von Seidlein L, Hanboonkunupakarn B, Jittamala P, Pongsuwan P, Chotivanich K, Tarning J, Hoglund RM, Winterberg M, Mukaka M, Peerawaranun P, Sirithiranont P, Doran Z, Ockenhouse CF, Ivinson K, Lee C, Birkett AJ, Kaslow DC, Singhasivanon P, Day NPJ, Dondorp AM, White NJ, Pukrittayakamee S. Combining antimalarial drugs and vaccine for malaria elimination campaigns: a randomized safety and immunogenicity trial of RTS,S/AS01 administered with dihydroartemisinin, piperaquine, and primaquine in healthy Thai adult volunteers. Hum Vaccin Immunother 2019; 16:33-41. [PMID: 31306084 PMCID: PMC7012096 DOI: 10.1080/21645515.2019.1643675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/06/2023] Open
Abstract
Introduction: RTS,S/AS01 is currently the most advanced malaria vaccine but provides incomplete, short-term protection. It was developed for use within the expanded program on immunizations (EPI) for African children. Another use could be adding mass RTS,S/AS01 vaccination to the integrated malaria elimination strategy in the Greater Mekong Subregion (GMS), where multidrug-resistant P.falciparum strains have emerged and spread. Prior to evaluating RTS,S/AS01 in large-scale trials we assessed whether the vaccine, administered with and without antimalarial drugs, is safe and immunogenic in Asian populations. Methods: An open-label, randomized, controlled phase 2 trial was conducted in healthy, adult Thai volunteers. Seven vaccine regimens with and without antimalarial drugs (dihydroartemisinin-piperaquine plus a single low dose primaquine) were assessed. Antibody titres against the PfCSP full-length (NANP) 6, PfCSP anti-C–term, PfCSP full-length (N + C-Terminal) were measured by standard enzyme-linked immunosorbent assays. Liquid chromatography was used to measure piperaquine, primaquine and carboxy-primaquine concentrations. Results: 193 volunteers were enrolled and 186 study participants completed the 6 months follow-up period. One month after the last vaccination all study participants had seroconverted to the PfCSP (NANP)6, and the PfCSP Full Length (N + C-Terminal). More than 90% had seroconverted to the Pfanti-C-Term CSP. There was no indication that drug concentrations were influenced by vaccine regimens or the antibody levels by the drug regimens. Adverse events were similarly distributed between the seven treatment groups. No serious adverse events attributable to the study interventions were detected. Conclusion: This study found that RTS,S/AS01 with and without dihydroartemisinin-piperaquine plus a single low dose primaquine was safe and immunogenic in a healthy, adult Asian population.
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Affiliation(s)
- Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Borimas Hanboonkunupakarn
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Podjanee Jittamala
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pongphaya Pongsuwan
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kesinee Chotivanich
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Richard M Hoglund
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Markus Winterberg
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Pimnara Peerawaranun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pasathorn Sirithiranont
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Zoe Doran
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Cynthia Lee
- PATH's Malaria Vaccine Initiative, Seattle, WA, USA
| | | | | | | | - Nicholas P J Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sasithon Pukrittayakamee
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,The Royal Society of Thailand, Dusit, Bangkok, Thailand
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French JA, Wechsler R, Gelfand MA, Pollard JR, Vazquez B, Friedman D, Gong LH, Kamemoto E, Isojarvi J, Cassella JV. Inhaled alprazolam rapidly suppresses epileptic activity in photosensitive participants. Epilepsia 2019; 60:1602-1609. [PMID: 31268555 DOI: 10.1111/epi.16279] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Treatment options for seizure clusters are limited; the need for easy-to-administer treatments remains. The Staccato system delivers drug deep into the lung via inhalation. In this phase 2a study, we investigated the ability of three different doses of Staccato alprazolam to suppress the electroencephalographic (EEG) photoparoxysmal response (PPR) compared with placebo in participants with photosensitive seizures. METHODS Adults (18-60 years) with a diagnosis and history of PPR on EEG with or without an epilepsy diagnosis were eligible to participate. Participants received Staccato alprazolam 0.5, 1.0, and 2.0 mg, and Staccato placebo (twice) in random order. Intermittent photic stimulation and clinical assessments were performed at one predose and seven postdose time points. The primary endpoint of the study was the change in standardized photosensitivity range (SPR) in participants receiving each dose of Staccato alprazolam. RESULTS Fifteen participants with a prior epilepsy diagnosis were screened; five were enrolled, randomized, and completed the study. All participants were white females with a mean (SD) age of 27.2 (6.8) years. All doses of Staccato alprazolam reduced the SPR at 2 minutes; the effect was sustained through 4 hours for the 0.5-mg dose and 6 hours for the 1.0- and 2.0-mg doses. The magnitude and duration of sedation and sleepiness were dose-related. Four participants (80%) experienced ≥1 adverse event (AE); none was severe or serious. Cough, diarrhea, dysgeusia, oral dysesthesia, sedation, and somnolence were experienced by two participants (40%) each. SIGNIFICANCE This proof-of-concept study demonstrated that Staccato alprazolam 0.5, 1.0, and 2.0 mg rapidly suppressed epileptiform activity in photosensitive participants with epilepsy. The AE profile of Staccato alprazolam was similar to what has been reported for alprazolam for other indications. The results support further development of Staccato alprazolam as a rescue medication for the acute treatment of seizures.
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Affiliation(s)
- Jacqueline A French
- Department of Neurology, New York University School of Medicine, New York, New York
| | | | - Michael A Gelfand
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John R Pollard
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Blanca Vazquez
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Daniel Friedman
- Department of Neurology, New York University School of Medicine, New York, New York
| | - Lily H Gong
- Alexza Pharmaceuticals, Mountain View, California
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43
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Sherman EJ, Dunn LA, Schöder H, Ho AL, Baxi SS, Ghossein RA, Haque SS, Sima C, Tuttle RM, Pfister DG. Phase 2 study of vascular endothelial growth factor trap for the treatment of metastatic thyroid cancer. Cancer 2019; 125:2984-2990. [PMID: 31174237 DOI: 10.1002/cncr.32046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several multitargeted tyrosine kinase inhibitors (TKIs) have demonstrated activity in patients with thyroid cancer that is refractory to radioactive iodine (RAI). The antitumor effect is attributed at least in part to the ability of these TKIs to inhibit angiogenesis in these vascular tumors. Vascular endothelial growth factor (VEGF) Trap (VT) is a recombinantly produced fusion protein consisting solely of human sequences for VEGF receptors 1 and 2 extracellular domains and human immunoglobulin 1. Evaluating VT in patients with thyroid cancer is reasonable considering the activity observed with TKIs targeting VEGF. METHODS The current study was a single-institution, phase 2, Simon 2-stage design (21 to >41 patients) study based on the objective response rate and/or 6-month progression-free survival as the primary endpoints. Eligible patients were required to have progressive, RAI-refractory and/or [18 F]fludeoxyglucose-avid, recurrent and/or metastatic, nonmedullary, nonanaplastic thyroid cancer; disease that was measurable using Response Evaluation Criteria In Solid Tumors (RECIST) criteria; and adequate organ and bone marrow function. VT at a dose of 4 mg/kg intravenously was administered every 14 days. RESULTS A total of 40 patients were included in the analysis. Of these patients, 24 had papillary thyroid cancer, 2 had follicular thyroid cancer, and 11 had Hurthle cell thyroid cancer. The final 3 tumors were classified as poorly differentiated. There were no complete and/or partial responses noted; 34 patients achieved stable disease and 6 patients experienced disease progression as their best response. Of the 34 patients with stable disease, 16 remained on the study for >6 months and 6 patients remained on the study for >12 months. The median duration on treatment was 4.1 months (range, 0.6-30.8 months). CONCLUSIONS Unlike TKIs, which have shown responses in this setting, to the authors' knowledge there have been no responses observed with the use of single-agent VT to date. It does not appear to be a promising drug for the treatment of patients with thyroid cancer.
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Affiliation(s)
- Eric J Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Lara A Dunn
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Shrujal S Baxi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sofia S Haque
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cami Sima
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medicine, New York, New York
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Kaira K, Imai H, Souma R, Sakurai R, Miura Y, Sunaga N, Kasahara N, Tsukagoshi Y, Koga Y, Kitahara S, Kotake M, Minato K, Naruse I, Fukushima Y, Hisada T, Ishizuka T. An Exploratory Randomized Phase II Trial Comparing CDDP Plus S-1 With Bevacizumab and CDDP Plus Pemetrexed With Bevacizumab Against Patients With Advanced Non-squamous Non-small Cell Lung Cancer. Anticancer Res 2019; 39:2483-2491. [PMID: 31092443 DOI: 10.21873/anticanres.13368] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM It remains unclear which chemotherapeutic regimens are better for the addition of bevacizumab. We conducted an exploratory randomized phase II trial comparing first-line S-1 plus cisplatin with bevacizumab and pemetrexed plus cisplatin with bevacizumab in patients with advanced non-squamous non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Chemotherapy-naïve patients received S-1 (80 mg/m2) from day 1 to day 14 plus cisplatin (80 mg/m2) on day 1 with bevacizumab (15 mg/kg) on day 1, followed by maintenance with bevacizumab plus S-1 (SCB) on day 1 every 3 weeks and pemetrexed (500 mg/m2) on day 1 plus cisplatin (75 mg/m2) on day 1 with bevacizumab (15 mg/kg) on day 1 followed by maintenance bevacizumab plus pemetrexed (PCB) on day 1 every 3 weeks. The expression of thymidylate synthase (TS) was analyzed using immunohistochemistry. RESULTS Forty-eight patients were enrolled in this study, and eligible patients were randomly assigned at 1:1 ratio to receive SCB (n=24) or PCB (n=24). The median number of chemotherapy and maintenance therapy for SCB and PCB was 4 (range, 1-6 cycles) and 4 (range, 2-6 cycles), and 5 (range, 0-39 cycles) and 5 (range, 0-28 cycles), respectively. The overall response rate (ORR) for PCB and SCB were 54.2% and 83.3%, respectively (p=0.06). The median progression-free survival (PFS) and overall survival (OS) for PCB and SCB were 406 and 351 days, (p=0.96), and 678 and 1190 days, respectively (p=0.23). The mild adverse events were observed in both regimens. TS expression was more predictive of the chemotherapeutic response in SCB compared to PCB, but not for PFS. CONCLUSION The combination regimen of SCB was identified as having a similar activity and tolerability to that of PCB in patients with advanced non-squamous NSCLC.
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Affiliation(s)
- Kyoichi Kaira
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan .,Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hisao Imai
- Division of Thoracic Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Ryousuke Souma
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Saitama Medical Center, Saitama, Japan
| | - Reiko Sakurai
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yosuke Miura
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan.,Division of Thoracic Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Noriaki Sunaga
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Norimitsu Kasahara
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yusuke Tsukagoshi
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yasuhiko Koga
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Shinsuke Kitahara
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Mie Kotake
- Division of Thoracic Oncology, Gunma Prefectural Cancer Center, Gunma, Japan.,Department of Respiratory Medicine, Shibukawa Medical Center, Gunma, Japan
| | - Koichi Minato
- Division of Thoracic Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Ichiro Naruse
- Department of Respiratory Medicine, Hidaka Hospital, Gunma, Japan
| | - Yasutsugu Fukushima
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Saitama Medical Center, Saitama, Japan
| | - Takeshi Hisada
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tamotsu Ishizuka
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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45
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Becnel MR, Nastoupil LJ, Samaniego F, Davis RE, You MJ, Green M, Hagemeister FB, Fanale MA, Fayad LE, Westin JR, Wang M, Oki Y, Forbes SG, Feng L, Neelapu SS, Fowler NH. Lenalidomide plus rituximab (R 2 ) in previously untreated marginal zone lymphoma: subgroup analysis and long-term follow-up of an open-label phase 2 trial. Br J Haematol 2019; 185:874-882. [PMID: 30919940 PMCID: PMC6619290 DOI: 10.1111/bjh.15843] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/18/2019] [Indexed: 02/06/2023]
Abstract
Lack of consensus for first‐line marginal zone lymphoma (MZL) treatment and toxicities associated with currently available systemic therapies have inspired evaluation of immunotherapeutic agents yielding robust outcomes with improved tolerability. We previously reported durable efficacy with first‐line lenalidomide and rituximab (R2) in follicular lymphoma, MZL and small lymphocytic lymphoma with a subsequent long‐term follow‐up shown here in MZL patients. This phase 2 investigator‐initiated study included previously untreated, stage III/IV MZL patients treated with lenalidomide 20 mg/day on days 1–21 and rituximab 375 mg/m2 on day 1 of each 28‐day cycle, continuing in responders for ≥6–12 cycles. The primary endpoint was overall response rate (ORR); secondary endpoints were complete and partial response (CR, PR), safety, and progression‐free survival (PFS). The ORR was 93% with 70% attaining CR/CR unconfirmed. At median follow‐up of 75·1 months, median PFS was 59·8 months and 5‐year OS was 96%. Most non‐haematological adverse events (AE) were grade 1/2. Grade 3 haematological AEs were neutropenia (33%) and leucopenia (7%), and grade 4 were leucopenia (3%) and thrombocytopenia (3%). Two patients died of secondary malignancies; no treatment‐related fatalities occurred. With extended follow‐up, outcomes for MZL patients receiving R2 were robust with no unexpected late or delayed toxicities.
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Affiliation(s)
- Melody R Becnel
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Loretta J Nastoupil
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Davis
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M J You
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Green
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fredrick B Hagemeister
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle A Fanale
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Seattle Genetics Inc., Bothell, WA, USA
| | - Luis E Fayad
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason R Westin
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Wang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yasuhiro Oki
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sheryl G Forbes
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Feng
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sattva S Neelapu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan H Fowler
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ott PA, Pavlick AC, Johnson DB, Hart LL, Infante JR, Luke JJ, Lutzky J, Rothschild NE, Spitler LE, Cowey CL, Alizadeh AR, Salama AK, He Y, Hawthorne TR, Bagley RG, Zhang J, Turner CD, Hamid O. A phase 2 study of glembatumumab vedotin, an antibody-drug conjugate targeting glycoprotein NMB, in patients with advanced melanoma. Cancer 2019; 125:1113-1123. [PMID: 30690710 DOI: 10.1002/cncr.31892] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/23/2018] [Accepted: 10/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Glembatumumab vedotin is an antibody-drug conjugate that produced preliminary clinical activity against advanced melanoma in a phase 1 dose-escalation trial. The objective of the current study was to investigate further the antitumor activity of glembatumumab vedotin at the recommended phase 2 dose in heavily pretreated patients with melanoma. METHODS This single-arm, phase 2 study enrolled patients with stage IV melanoma who were refractory to checkpoint inhibition and to B-raf proto-oncogene, serine/threonine kinase (BRAF)/mitogen-activated protein kinase kinase (MEK) inhibition (in the presence of a BRAF valine mutation at codon 600). Patients received 1.9 mg/kg glembatumumab vedotin intravenously every 3 weeks until they developed disease progression or intolerance. The primary endpoint was objective response rate (ORR), which was determined according to Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary endpoints included progression-free survival (PFS), duration of response, overall survival (OS), safety, and clinical efficacy versus tumor glycoprotein NMB (gpNMB) expression. Tumor expression of gpNMB was assessed using immunohistochemistry. RESULTS In total, 62 patients received treatment. The ORR was 11% and the median response duration was 6.0 months (95% confidence interval [CI], 4.1 months to not reached). The median PFS was 4.4 months (95% CI, 2.6-5.5 months), and the median OS was 9.0 months (95% CI, 6.1-11.7 months). For patients who developed rash during the first cycle versus those who did not, the ORR was 21% versus 7%, respectively, and there was an overall improvement in PFS (hazard ratio, 0.43; P = .013) and OS (hazard ratio, 0.43; P = .017). The most frequent adverse events were alopecia, neuropathy, rash, fatigue, and neutropenia. With one exception, all evaluable tumors were positive for gpNMB, and 46 of 59 tumors (76%) had 100% gpNMB-positive epithelial cells. CONCLUSIONS Glembatumumab vedotin had modest activity and an acceptable safety profile in patients with advanced melanoma who were refractory to checkpoint inhibitors and MEK/BRAF inhibition. Treatment-related rash may be associated with response.
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Affiliation(s)
- Patrick A Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna C Pavlick
- Department of Medical Oncology, New York University School of Medicine, New York, New York
| | - Douglas B Johnson
- Department of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Lowell L Hart
- Florida Cancer Specialists and Research Institute, Fort Myers, Florida
| | | | - Jason J Luke
- Department of Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois
| | - Jose Lutzky
- Mount Sinai Comprehensive Cancer Center, Miami Beach, Florida
| | | | | | - C Lance Cowey
- Northern California Melanoma Center, Baylor University Medical Center, Dallas, Texas
| | | | - April K Salama
- Department of Medical Oncology, Duke University, Durham, North Carolina
| | - Yi He
- Celldex Therapeutics, Inc, Hampton, New Jersey
| | | | | | | | | | - Omid Hamid
- The Angeles Clinic and Research Institute, Los Angeles, California
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Guda A, Feldman SR, Strowd L. Investigational drugs in phase II clinical trials for moderate to severe plaque psoriasis - potential new treatments on the horizon. Expert Opin Investig Drugs 2018; 27:931-939. [PMID: 30293437 DOI: 10.1080/13543784.2018.1533550] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Psoriasis is a common immune disorder for which there are many FDA-approved therapies. Older oral drugs had limited efficacy and considerable side effects. Biologics have been a major advance but require self-administered injections, and many patients prefer oral options. Because many patients fear needles, oral drugs are a welcome option. This review provides an update on oral drugs in Phase II development for psoriasis. AREAS COVERED A literature review was performed to identify these drugs by using search terms such as 'psoriasis', 'agents', 'drugs', and 'phase 2 development'. Baricitinib and KDO 25 are the oral drugs that appear to hold the most promise due to the balance they maintain between efficacy and adverse effects. If a RORγt inhibitor can be identified that has no hepatotoxicity, then that may be the most promising new oral treatment. EXPERT OPINION Several new oral psoriasis medications are currently being investigated. One major challenge remains medication cost and insurance coverage. Phase III studies are needed to determine efficacy and safety in large cohorts of psoriasis patients. An increase in the number of approved oral medications for psoriasis would mean more choice for psoriasis patients.
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Affiliation(s)
- Anisha Guda
- a UT Health San Antonio Long School of Medicine , San Antonio , TX , USA
| | - Steven R Feldman
- b Departments of Dermatology, Pathology and Department of Social Sciences & Health Policy Wake Forest School of Medicine , Center for Dermatology Research , Winston-Salem
| | - Lindsay Strowd
- c Center for Dermatology Research, Department of Dermatology , Wake Forest School of Medicine , Winston-Salem , North Carolina , USA
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Bauman JE, Duvvuri U, Thomas S, Gooding WE, Clump DA, Karlovits B, Wehbe A, Miller FR, Kim S, Sen M, Heron DE, Grandis JR, Argiris A. Phase 1 study of EGFR-antisense DNA, cetuximab, and radiotherapy in head and neck cancer with preclinical correlatives. Cancer 2018; 124:3881-3889. [PMID: 30291796 DOI: 10.1002/cncr.31651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/06/2018] [Accepted: 05/04/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cetuximab combined with radiation therapy (RT) is an evidence-based treatment for locally advanced head and neck squamous cell carcinoma (HNSCC); however, locoregional failure remains the primary cause of cancer-related death in this disease. Intratumoral injection of epidermal growth factor receptor (EGFR)-antisense plasmid DNA (EGFR-AS) is safe and has been associated with promising lesional responses in patients who have recurrent/metastatic HNSCC. For the current study, the authors investigated the antitumor effects of cetuximab and EGFR-AS in preclinical HNSCC models and reported their phase 1 experience adding intratumoral EGFR-AS to cetuximab RT. METHODS Antitumor mechanisms were investigated in cell line and xenograft models. Phase 1 trial eligibility required stage IVA through IVC HNSCC and a measurable lesion accessible for repeat injections. Patients received standard cetuximab was for 9 weeks. EGFR-AS was injected weekly until they achieved a lesional complete response. RT was delivered by conventional fractionation for 7 weeks, starting at week 3. Research biopsies were obtained at baseline and week 2. RESULTS When added to cetuximab, EGFR-AS decreased cell viability and xenograft growth compared with EGFR-sense control, partially mediated by reduced EGFR expression. Six patients were enrolled in the phase 1 cohort. No grade 2 or greater EGFR-AS-related adverse events occurred. The best lesional response was a complete response (4 patients), and 1 patient each had a partial response and disease progression. EGFR expression decreased in 4 patients who had available paired specimens. CONCLUSIONS In preclinical models, dual EGFR inhibition with cetuximab and EGFR-AS enhanced antitumor effects. In a phase 1 cohort, intratumoral EGFR-AS injections, cetuximab, and RT were well tolerated. A phase 2 trial is needed to conduct an extended evaluation of safety and to establish efficacy.
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Affiliation(s)
- Julie E Bauman
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sufi Thomas
- Departments of Otolaryngology and Cancer Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William E Gooding
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - David A Clump
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian Karlovits
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ahmad Wehbe
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Frank R Miller
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Seungwon Kim
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Malabika Sen
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer R Grandis
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Athanassios Argiris
- Department of Medical Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Suder E, Furuyama W, Feldmann H, Marzi A, de Wit E. The vesicular stomatitis virus-based Ebola virus vaccine: From concept to clinical trials. Hum Vaccin Immunother 2018; 14:2107-2113. [PMID: 29757706 PMCID: PMC6183239 DOI: 10.1080/21645515.2018.1473698] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/30/2018] [Indexed: 10/25/2022] Open
Abstract
The devastating Ebola virus (EBOV) epidemic in West Africa in 2013-2016 accelerated the progress of several vaccines and antivirals through clinical trials, including the replication-competent vesicular stomatitis virus-based vaccine expressing the EBOV glycoprotein (VSV-EBOV). Extensive preclinical testing in animal models demonstrated the prophylactic and post-exposure efficacy of this vaccine, identified the mechanism of protection, and suggested it was safe for human use. Based on these data, VSV-EBOV was extensively tested in phase 1-3 clinical trials in North America, Europe and Africa. Although some side effects of vaccination were observed, these clinical trials showed that the VSV-EBOV was safe and immunogenic in humans. Moreover, the data supported the use of VSV-EBOV as an emergency vaccine in individuals at risk for Ebola virus disease. In this review, we summarize the results of the extensive preclinical and clinical testing of the VSV-EBOV vaccine.
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MESH Headings
- Animals
- Clinical Trials as Topic
- Drug Carriers
- Drug Evaluation, Preclinical
- Drug-Related Side Effects and Adverse Reactions/epidemiology
- Drug-Related Side Effects and Adverse Reactions/pathology
- Ebola Vaccines/administration & dosage
- Ebola Vaccines/genetics
- Ebola Vaccines/immunology
- Ebola Vaccines/isolation & purification
- Hemorrhagic Fever, Ebola/prevention & control
- Humans
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/genetics
- Vaccines, Attenuated/immunology
- Vaccines, Attenuated/isolation & purification
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/genetics
- Vaccines, Synthetic/immunology
- Vaccines, Synthetic/isolation & purification
- Vesiculovirus/genetics
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Affiliation(s)
- Ellen Suder
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, MT, USA
| | - Wakako Furuyama
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, MT, USA
| | - Heinz Feldmann
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, MT, USA
| | - Andrea Marzi
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, MT, USA
| | - Emmie de Wit
- Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, MT, USA
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50
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Chera BS, Amdur RJ, Tepper JE, Tan X, Weiss J, Grilley-Olson JE, Hayes DN, Zanation A, Hackman TG, Patel S, Sheets N, Weissler MC, Mendenhall WM. Mature results of a prospective study of deintensified chemoradiotherapy for low-risk human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cancer 2018; 124:2347-2354. [PMID: 29579339 DOI: 10.1002/cncr.31338] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of the current study was to determine quality of life and tumor control from a prospective phase 2 clinical trial evaluating deintensified chemoradiotherapy for favorable risk, human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma. METHODS Patients with T0-T3, N0-N2c, M0, p16-positive disease and a minimal smoking history were treated with 60 grays of intensity-modulated radiotherapy with concurrent weekly intravenous cisplatin (30 mg/m2 ). The primary study endpoint was the pathologic complete response rate based on biopsy of the primary site and dissection of pretreatment positive lymph node regions. The pathologic complete response rate as previously reported was 86%. Herein, the authors report secondary endpoint measures of local control, regional control, cause-specific survival, distant metastasis-free survival, and overall survival, and patient-reported outcomes (European Organization for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire [EORTC QLQ-C30] and the Patient-Reported Outcomes version of Common Terminology Criteria for Adverse Events [PRO-CTCAE]). RESULTS A total of 44 patients enrolled with a median follow-up of 36 months (88% with ≥2 years). The 3-year local control, regional control, cause-specific survival, distant metastasis-free survival, and overall survival rates were 100%, 100%, 100%, 100%, and 95%, respectively. The mean before and 3-year after EORTC QOL scores were: global: 80 of 78; swallowing: 11 of 11; dry mouth: 16 of 41; and sticky saliva: 6 of 29. The mean before and 3-year after PRO-CTCAE scores were: swallowing: 0.4 of 0.7; and dry mouth: 0.4 of 1.4. Approximately 39% of patients required a feeding tube (median duration, 15 weeks; none were permanent). There were no ≥grade 3 late adverse events reported. CONCLUSIONS For patients with favorable-risk human papillomavirus-associated oropharyngeal squamous cell carcinoma, a substantially decreased intensity of therapy with 60 grays of intensity-modulated radiotherapy and weekly low-dose cisplatin produced better preservation of quality of life compared with standard therapies while maintaining excellent 3-year tumor control and survival. Cancer 2018;124:2347-54. © 2018 American Cancer Society.
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Affiliation(s)
- Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida.,UF Health Shands Cancer Center, University of Florida Hospitals, Gainesville, Florida
| | - Joel E Tepper
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Xianming Tan
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Jared Weiss
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina.,Division of Hematology Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Juneko E Grilley-Olson
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina.,Division of Hematology Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - D Neil Hayes
- Division of Hematology Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Adam Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Samip Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida.,UF Health Shands Cancer Center, University of Florida Hospitals, Gainesville, Florida
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