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Song Y, Liu Y, Li ZM, Li L, Su H, Jin Z, Zuo X, Wu J, Zhou H, Li K, He C, Zhou J, Qi J, Hao S, Cai Z, Li Y, Wang W, Zhang X, Zou J, Zhu J. SHR2554, an EZH2 inhibitor, in relapsed or refractory mature lymphoid neoplasms: a first-in-human, dose-escalation, dose-expansion, and clinical expansion phase 1 trial. Lancet Haematol 2022; 9:e493-e503. [PMID: 35772429 DOI: 10.1016/s2352-3026(22)00134-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Dysregulation of EZH2 has a crucial role in lymphomagenesis. We did a first-in-human study to assess the safety, pharmacokinetics, pharmacodynamics, and preliminary clinical activity of SHR2554, an oral EZH2 inhibitor, in patients with relapsed or refractory mature lymphoid neoplasms, including B-cell lymphomas, T-cell lymphomas, and classical Hodgkin lymphoma. METHODS This was a multicentre, dose-escalation, dose-expansion, and clinical expansion phase 1 study done at 13 hospitals in China. Eligible patients had histologically or cytologically confirmed mature lymphoid neoplasms that had relapsed or were refractory to standard systemic therapies or had no standard-of-care. The study included a dose-escalation phase, at doses of SHR2554 from 50 mg to 800 mg twice daily; a dose-expansion phase, at two selected doses; and a subsequent clinical expansion phase at the recommended phase 2 dose in selected tumours. Primary endpoints were the safety, maximum tolerated dose, and recommended phase 2 dose. Objective response rate was a secondary endpoint. Safety and activity were assessed in all patients who received at least one dose of SHR2554 and had at least one post-baseline evaluation. This study is registered with ClinicalTrials.gov, NCT03603951, and follow-up is ongoing. FINDINGS Between Aug 14, 2018, and July 13, 2021, 113 patients received SHR2554. At data cutoff (Sept 10, 2021), the median follow-up duration was 7·0 months (IQR 3·7-12·0). 71 (63%) patients were men and 42 (37%) were women, 110 (97%) were of Han ethnicity and 3 (3%) of other ethnicities, and 53 (47%) had received three or more lines of previous anticancer therapies. Dose-limiting toxicities occurred in two (67%) of three patients who received 400 mg SHR2554 twice daily and one (17%) of six patients who received 350 mg SHR2554 twice daily. The maximum tolerated dose and recommended phase 2 dose was determined to be 350 mg twice daily. The most common grade 3 or 4 treatment-related adverse events in all 113 patients were decreased platelet count (20 [18%]), decreased neutrophil count (ten [9%]), decreased white blood cell count (nine [8%]), and anaemia (seven [6%]). 18 (16%) patients had serious treatment-related adverse events. Two patients (2%) died due to treatment-related adverse events: one (1%) due to skin infection and toxic epidermal necrolysis and one (1%) due to respiratory failure. 107 (95%) of the 113 enrolled patients had post-baseline assessments for tumour response and were included in the activity analysis. 46 (43%; 95% CI 33-53) of these 107 patients had an overall response. INTERPRETATION SHR2554 showed an acceptable safety profile and promising antitumour activity in patients with relapsed or refractory lymphomas, providing evidence for future investigations. FUNDING Jiangsu Hengrui Pharmaceuticals. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yuqin Song
- Key Laboratory of Carcinogenesis and Transitional Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yanyan Liu
- Lymphatic Comprehensive Internal Medicine Ward, Henan Cancer Hospital, Zhengzhou, China
| | - Zhi-Ming Li
- Medical Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Lanfang Li
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hang Su
- The Fifth Medical Centre of the People's Liberation Army General Hospital, Beijing, China
| | - Zhengming Jin
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuelan Zuo
- Department of Hematopathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianyuan Wu
- Clinical Trial Centre, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Zhou
- Department of Lymphoma & Hematology (Children's Tumour Centre), Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Kunyan Li
- Early Clinical Trial Centre, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Chuan He
- Department of Hematopathology, West China Hospital Sichuan University, Chengdu, China
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Junyuan Qi
- Good Clinical Practice Ward, Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Siguo Hao
- Department of Hematology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen Cai
- Bone Marrow Transplantation Centre, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yijing Li
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | - Weiwei Wang
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | - Xiaojing Zhang
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | - Jianjun Zou
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Transitional Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, China.
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Feng X, Hua Y, Zou J, Jia S, Ji J, Xing Y, Zhou J, Liao J. Intelligible Models for HealthCare: Predicting the Probability of 6-Month Unfavorable Outcome in Patients with Ischemic Stroke. Neuroinformatics 2022; 20:575-585. [PMID: 34435319 DOI: 10.1007/s12021-021-09535-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 12/31/2022]
Abstract
Early prediction of unfavorable outcome after ischemic stroke is significant for clinical management. Machine learning as a novel computational modeling technique could help clinicians to address the challenge. We aim to investigate the applicability of machine learning models for individualized prediction in ischemic stroke patients and demonstrate the utility of various model-agnostic explanation techniques for machine learning predictions. A total of 499 consecutive patients with Unfavorable [modified Rankin Scale (mRS) score 3-6, n = 140] and favorable (mRS score 0-2, n = 359) outcome after 6-month from ischemic stroke were enrolled in this study. Four machine learning models, including Random Forest [RF], eXtreme Gradient Boosting [XGBoost], Adaptive Boosting [Adaboost] and Support Vector Machine [SVM] were performed with the area-under-the-curve (AUC): (90.20 ± 0.22)%, (86.91 ± 1.05)%, (86.49 ± 2.35)%, (81.89 ± 2.40)%, respectively. Three global interpretability techniques (Feature Importance shows the contribution of selected features, Partial Dependence Plot aims to visualize the average effect of a feature on the predicted probability of unfavorable outcome, Feature Interaction detects the change in the prediction that occurs by varying the features after considering the individual feature effects) and one local interpretability technique (Shapley Value indicates the probability of unfavorable outcome of different instances) have been applied to present the interpretability techniques via visualization. Thereby, the current study is important for better understanding intelligible healthcare analytics via explanations for the prediction of local and global levels, and potentially reduction of the mortality of patients with ischemic stroke by assisting clinicians in the decision-making process.
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Affiliation(s)
- Xiaobing Feng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yingrong Hua
- School of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shuopeng Jia
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jiatong Ji
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yan Xing
- School of Science, China Pharmaceutical University, #639 Longmian Avenue, Jiangning District, Nanjing, 211198, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing, China
| | - Jun Liao
- School of Science, China Pharmaceutical University, #639 Longmian Avenue, Jiangning District, Nanjing, 211198, China.
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Song Y, Liu Y, Li ZM, Li L, Su H, Jin Z, Zuo X, Wu J, Zhou H, Li K, He C, Zhou J, Qi J, Hao S, Cai Z, Li Y, Wang W, Zhang X, Zou J, Zhu J. SHR2554, an enhancer of zeste homolog 2 (EZH2) inhibitor, in relapsed or refractory (r/r) mature lymphoid neoplasms: A first-in-human phase 1 study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
7525 Background: Dysregulation of histone methyltransferase EZH2 plays critical roles in lymphomagenesis. Emerging evidence shows that EZH2 also contributes to tumor immune evasion. SHR2554 is an oral, small-molecule inhibitor exhibiting potent selectivity for EZH2. We initiated a first-in-human study to assess SHR2554 across a broad spectrum of lymphoid neoplasms that had relapsed or was refractory to standard systemic therapies, including B-cell lymphomas, T-cell lymphomas, and classical Hodgkin lymphoma (cHL). Methods: This multicenter, phase 1 study was composed of 3 parts: dose escalation phase according to mTPI-2 design, dose expansion phase, and clinical expansion phase in selected tumor subtypes. Dose was escalated at 50, 100, 200, and 400 mg BID, and then de-escalated at 300 and 350 mg based on the observed toxicities. Two dose levels (300 and 350 mg) were expanded. Subsequently, follicular lymphoma (FL), peripheral T-cell lymphoma (PTCL), and cHL were selected for clinical expansion at RP2D. Primary endpoints were to assess the safety and determine the MTD and RP2D. Key secondary endpoint included clinical activity at RP2D in different subtypes. Results: As of Sep 10, 2021, 113 heavily pretreated pts were enrolled, with 53 (46.9%) having received ≥3 lines of prior systemic therapies. In dose escalation phase, DLTs occurred in 2 of 3 pts at 400 mg and 1 of 6 pts at 350 mg; thus, 350 mg BID was the MTD. Combined with the safety, tolerability, PK/PD, and preliminary efficacy findings observed in dose escalation and expansion phases, RP2D was determined to be 350 mg BID. As of cutoff date, 41 FL, 22 PTCL, and 21 cHL pts who received SHR2445 at 350 mg BID completed at least one post-baseline efficacy assessment. ORR in FL was 58.5% (95% CI 42.1-73.7); majority of responses (66.7%) were still ongoing, and the estimated median DoR was 9.3 mos (95% CI 5.6-NR). EZH2mut FL pts showed a slightly higher ORR than EZH2WT FL pts (62.5% vs 55.2%). EZH2 mutations were not detected in pts with PTCL or cHL. ORR in PTCL was 63.6% (95% CI 40.7-82.8); majority of responses (71.4%) were still ongoing, and the estimated median DoR was 7.4 mos (95% CI 2.9-NR). All cHL pts had received prior chemotherapy and anti-PD-1/PD-L1 antibodies. Shrinkage in target lesions was shown in 76.2% of cHL pts; ORR was 19.0% (95% CI 5.4-41.9); majority of responses (75.0%) were still ongoing, and the median DoR had not been reached yet. Grade ≥3 treatment-related AEs occurred in 38 of the 113 pts (33.6%), with the most common being decreased platelet count (17.7%), decreased neutrophil count (8.8%), decreased white blood cell count (8.0%), and anemia (6.2%). Conclusions: SHR2554 showed a manageable safety profile and promising anti-tumor activity in pts with r/r lymphomas, supporting further explorations in FL, PTCL, and cHL. Clinical trial information: NCT03603951.
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Affiliation(s)
- Yuqin Song
- Key Laboratory of Carcinogenesis and Transitional Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yanyan Liu
- Lymphatic Comprehensive Internal Medicine Ward, Henan Cancer Hospital, Zhengzhou, China
| | - Zhi-Ming Li
- Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lanfang Li
- Department of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hang Su
- The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Zhengming Jin
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuelan Zuo
- Department of Hematopathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianyuan Wu
- Clinical Trial Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Zhou
- Hunan Cancer Hospital, Changsha, China
| | - Kunyan Li
- Early Clinical Trial Center, Hunan Cancer Hospital / The Affiliated Cancer Hospital of Xiangya School of Medicine Central South University, Changsha, China
| | - Chuan He
- Department of Hematopathology, West China Hospital Sichuan University, Chengdu, China
| | - Jianfeng Zhou
- Department of Hematology, Tongji Hospital Tongji Medical College of Hust, Wuhan, China
| | - Junyuan Qi
- GCP ward, Blood Diseases Hospital, Chinese Academy of Medical Sciences, Tianjin, China
| | - Siguo Hao
- Department of Hematology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University school of Medicine, Shanghai, China
| | - Zhen Cai
- Bone Marrow Transplantation Center, The first affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yijing Li
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Weiwei Wang
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Xiaojing Zhang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Jianjun Zou
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jun Zhu
- Peking University Cancer Hospital & Institute, Beijing, China
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Feng S, Mu H, Hou R, Liu Y, Zou J, Zhao Z, Zhu Y. Prognostic value of myosteatosis in patients with lung cancer: a systematic review and meta-analysis. Int J Clin Oncol 2022; 27:1127-1138. [PMID: 35604501 DOI: 10.1007/s10147-022-02181-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/24/2022] [Indexed: 11/05/2022]
Abstract
The prognostic value of myosteatosis has been widely investigated in lung cancer, yet conclusions remain controversial. The purpose of this meta-analysis was to illuminate this issue. Medline, Embase, Cochrane Library and Web of Science Core Collection online databases were systematically searched from inception to 24 September 2021. Newcastle-Ottawa Scale tool was applied to evaluate the quality of included studies. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) were used to examine prognostic value of myosteatosis. Subgroup analysis and sensitivity analysis were conducted to assess heterogeneity and stability of results. A total of 484 articles were screened from which 9 eligible studies involving 1667 patients were enrolled in this meta-analysis. Lung cancer patients with myosteatosis had significantly worse OS than patients without myosteatosis (HR 1.10, 95% CI 1.05-1.16, P < 0.001), both in six multivariate analysis (HR 1.46, 95% CI 1.16-1.85, P = 0.001) and in three univariate analysis (HR 1.08, 95% CI 1.03-1.14, P = 0.003). Pooled data from five studies using multivariate survival analysis also showed that patients with myosteatosis had a statistically significant unfavorable PFS (HR = 1.27, 95% CI 1.00-1.62, P = 0.049). Sensitivity analysis showed the result for OS was stable. But for PFS, the result was not robust. Myosteatosis might serve as an independent indicator of unfavorable survival outcomes for OS and PFS in lung cancer patients. Further studies are needed to confirm our results.
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Affiliation(s)
- Shaofang Feng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China.,Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Huiwen Mu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China.,Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Rong Hou
- School of Medical Imaging, Shanxi Medical University, Taiyuan, 030000, China
| | - Yunxin Liu
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Zheng Zhao
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Yubing Zhu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 210009, China. .,Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Wang F, Zheng X, Zhang J, Jiang F, Chen N, Xu M, Wu Y, Zhou J, Cui X, Zou J. A Dynamic Nomogram to Identify Patients at High Risk of Poor Outcome in Stroke Patients with Chronic Kidney Disease. Clin Interv Aging 2022; 17:755-766. [PMID: 35601241 PMCID: PMC9115835 DOI: 10.2147/cia.s352641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/18/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Fusang Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, People’s Republic of China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xiaohan Zheng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, People’s Republic of China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Juan Zhang
- Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Fuping Jiang
- Department of Geriatrics, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Nihong Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Mengyi Xu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yuezhang Wu
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Xiaoli Cui
- Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Clinical Pharmacology, Nanjing First Hospital, China Pharmaceutical University, Nanjing, People’s Republic of China
- Correspondence: Jianjun Zou; Xiaoli Cui, Email ;
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Liu P, Jiang L, Kong W, Xie Q, Li P, Liu X, Zhang J, Liu M, Wang Z, Zhu L, Yang H, Zhou Y, Zou J, Liu X, Liu L. PXR activation impairs hepatic glucose metabolism partly via inhibiting the HNF4 α-GLUT2 pathway. Acta Pharm Sin B 2022; 12:2391-2405. [PMID: 35646519 PMCID: PMC9136535 DOI: 10.1016/j.apsb.2021.09.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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] [Received: 07/14/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 01/20/2023] Open
Abstract
Drug-induced hyperglycemia/diabetes is a global issue. Some drugs induce hyperglycemia by activating the pregnane X receptor (PXR), but the mechanism is unclear. Here, we report that PXR activation induces hyperglycemia by impairing hepatic glucose metabolism due to inhibition of the hepatocyte nuclear factor 4-alpha (HNF4α)‒glucose transporter 2 (GLUT2) pathway. The PXR agonists atorvastatin and rifampicin significantly downregulated GLUT2 and HNF4α expression, and impaired glucose uptake and utilization in HepG2 cells. Overexpression of PXR downregulated GLUT2 and HNF4α expression, while silencing PXR upregulated HNF4α and GLUT2 expression. Silencing HNF4α decreased GLUT2 expression, while overexpressing HNF4α increased GLUT2 expression and glucose uptake. Silencing PXR or overexpressing HNF4α reversed the atorvastatin-induced decrease in GLUT2 expression and glucose uptake. In human primary hepatocytes, atorvastatin downregulated GLUT2 and HNF4α mRNA expression, which could be attenuated by silencing PXR. Silencing HNF4α downregulated GLUT2 mRNA expression. These findings were reproduced with mouse primary hepatocytes. Hnf4α plasmid increased Slc2a2 promoter activity. Hnf4α silencing or pregnenolone-16α-carbonitrile (PCN) suppressed the Slc2a2 promoter activity by decreasing HNF4α recruitment to the Slc2a2 promoter. Liver-specific Hnf4α deletion and PCN impaired glucose tolerance and hepatic glucose uptake, and decreased the expression of hepatic HNF4α and GLUT2. In conclusion, PXR activation impaired hepatic glucose metabolism partly by inhibiting the HNF4α‒GLUT2 pathway. These results highlight the molecular mechanisms by which PXR activators induce hyperglycemia/diabetes.
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Li N, Zhang Y, Wang J, Zhu J, Wang L, Wu X, Yao D, Wu Q, Liu J, Tang J, Yin R, Lou G, An R, Zhang G, Xia X, Li Q, Zhu Y, Zheng H, Yang X, Hu Y, Zhang X, Hao M, Huang Y, Lin Z, Wang D, Guo X, Yao S, Wan X, Zhou H, Yao L, Yang X, Cui H, Meng Y, Zhang S, Qu J, Zhang B, Zou J, Wu L. Fuzuloparib Maintenance Therapy in Patients With Platinum-Sensitive, Recurrent Ovarian Carcinoma (FZOCUS-2): A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase III Trial. J Clin Oncol 2022; 40:2436-2446. [PMID: 35404684 DOI: 10.1200/jco.21.01511] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This phase III trial aimed to explore the efficacy and safety of fuzuloparib (formerly fluzoparib) versus placebo as a maintenance treatment after response to second- or later-line platinum-based chemotherapy in patients with high-grade, platinum-sensitive, recurrent ovarian cancer. PATIENTS AND METHODS Patients with platinum-sensitive, recurrent ovarian cancer previously treated with at least two platinum-based regimens were assigned (2:1) to receive fuzuloparib (150 mg, twice daily) or matching placebo for 28-day cycles. The primary end points were progression-free survival (PFS) assessed by blinded independent review committee (BIRC) in the overall population and PFS by BIRC in the subpopulation with germline BRCA 1/2 mutation. RESULTS Between April 30, 2019, and January 10, 2020, 252 patients were randomly assigned to the fuzuloparib (n = 167) or placebo (n = 85). As of July 1, 2020, the median PFS per BIRC assessment in the overall population was significantly improved with fuzuloparib treatment (hazard ratio [HR], 0.25; 95% CI, 0.17 to 0.36; one-sided P < .0001) compared with that with placebo. The HR derived from a prespecified subgroup analysis showed a consistent trend of benefit in patients with germline BRCA 1/2 mutations (HR, 0.14; 95% CI, 0.07 to 0.28) or in those without mutations (HR, 0.46; 95% CI, 0.29 to 0.74). The most common grade ≥ 3 treatment-emergent adverse events reported in the fuzuloparib group were anemia (25.1%), decreased platelet count (16.8%), and decreased neutrophil count (12.6%). Only one patient (0.6%) discontinued fuzuloparib because of treatment-related toxicity (concurrent decreased white blood cell count and neutrophil count). CONCLUSION Fuzuloparib as maintenance therapy achieved a statistically significant and clinically meaningful improvement in PFS for patients with platinum-sensitive, recurrent ovarian cancer versus placebo, regardless of germline BRCA 1/2 mutation, and showed a manageable safety profile.
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Affiliation(s)
- Ning Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | | | - Jing Wang
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University (Hunan Cancer Hospital), Changsha, China
| | - Jianqing Zhu
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Li Wang
- Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xiaohua Wu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Desheng Yao
- Guangxi Medical University Cancer Hospital, Nanning, China
| | - Qiang Wu
- Jiangsu Cancer Hospital, Nanjing, China
| | - Jihong Liu
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Junying Tang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rutie Yin
- West China Second University Hospital, Sichuan University, Chengdu, China/Key Laboratory of Obstetrics & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ge Lou
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Ruifang An
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | | | - Qingshui Li
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yaping Zhu
- Shanghai General Hospital, Shanghai, China
| | | | | | - Yuanjing Hu
- Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Xin Zhang
- Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Min Hao
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yi Huang
- Hubei Cancer Hospital, Wuhan, China
| | - Zhongqiu Lin
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dong Wang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaoqing Guo
- Shanghai First Maternity and Infant Hospital, Shanghai, China
| | - Shuzhong Yao
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyun Wan
- Woman's Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Huaijun Zhou
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Liangqing Yao
- Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China
| | | | - Heng Cui
- Peking University People's Hospital, Beijing, China
| | | | - Songling Zhang
- The First Bethune Hospital of Jilin University, Changchun, China
| | - Jing Qu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Ben Zhang
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Lingying Wu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
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Zhao Z, Mu H, Feng S, Liu Y, Zou J, Zhu Y. Identification of Biomarkers Associated with Hepatocellular Carcinoma Stem Cell Characteristics Based on Co-Expression Network Analysis of Transcriptome Data and Stemness Index. Crit Rev Eukaryot Gene Expr 2022; 32:47-60. [PMID: 35381131 DOI: 10.1615/critreveukaryotgeneexpr.2021039692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mounting evidence has revealed the key role of cancer stem cells in hepatocellular carcinoma (HCC) metastasis and therapy resistance, yet the genes maintaining HCC stem cell features remain to be explored. This study aimed to identify and validate the key biomarkers associated with HCC stemness. mRNA expression-based stemness index (mRNAsi) was calculating using one-class logistic regression algorithm. RNA-sequencing data and clinical information of HCC samples were downloaded from the cancer genome atlas (TCGA) and merged with the corresponding mRNAsi. We investigated the correlation between mRNAsi and HCC clinical characteristics, including tumor grades, pathologic stages, vascular invasion, and survival outcomes. Significant genes associated HCC stemness features were screened through weighted gene co-expression network analysis (WGCNA) and were functionally annotated using enrichment analysis. Protein-protein interaction network was constructed among significant genes and the key biomarkers were finally identified based on the maximal clique centrality (MCC) method. The expression of key biomarkers and its correlation with HCC clinical outcomes were validated using oncomine and gene expression omnibus (GEO) database. mR-NAsi was significantly higher in HCC tissues and gradually increased according to tumor grades and pathologic stages. Patients with vascular invasion or poor survival exhibited higher mRNAsi. Forty-four highly-correlated significant gens were screened through WGCNA and functionally related to cell cycle, cellular senescence, p53 signaling pathway, DNA replication, and mismatch repair. Four different GEO datasets confirmed that the expression levels of these 44 genes were notably higher in HCC tissues. We finally identified 15 key biomarkers (KIF4A, TTK, CCNB1, CDC20, NCAPG, CCNB2, CDC45, UBE2C, CENPA, AURKB, RRM2, CDCA8, BIRC5, TPX2, and KIF2C) through MCC method. The expression of these biomarkers was up-regulated in multiple types of cancers and showed a gradually increasing trend with HCC tumor grades. Furthermore, high expression levels of these biomarkers were also correlated with HCC metastasis, recurrence, sorafenib resistance, and poor overall survival. We identified 15 key biomarkers associated with HCC stemness features and these genes might serve as promising therapeutic targets for HCC.
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Affiliation(s)
- Zheng Zhao
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Huiwen Mu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Shaofang Feng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Yunxin Liu
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Jianjun Zou
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Yubing Zhu
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China
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Chen T, Zhang Y, Dou Q, Zheng X, Wang F, Zou J, Jia R. Machine learning-assisted preoperative diagnosis of infection stones in urolithiasis patients. J Endourol 2022; 36:1091-1098. [PMID: 35369740 DOI: 10.1089/end.2021.0783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tingting Chen
- China Pharmaceutical University, 56651, School of Basic medical and Clinical pharmacy, Nanjing, Jiangsu, China
| | | | | | | | | | - Jianjun Zou
- Nanjing First Hospital, 385685, Clinical pharmarcy department, Nanjing, Nangjing, China, 210029
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Liu H, Vitzthum L, Williamson C, Hill L, Zou J, Nelson T, Faung B, Linnemeyer K, Todd J, Sacco A, Sanghvi P, Sharabi A, Califano J, Blumenfeld L, Mell L. Post-Treatment Evaluation of Swallowing Function Using Quantitative Videofluoroscopy in Head and Neck Patients Undergoing Immunoradiotherapy or Chemoradiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Some oral squamous cell carcinomas (OSCCs) originate from preexisting oral potentially malignant disorders (OPMDs). Oral leukoplakia (OLK) is the most common and typical OPMD in the clinic, so treatment for it is essential to reduce OSCC incidence. Local chemotherapy is an option other than surgery considering the superficial site of OLK. However, there are no standardized drugs applied to OLK, and traditionally used chemotherapeutic drugs revealed limited efficacy for lack of adhesion. Hence, there is a growing demand to prepare new agents that combine mucoadhesion with an anti-OLK effect. Here, an isoguanosine-tannic acid (isoG-TA) supramolecular hydrogel via dynamic borate esters was successfully fabricated based on isoG and TA. Previously reported guanosine-TA (G-TA) hydrogel was also explored for an anti-OLK effect. Both gels not only exhibited ideal adhesive properties but also integrated anti-OLK activities in one system. In vitro cell viability indicated that isoG and TA inhibited the proliferation of dysplastic oral keratinocytes (DOKs). The in vivo OLK model evidence revealed that both gels showed potential to prevent OLK canceration. In addition, the probable anti-DOK mechanisms of isoG and TA were investigated. The results indicated that isoG could bind to adenosine kinase (ADK) and then affected the mammalian target of rapamycin (mTOR) pathway to inhibit DOK proliferation. TA could significantly and continuously reduce reactive oxygen species (ROS) in DOKs through its antioxidant effect. ROS plays an important role in the progression of cell cycle. We proved that the low level of ROS may inhibit DOK proliferation by inducing G0/G1 arrest in the cell cycle. Altogether, this study innovatively fabricated an isoG-TA hydrogel with ideal adhesion, and both isoG and TA showed in vitro inhibition of DOKs. Moreover, both isoG-TA and G-TA hydrogels possessed potential in delaying the malignant transformation of OLK, and the G-TA hydrogel showed a better statistical effect, providing an effective strategy for controlling OLK.
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Affiliation(s)
- T Ding
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Med-X Center for Materials, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
| | - J Zou
- West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - J Qi
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Med-X Center for Materials, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
| | - H Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Med-X Center for Materials, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
| | - F Tang
- The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine and Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, P. R. China
| | - H Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Med-X Center for Materials, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Q Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, Med-X Center for Materials, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, P. R. China
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Peng G, He G, Chang H, Gao S, Liu X, Chen T, Li P, Han B, Miao M, Ge Z, Ge X, Li F, Li Y, Wang S, Wang Y, Shen Y, Zhang T, Zou J, Zhang F. A multicenter phase II study on the efficacy and safety of hetrombopag in patients with severe aplastic anemia refractory to immunosuppressive therapy. Ther Adv Hematol 2022; 13:20406207221085197. [PMID: 35371427 PMCID: PMC8972928 DOI: 10.1177/20406207221085197] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/17/2022] [Indexed: 02/05/2023] Open
Abstract
Background: In this single-arm phase II study (NCT03557099), we evaluated the efficacy and safety of hetrombopag, a small molecule thrombopoietin (TPO) receptor agonist, in patients with severe aplastic anemia (SAA) who were refractory to standard first-line immunosuppressive therapy (IST). Methods: SAA patients who were refractory to standard first-line IST were given hetrombopag orally at an initial dose of 7.5 mg once daily to a maximum of 15 mg once daily, for a total of 52 weeks. The primary endpoint was proportion of patients achieving hematologic responses in ⩾1 lineage at week 18. Results: A total of 55 eligible patients were enrolled and received hetrombopag treatment. This study met its primary endpoint, with 23 [41.8%, 95% confidence interval (CI) = 28.7–55.9] patients achieving hematologic response in ⩾1 lineage at week 18 after initiation of hetrombopag treatment. Twenty-four (43.6%, 95% CI = 30.3–57.7) and 27 (49.1%, 95% CI = 35.4–62.9) of the 55 patients responded in ⩾1 lineage at weeks 24 and 52, respectively. Median time to initial hematologic response was 7.9 weeks (range = 2.0–32.1). The responses were durable, with a 12-month relapse-free survival rate of 82.2% (95% CI = 62.2–92.2). Adverse events occurred in 54 (98.2%) patients, and 28 (50.9%) patients had treatment-related adverse events. Seventeen (30.9%) patients had adverse events of grade ⩾3. Serious adverse events occurred in 15 (27.3%) patients and three deaths (5.5%) were reported. Conclusion: Hetrombopag showed encouraging efficacy with durable hematologic responses in patients with SAA who were refractory to IST. Hetrombopag was well tolerant and safe for long-term use. ClinicalTrials.gov identifier: NCT03557099
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Affiliation(s)
- Guangxin Peng
- Anemia Therapeutic Center, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Guangsheng He
- Department of Hematology, Jiangsu Province Hospital, Nanjing, China
| | - Hong Chang
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Sujun Gao
- Department of Hematology, The First Hospital of Jilin University, Changchun, China
| | - Xinjian Liu
- Department of Hematology, Henan Cancer Hospital, Zhengzhou, China
| | - Tong Chen
- Department of Hematology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Pei Li
- Department of Hematology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Bing Han
- Department of Hematology, Peking Union Medical College Hospital, Beijing, China
| | - Miao Miao
- Department of Hematology, The First Affiliated Hospital of Suzhou University, Suzhou, China
| | - Zheng Ge
- Department of Hematology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Xiaoyan Ge
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Fei Li
- Department of Hematology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yingmei Li
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shunqing Wang
- Department of Hematology, Guangzhou First People’s Hospital, Guangzhou, China
| | - Yi Wang
- Department of Hematology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Yaqi Shen
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Tao Zhang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Fengkui Zhang
- Anemia Therapeutic Center, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 288 Nanjing Road, Heping District, 300020 Tianjin, China
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Qin X, Ji D, Gu W, Han W, Luo H, Du C, Zou Q, Sun Z, He C, Zhu S, Chong T, Yao X, Wan B, Yang X, Bai A, Jin C, Zou J, Ye D. Activity and safety of SHR3680, a novel antiandrogen, in patients with metastatic castration-resistant prostate cancer: a phase I/II trial. BMC Med 2022; 20:84. [PMID: 35241087 PMCID: PMC8895828 DOI: 10.1186/s12916-022-02263-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antagonizing the androgen-receptor (AR) pathway is an effective treatment strategy for patients with metastatic castration-resistant prostate cancer (CRPC). Here, we report the results of a first-in-human phase 1/2 study which assessed the safety, pharmacokinetics, and activity of SHR3680 (a novel AR antagonist) in patients with metastatic CRPC. METHODS This phase 1/2 study enrolled patients with progressive metastatic CRPC who had not been previously treated with novel AR-targeted agents. In the phase 1 dose-escalation portion, patients received oral SHR3680 at a starting daily dose of 40 mg, which was subsequently escalated to 80 mg, 160 mg, 240 mg, 360 mg, and 480 mg per day. In phase 2 dose-expansion portion, patients were randomized to receive daily dose of 80 mg, 160 mg, or 240 mg of SHR3680. The primary endpoint in phase 1 was safety and tolerability and in phase 2 was the proportion of patients with a prostate-specific antigen (PSA) response (≥ 50% decrease of PSA level) at week 12. RESULTS A total of 197 eligible patients were enrolled and received SHR3680 treatment, including 18 patients in phase 1 and 179 patients in phase 2. No dose-limiting toxicities were reported and the maximum tolerated dose was not reached. Treatment-related adverse events (TRAEs) occurred in 116 (58.9%) patients, with the most common one being proteinuria (13.7%). TRAEs of grade ≥ 3 occurred in only 23 (11.7%) patients, and no treatment-related deaths occurred. Antitumor activities were evident at all doses, including PSA response at week 12 in 134 (68.0%; 95% CI, 61.0-74.5) patients, stabilized bone disease at week 12 in 174 (88.3%; 95% CI, 87.2-95.5) patients, and responses in soft tissue lesions in 21 (34.4%, 95% CI, 22.7-47.7) of 61 patients. CONCLUSION SHR3680 was well tolerated and safe, with promising anti-tumor activity across all doses tested in patients with metastatic CRPC. The dose of 240 mg daily was recommended for further phase 3 study. TRIAL REGISTRATION Clinical trials.gov NCT02691975; registered February 25, 2016.
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Affiliation(s)
- Xiaojian Qin
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
| | - Dongmei Ji
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Weijie Gu
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
| | - Weiqing Han
- Department of Urology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan Cancer Center, Changsha, China
| | - Hong Luo
- Department of Urology, Chongqing University Cancer Hospital, Chongqing Cancer Hospital, Chongqing, China
| | - Chuanjun Du
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Zou
- Department of Urology, Jiangsu Cancer Hospital, Nanjing, China
| | - Zhongquan Sun
- Department of Urology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Chaohong He
- Department of Urology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaoxing Zhu
- Department of Urology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Tie Chong
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xin Yao
- Department of Urology, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Ben Wan
- Departmeint of Urology, Beijing Hospital, Beijing, China
| | - Xinfeng Yang
- Department of Clinical Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Aobing Bai
- Department of Clinical Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Chunlei Jin
- Department of Clinical Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Department of Clinical Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.
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Mei H, Liu X, Li Y, Zhou H, Feng Y, Gao G, Cheng P, Huang R, Yang L, Hu J, Hou M, Yao Y, Liu L, Wang Y, Wu D, Zhang L, Zheng C, Shen X, Hu Q, Liu J, Jin J, Luo J, Zeng Y, Gao S, Zhang X, Zhou X, Shi Q, Xia R, Xie X, Jiang Z, Gao L, Bai Y, Li Y, Xiong J, Li R, Zou J, Niu T, Yang R, Hu Y. Dose tapering to withdrawal stage and long-term efficacy and safety of hetrombopag for the treatment of immune thrombocytopenia: Results from an open-label extension study. J Thromb Haemost 2022; 20:716-728. [PMID: 34821020 DOI: 10.1111/jth.15602] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/18/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The efficacy of hetrombopag in Chinese patients with immune thrombocytopenia (ITP) has been demonstrated in a randomized, double-blind, placebo-controlled, multicenter, phase III trial (NCT03222843). OBJECTIVE This study aimed to report comprehensive data on a ≤6-week dose tapering to withdrawal (Stage 3) and an additional 24-week long-term extension period (Stage 4) in this phase III trial. PATIENTS/METHODS Patients who fulfilled the screening criteria were eligible to enter Stage 3 or 4. During Stage 3, hetrombopag was gradually tapered to withdrawal. During Stage 4, hetrombopag treatment was initiated at 2.5, 3.75, 5, or 7.5 mg once daily. The efficacy endpoints during Stage 3 or 4 and the safety profile during the entire treatment period were reported. RESULTS Among 194 patients who entered Stage 3, 171 (88.1%) relapsed. The median time to the first relapse since the start of Stage 3 was 15.0 days (95% CI, 14.0-16.0). In Stage 4, 144 (42.5%) patients responded at ≥75% of their assessments and 254 (74.9%) patients achieved platelet count ≥30 × 109 /L at least once, which was at least twice their baseline platelet count in the hetrombopag group (n = 339). The most common adverse events were upper respiratory tract infection (53.1%), thrombocytopenia (27.1%), and urinary tract infection (21.2%) in the hetrombopag group. CONCLUSION The majority of patients who experienced dose tapering to withdrawal experienced a relapse. Long-term treatment with hetrombopag was effective in increasing and maintaining platelet count within the desired range in Chinese adults with ITP. Hetrombopag was well tolerated.
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Affiliation(s)
- Heng Mei
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofan Liu
- Thrombosis and Hemostasis Center, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yan Li
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Hu Zhou
- Department of Hematology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Feng
- Department of Hematopathology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guangxun Gao
- The Blood Internal Medicine, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Peng Cheng
- Hematology Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ruibin Huang
- Hematology Department, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linhua Yang
- Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jianda Hu
- Hematology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Yazhou Yao
- Hematology Department, Baoji Central Hospital, Baoji, China
| | - Li Liu
- Department of Hematopathology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yi Wang
- Department of Hematopathology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Depei Wu
- Hematology Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liansheng Zhang
- Hematology Department, Lanzhou University Second Hospital, Lanzhou, China
| | - Changcheng Zheng
- Hematology Department, The First Affiliated Hospital of USTC, Hefei, China
| | - Xuliang Shen
- Department of Hematology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Qi Hu
- Department of Hematology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Jing Liu
- Hematology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Jianmin Luo
- Department of Hematology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yun Zeng
- Department of Hematology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Sujun Gao
- Hematology, The First Hospital of Jilin University, Changchun, China
| | - Xiaohui Zhang
- Department of Hematology, Peking University People's Hospital, Beijing, China
| | - Xin Zhou
- Hematology Department, Wuxi People's Hospital, Wuxi, China
| | - Qingzhi Shi
- Hematology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ruixiang Xia
- Hematology Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaobao Xie
- Hematology Department, The First People's Hospital of Changzhou, Changzhou, China
| | - Zhongxing Jiang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Gao
- Department of Hematology, The Second Affiliated Hospital of Military Medical University PLA, Chongqing, China
| | - Yuansong Bai
- Hematology & Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Li
- Hematology Department, The First Hospital of China Medical University, Shenyang, China
| | - Junye Xiong
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Runzi Li
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Jianjun Zou
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Ting Niu
- Department of Hematology, Institute of Hematology, West China Hospital, Sichuan University, Chengdu, China
| | - Renchi Yang
- Thrombosis and Hemostasis Center, State Key Laboratory of Experimental Hematology, National Clinical Research Center for Hematological Disorders, Tianjin Laboratory of Blood Disease Gene Therapy, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Yu Hu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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He M, Yang B, Wu J, Liu Z, Yang H, Tang J, Wang K, Liu Y, Wang H, Fu P, Zhang S, Liu Q, Jiang Z, Wang S, Huang J, Wang C, Wang S, Wang Y, Zhen L, Zhu X, Liu S, Yan P, Zou J. Abstract P5-18-10: Mecapegfilgrastim for primary prophylaxis of neutropenia in 355 HER2+ breast cancer patients treated with neoadjuvant docetaxel in combination with trastuzumab and/or pyrotinib: Exploratory analysis from randomized, double-blind, phase 3 PHEDRA study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-18-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A dose relationship may exist for both antitumor activity and toxicity of docetaxel in breast cancer (BC) patients, while 86% grade 4 neutropenia and 12% febrile neutropenia (FN) were reported when pretreated advanced breast cancer (ABC) patients received 100 mg/m2 docetaxel monotherapy without hematopoietic support. PHEDRA was a randomized, double-blind, multicenter, phase 3 study comparing the efficacy and safety of adding pyrotinib to trastuzumab and docetaxel as neoadjuvant treatment in women with HER2+ early or locally ABC (ClinicalTrials.gov: NCT03588091). We conducted this exploratory analysis to evaluate the effectiveness of mecapegfilgrastim, a long-acting recombinant human granulocyte colony-stimulating factor (rhG-CSF), as primary prophylaxis for neoadjuvant chemotherapy-induced neutropenia in BC patients. Methods: Patients with HER2-positive early or locally ABC were randomly assigned (1:1) to pyrotinib arm receiving 4 neoadjuvant cycles of docetaxel (100 mg/m2 iv d1 q3w), trastuzumab (8 mg/kg iv, cycle 1 d1, then 6 mg/kg d1 q3w), and pyrotinib (400 mg po qd, d1-21, q3w) or placebo arm with placebo, trastuzumab and docetaxel. Per protocol, patients were required to receive a single, 6-mg fixed dose of mecapegfilgrastim on Day 2 of each cycle. Other G-CSF was permitted if mecapegfilgrastim was unavailable at the local center or patients occurred mecapegfilgrastim intolerance. The incidence of neutropenia, FN, time to first neutropenia onset, duration per neutropenia event and cumulative neutropenia duration during neoadjuvant treatment period; and the incidences of grade 3/4 neutropenia, FN and decreased WBC count in Cycle 1 to 4 (C1-4) were presented. The data cutoff date was April 30, 2021. Results: Between July 23, 2018 and January 8, 2021, 355 patients were randomized (pyrotinib arm, n=178; placebo arm, n=177). Among them, 291 (82.0%) patients received a single, 6-mg fixed dose of mecapegfilgrastim in Cycle 1 and 270 (76.1%) patients received mecapegfilgrastim in each of the 4 cycles. Grade 3/4 neutropenia was reported in 33 (18.5%) patients in the pyrotinib arm and 36 (20.3%) patients in the placebo arm. Five (2.8%) patients in the pyrotinib arm and 2 (1.1%) patients in the placebo arm developed FN (5 FN occurred in C1; 2 FN occurred in C2). Median duration of grade 3/4 neutropenia was 3 days in the pyrotinib group and 3 days in the placebo group. Median cumulative duration of grade 3/4 neutropenia was 4 days and 3 days in the pyrotinib group and the placebo group, respectively. Grade 3/4 neutropenia mainly occurred during the first cycle of treatment for both pyrotinib (13.5%) and placebo arm (15.8%), reduced in the second cycle (5.9% vs 4.0%) and thereafter (C3: 1.8% vs 3.4%; C4: 2.4% vs 1.7%). Similar trends were observed for grade 3/4 WBC count decreased in Cycle 1 to 4. No grade 4 infection occurred. Overview of neutropenia, FN and WBC count decreased was summarized in Table 1. Consistent findings were observed in 291 mecapegfilgrastim treated patients. Conclusion: The exploratory analysis demonstrated 6-mg fixed dose of mecapegfilgrastim was effective when administrated as primary prophylaxis for neoadjuvant chemotherapy-induced neutropenia, which could be considered as a new treatment option for its advantage of once-per-cycle dosing and convenient dose management.
Table 1.Overview of neutropenia, febrile neutropenia and WBC count decrease during neoadjuvant treatment period.Docetaxel+Trastuzumab+Pyrotinib(N=178)Docetaxel+Trastuzumab+Placebo (N=177)All randomized patients(N=355)Neutropenia, n (%)Any grade57 (32.0)54 (30.5)111 (31.3)Grade 16 (3.4)5 (2.8)11 (3.1)Grade 218 (10.1)13 (7.3)31 (8.7)Grade 315 (8.4)20 (11.3)35 (9.9)Grade 418 (10.1)16 (9.0)34 (9.6)Median time to first onset (IQR), days7 (6-63)6 (6-49)7 (6-53)Median duration per grade 3 or higher neutropenia, days (range)3 (1-16)3 (2-12)3 (1-16)Median cumulative duration of grade 3 or higher neutropenia, days (range)4 (2-16)3 (2-14)3 (2-16)FN, n (%)5 (2.8)2 (1.1)7 (2.0)Grade 3 or higher neutropenia, n (%) *Cycle 124 (13.5)28 (15.8)52 (14.6)Cycle 210 (5.9)7 (4.0)17 (4.9)Cycle 33 (1.8)6 (3.4)9 (2.6)Cycle 44 (2.4)3 (1.7)7 (2.1)Grade 3 or higher FN, n (%) *Cycle 12 (1.1)2 (1.1)4 (1.1)Cycle 22 (1.2)02 (0.6)Cycle 3000Cycle 4000Grade 3 or higher WBC count decreased, n (%) *Cycle 120 (11.2)20 (11.3)40 (11.3)Cycle 28 (4.7)2 (1.1)10 (2.9)Cycle 32 (1.2)1 (0.6)3 (0.9)Cycle 44 (2.4)2 (1.1)6 (1.8)Note: IQR, interquartile range; FN, febrile neutropenia; WBC, white blood cell.*The denominator indicates number of patients with mecapegfilgrastim for prophylaxis use in this cycle.
Citation Format: Min He, Benlong Yang, Jiong Wu, Zhenzhen Liu, Hongjian Yang, Jinhai Tang, Kun Wang, Yunjiang Liu, Haibo Wang, Peifen Fu, Shuqun Zhang, Qiang Liu, Zefei Jiang, Shusen Wang, Jian Huang, Chuan Wang, Shu Wang, Yongsheng Wang, Linlin Zhen, Xiaoyu Zhu, Shulin Liu, Ping Yan, Jianjun Zou. Mecapegfilgrastim for primary prophylaxis of neutropenia in 355 HER2+ breast cancer patients treated with neoadjuvant docetaxel in combination with trastuzumab and/or pyrotinib: Exploratory analysis from randomized, double-blind, phase 3 PHEDRA study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-18-10.
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Affiliation(s)
- Min He
- Fudan University Cancer Hospital, Shanghai, China
| | - Benlong Yang
- Fudan University Cancer Hospital, Shanghai, China
| | - Jiong Wu
- Fudan University Cancer Hospital, Shanghai, China
| | - Zhenzhen Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | | | - Jinhai Tang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kun Wang
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yunjiang Liu
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haibo Wang
- The Affiliated Hospital Of Qingdao University, Qingdao, China
| | - Peifen Fu
- The First Affiliated Hospital Zhejiang University, Hangzhou, China
| | - Shuqun Zhang
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zefei Jiang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shusen Wang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jian Huang
- The Second Affiliated Hospital Zhejiang University, Hangzhou, China
| | - Chuan Wang
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Shu Wang
- Peking University People's Hospital, Beijing, China
| | | | - Linlin Zhen
- Huai'an First People's Hospital, Huai'an, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Shulin Liu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Ping Yan
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
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Jiang Z, Yan M, Bian L, Wang T, Hu X, Zhang Q, Ouyang Q, Feng J, Yin Y, Sun T, Tong Z, Wang X, Yao H, Jiang S, Zhu X, Zou J. Abstract PD8-05: Overall survival (OS) results from the phase III PHENIX trial of HER2+ metastatic breast cancer treated with pyrotinib plus capecitabine. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd8-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pyrotinib (an irreversible tyrosine kinase inhibitor targeting EGFR, HER2, and HER4) plus capecitabine previously demonstrated a statistically significant improvement in progression-free survival (PFS) over placebo plus capecitabine for HER2-positive local relapsed or metastatic breast cancer after prior trastuzumab and taxanes in the interim analysis of the PHENIX trial (NCT02973737; Jiang Z et al. Oral presentation at ASCO 2019, Abstract 1001). It is shown that patients also benefit from subsequent pyrotinib monotherapy after progressed on capecitabine alone. Here we present an updated OS from a follow-up period with a median of 42.1 months. Methods: This PHENIX trial enrolled patients with HER2-positive local relapsed or metastatic breast cancer who had received prior trastuzumab and taxanes and up to two prior lines of chemotherapy for relapsed or metastatic disease. Eligible patients were randomized 2:1 to receive pyrotinib (400 mg orally once daily) in combination with capecitabine (1000 mg/m2 orally twice daily on days 1-14 for 21-day cycles; P+C group) or placebo plus capecitabine followed by pyrotinib monotherapy upon disease progression (C-P group). Randomization was stratified by the presence of visceral disease (yes vs. no) and the hormone receptor status (estrogen receptor [ER]- and/or progesterone receptor [PR]-positive vs. ER- and PR-negative). The primary endpoint was the independent review committee-assessed PFS. The data cutoff for the updated OS analysis was January 15, 2021. Results: A total of 279 eligible patients were randomized, with 185 to P+C group and 94 to C-P group. As of data cutoff, the median duration of follow-up was 41.7 months (95% CI 40.2-42.4) in P+C group and 43.1 months (95% CI 38.8-44.5) in C-P group. 71 out of 94 patients who progressed on placebo plus capecitabine received pyrotinib monotherapy as the first subsequent anti-cancer therapy according to protocol. Excluding the protocol prespecified pyrotinib monotherapy, 129 (69.7%) patients in the P+C group and 74 (78.7%) patients in the C-P group received anti-cancer therapy after discontinuing study treatment, and 107 (57.8%) patients and 61 (64.9%) patients received post-discontinuation anti-HER2 drugs, respectively. 98 (53.0%) of the 185 patients in P+C group and 59 (62.8%) of the 94 patients in C-P group died by the time of data cutoff. Kaplan-Meier estimated median OS was 34.9 months (95% CI 28.4-42.1) in P+C group and 23.6 months (95% CI 19.3-34.4) in C-P group (HR 0.74, 95% CI 0.54-1.02; p=0.068). The 2-year OS rate was 65.2% (95% CI 57.6%-71.8%) versus 48.9% (95% CI 38.1%-58.7%), respectively. Subgroup analyses of OS were generally consistent with the overall result (Table 1). Conclusion: The updated OS analysis highlighted the long-term efficacy of pyrotinib plus capecitabine in pretreated HER2-positive local relapsed or metastatic breast cancer. We did not observe a statistically significant difference in OS between pyrotinib plus capecitabine group and capecitabine group followed by subsequent pyrotinib monotherapy upon disease progression.
Table 1.Subgroup analysis of OS.Pyrotinib plus capecitabine (n=185)Placebo plus capecitabine (n=94)HR (95% CI) *Brain metastasesPresentEvents14/21 (66.7)8/10 (80.0)Median OS22.9 (19.7-35.0)17.3 (1.6-34.4)0.77 (0.32-1.84)AbsentEvents84/164 (51.2)51/84 (60.7)Median OS36.7 (30.7-43.0)23.6 (21.5-40.4)0.72 (0.51-1.02)Previous chemotherapyNoneEvents29/60 (48.3)12/22 (54.5)Median OS37.5 (34.2-NA)32.6 (18.9-NA)0.75 (0.38-1.47)1 lineEvents34/70 (48.6)27/47 (57.4)Median OS35.6 (25.9-NA)31.6 (18.0-NA)0.73 (0.44-1.21)2 linesEvents30/44 (68.2)13/18 (72.2)Median OS21.1 (13.6-33.4)15.9 (5.4-44.0)0.77 (0.40-1.49)Data are n/N (%) or median (95% CI). NA, not available. *HRs are from unstratified analyses.
Citation Format: Zefei Jiang, Min Yan, Li Bian, Tao Wang, Xichun Hu, Qingyuan Zhang, Quchang Ouyang, Jifeng Feng, Yongmei Yin, Tao Sun, Zhongsheng Tong, Xiaojia Wang, Herui Yao, Shuping Jiang, Xiaoyu Zhu, Jianjun Zou. Overall survival (OS) results from the phase III PHENIX trial of HER2+ metastatic breast cancer treated with pyrotinib plus capecitabine [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD8-05.
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Affiliation(s)
- Zefei Jiang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Min Yan
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Li Bian
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Tao Wang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xichun Hu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qingyuan Zhang
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Quchang Ouyang
- Hunan Cancer Hospital,The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jifeng Feng
- Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - Yongmei Yin
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Sun
- Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Zhongsheng Tong
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | | | - Herui Yao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuping Jiang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
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Wu J, Liu Z, Yang H, Tang J, Wang K, Liu Y, Wang H, Fu P, Zhang S, Liu Q, Jiang Z, Wang S, Huang J, Wang C, Wang S, Wang Y, Zhen L, Zhu X, Wu F, Zhang T, Zou J. Abstract PD8-08: Pyrotinib in combination with trastuzumab and docetaxel as neoadjuvant treatment for HER2-positive early or locally advanced breast cancer (PHEDRA): A randomized, double-blind, multicenter, phase 3 study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd8-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pyrotinib (an irreversible pan-ErbB inhibitor) plus capecitabine have shown clinically and statistically meaningful progression free survival and overall survival benefits and acceptable tolerability in patients with HER2-positive metastatic breast cancer in phase 3 study. We compared the efficacy and safety of adding pyrotinib to trastuzumab and docetaxel vs placebo, trastuzumab and docetaxel as neoadjuvant treatment in women with HER2-positive early or locally advanced breast cancer (ABC) in this randomized, double-blind, multicenter, phase 3 study. Methods: Treatment naive patients with HER2-positive early or locally ABC (T2-3, N0-3, M0) were randomly assigned (1:1) to pyrotinib arm receiving 4 neoadjuvant cycles of pyrotinib (400 mg po qd, d1-21, q3w), trastuzumab (8 mg/kg iv, cycle 1 d1, then 6 mg/kg d1 q3w) and placebo arm with docetaxel (100 mg/m2 iv d1, q3w) or placebo, trastuzumab and docetaxel. Randomization was done via a centralized interactive web-response system and stratified by primary tumor size (>2 cm and ≤5cm, or >5cm) and hormone receptor status (ER positive and/or PR positive, or negative for both). After surgery, patients received 3 cycles of intravenous fluorouracil, epirubicin, and cyclophosphamide followed by anti-cancer treatment (anti-HER2 therapy, radiotherapy, or endocrine therapy) at physicians’ discretion in accordance with clinical practice guidelines. The primary endpoint was total pCR rate (tpCR; defined as absence of any residual invasive cancer in the breast and lymph nodes [ypT0/is, ypN0]), assessed by an independent review committee (IRC). This study is registered with ClinicalTrials.gov, number NCT03588091. The data cutoff date was April 30, 2021. Results: Between July 23, 2018 and January 8, 2021, a total of 355 patients were randomized (pyrotinib arm, n=178; and placebo arm, n=177; mean [SD] age, 48.8 [9.4] years). Baseline demographics and disease characteristics were well balanced. In the full analysis set, IRC-assessed tpCR rates were 41.0% (73 of 178) in the pyrotinib arm and 22.0% (39 of 177) in the placebo arm (difference, 19.0% [95% CI, 9.5%-28.4%]; one-sided P<0.0001). The local pathologist-assessed tpCR rates were 44.4% (79 of 178) and 24.3% (43 of 177) in the pyrotinib arm and the placebo arm, respectively. Incidence of grade ≥3 adverse events (AEs) was 71.3% (127 of 178) in the pyrotinib arm and 37.3% (66 of 177) in the placebo arm. Of the most-common grade ≥3 AEs (≥5% of patients in either arm), the incidences of diarrhea (79 of 178 [44.4%] vs 9 of 177 [5.1%]), decreased WBC count (29 of 178 [16.3%] vs 24 of 177 [13.6%]), vomiting (23 of 178 [12.9%] vs 2 of 177 [1.1%]), anemia (11 of 178 [6.2%] vs 2 of 177 [1.1%]), and hypokalemia (9 of 178 [5.1%] vs 0) were higher in the pyrotinib arm compared with the placebo arm. Grade 3 diarrhea occurred mainly during the first treatment cycle and decreased in the second cycle and thereafter. No grade 4 or 5 diarrheas occurred. The median duration per grade 3 episode was 2.0 days and median cumulative duration of grade 3 episodes was 4.0 days. Only 1 patient (1 of 178 [0.6%]) in the pyrotinb arm experienced diarrhea-related discontinuation. Serious AEs were reported in 14.6% of patients (26 of 178) in the pyrotinib arm and 6.8% of patients (12 of 177) in the placebo arm. Conclusions: Pyrotinib, trastuzumab, and docetaxel as neoadjuvant treatment achieved a statistically significant and clinically meaningful improvement in IRC-assessed tpCR rate for patients with HER2-positive early or locally ABC compared with placebo, trastuzumab, and docetaxel, with an acceptable and manageable safety profile. These findings support pyrotinib, trastuzumab, and docetaxel as a new neoadjuvant treatment option in this patient population.
Citation Format: Jiong Wu, Zhenzhen Liu, Hongjian Yang, Jinhai Tang, Kun Wang, Yunjiang Liu, Haibo Wang, Peifen Fu, Shuqun Zhang, Qiang Liu, Zefei Jiang, Shusen Wang, Jian Huang, Chuan Wang, Shu Wang, Yongsheng Wang, Linlin Zhen, Xiaoyu Zhu, Fei Wu, Tao Zhang, Jianjun Zou. Pyrotinib in combination with trastuzumab and docetaxel as neoadjuvant treatment for HER2-positive early or locally advanced breast cancer (PHEDRA): A randomized, double-blind, multicenter, phase 3 study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD8-08.
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Affiliation(s)
- Jiong Wu
- Fudan University Cancer Hospital, Shanghai, China
| | - Zhenzhen Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | | | - Jinhai Tang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kun Wang
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yunjiang Liu
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haibo Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peifen Fu
- The First Affiliated Hospital Zhejiang University, Hangzhou, China
| | - Shuqun Zhang
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zefei Jiang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shusen Wang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jian Huang
- The Second Affiliated Hospital Zhejiang University, Hangzhou, China
| | - Chuan Wang
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Shu Wang
- Peking University People's Hospital, Beijing, China
| | | | - Linlin Zhen
- Huai'an First People's Hospital, Huai'an, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Fei Wu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Tao Zhang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
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Yang B, Wu J, Liu Z, Yang H, Tang J, Wang K, Liu Y, Wang H, Fu P, Zhang S, Liu Q, Jiang Z, Wang S, Huang J, Wang C, Wang S, Wang Y, Zhen L, Wu F, Liu S, Lin X, Zou J. Abstract P5-18-06: Proactive diarrhea management improved tolerability of pyrotinib in combination with trastuzumab and docetaxel in patients with HER2+ early or locally advanced breast cancer: Exploratory analysis from randomized, double-blind, phase 3 PHEDRA study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-18-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Diarrhea is a common side effect of many anti-cancer treatments, including chemotherapeutic agents, tyrosine kinase inhibitors, and pelvic radiotherapy. PHEDRA was a randomized, double-blind, multicenter, phase 3 study comparing the efficacy and safety of adding pyrotinib (an irreversible pan-ErbB inhibitor) to trastuzumab and docetaxel (pyrotinib arm) vs placebo, trastuzumab, and docetaxel (placebo arm) as neoadjuvant treatment in women with HER2+ early or locally advanced breast cancer (ClinicalTrials.gov: NCT03588091). We conducted this exploratory analysis to evaluate the effectiveness of proactive diarrhea management (PDM) according to the recommendation from independent data monitoring committee. Methods: Between July 23, 2018 and January 8, 2021, 355 patients were enrolled and randomized, of whom 212 and 143 patients were randomized before and after the implementation of PDM strategy. The diarrhea management strategy was strengthened with the early identification and proactive management of diarrhea, including use of loperamide as first choice of antidiarrheal agents and strict application of loperamide recommended dose (4 mg initially and an additional 2 mg following each diarrhea stool, not exceeding 16 mg/day). Primary prophylaxis with loperamide was not allowed. The incidence, severity, onset, and duration of diarrhea were summarized. The data cutoff date was April 30, 2021. Results: Of all 178 patients with pyrotinib arm, there were 43 (40.6%) and 56 (77.8%) patients applied loperamide as the first choice of antidiarrheal agents before and after the PDM implementation, respectively. The incidence of grade 3 diarrhea has decreased from 50.0% before the PDM implementation to 36.1% after the PDM implementation (Table 1). During neoadjuvant treatment period, grade 3 diarrhea mainly occurred during the first cycle of treatment for both treatment arms (C1: 20.8%), showing a sharp decreased trend during the following cycles (C2: 8.7%; C3: 5.4%; C4: 4.5%). Furthermore, among patients with pyrotinib arm, the incidences of grade 3 diarrhea in the first, second cycle and thereafter were lower in patients enrolled after the implementation of PDM than those enrolled before the PDM implementation (C1: 29.2%. vs 44.3%; C2: 10.1% vs 21.8%; C3: 7.2% vs 14.1%; C4: 4.5% vs 11.1%). Among patients with pyrotinib, compared with those enrolled before the PDM implementation, the median duration per diarrhea episode (4 days [IQR, 2-9] vs 2 days [1-5]), median duration per grade 3 diarrhea episode (2 days [IQR, 2-3] vs 2 days [1-2]), and median cumulative duration of grade 3 diarrhea (6 days [IQR, 3-9] vs 2 [2-5] days) were shortened in those enrolled after the PDM implementation. During neoadjuvant treatment period, 31 (17.4%) patients experienced diarrhea leading to pyrotinib dose reduction, and only 1 (0.6%) patient discontinued study treatment due to diarrhea in the pyrotinib arm. Conclusion: Pyrotinib tolerability was improved with PDM, which reduced the incidence and duration of grade 3 diarrhea. Grade 3 diarrhoea occurred mainly during the first cycle of treatment and reduced in the second cycle and thereafter. Diarrhea in the pyrotinib group was characterized by early onset and short duration and was generally manageable.
Table 1.Characteristics of treatment-emergent diarrheaBEFORE the implementation of PDMAFTER the implementation of PDMPyrotinib+Trastuzumab+Docetaxel(N=106)Placebo+Trastuzumab+Docetaxel(N=106)Pyrotinib+Trastuzumab+Docetaxel(N=72)Placebo+Trastuzumab+Docetaxel(N=71)Diarrhea incidence, n (%)All grade106 (100.0)57 (53.8)72 (100.0)36 (50.7)Grade 112 (11.3)32 (30.2)7 (9.7)28 (39.4)Grade 241 (38.7)18 (17.0)39 (54.2)6 (8.5)Grade 353 (50.0)7 (6.6)26 (36.1)2 (2.8)Cycle 147 (44.3)4 (3.8)21 (29.2)2 (2.8)Cycle 222 (21.8)2 (1.9)7 (10.1)0Cycle 314 (14.1)05 (7.2)0Cycle 411 (11.1)2 (1.9)3 (4.5)0Grade 4 or 50000Median time to the first onset, days (IQR)All grade4 (2 to 5)7 (4 to 28)3 (2 to 4)6 (5 to 12)Grade 39 (5 to 11)16 (7 to 24)9 (6 to 12)11 (6 to 16)Median duration per diarrhea episode, days (IQR)All grade4 (2 to 9)2 (2 to 4)2 (1 to 5)2 (1 to 3)Grade 32 (2 to 3)2 (2 to 2)2 (1 to 2)1 (1 to 1)Median cumulative duration, days (IQR)Grade 36 (3 to 9)2 (2 to 3)2 (2 to 5)1 (1 to 1)Median time since the first onset to recovery, days (IQR)All grade7 (3 to 12)2 (2 to 4)3 (1 to 10)2 (1 to 4)Note: PDM, proactive diarrhea management; IQR, interquartile range.
Citation Format: Benlong Yang, Jiong Wu, Zhenzhen Liu, Hongjian Yang, Jinhai Tang, Kun Wang, Yunjiang Liu, Haibo Wang, Peifen Fu, Shuqun Zhang, Qiang Liu, Zefei Jiang, Shusen Wang, Jian Huang, Chuan Wang, Shu Wang, Yongsheng Wang, Linlin Zhen, Fei Wu, Shulin Liu, Xiang Lin, Jianjun Zou. Proactive diarrhea management improved tolerability of pyrotinib in combination with trastuzumab and docetaxel in patients with HER2+ early or locally advanced breast cancer: Exploratory analysis from randomized, double-blind, phase 3 PHEDRA study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-18-06.
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Affiliation(s)
- Benlong Yang
- Fudan University Cancer Hospital, Shanghai, China
| | - Jiong Wu
- Fudan University Cancer Hospital, Shanghai, China
| | - Zhenzhen Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | | | - Jinhai Tang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kun Wang
- Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yunjiang Liu
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haibo Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Peifen Fu
- The First Affiliated Hospital Zhejiang University, Hangzhou, China
| | - Shuqun Zhang
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zefei Jiang
- The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shusen Wang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jian Huang
- The Second Affiliated Hospital Zhejiang University, Hangzhou, China
| | - Chuan Wang
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Shu Wang
- Peking University People's Hospital, Beijing, China
| | | | - Linlin Zhen
- Huai'an First People's Hospital, Huai'an, China
| | - Fei Wu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Shulin Liu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Xiang Lin
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
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Xu B, Yan M, Ma F, Hu X, Feng J, Ouyang Q, Tong Z, Li H, Zhang Q, Sun T, Wang X, Yin Y, Cheng Y, Li W, Zhu X, Chen C, Zou J. Abstract GS3-02: Updated overall survival (OS) results from the phase 3 PHOEBE trial of pyrotinib versus lapatinib in combination with capecitabine in patients with HER2-positive metastatic breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs3-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pyrotinib (an irreversible tyrosine kinase inhibitor targeting EGFR, HER2 and HER4) plus capecitabine significantly improved progression-free survival (PFS) compared with that for lapatinib plus capecitabine in women with HER2-positive metastatic breast cancer after treatment with trastuzumab and taxanes in the interim analysis of the PHOEBE trial (NCT03080805; Xu et al. Lancet Oncology, 2021). In this report, we present an updated analysis of the overall survival data from this trial. Methods: This PHOEBE trial enrolled patients with HER2-positive metastatic breast cancer who had received prior trastuzumab and taxanes and up to two prior lines of chemotherapy for metastatic disease. Patients were randomly assigned (1:1) to receive either oral pyrotinib 400 mg or lapatinib 1250 mg once daily, combined with oral capecitabine 1000 mg/m² twice daily on days 1-14 of each 21-day cycle. Stratification factors were hormone receptor status (estrogen receptor [ER]- and/or progesterone receptor [PR]-positive vs. ER- and PR-negative) and previous lines of chemotherapy for metastatic disease (≤1 vs 2). The primary endpoint was PFS assessed by masked independent central review. Data cutoff for the updated overall survival analysis was March 31, 2021. Results: Between July 31, 2017 and October 30, 2018, 267 eligible patients were enrolled and randomized to either pyrotinib plus capecitabine (pyrotinib group) or lapatinib plus capecitabine (lapatinib group). 134 patients in pyrotinib group and 132 in lapatinib group started the assigned treatment. At data cutoff, the median follow-up duration was 33.2 months (95% CI 31.4-34.2) in the pyrotinib group and 31.8 months (95% CI 31.2-34.1) in the lapatinib group. 78 (58.2%) patients in the pyrotinib group and 98 (74.2%) patients in the lapatinib group received post-discontinuation therapy, with trastuzumab (60 [44.8%] in the pyrotinib group and 65 [49.2%] in the lapatinib group) being the most common. As of data cutoff date, 54 (40.3%) of 134 patients randomly assigned to the pyrotinib group and 69 (52.3%) of the 132 patients randomly assigned to lapatinib group had died. Median OS was not reached (95% CI 34.0-not reached) in the pyrotinib group and 26.9 months (22.4-not reached) in the lapatinib group (HR 0.69 [95% CI 0.48-0.98]; P=0.019). Kaplan-Meier estimated OS at 24 months was 66.6% (95% CI 57.7-74.0) and 58.8% (95% CI 49.7-66.7), respectively. 99 (73.9%) patients in the pyrotinib group and 121 (91.7%) in the lapatinib group had disease progression or had died. Pyrotinib plus capecitabine significantly improved PFS assessed by investigator compared with that for lapatinib plus capecitabine (12.5 months [95% CI 9.8-13.8] vs 5.6 months [95% CI 5.5-7.0]; HR 0.48 [95% CI 0.37-0.63]; P<0.0001). The benefits of pyrotinib plus capecitabine were observed in most clinically relevant subgroups for the updated analysis of both OS and PFS (Table 1). Conclusion: With extended follow-up, pyrotinib plus capecitabine demonstrated statistically significant OS improvement compared with lapatinib plus capecitabine in patients with HER2-positive metastatic breast cancer after trastuzumab and chemotherapy. This updated analysis of overall survival in the PHOEBE trial reaffirmed pyrotinib plus capecitabine as an established treatment option in this patient population.
Table 1.Subgroup analysis of OS and PFS per investigator.HR for OSHR for PFSAll Patients0.69 (0.48-0.98)0.48 (0.37-0.63)Trastuzumab therapy for metastatic disease<3 months0.67 (0.33-1.35)0.34 (0.17-0.69)3-6 months0.78 (0.34-1.76)0.66 (0.32-1.34)≥3 months0.79 (0.37-1.66)0.44 (0.26-0.75)Trastuzumab resistanceNo0.60 (0.39-0.91)0.44 (0.32-0.61)Yes0.94 (0.48-1.85)0.58 (0.35-0.98)HER2 amplification by FISH0.76 (0.39-1.51)0.57 (0.35-0.92)Pathological gradingII0.65 (0.33-1.28)0.51 (0.31-0.85)III0.82 (0.41-1.65)0.51 (0.31-0.83)Unknown0.70 (0.41-1.21)0.45 (0.29-0.70)Visceral lesionsVisceral0.59 (0.40-0.88)0.45 (0.33-0.62)Non-visceral1.28 (0.55-2.95)0.57 (0.31-1.04)ECOG performance status00.72 (0.40-1.29)0.42 (0.26-0.66)10.67 (0.43-1.04)0.50 (0.36-0.71)Estrogen and progesterone receptor statusPositive0.74 (0.44-1.25)0.58 (0.39-0.86)Negative0.64 (0.39-1.04)0.41 (0.28-0.60)Previous lines of chemotherapy for metastatic disease00.72 (0.38-1.35)0.47 (0.30-0.74)10.73 (0.44-1.22)0.49 (0.32-0.73)20.56 (0.24-1.32)0.56 (0.28-1.08)Data are median (95% CI). HRs are from unstratified analyses.
Citation Format: Binghe Xu, Min Yan, Fei Ma, Xichun Hu, Jifeng Feng, Quchang Ouyang, Zhongsheng Tong, Huiping Li, Qingyuan Zhang, Tao Sun, Xian Wang, Yongmei Yin, Ying Cheng, Wei Li, Xiaoyu Zhu, Chunxia Chen, Jianjun Zou. Updated overall survival (OS) results from the phase 3 PHOEBE trial of pyrotinib versus lapatinib in combination with capecitabine in patients with HER2-positive metastatic breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS3-02.
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Affiliation(s)
- Binghe Xu
- Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Min Yan
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Fei Ma
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xichun Hu
- Fudan University Cancer Hospital, Shanghai, China
| | | | - Quchang Ouyang
- Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhongsheng Tong
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | | | - Qingyuan Zhang
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Tao Sun
- Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Xian Wang
- Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, China
| | - Yongmei Yin
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | | | - Wei Li
- The First Bethune Hospital of Jilin University, Changchun, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Chunxia Chen
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
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Chen L, Jiang YZ, Wu S, Wu J, Di G, Liu G, Yu K, Fan L, Li J, Hou Y, Hu Z, Chen C, Huang X, Cao A, Hu X, Zhao S, Ma X, Zhu X, Zou J, Yang W, Wang Z, Shao ZM. Abstract P2-14-04: Updated data from FUTURE-C-PLUS: Combination of famitinib with camrelizumab plus nab-paclitaxel as first-line treatment for advanced, immunomodulatory triple-negative breast cancer, an open-label, single-arm, phase 2 trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-14-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Camrelizumab and nab-paclitaxel demonstrated promising anti-tumour activity in refractory metastatic immunomodulatory triple-negative breast cancer (TNBC) in FUTURE trial. Anti-angiogenic agents have been reported to facilitate immune infiltration. Famitinib is a tyrosine kinase inhibitor targeting VEGFR-2, PDGFR and c-kit. The FUTURE-C-PLUS trial (NCT04129996) which added famitinib to camrelizumab and nab-paclitaxel is a single-arm, phase 2 trial evaluating this novel triplet combinatorial strategy in patients with advanced immunomodulatory TNBC. Study design and the primary endpoint ORR has been reported previously (Zhi-ming Shao, et al. ASCO 2021, Abstract 1007). Here, we reported the updated results of this trial. Method Briefly, this study enrolled women aged 18-70 years, with previously untreated, histologically confirmed, unresectable, locally advanced, recurrent or metastatic immunomodulatory TNBC. Immunomodulatory TNBC was defined as CD8 expression on at least 10% of cells using immunohistochemistry analysis. Eligible patients received the triple therapy. Study design has been reported previously in ASCO 2021. Results Between Oct 2019 and Oct 2020, 48 patients were enrolled and treated. 39 (81.3%, 95% CI 70.2-92.3) patients had a confirmed objective response which has been reported in ASCO 2021. At this updating data cutoff (June 30, 2021), the median progression-free survival was 11.9 months (95% CI, 7.3-16.5) with the median follow-up was 14.0 months. While overall survival data were not mature yet, a promising overall survival rate was observed at 12 months (84•2%, 95% CI 73.4-95.0) and 18 months (73.6%, 95% CI 52.0-95.2). In the 39 responders, median duration of response was also not mature. The disease control rate was 95.8% (46/48). The most common treatment-related grade 3 or 4 adverse events were neutropenia (16 [33.3%]), anemia (5 [10.4%]), febrile neutropenia (5 [10.4%]), and thrombocytopenia (4 [8.3%]). No treatment-related deaths were reported. Conclusions These data, combined with those from our previous reports, provide further evidence for the triplet combination of famitinib, camrelizumab and nab-paclitaxel as an active therapy in advanced Immunomodulatory TNBC. To our knowledge, this is the best objective response rate reached in first-line treatment of advanced TNBC. A randomized controlled FUTURE-Super trial (NCT04395989) is keeping recruiting patients to further validate those findings.
Citation Format: Li Chen, Yi-Zhou Jiang, Songyang Wu, Jiong Wu, Genhong Di, Guangyu Liu, Keda Yu, Lei Fan, Junjie Li, Yifeng Hou, Zhen Hu, Canming Chen, Xiaoyan Huang, Ayong Cao, Xin Hu, Shen Zhao, Xiaoyan Ma, Xiaoyu Zhu, Jianjun Zou, Wentao Yang, Zhonghua Wang, Zhi-ming Shao. Updated data from FUTURE-C-PLUS: Combination of famitinib with camrelizumab plus nab-paclitaxel as first-line treatment for advanced, immunomodulatory triple-negative breast cancer, an open-label, single-arm, phase 2 trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-14-04.
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Affiliation(s)
- Li Chen
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yi-Zhou Jiang
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Songyang Wu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jiong Wu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Genhong Di
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Guangyu Liu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Keda Yu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lei Fan
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Junjie Li
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yifeng Hou
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhen Hu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Canming Chen
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoyan Huang
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ayong Cao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xin Hu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shen Zhao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoyan Ma
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Pharmaceuticals Co. Ltd, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co. Ltd, Shanghai, China
| | - Wentao Yang
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhonghua Wang
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhi-ming Shao
- Fudan University Shanghai Cancer Center, Shanghai, China
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Chen R, Guan X, Hu P, Dong Y, Zhu Y, Zhang T, Zou J, Zhang S. First-In-Human Study to Assess the Safety, Pharmacokinetics, and Pharmacodynamics of SHR2285, a Small-Molecule Factor XIa Inhibitor in Healthy Subjects. Front Pharmacol 2022; 13:821363. [PMID: 35222036 PMCID: PMC8866703 DOI: 10.3389/fphar.2022.821363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Targeting factor XI (FXI) is a promising therapeutic strategy for the treatment and prevention of thrombosis without increasing the risk of bleeding. Here, we assessed the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of SHR2285, a novel FXIa inhibitor, in healthy subjects.Methods: In this randomized, double-blinded, placebo-controlled, dose-ascending single-dosing trial (NCT03769831), eligible volunteer subjects receive either SHR2285 or placebo in a 3:1 ratio. Subjects assigned to the SHR2285 group received a single oral dose of SHR2285 at 50 mg, which was subsequently escalated to 100 mg, 200 mg, and 400 mg. Safety, pharmacokinetics, and pharmacodynamics parameters were assessed. All subjects were followed for 6 days.Results: SHR2285 was well tolerated. All adverse events were grade 1, and there was no evidence of bleeding events. The PK results revealed a rapid onset of action of SHR2285 (median time to maximum plasma concentration [Tmax] in different dose groups ranged 3.0–4.0 h) and the mean half-life ranged from 7.6 to 15.8 h. The metabolite SHR164471 had a slightly longer Tmax than the parent SHR2285, reaching a peak at a median of 6.0–7.0 h, and its mean half-life were 10.1–14.7 h in different dose groups. The sums of the area under the concentration–time curve from zero to time infinity of SHR2285 and SHR164471 in the 200 and 400 mg groups were similar, indicating the sum pharmacological activity of SHR2285 and SHR164471 showed a saturation trend between 200 and 400 mg. PD analysis showed that the inhibition of FXI activity was synchronized with prolonged activated partial thromboplastin time after SHR2285 administration, but the serum prothrombin time and international normalized ratio levels were not affected by SHR2285.Conclusion: SHR2285 demonstrated favorable safety, PK, and PD profiles in the dose range of 50 mg–400 mg. This first-in-human study supports the further development of SHR2285 for indications requiring anticoagulation.Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03769831, identifier [NCT03769831].
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Affiliation(s)
- Rui Chen
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoduo Guan
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pei Hu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanli Dong
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Yi Zhu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Tengfei Zhang
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Shuyang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Shuyang Zhang,
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Tang H, Cui B, Chen Y, Chen L, Wang Z, Zhang N, Yang Y, Wang X, Xie X, Sun L, Dang W, Wang X, Li R, Zou J, Zhao Y, Liu Y. Safety and efficacy of SHR4640 combined with febuxostat for primary hyperuricemia: a multicenter, randomized, double-blind, phase II study. Ther Adv Musculoskelet Dis 2022; 14:1759720X211067304. [PMID: 35126684 PMCID: PMC8808016 DOI: 10.1177/1759720x211067304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/30/2021] [Indexed: 02/05/2023] Open
Abstract
Background: To evaluate the safety, tolerability, and efficacy of SHR4640, a highly selective urate transporter-1 inhibitor, in combination with febuxostat, in patients with primary hyperuricemia. Methods: In this randomized, double-blind, parallel-controlled phase II study, patients whose fasting serum uric acid (sUA) levels were ⩾ 480 μmol/L at screening with gout or sUA levels were ⩾ 420 μmol/L lasting for at least 3 months without gout, either with sUA levels ⩾ 540 μmol/L at screening or sUA levels ⩾ 480 μmol/L with comorbidities at screening, were enrolled. Patients were randomized (1:1:1) to receive SHR4640 10 mg plus febuxostat 80 mg, SHR4640 10 mg plus febuxostat 40 mg, and SHR4640 5 mg plus febuxostat 20 mg orally once daily. The primary end point was the incidence of treatment-emergent adverse events (TEAEs). Results: A total of 93 patients were randomized and received treatment. TEAEs occurred in 55.9% of patients. The incidence of TEAEs was comparable among all the groups. Serious TEAEs occurred in one patient (1.1%), with no deaths observed. The proportion of patients who achieved the target sUA levels by week 4 was 79.3%, 96.6%, and 75.0% in the SHR4640 10 mg plus febuxostat 80 mg, SHR4640 10 mg plus febuxostat 40 mg, and SHR4640 5 mg plus febuxostat 20 mg groups, respectively. The mean percent reduction of sUA was 59.7%, 63.7%, and 41.8%, respectively. Conclusion: SHR4640 plus febuxostat exhibited a tolerable safety profile and substantial sUA lowering activity in patients with primary hyperuricemia. Registration: www.chinadrugtrials.org.cn; CTR 20192429
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Affiliation(s)
- Honghu Tang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Beibei Cui
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yiyu Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Lin Chen
- Department of Rheumatology and Immunology, Jilin Province People’s Hospital, Changchun, China
| | - Zhihong Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ning Zhang
- Department of Rheumatology and Immunology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yanlan Yang
- Department of Endocrinology, Shanxi Provincial People’s Hospital, Taiyuan, China
| | - Xiaodong Wang
- Department of Rheumatology and Osteology, The First Affiliated Hospital of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiangliang Xie
- Department of Rheumatology and Immunology, Maanshan People’s Hospital, Maanshan, China
| | - Lingyun Sun
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wantai Dang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xianyang Wang
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd. (formerly Jiangsu Hengrui Medicine Co., Ltd.), Shanghai, China
| | - Runzi Li
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd. (formerly Jiangsu Hengrui Medicine Co., Ltd.), Shanghai, China
| | - Jianjun Zou
- Clinical Research and Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd. (formerly Jiangsu Hengrui Medicine Co., Ltd.), Shanghai, China
| | - Yi Zhao
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, China
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Ge C, Zhang S, Mu H, Zheng S, Tan Z, Huang X, Xu C, Zou J, Zhu Y, Feng D, Aa J. Emerging Mechanisms and Disease Implications of Ferroptosis: Potential Applications of Natural Products. Front Cell Dev Biol 2022; 9:774957. [PMID: 35118067 PMCID: PMC8804219 DOI: 10.3389/fcell.2021.774957] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/09/2021] [Indexed: 01/09/2023] Open
Abstract
Ferroptosis, a newly discovered form of regulatory cell death (RCD), has been demonstrated to be distinct from other types of RCD, such as apoptosis, necroptosis, and autophagy. Ferroptosis is characterized by iron-dependent lipid peroxidation and oxidative perturbation, and is inhibited by iron chelators and lipophilic antioxidants. This process is regulated by specific pathways and is implicated in diverse biological contexts, mainly including iron homeostasis, lipid metabolism, and glutathione metabolism. A large body of evidence suggests that ferroptosis is interrelated with various physiological and pathological processes, including tumor progression (neuro)degenerative diseases, and hepatic and renal failure. There is an urgent need for the discovery of novel effective ferroptosis-modulating compounds, even though some experimental reagents and approved clinical drugs have been well documented to have anti- or pro-ferroptotic properties. This review outlines recent advances in molecular mechanisms of the ferroptotic death process and discusses its multiple roles in diverse pathophysiological contexts. Furthermore, we summarize chemical compounds and natural products, that act as inducers or inhibitors of ferroptosis in the prevention and treatment of various diseases. Herein, it is particularly highlighted that natural products show promising prospects in ferroptosis-associated (adjuvant) therapy with unique advantages of having multiple components, multiple biotargets and slight side effects.
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Affiliation(s)
- Chun Ge
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacy, School of Basic Medicine & Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Sujie Zhang
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacy, School of Basic Medicine & Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Huiwen Mu
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacy, School of Basic Medicine & Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Shaojun Zheng
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacy, School of Basic Medicine & Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Zhaoyi Tan
- Key Laboratory of Drug Metabolism and Pharmacokinetics, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Xintong Huang
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacy, School of Basic Medicine & Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Chen Xu
- Key Laboratory of Drug Metabolism and Pharmacokinetics, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacy, School of Basic Medicine & Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yubing Zhu
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacy, School of Basic Medicine & Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- *Correspondence: Yubing Zhu, ; Dong Feng, ; Jiye Aa,
| | - Dong Feng
- Key Laboratory of Drug Metabolism and Pharmacokinetics, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
- Nanjing Southern Pharmaceutical Technology Co., Ltd., Nanjing, China
- *Correspondence: Yubing Zhu, ; Dong Feng, ; Jiye Aa,
| | - Jiye Aa
- Key Laboratory of Drug Metabolism and Pharmacokinetics, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
- *Correspondence: Yubing Zhu, ; Dong Feng, ; Jiye Aa,
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Xu M, Zhu X, Wu J, Zhang Y, Zhao D, Wang X, Ding Y, Cao Y, Li C, Hu W, Sheng J, Luo Z, Zheng Z, Hu J, Liu J, Zhou X, Shen A, Ding X, Zhang Y, Zhao Y, Li Y, Zhong S, An S, Zou J, Yan L. PCSK9 inhibitor recaticimab for hypercholesterolemia on stable statin dose: a randomized, double-blind, placebo-controlled phase 1b/2 study. BMC Med 2022; 20:13. [PMID: 35039035 PMCID: PMC8763618 DOI: 10.1186/s12916-021-02208-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recaticimab (SHR-1209, a humanized monoclonal antibody against PCSK9) showed robust LDL-C reduction in healthy volunteers. This study aimed to further assess the efficacy and safety of recaticimab in patients with hypercholesterolemia. METHODS In this randomized, double-blind, placebo-controlled phase 1b/2 trial, patients receiving stable dose of atorvastatin with an LDL-C level of 2.6 mmol/L or higher were randomized in a ratio of 5:1 to subcutaneous injections of recaticimab or placebo at different doses and schedules. Patients were recruited in the order of 75 mg every 4 weeks (75Q4W), 150Q8W, 300Q12W, 150Q4W, 300Q8W, and 450Q12W. The primary endpoint was percentage change in LDL-C from the baseline to end of treatment (i.e., at week 16 for Q4W and Q8W schedule and at week 24 for Q12W schedule). RESULTS A total of 91 patients were enrolled and received recaticimab and 19 received placebo. The dose of background atorvastatin in all 110 patients was 10 or 20 mg/day. The main baseline LDL-C ranged from 3.360 to 3.759 mmol/L. The least-squares mean percentage reductions in LDL-C from baseline to end of treatment relative to placebo for recaticimab groups at different doses and schedules ranged from -48.37 to -59.51%. No serious treatment-emergent adverse events (TEAEs) occurred. The most common TEAEs included upper respiratory tract infection, increased alanine aminotransferase, increased blood glucose, and increased gamma-glutamyltransferase. CONCLUSION Recaticimab as add-on to moderate-intensity statin therapy significantly and substantially reduced the LDL-C level with an infrequent administration schedule (even given once every 12 weeks), compared with placebo. TRIAL REGISTRATION ClinicalTrials.gov , number NCT03944109.
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Affiliation(s)
- Mingtong Xu
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China
| | - Xiaoxue Zhu
- Phase I Clinical Trials Unit, The First Hospital of Jilin University, Changchun, China
| | - Junyan Wu
- Department of Pharmacy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuling Zhang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dong Zhao
- Endocrinology Center, Capital Medical University, Beijing Luhe Hospital, Beijing, China
| | - Xuhong Wang
- Endocrinology Center, Capital Medical University, Beijing Luhe Hospital, Beijing, China
| | - Yanhua Ding
- Phase I Clinical Trials Unit, The First Hospital of Jilin University, Changchun, China
| | - Yu Cao
- Phase I Clinical Research Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chengqian Li
- Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei Hu
- Department of Pharmacology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jianlong Sheng
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhu Luo
- Department of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zeqi Zheng
- Department of Cardiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinfang Hu
- Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianying Liu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoyang Zhou
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Aizong Shen
- Department of Pharmacy, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xiaomei Ding
- Department of Cardiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yongdong Zhang
- Department of Pharmacy, Chenzhou First People's Hospital, Chenzhou, China
| | - Yonggang Zhao
- Department of Emergency Medicine, Chenzhou First People's Hospital, Chenzhou, China
| | - Yijing Li
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Sheng Zhong
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Shimin An
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang Road West, Guangzhou, 510120, China.
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Zheng X, Wang F, Zhang J, Cui X, Jiang F, Chen N, Zhou J, Chen J, Lin S, Zou J. Using machine learning to predict atrial fibrillation diagnosed after ischemic stroke. Int J Cardiol 2022; 347:21-27. [PMID: 34774886 DOI: 10.1016/j.ijcard.2021.11.005] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/26/2021] [Accepted: 11/07/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Selecting best candidates for prolonged poststroke cardiac monitoring in acute ischemic stroke (AIS) patients is still challenging. We aimed to develop a machine learning (ML) model to select AIS patients at high risk of poststroke atrial fibrillation (AF) for prolonged cardiac monitoring and then to compare ML model with traditional risk scores and classic statistical logistic regression (classic-LR) model. METHODS AIS patients from July 2012 to September 2020 across Nanjing First Hospital were collected. We performed the LASSO regression for selecting the critical features and built five ML models to assess the risk of poststroke AF. The SHAP and partial dependence plot (PDP) method were introduced to interpret the optimal model. We also compared ML model with CHADS2 score, CHA2DS2-VASc score, AS5F score, HAVOC score, and classic-LR model. RESULTS A total of 3929 AIS patients were included. Among the five ML models, deep neural network (DNN) was the model with best performance. It also exhibited superior performance compared with CHADS2 score, CHA2DS2-VASc score, AS5F score, HAVOC score and classic-LR model. The results of SHAP and PDP method revealed age, cardioembolic stroke, large-artery atherosclerosis stroke, and NIHSS score at admission were the top four important features and revealed the DNN model had good interpretability and reliability. CONCLUSION The DNN model achieved best performance and improved prediction performance compared with traditional risk scores and classic-LR model. The DNN model can be applied to identify AIS patients at high risk of poststroke AF as best candidates for prolonged poststroke cardiac monitoring.
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Affiliation(s)
- Xiaohan Zheng
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fusang Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Juan Zhang
- Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoli Cui
- Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Fuping Jiang
- Department of Geriatrics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Nihong Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jinsong Chen
- Department of Cardiovascular Medicine, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
| | - Song Lin
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Lin X, Lin S, Cui X, Zou D, Jiang F, Zhou J, Chen N, Zhao Z, Zhang J, Zou J. Prediction-Driven Decision Support for Patients With Mild Stroke: A Model Based on Machine Learning Algorithms. Front Neurol 2022; 12:761092. [PMID: 35002923 PMCID: PMC8733999 DOI: 10.3389/fneur.2021.761092] [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: 08/19/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: Treatment for mild stroke remains an open question. We aim to develop a decision support tool based on machine learning (ML) algorithms, called DAMS (Disability After Mild Stroke), to identify mild stroke patients who would be at high risk of post-stroke disability (PSD) if they only received medical therapy and, more importantly, to aid neurologists in making individual clinical decisions in emergency contexts. Methods: Ischemic stroke patients were prospectively recorded in the National Advanced Stroke Center of Nanjing First Hospital (China) between July 2016 and September 2020. The exclusion criteria were patients who received thrombolytic therapy, age <18 years, lack of 3-month modified Rankin Scale (mRS), disabled before the index stroke, with an admission National Institute of Health stroke scale (NIHSS) > 5. The primary outcome was PSD, corresponding to 3-month mRS ≥ 2. We developed five ML models and assessed the area under curve (AUC) of receiver operating characteristic, calibration curve, and decision curve analysis. The optimal ML model was selected to be DAMS. In addition, SHapley Additive exPlanations (SHAP) approach was introduced to rank the feature importance. Finally, rapid-DAMS (R-DAMS) was constructed for a more urgent situation based on DAMS. Results: A total of 1,905 mild stroke patients were enrolled in this study, and patients with PSD accounted for 23.4% (447). There was no difference in AUCs between the five models (ranged from 0.691 to 0.823). Although there was similar discriminative performance between ML models, the support vector machine model exhibited higher net benefit and better calibration (Brier score, 0.159, calibration slope, 0.935, calibration intercept, 0.035). Therefore, this model was selected for DAMS. In addition, SHAP approach showed that the most crucial feature was NIHSS on admission. Finally, R-DAMS was constructed and there was similar discriminative performance between R-DAMS and DAMS, but the former performed worse on calibration. Conclusions: DAMS and R-DAMS, as prediction-driven decision support tools, were designed to aid clinical decision-making for mild stroke patients in emergency contexts. In addition, even within a narrow range of baseline scores, NIHSS on admission is the strongest feature that contributed to the prediction.
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Affiliation(s)
- Xinping Lin
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shiteng Lin
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - XiaoLi Cui
- Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Daizun Zou
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.,Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - FuPing Jiang
- Department of Geriatrics, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - JunShan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - NiHong Chen
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhihong Zhao
- Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Juan Zhang
- Department of Neurology, Nanjing Yuhua Hospital, Yuhua Branch of Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.,Department of Clinical Pharmacology, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
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Jiang T, Chen J, Xu X, Cheng Y, Chen G, Pan Y, Fang Y, Wang Q, Huang Y, Yao W, Wang R, Li X, Zhang W, Zhang Y, Hu S, Guo R, Shi J, Wang Z, Cao P, Wang D, Fang J, Luo H, Geng Y, Xing C, Lv D, Zhang Y, Yu J, Cang S, Zhang Y, Zhang J, Yang Z, Shi W, Zou J, Zhou C, Ren S. On-treatment blood TMB as predictors for camrelizumab plus chemotherapy in advanced lung squamous cell carcinoma: biomarker analysis of a phase III trial. Mol Cancer 2022; 21:4. [PMID: 34980131 PMCID: PMC8722280 DOI: 10.1186/s12943-021-01479-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 09/18/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Camrelizumab plus chemotherapy significantly prolonged progression-free survival (PFS) and overall survival (OS) compared to chemotherapy alone as first-line treatment in advanced lung squamous cell carcinoma (LUSC) in the phase III trial (CameL-sq), which has become an option of standard-of-cares for Chinese patients with advanced LUSC. However, the predictive biomarkers remain unknown. Methods Tumor tissue samples at baseline, and peripheral blood samples at baseline (pretreatment) and after two cycles of treatment (on-treatment) were prospectively collected from 270 LUSC patients from the CameL-sq study. Blood tumor mutation burden (bTMB) and its dynamics were analyzed to explore their predictive values. Results Pretreatment bTMB was not associated with objective response, PFS and OS in camrelizumab or placebo plus chemotherapy groups. Low on-treatment bTMB was associated with significantly better objective response (73.8% vs 27.8%, P < 0.001), PFS (median, 9.1 vs 4.1 months; P < 0.001) and OS (median, not reached vs 8.0 months; P < 0.001) in camrelizumab plus chemotherapy group whereas it did not correlate with objective response and PFS in chemotherapy alone group. Importantly, on-treatment bTMB level could discriminate patients of initially radiological stable disease who would long-term benefit from camrelizumab plus chemotherapy (low vs high, median OS, 18.2 vs 7.8 months; P = 0.001). Combing on-treatment bTMB and its dynamics improved the ability for predicting the efficacy of camrelizumab plus chemotherapy. Conclusion On-treatment bTMB together with its dynamics could serve as a predictive biomarker for camrelizumab plus chemotherapy in patients with advanced LUSC. Trial registration ClinicalTrials.gov identifier: NCT03668496. Supplementary Information The online version contains supplementary material available at 10.1186/s12943-021-01479-4.
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Affiliation(s)
- Tao Jiang
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No.507, Zhengmin Road, Shanghai, 200433, China
| | | | - Xingxiang Xu
- Northern Jiangsu People's Hospital, Yangzhou, China
| | | | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | | | - Yong Fang
- Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, China
| | | | - Yunchao Huang
- Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Centre, Kunming, China
| | - Wenxiu Yao
- Sichuan Provincial Cancer Hospital, Chengdu, China
| | - Rui Wang
- Anhui Chest Hospital, Hefei, China
| | - Xingya Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Zhang
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanjun Zhang
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Sheng Hu
- Hubei Cancer Hospital, Wuhan, China
| | - Renhua Guo
- Jiangsu Province Hospital, Nanjing, China
| | | | - Zhiwu Wang
- Tangshan People's Hospital, Tangshan, China
| | - Peiguo Cao
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Donglin Wang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Jian Fang
- Beijing Cancer Hospital, Beijing, China
| | - Hui Luo
- Jiangxi Cancer Hospital, Nanchang, China
| | - Yi Geng
- Baoji Central Hospital, Baoji, China
| | | | - Dongqing Lv
- Taizhou Hospital of Zhejiang Province, Taizhou, China
| | | | - Junyan Yu
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Shundong Cang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Yaxi Zhang
- Genecast Biotechnology Co., Ltd., Wuxi City, China
| | - Jiao Zhang
- Genecast Biotechnology Co., Ltd., Wuxi City, China
| | - Zeyu Yang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Wei Shi
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No.507, Zhengmin Road, Shanghai, 200433, China.
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, No.507, Zhengmin Road, Shanghai, 200433, China.
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Mei H, Chen X, Zhou J, Luo J, Shi Q, Liu J, Wu D, Chen G, Tai Y, Xiong J, Zou J, Hu Y. Safety and efficacy of hetrombopag in patients with chronic immune thrombocytopenia: a single-arm, open-label, multi-center phase 1 study. Ann Transl Med 2022; 10:30. [PMID: 35282136 PMCID: PMC8848441 DOI: 10.21037/atm-21-4361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Heng Mei
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiequn Chen
- Hematology Department, The First Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Jianfeng Zhou
- Hematology Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianmin Luo
- Hematology Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingzhi Shi
- Hematology Department, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Liu
- Hematology Department, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Depei Wu
- Hematology Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoan Chen
- Hematology Department, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanfei Tai
- Department of Clinical Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Junye Xiong
- Department of Clinical Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Department of Clinical Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Yu Hu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ren S, Chen J, Xu X, Jiang T, Cheng Y, Chen G, Pan Y, Fang Y, Wang Q, Huang Y, Yao W, Wang R, Li X, Zhang W, Zhang Y, Hu S, Guo R, Shi J, Wang Z, Cao P, Wang D, Fang J, Luo H, Geng Y, Xing C, Lv D, Zhang Y, Yu J, Cang S, Yang Z, Shi W, Zou J, Zhou C. Camrelizumab plus carboplatin and paclitaxel as first-line treatment for advanced squamous non-small-cell lung cancer (CameL-sq): a phase 3 trial. J Thorac Oncol 2021; 17:544-557. [PMID: 34923163 DOI: 10.1016/j.jtho.2021.11.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Camrelizumab, a humanized IgG4-κ monoclonal antibody against PD-1, has demonstrated anti-tumor activity and tolerability across various tumors, including lung cancers. We conducted this double-blind, randomized phase 3 trial to investigate the efficacy and safety of camrelizumab or placebo plus chemotherapy as first-line treatment for patients with advanced squamous non-small-cell lung cancer (NSCLC). The predictive value of circulating tumor DNA (ctDNA) dynamics was also analyzed. METHODS CameL-sq, a double-blind, randomized phase 3 trial (NCT03668496), was conducted in 53 centers in China. 389 patients with stage IIIB-IV squamous NSCLC were randomized (1:1) to receive 4-6 cycles of carboplatin plus paclitaxel with camrelizumab or placebo (q3w), followed by maintenance therapy with camrelizumab or placebo. Peripheral blood ctDNA samples were collected at the baseline and the time after two cycles of treatment. RESULTS Of 389 eligible patients, 193 patients allocated camrelizumab plus chemotherapy and 196 patients allocated placebo plus chemotherapy were included in the efficacy and safety analysis. The results showed significantly prolonged progression-free survival (PFS, median, 8·5 vs 4.9 months; p<0.0001) and overall survival (OS, median, not reached vs 14.5 months; p<0.0001) with camrelizumab-chemotherapy versus placebo-chemotherapy. No unexpected treatment/immune-related adverse events were observed in both two groups. Biomarker analysis revealed that ctDNA clearance after two cycles treatment was independently associated with dramatically longer PFS (p<0.0001) and OS (p<0.0001) in camrelizumab plus chemotherapy group. CONCLUSIONS Our findings support camrelizumab plus chemotherapy as a first-line treatment option in advanced squamous NSCLC. On-treatment ctDNA dynamics showed the potent to predict the efficacy of camrelizumab plus chemotherapy.
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Affiliation(s)
- Shengxiang Ren
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Xingxiang Xu
- Northern Jiangsu People's Hospital, Yangzhou, China
| | - Tao Jiang
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | | | - Yong Fang
- Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, China
| | | | - Yunchao Huang
- Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Centre, Kunming, China
| | - Wenxiu Yao
- Sichuan Provincial Cancer Hospital, Chengdu, China
| | - Rui Wang
- Anhui Chest Hospital, Hefei, China
| | - Xingya Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Zhang
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yanjun Zhang
- Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Sheng Hu
- Hubei Cancer Hospital, Wuhan, China
| | - Renhua Guo
- Jiangsu Province Hospital, Nanjing, China
| | | | - Zhiwu Wang
- Tangshan People's Hospital, Tangshan, China
| | - Peiguo Cao
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Donglin Wang
- Chongqing University Cancer Hospital, Chongqing, China
| | - Jian Fang
- Beijing Cancer Hospital, Beijing, China
| | - Hui Luo
- Jiangxi Cancer Hospital, Nanchang, China
| | - Yi Geng
- Baoji Central Hospital, Baoji, China
| | | | - Dongqing Lv
- Taizhou Hospital of Zhejiang Province, Taizhou, China
| | | | - Junyan Yu
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Shundong Cang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Zeyu Yang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Wei Shi
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Yang Y, Zhou T, Chen X, Li J, Pan J, He X, Lin L, Shi YR, Feng W, Xiong J, Yang K, Yu Q, Zhang Q, Hu D, Sun Y, Hu G, Li P, Shen L, Lin Q, Zhang B, Qu X, Zou J, Zhang L, Fang W, Zhao Y. Efficacy, safety, and biomarker analysis of Camrelizumab in Previously Treated Recurrent or Metastatic Nasopharyngeal Carcinoma (CAPTAIN study). J Immunother Cancer 2021; 9:e003790. [PMID: 34933967 PMCID: PMC8693086 DOI: 10.1136/jitc-2021-003790] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the antitumor activity of camrelizumab, an antiprogrammed cell death-1 antibody, in pretreated recurrent or metastatic nasopharyngeal carcinoma (NPC) and to explore predictive biomarkers. METHODS Patients with recurrent (not amenable to locally curative treatment) or metastatic NPC who had failed at least two lines of chemotherapy were eligible to receive camrelizumab (200 mg intravenously every 2 weeks) for 2 years or until disease progression, intolerable adverse events, withdrawal of consents, or investigator decision. The primary endpoint was objective response rate (ORR) assessed by an independent review committee (IRC). Programmed cell death-ligand 1 (PD-L1) expression was assessed by immunohistochemistry. Other immune-related biomarkers including major histocompatibility complex class I and major histocompatibility complex class II (MHC-II) were assessed by multiplex immunofluorescence staining. RESULTS Between August 14, 2018, and December 30, 2019, a total of 156 patients were enrolled. The IRC-assessed ORR was 28.2% (95% CI 21.3% to 36.0%). The median progression-free survival was 3.7 months (95% CI 2.0 to 4.1) per IRC, and the median overall survival was 17.4 months (95% CI 15.2 to 21.9). The ORRs were 35.2% (95% CI 25.3% to 46.1%) vs 19.4% (95% CI 10.4% to 31.4%) in patients with tumor PD-L1 expression of ≥10% and<10%, respectively. Patients with durable clinical benefit (DCB), which was defined as complete response, partial response or stable disease of ≥18 weeks, had higher density of MHC-II+ cell in stroma than patients without DCB (median 868.1 (IQR 413.4-2854.0) cells/mm2 vs median 552.4 (IQR 258.4 to 1242.1) cells/mm2). MHC-II+ cell density did not correlate with PD-L1 expression, and a composite of high stromal MHC-II+ cell density and tumor PD-L1 expression further enriched patients who could benefit from camrelizumab. CONCLUSIONS Camrelizumab had clinically meaningful antitumor activity in patients with recurrent or metastatic NPC. The composition of both MHC-II+ cell density and PD-L1 expression could result in better patient selection.
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Affiliation(s)
- Yunpeng Yang
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ting Zhou
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaozhong Chen
- Department of Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jingao Li
- Department of Head and Neck Radiotherapy, Jiangxi Cancer Hospital of Nanchang University, Nanchang, China
| | - Jianji Pan
- Department of Head and Neck Radiation Oncology, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaohui He
- Department of Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Lizhu Lin
- Department of Oncology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Ying-Rui Shi
- Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Weineng Feng
- Department of Head, Neck and Thoracic Oncology, Foshan First People's Hospital, Foshan, China
| | - Jianping Xiong
- Department of Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kunyu Yang
- Department of Head and Neck Oncology, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, China
| | - Qitao Yu
- Department of Respiratory Oncology, Guangxi Medical University Affiliated Tumor Hospital, Nanning, China
| | - Qunling Zhang
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Desheng Hu
- Department of Head and Neck Tumor Radiotherapy, Hubei Cancer Hospital, Wuhan, China
| | - Yan Sun
- Department of Radiotherapy, Beijing Cancer Hospital, Beijing, China
| | - Guangyuan Hu
- Department of Comprehensive Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Li
- Department of Head and Neck Oncology, West China School of Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Qin Lin
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ben Zhang
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Xiao Qu
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Jianjun Zou
- Clinical Research & Development, Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Li Zhang
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wenfeng Fang
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuanyuan Zhao
- Department of Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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Wu H, Ji J, Tian H, Chen Y, Ge W, Zhang H, Yu F, Zou J, Nakamura M, Liao J. Chinese-Named Entity Recognition From Adverse Drug Event Records: Radical Embedding-Combined Dynamic Embedding-Based BERT in a Bidirectional Long Short-term Conditional Random Field (Bi-LSTM-CRF) Model. JMIR Med Inform 2021; 9:e26407. [PMID: 34855616 PMCID: PMC8686410 DOI: 10.2196/26407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/22/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022] Open
Abstract
Background With the increasing variety of drugs, the incidence of adverse drug events (ADEs) is increasing year by year. Massive numbers of ADEs are recorded in electronic medical records and adverse drug reaction (ADR) reports, which are important sources of potential ADR information. Meanwhile, it is essential to make latent ADR information automatically available for better postmarketing drug safety reevaluation and pharmacovigilance. Objective This study describes how to identify ADR-related information from Chinese ADE reports. Methods Our study established an efficient automated tool, named BBC-Radical. BBC-Radical is a model that consists of 3 components: Bidirectional Encoder Representations from Transformers (BERT), bidirectional long short-term memory (bi-LSTM), and conditional random field (CRF). The model identifies ADR-related information from Chinese ADR reports. Token features and radical features of Chinese characters were used to represent the common meaning of a group of words. BERT and Bi-LSTM-CRF were novel models that combined these features to conduct named entity recognition (NER) tasks in the free-text section of 24,890 ADR reports from the Jiangsu Province Adverse Drug Reaction Monitoring Center from 2010 to 2016. Moreover, the man-machine comparison experiment on the ADE records from Drum Tower Hospital was designed to compare the NER performance between the BBC-Radical model and a manual method. Results The NER model achieved relatively high performance, with a precision of 96.4%, recall of 96.0%, and F1 score of 96.2%. This indicates that the performance of the BBC-Radical model (precision 87.2%, recall 85.7%, and F1 score 86.4%) is much better than that of the manual method (precision 86.1%, recall 73.8%, and F1 score 79.5%) in the recognition task of each kind of entity. Conclusions The proposed model was competitive in extracting ADR-related information from ADE reports, and the results suggest that the application of our method to extract ADR-related information is of great significance in improving the quality of ADR reports and postmarketing drug safety evaluation.
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Affiliation(s)
- Hong Wu
- School of Science, China Pharmaceutical University, Nanjing, China
| | - Jiatong Ji
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Haimei Tian
- School of Computer Engineering, Jinling Institute of Technology, Nanjing, China
| | - Yao Chen
- School of Science, China Pharmaceutical University, Nanjing, China
| | - Weihong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, China
| | - Haixia Zhang
- Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, China
| | - Feng Yu
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Mitsuhiro Nakamura
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, Gifu, Japan
| | - Jun Liao
- School of Science, China Pharmaceutical University, Nanjing, China
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Huang T, Zhou Y, Lu X, Tang C, Ren C, Bao X, Deng Z, Cao X, Zou J, Zhang Q, Ma B. Cordycepin, a major bioactive component of Cordyceps militaris, ameliorates diabetes-induced testicular damage through the Sirt1/Foxo3a pathway. Andrologia 2021; 54:e14294. [PMID: 34811786 DOI: 10.1111/and.14294] [Citation(s) in RCA: 3] [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] [Received: 06/18/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 12/29/2022] Open
Abstract
Diabetes-induced male dysfunction is considered as a worldwide challenge, and testicular damage mainly caused by oxidative stress is its most common manifestation. Cordycepin, a natural antioxidant, has been used in the treatment of diabetic complications. However, the protective action and underlying mechanism of cordycepin on hyperglycaemia-induced testicular damage are unclear. This study aimed to investigate the protective effects and molecular mechanisms of cordycepin against diabetes-induced testicular damage. The type 2 diabetes model was established in C57BL/6 male mice via high-fat diet for 4 weeks and injected intraperitoneally with 50 mg/kg/day streptozotocin for five consecutive days. Then mice were treated with cordycepin (10 and 20 mg/kg, respectively) for 8 weeks. At the end of experiment, biochemical indicators, microstructure of testicular tissue, sperm morphology, TUNEL staining and protein expressions were evaluated. In the present study, cordycepin alleviated the testicular damage, restored disruption of the blood-testis barrier, and improved spermatogenic function via the antiapoptotic and antioxidant capacity. Mechanistically, cordycepin significantly enhanced SIRT1 expression and triggered the activity of Foxo3a, further to induce the expression of its downstream antioxidant enzymes, including Mn-SOD and CAT. These findings indicated that cordycepin could improve hyperglycaemia-induced testicular damage by regulating downstream antioxidant enzymes activity through the SIRT1/Foxo3a signalling pathway.
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Affiliation(s)
- Tao Huang
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
| | - Yanfen Zhou
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
| | - Xuanzhao Lu
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
| | - Chenglun Tang
- Luzhou Pinchuang Technology Co. Ltd., Luzhou, China.,Nanjing Sheng Ming Yuan Health Technology Co. Ltd., Nanjing, China
| | - Chaoxing Ren
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
| | - Xiaowen Bao
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
| | - Zhewen Deng
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
| | - Xiaomei Cao
- Department of Pharmacology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qi Zhang
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
| | - Bo Ma
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing, China
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83
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Xu B, Zhang Q, Zhang P, Hu X, Li W, Tong Z, Sun T, Teng Y, Wu X, Ouyang Q, Yan X, Cheng J, Liu Q, Feng J, Wang X, Yin Y, Shi Y, Pan Y, Wang Y, Xie W, Yan M, Liu Y, Yan P, Wu F, Zhu X, Zou J. Dalpiciclib or placebo plus fulvestrant in hormone receptor-positive and HER2-negative advanced breast cancer: a randomized, phase 3 trial. Nat Med 2021; 27:1904-1909. [PMID: 34737452 DOI: 10.1038/s41591-021-01562-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/28/2021] [Indexed: 02/05/2023]
Abstract
Blockade of the cyclin-dependent kinase 4 and 6 pathway has been shown to be effective in the treatment of hormone receptor-positive advanced breast cancer (ABC). We report the interim results of DAWNA-1 ( NCT03927456 ), a double-blind, randomized, phase 3 trial of dalpiciclib (a new cyclin-dependent kinase 4 and 6 inhibitor) plus fulvestrant in hormone receptor-positive, HER2-negative ABC with disease progression after endocrine therapy. A total of 361 patients were randomized 2:1 to receive dalpiciclib plus fulvestrant or placebo plus fulvestrant. The study met the primary end point, showing significantly prolonged investigator-assessed progression-free survival with dalpiciclib plus fulvestrant versus placebo plus fulvestrant (median = 15.7, 95% confidence interval (CI) = 11.1-not reached versus 7.2, 95% CI = 5.6-9.2 months; hazard ratio = 0.42, 95% CI = 0.31-0.58; one-sided P < 0.0001 (boundary was P ≤ 0.008)). The most common grade 3 or 4 adverse events with dalpiciclib plus fulvestrant were neutropenia (84.2%) and leukopenia (62.1%). The incidence of serious adverse events was 5.8% with dalpiciclib plus fulvestrant versus 6.7% with placebo plus fulvestrant. Our findings support dalpiciclib plus fulvestrant as a new treatment option for pretreated hormone receptor-positive, HER2-negative ABC.
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Affiliation(s)
- Binghe Xu
- Department of Medical Oncology and Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qingyuan Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Pin Zhang
- Department of Medical Oncology and Clinical Trial Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xichun Hu
- Department of Medical Oncology, Fudan University Cancer Hospital, Shanghai, China
| | - Wei Li
- Department of Medical Oncology, The First Hospital of Jilin University, Changchun, China
| | - Zhongsheng Tong
- Department of Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Tao Sun
- Department of Medical Oncology, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, China
| | - Yuee Teng
- Department of Medical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xinhong Wu
- Department of Breast Oncology, Hubei Cancer Hospital, Wuhan, China
| | - Quchang Ouyang
- Department of Medical Oncology, Hunan Cancer Hospital, Changsha, China
| | - Xi Yan
- Department of Head and Neck Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Cheng
- Department of Breast Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Qiang Liu
- Department of Medical Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jifeng Feng
- Department of Medical Oncology, Jiangsu Cancer Hospital, Nanjing, China
| | - Xiaojia Wang
- Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Yongmei Yin
- Department of Oncology, Jiangsu Province Hospital, Nanjing, China
| | - Yanxia Shi
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yueyin Pan
- Department of Medical Oncology/Chemotherapy, Anhui Provincial Hospital, Hefei, China
| | - Yongsheng Wang
- Breast Cancer Center, Shandong Cancer Hospital, Jinan, China
| | - Weimin Xie
- Department of Breast, Bone & Soft Tissue Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Min Yan
- Department of Breast Disease, Henan Breast Cancer Center/The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Yunjiang Liu
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ping Yan
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Fei Wu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Xiaoyu Zhu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
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Hua Y, Zhou L, Yang W, An W, Kou X, Ren J, Su H, Chen R, Zhang Z, Zou J, Zhao Z. Y-2 reduces oxidative stress and inflammation and improves neurological function of collagenase-induced intracerebral hemorrhage rats. Eur J Pharmacol 2021; 910:174507. [PMID: 34536364 DOI: 10.1016/j.ejphar.2021.174507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Intracerebral hemorrhage (ICH) is a devastating disease, and there is currently no specific pharmacological treatment that can improve clinical outcomes. Y-2 sublingual tablets, each containing 30 mg edaravone and 6 mg (+)-borneol, is undergoing a phase III clinical trial for treatment of ischemic stroke in China. The purpose of the present study is to investigate the efficacy and potential mechanism of Y-2 in a rat model of collagenase IV injection induced ICH. Sublingual administration of Y-2 at the dose of 1, 3 and 6 mg/kg improved ICH-induced sensorimotor dysfunction, alleviated cell death and histopathological change, restored the hippocampal long-term potentiation (LTP), reduced brain edema and maintained blood-brain barrier (BBB) integrality in ICH rats. Further study demonstrated that Y-2 could reduce inflammatory response and oxidative stress by decreasing the levels of myeloperoxidase (MPO), ionized calcium-binding adaptor protein-1 (Iba-1), inflammatory cytokines and oxidative products, inhibit transcription factor nuclear factor-κB (NF-κB) activation, cyclooxygenase-2 (COX-2) and matrix metallopeptidase 9 (MMP-9) expression in brain tissue around in the core regions of hematoma. Importantly, the protective efficacy of Y-2 from ICH-induced injury was superior to edaravone. In conclusion, Y-2 sublingual tablets might be a promising therapeutic agent for the treatment of ICH.
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Affiliation(s)
- Yao Hua
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China
| | - Limei Zhou
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China
| | - Weidong Yang
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China
| | - Wenji An
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China
| | - Xiaolin Kou
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China
| | - Jian Ren
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China
| | - Hailang Su
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China
| | - Rong Chen
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China
| | - Zhengping Zhang
- NeuroDawn Pharmaceutical Co., Ltd., Nanjing, 211199, China; State Key Laboratory of Translational Medicine and Innovative Drug, No.699-18, Xuanwu Avenue, Nanjing, Jiangsu, 210042, PR China.
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
| | - Zhihong Zhao
- Department of Neurology, The First Affiliated Hospital (People's Hospital of Hunan Province), Hunan Normal University, Changsha, 410005, China.
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Su S, Lin A, Luo P, Zou J, Huang Z, Wang X, Zeng Y, Cen W, Zhang X, Huang H, Hu J, Zhang J. Effect of mesenchymal-epithelial transition amplification on immune microenvironment and efficacy of immune checkpoint inhibitors in patients with non-small cell lung cancer. Ann Transl Med 2021; 9:1475. [PMID: 34734027 PMCID: PMC8506755 DOI: 10.21037/atm-21-4543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/18/2021] [Indexed: 01/10/2023]
Abstract
Background Immune checkpoint inhibitors (ICIs) have brought clinical benefits to patients with various histological types of lung cancer. Previous studies have shown an association between mesenchymal-epithelial transition (MET) and the immunotherapy response in non-small cell lung cancer (NSCLC) but there is a lack of clinical data on the correlation of MET amplification with the ICI response in NSCLC. Methods Copy number alteration (CNA), somatic mutation, and clinical data from two immunotherapy cohorts (Rizvi et al. cohort and our local cohort) were collected and pooled to further investigate the key role of MET amplification in patients with NSCLC receiving ICIs. The correlations between MET amplification and tumor immunogenicity and antitumor immunity were further investigated in The Cancer Genome Atlas (TCGA)-NSCLC [lung adenocarcinoma (LUAD)/lung squamous cell carcinoma (LUSC)] data-set. Results In the immunotherapy cohorts, MET amplification was associated with longer progression-free survival (PFS) times in patients receiving ICI treatment (P=0.039; HR =0.37; 95% CI: 0.18–0.73). In the TCGA-NSCLC data-set, MET amplification was associated with high MET mRNA and protein levels, tumor mutation burden (TMB), neoantigen load (NAL), immune-activated cell patterns, immune-related gene expression levels, and the number of gene alterations in the DNA damage response and repair (DDR) pathway. Gene set enrichment analysis (GSEA) results indicated significant up-regulation of the immune response-related pathways in the MET-amplification group. Conclusions Our results suggest that MET amplification may be a novel predictive marker for immunotherapy efficacy in NSCLC.
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Affiliation(s)
- Shan Su
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Anqi Lin
- Department of Oncology, Zhujiang Hospital, the Southern Medical University, Guangzhou, China
| | - Peng Luo
- Department of Oncology, Zhujiang Hospital, the Southern Medical University, Guangzhou, China
| | - Jianjun Zou
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Zhihao Huang
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Xiaojun Wang
- Department of Oncology, First People's Hospital of Chenzhou, Chenzhou, China
| | - Yunyun Zeng
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Wenchang Cen
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Xianlan Zhang
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Huiyi Huang
- Department of Oncology, Guangzhou Chest Hospital, Guangzhou, China
| | - Jinxing Hu
- Department of Respiratory, Guangzhou Chest Hospital, Guangzhou, China
| | - Jian Zhang
- Department of Oncology, Zhujiang Hospital, the Southern Medical University, Guangzhou, China
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86
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Ismat FA, Usansky H, Dhar Murthy S, Zou J, Teper A. Safety, tolerability, and pharmacokinetics (PK) of treprostinil palmitil inhalation powder (TPIP): a phase 1, randomised, double-blind, single- and multiple-dose study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Use of treprostinil in the treatment of pulmonary arterial hypertension (PAH) is limited by a short half-life and dose-limiting adverse events. TPIP, a dry powder formulation of the treprostinil prodrug treprostinil palmitil, is under investigation for PAH. In preclinical models, TPIP provided sustained treprostinil release in the lung and demonstrated sustained reduction of pulmonary arterial pressures.
Purpose
To examine the safety, tolerability, and PK of single- and multiple-dose administration of once-daily (QD) TPIP in healthy volunteers.
Methods
In this phase 1 study, healthy adults (aged 18–45 years) were randomised to receive single or multiple QD inhalation doses of TPIP. Single-dose participants received TPIP 112.5, 225, 450, or 675 μg (n=6 per dose) or placebo (n=2). Multiple-dose participants received TPIP 225 μg QD for 7 days (n=6), 112.5 μg QD for 4 days followed by 225 μg QD for 3 days (n=6), or placebo for 7 days (n=4).
Results
Of 42 randomly assigned participants who received ≥1 dose, 41 (97.6%) completed the study. Of the single-dose TPIP–treated participants, 70.8% (n=17/24) experienced a treatment-emergent adverse event (TEAE) vs 0% (0/2) of placebo-treated participants; the most common TEAEs (≥15%) among TPIP-treated participants were cough (45.8%), dizziness (29.2%), throat irritation (20.8%), nausea (16.7%), and hypotension (16.7%). Of the multiple-dose TPIP–treated participants, 83.3% (n=10/12) experienced a TEAE vs 50.0% of placebo-treated participants (2/4); the most common TEAEs were cough (58.3% TPIP vs 50.0% placebo), headache (50.0% vs 0%), nausea (33.3% vs 0%), and dizziness (25.0% vs 0%). Overall, 69.0% of participants (29/42) experienced mild TEAEs and 16.7% (7/42) experienced moderate TEAEs; no severe or serious TEAEs occurred. TEAEs were more frequent with increasing TPIP doses. Participants titrated from TPIP 112.5 μg QD to 225 μg QD experienced fewer TEAEs than those who received 225 μg QD at treatment initiation; all TEAEs were mild. After single-dose TPIP treatment, treprostinil exposure was dose proportional, with mean (CV%) Cmax = 78.4–717 pg/mL (38.6-72.9%) and AUC(0–∞) = 1.09–5.48 h·ng/mL (11.5–30.0%). At steady-state (225 μg), the mean (CV%) of Cmax, Cmin, and AUC(0–t) were 193–228 pg/mL (32.9–46.4%), 17.6–22.8 ng/mL (43.7%-64.4%) and 1.68–1.82 ng·h/mL (28.7–36.6%), respectively. No steady-state accumulation was observed. Elimination t1/2 was 8.7–11.6 h after a single dose and 6.8–8.8 h at steady state. Plasma concentrations of treprostinil palmitil were below the limit of quantification (100 pg/mL) at all time points measured.
Conclusions
In this phase 1 study, single and multiple TPIP dosing was generally well tolerated in healthy volunteers, with a PK profile that supports QD dosing. TEAEs were dose related; most were mild, none were severe or serious, and a titration schedule improved tolerability. These results support further examination of TPIP in patients with PAH.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Insmed Incorporated
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Affiliation(s)
- F A Ismat
- Insmed Incorporated, Bridgewater, United States of America
| | - H Usansky
- Insmed Incorporated, Bridgewater, United States of America
| | - S Dhar Murthy
- Insmed Incorporated, Bridgewater, United States of America
| | - J Zou
- Insmed Incorporated, Bridgewater, United States of America
| | - A Teper
- Insmed Incorporated, Bridgewater, United States of America
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Jiang L, Zhou L, Yong W, Cui J, Geng W, Chen H, Zou J, Chen Y, Yin X, Chen YC. A deep learning-based model for prediction of hemorrhagic transformation after stroke. Brain Pathol 2021; 33:e13023. [PMID: 34608705 PMCID: PMC10041160 DOI: 10.1111/bpa.13023] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/26/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022] Open
Abstract
Hemorrhagic transformation (HT) is one of the most serious complications after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) patients. The purpose of this study is to develop and validate deep-learning (DL) models based on multiparametric magnetic resonance imaging (MRI) to automatically predict HT in AIS patients. Multiparametric MRI and clinical data of AIS patients with EVT from two centers (data set 1 for training and testing: n = 338; data set 2 for validating: n = 54) were used in the DL models. The acute infarction area of diffusion-weighted imaging (DWI) and hypoperfusion of perfusion-weighted imaging (PWI) was labeled manually. Two forms of data sets (volume of interest [VOI] data sets and slice data sets) were analyzed, respectively. The models based on single parameter and multiparameter models were developed and validated to predict HT in AIS patients after EVT. Performance was evaluated by area under the receiver-operating characteristic curve (AUC), accuracy (ACC), sensitivity, specificity, negative predictive value, and positive predictive value. The results showed that the performance of single parameter model based on MTT (VOI data set: AUC = 0.933, ACC = 0.843; slice data set: AUC = 0.945, ACC = 0.833) and TTP (VOI data set: AUC = 0.916, ACC = 0.873; slice data set: AUC = 0.889, ACC = 0.818) were better than the other single parameter model. The multiparameter model based on DWI & MTT & TTP & Clinical (DMTC) had the best performance for predicting HT (VOI data set: AUC = 0.948, ACC = 0.892; slice data set: AUC = 0.932, ACC = 0.873). The DMTC model in the external validation set achieved similar performance with the testing set (VOI data set: AUC = 0.939, ACC = 0.884; slice data set: AUC = 0.927, ACC = 0.871) (p > 0.05). The proposed clinical, DWI, and PWI multiparameter DL model has great potential for assisting the periprocedural management in the early prediction HT of the AIS patients with EVT.
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Affiliation(s)
- Liang Jiang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Leilei Zhou
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wei Yong
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jinluan Cui
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen Geng
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Huiyou Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yang Chen
- Laboratory of Image Science and Technology, School of Computer Science and Engineering, Southeast University, Nanjing, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Dash D, He B, Brown I, Zou J. 107 Real-Time Computer Vision TTE Analytics using Existing Ultrasound Workflows. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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89
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Wang YB, Shen W, Gan YH, Zou J, Zhang Y, Zhu LJ, Ju L, Jiang ZQ, Ying SB. [Effect of PPAR-γ agonist pioglitazone on the prolifeiration of malignant nesothelionma cells induced by HMGB1]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:641-647. [PMID: 34624942 DOI: 10.3760/cma.j.cn121094-20201102-00600] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect and mechanism of PPAR-γ agonist Pioglitazone (PGZ) on the proliferation of malignant mesothelioma (MM) cells. Methods: In December 2019, MM cell lines MSTO-211H and NCI-H2452 were incubated with different final concentrations of PGZ (0, 10, 50, 100, 150, and 200 μmol/L) for different periods of time (24 h, 48 h, and 72 h) , and then the cell proliferation level was detected by CCK8 assay. After given various final concentration of PGZ (0, 10, 50, 100, 150, 200 μmol/L) the for 72 hours, the changes of number and morphology of MM cells were observed under an inverted microscope. The expressions of PPAR-γ and HMGB1 mRNA were determined by real-time fluorescence quantitative reverse transcription-polymerase chain reaction (qRT-PCR) after treatment of MM cells with PGZ of 0, 10, 50, 100 μmol/L for 72 h. The MM cells were treated with PGZ at concentration of 0, 100 μmol/L for 72 h, and the protein expressions of HMGB1 were examined using Western blotting and immunofluorescence; the protein expressions of Ki67 were assessed by immunohistochemistry. Results: The cell viability rate of MM cells was decreased after treated with PGZ (P<0.05) . Cell number in PGZ-treated group was significantly less than that in control group and morphology changes were observed under light microscope. QRT-PCR results revealed significantly increased PPAR-γ mRNA expression in the PGZ-treated group compared to the control group (P<0.05) . There was a significant decrease in the mRNA expression level of HMGB1 in the PGZ-treated group (100 μmol/L) as compared to the control group in MSTO-211H (P<0.05) ; however, the expression level of HMGB1 in NCI-H2452 was an increase or no significant differences (P>0.05) . Western blotting and immunofluorescence results showed that the protein expression of HMGB1 was reduced in the PGZ-treated group compared with the control group in MSTO-211H (P<0.05) , but the protein expression of that in NCI-H2452 was no significant differences (P>0.05) . Immunohistochemistry results showed increased expression of proliferation marker Ki-67. Conclusion: Pioglitazone suppresses the proliferation of MM cells through inhibition of HMGB1 by the activation of PPAR-γ.
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Affiliation(s)
- Y B Wang
- Hangzhou Medical College, Hangzhou 310013, China
| | - W Shen
- Department of Respiratory Medicine, The Third People's Hospital of Cixi, Ningbo 315324, China
| | - Y H Gan
- Hangzhou Medical College, Hangzhou 310013, China
| | - J Zou
- Hangzhou Medical College, Hangzhou 310013, China
| | - Y Zhang
- Hangzhou Medical College, Hangzhou 310013, China
| | - L J Zhu
- Hangzhou Medical College, Hangzhou 310013, China
| | - L Ju
- Hangzhou Medical College, Hangzhou 310013, China
| | - Z Q Jiang
- Hangzhou Medical College, Hangzhou 310013, China
| | - S B Ying
- Hangzhou Medical College, Hangzhou 310013, China
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90
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Luo H, Lu J, Bai Y, Mao T, Wang J, Fan Q, Zhang Y, Zhao K, Chen Z, Gao S, Li J, Fu Z, Gu K, Liu Z, Wu L, Zhang X, Feng J, Niu Z, Ba Y, Zhang H, Liu Y, Zhang L, Min X, Huang J, Cheng Y, Wang D, Shen Y, Yang Q, Zou J, Xu RH. Effect of Camrelizumab vs Placebo Added to Chemotherapy on Survival and Progression-Free Survival in Patients With Advanced or Metastatic Esophageal Squamous Cell Carcinoma: The ESCORT-1st Randomized Clinical Trial. JAMA 2021; 326:916-925. [PMID: 34519801 PMCID: PMC8441593 DOI: 10.1001/jama.2021.12836] [Citation(s) in RCA: 266] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Standard first-line therapy for advanced or metastatic esophageal carcinoma is chemotherapy, but the prognosis remains poor. Camrelizumab (an anti-programmed death receptor 1 [PD-1] antibody) showed antitumor activity in previously treated advanced or metastatic esophageal squamous cell carcinoma. OBJECTIVE To evaluate the efficacy and adverse events of camrelizumab plus chemotherapy vs placebo plus chemotherapy as a first-line treatment in advanced or metastatic esophageal squamous cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS This randomized, double-blind, placebo-controlled, multicenter, phase 3 trial (ESCORT-1st study) enrolled patients from 60 hospitals in China between December 3, 2018, and May 12, 2020 (final follow-up, October 30, 2020). A total of 751 patients were screened and 596 eligible patients with untreated advanced or metastatic esophageal squamous cell carcinoma were randomized. INTERVENTIONS Patients were randomized 1:1 to receive either camrelizumab 200 mg (n = 298) or placebo (n = 298), combined with up to 6 cycles of paclitaxel (175 mg/m2) and cisplatin (75 mg/m2). All treatments were given intravenously every 3 weeks. MAIN OUTCOMES AND MEASURES Coprimary end points were overall survival (significance threshold, 1-sided P < .02) and progression-free survival (significance threshold, 1-sided P < .005). RESULTS Of the 596 patients randomized (median age, 62 years [interquartile range, 56-67 years]; 523 men [87.8%]), 1 patient in the placebo-chemotherapy group did not receive planned treatment. A total of 490 patients (82.2%) had discontinued the study treatment. The median follow-up was 10.8 months. The overall survival for the camrelizumab-chemotherapy group was a median of 15.3 months (95% CI, 12.8-17.3; 135 deaths) vs a median of 12.0 months (95% CI, 11.0-13.3; 174 deaths) for the placebo-chemotherapy group (hazard ratio [HR] for death, 0.70 [95% CI, 0.56-0.88]; 1-sided P = .001). Progression-free survival for camrelizumab plus chemotherapy was a median of 6.9 months (95% CI, 5.8-7.4; 199 progression or deaths) vs 5.6 months (95% CI, 5.5-5.7; 229 progression or deaths) for the placebo-chemotherapy group (HR for progression or death, 0.56 [95% CI, 0.46-0.68]; 1-sided P < .001). Treatment-related adverse events of grade 3 or higher occurred in 189 patients (63.4%) in the camrelizumab-chemotherapy group and 201 (67.7%) in the placebo-chemotherapy group, including treatment-related deaths among 9 patients (3.0%) and 11 patients (3.7%), respectively. CONCLUSIONS AND RELEVANCE Among patients with advanced or metastatic esophageal squamous cell carcinoma, the addition of camrelizumab to chemotherapy, compared with placebo and chemotherapy, significantly improved overall survival and progression-free survival. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03691090.
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Affiliation(s)
- Huiyan Luo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China
| | - Jin Lu
- Sichuan Cancer Hospital, Chengdu, China
| | - Yuxian Bai
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Teng Mao
- Shanghai Chest Hospital, Shanghai, China
| | - Jun Wang
- The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qingxia Fan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Kuaile Zhao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhendong Chen
- The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shegan Gao
- The First Affiliated Hospital of Henan University of Science & Technology, Luoyang, China
| | - Jiancheng Li
- Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Zhichao Fu
- 900 Hospital of the Joint Logistics Support Force, Fuzhou, China
| | - Kangsheng Gu
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhihua Liu
- Jiangxi Provincial Cancer Hospital, Nanchang, China
| | - Lin Wu
- Hunan Cancer Hospital, Changsha, China
| | - Xiaodong Zhang
- Peking University Cancer Hospital and Institute, Beijing, China
| | | | - Zuoxing Niu
- Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Yi Ba
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Helong Zhang
- The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Ying Liu
- Henan Cancer Hospital, Zhengzhou, China
| | - Li Zhang
- Chongqing Three Gorges Central Hospital, Chongqing, China
| | | | - Jing Huang
- Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | | | - Dong Wang
- Army Medical Center of PLA, Chongqing, China
| | - Yu Shen
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Qing Yang
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Rui-Hua Xu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China
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91
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McMullen M, Avery L, Zou J, Zhao Z, Tesfu A, Dhani N, Oza A, Kathy H, Bratman S, Lheureux S. 788P Circulating human papillomavirus DNA as a biomarker of response in advanced cervical cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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92
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Taylor K, Zou J, Burgener J, Zhao E, Torti D, Oliva M, Spreafico A, Hansen A, Jang R, McDade S, Coyle V, Lawler M, Elimova E, Bratman S, Siu L. 886P Circulating tumor DNA kinetics in recurrent/metastatic head & neck squamous cell cancer (R/M HNSCC) patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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93
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Yang Y, Qu S, Li J, Hu C, Xu M, Li W, Zhou T, Shen L, Wu H, Lang J, Hu G, Luo Z, Fu Z, Qu S, Feng W, Chen X, Lin S, Zhang W, Li X, Sun Y, Lin Z, Lin Q, Lei F, Long J, Hong J, Huang X, Zeng L, Wang P, He X, Zhang B, Yang Q, Zhang X, Zou J, Fang W, Zhang L. Camrelizumab versus placebo in combination with gemcitabine and cisplatin as first-line treatment for recurrent or metastatic nasopharyngeal carcinoma (CAPTAIN-1st): a multicentre, randomised, double-blind, phase 3 trial. Lancet Oncol 2021; 22:1162-1174. [PMID: 34174189 DOI: 10.1016/s1470-2045(21)00302-8] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The addition of camrelizumab to gemcitabine and cisplatin showed promising activity as first-line therapy in patients with recurrent or metastatic nasopharyngeal carcinoma in a phase 1 trial. We therefore compared camrelizumab plus gemcitabine and cisplatin with placebo plus gemcitabine and cisplatin in a randomised phase 3 trial. METHODS In this randomised, double-blind, phase 3 trial done at 28 hospitals in China, patients were eligible if they were aged 18-75 years, had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and had previously untreated recurrent or metastatic nasopharyngeal carcinoma. Patients were randomly assigned (1:1; using an interactive web-response system with a block size of four) to receive either camrelizumab (200 mg on day 1) or matching placebo intravenously, plus gemcitabine and cisplatin (gemcitabine 1000 mg/m2 on days 1 and 8; cisplatin 80 mg/m2 on day 1) intravenously every 3 weeks for four to six cycles, followed by maintenance therapy with camrelizumab or placebo, until radiographic progression, unacceptable toxicity, start of new anticancer treatment, investigator decision, or withdrawal of consent. Stratification factors used in randomisation were liver metastases, previous radical concurrent chemoradiotherapy, and ECOG performance status. The allocation sequence was generated by an independent randomisation group. The primary endpoint was progression-free survival per independent review committee. The significance threshold for independent review committee-assessed progression-free survival was p=0·0086 (one-sided) at the interim analysis. Efficacy and safety analyses included all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT03707509, and is closed for enrolment but is ongoing. FINDINGS Between Nov 13, 2018, and Nov 29, 2019, 343 patients were screened and 263 were eligible and were randomly assigned to the camrelizumab group (n=134) or placebo group (n=129). At the prespecified interim analysis (June 15, 2020), independent review committee-assessed progression-free survival was significantly longer in the camrelizumab group (median 9·7 months [95% CI 8·3-11·4]) than in the placebo group (median 6·9 months [5·9-7·3]; hazard ratio 0·54 [95% CI 0·39-0·76]; one-sided p=0·0002). As of Dec 31, 2020, the most common grade 3 or worse adverse events of any cause were decreased white blood cell count (89 [66%] of 134 patients in the camrelizumab group vs 90 [70%] of 129 patients in the placebo group), decreased neutrophil count (86 [64%] vs 85 [66%]), anaemia (53 [40%] vs 57 [44%]), and decreased platelet count (53 [40%] vs 52 [40%]). Serious adverse events were reported in 59 (44%) of 134 patients in the camrelizumab group and 48 (37%) of 129 patients in the placebo group. Treatment-related deaths occurred in five (4%) patients in the camrelizumab group (two unknown cause of death, one multiple organ dysfunction syndrome, one pharyngeal haemorrhage, and one arrhythmia) and one (<1%) patient in the placebo group (unknown cause of death). INTERPRETATION Our findings suggest that camrelizumab plus gemcitabine and cisplatin could be a new standard of care for patients with recurrent or metastatic nasopharyngeal carcinoma in the first-line setting. Longer follow-up is needed to confirm this conclusion. FUNDING Jiangsu Hengrui Pharmaceuticals (formerly Jiangsu Hengrui Medicine). TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yunpeng Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Song Qu
- Guangxi Medical University Affiliated Tumor Hospital, Nanning, China
| | - Jingao Li
- Jiangxi Cancer Hospital of Nanchang University, Nanchang, China
| | - Chaosu Hu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Mingjun Xu
- First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Weidong Li
- Guangzhou Medical University Affiliated Oncology Hospital, Guangzhou, China
| | - Ting Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Liangfang Shen
- Xiangya Hospital Central South University, Changsha, China
| | - Hui Wu
- Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinyi Lang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guangyuan Hu
- Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Zhichao Fu
- 900th Hospital of The Joint Logistics Team, PLA, Fuzhou, China
| | - Shenhong Qu
- Guangxi Zhuang Autonomous Region People's Hospital, Nanning, China
| | - Weineng Feng
- The First People's Hospital of Foshan, Foshan, China
| | | | - Shaojun Lin
- Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, China
| | - Weimin Zhang
- General Hospital of Southern Theatre Command, Guangzhou, China
| | | | - Yan Sun
- Beijing Cancer Hospital, Beijing, China
| | - Zhixiong Lin
- Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Qin Lin
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Feng Lei
- Zhongshan People's Hospital, Zhongshan, China
| | - Jianting Long
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinsheng Hong
- The First Affiliated Hospital of Fujian Medical University/Key Laboratory of Radiation Biology, Fuzhou, China
| | - Xiaoming Huang
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lingzhi Zeng
- Jiujiang No.1 People's Hospital of Nanchang University, Jiujiang, China
| | - Peiguo Wang
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiaohui He
- Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Ben Zhang
- Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | - Qing Yang
- Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | | | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals, Shanghai, China
| | - Wenfeng Fang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Li Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Weng J, Zeng L, Zhang Y, Qu S, Wang X, Li P, Fu L, Ma B, Ye S, Sun J, Lu W, Liu Z, Chen D, Cheng Z, Liu H, Zhang T, Zou J. Henagliflozin as add-on therapy to metformin in patients with type 2 diabetes inadequately controlled with metformin: A multicentre, randomized, double-blind, placebo-controlled, phase 3 trial. Diabetes Obes Metab 2021; 23:1754-1764. [PMID: 33769656 DOI: 10.1111/dom.14389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the efficacy and safety of henagliflozin in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin. MATERIAL AND METHODS This multicentre phase 3 trial included a 24-week randomized, double-blind, placebo-controlled period, followed by a 28-week extension period. Patients with a glycated haemoglobin (HbA1c) level of 7.0% (53 mmol/mol) to 10.5% (91 mmol/mol) were randomized and treated with once-daily placebo (n = 161), henagliflozin 5 mg (n = 162), or henagliflozin 10 mg (n = 160). After 24 weeks, patients on placebo were switched to 5 mg or 10 mg henagliflozin for the additional 28-week treatment, and patients on henagliflozin during 24-week treatment period maintained this initial therapy. The primary endpoint was change in HbA1c from baseline to Week 24. RESULTS At Week 24, the least squares mean HbA1c changes versus placebo from baseline were - 0.76% (-8.3 mmol/mol) and - 0.80% (-8.7 mmol/mol) for henagliflozin 5 and 10 mg, respectively (all P < 0.0001). Compared with the placebo group, both doses of henagliflozin lowered fasting plasma glucose, 2-hour postprandial plasma glucose, body weight and blood pressure, and increased the proportions of patients achieving HbA1c <7.0% (53 mmol/mol) at Week 24. The trends in these improvements were sustained over an additional 28 weeks. Slightly higher proportions of ketosis and presence of urine ketone bodies were observed in patients treated with henagliflozin compared to placebo at Week 24. No diabetic ketoacidosis or episodes of severe hypoglycaemia were reported. CONCLUSIONS Henagliflozin 5 mg or 10 mg as add-on therapy to metformin provided a new therapeutic option for the treatment of T2DM patients who have inadequate glycaemic control with metformin alone, and was generally well tolerated.
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Affiliation(s)
- Jianping Weng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Longyi Zeng
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuwei Zhang
- Huaxi Hospital of Sichuan University, Chengdu, China
| | - Shen Qu
- Shanghai 10th People's Hospital, Shanghai, China
| | | | - Ping Li
- Yuncheng Central Hospital, Taiyuan, China
| | - Liujun Fu
- First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Boqing Ma
- Hebei General Hospital, Shijiazhuang, China
| | - Shandong Ye
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jiao Sun
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Weiping Lu
- First Affiliated Huai'an Hospital of Nanjing Medical University, Huai'an, China
| | - Zhiwen Liu
- Shanghai Xuhui District Central Hospital, Shanghai, China
| | | | - Zhifeng Cheng
- Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haiyan Liu
- Jiangsu Hengrui Medicine Co., Ltd, Shanghai, China
| | - Tao Zhang
- Jiangsu Hengrui Medicine Co., Ltd, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Medicine Co., Ltd, Shanghai, China
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95
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Chen X, Qin S, Gu S, Ren Z, Chen Z, Xiong J, Liu Y, Meng Z, Zhang X, Wang L, Zhang X, Zou J. Camrelizumab plus oxaliplatin-based chemotherapy as first-line therapy for advanced biliary tract cancer: A multicenter, phase 2 trial. Int J Cancer 2021; 149:1944-1954. [PMID: 34309846 DOI: 10.1002/ijc.33751] [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: 03/01/2021] [Revised: 06/18/2021] [Accepted: 07/01/2021] [Indexed: 12/19/2022]
Abstract
Biliary tract cancer (BTC) is a highly malignant tumor with limited treatment options and poor prognosis. Our study aimed to evaluate camrelizumab plus oxaliplatin-based chemotherapy as first-line therapy for advanced BTC. In this multicenter, open-label, phase 2 trial conducted in China (ClinicalTrials.gov, NCT03092895), untreated patients with advanced BTC were given camrelizumab (3 mg/kg iv drip injection, every 2 weeks) plus typical FOLFOX4 (Cam-FOLFOX4 group; infusional 5-fluorouracil, leucovorin and oxaliplatin) or GEMOX (Cam-GEMOX group; infusional gemcitabine and oxaliplatin). The primary endpoint was objective response rate (ORR). Ninety-two patients were enrolled: 29 received Cam-FOLFOX4 and 63 received Cam-GEMOX. The confirmed ORR and disease control rate were 16.3% (95% confidence interval [CI] = 9.4-25.5) and 75.0% (95% CI = 64.9-83.4), respectively. Median duration of response was 8.7 months (95% CI = 5.1-not reached). Median progression-free survival and overall survival were 5.3 months (95% CI = 3.7-5.7) and 12.4 months (95% CI = 8.9-16.1), respectively. Grade ≥3 treatment-related adverse events (TRAEs) occurred in 82.8% of patients receiving Cam-FOLFOX4 and in 68.3% receiving Cam-GEMOX, with no unexpected effects observed. Six (6.5%) patients discontinued treatment due to TRAE. Camrelizumab plus FOLFOX4 or GEMOX as first-line treatment was effective and tolerable for Chinese patients with advanced BTC, warranting phase 3 trials.
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Affiliation(s)
- Xinni Chen
- Department of Medical Oncology Center, Bayi Affiliated Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shukui Qin
- Department of Medical Oncology Center, Bayi Affiliated Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shanzhi Gu
- Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, China
| | - Zhenggang Ren
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhendong Chen
- Department of Medical Oncology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jianping Xiong
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ying Liu
- Department of Medical Oncology, Henan Cancer Hospital, Zhengzhou, China
| | - Zhiqiang Meng
- Minimally Invasive Therapy Center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiao Zhang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Linna Wang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Xiaojing Zhang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
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96
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Palmer CE, Zhao W, Loughnan R, Zou J, Fan CC, Thompson WK, Dale AM, Jernigan TL. Distinct Regionalization Patterns of Cortical Morphology are Associated with Cognitive Performance Across Different Domains. Cereb Cortex 2021; 31:3856-3871. [PMID: 33825852 PMCID: PMC8258441 DOI: 10.1093/cercor/bhab054] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 02/02/2023] Open
Abstract
Cognitive performance in children is predictive of academic and social outcomes; therefore, understanding neurobiological mechanisms underlying individual differences in cognition during development may be important for improving quality of life. The belief that a single, psychological construct underlies many cognitive processes is pervasive throughout society. However, it is unclear if there is a consistent neural substrate underlying many cognitive processes. Here, we show that a distributed configuration of cortical surface area and apparent thickness, when controlling for global imaging measures, is differentially associated with cognitive performance on different types of tasks in a large sample (N = 10 145) of 9-11-year-old children from the Adolescent Brain and Cognitive DevelopmentSM (ABCD) study. The minimal overlap in these regionalization patterns of association has implications for competing theories about developing intellectual functions. Surprisingly, not controlling for sociodemographic factors increased the similarity between these regionalization patterns. This highlights the importance of understanding the shared variance between sociodemographic factors, cognition and brain structure, particularly with a population-based sample such as ABCD.
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Affiliation(s)
- C E Palmer
- Center for Human Development, University of California, San Diego, La Jolla, CA 92161, USA
| | - W Zhao
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA 92093, USA
| | - R Loughnan
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA 92093, USA
| | - J Zou
- Division of Biostatistics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92161, USA
| | - C C Fan
- Center for Human Development, University of California, San Diego, La Jolla, CA 92161, USA
- Center for Multimodal Imaging and Genetics, University of California, San Diego School of Medicine, La Jolla, CA 92037, USA
| | - W K Thompson
- Division of Biostatistics, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA 92161, USA
| | - A M Dale
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Radiology, University of California, San Diego School of Medicine, La Jolla, CA 92037, USA
- Department of Neuroscience, University of California, San Diego School of Medicine, La Jolla, CA 92037, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, CA 92037, USA
| | - T L Jernigan
- Center for Human Development, University of California, San Diego, La Jolla, CA 92161, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Radiology, University of California, San Diego School of Medicine, La Jolla, CA 92037, USA
- Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla, CA 92037, USA
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97
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Qin S, Li Q, Gu S, Chen X, Lin L, Wang Z, Xu A, Chen X, Zhou C, Ren Z, Yang L, Xu L, Bai Y, Chen L, Li J, Pan H, Cao B, Fang W, Wu W, Wang G, Cheng Y, Yu Z, Zhu X, Jiang D, Lu Y, Wang H, Xu J, Bai L, Liu Y, Lin H, Wu C, Zhang Y, Yan P, Jin C, Zou J. Apatinib as second-line or later therapy in patients with advanced hepatocellular carcinoma (AHELP): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol 2021; 6:559-568. [PMID: 33971141 DOI: 10.1016/s2468-1253(21)00109-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inhibition of vascular endothelial growth factor receptor (VEGFR) has shown antitumour activity in advanced hepatocellular carcinoma, but few studies of VEGFR inhibitors have been done in populations with a high prevalence of hepatitis B virus infection. The aim of this study was to evaluate the efficacy and safety of apatinib in patients with pretreated advanced hepatocellular carcinoma. METHODS AHELP was a randomised, double-blind, placebo-controlled, phase 3 trial done at 31 hospitals in China, in patients (aged ≥18 years) with advanced hepatocellular carcinoma who had previously been refractory or intolerant to at least one line of systemic chemotherapy or targeted therapy. Patients were randomly assigned (2:1) to receive apatinib 750 mg or placebo orally once daily in 28-day treatment cycles. Group allocation was done with a central randomisation system, with a block size of six, and was stratified by Eastern Cooperative Oncology Group performance status, previous sorafenib treatment, and presence of vascular invasion or extrahepatic metastasis. The primary endpoint was overall survival, which was defined as time from randomisation to death from any cause, and was analysed in patients who were randomly assigned and received at least one dose of the study drug. Safety analyses were done in patients who received at least one dose of the study treatment and had post-dose safety assessments. This trial is registered with ClinicalTrials.gov, NCT02329860. FINDINGS Between April 1, 2014, and May 3, 2017, 400 eligible patients were randomly assigned to receive apatinib (n=267) or placebo (n=133). Seven patients (six in the apatinib group and one in the placebo group) did not receive study treatment and were excluded from efficacy analyses. Overall survival was significantly improved in the apatinib group compared with the placebo group (median 8·7 months [95% CI 7·5‒9·8] vs 6·8 months [5·7‒9·1]; hazard ratio 0·785 [95% CI 0·617‒0·998], p=0·048). 387 patients (257 in the apatinib group and 130 in the placebo group) had a safety assessment after study treatment and were included in safety analyses. The most common treatment-related adverse events of grade 3 or 4 were hypertension (71 [28%] patients in the apatinib group vs three [2%] in the placebo group), hand-foot syndrome (46 [18%] vs none), and decreased platelet count (34 [13%] vs one [1%]). 24 (9%) patients in the apatinib group and 13 (10%) in the placebo group died due to adverse events, but none of these deaths were deemed to be related to treatment by investigators. INTERPRETATION Apatinib significantly improved overall survival in patients with pretreated advanced hepatocellular carcinoma compared with placebo, with a manageable safety profile. FUNDING Jiangsu Hengrui Medicine.
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Affiliation(s)
- Shukui Qin
- Department of Medical Oncology, Cancer Center of Bayi Hospital, Nanjing Chinese Medicine University, Nanjing, China.
| | - Qiu Li
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shanzhi Gu
- Department of Intervention, Hunan Cancer Hospital, Changsha, China
| | - Xiaoming Chen
- Department of Invasive Technology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Lizhu Lin
- Cancer Center, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Zishu Wang
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Aibing Xu
- Department of Interventional Therapy, Nantong Tumor Hospital, Nantong, China
| | - Xi Chen
- Department of Oncology, The 900th Hospital of Joint Logistics Support Force, Fuzhou, China
| | - Cuncai Zhou
- Department of Hepatobiliary Interventional, Jiangxi Cancer Hospital, Nanchang, China
| | - Zhenggang Ren
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Xu
- Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuxian Bai
- Department of Gastroenterology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lei Chen
- Department of Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Jun Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongming Pan
- Department of Oncology, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Bangwei Cao
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Weijia Fang
- Department of Oncology, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Wei Wu
- Department of Hepatopathy, The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Ge Wang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Ying Cheng
- Department of Internal Medicine-Oncology, Jilin Cancer Hospital, Changchun, China
| | - Zhuang Yu
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xu Zhu
- Department of Interventional Therapy Unit, Beijing Cancer Hospital, Beijing, China
| | - Da Jiang
- Department of Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yinying Lu
- Comprehensive Liver Cancer Centre, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Huaming Wang
- Department of Interventional Therapy, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Jianming Xu
- Department of Digestive Oncology, The Fifth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Li Bai
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Yunpeng Liu
- Department of Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Hailan Lin
- Department of Intervention, Fujian Cancer Hospital, Fuzhou, China
| | - Changping Wu
- Department of Medical Oncology, The First People's Hospital of Changzhou, Changzhou, China
| | - Yang Zhang
- Department of Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ping Yan
- Clinical Research and Development, Jiangsu Hengrui Medicine, Shanghai, China
| | - Chunlei Jin
- Clinical Research and Development, Jiangsu Hengrui Medicine, Shanghai, China
| | - Jianjun Zou
- Clinical Research and Development, Jiangsu Hengrui Medicine, Shanghai, China
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98
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Ren Z, Qin S, Meng Z, Chen Z, Chai X, Xiong J, Bai Y, Yang L, Zhu H, Fang W, Lin X, Chen X, Li E, Wang L, Yan P, Zou J. A Phase 2 Study of Camrelizumab for Advanced Hepatocellular Carcinoma: Two-Year Outcomes and Continued Treatment beyond First RECIST-Defined Progression. Liver Cancer 2021; 10:500-509. [PMID: 34721511 PMCID: PMC8527901 DOI: 10.1159/000516470] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/25/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION In a multicenter, open-label, parallel-group, randomized, phase 2 study for pretreated advanced hepatocellular carcinoma (HCC), camrelizumab showed potent antitumor activity and acceptable safety profile. The aim of this report was to provide long-term data and evaluate potential benefit of treatment with camrelizumab beyond progression. METHODS From November 15, 2016, to November 16, 2017, 217 patients received camrelizumab 3 mg/kg intravenously every 2 or 3 weeks. Treatment beyond first Response Evaluation Criteria in Solid Tumors (RECIST)-defined progression (TBP) with camrelizumab was allowed. RESULTS At data cutoff of December 16, 2019 (>2 years after the last patient enrollment; median duration of follow-up, 13.2 months [IQR 5.7-25.8]), 14 (43.8%) of the 32 responses per blinded independent central review were ongoing. The median duration of response was not reached (range 2.5-30.5 + months). The ongoing response rates at 12, 18, and 24 months were 68.3% (95% confidence interval [CI] 47.7-82.2), 59.8% (95% CI 38.8-75.6), and 53.1% (95% CI 31.0-71.0), respectively. The median overall survival (OS) was 14.2 months (95% CI 11.5-16.3). The 18- and 24-month OS rates were 41.3% (95% CI 34.6-47.9) and 33.7% (95% CI 27.3-40.2), respectively. Of the 172 patients who experienced RECIST-defined progression per investigator, 102 received TBP, while 70 did not (non-TBP). The median OS was 16.9 months (95% CI 13.3-22.6) in the TBP group versus 9.4 months (95% CI 5.8-14.8) in the non-TBP group, and the 18- and 24-month OS rates were 47.5% (95% CI 37.3-56.9) versus 33.1% (95% CI 22.3-44.3) and 38.8% (95% CI 29.2-48.4) versus 23.2% (95% CI 13.8-34.1), respectively. No new safety signals of camrelizumab were observed. CONCLUSIONS With prolonged follow-up, camrelizumab continues to demonstrate the durable response and long survival in pretreated advanced HCC patients with manageable toxicities, especially in those who continued the treatment beyond first RECIST-defined progression.
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Affiliation(s)
- Zhenggang Ren
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shukui Qin
- Department of Medical Oncology Center, Bayi Affiliated Hospital, Nanjing University of Chinese Medicine, Nanjing, China,*Shukui Qin,
| | - Zhiqiang Meng
- Minimally Invasive Therapy Center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhendong Chen
- Department of Medical Oncology, Second Hospital of Anhui Medical University, Hefei, China
| | - Xiaoli Chai
- Department of Intervention, Hunan Cancer Hospital, Changsha, China
| | - Jianping Xiong
- Department of Medical Oncology, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuxian Bai
- Department of Medical Oncology, Third Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zhu
- Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Weijia Fang
- Department of Medical Oncology, First Affiliated Hospital of Zhejiang University (School of Medicine), Hangzhou, China
| | - Xiaoyan Lin
- Department of Medical Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoming Chen
- Department of Interventional Radiology, Cancer Center, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Enxiao Li
- Department of Medical Oncology, First Affiliated Hospital of Xi'an Jiaotong University (School of Medicine), Xi'an, China
| | - Linna Wang
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Ping Yan
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
| | - Jianjun Zou
- Jiangsu Hengrui Pharmaceuticals Co., Ltd, Shanghai, China
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99
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Jiang F, Yang H, Wang L, Wang Y, Tang Y, Wang D, Wang Q, Zou J. [ Escherichia coli expressing gas vesicles is safe for enhancing the ablation effect of highintensity focused ultrasound in tumor-bearing mice]. Nan Fang Yi Ke Da Xue Xue Bao 2021; 41:649-656. [PMID: 34134950 DOI: 10.12122/j.issn.1673-4254.2021.05.03] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effect and safety of Escherichia coli (E.coli) expressing gas vesicle (GVs) for enhancing the efficacy of tumor ablation by high intensity focused ultrasound (HIFU) in tumor-bearing mice. OBJECTIVE Thirty-two female BALB/c mice were used to establish mouse models bearing 4T1 tumor, which were randomized into GVs group [E.coli BL21 (AI)-PET28a-Arg1] and control group (PBS), and the efficacy of HIFU ablation was evaluated by examining coagulative necrotic volume and pathology of the tumors. Another 104 BALB/c mice were also randomly divided into GVs group and control group, and body weight changes of the mice were recorded on days 1, 4 and 15 after intravenous injection of E.coli containing GVs or PBS. White blood cells, red blood cells, hemoglobin and platelet counts and liver and renal function parameters of the mice were detected, and serum levels of TNF-α and IL-1β were examined using ELISA. The pathological changes in the liver and spleen were evaluated using HE staining to assess the safety of the treatments. OBJECTIVE HIFU ablation resulted in a significantly greater volume of coagulative necrosis and severer tissue damage in GVs group than in the control group (P < 0.001). In the 104 BALB/c mice without tumor cell inoculation, intravenous injection of E.coli expressing GVs, as compared with PBS, did not significantly affect body weight or cause changes in white blood cell, red blood cell and platelet counts or hemoglobin level (P1=0.59, P2=0.27, P3=0.76, P4=0.81). The liver and kidney function parameters (P1=0.12, P2=0.46, P3=0.62, P4=0.86) and serum levels of TNF-α and IL-1β (P1=0.48, P2=0.56) were all comparable between GVs group and control group. No obvious pathological changes were detected in the liver and spleen tissues in either GVs group or the control group. OBJECTIVE E.coli expressing GVs is safe for enhancing the ablation effect of HIFU in tumor-bearing mice.
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Affiliation(s)
- F Jiang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - H Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - L Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Y Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Y Tang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - D Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Q Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - J Zou
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
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100
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Valdivia MP, Stutman D, Stoeckl C, Theobald W, Collins GW, Bouffetier V, Vescovi M, Mileham C, Begishev IA, Klein SR, Melean R, Muller S, Zou J, Veloso F, Casner A, Beg FN, Regan SP. Talbot-Lau x-ray deflectometer: Refraction-based HEDP imaging diagnostic. Rev Sci Instrum 2021; 92:065110. [PMID: 34243593 DOI: 10.1063/5.0043655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
Talbot-Lau x-ray interferometry has been implemented to map electron density gradients in High Energy Density Physics (HEDP) experiments. X-ray backlighter targets have been evaluated for Talbot-Lau X-ray Deflectometry (TXD). Cu foils, wires, and sphere targets have been irradiated by 10-150 J, 8-30 ps laser pulses, while two pulsed-power generators (∼350 kA, 350 ns and ∼200 kA, 150 ns) have driven Cu wire, hybrid, and laser-cut x-pinches. A plasma ablation front generated by the Omega EP laser was imaged for the first time through TXD for densities >1023 cm-3. Backlighter optimization in combination with x-ray CCD, image plates, and x-ray film has been assessed in terms of spatial resolution and interferometer contrast for accurate plasma characterization through TXD in pulsed-power and high-intensity laser environments. The results obtained thus far demonstrate the potential of TXD as a powerful diagnostic for HEDP.
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Affiliation(s)
- M P Valdivia
- Physics and Astronomy Department, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - D Stutman
- Physics and Astronomy Department, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - C Stoeckl
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - W Theobald
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - G W Collins
- Center for Energy Research, University of California San Diego, San Diego, California 92093, USA
| | - V Bouffetier
- Université de Bordeaux-CNRS-CEA, Centre Lasers Intenses et Applications, UMR5107, F-33405 Talence, France
| | - M Vescovi
- Pontificia Universidad Catolica de Chile, Casilla 306, Santiago, Chile
| | - C Mileham
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - I A Begishev
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - S R Klein
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - R Melean
- University of Michigan, Ann Arbor, Michigan 48109, USA
| | - S Muller
- General Atomics, Inertial Fusion Technology, San Diego, California 92921, USA
| | - J Zou
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - F Veloso
- Pontificia Universidad Catolica de Chile, Casilla 306, Santiago, Chile
| | - A Casner
- CEA-CESTA, 15 avenue des Sablières, CS 60001, 33116 Le Barp CEDEX, France
| | - F N Beg
- Center for Energy Research, University of California San Diego, San Diego, California 92093, USA
| | - S P Regan
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
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