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Jensen LH. Clinical aspects and perspectives of erlotinib in the treatment of patients with biliary tract cancer. Expert Opin Investig Drugs 2016; 25:359-65. [PMID: 26781267 DOI: 10.1517/13543784.2016.1142973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Patients with non-resectable biliary tract cancer have a poor prognosis even if treated with systemic chemotherapy. One hope for improving treatment is through molecular biology and the characterization of specific cancer driving alterations followed by the design of targeted drugs. The epidermal growth factor receptor system is upregulated in many cancers and can be targeted by the protein kinase inhibitor erlotinib. Erlotinib has demonstrated a clinically applicable effect in pancreatic and lung cancer Areas covered: In this review, the author presents the published clinical data about erlotinib in biliary tract cancer. The data is interpreted with respect to its clinical value and in regards to its future development. EXPERT OPINION Erlotinib has low activity as a monotherapy, but has shown synergistic effects when combined with bevacizumab. The only phase III trial with erlotinib was negative, but suggested improved progression free survival in cholangiocarcinoma patients when added to gemcitabine and oxaliplatin. There is no clinical, radiological or molecular marker to guide therapy, but genomic profiling and basket or umbrella trials may be useful in identifying the subset of patients benefitting from erlotinib. Until this subgroup has been defined, erlotinib has no value to biliary tract cancer patients in the daily clinic.
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Affiliation(s)
- Lars Henrik Jensen
- a Department of Oncology , Vejle Hospital and University of Southern Denmark , Vejle , Denmark
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52
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Billingham L, Malottki K, Steven N. Research methods to change clinical practice for patients with rare cancers. Lancet Oncol 2016; 17:e70-e80. [PMID: 26868356 DOI: 10.1016/s1470-2045(15)00396-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 12/11/2022]
Abstract
Rare cancers are a growing group as a result of reclassification of common cancers by molecular markers. There is therefore an increasing need to identify methods to assess interventions that are sufficiently robust to potentially affect clinical practice in this setting. Methods advocated for clinical trials in rare diseases are not necessarily applicable in rare cancers. This Series paper describes research methods that are relevant for rare cancers in relation to the range of incidence levels. Strategies that maximise recruitment, minimise sample size, or maximise the usefulness of the evidence could enable the application of conventional clinical trial design to rare cancer populations. Alternative designs that address specific challenges for rare cancers with the aim of potentially changing clinical practice include Bayesian designs, uncontrolled n-of-1 trials, and umbrella and basket trials. Pragmatic solutions must be sought to enable some level of evidence-based health care for patients with rare cancers.
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Affiliation(s)
- Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK.
| | - Kinga Malottki
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Neil Steven
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Vivot A, Li J, Zeitoun JD, Mourah S, Crequit P, Ravaud P, Porcher R. Pharmacogenomic biomarkers as inclusion criteria in clinical trials of oncology-targeted drugs: a mapping of ClinicalTrials.gov. Genet Med 2015; 18:796-805. [PMID: 26681315 DOI: 10.1038/gim.2015.165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/05/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study was to describe pharmacogenomics-based inclusion criteria (enrichment) and the main characteristics of clinical trials involving oncology-targeted therapies. METHODS Clinical trials of oncology-targeted therapies approved after 2005 with pharmacogenomic testing required or recommended in their label were retrieved from a mapping of the ClinicalTrials.gov database. RESULTS We examined information for 12 drugs and 858 trials. Overall, 434 trials (51%) were enriched on the biomarker first mentioned in the label and 145 (17%) were enriched on another biomarker, whereas 270 trials (31%) included all patients. The median proportion of trials corresponding to both the drug's indication and drug's target was 35%. Of the 361 trials that tested drugs in another disease than the first one in the label, 219 (61%) were without enrichment and 87 (24%) were actually enriched but on another biomarker than the first one in the label. CONCLUSION Several drugs have been tested in trials enriched on many different biomarkers. Nonetheless, most targeted therapies have been developed only using biomarker-positive patients; therefore, exclusion of biomarker-negative patients from treatment relies on only preclinical data and on biological understanding of the disease and target.Genet Med 18 8, 796-805.
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Affiliation(s)
- Alexandre Vivot
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Épidémiologie Clinique, Paris, France.,INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris Descartes University, Paris, France
| | - Jacques Li
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Épidémiologie Clinique, Paris, France.,INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris Descartes University, Paris, France
| | - Jean-David Zeitoun
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Épidémiologie Clinique, Paris, France.,INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris Descartes University, Paris, France
| | - Samia Mourah
- Department of Pharmacology-Genetics, Assistance Publique des Hôpitaux de Paris (AP-HP), Saint-Louis Hospital, Paris, France.,INSERM UMRS 976, Paris, France
| | - Perrine Crequit
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Épidémiologie Clinique, Paris, France.,INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris Descartes University, Paris, France
| | - Philippe Ravaud
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Épidémiologie Clinique, Paris, France.,INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris Descartes University, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Raphaël Porcher
- Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Épidémiologie Clinique, Paris, France.,INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (CRESS), METHODS Team, Paris Descartes University, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
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Mockus SM, Patterson SE, Statz C, Bult CJ, Tsongalis GJ. Clinical Trials in Precision Oncology. Clin Chem 2015; 62:442-8. [PMID: 26607725 DOI: 10.1373/clinchem.2015.247437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/28/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Availability of genomic information used in the management of cancer treatment has outpaced both regulatory and reimbursement efforts. Many types of clinical trials are underway to validate the utility of emerging genome-based biomarkers for diagnostic, prognostic, and predictive applications. Clinical trials are a key source of evidence required for US Food and Drug Administration approval of therapies and companion diagnostics and for establishing the acceptance criteria for reimbursement. CONTENT Determining the eligibility of patients for molecular-based clinical trials and the interpretation of data emerging from clinical trials is significantly hampered by 2 primary factors: the lack of specific reporting standards for biomarkers in clinical trials and the lack of adherence to official gene and variant naming standards. Clinical trial registries need specifics on the mutation required for enrollment as opposed to allowing a generic mutation entry such as, "EGFR mutation." The use of clinical trials data in bioinformatics analysis and reporting is also gated by the lack of robust, state of the art programmatic access support. An initiative is needed to develop community standards for clinical trial descriptions and outcome reporting that are modeled after similar efforts in the genomics research community. SUMMARY Systematic implementation of reporting standards is needed to insure consistency and specificity of biomarker data, which will in turn enable better comparison and assessment of clinical trial outcomes across multiple studies. Reporting standards will facilitate improved identification of relevant clinical trials, aggregation and comparison of information across independent trials, and programmatic access to clinical trials databases.
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Affiliation(s)
- Susan M Mockus
- The Jackson Laboratory for Genomic Medicine, Farmington, CT;
| | | | - Cara Statz
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | | | - Gregory J Tsongalis
- Dartmouth Hitchcock Medical Center and The Audrey and Theodor Geisel School of Medicine at Dartmouth, Lebanon, NH
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Pichler M, Calin GA. MicroRNAs in cancer: from developmental genes in worms to their clinical application in patients. Br J Cancer 2015; 113:569-73. [PMID: 26158421 PMCID: PMC4647691 DOI: 10.1038/bjc.2015.253] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/03/2015] [Accepted: 06/07/2015] [Indexed: 12/21/2022] Open
Abstract
Several discoveries have paved the way to personalise cancer medicine and a tremendous gain of
knowledge in genomics and molecular mechanisms of cancer progression cumulated over the last years.
Big stories in biology commonly start in a simple model system. No wonder microRNAs have been
identified as regulators of embryonic development in the nematode Caenorhabditis elegans.
From the first identification in worms to the first-in-man microRNA-based clinical trial in humans,
almost 20 years passed. In this review we follow the story of understanding microRNA alterations in
cancer, describe recent developments in the microRNA field and critically discuss their potential as
diagnostic, prognostic and therapeutics factors in cancer medicine. We will explain the rationale
behind the use of microRNAs in cancer diagnosis and prognosis prediction, but also discuss the
limitations and pitfalls associated with this. Novel developments of combined microRNA/siRNA
pharmacological approaches will be discussed and most recently data about MXR34, the first-tested
microRNA drug will be described.
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Affiliation(s)
- M Pichler
- 1] Department of Experimental Therapeutics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA [2] Division of Oncology, Medical University of Graz, Austria
| | - G A Calin
- 1] Department of Experimental Therapeutics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA [2] The Center for RNA Interference and Non-coding RNAs, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Beyond conventional chemotherapy: Emerging molecular targeted and immunotherapy strategies in urothelial carcinoma. Cancer Treat Rev 2015; 41:699-706. [PMID: 26138514 DOI: 10.1016/j.ctrv.2015.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/17/2015] [Indexed: 01/20/2023]
Abstract
Advanced urothelial carcinoma is frequently lethal, and improvements in cytotoxic chemotherapy have plateaued. Recent technological advances allows for a comprehensive analysis of genomic alterations in a timely manner. The Cancer Genome Atlas (TCGA) study revealed that there are numerous genomic aberrations in muscle-invasive urothelial carcinoma, such as TP53, ARID1A, PIK3CA, ERCC2, FGFR3, and HER2. Molecular targeted therapies against similar genetic alterations are currently available for other malignancies, but their efficacy in urothelial carcinoma has not been established. This review describes the genomic landscape of malignant urothelial carcinomas, with an emphasis on the potential to prosecute these tumours by deploying novel targeted agents and immunotherapy in appropriately selected patient populations.
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Steuer CE, Papadimitrakopoulou V, Herbst RS, Redman MW, Hirsch FR, Mack PC, Ramalingam SS, Gandara DR. Innovative Clinical Trials: The LUNG-MAP Study. Clin Pharmacol Ther 2015; 97:488-91. [DOI: 10.1002/cpt.88] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 01/19/2015] [Accepted: 02/04/2015] [Indexed: 01/20/2023]
Affiliation(s)
- CE Steuer
- Winship Cancer Institute; Emory University; Atlanta Georgia USA
| | | | - RS Herbst
- Yale Comprehensive Cancer Center; Yale School of Medicine; New Haven Connecticut USA
| | - MW Redman
- Fred Hutchinson Cancer Research Center and Southwest Oncology Group Statistical Center
| | - FR Hirsch
- University of Colorado Cancer Center; Aurora Colorado USA
| | - PC Mack
- University of California Davis Cancer Center; Davis California USA
| | - SS Ramalingam
- Winship Cancer Institute; Emory University; Atlanta Georgia USA
| | - DR Gandara
- University of California Davis Cancer Center; Davis California USA
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Mandrekar SJ, Dahlberg SE, Simon R. Improving Clinical Trial Efficiency: Thinking outside the Box. Am Soc Clin Oncol Educ Book 2015:e141-7. [PMID: 25993165 PMCID: PMC6995119 DOI: 10.14694/edbook_am.2015.35.e141] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Clinical trial design strategies have evolved over the past few years as a means to accelerate the drug development process so that the right therapies can be delivered to the right patients. Basket, umbrella, and adaptive enrichment strategies represent a class of novel designs for testing targeted therapeutics in oncology. Umbrella trials include a central infrastructure for screening and identification of patients, and focus on a single tumor type or histology with multiple subtrials, each testing a targeted therapy within a molecularly defined subset. Basket trial designs offer the possibility to include multiple molecularly defined subpopulations, often across histology or tumor types, but included in one cohesive design to evaluate the targeted therapy in question. Adaptive enrichment designs offer the potential to enrich for patients with a particular molecular feature that is predictive of benefit for the test treatment based on accumulating evidence from the trial. This review will aim to discuss the fundamentals of these design strategies, the underlying statistical framework, the logistical barriers of implementation, and, ultimately, the interpretation of the trial results. New statistical approaches, extensive multidisciplinary collaboration, and state of the art data capture technologies are needed to implement these strategies in practice. Logistical challenges to implementation arising from centralized assay testing, requirement of multiple specimens, multidisciplinary collaboration, and infrastructure requirements will also be discussed. This review will present these concepts in the context of the National Cancer Institute's precision medicine initiative trials: MATCH, ALCHEMIST, Lung MAP, as well as other trials such as FOCUS4.
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Affiliation(s)
- Sumithra J Mandrekar
- From the Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; National Institutes of Health, Rockville, MD
| | - Suzanne E Dahlberg
- From the Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; National Institutes of Health, Rockville, MD
| | - Richard Simon
- From the Mayo Clinic, Rochester, MN; Dana-Farber Cancer Institute, Boston, MA; National Institutes of Health, Rockville, MD
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