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Kim JA, Crawford KA, Spada PA, Martin LR, Zhang J, Wong R, Reid JM, Stewart CF, Frank TM, Liu Q, Michalek JE, Keller C. Non-chemotherapy adjuvant agents in TP53 mutant Ewing sarcoma. Sci Rep 2023; 13:14360. [PMID: 37658148 PMCID: PMC10474113 DOI: 10.1038/s41598-023-40751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 08/16/2023] [Indexed: 09/03/2023] Open
Abstract
Ewing sarcoma (EWS) is a malignant tumor arising in bone or soft tissue that occurs in adolescent and young adult patients as well as adults later in life. Although non-metastatic EWS is typically responsive to treatment when newly diagnosed, relapsed cases have an unmet need for which no standard treatment approach exists. Recent phase III clinical trials for EWS comparing 7 vs 5 chemotherapy drugs have failed to improve survival. To extend the durability of remission for EWS, we investigated 3 non-chemotherapy adjuvant therapy drug candidates to be combined with chemotherapy. The efficacy of these adjuvant drugs was investigated via anchorage-dependent growth assays, anchorage-independent soft-agar colony formation assays and EWS xenograft mouse models. Enoxacin and entinostat were the most effective adjuvant drug in both long-term in vitro and in vivo adjuvant studies. In the context that enoxacin is an FDA-approved antibiotic, and that entinostat is an investigational agent not yet FDA-approved, we propose enoxacin as an adjuvant drug for further preclinical and clinical investigation in EWS patients.
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Affiliation(s)
- Jin-Ah Kim
- Children's Cancer Therapy Development Institute, 9025 NE Von Neumann Drive Ste 110, Hillsboro, OR, 97006, USA.
| | - Kenneth A Crawford
- Children's Cancer Therapy Development Institute, 9025 NE Von Neumann Drive Ste 110, Hillsboro, OR, 97006, USA
| | - Piero A Spada
- Children's Cancer Therapy Development Institute, 9025 NE Von Neumann Drive Ste 110, Hillsboro, OR, 97006, USA
| | - Leah R Martin
- Children's Cancer Therapy Development Institute, 9025 NE Von Neumann Drive Ste 110, Hillsboro, OR, 97006, USA
| | - Jiaqi Zhang
- Children's Cancer Therapy Development Institute, 9025 NE Von Neumann Drive Ste 110, Hillsboro, OR, 97006, USA
| | - Rain Wong
- Children's Cancer Therapy Development Institute, 9025 NE Von Neumann Drive Ste 110, Hillsboro, OR, 97006, USA
| | - Joel M Reid
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Clinton F Stewart
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, 38105-2794, USA
| | - Timothy M Frank
- Children's Cancer Therapy Development Institute, 9025 NE Von Neumann Drive Ste 110, Hillsboro, OR, 97006, USA
| | - Qianqian Liu
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Joel E Michalek
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Charles Keller
- Children's Cancer Therapy Development Institute, 9025 NE Von Neumann Drive Ste 110, Hillsboro, OR, 97006, USA.
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Frizziero M, Spada F, Lamarca A, Kordatou Z, Barriuso J, Nuttall C, McNamara MG, Hubner RA, Mansoor W, Manoharan P, Fazio N, Valle JW. Carboplatin in Combination with Oral or Intravenous Etoposide for Extra-Pulmonary, Poorly-Differentiated Neuroendocrine Carcinomas. Neuroendocrinology 2019; 109:100-112. [PMID: 30703770 DOI: 10.1159/000497336] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carboplatin-etoposide (CarboEtop) is a 1st-line option for patients with advanced extra-pulmonary (EP), poorly-differentiated (PD) neuroendocrine carcinoma (NEC). Different schedules are used in clinical practice and randomised evidence is lacking. OBJECTIVES To provide real-life outcomes of carboplatin combined with oral or intravenous (IV) etoposide (Etop) in advanced EP-PD-NEC, from 2 specialist centres. METHODS Activity/efficacy/toxicity data of CarboEtop were collected retrospectively and analysed. RESULTS We identified 113 patients; median age: 65.8 years; male: 64%; gastro-entero-pancreatic origin: 54%; stage IV: 90%; median Ki-67: 70%; median follow-up: 11.5 months. A total of 123 courses of CarboEtop (oral: 45%; IV: 55%) were administered; 106 (86%) 1st-line, 16 (13%) 2nd-line, and 1 (1%) 3rd-line. Disease control rate: 74.5% in 1st-line and 69.2% in 2nd/3rd-line, with no significant difference between oral and IV Etop in 1st-line (69.8 vs. 80.8%, p = 0.237). Median progression-free survival (PFS): 6.0 and 4.5 months in 1st-line and 2nd/3rd-line, respectively. Overall survival (OS): 11.5 and 12.5 months in 1st-line and 2nd/3rd-line, respectively. The schedule (oral versus IV Etop) did not impact on 1st-line PFS (5.6 vs. 6.2 months, p = 0.179), although there was a trend towards shorter OS (8.9 vs. 12.1 months, p = 0.069). Liver metastases correlated with worse 1st-line PFS (p = 0.015) and 1st-line OS (p < 0.001) on multivariable analysis. The commonest grade 3-4 adverse event was myelosuppression (49%), with comparable toxicity between oral and IV Etop, except for venous thromboembolism (12.5 vs. 1.7%, p = 0.04). CONCLUSIONS CarboEtop for advanced EP-PD-NEC is active, effective, and well-tolerated. Oral and IV Etop schedules are associated with comparable toxicity; activity should be compared in larger cohorts.
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Affiliation(s)
- Melissa Frizziero
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Francesca Spada
- Gastrointestinal Medical Oncology and Neuroendocrine Tumors Unit, European Institute of Oncology, Milan, Italy
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Zoe Kordatou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jorge Barriuso
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Christina Nuttall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Prakash Manoharan
- Department of Radiology and Nuclear Medicine, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Nicola Fazio
- Gastrointestinal Medical Oncology and Neuroendocrine Tumors Unit, European Institute of Oncology, Milan, Italy
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom,
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom,
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Bakkenist CJ, Czambel RK, Hershberger PA, Tawbi H, Beumer JH, Schmitz JC. A quasi-quantitative dual multiplexed immunoblot method to simultaneously analyze ATM and H2AX Phosphorylation in human peripheral blood mononuclear cells. Oncoscience 2015; 2:542-54. [PMID: 26097887 PMCID: PMC4468340 DOI: 10.18632/oncoscience.162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/05/2015] [Indexed: 12/12/2022] Open
Abstract
Pharmacologic inhibition of DNA repair may increase the efficacy of many cytotoxic cancer agents. Inhibitors of DNA repair enzymes including APE1, ATM, ATR, DNA-PK and PARP have been developed and the PARP inhibitor olaparib is the first-in-class approved in Europe and the USA for the treatment of advanced BRCA-mutated ovarian cancer. Sensitive pharmacodynamic (PD) biomarkers are needed to further evaluate the efficacy of inhibitors of DNA repair enzymes in clinical trials. ATM is a protein kinase that mediates cell-cycle checkpoint activation and DNA double-strand break repair. ATM kinase activation at DNA double-strand breaks (DSBs) is associated with intermolecular autophosphorylation on serine-1981. Exquisite sensitivity and high stoichiometry as well as facile extraction suggest that ATM serine-1981 phosphorylation may be a highly dynamic PD biomarker for both ATM kinase inhibitors and radiation- and chemotherapy-induced DSBs. Here we report the pre-clinical analytical validation and fit-for-purpose biomarker method validation of a quasi-quantitative dual multiplexed immunoblot method to simultaneously analyze ATM and H2AX phosphorylation in human peripheral blood mononuclear cells (PBMCs). We explore the dynamics of these phosphorylations in PBMCs exposed to chemotherapeutic agents and DNA repair inhibitors in vitro, and show that ATM serine-1981 phosphorylation is increased in PBMCs in sarcoma patients treated with DNA damaging chemotherapy.
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Affiliation(s)
| | - R Kenneth Czambel
- Medicine, University of Pittsburgh School of Medicine, 5117 Centre Avenue, Pittsburgh, PA 15213-1863
| | - Pamela A Hershberger
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263
| | - Hussein Tawbi
- Medicine, University of Pittsburgh School of Medicine, 5117 Centre Avenue, Pittsburgh, PA 15213-1863
| | - Jan H Beumer
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, 5117 Centre Avenue, Pittsburgh, PA 15213-1863
| | - John C Schmitz
- Medicine, University of Pittsburgh School of Medicine, 5117 Centre Avenue, Pittsburgh, PA 15213-1863
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Hermes A, Bergman B, Bremnes R, Ek L, Fluge S, Sederholm C, Sundstrøm S, Thaning L, Vilsvik J, Aasebø U, Sörenson S. Irinotecan Plus Carboplatin Versus Oral Etoposide Plus Carboplatin in Extensive Small-Cell Lung Cancer: A Randomized Phase III Trial. J Clin Oncol 2008; 26:4261-7. [DOI: 10.1200/jco.2007.15.7545] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose A Japanese randomized trial showed superior survival for patients with extensive-disease (ED) small-cell lung cancer (SCLC) receiving irinotecan plus cisplatin compared with etoposide plus cisplatin. The present trial evaluated the efficacy of irinotecan plus carboplatin (IC) compared with oral etoposide plus carboplatin (EC). Patients and Methods Patients with ED SCLC were randomly assigned to receive either IC, which consisted of carboplatin (area under the curve = 4; Chatelut formula) and irinotecan (175 mg/m2) intravenously both on day 1, or EC, which consisted of carboplatin as in IC and etoposide (120 mg/m2/d) orally on days 1 through 5. Courses were repeated every 3 weeks with four cycles planned. Doses were reduced by one third in patients with a WHO performance status (PS) of 3 to 4 and/or age older than 70 years. Primary end point was overall survival (OS). Secondary end points were quality of life (QOL) and complete response (CR) rate. Results Of 220 randomly assigned patients, 209 were eligible for analysis (IC, n = 105; EC, n = 104). Thirty-five percent were older than 70 years, and 47% had a PS of 2 to 4. The groups were well balanced with respect to prognostic factors. OS was inferior in the EC group (hazard ratio = 1.41; 95% CI, 1.06 to 1.87; P = .02). Median survival time was 8.5 months for IC compared with 7.1 months for EC. One-year survival rate was 34% for IC and 24% for EC. CR was seen in 18 IC patients compared with seven EC patients (P = .02). There were no statistically significant differences in hematologic grade 3 or 4 toxicity. Grade 3 or 4 diarrhea was more common in the IC group. QOL differences were small, with a trend toward prolonged palliation with the IC regimen. Conclusion IC prolongs survival in ED SCLC with slightly better scores for QOL.
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Affiliation(s)
- Andreas Hermes
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Bengt Bergman
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Roy Bremnes
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Lars Ek
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Sverre Fluge
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Christer Sederholm
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Stein Sundstrøm
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Lars Thaning
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Jan Vilsvik
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Ulf Aasebø
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
| | - Sverre Sörenson
- From the Department of Pulmonary Oncology, Grosshansdorf Hospital, Grosshansdorf, Germany; Department of Chest Medicine, Haukeland University Hospital, Bergen; Institute of Clinical Medicine, University of Tromsø, Tromsø; Department of Medicine, Haugesund Hospital, Haugesund; Departments of Oncology and Medicine, University Hospital, Trondheim, Norway; Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Göteborg; Department of Respiratory Medicine and Allergology, Heart
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