Indomethacin to the rescue of TRAIL-resistant melanomas

Model based approach for estimating the dosage regimen of indomethacin a potential antiviral treatment of patients infected with SARS CoV-2

To face SARS-CoV-2 pandemic various attempts are made to identify potential effective treatments by repurposing available drugs. Among them, indomethacin, an anti-inflammatory drug, was shown to have potent in-vitro antiviral properties on human SARS-CoV-1, canine CCoV, and more recently on human SARS-CoV-2 at low micromolar range. Our objective was to show that indomethacin could be considered as a promising candidate for the treatment of SARS-CoV-2 and to provide criteria for comparing benefits of alternative dosage regimens using a model-based approach. A multi-stage model-based approach was developed to characterize % of recovery and viral load in CCoV-infected dogs, to estimate the PK of indomethacin in dog and human using published data after administration of immediate (IR) and sustained-release (SR) formulations, and to estimate the expected antiviral activity as a function of different assumptions on the effective exposure in human. Different dosage regimens were evaluated for IR formulation (25 mg and 50 mg three-times-a-day, and 25 mg four-times-a-day), and SR formulation (75 mg once and twice-a-day). The best performing dosing regimens were: 50 mg three-times-a-day for the IR formulation, and 75 mg twice-a-day for the SR formulation. The treatment with the SR formulation at the dose of 75 mg twice-a-day is expected to achieve a complete response in three days for the treatment in patients infected by the SARS-CoV-2 coronavirus. These results suggest that indomethacin could be considered as a promising candidate for the treatment of SARS-CoV-2 whose potential therapeutic effect need to be further assessed in a prospective clinical trial.

[What's new in skin cancers?]

The present "what's new in oncology in 2014?" is in keeping with data reported in the past years. Indeed, metastatic melanoma still keeps the lion's share. The results of the combinations schedules with BRAF and MEK inhibitors showed an improvement in progression-free survival. Otherwise, resistance mechanisms to MAPKinase pathway inhibitors are of interest worldwide. Nevertheless, more fundamental and transversal researches are currently being investigated than validated schedules in daily clinical practice. Following anti-CTLA-4 drugs, second-generation immunotherapies, including anti-PD1 and PD-L1 molecules, confirmed their results in extended cohorts. In the setting of localized melanoma, the final results from MLST-1, Morton's study, regarding the sentinel node procedure versus observation alone, prompted a new enhancement in the sentinel node controversy. From another point of view, "what is not new in oncology in 2014?" In this area, the absence of original investigations on the primary melanoma detection in France and the absence of innovations in the adjuvant treatment of melanoma after surgery should be mentioned. While recent revolutionary drugs, i.e. targeted therapies and immunotherapies, will know advances under the resistance pressure in a near future, a revolution is still awaited in melanoma earlier stages.