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Ellingson BM, Hagiwara A, Morris CJ, Cho NS, Oshima S, Sanvito F, Oughourlian TC, Telesca D, Raymond C, Abrey LE, Garcia J, Aftab DT, Hessel C, Minei TR, Harats D, Nathanson DA, Wen PY, Cloughesy TF. Depth of Radiographic Response and Time to Tumor Regrowth Predicts Overall Survival Following Anti-VEGF Therapy in Recurrent Glioblastoma. Clin Cancer Res 2023; 29:4186-4195. [PMID: 37540556 PMCID: PMC10592195 DOI: 10.1158/1078-0432.ccr-23-1235] [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: 04/26/2023] [Revised: 06/04/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Antiangiogenic therapies are known to cause high radiographic response rates due to reduction in vascular permeability resulting in a lower degree of contrast extravasation. In this study, we investigate the prognostic ability for model-derived parameters describing enhancing tumor volumetric dynamics to predict survival in recurrent glioblastoma treated with antiangiogenic therapy. EXPERIMENTAL DESIGN N = 276 patients in two phase II trials were used as training data, including bevacizumab ± irinotecan (NCT00345163) and cabozantinib (NCT00704288), and N = 74 patients in the bevacizumab arm of a phase III trial (NCT02511405) were used for validation. Enhancing volumes were estimated using T1 subtraction maps, and a biexponential model was used to estimate regrowth (g) and regression (d) rates, time to tumor regrowth (TTG), and the depth of response (DpR). Response characteristics were compared to diffusion MR phenotypes previously shown to predict survival. RESULTS Optimized thresholds occurred at g = 0.07 months-1 (phase II: HR = 0.2579, P = 5 × 10-20; phase III: HR = 0.2197, P = 5 × 10-5); d = 0.11 months-1 (HR = 0.3365, P < 0.0001; HR = 0.3675, P = 0.0113); TTG = 3.8 months (HR = 0.2702, P = 6 × 10-17; HR = 0.2061, P = 2 × 10-5); and DpR = 11.3% (HR = 0.6326, P = 0.0028; HR = 0.4785, P = 0.0206). Multivariable Cox regression controlling for age and baseline tumor volume confirmed these factors as significant predictors of survival. Patients with a favorable pretreatment diffusion MRI phenotype had a significantly longer TTG and slower regrowth. CONCLUSIONS Recurrent glioblastoma patients with a large, durable radiographic response to antiangiogenic agents have significantly longer survival. This information is useful for interpreting activity of antiangiogenic agents in recurrent glioblastoma.
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Affiliation(s)
- Benjamin M. Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Neuroscience Interdepartmental PhD Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Connor J. Morris
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicholas S. Cho
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, CA, USA
- Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sonoko Oshima
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Francesco Sanvito
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Talia C. Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Neuroscience Interdepartmental PhD Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Donatello Telesca
- Department of Biostatistics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | | | | | - David A. Nathanson
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Timothy F. Cloughesy
- UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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2
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Bruno R, Marchand M, Yoshida K, Chan P, Li H, Zou W, Mercier F, Chanu P, Wu B, Lee A, Li C, Jin JY, Maitland ML, Reck M, Socinski MA. Tumor Dynamic Model-Based Decision Support for Phase Ib/II Combination Studies: A Retrospective Assessment Based on Resampling of the Phase III Study IMpower150. Clin Cancer Res 2023; 29:1047-1055. [PMID: 36595566 PMCID: PMC10023325 DOI: 10.1158/1078-0432.ccr-22-2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/17/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Model-based tumor growth inhibition (TGI) metrics are increasingly incorporated into go/no-go decisions in early clinical studies. To apply this methodology to new investigational combinations requires independent evaluation of TGI metrics in recently completed Phase III trials of effective immunotherapy. PATIENTS AND METHODS Data were extracted from IMpower150, a positive, randomized, Phase III study of first-line therapy in 1,202 patients with non-small cell lung cancer. We resampled baseline characteristics and longitudinal sum of longest diameters of tumor lesions of patients from both arms, atezolizumab+ bevacizumab+chemotherapy (ABCP) versus BCP, to mimic Phase Ib/II studies of 15 to 40 patients/arm with 6 to 24 weeks follow-up. TGI metrics were estimated using a bi-exponential TGI model. Effect sizes were calculated as TGI metrics geometric mean ratio (GMR), objective response rate (ORR) difference (d), and progression-free survival (PFS), hazard ratio (HR) between arms. Correct and incorrect go decisions were evaluated as the probability to achieve desired effect sizes in ABCP versus BCP and BCP versus BCP, respectively, across 500 replicated subsamples for each design. RESULTS For 40 patients/24 weeks follow-up, correct go decisions based on probability tumor growth rate (KG) GMR <0.90, dORR >0.10, and PFS HR <0.70 were 83%, 69%, and 58% with incorrect go decision rates of 4%, 12%, and 11%, respectively. For other designs, the ranking did not change with TGI metrics consistently overperforming RECIST endpoints. The predicted overall survival (OS) HR was around 0.80 in most of the scenarios investigated. CONCLUSIONS Model-based estimate of KG GMR is an exploratory endpoint that informs early clinical decisions for combination studies.
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Affiliation(s)
- René Bruno
- Clinical Pharmacology, Genentech-Roche, Marseille, France
| | | | - Kenta Yoshida
- Clinical Pharmacology, Genentech, South San Francisco, California
| | - Phyllis Chan
- Clinical Pharmacology, Genentech, South San Francisco, California
| | - Haocheng Li
- Product Development, Roche/Genentech, Mississauga, Ontario, Canada
| | - Wei Zou
- Product Development, Genentech, South San Francisco, California
| | | | - Pascal Chanu
- Clinical Pharmacology, Genentech-Roche, Lyon, France
| | - Benjamin Wu
- Clinical Pharmacology, Genentech, South San Francisco, California
| | - Anthony Lee
- Product Development, Genentech, South San Francisco, California
| | - Chunze Li
- Clinical Pharmacology, Genentech, South San Francisco, California
| | - Jin Y Jin
- Clinical Pharmacology, Genentech, South San Francisco, California
| | - Michael L Maitland
- Inova Schar Cancer Institute, Fairfax, Virginia
- University of Virginia Cancer Center, Charlottesville, Virginia
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
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3
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He LN, Fu S, Ma H, Chen C, Zhang X, Li H, Du W, Chen T, Jiang Y, Wang Y, Wang Y, Zhou Y, Lin Z, Yang Y, Huang Y, Zhao H, Fang W, Zhang H, Zhang L, Hong S. Early on-treatment tumor growth rate (EOT-TGR) determines treatment outcomes of advanced non-small-cell lung cancer patients treated with programmed cell death protein 1 axis inhibitor. ESMO Open 2022; 7:100630. [PMID: 36442353 PMCID: PMC9808481 DOI: 10.1016/j.esmoop.2022.100630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Tumor growth rate (TGR), denoted as percentage change in tumor size per month, is a well-established indicator of tumor growth kinetics. The predictive value of early on-treatment TGR (EOT-TGR) for immunotherapy remains unclear. We sought to establish and validate the association of EOT-TGR with treatment outcomes in patients with advanced non-small-cell lung cancer (aNSCLC) undergoing anti-PD-1/PD-L1 (programmed cell death protein 1/programmed death-ligand 1) therapy. PATIENTS AND METHODS This bicenter retrospective cohort study included a training cohort, a contemporaneously treated internal validation cohort, and an external validation cohort. Computed tomography images were retrieved to calculate EOT-TGR, denoted as tumor burden change per month during a period between baseline and the first imaging evaluation after immunotherapy. Kaplan-Meier methodology and Cox regression analysis were conducted for survival analyses. RESULTS In the pooled cohort (n = 172), 125 patients (72.7%) were males; median age at diagnosis was 58 (range 28-79) years. Based on the training cohort, we determined the optimal cut-off value for EOT-TGR as 10.4%/month. Higher EOT-TGR was significantly associated with inferior overall survival [OS; hazard ratio (HR) 2.93, 95% confidence interval (CI) 1.47-5.83; P = 0.002], worse progression-free survival (PFS; HR 2.44, 95% CI 1.46-4.08; P = 0.001), and lower objective response rate (3.3% versus 20.9%; P = 0.040) and durable clinical benefit rate (6.7% versus 41.9%; P = 0.001). Results were reproducible in the two validation cohorts for OS and PFS. Among 43 patients who had a best response of progressive disease in the training cohort, those with high EOT-TGR had worse OS (HR 2.64; P = 0.041) and were more likely to progress due to target lesions at the first tumor evaluation (85.2% versus 0.0%; P <0.001). CONCLUSIONS Higher EOT-TGR was associated with inferior OS and immunotherapeutic response in patients with aNSCLC undergoing anti-PD-1/PD-L1 therapy. This easy-to-calculate radiologic biomarker may help evaluate the abilities of immunotherapy to prolong survival and assist in tailoring patients' management. TRIAL REGISTRATION ClinicalTrials.govNCT04722406; https://clinicaltrials.gov/ct2/show/NCT04722406.
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Affiliation(s)
- L.-N. He
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - S. Fu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation of Sun Yat-Sen University; Department of Cellular & Molecular Diagnostics Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - H. Ma
- Department of Oncology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China
| | - C. Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Departments of Radiation Oncology, Guangzhou, China
| | - X. Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - H. Li
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - W. Du
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - T. Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Nuclear Medicine, Guangzhou, China
| | - Y. Jiang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Nuclear Medicine, Guangzhou, China
| | - Y. Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Y. Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Endoscopy, Guangzhou, China
| | - Y. Zhou
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,VIP Region, Guangzhou, China
| | - Z. Lin
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Y. Yang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Y. Huang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - H. Zhao
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - W. Fang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - H. Zhang
- Department of Oncology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China,Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Guangzhou, China,Prof. Haibo Zhang, Department of Oncology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou, Guangdong 510120, People’s Republic of China. Tel: +86-20-81887233-34830
| | - L. Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China,Prof. Li Zhang, MD, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong 510060, People’s Republic of China. Tel: +86-20-87343458
| | - S. Hong
- State Key Laboratory of Oncology in South China, Guangzhou, China,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China,Correspondence to: Prof. Shaodong Hong, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, Guangdong 510060, People’s Republic of China. Tel: +86-20-87342480
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4
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Yeh C, Zhou M, Sigel K, Jameson G, White R, Safyan R, Saenger Y, Hecht E, Chabot J, Schreibman S, Juzyna B, Ychou M, Conroy T, Fojo T, Manji GA, Von Hoff D, Bates SE. Tumor Growth Rate Informs Treatment Efficacy in Metastatic Pancreatic Adenocarcinoma: Application of a Growth and Regression Model to Pivotal Trial and Real-World Data. Oncologist 2022; 28:139-148. [PMID: 36367377 PMCID: PMC9907043 DOI: 10.1093/oncolo/oyac217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Methods for screening agents earlier in development and strategies for conducting smaller randomized controlled trials (RCTs) are needed. METHODS We retrospectively applied a tumor growth model to estimate the rates of growth of pancreatic cancer using radiographic tumor measurements or serum CA 19-9 values from 3033 patients with stages III-IV PDAC who were enrolled in 8 clinical trials or were included in 2 large real-world data sets. RESULTS g correlated inversely with OS and was consistently lower in the experimental arms than in the control arms of RCTs. At the individual patient level, g was significantly faster for lesions metastatic to the liver relative to those localized to the pancreas. Regardless of regimen, g increased toward the end of therapy, often by over 3-fold. CONCLUSIONS Growth rates of PDAC can be determined using radiographic tumor measurement and CA 19-9 values. g is inversely associated with OS and can differentiate therapies within the same trial and across trials. g can also be used to characterize changes in the behavior of an individual's PDAC, such as differences in the growth rate of lesions based on metastatic site, and the emergence of chemoresistance. We provide examples of how g can be used to benchmark phase II and III clinical data to a virtual reference arm to inform go/no go decisions and consider novel trial designs to optimize and accelerate drug development.
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Affiliation(s)
- Celine Yeh
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Mengxi Zhou
- Department of Medicine, Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Keith Sigel
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gayle Jameson
- Department of Medical Oncology/Hematology, HonorHealth Research Institute, Scottsdale, AZ, USA
| | - Ruth White
- Department of Medicine, Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Rachael Safyan
- Department of Medicine, Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Yvonne Saenger
- Department of Medicine, Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Elizabeth Hecht
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - John Chabot
- Department of Medicine, Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Stephen Schreibman
- Department of Medicine, Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Béata Juzyna
- R&D UNICANCER, Fédération Nationale des Centres de Lutte Contre le Cancer, Paris, France
| | - Marc Ychou
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Thierry Conroy
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy Cedex, France
| | - Tito Fojo
- Department of Medicine, Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA,Hematology/Oncology, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Gulam A Manji
- Department of Medicine, Division of Hematology/Oncology, Columbia University Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Daniel Von Hoff
- Virginia G. Piper Cancer Center Clinical Trials, HonorHealth Research Institute, Scottsdale, AZ, USA,Translational Genomics Research Institute, Clinical Translational Research Division, Phoenix, AZ, USA
| | - Susan E Bates
- Corresponding author: Susan E. Bates, MD, Columbia University Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Avenue, Herbert Irving Pavilion, 9th Floor, New York, NY 10032, USA. Tel: +1 212 305 9422.
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5
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Maniar A, Wei AZ, Dercle L, Bien HH, Fojo T, Bates SE, Schwartz LH. Novel biomarkers in NSCLC: Radiomic analysis, kinetic analysis, and circulating tumor DNA. Semin Oncol 2022; 49:S0093-7754(22)00042-2. [PMID: 35914982 DOI: 10.1053/j.seminoncol.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Current radiographic methods of measuring treatment response for patients with nonsmall cell lung cancer have significant limitations. Recently, new modalities using standard of care images or minimally invasive blood-based DNA tests have gained interest as methods of evaluating treatment response. This article highlights three emerging modalities: radiomic analysis, kinetic analysis and serum-based measurement of circulating tumor DNA, with a focus on the clinical evidence supporting these methods. Additionally, we discuss the possibility of combining these modalities to develop a robust biomarker with strong correlation to clinically meaningful outcomes that could impact clinical trial design and patient care. At Last, we focus on how these methods specifically apply to a Veteran population.
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Affiliation(s)
- Ashray Maniar
- Columbia University Irving Medical Center, Division of Hematology and Oncology, New York, NY
| | - Alexander Z Wei
- Columbia University Irving Medical Center, Division of Hematology and Oncology, New York, NY
| | - Laurent Dercle
- Columbia University Irving Medical Center, Division of Radiology, New York, NY
| | - Harold H Bien
- Northport VA Medical Center, Division of Hematology and Oncology, Northport, NY
| | - Tito Fojo
- Columbia University Irving Medical Center, Division of Hematology and Oncology, New York, NY; James J. Peters Bronx VA Medical Center, Division of Hematology and Oncology, Bronx, NY
| | - Susan E Bates
- Columbia University Irving Medical Center, Division of Hematology and Oncology, New York, NY; Northport VA Medical Center, Division of Hematology and Oncology, Northport, NY.
| | - Lawrence H Schwartz
- Columbia University Irving Medical Center, Division of Radiology, New York, NY
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6
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Dercle L, Zhao B, Gönen M, Moskowitz CS, Connors DE, Yang H, Lu L, Reidy-Lagunes D, Fojo T, Karovic S, Maitland ML, Oxnard GR, Schwartz LH. An imaging signature to predict outcome in metastatic colorectal cancer using routine computed tomography scans. Eur J Cancer 2022; 161:138-147. [PMID: 34916122 PMCID: PMC10018811 DOI: 10.1016/j.ejca.2021.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/10/2021] [Accepted: 10/24/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Quantitative analysis of computed tomography (CT) scans of patients with metastatic colorectal cancer (mCRC) can identify imaging signatures that predict overall survival (OS). METHODS We retrospectively analysed CT images from 1584 mCRC patients on two phase III trials evaluating FOLFOX ± panitumumab (n = 331, 350) and FOLFIRI ± aflibercept (n = 437, 466). In the training set (n = 720), an algorithm was trained to predict OS landmarked from month 2; the output was a signature value on a scale from 0 to 1 (most to least favourable predicted OS). In the validation set (n = 864), hazard ratios (HRs) evaluated the association of the signature with OS using RECIST1.1 as a benchmark of comparison. RESULTS In the training set, the selected signature combined three features - change in tumour volume, change in tumour spatial heterogeneity, and tumour volume - to predict OS. In the validation set, RECIST1.1 classified patients in three categories: response (n = 166, 19.2%), stable disease (n = 636, 73.6%), and progression (n = 62, 7.2%). The HR was 3.93 (2.79-5.54). Using the same distribution for the signature, the HR was 21.04 (14.88-30.58), showing an incremental prognostic separation. Stable disease by RECIST1.1 was reclassified by the signature along a continuum where patients belonging to the most and least favourable signature quartiles had a median OS of 40.73 (28.49 to NA) months (n = 94) and 7.03 (5.66-7.89) months (n = 166), respectively. CONCLUSIONS A signature combining three imaging features provides early prognostic information that can improve treatment decisions for individual patients and clinical trial analyses.
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Affiliation(s)
- Laurent Dercle
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA.
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Dana E Connors
- Foundation for the National Institutes of Health (FNIH), 11400 Rockville Pike, Suite 600, North Bethesda, MD 20852, USA
| | - Hao Yang
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA
| | - Lin Lu
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA
| | - Diane Reidy-Lagunes
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Tito Fojo
- Columbia University Herbert Irving Comprehensive Cancer Center, 161 Fort Washington Ave., New York, NY 10032, USA
| | - Sanja Karovic
- Inova Center for Personalized Health and Schar Cancer Institute, 8100 Innovation Park Dr, Fairfax, VA 22031, USA
| | - Michael L Maitland
- Inova Center for Personalized Health and Schar Cancer Institute, 8100 Innovation Park Dr, Fairfax, VA 22031, USA; University of Virginia Cancer Center, 1240 Lee St., Charlottesville, VA 22903, USA
| | - Geoffrey R Oxnard
- Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA 02215, USA
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center and New York Presbyterian Hospital, 710 West 168th St., New York, NY 10032, USA
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7
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Nishino M, Lu J, Hino T, Vokes NI, Jänne PA, Hatabu H, Johnson BE. Tumor Growth Rate After Nadir Is Associated With Survival in Patients With EGFR-Mutant Non-Small-Cell Lung Cancer Treated With Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor. JCO Precis Oncol 2021; 5:1603-1610. [PMID: 34994646 PMCID: PMC9848598 DOI: 10.1200/po.21.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/24/2021] [Accepted: 09/09/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the association between tumor volume growth rate after the nadir and survival in patients with EGFR-mutant advanced non-small-cell lung cancer (NSCLC) treated with erlotinib. MATERIALS AND METHODS Seventy-one patients with EGFR-mutant advanced NSCLC treated with erlotinib were studied for computed tomography tumor volume kinetics during therapy. The tumor growth rate after nadir was obtained using a previously published analytic module for longitudinal volume tracking to study its relationship with overall survival (OS). RESULTS The median tumor volume for the cohort was 19,842 mm3 at baseline and 4,083 mm3 at nadir. The median time to nadir was 6.2 months. The tumor growth rate after nadir for logeV (the natural logarithm of tumor volume measured in mm3) was 0.11/mo on average for the cohort (SE: 0.014), which was very similar to the previously validated reference value of 0.12/mo to define slow and fast tumor growth. The OS of 48 patients with slow tumor growth (≤ 0.12/mo) was significantly longer compared with 23 patients with fast tumor growth (> 0.12/mo; median OS: 37.8 v 25.0 months; P = .0012). In Cox models, tumor growth rate was also associated with survival (regression coefficient: 3.9903; P = .0024; faster rate leads to increased hazards), after adjusting for time to nadir (regression coefficient: -0.0863; P = .0008; longer time to nadir leads to decreased hazards) and smoking history. CONCLUSION In patients with EGFR-mutant advanced NSCLC treated with erlotinib, slower tumor growth rates after nadir were associated with longer OS, providing a rationale for using tumor growth rates to guide precision therapy for lung cancer.
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Affiliation(s)
- Mizuki Nishino
- Department of Imaging, Dana Farber Cancer
Institute, Boston, MA
- Department of Radiology, Brigham and
Women's Hospital, Boston, MA
| | - Junwei Lu
- Department of Biostatistics, Harvard Chan
School of Public Health, Boston, MA
| | - Takuya Hino
- Department of Radiology, Brigham and
Women's Hospital, Boston, MA
| | - Natalie I. Vokes
- Department of Medical Oncology, Dana
Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and
Women's Hospital, Boston, MA
| | - Pasi A. Jänne
- Department of Medical Oncology, Dana
Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and
Women's Hospital, Boston, MA
| | - Hiroto Hatabu
- Department of Imaging, Dana Farber Cancer
Institute, Boston, MA
- Department of Radiology, Brigham and
Women's Hospital, Boston, MA
| | - Bruce E. Johnson
- Department of Medical Oncology, Dana
Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and
Women's Hospital, Boston, MA
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8
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Nishino M, Lu J, Hino T, Vokes NI, Jänne PA, Hatabu H, Johnson BE. Tumor Growth Rate After Nadir Is Associated With Survival in Patients With EGFR-Mutant Non-Small-Cell Lung Cancer Treated With Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor. JCO Precis Oncol 2021. [PMID: 34994646 DOI: 10.1200/po.20.00478:501-509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
PURPOSE To investigate the association between tumor volume growth rate after the nadir and survival in patients with EGFR-mutant advanced non-small-cell lung cancer (NSCLC) treated with erlotinib. MATERIALS AND METHODS Seventy-one patients with EGFR-mutant advanced NSCLC treated with erlotinib were studied for computed tomography tumor volume kinetics during therapy. The tumor growth rate after nadir was obtained using a previously published analytic module for longitudinal volume tracking to study its relationship with overall survival (OS). RESULTS The median tumor volume for the cohort was 19,842 mm3 at baseline and 4,083 mm3 at nadir. The median time to nadir was 6.2 months. The tumor growth rate after nadir for logeV (the natural logarithm of tumor volume measured in mm3) was 0.11/mo on average for the cohort (SE: 0.014), which was very similar to the previously validated reference value of 0.12/mo to define slow and fast tumor growth. The OS of 48 patients with slow tumor growth (≤ 0.12/mo) was significantly longer compared with 23 patients with fast tumor growth (> 0.12/mo; median OS: 37.8 v 25.0 months; P = .0012). In Cox models, tumor growth rate was also associated with survival (regression coefficient: 3.9903; P = .0024; faster rate leads to increased hazards), after adjusting for time to nadir (regression coefficient: -0.0863; P = .0008; longer time to nadir leads to decreased hazards) and smoking history. CONCLUSION In patients with EGFR-mutant advanced NSCLC treated with erlotinib, slower tumor growth rates after nadir were associated with longer OS, providing a rationale for using tumor growth rates to guide precision therapy for lung cancer.
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Affiliation(s)
- Mizuki Nishino
- Department of Imaging, Dana Farber Cancer Institute, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Junwei Lu
- Department of Biostatistics, Harvard Chan School of Public Health, Boston, MA
| | - Takuya Hino
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Natalie I Vokes
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Pasi A Jänne
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Hiroto Hatabu
- Department of Imaging, Dana Farber Cancer Institute, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Bruce E Johnson
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Tumor Growth Rate Decline despite Progressive Disease May Predict Improved Nivolumab Treatment Outcome in mRCC: When RECIST Is Not Enough. Cancers (Basel) 2021; 13:cancers13143492. [PMID: 34298702 PMCID: PMC8304626 DOI: 10.3390/cancers13143492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The treatment scenario of metastatic renal cell carcinoma has drastically changed in recent years, with the advent of immunotherapy. Since 2015 immune-checkpoint inhibitors, either alone or in combination with other compounds, are constantly enriching the treatment scenario, with a drastic change of patients’ outcomes. The benefit from immunotherapy is difficult to capture with the currently available assessment radiological criteria. Often, with rhe use of immunotherapy, we can observe atypical patterns of response, such as hyperprogression or pseudoprogression. Pseudoprogression consists of an initial increase in tumor burden followed by a response to therapy, while hyperprogression is defined as a tumor growth rate that was at least 2-fold greater in patients with disease progression during immunotherapy. We performed a retrospective monocentric study to explore the impact of tumor growth rate change after immunotherapy administration as second or later line of treatment in patients with metastatic renal cell carcinoma. Abstract Treatment response is usually assessed by the response evaluation criteria in solid tumors (RECIST). These criteria may not be adequate to evaluate the response to immunotherapy, considering the peculiar patterns of response reported with this therapy. With the advent of immunotherapy these criteria have been modified to include the evaluation of the peculiar responses seen with this type of therapy (iRECIST criteria), including pseudoprogressions and hyperprogressions. Tumor growth rate (TGR) is a dynamic evaluation that takes into account the kinetics of response to treatment and may help catch the real efficacy of an immunotherapy approach. We performed a retrospective monocentric study to explore the impact of TGR change after nivolumab administration as the second or later line of treatment in patients with metastatic renal cell carcinoma (RCC). We evaluated 27 patients, divided into three categories: Disease control (DC) if there was no PD; lower velocity PD (LvPD) if disease progressed but the TGR at second assessment (TGR2) was lower than the TGR at first assessment (TGR1); higher velocity PD (HvPD) if TGR2 was higher than TGR1. The median OS for the DC group was 11.0 months (95% CI 5.0–17.0) (reference) vs. (not reached) NR (95% CI NR-NR) for LvPD (HR 0.27; 95% CI 0.06–1.30; p 0.102) vs. NR (95% CI NR–NR) for HvPD (HR 0.23; 95% CI 0.06–0.88; p 0.032). There was no difference between LvPD and DC (HR 1.21; 95% CI 0.20–7.28; p 0.838). In patients with metastatic RCC, the second or later line of nivolumab treatment may lead to a deceleration in TGR resulting in an improved survival outcome similar to that observed in patients experiencing tumor regression. In this subgroup, especially in the presence of a clinical benefit, continuing the treatment beyond progression can be recommended.
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Sigel K, Zhou M, Park YHA, Mutetwa T, Nadkarni G, Yeh C, Polak P, Sigel C, Conroy T, Juzyna B, Ychou M, Fojo T, Wisnivesky JP, Bates SE. Gemcitabine plus nab-paclitaxel versus FOLFIRINOX for unresected pancreatic cancer: Comparative effectiveness and evaluation of tumor growth in Veterans. Semin Oncol 2021; 48:69-75. [PMID: 33714591 PMCID: PMC9703645 DOI: 10.1053/j.seminoncol.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE Advanced, unresectable pancreatic cancer is often treated with either gemcitabine plus nab-paclitaxel (Gem/NabP) or FOLFIRINOX, although these regimens have never been compared in a head-to-head trial. In this study, we compared these two regimens using Veterans Administration (VA) data and evaluated the use of a novel tumor growth formula to predict outcomes. METHODS We identified 670 Veterans from national VA data with unresected stage II-IV pancreatic adenocarcinoma diagnosed between 2003 and 2016 who were treated with either first-line Gem/NabP or FOLFIRINOX. We compared overall survival (OS) and adverse events by treatment using propensity scores (PS) to account for allocation bias. Using longitudinal CA19-9 biomarker information we then fit the data to a novel tumor growth equation, comparing growth with OS. RESULTS We found no difference in PS-adjusted (hazard ratio [HR] 1.00; 95% confidence interval [95% CI] 0.84-1.20) or PS-matched (HR: 0.93; 95% CI: 0.76-1.13) OS between the two treatment groups. Tumor growth analysis revealed similar growth parameter values for Gem/NabP and FOLFIRINOX (P = .074 for difference). CONCLUSIONS Gem/NabP appeared noninferior to FOLFIRINOX for survival outcomes for advanced pancreatic adenocarcinoma based on national VA data. Biomarker-based growth equations may be useful for monitoring treatment response and predicting prognosis for pancreatic cancer.
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Affiliation(s)
- Keith Sigel
- The Mount Sinai School of Medicine, New York, NY.
| | - Mengxi Zhou
- The College of Physicians and Surgeons at Columbia University, New York, NY
| | | | | | - Girish Nadkarni
- The College of Physicians and Surgeons at Columbia University, New York, NY
| | - Celine Yeh
- The College of Physicians and Surgeons at Columbia University, New York, NY
| | - Paz Polak
- The Mount Sinai School of Medicine, New York, NY; The College of Physicians and Surgeons at Columbia University, New York, NY
| | - Carlie Sigel
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thierry Conroy
- Institut de cancerologie de Lorraine, Vandouevre de Nancy, France
| | | | - Mark Ychou
- Institut de cancer de Montpellier, Montpellier, France
| | - Tito Fojo
- James J. Peters VA Medical Center, Bronx, NY; The College of Physicians and Surgeons at Columbia University, New York, NY
| | | | - Susan E Bates
- James J. Peters VA Medical Center, Bronx, NY; The College of Physicians and Surgeons at Columbia University, New York, NY
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11
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He LN, Zhang X, Li H, Chen T, Chen C, Zhou Y, Lin Z, Du W, Fang W, Yang Y, Huang Y, Zhao H, Hong S, Zhang L. Pre-Treatment Tumor Growth Rate Predicts Clinical Outcomes of Patients With Advanced Non-Small Cell Lung Cancer Undergoing Anti-PD-1/PD-L1 Therapy. Front Oncol 2021; 10:621329. [PMID: 33552993 PMCID: PMC7863973 DOI: 10.3389/fonc.2020.621329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022] Open
Abstract
Tumor growth rate (TGR; percent size change per month [%/m]) is postulated as an early radio-graphic predictor of response to anti-cancer treatment to overcome limitations of RECIST. We aimed to evaluate the predictive value of pre-treatment TGR (TGR0) for outcomes of advanced non-small cell lung cancer (aNSCLC) patients treated with anti-PD-1/PD-L1 monotherapy. We retrospectively screened all aNSCLC patients who received PD-1 axis inhibitors in Sun Yat-Sen University Cancer Center between August 2016 and June 2018. TGR0 was calculated as the percentage change in tumor size per month (%/m) derived from two computed tomography (CT) scans during a "wash-out" period before the initiation of PD-1 axis inhibition. Final follow-up date was August 28, 2019. The X-tile program was used to identify the cut-off value of TGR0 based on maximum progression-free survival (PFS) stratification. Patients were divided into two groups per the selected TGR0 cut-off. The primary outcome was the difference of PFS between the two groups. The Kaplan-Meier methods and Cox regression models were performed for survival analysis. A total of 80 eligible patients were included (54 [67.5%] male; median [range] age, 55 [30-74] years). Median (range) TGR0 was 21.1 (-33.7-246.0)%/m. The optimal cut-off value of TGR0 was 25.3%/m. Patients with high TGR0 had shorter median PFS (1.8 months; 95% CI, 1.6 - 2.1 months) than those with low TGR0 (2.7 months; 95% CI, 0.5 - 4.9 months) (P = 0.005). Multivariate Cox regression analysis revealed that higher TGR0 independently predicted inferior PFS (hazard ratio [HR] 1.97; 95% CI, 1.08-3.60; P = 0.026). Higher TGR0 was also significantly associated with less durable clinical benefit rate (34.8% vs. 8.8%, P = 0.007). High pre-treatment TGR was a reliable predictor of inferior PFS and clinical benefit in aNSCLC patients undergoing anti-PD-1/PD-L1 monotherapy. The findings highlight the role of TGR0 as an early biomarker to predict benefit from immunotherapy and could allow tailoring patient's follow-up.
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Affiliation(s)
- Li-Na He
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xuanye Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Haifeng Li
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tao Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chen Chen
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yixin Zhou
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of VIP Region, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zuan Lin
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wei Du
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wenfeng Fang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yunpeng Yang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yan Huang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hongyun Zhao
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shaodong Hong
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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12
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Dromain C, Loaiza-Bonilla A, Mirakhur B, Beveridge TJR, Fojo AT. Novel Tumor Growth Rate Analysis in the Randomized CLARINET Study Establishes the Efficacy of Lanreotide Depot/Autogel 120 mg with Prolonged Administration in Indolent Neuroendocrine Tumors. Oncologist 2021; 26:e632-e638. [PMID: 33393112 PMCID: PMC8018300 DOI: 10.1002/onco.13669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Tumor quantity while receiving cancer therapy is the sum of simultaneous regression of treatment‐sensitive and growth of treatment‐resistant fractions at constant rates. Exponential rate constants for tumor regression/decay (d) and growth (g) can be estimated. Previous studies established g as a biomarker for overall survival; g increases after treatment cessation, can estimate doubling times, and can assess treatment effectiveness in small cohorts by benchmarking to large reference data sets. Using this approach, we analyzed data from the clinical trial CLARINET, evaluating lanreotide depot/autogel 120 mg/4 weeks (LAN) for treatment of neuroendocrine tumors (NETs). Methods and Materials Computed tomography imaging data from 97 LAN‐ and 101 placebo‐treated patients from CLARINET were analyzed to estimate g and d. Results Data from 92% of LAN‐ and 94% of placebo‐treated patients could be fit to one of the equations to derive g and d (p < .001 in most data sets). LAN‐treated patients demonstrated significantly slower g than placebo recipients (p = .00315), a difference of 389 days in doubling times. No significant difference was observed in d. Over periods of LAN administration up to 700 days, g did not change appreciably. Simulated analysis with g as the endpoint showed a sample size of 48 sufficient to detect a difference in median g with 80% power. Conclusion Although treatment of NETs with LAN can affect tumor shrinkage, LAN primarily slows tumor growth rather than accelerates tumor regression. Evidence of LAN efficacy across tumors was identified. The growth‐retarding effect achieved with LAN was sustained for a prolonged period of time. Implications for Practice The only curative treatment for neuroendocrine tumors (NETs) is surgical resection; however, because of frequent late diagnosis, this is often impossible. Because of this, treatment of NETs is challenging and often aims to reduce tumor burden and delay progression. A novel method of analysis was used to examine data from the CLARINET trial, confirming lanreotide depot/autogel is effective at slowing tumor growth and extending progression‐free survival. By providing the expected rate and doubling time of tumor growth early in the course of treatment, this method of analysis has the potential to guide physicians in their management of patients with NETs. Treatment of neuroendocrine tumors is challenging, mainly aiming to reduce tumor burden and delay disease progression. This article reports on the kinetics of tumor growth using a novel method of analysis and data from the CLARINET study.
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Affiliation(s)
| | | | - Beloo Mirakhur
- Ipsen Biopharmaceuticals, Inc., Cambridge, Massachusetts, USA
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13
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Maitland ML, Wilkerson J, Karovic S, Zhao B, Flynn J, Zhou M, Hilden P, Ahmed FS, Dercle L, Moskowitz CS, Tang Y, Connors DE, Adam SJ, Kelloff G, Gonen M, Fojo T, Schwartz LH, Oxnard GR. Enhanced Detection of Treatment Effects on Metastatic Colorectal Cancer with Volumetric CT Measurements for Tumor Burden Growth Rate Evaluation. Clin Cancer Res 2020; 26:6464-6474. [PMID: 32988968 DOI: 10.1158/1078-0432.ccr-20-1493] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/02/2020] [Accepted: 09/23/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Mathematical models combined with new imaging technologies could improve clinical oncology studies. To improve detection of therapeutic effect in patients with cancer, we assessed volumetric measurement of target lesions to estimate the rates of exponential tumor growth and regression as treatment is administered. EXPERIMENTAL DESIGN Two completed phase III trials were studied (988 patients) of aflibercept or panitumumab added to standard chemotherapy for advanced colorectal cancer. Retrospectively, radiologists performed semiautomated measurements of all metastatic lesions on CT images. Using exponential growth modeling, tumor regression (d) and growth (g) rates were estimated for each patient's unidimensional and volumetric measurements. RESULTS Exponential growth modeling of volumetric measurements detected different empiric mechanisms of effect for each drug: panitumumab marginally augmented the decay rate [tumor half-life; d [IQR]: 36.5 days (56.3, 29.0)] of chemotherapy [d: 44.5 days (67.2, 32.1), two-sided Wilcoxon P = 0.016], whereas aflibercept more significantly slowed the growth rate [doubling time; g = 300.8 days (154.0, 572.3)] compared with chemotherapy alone [g = 155.9 days (82.2, 347.0), P ≤ 0.0001]. An association of g with overall survival (OS) was observed. Simulating clinical trials using volumetric or unidimensional tumor measurements, fewer patients were required to detect a treatment effect using a volumetric measurement-based strategy (32-60 patients) than for unidimensional measurement-based strategies (124-184 patients). CONCLUSIONS Combined tumor volume measurement and estimation of tumor regression and growth rate has potential to enhance assessment of treatment effects in clinical studies of colorectal cancer that would not be achieved with conventional, RECIST-based unidimensional measurements.
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Affiliation(s)
- Michael L Maitland
- Inova Schar Cancer Institute, Fairfax, Virginia. .,University of Virginia Cancer Center and Department of Medicine, Charlottesville, Virginia
| | - Julia Wilkerson
- Columbia University Herbert Irving Comprehensive Cancer Center, New York, New York
| | | | - Binsheng Zhao
- Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian Hospital, New York, New York
| | - Jessica Flynn
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, New York
| | - Mengxi Zhou
- Columbia University Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Patrick Hilden
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, New York
| | - Firas S Ahmed
- Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian Hospital, New York, New York
| | - Laurent Dercle
- Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian Hospital, New York, New York
| | - Chaya S Moskowitz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, New York
| | | | - Dana E Connors
- Foundation for the National Institutes of Health Biomarkers Consortium, North Bethesda, Maryland
| | - Stacey J Adam
- Foundation for the National Institutes of Health Biomarkers Consortium, North Bethesda, Maryland
| | - Gary Kelloff
- Foundation for the National Institutes of Health Biomarkers Consortium, North Bethesda, Maryland
| | - Mithat Gonen
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, New York
| | - Tito Fojo
- Columbia University Herbert Irving Comprehensive Cancer Center, New York, New York
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian Hospital, New York, New York
| | - Geoffrey R Oxnard
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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Badran A, Elshenawy MA, Shahin A, Aljubran A, Alzahrani A, Eldali A, Bazarbashi S. Efficacy and Prognostic Factors of Sunitinib as First-Line Therapy for Patients With Metastatic Renal Cell Carcinoma in an Arab Population. JCO Glob Oncol 2020; 6:19-26. [PMID: 32031432 PMCID: PMC6998020 DOI: 10.1200/jgo.19.00111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Antiangiogenic tyrosine kinase inhibitors have been the mainstay first-line therapy for metastatic renal cell carcinoma (mRCC). We reviewed the efficacy of first-line therapy with sunitinib in patients with mRCC in an Arab population. METHODS Medical records of patients with mRCC treated at a tertiary care center in Saudi Arabia, during the period from 2007 to 2016, were reviewed. Demographic data, treatment received, response, and prognostic factors were analyzed. RESULTS Fifty-five patients who received sunitinib were identified. The median age was 60 years (range, 18 to 78 years), and 42 of the 55 patients were men (76.3%). International Metastatic RCC Diagnostic Consortium prognostic scores for favorable/intermediate/poor were 14.5%/43.6%/38.2%, respectively. The median performance status was 1, and the median Charlson comorbidity index score was 9. Thirty-seven patients (67.2%) had cytoreductive nephrectomy. Thirty-seven patients (67.2%) had clear cell histology. Twenty-two patients (40%) underwent dose reduction. Twenty-seven patients (49%) received second-line therapy, and seven patients (12.7%) received third-line therapy. Response rates were complete response in one patient (1.8%), partial response in 17 (30.9%), stable disease in 10 (18.1), and disease progression in 20 (36.3%). Progression-free survival (PFS) and overall survival (OS) were 6.0 and 24.7 months, respectively. Univariate analysis showed statistically improved PFS for dose reduction (P = .015) and the development of hypothyroidism (P = .03). It also showed statistically improved OS for dose reduction (P = .035), hypothyroidism (P = .0002), and cytoreductive nephrectomy (P = .0052). Multivariate analysis showed statistically improved PFS for dose reduction (P = .01) and OS for development of hypothyroidism (P = .007). CONCLUSION Our data for sunitinib in mRCC show significantly lower PFS than expected. The absence of prognostic value of the International Metastatic RCC Diagnostic Consortium scoring system and pathologic subtype warrant further investigation and possible inclusion of genetic scoring in this ethnic group of patients.
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Affiliation(s)
- Ahmed Badran
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud A. Elshenawy
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Amgad Shahin
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ali Aljubran
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed Alzahrani
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdelmoneim Eldali
- Department of Biostatistics, Epidemiology and Scientific Computing, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Medical Oncology, Oncology Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Shouki Bazarbashi, MBBS, Oncology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; e-mail:
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Ten Berge DMHJ, Hurkmans DP, den Besten I, Kloover JS, Mathijssen RHJ, Debets R, Smit EF, Aerts JGJV. Tumour growth rate as a tool for response evaluation during PD-1 treatment for non-small cell lung cancer: a retrospective analysis. ERJ Open Res 2019; 5:00179-2019. [PMID: 31857994 PMCID: PMC6911925 DOI: 10.1183/23120541.00179-2019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/03/2019] [Indexed: 12/25/2022] Open
Abstract
Background Immune checkpoint inhibitors have emerged as a standard of care treatment for non-small cell lung cancer (NSCLC). To get insight into variations in tumour growth kinetics and their potential predictive values for outcome, we evaluated tumour growth rate (TGR) in patients receiving programmed cell death 1 (PD-1) checkpoint inhibitors. Patients and methods Differences in TGR before and after the start of treatment were calculated by entering the sum of the longest diameters from computer tomography scans before and after the initiation of therapy into a formula that assumes volumetric exponential tumour growth. TGR variations, possible predictors for TGR changes and its relationship to overall survival (OS) were studied. For comparison, tumour response was assessed using Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Results Among the 58 evaluable patients, 37 patients (64%) showed deceleration of TGR and 16 patients (27%) showed an acceleration of TGR after initiation of therapy, with a significant difference in median OS of 18.0 months versus 6.0 months (hazard ratio 0.35, 95% CI 0.18–0.71) between these groups. Four patients (7%) were defined as having hyperprogressive disease. In five patients (9%), tumour growth remained stable. These TGR categories were not significantly different according to age, sex, histology, smoking or previous radiotherapy. Of the patients defined as having progressive disease by RECIST version 1.1 at first follow-up, 40% showed response to checkpoint inhibitors by a decrease in TGR. Conclusion Tumour growth kinetics can be used as a clinically relevant predictor for OS in anti-PD-1-treated patients with NSCLC, and may provide additional information to RECIST measurements. Tumour growth rate changes can be used as a clinically relevant predictor of overall survival during PD-1 inhibitor therapy for NSCLC and provide additional information to RECIST measurements alonehttp://bit.ly/2nxT17e
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Affiliation(s)
- Deirdre M H J Ten Berge
- Dept of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.,Dept of Pulmonary Diseases, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Daniel P Hurkmans
- Dept of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Dept of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ilse den Besten
- Dept of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jeroen S Kloover
- Dept of Pulmonary Diseases, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Ron H J Mathijssen
- Dept of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Reno Debets
- Dept of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Egbert F Smit
- Netherlands Cancer Institute, Amsterdam, The Netherlands.,These authors contributed equally
| | - Joachim G J V Aerts
- Dept of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Dept of Pulmonary Medicine, Amphia Hospital, Breda, The Netherlands.,These authors contributed equally
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16
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Dercle L, Connors DE, Tang Y, Adam SJ, Gönen M, Hilden P, Karovic S, Maitland M, Moskowitz CS, Kelloff G, Zhao B, Oxnard GR, Schwartz LH. Vol-PACT: A Foundation for the NIH Public-Private Partnership That Supports Sharing of Clinical Trial Data for the Development of Improved Imaging Biomarkers in Oncology. JCO Clin Cancer Inform 2019; 2:1-12. [PMID: 30652552 DOI: 10.1200/cci.17.00137] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To develop a public-private partnership to study the feasibility of a new approach in collecting and analyzing clinically annotated imaging data from landmark phase III trials in advanced solid tumors. PATIENTS AND METHODS The collection of clinical trials fulfilled the following inclusion criteria: completed randomized trials of > 300 patients, highly measurable solid tumors (non-small-cell lung cancer, colorectal cancer, renal cell cancer, and melanoma), and required sponsor and institutional review board sign-offs. The new approach in analyzing computed tomography scans was to transfer to an academic image analysis laboratory, draw contours semi-automatically by using in-house-developed algorithms integrated into the open source imaging platform Weasis, and perform serial volumetric measurement. RESULTS The median duration of contracting with five sponsors was 12 months. Ten trials in 7,085 patients that covered 12 treatment regimens across 20 trial arms were collected. To date, four trials in 3,954 patients were analyzed. Source imaging data were transferred to the academic core from 97% of trial patients (n = 3,837). Tumor imaging measurements were extracted from 82% of transferred computed tomography scans (n = 3,162). Causes of extraction failure were nonmeasurable disease (n = 392), single imaging time point (n = 224), and secondary captured images (n = 59). Overall, clinically annotated imaging data were extracted in 79% of patients (n = 3,055), and the primary trial end point analysis in each trial remained representative of each original trial end point. CONCLUSION The sharing and analysis of source imaging data from large randomized trials is feasible and offer a rich and reusable, but largely untapped, resource for future research on novel trial-level response and progression imaging metrics.
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Affiliation(s)
- Laurent Dercle
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Dana E Connors
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Ying Tang
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Stacey J Adam
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Mithat Gönen
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Patrick Hilden
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Sanja Karovic
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Michael Maitland
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Chaya S Moskowitz
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Gary Kelloff
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Binsheng Zhao
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Geoffrey R Oxnard
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Lawrence H Schwartz
- Laurent Dercle, Binsheng Zhao, and Lawrence H. Schwartz, Columbia University Medical Center and New York Presbyterian Hospital; Mithat Gönen, Patrick Hilden, and Chaya S. Moskowitz, Memorial Sloan Kettering Cancer Center, New York, NY; Dana E. Connors and Stacey J. Adam, Foundation for the National Institutes of Health, North Bethesda, MD; Ying Tang, CCS Associates, San Jose, CA; Sanja Karovic and Michael Maitland, Inova Schar Cancer Institute, Fairfax, VA; Gary Kelloff, National Cancer Institute, Rockville, MD; and Geoffrey R. Oxnard, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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17
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Leuva H, Sigel K, Zhou M, Wilkerson J, Aggen DH, Park YHA, Anderson CB, Hsu TCM, Langhoff E, McWilliams G, Drake CG, Simon R, Bates SE, Fojo T. A novel approach to assess real-world efficacy of cancer therapy in metastatic prostate cancer. Analysis of national data on Veterans treated with abiraterone and enzalutamide. Semin Oncol 2019; 46:351-361. [DOI: 10.1053/j.seminoncol.2019.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Indexed: 11/11/2022]
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18
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Burotto M, Wilkerson J, Stein WD, Bates SE, Fojo T. Adjuvant and neoadjuvant cancer therapies: A historical review and a rational approach to understand outcomes. Semin Oncol 2019; 46:83-99. [DOI: 10.1053/j.seminoncol.2019.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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19
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Dromain C, Pavel ME, Ruszniewski P, Langley A, Massien C, Baudin E, Caplin ME. Tumor growth rate as a metric of progression, response, and prognosis in pancreatic and intestinal neuroendocrine tumors. BMC Cancer 2019; 19:66. [PMID: 30642293 PMCID: PMC6332566 DOI: 10.1186/s12885-018-5257-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/27/2018] [Indexed: 01/02/2023] Open
Abstract
Background Lanreotide depot/autogel antitumor activity in intestinal/pancreatic neuroendocrine tumors (NETs) was demonstrated in the phase-3 CLARINET study (NCT00353496), based on significantly prolonged progression-free survival (PFS) versus placebo. Methods During CLARINET, patients with metastatic intestinal/pancreatic NETs received lanreotide depot/autogel 120 mg or placebo every 4 weeks for 96 weeks. Imaging data (response evaluation criteria in solid tumors [RECIST] v1.0, centrally reviewed) were re-evaluated in this post hoc analysis of tumor growth rate (TGR) in NETs. TGR (%/month) was calculated from two imaging scans during relevant periods: pre-treatment (TGR0); 12–24 weeks before randomization versus baseline; each treatment visit versus baseline (TGRTx-0); between consecutive treatment visits (TGRTx-Tx). To assess TGR as a measure of prognosis, PFS was compared for TGR0 subgroups stratified by optimum TGR0 cut-off; a multivariate analysis was conducted to identify prognostic factors for PFS. Results TGR0 revealed tumors growing during pre-treatment (median [interquartile range] TGR0: lanreotide 2.1%/month [0.2; 6.1]; placebo 2.7%/month [0.15; 6.8]), contrary to RECIST status. TGR was significantly reduced by 12 weeks with lanreotide versus placebo (difference in least-square mean TGR0–12 of − 2.9 [− 5.1, − 0.8], p = 0.008), a difference that was maintained at most subsequent visits. TGR0 > 4%/month had greater risk of progression/death than ≤4%/month (hazard ratio 4.1; [95% CI 2.5–6.5]; p < 0.001); multivariate analysis revealed lanreotide treatment, progression at baseline, TGR0, hepatic tumor load, and primary tumor type were independently associated with PFS. Conclusions TGR provides valuable information on tumor activity and prognosis in patients with metastatic intestinal/pancreatic NETs, and identifies early lanreotide depot/autogel antitumor activity. Trial registration Retrospective registration, 18 July 2006; EudraCT: 2005–004904-35; ClinicalTrials.gov: NCT00353496. Electronic supplementary material The online version of this article (10.1186/s12885-018-5257-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clarisse Dromain
- Department of Diagnostic and Interventional Radiology, CHUV University Hospital, Lausanne, Switzerland.
| | - Marianne E Pavel
- Department of Medicine 1, Division of Endocrinology and Diabetology, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Philippe Ruszniewski
- Division of Gastroenterology and Pancreatology, Beaujon Hospital, Clichy, France.,Faculty of Medicine, Paris Diderot University, Paris, France
| | | | - Christine Massien
- Ipsen, Boulogne-Billancourt, France.,APHP, Hypertension unit, Georges Pompidou European Hospital, F-75015, Paris, France
| | - Eric Baudin
- Endocrine Tumour and Nuclear Medicine Unit, Gustave-Roussy Cancer Campus, Villejuif, France
| | - Martyn E Caplin
- Neuroendocrine Tumour Unit, Department of Gastroenterology, Royal Free Hospital, London, UK
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20
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Nishino M. Tumor Response Assessment for Precision Cancer Therapy: Response Evaluation Criteria in Solid Tumors and Beyond. Am Soc Clin Oncol Educ Book 2018; 38:1019-1029. [PMID: 30231378 DOI: 10.1200/edbk_201441] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective assessment of tumor responses and treatment results has been the basis for the advancement of cancer therapies, and imaging plays a key role to provide a "common language" to describe the results of cancer treatment. Although Response Evaluation Criteria in Solid Tumors (RECIST) has been the most widely accepted method for assessing tumor response in the past decades, the limitations of RECIST have increasingly becoming recognized, especially with the recent advances of precision-medicine approaches to cancer. This article reviews the current concept of tumor response evaluations based on RECIST, describes the limitations of RECIST, and proposes strategies to overcome the limitations. The article emphasizes specific limitations in the setting of precision cancer therapy and cancer immunotherapy and discusses the important insights provided by the cutting-edge investigations in the emerging fields.
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Affiliation(s)
- Mizuki Nishino
- From the Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
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21
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Hyperprogressive disease: recognizing a novel pattern to improve patient management. Nat Rev Clin Oncol 2018; 15:748-762. [DOI: 10.1038/s41571-018-0111-2] [Citation(s) in RCA: 237] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Automated image analysis tool for tumor volume growth rate to guide precision cancer therapy: EGFR-mutant non-small-cell lung cancer as a paradigm. Eur J Radiol 2018; 109:68-76. [PMID: 30527314 DOI: 10.1016/j.ejrad.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/13/2018] [Accepted: 10/16/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To develop an automated analytic module for calculation of tumor growth rate from serial CT scans and to apply the module and evaluate reproducibility in a pilot cohort of advanced NSCLC patients with EGFR mutations treated with EGFR tyrosine kinase inhibitors. MATERIALS AND METHODS The module utilized a commercially available image-processing workstation equipped with a validated tumor volume measurement tool. An automated analytic software module was programmed with the capability to record and display serial tumor volume changes and to calculate tumor volume growth rate over time and added to the workstation. The module was applied to evaluate the tumor growth rate in a pilot cohort of 24 EGFR-mutant patients treated with EGFR inhibitors, and reproducibility references as tested by two independent thoracic radiologists. RESULTS The module analyzed chest CT scans from 24 patients (5 males, 19 females; median age: 61) with a median of 8 scans per patient, totaling 227 scans and provided a graphical display with an automated and instant calculation of tumor growth rate after the nadir volume for each patient. High inter and intraobserver agreements were noted for tumor growth rates, with concordance correlation coefficients of 0.9323 and 0.9668, respectively. Interpretation of slow versus fast tumor growth using previously identified threshold of ≤0.15/month had a perfect interobserver agreement (κ = 1.00), and an excellent intraobserver agreement (κ = 0.895). CONCLUSIONS The present study describes the development of an image analytic module for assessing tumor growth rate and the data demonstrates the functionality and reproducibility of the module in a pilot cohort of EGFR-mutant NSCLC patients treated with EGFR-TKI. The image analytic module is an initial step for clinical translation of the tumor growth rate approach to guide cancer treatment in precision oncology.
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23
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Mistry HB. On the relationship between tumour growth rate and survival in non-small cell lung cancer. PeerJ 2017; 5:e4111. [PMID: 29201573 PMCID: PMC5712205 DOI: 10.7717/peerj.4111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/09/2017] [Indexed: 01/20/2023] Open
Abstract
A recurrent question within oncology drug development is predicting phase III outcome for a new treatment using early clinical data. One approach to tackle this problem has been to derive metrics from mathematical models that describe tumour size dynamics termed re-growth rate and time to tumour re-growth. They have shown to be strong predictors of overall survival in numerous studies but there is debate about how these metrics are derived and if they are more predictive than empirical end-points. This work explores the issues raised in using model-derived metric as predictors for survival analyses. Re-growth rate and time to tumour re-growth were calculated for three large clinical studies by forward and reverse alignment. The latter involves re-aligning patients to their time of progression. Hence, it accounts for the time taken to estimate re-growth rate and time to tumour re-growth but also assesses if these predictors correlate to survival from the time of progression. I found that neither re-growth rate nor time to tumour re-growth correlated to survival using reverse alignment. This suggests that the dynamics of tumours up until disease progression has no relationship to survival post progression. For prediction of a phase III trial I found the metrics performed no better than empirical end-points. These results highlight that care must be taken when relating dynamics of tumour imaging to survival and that bench-marking new approaches to existing ones is essential.
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Affiliation(s)
- Hitesh B Mistry
- Division of Pharmacy, University of Manchester, Manchester, United Kingdom
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24
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Blagoev KB, Wilkerson J, Burotto M, Kim C, Espinal-Domínguez E, García-Alfonso P, Alimchandani M, Miettinen M, Blanco-Codesido M, Fojo T. Neutral evolution of drug resistant colorectal cancer cell populations is independent of their KRAS status. PLoS One 2017; 12:e0175484. [PMID: 28981524 PMCID: PMC5628783 DOI: 10.1371/journal.pone.0175484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/27/2017] [Indexed: 01/13/2023] Open
Abstract
Emergence of tumor resistance to an anti-cancer therapy directed against a putative target raises several questions including: (1) do mutations in the target/pathway confer resistance? (2) Are these mutations pre-existing? (3) What is the relative fitness of cells with/without the mutation? We addressed these questions in patients with metastatic colorectal cancer (mCRC). We conducted an exhaustive review of published data to establish a median doubling time for CRCs and stained a cohort of CRCs to document mitotic indices. We analyzed published data and our own data to calculate rates of growth (g) and regression (d, decay) of tumors in patients with CRC correlating these results with the detection of circulating MT-KRAS DNA. Additionally we estimated mathematically the caloric burden of such tumors using data on mitotic and apoptotic indices. We conclude outgrowth of cells harboring intrinsic or acquired MT-KRAS cannot explain resistance to anti-EGFR (epidermal growth factor receptor) antibodies. Rates of tumor growth with panitumumab are unaffected by presence/absence of MT-KRAS. While MT-KRAS cells may be resistant to anti-EGFR antibodies, WT-KRAS cells also rapidly bypass this blockade suggesting inherent resistance mechanisms are responsible and a neutral evolution model is most appropriate. Using the above clinical data on tumor doubling times and mitotic and apoptotic indices we estimated the caloric intake required to support tumor growth and suggest it may explain in part cancer-associated cachexia.
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Affiliation(s)
- Krastan B. Blagoev
- Physics of Living Systems, National Science Foundation, Arlington, Virginia, United States of America
- Department of Biophysics, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Julia Wilkerson
- Medical Oncology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, United States of America
| | - Mauricio Burotto
- Departamento de Oncologia, Clinica Alemana de Santiago, Santiago, Chile
| | - Chul Kim
- Medical Oncology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, United States of America
| | | | - Pilar García-Alfonso
- Departamento de Oncologia Medica, Gregorio Marañon University Hospital, Madrid, Spain
| | - Meghna Alimchandani
- Center for Biologics Evaluation and Research, US Food and Drug Administration (USFDA), Silver Spring, Maryland, United States of America
| | - Markku Miettinen
- Laboratory of Pathology, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, United States of America
| | | | - Tito Fojo
- Division of Hematology and Oncology, Department of Medicine, Columbia University, New York and James J. Peters VA Medical Center, Bronx, New York, United States of America
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25
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Dillon PM, Petroni GR, Horton BJ, Moskaluk CA, Fracasso PM, Douvas MG, Varhegyi N, Zaja-Milatovic S, Thomas CY. A Phase II Study of Dovitinib in Patients with Recurrent or Metastatic Adenoid Cystic Carcinoma. Clin Cancer Res 2017; 23:4138-4145. [PMID: 28377480 PMCID: PMC5540767 DOI: 10.1158/1078-0432.ccr-16-2942] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/28/2016] [Accepted: 03/30/2017] [Indexed: 12/20/2022]
Abstract
Purpose: Genetic and preclinical studies have implicated FGFR signaling in the pathogenesis of adenoid cystic carcinoma (ACC). Dovitinib, a suppressor of FGFR activity, may be active in ACC.Experimental Design: In a two-stage phase II study, 35 patients with progressive ACC were treated with dovitinib 500 mg orally for 5 of 7 days continuously. The primary endpoints were objective response rate and change in tumor growth rate. Progression-free survival, overall survival, metabolic response, biomarker, and quality of life were secondary endpoints.Results: Of 34 evaluable patients, 2 (6%) had a partial response and 22 (65%) had stable disease >4 months. Median PFS was 8.2 months and OS was 20.6 months. The slope of the overall TGR fell from 1.95 to 0.63 on treatment (P < 0.001). Toxicity was moderate; 63% of patients developed grade 3-4 toxicity, 94% required dose modifications, and 21% stopped treatment early. An early metabolic response based on 18FDG-PET scans was seen in 3 of 15 patients but did not correlate with RECIST response. MYB gene translocation was observed and significantly correlated with overexpression of MYB but did not correlate with FGFR1 phosphorylation or clinical response to dovitinib.Conclusions: Dovitinib produced few objective responses in patients with ACC but did suppress the TGR with a PFS that compares favorably with those reported with other targeted agents. Future studies of more potent and selective FGFR inhibitors in biomarker-selected patients will be required to determine whether FGFR signaling is a valid therapeutic target in ACC. Clin Cancer Res; 23(15); 4138-45. ©2017 AACR.
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Affiliation(s)
- Patrick M Dillon
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia.
| | - Gina R Petroni
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Bethany J Horton
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | | | - Paula M Fracasso
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Michael G Douvas
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
| | - Nikole Varhegyi
- UVA Cancer Center at the University of Virginia, Charlottesville, Virginia
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Shustov A, Coiffier B, Horwitz S, Sokol L, Pro B, Wolfson J, Balser B, Eisch R, Popplewell L, Prince HM, Allen SL, Piekarz R, Bates S. Romidepsin is effective and well tolerated in older patients with peripheral T-cell lymphoma: analysis of two phase II trials. Leuk Lymphoma 2017; 58:2335-2341. [PMID: 28264616 DOI: 10.1080/10428194.2017.1295143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Peripheral T-cell lymphomas (PTCLs) are a rare group of lymphoid neoplasms with high relapse rates after initial therapy and poor prognosis. Most patients are aged ≥60 years and are often not candidates for aggressive salvage therapies. Romidepsin, a potent class I histone deacetylase inhibitor, has shown significant single-agent activity in relapsed/refractory PTCL. We evaluated the efficacy and tolerability of romidepsin in elderly patients in this setting. Ninety-five patients aged ≥60 years were identified from 2 prospective phase 2 registration trials of romidepsin, and comparative analyses were performed with younger patients from these trials. Response rates, progression-free survival, and overall survival were not statistically different for younger vs older patients. The toxicity profile in older and younger patients was similar in both trials. Romidepsin demonstrated similar efficacy and tolerability in younger and older patients and presents an attractive treatment option for relapsed/refractory PTCL regardless of age. TRIAL REGISTRATION Clinicaltrials.gov identifiers: NCT00426764, NCT00007345.
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Affiliation(s)
- Andrei Shustov
- a Department of Hematology , University of Washington Medical Center , Seattle , WA , USA
| | - Bertrand Coiffier
- b Department of Hematology , Hospices Civils de Lyon , Lyon , France
| | - Steven Horwitz
- c Department of Oncology , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Lubomir Sokol
- d Department of Hematology , Moffitt Cancer Center , Tampa , FL , USA
| | - Barbara Pro
- e Department of Hematology/Oncology , Kimmel Cancer Center, Thomas Jefferson University , Philadelphia , PA , USA
| | | | | | - Robin Eisch
- g Department of Investigational Therapeutics , National Cancer Institute , Bethesda , MD , USA
| | - Leslie Popplewell
- h Department of Hematology/Oncology , City of Hope Medical Center-Oncology , Duarte , CA , USA
| | - H Miles Prince
- i Department of Hematology , Peter MacCallum Cancer Centre and University of Melbourne , Melbourne , Australia
| | - Steven L Allen
- j Department of Hematology , Hofstra North Shore-LIJ School of Medicine and Monter Cancer Center , Lake Success , NY , USA
| | - Richard Piekarz
- g Department of Investigational Therapeutics , National Cancer Institute , Bethesda , MD , USA
| | - Susan Bates
- k Department of Hematology/Oncology , Columbia University Medical Center , New York , NY , USA
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Estimation of tumour regression and growth rates during treatment in patients with advanced prostate cancer: a retrospective analysis. Lancet Oncol 2017; 18:143-154. [DOI: 10.1016/s1470-2045(16)30633-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 12/28/2022]
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Motzer RJ, Escudier B, Gannon A, Figlin RA. Sunitinib: Ten Years of Successful Clinical Use and Study in Advanced Renal Cell Carcinoma. Oncologist 2016; 22:41-52. [PMID: 27807302 DOI: 10.1634/theoncologist.2016-0197] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/03/2016] [Indexed: 01/07/2023] Open
Abstract
The oral multikinase inhibitor sunitinib malate was approved by the U.S. Food and Drug Administration in January 2006 for use in patients with advanced renal cell carcinoma (RCC). Since then, it has been approved globally for this indication and for patients with imatinib-resistant or -intolerant gastrointestinal stromal tumors and advanced pancreatic neuroendocrine tumors. As we mark the 10-year anniversary of the beginning of the era of targeted therapy, and specifically the approval of sunitinib, it is worthwhile to highlight the progress that has been made in advanced RCC as it relates to the study of sunitinib. We present the key trials and data for sunitinib that established it as a reference standard of care for first-line advanced RCC therapy and, along with other targeted agents, significantly altered the treatment landscape in RCC. Moreover, we discuss the research with sunitinib that has sought to refine its role via patient selection and prognostic markers, improve dosing and adverse event management, and identify predictive efficacy biomarkers, plus the extent to which this research has contributed to the overall understanding and management of RCC. We also explore the key learnings regarding study design and data interpretation from the sunitinib studies and how these findings and the sunitinib development program, in general, can be a model for successful development of other agents. Finally, ongoing research into the continued and future role of sunitinib in RCC management is discussed. THE ONCOLOGIST 2017;22:41-52 IMPLICATIONS FOR PRACTICE: Approved globally, sunitinib is established as a standard of care for first-line advanced renal cell carcinoma (RCC) therapy and, along with other targeted agents, has significantly altered the treatment landscape in RCC. Research with sunitinib that has sought to refine its role via patient selection and prognostic markers, improve dosing and adverse event management, and identify predictive efficacy biomarkers has contributed to the overall understanding and management of RCC. Key learnings regarding study design and data interpretation from the sunitinib studies and the sunitinib development program, in general, can be a model for the successful development of other agents.
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Affiliation(s)
- Robert J Motzer
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Robert A Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Milella M. Optimizing clinical benefit with targeted treatment in mRCC: "Tumor growth rate" as an alternative clinical endpoint. Crit Rev Oncol Hematol 2016; 102:73-81. [PMID: 27129438 DOI: 10.1016/j.critrevonc.2016.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 02/27/2016] [Accepted: 03/30/2016] [Indexed: 12/29/2022] Open
Abstract
Tumor growth rate (TGR), usually defined as the ratio between the slope of tumor growth before the initiation of treatment and the slope of tumor growth during treatment, between the nadir and disease progression, is a measure of the rate at which tumor volume increases over time. In patients with metastatic renal cell carcinoma (mRCC), TGR has emerged as a reliable alternative parameter to allow a quantitative and dynamic evaluation of tumor response. This review presents evidence on the correlation between TGR and treatment outcomes and discusses the potential role of this tool within the treatment scenario of mRCC. Current evidence, albeit of retrospective nature, suggests that TGR might represent a useful tool to assess whether treatment is altering the course of the disease, and has shown to be significantly associated with progression-free survival and overall survival. Therefore, TGR may represent a valuable endpoint for clinical trials evaluating new molecularly targeted therapies. Most importantly, incorporation of TGR in the assessment of individual patients undergoing targeted therapies may help clinicians decide if a given agent is no longer able to control disease growth and whether continuing therapy beyond RECIST progression may still produce clinical benefit.
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Affiliation(s)
- Michele Milella
- Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
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30
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Predicting survival of pancreatic cancer patients treated with gemcitabine using longitudinal tumour size data. Cancer Chemother Pharmacol 2016; 77:927-38. [PMID: 26940939 PMCID: PMC4844653 DOI: 10.1007/s00280-016-2994-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/16/2016] [Indexed: 12/25/2022]
Abstract
Purpose Measures derived from longitudinal tumour size data have been increasingly utilised to predict survival of patients with solid tumours. The aim of this study was to examine the prognostic value of such measures for patients with metastatic pancreatic cancer undergoing gemcitabine therapy. Methods The control data from two Phase III studies were retrospectively used to develop (271 patients) and validate (398 patients) survival models. Firstly, 31 baseline variables were screened from the training set using penalised Cox regression. Secondly, tumour shrinkage metrics were interpolated for each patient by hierarchical modelling of the tumour size time-series. Subsequently, survival models were built by applying two approaches: the first aimed at incorporating model-derived tumour size metrics in a parametric model, and the second simply aimed at identifying empirical factors using Cox regression. Finally, the performance of the models in predicting patient survival was evaluated on the validation set. Results Depending on the modelling approach applied, albumin, body surface area, neutrophil, baseline tumour size and tumour shrinkage measures were identified as potential prognostic factors. The distributional assumption on survival times appeared to affect the identification of risk factors but not the ability to describe the training data. The two survival modelling approaches performed similarly in predicting the validation data. Conclusions A parametric model that incorporates model-derived tumour shrinkage metrics in addition to other baseline variables could predict reasonably well survival of patients with metastatic pancreatic cancer. However, the predictive performance was not significantly better than a simple Cox model that incorporates only baseline characteristics. Electronic supplementary material The online version of this article (doi:10.1007/s00280-016-2994-x) contains supplementary material, which is available to authorized users.
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Nishino M, Dahlberg SE, Fulton LE, Digumarthy SR, Hatabu H, Johnson BE, Sequist LV. Volumetric Tumor Response and Progression in EGFR-mutant NSCLC Patients Treated with Erlotinib or Gefitinib. Acad Radiol 2016; 23:329-36. [PMID: 26776293 PMCID: PMC4744559 DOI: 10.1016/j.acra.2015.11.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/04/2015] [Accepted: 11/06/2015] [Indexed: 02/08/2023]
Abstract
RATIONALE AND OBJECTIVES The aims of this study were to investigate the association between 8-week tumor volume decrease and survival in an independent cohort of epidermal growth factor receptor (EGFR)-mutant advanced non-small cell lung cancer (NSCLC) patients treated with first-line erlotinib or gefitinib, and to assess the rate of their volumetric tumor growth after the volume nadir. MATERIALS AND METHODS In patients with advanced NSCLC harboring sensitizing EGFR mutations treated with first-line erlotinib or gefitinib, computed tomography (CT) tumor volumes of dominant lung lesions were analyzed for (1) the association with survival, and (2) the volumetric tumor growth rate after the volume nadir. RESULTS In 44 patients with the 8-week follow-up CT, the 8-week tumor volume decrease (%) was significantly associated with longer overall survival when fitted as a continuous variable in a Cox model (P = 0.01). The growth rate of the logarithm of tumor volume (logeV), obtained using a linear mixed-effects model adjusting for time since baseline, was 0.096/month (SE: 0.013/month; 95% confidence interval [CI]: 0.071-0.12/month), which was similar to the rate of 0.12/month (SE: 0.015/month; 95%CI: 0.090-0.15/month) observed in the previous report. CONCLUSIONS The 8-week tumor volume decrease was validated as a marker for longer survival in the independent cohort of EGFR-mutant NSCLC patients treated with first-line erlotinib or gefitinib. The volumetric tumor growth rate after the nadir in this cohort was similar to that of the previous cohort, indicating the reproducibility of the observation among different patient cohorts.
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Affiliation(s)
- Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA 02215.
| | - Suzanne E Dahlberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Linnea E Fulton
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Subba R Digumarthy
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave., Boston, MA 02215
| | - Bruce E Johnson
- Department of Medical Oncology and Department of Medicine, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lecia V Sequist
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Li CH, Bies RR, Wang Y, Sharma MR, Karovic S, Werk L, Edelman MJ, Miller AA, Vokes EE, Oto A, Ratain MJ, Schwartz LH, Maitland ML. Comparative Effects of CT Imaging Measurement on RECIST End Points and Tumor Growth Kinetics Modeling. Clin Transl Sci 2016; 9:43-50. [PMID: 26790562 PMCID: PMC4760886 DOI: 10.1111/cts.12384] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 01/12/2023] Open
Abstract
Quantitative assessments of tumor burden and modeling of longitudinal growth could improve phase II oncology trials. To identify obstacles to wider use of quantitative measures we obtained recorded linear tumor measurements from three published lung cancer trials. Model-based parameters of tumor burden change were estimated and compared with similarly sized samples from separate trials. Time-to-tumor growth (TTG) was computed from measurements recorded on case report forms and a second radiologist blinded to the form data. Response Evaluation Criteria in Solid Tumors (RECIST)-based progression-free survival (PFS) measures were perfectly concordant between the original forms data and the blinded radiologist re-evaluation (intraclass correlation coefficient = 1), but these routine interrater differences in the identification and measurement of target lesions were associated with an average 18-week delay (range, -20 to 55 weeks) in TTG (intraclass correlation coefficient = 0.32). To exploit computational metrics for improving statistical power in small clinical trials will require increased precision of tumor burden assessments.
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Affiliation(s)
- CH Li
- Indiana University School of MedicineIndianapolisIndianaUSA
- Indiana Clinical and Translational Sciences Institute (CTSI)IndianapolisIndianaUSA
| | - RR Bies
- Indiana University School of MedicineIndianapolisIndianaUSA
- Indiana Clinical and Translational Sciences Institute (CTSI)IndianapolisIndianaUSA
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
| | - Y Wang
- Office of Clinical Pharmacology, US Food and Drug AdministrationSilver SpringMarylandUSA
| | - MR Sharma
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- University of Chicago Medicine and Biological SciencesChicagoIllinoisUSA
| | - S Karovic
- University of Chicago Medicine and Biological SciencesChicagoIllinoisUSA
| | - L Werk
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- Duke UniversityDurhamNorth CarolinaUSA
| | - MJ Edelman
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- University of Maryland Greenebaum Cancer Center, School of MedicineBaltimoreMarylandUSA
| | - AA Miller
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- Wake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - EE Vokes
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- University of Chicago Medicine and Biological SciencesChicagoIllinoisUSA
| | - A Oto
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- University of Chicago Medicine and Biological SciencesChicagoIllinoisUSA
| | - MJ Ratain
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- University of Chicago Medicine and Biological SciencesChicagoIllinoisUSA
| | - LH Schwartz
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- Columbia University College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - ML Maitland
- Alliance for Clinical Trials in OncologyBostonMassachusettsUSA
- University of Chicago Medicine and Biological SciencesChicagoIllinoisUSA
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Mangel L, Bíró K, Battyáni I, Göcze P, Tornóczky T, Kálmán E. A case study on the potential angiogenic effect of human chorionic gonadotropin hormone in rapid progression and spontaneous regression of metastatic renal cell carcinoma during pregnancy and after surgical abortion. BMC Cancer 2015; 15:1013. [PMID: 26704433 PMCID: PMC4691015 DOI: 10.1186/s12885-015-2031-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 12/17/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment possibilities of metastatic renal cell carcinoma (mRCC) have recently changed dramatically prolonging the overall survival of the patients. This kind of development brings new challenges for the care of mRCC. CASE PRESENTATION A 22 year-old female patient with translocation type mRCC, who previously had been treated for nearly 5 years, became pregnant during the treatment break period. Follow-up examinations revealed a dramatic clinical and radiological progression of mRCC in a few weeks therefore the pregnancy was terminated. A few days after surgical abortion, CT examination showed a significant spontaneous regression of the pulmonary metastases, and the volume of the largest manifestation decreased from ca. 30 to 3.5 cm(3) in a week. To understand the possible mechanism of this spectacular regression, estrogen, progesterone and luteinizing hormone receptors (ER, PGR and LHR, respectively) immuno-histochemistry assays were performed on the original surgery samples. Immuno-histochemistry showed negative ER, PGR and positive LHR status suggesting the possible angiogenic effect of human chorionic gonadotropin hormone (hCG) in the background. CONCLUSION We hypothesize that pregnancy may play a causal role in the progression of mRCC via the excess amount of hCG, however, more data are necessary to validate the present notions and the predictive role of LHR overexpression.
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Affiliation(s)
- László Mangel
- Institute of Oncotherapy, University of Pécs, H-7624, Édesanyák útja 17, Pécs, Hungary.
| | - Krisztina Bíró
- Department of Chemotherapy, National Institute of Oncology, Budapest, Hungary.
| | | | - Péter Göcze
- Clinic of Obstetrics and Gynecology, University of Pécs, Pécs, Hungary.
| | | | - Endre Kálmán
- Institute of Pathology, University of Pécs, Pécs, Hungary.
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Claret L, Mercier F, Houk BE, Milligan PA, Bruno R. Modeling and simulations relating overall survival to tumor growth inhibition in renal cell carcinoma patients. Cancer Chemother Pharmacol 2015. [DOI: 10.1007/s00280-015-2820-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Blagoev KB, Wilkerson J, Stein WD, Yang J, Bates SE, Fojo T. Therapies with diverse mechanisms of action kill cells by a similar exponential process in advanced cancers. Cancer Res 2015; 74:4653-62. [PMID: 25183789 DOI: 10.1158/0008-5472.can-14-0420] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Successful cancer treatments are generally defined as those that decrease tumor quantity. In many cases, this decrease occurs exponentially, with deviations from a strict exponential being attributed to a growing fraction of drug-resistant cells. Deviations from an exponential decrease in tumor quantity can also be expected if drugs have a nonuniform spatial distribution inside the tumor, for example, because of interstitial pressure inside the tumor. Here, we examine theoretically different models of cell killing and analyze data from clinical trials based on these models. We show that the best description of clinical outcomes is by first-order kinetics with exponential decrease of tumor quantity. We analyzed the total tumor quantity in a diverse group of clinical trials with various cancers during the administration of different classes of anticancer agents and in all cases observed that the models that best fit the data describe the decrease of the sensitive tumor fraction exponentially. The exponential decrease suggests that all drug-sensitive cancer cells have a single rate-limiting step on the path to cell death. If there are intermediate steps in the path to cell death, they are not rate limiting in the observational time scale utilized in clinical trials--tumor restaging at 6- to 8-week intervals. On shorter time scales, there might be intermediate steps, but the rate-limiting step is the same. Our analysis, thus, points to a common pathway to cell death for cancer cells in patients. See all articles in this Cancer Research section, "Physics in Cancer Research."
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Affiliation(s)
- Krastan B Blagoev
- National Science Foundation, Arlington, Virginia. Department of Radiology, Massachusetts General Hospital, Harvard Medical School and the Antinula Martinos Center for Biomedical Imaging, Charlestown, Massachusetts.
| | - Julia Wilkerson
- Medical Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Wilfred D Stein
- Medical Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Hebrew University, Jerusalem, Israel
| | - James Yang
- Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Susan E Bates
- Medical Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tito Fojo
- Medical Oncology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Venkatakrishnan K, Friberg LE, Ouellet D, Mettetal JT, Stein A, Trocóniz IF, Bruno R, Mehrotra N, Gobburu J, Mould DR. Optimizing oncology therapeutics through quantitative translational and clinical pharmacology: challenges and opportunities. Clin Pharmacol Ther 2014; 97:37-54. [PMID: 25670382 DOI: 10.1002/cpt.7] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/15/2014] [Indexed: 01/01/2023]
Abstract
Despite advances in biomedical research that have deepened our understanding of cancer hallmarks, resulting in the discovery and development of targeted therapies, the success rates of oncology drug development remain low. Opportunities remain for objective dose selection informed by exposure-response understanding to optimize the benefit-risk balance of novel therapies for cancer patients. This review article discusses the principles and applications of modeling and simulation approaches across the lifecycle of development of oncology therapeutics. Illustrative examples are used to convey the value gained from integration of quantitative clinical pharmacology strategies from the preclinical-translational phase through confirmatory clinical evaluation of efficacy and safety.
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Affiliation(s)
- K Venkatakrishnan
- Clinical Pharmacology, Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
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Iacovelli R, Massari F, Albiges L, Loriot Y, Massard C, Fizazi K, Escudier B. Evidence and Clinical Relevance of Tumor Flare in Patients Who Discontinue Tyrosine Kinase Inhibitors for Treatment of Metastatic Renal Cell Carcinoma. Eur Urol 2014; 68:154-60. [PMID: 25466943 DOI: 10.1016/j.eururo.2014.10.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/21/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several tyrosine kinase inhibitors (TKIs) and one monoclonal antibody targeting the vascular endothelial growth factor (VEGF)/VEGF receptor (VEGFR) axis have been approved for the treatment of metastatic renal cell carcinoma (mRCC). Preclinical data suggest that cessation of anti-VEGF therapy may generate a tumor flare (TF) but its clinical relevance is still questionable. OBJECTIVE This analysis investigates the occurrence of tumor flare and its prognostic role after discontinuation of anti-VEGFR TKIs in patients affected by mRCC. DESIGN, SETTING, AND PARTICIPANTS Patients with mRCC treated with first-line sunitinib or pazopanib at standard dosages were screened. Patients included in the analysis were required to have: (1) discontinued treatment because of progression of disease or intolerable toxicity or sustained response; (2) evaluation of tumor growth rates immediately before (GR1) and after discontinuation (GR2); and (3) no treatment during evaluation of GR2. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Overall survival (OS) was the main outcome. TF was calculated as the difference between the GR values (TF=GR2 - GR1). Cox proportional hazards regression was used to assess the prognostic role. RESULTS AND LIMITATIONS Sixty-three consecutive patients were analyzed; the median duration of treatment was 9.3 mo, the median progression-free survival (PFS) was 11.1 mo, and the median OS was 41.5 mo. The reasons for treatment discontinuation were sustained response (partial response/stable disease) in 15.9%, toxicity in 22.2%, and progression of disease in 61.9% of cases. The median GR1 and GR2 were 0.16cm/mo (interquartile range [IQR] -0.07 to 0.53) and 0.70cm/mo (IQR 0.21-1.46), respectively (p=0.001). In the overall population, the median TF was 0.55cm/mo (IQR 0.08-1.22) and differed according to the reason for discontinuation: 0.15cm/mo for response, 0.95cm/mo for toxicity, and 1.66cm/mo for progression. When TF was compared to other prognostic variables, Cox analysis confirmed its prognostic role (hazard ratio 1.11, 95% confidence interval 1.001-1.225; p=0.048). CONCLUSIONS This study reports clinical evidence that TKI discontinuation results in acceleration of tumor GR and induces TF, which can negatively affect the prognosis of mRCC patients. PATIENT SUMMARY In this report, we looked at the outcomes for patients affected by metastatic kidney tumors who discontinued treatment with antiangiogenic agents. We found that tumor regrowth after discontinuation of therapy was related to the reason for discontinuation: regrowth was higher in patients who discontinued treatment because of disease progression, and lower in patients who discontinued treatment because of a sustained response. Moreover, we found that the higher the growth rate, the shorter the survival. We conclude that discontinuation of antiangiogenic agents may cause an increase in tumor growth rate, which is related to patient survival.
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Affiliation(s)
- Roberto Iacovelli
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France; Department of Radiology, Oncology and Human Pathology, Sapienza University of Rome, Rome, Italy.
| | - Francesco Massari
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France; Department of Medical Oncology, University of Verona, Verona, Italy
| | - Laurence Albiges
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Yohann Loriot
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | | | - Karim Fizazi
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Bernard Escudier
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
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Verlingue L, Koscielny S, Ferté C. Should we resist to including tumour growth patterns in Response Evaluation Criteria in Solid Tumours evaluation? (Response to Litière et al.). Eur J Cancer 2014; 50:2887-8. [PMID: 25218336 DOI: 10.1016/j.ejca.2014.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Loic Verlingue
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Serge Koscielny
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.
| | - Charles Ferté
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM U981, Gustave Roussy, Villejuif, France
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Burotto M, Wilkerson J, Stein W, Motzer R, Bates S, Fojo T. Continuing a cancer treatment despite tumor growth may be valuable: sunitinib in renal cell carcinoma as example. PLoS One 2014; 9:e96316. [PMID: 24796484 PMCID: PMC4010463 DOI: 10.1371/journal.pone.0096316] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/04/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The US FDA and the EMA have approved seven agents for the treatment of renal cell carcinoma, primarily based on differences in progression-free survival (PFS). Because PFS is an arbitrary endpoint we hypothesized that an analysis would demonstrate the growth rate of tumors remained constant at the time of RECIST-defined disease progression. METHODS We previously estimated the growth (g) and regression (d) rates and the stability of g using data from the Phase III trial comparing sunitinib and interferon. RESULTS Sufficient data were available and rate constants statistically valid in 321 of 374 patients randomized to sunitinib. Median d was 0•0052 days(-1); in 53 patients no tumor growth was recorded. Median g was 0•00082 days(-1) and was stable for a median of 275 days on therapy, remaining stable beyond 300, 600 and 900 days in 122, 65 and 27 patients, respectively. A possible increase in g while receiving sunitinib could be discerned in only 18 of 321 patients. Given a median g of 0•00082 days(-1) the estimated median time to a second progression were sunitinib continued past RECIST-defined progression was 7.3 months. At 100, 200, and 300 days after starting therapy, an estimated 47%, 27%, and 13% of tumor remains sunitinib sensitive and could explain a RECIST-defined response to a new TKI. CONCLUSION Prolonged stability of g with sunitinib suggests continued sunitinib beyond RECIST-defined progression may provide a beneficial outcome. Randomized trials in patients whose disease has "progressed" on sunitinib are needed to test this hypothesis.
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Affiliation(s)
- Mauricio Burotto
- Medical Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, United States of America
- * E-mail:
| | - Julia Wilkerson
- Medical Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, United States of America
| | - Wilfred Stein
- Medical Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, United States of America
- Hebrew University, Jerusalem, Israel
| | - Robert Motzer
- Memorial Sloan Kettering Cancer Institute, New York, New York, United States of America
| | - Susan Bates
- Medical Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, United States of America
| | - Tito Fojo
- Medical Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland, United States of America
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O'Sullivan C, Edgerly M, Velarde M, Wilkerson J, Venkatesan AM, Pittaluga S, Yang SX, Nguyen D, Balasubramaniam S, Fojo T. The VEGF inhibitor axitinib has limited effectiveness as a therapy for adrenocortical cancer. J Clin Endocrinol Metab 2014; 99:1291-7. [PMID: 24423320 PMCID: PMC3973787 DOI: 10.1210/jc.2013-2298] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis in need of more effective treatment options. Published evidence indicates many ACCs express the vascular endothelial growth factor receptor (VEGFR), suggesting inhibiting vascular endothelial growth factor signaling could potentially impact tumor growth. OBJECTIVE The objective of the study was to determine the antitumor efficacy of axitinib (AG-013736), a potent, selective inhibitor of VEGFR1, -2, and -3. DESIGN This was a phase II, open-label trial using a two-stage design. PATIENTS Thirteen patients with metastatic ACC previously treated with at least one chemotherapy regimen with or without mitotane participated in the study. INTERVENTION Starting axitinib dose was 5 mg orally twice daily. Dose escalations were permitted if the administered dose was tolerable. RESULTS Thirteen patients were enrolled. Dose escalation was possible in seven patients, but the majority could not tolerate a dose higher than the starting 5 mg, twice-daily dose for prolonged periods of time. All patients experienced known grade 1/2 toxicities, and 10 of 13 patients had at least one grade 3/4 adverse event. No patient tumor could be scored as a Response Evaluation Criteria in Solid Tumors response, although the growth rate on therapy compared with that prior to starting axitinib was reduced in 4 of the 13 patients. The median progression-free survival was 5.48 months, and the median overall survival was longer than 13.7 months. CONCLUSION Axitinib has limited effectiveness in ACC. Together with 48 patients previously reported who received either sorafenib or sunitinib, a total of 61 ACC patients have now been treated with a VEGFR tyrosine kinase inhibitor without an objective Response Evaluation Criteria in Solid Tumors response. Future trials in ACC should look to other targets for possible active agents.
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Affiliation(s)
- Ciara O'Sullivan
- Medical Oncology Branch (C.O., M.E., M.V., J.W., S.B., T.F.), Center for Cancer Research, Laboratory of Pathology (S.P.), and National Clinical Target Validation Laboratory, Division of Cancer Treatment and Diagnosis (S.X.Y., D.N.), National Cancer Institute, and Radiology and Imaging Sciences (A.M.V.), Clinical Center, National Institutes of Health, Bethesda, Maryland 20892
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Lavi O, Greene JM, Levy D, Gottesman MM. Simplifying the complexity of resistance heterogeneity in metastasis. Trends Mol Med 2014; 20:129-36. [PMID: 24491979 DOI: 10.1016/j.molmed.2013.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/23/2013] [Accepted: 12/24/2013] [Indexed: 11/18/2022]
Abstract
The main goal of treatment regimens for metastasis is to control growth rates, not eradicate all cancer cells. Mathematical models offer methodologies that incorporate high-throughput data with dynamic effects on net growth. The ideal approach would simplify, but not over-simplify, a complex problem into meaningful and manageable estimators that predict the response of a patient to specific treatments. We explore here three fundamental approaches with different assumptions concerning resistance mechanisms in which the cells are categorized into either discrete compartments or described by a continuous range of resistance levels. We argue in favor of modeling resistance as a continuum, and demonstrate how integrating cellular growth rates, density-dependent versus exponential growth, and intratumoral heterogeneity improves predictions concerning the resistance heterogeneity of metastases.
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Affiliation(s)
- Orit Lavi
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James M Greene
- Department of Mathematics and Center for Scientific Computation and Mathematical Modeling (CSCAMM), University of Maryland, College Park, MD, USA
| | - Doron Levy
- Department of Mathematics and Center for Scientific Computation and Mathematical Modeling (CSCAMM), University of Maryland, College Park, MD, USA
| | - Michael M Gottesman
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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42
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Evaluation of Tumor Size Response Metrics to Predict Survival in Oncology Clinical Trials. Clin Pharmacol Ther 2014; 95:386-93. [DOI: 10.1038/clpt.2014.4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 01/06/2014] [Indexed: 11/08/2022]
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Ferté C, Fernandez M, Hollebecque A, Koscielny S, Levy A, Massard C, Balheda R, Bot B, Gomez-Roca C, Dromain C, Ammari S, Soria JC. Tumor growth rate is an early indicator of antitumor drug activity in phase I clinical trials. Clin Cancer Res 2013; 20:246-52. [PMID: 24240109 DOI: 10.1158/1078-0432.ccr-13-2098] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Response Evaluation Criteria in Solid Tumors (RECIST) evaluation does not take into account the pretreatment tumor kinetics and may provide incomplete information about experimental drug activity. Tumor growth rate (TGR) allows for a dynamic and quantitative assessment of the tumor kinetics. How TGR varies along the introduction of experimental therapeutics and is associated with outcome in phase I patients remains unknown. EXPERIMENTAL DESIGN Medical records from all patients (N = 253) prospectively treated in 20 phase I trials were analyzed. TGR was computed during the pretreatment period (reference) and the experimental period. Associations between TGR, standard prognostic scores [Royal Marsden Hospital (RMH) score], and outcome [progression-free survival (PFS) and overall survival (OS)] were computed (multivariate analysis). RESULTS We observed a reduction of TGR between the reference versus experimental periods (38% vs. 4.4%; P < 0.00001). Although most patients were classified as stable disease (65%) or progressive disease (25%) by RECIST at the first evaluation, 82% and 65% of them exhibited a decrease in TGR, respectively. In a multivariate analysis, only the decrease of TGR was associated with PFS (P = 0.004), whereas the RMH score was the only variable associated with OS (P = 0.0008). Only the investigated regimens delivered were associated with a decrease of TGR (P < 0.00001, multivariate analysis). Computing TGR profiles across different clinical trials reveals specific patterns of antitumor activity. CONCLUSIONS Exploring TGR in phase I patients is simple and provides clinically relevant information: (i) an early and subtle assessment of signs of antitumor activity; (ii) independent association with PFS; and (iii) it reveals drug-specific profiles, suggesting potential utility for guiding the further development of the investigational drugs.
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Affiliation(s)
- Charles Ferté
- Authors' Affiliations: Departments of Medical Oncology, Biostatistics and Epidemiology, Innovative Therapeutics and Early Drug Development, Radiology, and Radiotherapy; INSERM U981, University Paris Sud, Gustave Roussy, Villejuif, France; and Sage Bionetworks, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Wieder T, Braumüller H, Brenner E, Zender L, Röcken M. Changing T-cell enigma: cancer killing or cancer control? Cell Cycle 2013; 12:3146-53. [PMID: 24013429 DOI: 10.4161/cc.26060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Data from different laboratories and theoretical considerations challenge our current view on anticancer immunity. Immune cells are capable of destroying cancer cells under in vitro and in vivo conditions. Therefore, cellular immunity is considered to control cancers through mechanisms that kill cancers. Yet, therapeutic anticancer immune responses rarely delete cancers. If efficient, they rather establish a life with stable disease. This raises the question of whether killing is the sole mechanism by which immune therapy attacks cancers. Here, we show that, besides cancer eradication by cytotoxic lymphocytes, other modes of action are operative and strictly required for cancer control. We show that T helper-1 cells arrest cancer growth by driving cancers into a state of stable or permanent growth arrest, called senescence. Such immune cells establish cytokine-producing walls around developing cancers. When producing interferon-γ and tumor necrosis factor, this cytokine-induced tumor immune-surveillance keeps the cancer cells in a permanently non-proliferating state. Simultaneously, antiangiogenic chemokines cut their connections to the surrounding tissues. This strategy significantly reduces tumor burden and prolongs life of cancer-bearing animals. As human cancers also undergo senescence, the current data suggest tumor-immune surveillance through cytokine-induced senescence, instead of tumor eradication, as the more realistic and primary goal of cancer control.
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Affiliation(s)
- Thomas Wieder
- Department of Dermatology; Eberhard Karls University; Tübingen, Germany
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45
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Ferté C, Koscielny S, Albiges L, Rocher L, Soria JC, Iacovelli R, Loriot Y, Fizazi K, Escudier B. Tumor growth rate provides useful information to evaluate sorafenib and everolimus treatment in metastatic renal cell carcinoma patients: an integrated analysis of the TARGET and RECORD phase 3 trial data. Eur Urol 2013; 65:713-20. [PMID: 23993162 DOI: 10.1016/j.eururo.2013.08.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/02/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Response Evaluation Criteria in Solid Tumors (RECIST) criteria may not be sufficient to evaluate the response of targeted therapies in metastatic renal cell carcinoma (mRCC). The tumor growth rate (TGR) incorporates the time between evaluations and may be adequate. OBJECTIVE To determine how TGR is modified along the treatment sequence and is associated with outcome in mRCC patients. DESIGN, SETTING, AND PARTICIPANTS Medical records from all patients prospectively treated at Gustave Roussy (IGR) in the Treatment Approaches in Renal Cancer Global Evaluation Trial (TARGET) (sorafenib vs placebo, n=84) and the RECORD (everolimus vs placebo, n=43) phase 3 trials were analyzed. TGR was computed across clinically relevant periods: BEFORE treatment introduction (wash-out), UNDER (first cycle), at PROGRESSION (last cycle) and AFTER treatment discontinuation (washout). The association between TGR and outcome (overall survival [OS] and progression-free survival [PFS]) was computed in the entire TARGET cohort (n=903). INTERVENTION Sorafenib, everolimus, or placebo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS TGR, RECIST, OS, and PFS rates. RESULTS AND LIMITATIONS Although nearly all the patients (IGR) were classified as stable disease (RECIST) after the first cycle, the great majority of the patients exhibited a decrease in TGR UNDER compared with BEFORE (sorafenib: p<0.00001; everolimus: p<0.00001). In sorafenib-treated but not in everolimus-treated patients (IGR), TGR at PROGRESSION (last cycle) was still lower than TGR BEFORE (washout) (p=0.012), while TGR AFTER progression (washout) was higher than TGR at PROGRESSION (last cycle) (p=0.0012). Higher TGR (first cycle) was associated with worse PFS (hazard ratio [HR]: 3.61; 95% confidence interval [CI], 2.45-5.34) and worse OS (HR: 4.69; 95% CI, 1.54-14.39), independently from the Motzer score and from the treatment arm in the entire TARGET cohort. CONCLUSIONS Computing TGR in mRCC patients is simple and provides clinically useful information for mRCC patients: (1) TGR is independently associated with prognosis (PFS, OS), (2) TGR allows for a subtle and quantitative characterization of drug activity at the first evaluation, and (3) TGR reveals clear drug-specific profiles at progression.
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Affiliation(s)
- Charles Ferté
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM U981, Paris Sud University, Gustave Roussy, Villejuif, France; Sage Bionetworks, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Serge Koscielny
- INSERM U981, Paris Sud University, Gustave Roussy, Villejuif, France; Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM U981, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Laurence Rocher
- Department of Radiology, University Hospital of Bicêtre, Le Kremlin-Bicêtre, France
| | - Jean-Charles Soria
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM U981, Paris Sud University, Gustave Roussy, Villejuif, France
| | | | - Yohann Loriot
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM U981, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Karim Fizazi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM U981, Paris Sud University, Gustave Roussy, Villejuif, France
| | - Bernard Escudier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM U981, Paris Sud University, Gustave Roussy, Villejuif, France.
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Nishino M, Dahlberg SE, Cardarella S, Jackman DM, Rabin MS, Ramaiya NH, Hatabu H, Jänne PA, Johnson BE. Volumetric tumor growth in advanced non-small cell lung cancer patients with EGFR mutations during EGFR-tyrosine kinase inhibitor therapy: developing criteria to continue therapy beyond RECIST progression. Cancer 2013; 119:3761-8. [PMID: 23922022 DOI: 10.1002/cncr.28290] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective of this study was to define the volumetric tumor growth rate in patients who had advanced nonsmall cell lung cancer (NSCLC) with sensitizing epidermal growth factor receptor (EGFR) mutations and had initially received treatment with EGFR-tyrosine kinase inhibitor (TKI) therapy beyond progression. METHODS The study included 58 patients with advanced NSCLC who had sensitizing EGFR mutations treated with first-line gefitinib or erlotinib, had baseline computed tomography (CT) scans available that revealed a measurable lung lesion, had at least 2 follow-up CT scans during TKI therapy, and had experienced volumetric tumor growth. The tumor volume (in mm3) of the dominant lung lesion was measured on baseline and follow-up CT scans during therapy. In total, 405 volume measurements were analyzed in a linear mixed-effects model, fitting time as a random effect, to define the growth rate of the logarithm of tumor volume (log(e)V). RESULTS A linear mixed-effects model was fitted to predict the growth of log(e)V, adjusting for time in months from baseline. Log(e)V was estimated as a function of time in months among patients whose tumors started growing after the nadir: log(e)V = 0.12*time + 7.68. In this formula, the regression coefficient for time, 0.12/month, represents the growth rate of log(e)V (standard error, 0.015/month; P < .001). When adjusted for baseline volume, log(e)V0, the growth rate was also 0.12/month (standard error, 0.015/month; P < .001; log(e)V = 0.12*months + 0.72 log(e)V0 + 0.61). CONCLUSIONS Tumor volume models defined volumetric tumor growth after the nadir in patients with EGFR-mutant, advanced NSCLC who were receiving TKI, providing a reference value for the tumor growth rate in patients who progress after the nadir on TKI therapy. The results can be studied further in additional cohorts to develop practical criteria to help identify patients who are slowly progressing and can safely remain on EGFR-TKIs.
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Affiliation(s)
- Mizuki Nishino
- Department of Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
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Lankelma J, Fernández Luque R, Dekker H, van den Berg J, Kooi B. A new mathematical pharmacodynamic model of clonogenic cancer cell death by doxorubicin. J Pharmacokinet Pharmacodyn 2013; 40:513-25. [PMID: 23864485 DOI: 10.1007/s10928-013-9326-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 06/27/2013] [Indexed: 11/26/2022]
Abstract
Previous models for predicting tumor cell growth are mostly based on measurements of total cell numbers. The purpose of this paper is to provide a new simple mathematical model for calculating tumor cell growth focusing on the fraction of cells that is clonogenic. The non-clonogenic cells are considered to be relatively harmless. We performed a number of different types of experiments: a long-term drug "treatment", several concentrations/fixed time experiments and time-series experiments, in which human MCF-7 breast cancer cells were exposed to doxorubicin and the total number of cells were counted. In the latter two types, at every measurement point a plating efficiency experiment was started. The final number of colonies formed is equal to the number of clonogenic cells at the onset of the experiment. Based on the intracellular drug concentration, our model predicts cell culture effects taking clonogenic ability and growth inhibition by neighboring cells into account. The model fitted well to the experimental data. The estimated damage parameter which represents the chance of an MCF-7 cell to become non-clonogenic per unit time and per unit intracellular doxorubicin concentration was found to be 0.0025 ± 0.0008 (mean ± SD) nM(-1) h(-1). The model could be used to calculate the effect of every doxorubicin concentration versus time (C-t) profile. Although in vivo parameters may well be different from those found in vitro, the model can be used to predict trends, e.g. by comparing effects of different in vivo C-t profiles.
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Affiliation(s)
- Jan Lankelma
- Department of Molecular Cell Physiology, VU University, De Boelelaan 1085, Room G-226a, 1081 HV Amsterdam, The Netherlands.
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Bruno R, Mercier F, Claret L. Model-Based Drug Development in Oncology: What’s Next? Clin Pharmacol Ther 2013; 93:303-5. [DOI: 10.1038/clpt.2013.8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Blagoev KB, Wilkerson J, Stein WD, Motzer RJ, Bates SE, Fojo AT. Sunitinib does not accelerate tumor growth in patients with metastatic renal cell carcinoma. Cell Rep 2013; 3:277-81. [PMID: 23395639 PMCID: PMC6936322 DOI: 10.1016/j.celrep.2013.01.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/04/2012] [Accepted: 01/15/2013] [Indexed: 12/28/2022] Open
Abstract
Preclinical studies have suggested that sunitinib accelerates metastases in animals, ascribing this to inhibition of the vascular endothelial growth factor receptor or the tumor’s adaptation. To address whether sunitinib accelerates tumors in humans, we analyzed data from the pivotal randomized phase III trial comparing sunitinib and interferon alfa in patients with metastatic renal cell carcinoma. The evidence clearly shows that sunitinib was not harm- ful, did not accelerate tumor growth, and did not shorten survival. Specifically, neither longer sunitinib treatment nor a greater effect of sunitinib on tumors reduced survival. Sunitinib did reduce the tumor’s growth rate while administered, thereby improving survival, without appearing to alter tumor biology after discontinuation. Concerns arising from animal models do not apply to patients receiving sunitinib and likely will not apply to similar agents.
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Abstract
To improve future drug development efficiency in renal cell carcinoma (RCC), a disease-progression model was developed with longitudinal tumor size data from a phase III trial of sorafenib in RCC. The best-fit model was externally evaluated on 145 placebo-treated patients in a phase III trial of pazopanib; the model incorporated baseline tumor size, a linear disease-progression component, and an exponential drug effect (DE) parameter. With the model-estimated effect of sorafenib on RCC growth, we calculated the power of randomized phase II trials between sorafenib and hypothetical comparators over a range of effects. A hypothetical comparator with 80% greater DE than sorafenib would have 82% power (one-sided α = 0.1) with 50 patients per arm. Model-based quantitation of treatment effect with computed tomography (CT) imaging offers a scaffold on which to develop new, more efficient, phase II trial end points and analytic strategies for RCC.
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