1
|
Kao EY, Wakeman KM, Wu Y, Gross JM, Chen EY, Ricciotti RW, Liu YJ, Mantilla JG. Prevalence and detection of actionable BRAF V600 and NRAS Q61 mutations in malignant peripheral nerve sheath tumor by droplet digital PCR. Hum Pathol 2022; 129:90-97. [PMID: 36067829 DOI: 10.1016/j.humpath.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
Malignant peripheral nerve sheath tumors ( MPNSTs) are aggressive tumors with poor prognosis that do not typically respond well to standard chemotherapy. Recently, point mutations involving BRAF V600E have been demonstrated in a subset of MPNST, offering the possibility of targeted treatment. However, the reported prevalence of these alterations is variable. Mutations involving NRAS, which is also involved in the MAPK/ERK pathway and amenable to targeted inhibitors, have not been well characterized in MPNST. In this study, we validated droplet digital polymerase chain reaction for the detection of BRAF V600E and NRAS Q61 mutations and evaluate the prevalence of BRAF V600E and NRAS Q61 mutations in 79 cases of MPNST, including 45 sporadic, 27 NF-1 associated, and 7 radiation-associated tumors. We detected actionable BRAF or NRAS mutations in 3 of 44 sporadic MPNSTs (6.8%), including 2 BRAF V600 and 1 NRAS Q61 mutations, as well as 1 NRAS Q61 mutation in a tumor that was ultimately considered to represent melanoma. These 3 cases with positive mutations were exclusively in sporadic, high-grade MPNST (FNCLCC grade 3 of 3), with a prevalence of 11.5% in this group (3.8% NRAS Q61 mutations and 7.7% BRAF V600 mutations). None of the tumors associated with NF-1 or prior radiation had detectable mutations in the genes tested. Overall, the prevalence of these alterations offers the possibility of targeted therapy in this aggressive type of sarcoma and suggests the potential benefit of routine clinical testing.
Collapse
Affiliation(s)
- Erica Y Kao
- Department of Pathology, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Kristina M Wakeman
- Department of Pathology, University of Louisville, Louisville, KY, 40202, USA
| | - Yu Wu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98195, USA
| | - John M Gross
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Eleanor Y Chen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98195, USA
| | - Robert W Ricciotti
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98195, USA
| | - Yajuan J Liu
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98195, USA.
| | - Jose G Mantilla
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, 98195, USA.
| |
Collapse
|
2
|
Wabitsch S, Tandon M, Ruf B, Zhang Q, McCallen JD, McVey JC, Ma C, Green BL, Diggs LP, Heinrich B, Greten TF. Anti-PD-1 in Combination With Trametinib Suppresses Tumor Growth and Improves Survival of Intrahepatic Cholangiocarcinoma in Mice. Cell Mol Gastroenterol Hepatol 2021; 12:1166-1178. [PMID: 34033968 PMCID: PMC8413239 DOI: 10.1016/j.jcmgh.2021.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Intrahepatic cholangiocarcinoma (iCCA) accounts for a fraction of primary liver cancers but has a 5-year survival rate of only 10%. Immune checkpoint inhibitors are effective in treating many solid cancers, but immune checkpoint inhibitor monotherapy has no clear benefit in iCCA. Mitogen-activated kinase (MEK) inhibitors, such as trametinib, have shown promising results in preclinical studies for iCCA by inhibiting cell proliferation and modifying the tumor microenvironment. This study aimed to show the potential benefit of combining trametinib with anti-programmed cell death protein 1 (PD-1) therapy in different iCCA mouse models. METHODS Here, we assessed the in vitro cytotoxicity of trametinib in mouse (SB1 and LD-1) and human (EGI-1) cholangiocarcinoma cell lines. We examined the efficacy of single-agent trametinib, anti-PD-1, and a combination of both in subcutaneous, orthotopic, and plasmid-induced iCCA mouse models. Flow cytometry analysis was used to elucidate changes in the tumor immune microenvironment upon treatment. Whole-exome sequencing (WES) was performed on the SB1 tumor cell line to correlate this preclinical model with iCCAs in patients. RESULTS Trametinib reduced tumor cell growth of SB1, LD-1, and EGI-1 tumor cells in vitro. Trametinib treatment led to up-regulation of major histocompatibility complex (MHC-I) and programmed cell death ligand 1 (PD-L-1) (programmed cell death ligand 1) on tumor cells in vitro. The combination of trametinib and anti-PD-1 reduced tumor burden in several iCCA tumor models and improved survival in SB1 tumor-bearing mice compared with either agent alone. Immunoprofiling of tumor-bearing mice showed an increase of hepatic effector memory CD8+ and CD4+ T cells, as well as an increased degranulation of CD8+ T cells, indicating enhanced cytotoxicity. WES and somatic mutational analysis showed no mutations of KRAS, BRAF, and ERK in SB1 tumor cells, and showed a similar genetic signature of SB1 found in a cohort of patients with iCCA. CONCLUSIONS Altogether, our study shows that trametinib improves the immunogenicity of tumor cells by up-regulating MHC-I surface expression. The combination with anti-PD-1 results in optimal treatment efficacy for iCCA. WES of SB1 cells suggests that KRAS wild-type iCCAs also respond to this combination therapy.
Collapse
Affiliation(s)
- Simon Wabitsch
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch
| | - Mayank Tandon
- Center for Cancer Research Collaborative Bioinformatics Resource, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Benjamin Ruf
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch
| | - Qianfei Zhang
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch
| | - Justin D. McCallen
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch
| | - John C. McVey
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Chi Ma
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch
| | - Benjamin L. Green
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch
| | - Laurence P. Diggs
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch
| | - Bernd Heinrich
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch
| | - Tim F. Greten
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch,Correspondence Address correspondence to: Tim F. Greten, MD, Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, 9000 Rockville Pike, 10/3B43, Bethesda, Maryland 20892. fax: (301) 451-4723.
| |
Collapse
|
3
|
Guttà C, Rahman A, Aura C, Dynoodt P, Charles EM, Hirschenhahn E, Joseph J, Wouters J, de Chaumont C, Rafferty M, Warren M, van den Oord JJ, Gallagher WM, Rehm M. Low expression of pro-apoptotic proteins Bax, Bak and Smac indicates prolonged progression-free survival in chemotherapy-treated metastatic melanoma. Cell Death Dis 2020; 11:124. [PMID: 32054850 DOI: 10.1038/s41419-020-2309-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 12/30/2022]
Abstract
Despite the introduction of novel targeted therapies, chemotherapy still remains the primary treatment for metastatic melanoma in poorly funded healthcare environments or in case of disease relapse, with no reliable molecular markers for progression-free survival (PFS) available. As chemotherapy primarily eliminates cancer cells by apoptosis, we here evaluated if the expression of key apoptosis regulators (Bax, Bak, Bcl-2, Bcl-xL, Smac, Procaspase-9, Apaf-1, Procaspase-3 and XIAP) allows prognosticating PFS in stage III/IV melanoma patients. Following antibody validation, marker expression was determined by automated and manual scoring of immunohistochemically stained tissue microarrays (TMAs) constructed from treatment-naive metastatic melanoma biopsies. Interestingly and counter-intuitively, low expression of the pro-apoptotic proteins Bax, Bak and Smac indicated better prognosis (log-rank p < 0.0001, p = 0.0301 and p = 0.0227 for automated and p = 0.0422, p = 0.0410 and p = 0.0073 for manual scoring). These findings were independently validated in the cancer genome atlas (TCGA) metastatic melanoma cohort (TCGA-SKCM) at transcript level (log-rank p = 0.0004, p = 0.0104 and p = 0.0377). Taking expression heterogeneity between the markers in individual tumour samples into account allowed defining combinatorial Bax, Bak, Smac signatures that were associated with significantly increased PFS (p = 0.0002 and p = 0.0028 at protein and transcript level, respectively). Furthermore, combined low expression of Bax, Bak and Smac allowed predicting prolonged PFS (> 12 months) on a case-by-case basis (area under the receiver operating characteristic curve (ROC AUC) = 0.79). Taken together, our results therefore suggest that Bax, Bak and Smac jointly define a signature with potential clinical utility in chemotherapy-treated metastatic melanoma.
Collapse
|
4
|
Tripathi R, Knusel KD, Ezaldein HH, Bordeaux JS, Scott JF. National Burden of Hospitalization Due to Cutaneous Melanoma in Adolescents and Young Adults. Am J Clin Oncol 2019; 42:830-836. [PMID: 31569167 DOI: 10.1097/coc.0000000000000605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although adolescents and young adults (AYA) suffer disproportionately from cutaneous melanoma (CM), little is known regarding the burden of CM leading to hospitalization in AYA. The objective of this study was to elucidate sociodemographic/hospitalization characteristics of AYA CM inpatients, determine which factors lead to the greater length of stay (LOS) and cost of care for AYA CM inpatients, and evaluate trends in the prevalence, LOS, and cost of care for AYA CM hospitalizations. MATERIALS AND METHODS A retrospective cohort study of nationally representative data from the 2009 to 2015 National Inpatient Sample. Multivariable survey-weighted logistic regression models were used to determine sociodemographic factors associated with AYA CM hospitalization. Multivariable survey-weighted linear regression models were used to determine characteristics associated with the greater cost of care and LOS in AYA CM inpatients. RESULTS A total of 8986 AYA CM inpatients were included in this study. The prevalence of AYA CM hospitalizations is decreasing over time while the cost of care is increasing. On average, AYA CM hospitalizations were 3.3 days long and cost $38,018.40. Controlling for all covariates, male sex, older age, non-Hispanic white race, higher income, private insurance, and elective admissions were associated with AYA hospitalization due to CM (P<0.0001). Male sex was associated with longer LOS (P=0.007) and cost of care (P=0.01) among AYA hospitalized for CM. CONCLUSIONS Despite a decreasing prevalence of CM hospitalizations in AYA inpatients, the economic burden of these hospitalizations is increasing. Substantial sex-based differences exist in the inpatient burden of AYA CM. Further research is required to elucidate the causes of these differences and prevent AYA hospitalization due to CM.
Collapse
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Konrad D Knusel
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Harib H Ezaldein
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Jeremy S Bordeaux
- Department of Dermatology, Case Western Reserve University School of Medicine
- Department of Dermatology, University Hospitals Cleveland Medical Center
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, Cleveland, OH
| |
Collapse
|
5
|
Abstract
AIM To investigate patient preferences for clinical attributes of first-line metastatic melanoma treatments. MATERIALS & METHODS A discrete-choice experiment and best-worst scaling exercise were used to assess relative preferences for treatment attributes. RESULTS The 200 survey respondents had distinct preferences. Avoiding a 30% risk of colitis or hormone gland problems and avoiding severe fever were more important to respondents than avoiding a 20% risk of extreme sun sensitivity (p < 0.05). Patients preferred taking pills to receiving intravenous infusions in a clinic. When attributes were combined, approximately 85% of respondents preferred a risk profile similar to targeted therapy over a profile similar to immunotherapy, holding efficacy constant. CONCLUSION Taking patient preferences into account can help patients get the full benefit from metastatic melanoma therapies.
Collapse
Affiliation(s)
| | - Briana Ndife
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Joyce Chen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | | | - Sameer Ghate
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| |
Collapse
|
6
|
Rubió-Casadevall J, Puig-Vives M, Puigdemont M, Vilardell L, Carbó-Bagué A, Marcos-Gragera R, Vilar-Coromina N. Patterns of increased incidence and survival of cutaneous melanoma in Girona (Spain) 1994-2013: a population-based study. Clin Transl Oncol 2018; 20:1617-1625. [PMID: 29873027 DOI: 10.1007/s12094-018-1900-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/21/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION We conducted a population-based study on the Girona Cancer Registry (Spain) for the period 1994-2013 to determine patterns of change in the incidence of melanoma, which is increasing in many countries, and patient survival in our geographical area. MATERIALS AND METHODS Using the standard registration rules for cancer registries, we calculated crude and standardized incidence rates as well as their trends. We also analysed the observed survival, 1-year conditioned survival and relative survival at 3, 5 and 10 years. RESULTS Our crude incidence rate was 9.13 cases/100,000 inhabitants for invasive and 2.59 for "in situ" melanomas. A statistically significant increase in incidence was found for melanomas of less than 1 mm in Breslow index and in males. 10-year observed and relative survival rates were 64.1 and 83.1%, respectively. CONCLUSIONS We found an increasing trend in the incidence of low-risk melanoma and a survival rate similar to that reported elsewhere in Europe.
Collapse
Affiliation(s)
- J Rubió-Casadevall
- Medical Oncology Department, Hospital Josep Trueta, Catalan Institute of Oncology of Girona, Av. França s/n, 17005, Girona, Spain.
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.
- School of Medicine, University of Girona (UdG), Girona, Spain.
| | - M Puig-Vives
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - M Puigdemont
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- University Hospital Josep Trueta Cancer Registry Coordinator, Catalan Institute of Oncology of Girona, Girona, Spain
- School of Nursery, University of Girona (UdG), Girona, Spain
| | - L Vilardell
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - A Carbó-Bagué
- Medical Oncology Department, Hospital Josep Trueta, Catalan Institute of Oncology of Girona, Av. França s/n, 17005, Girona, Spain
| | - R Marcos-Gragera
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- School of Medicine, University of Girona (UdG), Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan Department of Health Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - N Vilar-Coromina
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- School of Medicine, University of Girona (UdG), Girona, Spain
- Dermatology Department, University Hospital Josep Trueta, Catalan Institute of Health, Girona, Spain
| |
Collapse
|
7
|
Cesi G, Philippidou D, Kozar I, Kim YJ, Bernardin F, Van Niel G, Wienecke-Baldacchino A, Felten P, Letellier E, Dengler S, Nashan D, Haan C, Kreis S. A new ALK isoform transported by extracellular vesicles confers drug resistance to melanoma cells. Mol Cancer 2018; 17:145. [PMID: 30290811 PMCID: PMC6172729 DOI: 10.1186/s12943-018-0886-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/03/2018] [Indexed: 12/31/2022] Open
Abstract
Background Drug resistance remains an unsolved clinical issue in oncology. Despite promising initial responses obtained with BRAF and MEK kinase inhibitors, resistance to treatment develops within months in virtually all melanoma patients. Methods Microarray analyses were performed in BRAF inhibitor-sensitive and resistant cell lines to identify changes in the transcriptome that might play a role in resistance. siRNA approaches and kinase inhibitors were used to assess the involvement of the identified Anaplastic Lymphoma Kinase (ALK) in drug resistance. The capability of extracellular vesicles (EVs) to transfer drug resistant properties was investigated in co-culture assays. Results Here, we report a new mechanism of acquired drug resistance involving the activation of a novel truncated form of ALK. Knock down or inhibition of ALK re-sensitised resistant cells to BRAF inhibition and induced apoptosis. Interestingly, truncated ALK was also secreted into EVs and we show that EVs were the vehicle for transferring drug resistance. Conclusions To our knowledge, this is the first report demonstrating the functional involvement of EVs in melanoma drug resistance by transporting a truncated but functional form of ALK, able to activate the MAPK signalling pathway in target cells. Combined inhibition of ALK and BRAF dramatically reduced tumour growth in vivo. These findings make ALK a promising clinical target in melanoma patients. Electronic supplementary material The online version of this article (10.1186/s12943-018-0886-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Giulia Cesi
- Life Sciences Research Unit, University of Luxembourg, Belvaux, Luxembourg
| | | | - Ines Kozar
- Life Sciences Research Unit, University of Luxembourg, Belvaux, Luxembourg
| | | | | | - Guillaume Van Niel
- Institute Curie, PSL Research University, CNRS UMR144, Paris, France.,Center for Psychiatry and Neuroscience, Hopital Saint-Anne, Université Descartes, INSERM U894, Paris, France
| | | | - Paul Felten
- Life Sciences Research Unit, University of Luxembourg, Belvaux, Luxembourg
| | | | | | | | - Claude Haan
- Life Sciences Research Unit, University of Luxembourg, Belvaux, Luxembourg
| | - Stephanie Kreis
- Life Sciences Research Unit, University of Luxembourg, Belvaux, Luxembourg.
| |
Collapse
|
8
|
Tripathi SV, Morris CR, Alhamad T, Fields RC, Linette GP, Cornelius LA. Metastatic melanoma after solid organ transplantation: An interdisciplinary, institution-based review of management with systemic and targeted therapies. J Am Acad Dermatol 2018; 78:184-185. [PMID: 29241778 DOI: 10.1016/j.jaad.2017.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 06/10/2017] [Accepted: 06/18/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Shivani V Tripathi
- Division of Dermatology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Caroline R Morris
- Division of Dermatology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Tarek Alhamad
- Renal Division, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Transplant Epidemiology Research Collaboration, Institute of Public Health, Washington University in St. Louis, St. Louis, Missouri
| | - Ryan C Fields
- Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Gerald P Linette
- Division of Oncology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Lynn A Cornelius
- Division of Dermatology, Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri.
| |
Collapse
|
9
|
Fruehauf JP, El-Masry M, Osann K, Parmakhtiar B, Yamamoto M, Jakowatz JG. Phase II study of pazopanib in combination with paclitaxel in patients with metastatic melanoma. Cancer Chemother Pharmacol 2018; 82:353-360. [PMID: 29943192 PMCID: PMC6060847 DOI: 10.1007/s00280-018-3624-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 06/12/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE This phase II study evaluated the safety and clinical activity of pazopanib, a potent and mutlitargeted tyrosine kinase inhibitor (TKI) of vascular endothelial growth factor receptors (VEGFRs)-1, -2 and -3, platelet-derived growth factor receptor (PDGFR)-α and β, and cKit, in combination with metronomic paclitaxel in patients with metastatic melanoma. EXPERIMENTAL DESIGN Sixty chemotherapy-naive patients received pazopanib at a starting dose of 800 mg daily in combination with metronomic dosing of paclitaxel 80 mg/m2 weekly thrice every 4 weeks. The primary endpoint was 6-month progression-free survival (PFS) rate, while secondary endpoints included 1-year overall survival rate, RECIST response rates, progression-free survival rates and median overall survival. Prior BRAF-targeted therapy or checkpoint inhibitors were permitted. RESULTS The 6-month PFS rate was 68%, with a 1-year OS rate of 48%. Objective response rate was 37% comprising one complete and 20 partial responses. Stable disease at 8 weeks was noted in 32 patients (55%) with an overall clinical benefit rate of 93%. Six-month median progression-free survival was 8 months and median OS was 12.7 months. The most frequently (> 15%) reported non-hematologic, treatment-related adverse events were fatigue, diarrhea, hypertension, transaminitis and peripheral neuropathy. Treatment-related non-fatal bowel perforation, a known class effect, occurred in one patient. No significant association was noted between plasma levels of pazopanib and response. CONCLUSIONS The combination of pazopanib and metronomic paclitaxel was well-tolerated, demonstrating significant activity in metastatic melanoma. Further evaluation of this combination is warranted.
Collapse
Affiliation(s)
- John P Fruehauf
- Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California, 101 The City Drive South, Bldg 56, Orange, Irvine, CA, 92868, USA.
| | - Monica El-Masry
- Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California, 101 The City Drive South, Bldg 56, Orange, Irvine, CA, 92868, USA
| | - Katherine Osann
- Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California, 101 The City Drive South, Bldg 56, Orange, Irvine, CA, 92868, USA
| | - Basmina Parmakhtiar
- Division of Hematology/Oncology, Chao Family Comprehensive Cancer Center, University of California, 101 The City Drive South, Bldg 56, Orange, Irvine, CA, 92868, USA
| | - Maki Yamamoto
- Division of Surgical Oncology, Chao Family Comprehensive Cancer Center, University of California, 101 The City Drive South, Bldg 56, Orange, Irvine, CA, 92868, USA
| | - James G Jakowatz
- Division of Surgical Oncology, Chao Family Comprehensive Cancer Center, University of California, 101 The City Drive South, Bldg 56, Orange, Irvine, CA, 92868, USA
| |
Collapse
|
10
|
Steinkamp AD, Schmitt L, Chen X, Fietkau K, Heise R, Baron JM, Bolm C. Synthesis of a Sulfonimidamide-Based Analog of Tasisulam and Its Biological Evaluation in the Melanoma Cell Lines SKMel23 and A375. Skin Pharmacol Physiol 2016; 29:281-290. [PMID: 28013301 DOI: 10.1159/000453042] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
Tasisulam is a promising antitumor agent with complex pharmacology, which is used as an antiproliferative agent in patients with metastatic melanoma and other solid tumors. Phase 2 melanoma studies showed promising results but had to be stopped because of insufficient tasisulam clearance leading to toxic side effects. To reduce the negative effects of tasisulam, we synthesized a novel sulfonimidamide-based analog to evaluate its antiproliferative effects in comparison to the original compound by performing a cell proliferation assay in melanoma cell lines SKMel23 and A375. The results revealed that the analog had inhibitory effects on the proliferation comparable to tasisulam in both investigated cell lines. These results could contribute to a reduced toxicity of tasisulam and lead to further clinical trials in metastatic melanoma.
Collapse
|