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Nathan CAO, Hayes DN, Karrison T, Harismendy O, Flores JM, Moore-Medlin T, Vokes EE, Gutkind JS, Neupane P, Mills G, Sargi Z, Seiwert T, Grilley-Olson J, Day T, Gillison M, Wade JL, Feldman L, Jha G, Kozloff M, O’ Leary M, Worden FP, Cohen EEW. A Randomized Multi-institutional Phase II Trial of Everolimus as Adjuvant Therapy in Patients with Locally Advanced Squamous Cell Cancer of the Head and Neck. Clin Cancer Res 2022; 28:5040-5048. [PMID: 36194164 PMCID: PMC9722644 DOI: 10.1158/1078-0432.ccr-21-4290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Investigate whether adjuvant everolimus, an mTOR inhibitor, improves progression-free survival (PFS) in advanced-stage head and neck squamous cell carcinoma (HNSCC) and provide outcomes related to correlative biological factors associated with disease control. PATIENTS AND METHODS This was a prospective, randomized, double-blind phase II trial of patients with advanced-stage HNSCC from 13 institutions who were confirmed disease-free post-definitive therapy and enrolled between December 2010 and March 2015. Patients received adjuvant everolimus or placebo daily (10 mg, oral) for a maximum of 1 year. p16 IHC as a surrogate marker for human papillomavirus infection and whole-exome sequencing were performed. Cox proportional hazard models estimated hazard rates. Log-rank tests evaluated differences in survival. The primary endpoint was PFS. Secondary endpoints and objectives included overall survival (OS) and toxicity assessment. RESULTS 52 patients [median (range) age, 58 (37-76) years; 43 men (83%), 9 women (17%)] were randomized to placebo (n = 24) or everolimus (n = 28). PFS favored everolimus, but was not significant [log-rank P = 0.093; HR = 0.44; 95% confidence interval (CI), 0.17-1.17]. There was no difference in OS (P = 0.29; HR = 0.57; 95% CI, 0.20-16.2). Everolimus resulted in significant improvement in PFS for p16-negative patients (n = 31; P = 0.031; HR = 0.26; 95% CI, 0.07-0.97), although subgroup analysis showed no difference for p16-positive patients (n = 21; P = 0.93). Further, PFS was significantly higher in TP53-mutated (TP53mut) patients treated with everolimus compared with placebo (log-rank P = 0.027; HR = 0.24; 95% CI, 0.06-0.95). No treatment difference was seen in patients with TP53 wild-type tumors (P = 0.79). CONCLUSIONS p16-negative and TP53mut patients may benefit from adjuvant treatment with everolimus.
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Affiliation(s)
- Cherie-Ann O. Nathan
- Department of Otolaryngology-Head and Neck Surgery, Feist-Weiller Cancer Center, Louisiana State University Health-Shreveport., Shreveport, LA
| | - D Neil Hayes
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Theodore Karrison
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
| | - Olivier Harismendy
- Division of Biomedical Informatics, Department of Medicine, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - José M. Flores
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Tara Moore-Medlin
- Department of Otolaryngology-Head and Neck Surgery, Feist-Weiller Cancer Center, Louisiana State University Health-Shreveport., Shreveport, LA
| | | | - J. Silvio Gutkind
- Department of Pharmacology, Moores Cancer Center, University of California San Diego, San Diego, CA
| | - Prakash Neupane
- Department of Medical Oncology, University of Kansas Medical Center, Kansas City, KS
| | - Glenn Mills
- Department of Medicine, Feist-Weiller Cancer Center, Louisiana State University Health-Shreveport, Shreveport, LA
| | - Zoukaa Sargi
- Department of Otolaryngology, University of Miami, Miami, FL
| | - Tanguy Seiwert
- Department of Medicine, The University of Chicago, Chicago, IL
| | | | - Terry Day
- Department of Otolaryngology, Medical University of South Carolina, Charleston, SC
| | - Maura Gillison
- Viral Oncology, Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - James L. Wade
- Department of Medicine, Decatur Memorial Hospital, Decatur, IL
| | - Lawrence Feldman
- Department of Medicine, University of Illinois Cancer Center, Chicago, IL
| | - Gautam Jha
- Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Mark Kozloff
- Department of Medicine, Ingalls Cancer Research Center, Chicago, IL
| | - Miriam O’ Leary
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, MA
| | - Francis P. Worden
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Hutson TE, Bukowski RM, Cowey CL, Figlin R, Escudier B, Sternberg CN. Sequential use of targeted agents in the treatment of renal cell carcinoma. Crit Rev Oncol Hematol 2011; 77:48-62. [DOI: 10.1016/j.critrevonc.2010.07.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 07/16/2010] [Accepted: 07/19/2010] [Indexed: 11/16/2022] Open
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Amato RJ, Jac J, Giessinger S, Saxena S, Willis JP. A phase 2 study with a daily regimen of the oral mTOR inhibitor RAD001 (everolimus) in patients with metastatic clear cell renal cell cancer. Cancer 2009; 115:2438-46. [PMID: 19306412 DOI: 10.1002/cncr.24280] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Everolimus, an oral mammalian target of rapamycin (mTOR) inhibitor, affects tumor growth by blocking growth factor stimulation, arresting cell cycle progression, and inhibiting angiogenesis. mTOR inhibitors and agents with primarily antiangiogenic activity have been shown to have efficacy in renal cell cancer (RCC). This phase 2 study assessed the efficacy of daily oral dosing with everolimus in patients with RCC. METHODS Patients had confirmed predominantly clear cell RCC; had received <or=1 prior therapy; and had progressive, measurable metastatic disease. Everolimus was given at a dose of 10 mg daily orally without interruption (28-day cycle), with dose modifications for toxicity (graded according to National Cancer Institute Common Toxicity Criteria, version 3.0). Patients were evaluated every 2 cycles (8 weeks) using Response Evaluation Criteria in Solid Tumors (RECIST). RESULTS Of 41 enrolled patients, 39 were treated and evaluable for safety, 37 of whom were evaluable for response (2 patients withdrew after the first week of therapy). Approximately 78% of the patients were male, the median age was 60 years, 93% had a Zubrod performance status of 0 to 1, and 83% had received prior therapy. The median progression-free survival (PFS) was 11.2 months and the median overall survival was 22.1 months. Partial responses were observed in 5 (14%) patients, stable disease lasting >or=3 months was reported in 27 (73%) patients, and stable disease lasting >or=6 months was reported in 21 (57%) patients. Nausea (38% of patients), anorexia (38% of patients), diarrhea (31% of patients), stomatitis (31% of patients), pneumonitis (31% of patients), and rash (26% of patients) were common. Grade 3 of 4 adverse events included pneumonitis (18% of patients); transaminase elevations (10% of patients); thrombocytopenia, hyperglycemia, and alkaline phosphatase elevations (8% each of patients); and hyperlipidemia (5% of patients). CONCLUSIONS In the current study, everolimus demonstrated encouraging antitumor activity against metastatic RCC as indicated by a PFS >or= 6 months for approximately 70% of patients.
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Affiliation(s)
- Robert J Amato
- Department of Internal Medicine, Division of Oncology, The University of Texas Health Medical School, Memorial Hermann Cancer Center, Houston, Texas 77030, USA.
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Bellmunt J, Calvo E, Castellano D, Climent MÁ, Esteban E, García del Muro X, González-Larriba JL, Maroto P, Trigo JM. Recommendations from the Spanish Oncology Genitourinary Group for the treatment of metastatic renal cancer. Cancer Chemother Pharmacol 2009; 63 Suppl 1:S1-13. [DOI: 10.1007/s00280-009-0955-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Escudier B, Cosaert J, Pisa P. Bevacizumab: direct anti-VEGF therapy in renal cell carcinoma. Expert Rev Anticancer Ther 2009; 8:1545-57. [PMID: 18925847 DOI: 10.1586/14737140.8.10.1545] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Bevacizumab, in combination with IFN, is approved in the EU as first-line therapy for advanced and/or metastatic renal cell carcinoma (mRCC). Data from Avastin and Roferon in Renal Cell Carcinoma [BO17705] (AVOREN), a Phase III trial, demonstrated that bevacizumab plus IFN significantly improves progression-free survival and response rate in patients with previously untreated mRCC compared with IFN plus placebo. Furthermore, bevacizumab plus IFN is well tolerated and has a predictable and well-established tolerability profile; reducing the dose of IFN, when necessary, can effectively manage IFN-related side effects without compromising efficacy. The rapid evolution of options for RCC therapy means that the optimal use of available agents to maximize patient benefit is not currently well defined. Combination regimens and sequencing of agents are both being investigated to maximize future outcomes, with bevacizumab playing a key role in first-line regimens. Trials over the next 5 years will guide clinical practice, but bevacizumab plus IFN is currently a standard first-line option for mRCC.
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Affiliation(s)
- Bernard Escudier
- Immunotherapy Unit, Institut Gustave Roussy, Villejuif Cedex, France.
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