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Panattoni L, Kearney M, Land N, Flottemesch T, Sullivan P, Kirker M, Bharmal M, Hauber B. Understanding Clinician Preferences for Treatment Attributes in Oncology: A Discrete Choice Experiment of Oncologists' and Urologists' Preferences for First-Line Treatment of Locally Advanced/Unresectable Metastatic Urothelial Carcinoma in Five European Countries. PHARMACOECONOMICS 2024:10.1007/s40273-024-01359-x. [PMID: 38472738 DOI: 10.1007/s40273-024-01359-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Prior discrete choice experiments (DCE) in oncology found that, on average, clinicians rank survival as the most important treatment attribute. We investigate heterogeneity in clinician preferences within the context of first-line treatment for advanced urothelial carcinoma in Spain, France, Italy, Germany, and the UK. METHODS The online DCE included 12 treatment choice tasks, each comparing two hypothetical therapy profiles defined by treatment attributes: grade 3/4 treatment-related adverse events (TRAEs), induction and maintenance administration schedules, progression-free survival, and overall survival (OS). We used a random parameters logit model to estimate attribute relative importance (RI) (0-100%) and generate preference shares for four treatment profiles. Results were stratified by country. Preference heterogeneity was evaluated by latent class analysis. RESULTS In August and September 2022, 498 clinicians (343 oncologists and 155 urologists) completed the DCE. OS had the strongest influence on clinicians' preferences [RI = 62%; range, 51.6% (Germany) to 63.7% (Spain)] followed by frequency of grade 3/4 TRAEs (RI = 27%). Among treatment profiles, the chemotherapy plus immune checkpoint inhibitor maintenance therapy profile had the largest preference share [51%; range, 38% (Italy) to 56% (UK)]. Four latent classes of clinicians were identified (N = 469), with different treatment profile preferences: survival class (30.1%), trade-off class (22.4%), no strong preference class (40.9%), and aggressive treatment class (6.6%). OS was not the most important attribute for 30.0% of clinicians. CONCLUSION While average sample results were consistent with those of prior DCEs, this study found heterogeneity in clinician preferences within and across countries, highlighting the diversity in clinician decision making in oncology.
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Affiliation(s)
| | | | | | | | | | | | - Murtuza Bharmal
- EMD Serono, Research & Development Institute, Inc. (an Affiliate of Merck KGaA), Billerica, MA, USA
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Thibault C, Fléchon A, Albiges L, Joly C, Barthelemy P, Gross-Goupil M, Chevreau C, Coquan E, Rolland F, Laguerre B, Gravis G, Pécuchet N, Elaidi RT, Timsit MO, Brihoum M, Auclin E, de Reyniès A, Allory Y, Oudard S. Gemcitabine plus platinum-based chemotherapy in combination with bevacizumab for kidney metastatic collecting duct and medullary carcinomas: Results of a prospective phase II trial (BEVABEL-GETUG/AFU24). Eur J Cancer 2023; 186:83-90. [PMID: 37054556 DOI: 10.1016/j.ejca.2023.03.018] [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: 02/03/2023] [Revised: 03/15/2023] [Accepted: 03/15/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Renal medullary carcinoma (RMC) and collecting duct carcinoma (CDC) are rare entities with a poor outcome. First-line metastatic treatment is based on gemcitabine + platinum chemotherapy (GC) regimen but retrospective data suggest enhanced anti-tumour activity with the addition of bevacizumab. Therefore, we performed a prospective assessment of the safety and efficacy of GC + bevacizumab in metastatic RMC/CDC. METHODS We conducted a phase 2 open-label trial in 18 centres in France in patients with metastatic RMC/CDC and no prior systemic treatment. Patients received bevacizumab plus GC up to 6 cycles followed, for non-progressive disease, by maintenance therapy with bevacizumab until progression or unacceptable toxicity. The co-primary end-points were objective response rates (ORRs) and progression-free survival (PFS) at 6 months (ORR-6; PFS-6). PFS, overall survival (OS) and safety were secondary end-points. At interim analysis, the trial was closed due to toxicity and lack of efficacy. RESULTS From 2015 to 2019, 34 of the 41 planned patients have been enroled. After a median follow-up of 25 months, ORR-6 and PFS-6 were 29.4% and 47.1%, respectively. Median OS was 11.1 months (95% confidence interval [CI]: 7.6-24.2). Seven patients (20.6%) discontinued bevacizumab because of toxicities (hypertension, proteinuria, colonic perforation). Grade 3-4 toxicities were reported in 82% patients, the most common being haematologic toxicities and hypertension. Two patients experienced grade 5 toxicity (subdural haematoma related to bevacizumab and encephalopathy of unknown origin). CONCLUSION Our study showed no benefit for bevacizumab added to chemotherapy in metastatic RMC and CDC with higher than expected toxicity. Consequently, GC regimen remains a therapeutic option for RMC/CDC patients.
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Affiliation(s)
- Constance Thibault
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, APHP-Centre, Université Paris Cité, Paris, France; Université Paris Cité, AP-HP, Centre de Recherche des Cordeliers INSERM UMR-S 1138, Paris, France
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Laurence Albiges
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Charlotte Joly
- Department of Medical Oncology, Hôpital Henri Mondor, Créteil, France
| | - Philippe Barthelemy
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Centre hospitalo-Universitaire, Bordeaux, France
| | - Christine Chevreau
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Elodie Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Frédéric Rolland
- Department of Medical Oncology, Centre René Gauducheau, Saint-Herblin, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli Calmette, Marseille, France
| | - Nicolas Pécuchet
- Department of Medical Oncology, Hôpital d'Instruction des Armées Bégin, Saint Mandé F-94160, France
| | - Réza-Thierry Elaidi
- ARTIC: Association pour la Recherche de Thérapeutiques Innovantes en Cancérologie, Paris, France
| | - Marc-Olivier Timsit
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, APHP-Centre, Université Paris Cité, Paris, France; Department of Urology, Hôpital Européen Georges Pompidou, APHP-Centre, France
| | | | - Edouard Auclin
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, APHP-Centre, Université Paris Cité, Paris, France
| | - Aurélien de Reyniès
- Université Paris Cité, AP-HP, laboratoire SeQOIA, Centre de Recherche des Cordeliers INSERM UMR-S 1138, Paris, France
| | - Yves Allory
- Department of Anatomopathology, Institut Curie, Université Paris Saclay, Saint-Cloud, France; Institut Curie, CNRS, UMR 144, Paris 75248, France
| | - Stéphane Oudard
- Department of Medical Oncology, Hôpital Européen Georges Pompidou, Institut du Cancer Paris CARPEM, APHP-Centre, Université Paris Cité, Paris, France; Université Paris Cité, PARCC, INSERM U970, Paris, France.
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Guillaume Z, Allory Y, Auclin E, Gervais C, Auvray M, Rochand A, Mejean A, Audenet F, Vano YA, Oudard S, Thibault C. [Collecting duct carcinoma and renal medullary carcinoma in the age of new therapies]. Bull Cancer 2023; 110:450-462. [PMID: 36906403 DOI: 10.1016/j.bulcan.2023.02.015] [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: 11/01/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
Collecting duct carcinoma (also known as Bellini tumour) and renal medullary carcinoma are two extremely rare and aggressive renal cancers. They are both less responsive to conventional treatments used in clear cell renal carcinoma. There are very few studies evaluating their optimal management and currently, at the metastatic stage, polychemotherapy based on platinum salts remains the most widely used. The emergence of new treatments such as anti-angiogenic TKIs, immunotherapy or treatments targeting specific genetic abnormalities, opens up a new field of possibilities in the management of these cancers. The evaluation of the response to these treatments is therefore essential. In this article, we will review the status of their management and the various studies that have evaluated recent treatments in these two cancers.
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Affiliation(s)
- Zoé Guillaume
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | | | - Edouard Auclin
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Claire Gervais
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Marie Auvray
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Adrien Rochand
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Arnaud Mejean
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - François Audenet
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Yann-Alexandre Vano
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Stéphane Oudard
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France
| | - Constance Thibault
- Université de Paris, Européen Georges-Pompidou hospital, 75020 Paris, France.
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Jain RK, Singh AM, Wang X, Guevara-Patiño JA, Sonpavde G. Emerging monoclonal antibody therapies in the treatment of metastatic urothelial carcinoma. Expert Opin Emerg Drugs 2023; 28:17-26. [PMID: 36882977 DOI: 10.1080/14728214.2023.2186398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION The treatment landscape for advanced-stage, unresectable or metastatic urothelial carcinoma (mUC) has shifted dramatically over a short period of time, with new therapeutic agents available for clinical use. However, despite these recent advances in the field, mUC continues to be a disease with significant morbidity and mortality and remains generally incurable. While platinum-based therapy remains the backbone of therapy, many patients are ineligible for chemotherapy or have failed initial chemotherapy treatment. In post-platinum treated patients, immunotherapy and antibody drug conjugates have provided incremental advances, but agents with better therapeutic index guided by precision medicine are needed. AREAS COVERED This article covers the available monoclonal antibody therapies in mUC excluding immunotherapy and antibody drug conjugates. Included are a review of data utilizing monoclonal antibodies targeting VEG-F, HER-2, FGFR, and KIR-2 in the setting of mUC. A literature search from 6/2022- 9/2022 was performed utilizing PubMed with key terms including urothelial carcinoma, monoclonal antibody, VEG-F, HER-2, FGFR. EXPERT OPINION Often used in combination with immunotherapy or other therapeutic agents, monoclonal antibody therapies have exhibited efficacy in mUC in early trials. Upcoming clinical trials will further explore their full clinical utility in treating mUC patients.
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Affiliation(s)
- Rohit K Jain
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Avani M Singh
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Xuefeng Wang
- Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Guru Sonpavde
- Division of Medical Oncology, Advent Health Cancer Institute, Orlando, FL, USA
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Grivas P, Veeranki P, Chiu K, Pawar V, Chang J, Bharmal M. Preferences for first-line treatment of advanced urothelial carcinoma among US practicing oncologists and patients. Future Oncol 2023; 19:369-383. [PMID: 36876486 DOI: 10.2217/fon-2022-0767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Aim: Investigate oncologist and patient preferences for the first-line treatment of advanced urothelial carcinoma. Materials & methods: A discrete-choice experiment was used to elicit treatment attribute preferences, including patient treatment experience (number and duration of treatments and grade 3/4 treatment-related adverse events), overall survival and treatment administration frequency. Results: The study included 151 eligible medical oncologists and 150 patients with urothelial carcinoma. Both physicians and patients appeared to prefer treatment attributes related to overall survival, treatment-related adverse events and the number and duration of the medications in a regimen over frequency of administration. Overall survival had the most influence in driving oncologists' treatment preferences, followed by the patient's treatment experience. Patients found the treatment experience the most important attribute when considering options, followed by overall survival. Conclusion: Patient preferences were based on treatment experience, while oncologists preferred treatments that prolong overall survival. These results help to direct clinical conversations, treatment recommendations and clinical guideline development.
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Affiliation(s)
- Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109-1023, USA.,Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109-1023, USA
| | | | - Kevin Chiu
- PRECISIONheor, Los Angeles, CA 90025, USA
| | - Vivek Pawar
- EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA
| | | | - Murtuza Bharmal
- EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA
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Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12122954. [PMID: 36552961 PMCID: PMC9777086 DOI: 10.3390/diagnostics12122954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/06/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: Venous thromboembolism (VTE) is a life-threatening complication that may exacerbate cancer prognosis. Whilst some studies indicate an increased risk of VTE in cancer patients undergoing chemotherapy, the prevalence estimates on the pooled prevalence of VTE in cancer patients undergoing chemotherapy are not known. This study aims to calculate the pooled prevalence of VTE in chemotherapy-treated cancer patients. Methods: Studies on VTE occurrence in cancer patients undergoing chemotherapy were retrieved after database search. The terms used included “cancer”, “chemotherapy”, and “venous thromboembolism”. A random-effects meta-analysis was conducted to obtain a pooled estimate of VTE prevalence in cancer patients undergoing chemotherapy. Results: A total of 102 eligible studies involving 30,671 patients (1773 with VTE, 28,898 without) were included in the meta-analysis. The pooled estimate of VTE prevalence was found to be 6%, ranging from 6% to 7% (ES 6%; 95% CI 6−7%; z = 18.53; p < 0.001). Conclusions: The estimated pooled prevalence rate of VTEs was 6% in cancer patients undergoing CRT, which was higher than the overall crude prevalence rate (5.78%). Comprehensive cancer care should consider stratified VTE risk assessment based on cancer phenotype, given that certain phenotypes of cancer such as bladder, gastric and ovarian posing particularly high risks of VTE.
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Hussain SA, Lester JF, Jackson R, Gornall M, Qureshi M, Elliott A, Crabb SJ, Huddart RA, Vasudev N, Birtle AJ, Worlding J, James ND, Parikh O, Vilarino-Varela M, Alonzi R, Linch MD, Riaz IB, Catto JWF, Powles T, Jones RJ. Addition of nintedanib or placebo to neoadjuvant gemcitabine and cisplatin in locally advanced muscle-invasive bladder cancer (NEOBLADE): a double-blind, randomised, phase 2 trial. Lancet Oncol 2022; 23:650-658. [PMID: 35421369 DOI: 10.1016/s1470-2045(22)00158-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recurrence is common after neoadjuvant chemotherapy and radical treatment for muscle-invasive bladder cancer. We investigated the effect of adding nintedanib to neoadjuvant chemotherapy on response and survival in muscle-invasive bladder cancer. METHODS NEOBLADE was a parallel-arm, double-blind, randomised, placebo-controlled, phase 2 trial of neoadjuvant gemcitabine and cisplatin chemotherapy with nintedanib or placebo in locally advanced muscle-invasive bladder cancer. Patients aged 18 years or older, with an Eastern Cooperative Oncology Group performance status of 0-1, were recruited from 15 hospitals in the UK. Patients were randomly assigned (1:1) to nintedanib or placebo using permuted blocks with random block sizes of two or four, stratified by centre and glomerular filtration rate. Treatments were allocated using an interactive web-based system, and patients and investigators were masked to treatment allocation throughout the study. Patients received oral nintedanib (150 mg or 200 mg twice daily for 12 weeks) or placebo, in addition to usual neoadjuvant chemotherapy with intravenous gemcitabine 1000 mg/m2 on days 1 and 8 and intravenous cisplatin 70 mg/m2 on day 1 of a 3-weekly cycle. The primary endpoint was pathological complete response rate, assessed at cystectomy or at day 8 of cyclde 3 (plus or minus 7 days) if cystectomy did not occur. Primary analyses were done in the intention-to-treat population. The trial is registered with EudraCT, 2012-004895-01, and ISRCTN, 56349930, and has completed planned recruitment. FINDINGS Between Dec 4, 2014, and Sept 3, 2018, 120 patients were recruited and were randomly allocated to receive nintedanib (n=57) or placebo (n=63). The median follow-up for the study was 33·5 months (IQR 14·0-44·0). Pathological complete response in the intention-to-treat population was reached in 21 (37%) of 57 patients in the nintedanib group and 20 (32%) of 63 in the placebo group (odds ratio [OR] 1·25, 70% CI 0·84-1·87; p=0·28). Grade 3 or worse toxicities were observed in 53 (93%) of 57 participants who received nintedanib and 50 (79%) of 63 patients in the placebo group (OR 1·65, 95% CI 0·74-3·65; p=0·24). The most common grade 3 or worse adverse events were thromboembolic events (17 [30%] of 57 patients in the nintedanib group vs 13 [21%] of 63 patients in the placebo group [OR 1·63, 95% CI 0·71-3·76; p=0·29]) and decreased neutrophil count (22 [39%] in the nintedanib group vs seven [11%] in the placebo group [5·03, 1·95-13·00; p=0·0006]). 45 treatment-related serious adverse events occurred in the nintedanib group and 43 occurred in the placebo group. One treatment-related death occurred in the placebo group, which was due to myocardial infarction. INTERPRETATION The addition of nintedanib to chemotherapy was safe but did not improve the rate of pathological complete response in muscle-invasive bladder cancer. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Syed A Hussain
- Department of Oncology and Metabolism, Academic Unit of Oncology, University of Sheffield, Sheffield, UK.
| | | | - Richard Jackson
- Department of Oncology, University of Liverpool, Liverpool, UK
| | - Matthew Gornall
- Department of Oncology, University of Liverpool, Liverpool, UK
| | - Muneeb Qureshi
- Department of Oncology and Metabolism, Academic Unit of Oncology, University of Sheffield, Sheffield, UK
| | | | - Simon J Crabb
- Department of Oncology, University of Southampton, Southampton, UK
| | - Robert A Huddart
- Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Nicholas D James
- Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, London, UK
| | - Omi Parikh
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | | | | | - Mark D Linch
- University College London Cancer Institute, London, UK
| | | | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University London, London, UK
| | - Robert J Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
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Carboplatin-based adjuvant chemotherapy versus observation after radical cystectomy in patients with pN1-3 urothelial bladder cancer. World J Urol 2022; 40:1489-1496. [PMID: 35142865 DOI: 10.1007/s00345-022-03948-x] [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: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To test the impact of carboplatin-based ACT on overall survival (OS) in patients with pN1-3 cM0 BCa. METHODS A retrospective analysis was conducted on 1057 patients with pTany pN1-3 cM0 urothelial BCa treated with or without carboplatin-based ACT after radical cystectomy and bilateral lymph-node dissection between 2002 and 2018 at 12 European and North-American hospitals. No patient received neoadjuvant chemotherapy or radiation therapy. Only patients with negative surgical margins at surgery were included. A 3:1 propensity score matching (PSM) was performed using logistic regression to adjust for baseline characteristics. Univariable and multivariable Cox regression analyses were used to predict the effect of carboplatin-based ACT on OS. The Kaplan-Meier method was used to display OS in the matched cohort. RESULTS Of the 1057 patients included in the study, 69 (6.5%) received carboplatin-based ACT. After PSM, 244 total patients were identified in two cohorts that did not differ for baseline characteristics. Death was recorded in 114 (46.7%) patients over a median follow-up of 19 months. In the multivariable Cox regression analyses, increasing age at surgery (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.06, p < 0.001) and increasing number of positive lymph nodes (HR 1.06, 95% CI 1.01-1.07, p = 0.02) were independent predictors of worse OS. The delivery of carboplatin-based ACT was not predictive of improved OS (HR 0.67, 95% CI 0.43-1.04, p = 0.08). The main limitations of this study are its retrospective design and the relatively low number of patients involved. CONCLUSIONS Carboplatin-based might not improve OS in patients with pN1-3 cM0 BCa. Our results underline the need for alternative therapies for cisplatin-ineligible patients.
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Rosenberg JE, Ballman KA, Halabi S, Atherton PJ, Mortazavi A, Sweeney C, Stadler WM, Teply BA, Picus J, Tagawa ST, Katragadda S, Vaena D, Misleh J, Hoimes C, Plimack ER, Flaig TW, Dreicer R, Bajorin D, Hahn O, Small EJ, Morris MJ. Randomized Phase III Trial of Gemcitabine and Cisplatin With Bevacizumab or Placebo in Patients With Advanced Urothelial Carcinoma: Results of CALGB 90601 (Alliance). J Clin Oncol 2021; 39:2486-2496. [PMID: 33989025 DOI: 10.1200/jco.21.00286] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The combination of gemcitabine and cisplatin (GC) is a standard therapy for metastatic urothelial carcinoma. Based on data that angiogenesis plays a role in urothelial carcinoma growth and progression, a randomized placebo-controlled trial was performed with the primary objective of testing whether patients treated with GC and bevacizumab (GCB) have superior overall survival (OS) than patients treated with GC and placebo (GCP). PATIENTS AND METHODS Between July 2009 and December 2014, 506 patients with metastatic urothelial carcinoma without prior chemotherapy for metastatic disease and no neoadjuvant or adjuvant chemotherapy within 12 months were randomly assigned to receive either GCB or GCP. The primary end point was OS, with secondary end points of progression-free survival, objective response, and toxicity. RESULTS With a median follow-up of 76.3 months among alive patients, the median OS was 14.5 months for patients treated with GCB and 14.3 months for patients treated with GCP (hazard ratio for death = 0.87; 95% CI, 0.72 to 1.05; two-sided stratified log-rank P = .14). The median progression-free survival was 8.0 months for GCB and 6.7 months for GCP (hazard ratio = 0.77; 95% CI, 0.63 to 0.95; P = .016). The proportion of patients with grade 3 or greater adverse events did not differ significantly between both arms, although increased bevacizumab-related toxicities such as hypertension and proteinuria occurred in the bevacizumab-treated arm. CONCLUSION The addition of bevacizumab to GC did not result in improved OS. The observed median OS of about 14 months is consistent with prior phase III trials of cisplatin-based chemotherapy.
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Affiliation(s)
| | - Karla A Ballman
- Alliance Statistics and Data Center, Weill Medical College of Cornell University, New York, NY
| | - Susan Halabi
- Alliance Statistics and Data Center, Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke Cancer Institute-Biostatistics, Duke University, Durham, NC
| | | | - Amir Mortazavi
- Division of Medical Oncology, Department of Internal Medicine, College of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Joel Picus
- Washington University School of Medicine, St Louis, MO
| | | | | | - Daniel Vaena
- University of Iowa/Holden Comprehensive Cancer Center, Iowa City, IA
| | - Jamal Misleh
- Christiana Care NCI Community Oncology Research Program, Newark, DE
| | - Christopher Hoimes
- Case Comprehensive Cancer Center at UH-Seidman, Cleveland, OH.,Duke University, Durham, NC
| | | | - Thomas W Flaig
- University of Colorado Denver School of Medicine, Aurora, CO
| | - Robert Dreicer
- University of Virginia Cancer Center, Charlottesville, VA
| | - Dean Bajorin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Olwen Hahn
- University of Chicago Comprehensive Cancer Center, Chicago, IL
| | - Eric J Small
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
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Thibault C, Loriot Y. Emerging Targeted Therapy for Bladder Cancer. Hematol Oncol Clin North Am 2021; 35:585-596. [PMID: 33958152 DOI: 10.1016/j.hoc.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
For the last decade, biology of urothelial tumorigenesis has been widely explored, helping to better understand the molecular pathways in urothelial carcinoma (UC). Until recently, no targeted therapies have been approved in UC. However, several new molecules have shown promising results in metastatic UC: fibroblast growth factor receptor inhibitors, conjugated antibodies, PARP inhibitors, and antiangiogenics. In this article, the authors review the targeted therapies that are being evaluated in bladder UC.
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Affiliation(s)
- Constance Thibault
- Medical Oncology Department, European Georges Pompidou Hospital, APHP.5, 20 rue Leblanc, Paris 75015, France
| | - Yohann Loriot
- Département de médicine oncologique, Gustave Roussy, Université Paris-Saclay, Gustave Roussy 114 rue Edouard Vaillant, 94805 Villejuif, France.
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Vacchelli E, Aranda F, Eggermont A, Galon J, Sautès-Fridman C, Zitvogel L, Kroemer G, Galluzzi L. Trial Watch: Tumor-targeting monoclonal antibodies in cancer therapy. Oncoimmunology 2021; 3:e27048. [PMID: 24605265 PMCID: PMC3937194 DOI: 10.4161/onci.27048] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 02/06/2023] Open
Abstract
In 1997, for the first time in history, a monoclonal antibody (mAb), i.e., the chimeric anti-CD20 molecule rituximab, was approved by the US Food and Drug Administration for use in cancer patients. Since then, the panel of mAbs that are approved by international regulatory agencies for the treatment of hematopoietic and solid malignancies has not stopped to expand, nowadays encompassing a stunning amount of 15 distinct molecules. This therapeutic armamentarium includes mAbs that target tumor-associated antigens, as well as molecules that interfere with tumor-stroma interactions or exert direct immunostimulatory effects. These three classes of mAbs exert antineoplastic activity via distinct mechanisms, which may or may not involve immune effectors other than the mAbs themselves. In previous issues of OncoImmunology, we provided a brief scientific background to the use of mAbs, all types confounded, in cancer therapy, and discussed the results of recent clinical trials investigating the safety and efficacy of this approach. Here, we focus on mAbs that primarily target malignant cells or their interactions with stromal components, as opposed to mAbs that mediate antineoplastic effects by activating the immune system. In particular, we discuss relevant clinical findings that have been published during the last 13 months as well as clinical trials that have been launched in the same period to investigate the therapeutic profile of hitherto investigational tumor-targeting mAbs.
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Affiliation(s)
- Erika Vacchelli
- Gustave Roussy; Villejuif, France ; INSERM, U848; Villejuif, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers; Paris, France ; Université Paris-Sud/Paris XI; Paris, France
| | - Fernando Aranda
- Gustave Roussy; Villejuif, France ; INSERM, U848; Villejuif, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers; Paris, France
| | | | - Jérôme Galon
- Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France ; Université Pierre et Marie Curie/Paris VI; Paris, France ; INSERM, U872; Paris, France ; Equipe 15, Centre de Recherche des Cordeliers; Paris, France
| | - Catherine Sautès-Fridman
- Université Pierre et Marie Curie/Paris VI; Paris, France ; INSERM, U872; Paris, France ; Equipe 13, Centre de Recherche des Cordeliers; Paris, France
| | - Laurence Zitvogel
- Gustave Roussy; Villejuif, France ; INSERM, U1015; CICBT507; Villejuif, France
| | - Guido Kroemer
- Pôle de Biologie; Hôpital Européen Georges Pompidou; AP-HP; Paris, France ; Metabolomics and Cell Biology Platforms; Gustave Roussy; Villejuif, France ; INSERM, U848; Villejuif, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers; Paris, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France
| | - Lorenzo Galluzzi
- Gustave Roussy; Villejuif, France ; Université Paris Descartes/Paris V; Sorbonne Paris Cité; Paris, France ; Equipe 11 labellisée par la Ligue Nationale contre le Cancer; Centre de Recherche des Cordeliers; Paris, France
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12
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Torres-Jiménez J, Albarrán-Fernández V, Pozas J, Román-Gil MS, Esteban-Villarrubia J, Carrato A, Rosero A, Grande E, Alonso-Gordoa T, Molina-Cerrillo J. Novel Tyrosine Kinase Targets in Urothelial Carcinoma. Int J Mol Sci 2021; 22:E747. [PMID: 33451055 PMCID: PMC7828553 DOI: 10.3390/ijms22020747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 01/03/2023] Open
Abstract
Urothelial carcinoma represents one of the most prevalent types of cancer worldwide, and its incidence is expected to grow. Although the treatment of the advanced disease was based on chemotherapy for decades, the developments of different therapies, such as immune checkpoint inhibitors, antibody drug conjugates and tyrosine kinase inhibitors, are revolutionizing the therapeutic landscape of this tumor. This development coincides with the increasing knowledge of the pathogenesis and genetic alterations in urothelial carcinoma, from the non-muscle invasive setting to the metastatic one. The purpose of this article is to provide a comprehensive review of the different tyrosine kinase targets and their roles in the therapeutic scene of urothelial carcinoma.
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Affiliation(s)
- Javier Torres-Jiménez
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.T.-J.); (V.A.-F.); (J.P.); (M.S.R.-G.); (J.E.-V.)
| | - Víctor Albarrán-Fernández
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.T.-J.); (V.A.-F.); (J.P.); (M.S.R.-G.); (J.E.-V.)
| | - Javier Pozas
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.T.-J.); (V.A.-F.); (J.P.); (M.S.R.-G.); (J.E.-V.)
| | - María San Román-Gil
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.T.-J.); (V.A.-F.); (J.P.); (M.S.R.-G.); (J.E.-V.)
| | - Jorge Esteban-Villarrubia
- Medical Oncology Department, University Hospital Ramon y Cajal, 28034 Madrid, Spain; (J.T.-J.); (V.A.-F.); (J.P.); (M.S.R.-G.); (J.E.-V.)
| | - Alfredo Carrato
- Medical Oncology Department, Ramón y Cajal Health Research Institute (IRYCIS), CIBERONC, Alcalá University, University Hospital Ramon y Cajal, 28034 Madrid, Spain;
| | - Adriana Rosero
- Medical Oncology Department, Infanta Cristina Hospital, 28607 Madrid, Spain;
| | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center, 28033 Madrid, Spain
| | - Teresa Alonso-Gordoa
- Medical Oncology Department, Ramón y Cajal Health Research Institute (IRYCIS), CIBERONC, Alcalá University, University Hospital Ramon y Cajal, 28034 Madrid, Spain;
| | - Javier Molina-Cerrillo
- Medical Oncology Department, Ramón y Cajal Health Research Institute (IRYCIS), CIBERONC, Alcalá University, University Hospital Ramon y Cajal, 28034 Madrid, Spain;
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Novel Therapies. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Future Strategies Involving Immune Checkpoint Inhibitors in Advanced Urothelial Carcinoma. Curr Treat Options Oncol 2020; 22:7. [PMID: 33269438 DOI: 10.1007/s11864-020-00799-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 01/05/2023]
Abstract
OPINION STATEMENT Immune checkpoint inhibitors have importantly improved the outcome of patients with urothelial carcinoma. Different immune checkpoint inhibitors are currently approved and used in first- and second-line setting. The multiple agents currently approved in these setting make the choice sometimes difficult for clinicians. Furthermore, only a minority of patients present drastic response and long-term benefit with current immunotherapy. In this review, we describe the current use of immunotherapy in urothelial carcinoma but we also highlight the new strategies of treatment involving immune checkpoint inhibitors; we describe the place of immunotherapy with chemotherapy, targeted agents, and anti-angiogenic agents, incorporating the recent results presented at ASCO 2020. This review explores also the different action mechanisms of immune checkpoint inhibitors and the molecular rational to evaluate these agents in other strategies, such as maintenance and salvage strategies. The new advances in biomarker development are also presented.
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Wang X, Bai Y, Zhang F, Yang Y, Feng D, Li A, Yang Z, Li D, Tang Y, Wei X, Wei W, Han P. Targeted Inhibition of P4HB Promotes Cell Sensitivity to Gemcitabine in Urothelial Carcinoma of the Bladder. Onco Targets Ther 2020; 13:9543-9558. [PMID: 33061438 PMCID: PMC7532080 DOI: 10.2147/ott.s267734] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/15/2020] [Indexed: 02/05/2023] Open
Abstract
Background Bladder cancer (BC) is a common malignancy worldwide that accounts for 3% of global cancer diagnoses. Chemotherapy resistance limits the therapeutic effect of chemotherapeutic agents in patients with BC. Prolyl 4-hydroxylase, beta polypeptide (P4HB) is an endoplasmic reticulum (ER) chaperone that is upregulated in bladder cancer tissues (The Cancer Genome Atlas, TCGA datasets). Knockdown or suppression of P4HB exerts anticancer activity and sensitizes cells to chemotherapy in various types of cancer. Purpose We aimed to investigate whether the inhibition of P4HB enhances the anticancer efficacy of gemcitabine (GEM) in BC cells and to study the underlying molecular mechanisms. Patients and Methods The P4HB mRNA expression levels of 411 BC patients from the TCGA database and P4HB expression level of eighty BC paraffin-embedded samples detected by immunohistochemistry (IHC) staining were used for clinical feature and prognostic analyses. Bioinformatics analysis was utilized for the mechanistic investigation. Highly P4HB-expressed BC cell lines (T24 and 5637) treated with P4HB inhibitor (Bacitracin, BAC) were used to study the effects of BAC on the sensitivity of BC cells to GEM and the potential mechanism. P4HB inhibition experiments were performed in highly P4HB-expressed BC cells, and cell viability, colony formation, cell cycle, reactive oxygen species (ROS), apoptosis and pathway proteins were assessed in T24 and 5637 cells. Results Western blot analysis showed that P4HB expression was significantly higher in BC tissues than in paired normal tissues. IHC showed that patients with high P4HB expression had a poorer overall survival (OS) rate than those with low P4HB expression. Furthermore, increased P4HB expression was demonstrated to be an independent prognostic marker for BC. Functionally, P4HB inhibition by BAC decreased the cell proliferation ability in vitro. Moreover, BAC treatment sensitized BC cells to GEM. Molecular mechanism analysis indicated that inhibition of P4HB by BAC treatment enhanced the anticancer effects of GEM through increasing cellular ROS content and promoting cell apoptosis and PERK/eIF2α/ATF4/CHOP signaling. Conclusion High P4HB expression was significantly correlated with poor prognosis in BC patients. Inhibition of P4HB by BAC decreased the cell proliferation ability and sensitized BC cells to GEM by activating apoptosis and the PERK/eIF2α/ATF4/CHOP pathways.
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Affiliation(s)
- Xiaoming Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Yunjin Bai
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Facai Zhang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Yubo Yang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Dechao Feng
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Ao Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Zhiqiang Yang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Dengxiong Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Yin Tang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Xin Wei
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Wuran Wei
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
| | - Ping Han
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, People's Republic of China
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Apolo AB, Nadal R, Tomita Y, Davarpanah NN, Cordes LM, Steinberg SM, Cao L, Parnes HL, Costello R, Merino MJ, Folio LR, Lindenberg L, Raffeld M, Lin J, Lee MJ, Lee S, Alarcon SV, Yuno A, Dawson NA, Allette K, Roy A, De Silva D, Lee MM, Sissung TM, Figg WD, Agarwal PK, Wright JJ, Ning YM, Gulley JL, Dahut WL, Bottaro DP, Trepel JB. Cabozantinib in patients with platinum-refractory metastatic urothelial carcinoma: an open-label, single-centre, phase 2 trial. Lancet Oncol 2020; 21:1099-1109. [PMID: 32645282 PMCID: PMC8236112 DOI: 10.1016/s1470-2045(20)30202-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/12/2020] [Accepted: 03/19/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Cabozantinib is a multikinase inhibitor of MET, VEGFR, AXL, and RET, which also has an effect on the tumour immune microenvironment by decreasing regulatory T cells and myeloid-derived suppressor cells. In this study, we examined the activity of cabozantinib in patients with metastatic platinum-refractory urothelial carcinoma. METHODS This study was an open-label, single-arm, three-cohort phase 2 trial done at the National Cancer Institute (Bethesda, MD, USA). Eligible patients were 18 years or older, had histologically confirmed urothelial carcinoma or rare genitourinary tract histologies, Karnofsky performance scale index of 60% or higher, and documented disease progression after at least one previous line of platinum-based chemotherapy (platinum-refractory). Cohort one included patients with metastatic urothelial carcinoma with measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Two additional cohorts that enrolled in parallel (patients with bone-only urothelial carcinoma metastases and patients with rare histologies of the genitourinary tract) were exploratory. Patients received cabozantinib 60 mg orally once daily in 28-day cycles until disease progression or unacceptable toxicity. The primary endpoint was investigator-assessed objective response rate by RECIST in cohort one. Response was assessed in all patients who met the eligibility criteria and who received at least 8 weeks of therapy. All patients who received at least one dose of cabozantinib were included in the safety analysis. This completed study is registered with ClinicalTrials.gov, NCT01688999. FINDINGS Between Sept 28, 2012, and Oct, 20, 2015, 68 patients were enrolled on the study (49 in cohort one, six in cohort two, and 13 in cohort three). All patients received at least one dose of cabozantinib. The median follow-up was 61·2 months (IQR 53·8-70·0) for the 57 patients evaluable for response. In the 42 evaluable patients in cohort one, there was one complete response and seven partial responses (objective response rate 19%, 95% CI 9-34). The most common grade 3-4 adverse events were fatigue (six [9%] patients), hypertension (five [7%]), proteinuria (four [6%]), and hypophosphataemia (four [6%]). There were no treatment-related deaths. INTERPRETATION Cabozantinib has single-agent clinical activity in patients with heavily pretreated, platinum-refractory metastatic urothelial carcinoma with measurable disease and bone metastases and is generally well tolerated. Cabozantinib has innate and adaptive immunomodulatory properties providing a rationale for combining cabozantinib with immunotherapeutic strategies. FUNDING National Cancer Institute Intramural Program and the Cancer Therapy Evaluation Program.
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Affiliation(s)
- Andrea B Apolo
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA.
| | - Rosa Nadal
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Yusuke Tomita
- Developmental Therapeutics Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Nicole N Davarpanah
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Lisa M Cordes
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Seth M Steinberg
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Liang Cao
- Genetics Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Howard L Parnes
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Rene Costello
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Maria J Merino
- Laboratory of Pathology, Magnuson Clinical Center, Bethesda, MD, USA
| | - Les R Folio
- Radiology and Imaging Sciences, Magnuson Clinical Center, Bethesda, MD, USA
| | - Liza Lindenberg
- Molecular Imaging Program, Magnuson Clinical Center, Bethesda, MD, USA
| | - Mark Raffeld
- Laboratory of Pathology, Magnuson Clinical Center, Bethesda, MD, USA
| | - Jeffrey Lin
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Min-Jung Lee
- Developmental Therapeutics Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Sunmin Lee
- Developmental Therapeutics Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Sylvia V Alarcon
- Developmental Therapeutics Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Akira Yuno
- Developmental Therapeutics Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Nancy A Dawson
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington DC, USA
| | - Kimaada Allette
- Genitourinary Malignancies Branch, Center for Cancer Research, Magnuson Clinical Center, Bethesda, MD, USA
| | - Arpita Roy
- Urologic Oncology Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Dinuka De Silva
- Urologic Oncology Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Molly M Lee
- Urologic Oncology Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Tristan M Sissung
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - William D Figg
- Genitourinary Malignancies Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Piyush K Agarwal
- Urologic Oncology Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - John J Wright
- Genitourinary Malignancies Branch, Center for Cancer Research, Magnuson Clinical Center, Bethesda, MD, USA
| | - Yangmin M Ning
- Genitourinary Malignancies Branch, Center for Cancer Research, Magnuson Clinical Center, Bethesda, MD, USA
| | - James L Gulley
- Developmental Therapeutics Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - William L Dahut
- Developmental Therapeutics Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Donald P Bottaro
- Urologic Oncology Branch, Magnuson Clinical Center, Bethesda, MD, USA
| | - Jane B Trepel
- Developmental Therapeutics Branch, Magnuson Clinical Center, Bethesda, MD, USA
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Fattahi N, Shahbazi MA, Maleki A, Hamidi M, Ramazani A, Santos HA. Emerging insights on drug delivery by fatty acid mediated synthesis of lipophilic prodrugs as novel nanomedicines. J Control Release 2020; 326:556-598. [PMID: 32726650 DOI: 10.1016/j.jconrel.2020.07.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/25/2022]
Abstract
Many drug molecules that are currently in the market suffer from short half-life, poor absorption, low specificity, rapid degradation, and resistance development. The design and development of lipophilic prodrugs can provide numerous benefits to overcome these challenges. Fatty acids (FAs), which are lipophilic biomolecules constituted of essential components of the living cells, carry out many necessary functions required for the development of efficient prodrugs. Chemical conjugation of FAs to drug molecules may change their pharmacodynamics/pharmacokinetics in vivo and even their toxicity profile. Well-designed FA-based prodrugs can also present other benefits, such as improved oral bioavailability, promoted tumor targeting efficiency, controlled drug release, and enhanced cellular penetration, leading to improved therapeutic efficacy. In this review, we discuss diverse drug molecules conjugated to various unsaturated FAs. Furthermore, various drug-FA conjugates loaded into various nanostructure delivery systems, including liposomes, solid lipid nanoparticles, emulsions, nano-assemblies, micelles, and polymeric nanoparticles, are reviewed. The present review aims to inspire readers to explore new avenues in prodrug design based on the various FAs with or without nanostructured delivery systems.
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Affiliation(s)
- Nadia Fattahi
- Department of Chemistry, Faculty of Science, University of Zanjan, P.O. Box 45195-313, Zanjan, Iran; Trita Nanomedicine Research Center (TNRC), Trita Third Millennium Pharmaceuticals, 45331-55681 Zanjan, Iran
| | - Mohammad-Ali Shahbazi
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki FI-00014, Finland; Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran; Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC), Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Aziz Maleki
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran; Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC), Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mehrdad Hamidi
- Trita Nanomedicine Research Center (TNRC), Trita Third Millennium Pharmaceuticals, 45331-55681 Zanjan, Iran; Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran; Zanjan Pharmaceutical Nanotechnology Research Center (ZPNRC), Zanjan University of Medical Sciences, Zanjan, Iran.
| | - Ali Ramazani
- Department of Chemistry, Faculty of Science, University of Zanjan, P.O. Box 45195-313, Zanjan, Iran; Research Institute of Modern Biological Techniques (RIMBT), University of Zanjan, P.O. Box 45195-313, Zanjan, Iran
| | - Hélder A Santos
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki FI-00014, Finland; Helsinki Institute of Life Science (HiLIFE), Faculty of Pharmacy, University of Helsinki, Helsinki FI-00014, Finland.
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Ghafouri S, Burkenroad A, Pantuck M, Almomani B, Stefanoudakis D, Shen J, Drakaki A. VEGF inhibition in urothelial cancer: the past, present and future. World J Urol 2020; 39:741-749. [PMID: 32361873 DOI: 10.1007/s00345-020-03213-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 04/11/2020] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To describe the role of anti-angiogenic agents that have been used as a treatment approach for locally advanced or metastatic urothelial cancers and to propose future directions. METHODS PubMed/MEDLINE was searched for articles related to VEGF inhibition and locally advanced or metastatic urothelial cancer. RESULTS Angiogenesis is a fundamental process for urothelial cancer initiation and progression. First-line therapy for locally advanced or metastatic urothelial cancer includes cisplatin-based chemotherapy combinations; subsequent systemic therapy includes taxanes, nanoparticle albumin-bound (nab) paclitaxel, or pemetrexed. More recently, several anti-PD-L1 and anti-PD-1 antibodies have shown promising activity in the first-line and post-platinum setting; however, immunotherapy remains ineffective in most patients. FGFR inhibitor erdafitinib was recently approved in the third-line setting. Studies on bevacizumab, pazopanib and ramucirumab have shown improved response rates when added to chemotherapy in selected patients, but have not led to overall survival (OS) benefit in randomized controlled studies. CONCLUSION Anti-angiogenic agents have shown promise in recent studies treating locally advanced or metastatic urothelial cancer. However, further work is needed to elucidate ideal treatment combinations in selected patient populations to maximize benefit, with the ultimate goal of being added to the FDA-approved treatment armamentarium for this disease.
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Affiliation(s)
- Sanaz Ghafouri
- Division of Hematology and Oncology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Aaron Burkenroad
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Morgan Pantuck
- Lewis Katz School of Medicine, Temple University, Philadelphia, USA
| | - Bara Almomani
- Division of Hematology and Oncology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | | | - John Shen
- Division of Hematology and Oncology, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | - Alexandra Drakaki
- Division of Hematology and Oncology, David Geffen School of Medicine, UCLA, Los Angeles, USA.
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Muñoz Martín AJ, Ramírez SP, Morán LO, Zamorano MR, Benéitez MCV, Salcedo IA, Escobar IG, Fernández JMS. Pharmacological cancer treatment and venous thromboembolism risk. Eur Heart J Suppl 2020; 22:C2-C14. [PMID: 32368194 PMCID: PMC7189737 DOI: 10.1093/eurheartj/suaa004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Risk factors for cancer-associated thrombosis are commonly divided into three categories: patient-, cancer-, and treatment-related factors. Currently, different types of drugs are used in cancer treatment. Chemotherapy has been identified as an independent risk factor for venous thromboembolism (VTE). However, it should be noted, that the risk of VTE is not consistent among all cytotoxic agents. In addition, different supportive care drugs, such as erythropoiesis stimulating agents or granulocyte colony stimulating factors, and hormonotherapy have been associated to an increased risk of VTE. Immunotherapy and molecular-targeted therapies have significantly changed the treatment of cancer over the past decade. The main subtypes include tyrosine-kinase inhibitors, monoclonal antibodies, small molecules, and immunomodulatory agents. The relationship between VTE and targeted therapies remains largely unknown.
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Affiliation(s)
- Andrés J Muñoz Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Sara Pérez Ramírez
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Laura Ortega Morán
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Magdalena Ruiz Zamorano
- Department of Medicine, Faculty of Medicine, Universidad Complutense, Av. Séneca 2, 28040 Madrid, Spain
| | | | - Inmaculada Aparicio Salcedo
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Ignacio García Escobar
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain
| | - José Manuel Soria Fernández
- Genomic of Complex Disease Unit, Institut d'investigació Sant Pau (IIB-SANT PAU), Joan Alcover, 7-2° 2ª, 08031 Barcelona, Spain
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Petrylak DP, de Wit R, Chi KN, Drakaki A, Sternberg CN, Nishiyama H, Castellano D, Hussain SA, Fléchon A, Bamias A, Yu EY, van der Heijden MS, Matsubara N, Alekseev B, Necchi A, Géczi L, Ou YC, Coskun HS, Su WP, Bedke J, Gakis G, Percent IJ, Lee JL, Tucci M, Semenov A, Laestadius F, Peer A, Tortora G, Safina S, Garcia Del Muro X, Rodriguez-Vida A, Cicin I, Harputluoglu H, Tagawa ST, Vaishampayan U, Aragon-Ching JB, Hamid O, Liepa AM, Wijayawardana S, Russo F, Walgren RA, Zimmermann AH, Hozak RR, Bell-McGuinn KM, Powles T. Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): overall survival and updated results of a randomised, double-blind, phase 3 trial. Lancet Oncol 2020; 21:105-120. [PMID: 31753727 PMCID: PMC6946880 DOI: 10.1016/s1470-2045(19)30668-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Ramucirumab-an IgG1 vascular endothelial growth factor receptor 2 antagonist-plus docetaxel was previously reported to improve progression-free survival in platinum-refractory, advanced urothelial carcinoma. Here, we report the secondary endpoint of overall survival results for the RANGE trial. METHODS We did a randomised, double-blind, phase 3 trial in patients with advanced or metastatic urothelial carcinoma who progressed during or after platinum-based chemotherapy. Patients were enrolled from 124 investigative sites (hospitals, clinics, and academic centres) in 23 countries. Previous treatment with one immune checkpoint inhibitor was permitted. Patients were randomly assigned (1:1) using an interactive web response system to receive intravenous ramucirumab 10 mg/kg or placebo 10 mg/kg volume equivalent followed by intravenous docetaxel 75 mg/m2 (60 mg/m2 in Korea, Taiwan, and Japan) on day 1 of a 21-day cycle. Treatment continued until disease progression, unacceptable toxicity, or other discontinuation criteria were met. Randomisation was stratified by geographical region, Eastern Cooperative Oncology Group performance status at baseline, and visceral metastasis. Progression-free survival (the primary endpoint) and overall survival (a key secondary endpoint) were assessed in the intention-to-treat population. The study is registered with ClinicalTrials.gov, NCT02426125; patient enrolment is complete and the last patient on treatment is being followed up for safety issues. FINDINGS Between July 20, 2015, and April 4, 2017, 530 patients were randomly allocated to ramucirumab plus docetaxel (n=263) or placebo plus docetaxel (n=267) and comprised the intention-to-treat population. At database lock (March 21, 2018) for the final overall survival analysis, median follow-up was 7·4 months (IQR 3·5-13·9). In our sensitivity analysis of investigator-assessed progression-free survival at the overall survival database lock, median progression-free survival remained significantly improved with ramucirumab compared with placebo (4·1 months [95% CI 3·3-4·8] vs 2·8 months [2·6-2·9]; HR 0·696 [95% CI 0·573-0·845]; p=0·0002). Median overall survival was 9·4 months (95% CI 7·9-11·4) in the ramucirumab group versus 7·9 months (7·0-9·3) in the placebo group (stratified HR 0·887 [95% CI 0·724-1·086]; p=0·25). Grade 3 or worse treatment-related treatment-emergent adverse events in 5% or more of patients and with an incidence more than 2% higher with ramucirumab than with placebo were febrile neutropenia (24 [9%] of 258 patients in the ramucirumab group vs 16 [6%] of 265 patients in the placebo group) and neutropenia (17 [7%] of 258 vs six [2%] of 265). Serious adverse events were similar between groups (112 [43%] of 258 patients in the ramucirumab group vs 107 [40%] of 265 patients in the placebo group). Adverse events related to study treatment and leading to death occurred in eight (3%) patients in the ramucirumab group versus five (2%) patients in the placebo group. INTERPRETATION Additional follow-up supports that ramucirumab plus docetaxel significantly improves progression-free survival, without a significant improvement in overall survival, for patients with platinum-refractory advanced urothelial carcinoma. Clinically meaningful benefit might be restricted in an unselected population. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | - Kim N Chi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Alexandra Drakaki
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Syed A Hussain
- Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK
| | | | | | - Evan Y Yu
- University of Washington, Seattle, WA, USA
| | | | | | - Boris Alekseev
- P.A. Herzen Moscow Oncological Research Institute, Moscow, Russia
| | - Andrea Necchi
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori, Milan, Italy
| | - Lajos Géczi
- National Institute of Oncology, Budapest, Hungary
| | - Yen-Chuan Ou
- Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan
| | | | - Wen-Pin Su
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University & Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jens Bedke
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Georgios Gakis
- Department of Urology, University of Tübingen, Tübingen, Germany; Pediatric Urology, Julius Maximillians University, Würzburg, Germany
| | | | - Jae-Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | - Andrey Semenov
- RBHI Ivanovo Regional Oncology Dispensary, Ivanovo, Russia
| | | | | | - Giampaolo Tortora
- University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Xavier Garcia Del Muro
- Institut Català d'Oncologia L'Hospitalet, Institut d'Investigacio Biomedica de Bellvitge, University of Barcelona, Barcelona, Spain
| | | | | | | | - Scott T Tagawa
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | | | | | - Oday Hamid
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | | | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
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Essa A, Diab O, Munir A, Andukuri V. Transient Asymptomatic Sinus Bradycardia and Sinus Pauses with Bevacizumab: Case Report and Literature Review. Cureus 2019; 11:e6177. [PMID: 31890384 PMCID: PMC6913932 DOI: 10.7759/cureus.6177] [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] [Indexed: 11/07/2022] Open
Abstract
Systemic side effects of anti-cancer therapy remain a major limiting factor for patients, even with targeted therapy. Bevacizumab is an example of targeted cancer therapy which targets the vascular endothelial growth factor receptor (VEGFR) that has been approved for the treatment of various cancers and has been evaluated in metastatic urothelial carcinoma (MUC). We report a case of MUC on bevacizumab containing regimen who developed temporary asymptomatic sinus bradycardia with sinus pauses. That adverse event was thought to be related to the bevacizumab in her cancer regimen. Her Holter monitoring recording for a total duration of 28 days and 14 h after discharge did not show recurrence of sinus pauses. This case indicates the necessity for observation for the cardiac conduction defects as side effects in patients receiving bevacizumab, especially since they might be asymptomatic and transient.
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Affiliation(s)
- Amr Essa
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Osama Diab
- Hematology and Oncology, Kansas University Medical Center, Kansas, USA
| | - Ahmed Munir
- Pulmonary/Critical Care Medicine, State University of New York, Buffalo, USA
| | - Venkata Andukuri
- Internal Medicine, Creighton University Medical Center, Omaha, USA
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Systematic Literature Review and Meta-Analysis of Response to First-Line Therapies for Advanced/Metastatic Urothelial Cancer Patients Who Are Cisplatin Ineligible. Am J Clin Oncol 2019; 42:802-809. [DOI: 10.1097/coc.0000000000000585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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24
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Nadal R, Bellmunt J. Management of metastatic bladder cancer. Cancer Treat Rev 2019; 76:10-21. [PMID: 31030123 DOI: 10.1016/j.ctrv.2019.04.002] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
Abstract
Important advances in the understanding of the biology and mechanisms of tumor progression of urothelial carcinoma (UC) have been achieved over the past decade. The treatment landscape for advanced-stage, unresectable or metastatic UC has shifted dramatically over a short period of time, with 6 new therapeutic agents available for clinical use. The use of traditional chemotherapy and new immune checkpoints inhibitors (ICIs) directed at programmed cell-death protein 1 (PD-1) or its ligand has led to unprecedented survival benefits in selected patients with metastatic UC. Data show that anti-PD-1 ICIs are not only improving long-term clinical benefit, but also quality of life for patients in the second-line setting. In the front-line setting, regulatory agencies have restricted the indications of atezolizumab and pembrolizumab (both ICIs) to patients with PD-L1positivity with advanced UC and who are platinum-ineligible. Very recently, erdafitinib, a pan-FGFR inhibitor, has been granted accelerated approval by FDA for platinum-pretreated advanced metastatic UC with susceptible FGFR3 or FGFR2 genetic alterations. Enfortumab vedotin, an antibody-drug conjugate, have been granted breakthrough designation by the FDA for the treatment of metastatic UC. Here we review the clinical trial data that have established standard-of-care treatment for advanced-stage UC. In addition, mechanisms of resistance and biomarkers of response to platinum-based chemotherapies and immunotherapies are also discussed, along with the clinical benefits and limitations of these therapies.
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Affiliation(s)
- Rosa Nadal
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joaquim Bellmunt
- IMIM-Hospital del Mar Research Institute, Barcelona, Spain; Harvard Medical School, Boston, MD, USA.
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25
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Hindy JR, Souaid T, Kourie HR, Kattan J. Targeted therapies in urothelial bladder cancer: a disappointing past preceding a bright future? Future Oncol 2019; 15:1505-1524. [PMID: 30977669 DOI: 10.2217/fon-2018-0459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Bladder cancer (BC) is the most frequent cancer affecting the urinary tract. With the growing era of targeted therapies around the 2000s, many trials evaluated the efficacy of targeted therapy in advanced BC. However, no approval was given yet to any form of targeted therapy when it comes to BC. The aim of this paper was to report the most pivotal trials that evaluated different families of targeted therapy in the treatment of BC, according to their biomarkers (FGFR3, EGFR, HER2, VEGF and PI3K/AKT/mTOR). The ongoing trials testing targeted therapies in advanced BC were then summarized. Finally, the different immunotherapies approved for this disease and their potential combination with targeted therapy were addressed.
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Affiliation(s)
- Joya-Rita Hindy
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tarek Souaid
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Hampig Raphael Kourie
- Medical Genetics Unit, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.,Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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26
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Bianconi M, Cimadamore A, Faloppi L, Scartozzi M, Santoni M, Lopez-Beltran A, Cheng L, Scarpelli M, Montironi R. Contemporary best practice in the management of urothelial carcinomas of the renal pelvis and ureter. Ther Adv Urol 2019; 11:1756287218815372. [PMID: 30671136 PMCID: PMC6329040 DOI: 10.1177/1756287218815372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022] Open
Abstract
Upper tract urothelial carcinoma (UTUC) accounts for 5% of urothelial carcinomas (UCs), the estimated annual incidence being 1-2 cases per 100,000 inhabitants. Similarly to bladder UC, divergent differentiations and histologic variants confer an adverse risk factor in comparison with pure UTUC. Molecular and genomic characterization studies on UTUC have shown changes occurring at differing frequencies from bladder cancer, with unique molecular and clinical subtypes, potentially with different responses to treatment. Systemic chemotherapy is the standard approach for patients with inoperable locally advanced or metastatic UCs. Although initial response rates are high, the median survival with combination chemotherapy is about 15 months. In first-line chemotherapy several cisplatin-based regimens have been proposed. For patients with advanced UC who progress to first-line treatment, the only product licensed in Europe is vinflunine, a third-generation, semisynthetic, vinca alkaloid. Better response rates (15-60%), with higher toxicity rates and no overall survival (OS) benefit, are generally achieved in multidrug combinations, which often include taxanes and gemcitabine. The US FDA has recently approved five agents targeting the programmed death-1 and programmed death ligand-1 pathway as a second-line therapy in patients with locally advanced or metastatic UC with disease progression during or following platinum-containing chemotherapy. Potential therapeutic targets are present in 69% of tumours analyzed. Specific molecular alterations include those involved in the RTK/Ras/PI(3)K, cell-cycle regulation and chromatin-remodeling pathways, many of them have either targeted therapies approved or under investigation. Angiogenic agents, anti-epidermal growth factor receptor therapy, phosphoinositide 3-kinase (PI3K) and mammalian target of rapamycin (mTOR) pathway inhibitors and immunotherapeutic drugs are being successfully investigated.
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Affiliation(s)
- Maristella Bianconi
- Medical Oncology Unit, ‘Madonna del Soccorso’ Hospital, ASUR Marche AV5, San Benedetto del Tronto, Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Luca Faloppi
- Medical Oncology Unit, Macerata General Hospital, ASUR Marche AV3, Macerata, Italy Department of Medical Oncology, ‘Duilio Casula’ Polyclinic, Cagliari State University, Cagliari, Italy
| | - Mario Scartozzi
- Department of Medical Oncology, ‘Duilio Casula’ Polyclinic, Cagliari State University, Cagliari, Italy
| | - Matteo Santoni
- Medical Oncology Unit, Macerata General Hospital, ASUR Marche AV3, Macerata, Italy
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Via Conca 71, Ancona, Marche, I−60126, Italy
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27
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Gómez De Liaño A, Duran I. The continuing role of chemotherapy in the management of advanced urothelial cancer. Ther Adv Urol 2018; 10:455-480. [PMID: 30574206 PMCID: PMC6295780 DOI: 10.1177/1756287218814100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/17/2018] [Indexed: 01/12/2023] Open
Abstract
Despite intense drug development in the last decade in metastatic urothelial carcinoma and the incorporation of novel compounds to the treatment armamentarium, chemotherapy remains a key treatment strategy for this disease. Platinum-based combinations are still the backbone of first-line therapy in most cases. The role of chemotherapy in the second line has been more ill-defined due to the complexity of this setting, where patient selection remains critical. Nevertheless, two regimens, one in monotherapy (i.e. vinflunine) and one in combination with antiangiogenics (i.e. docetaxel + ramucirumab) have shown efficacy. Immunotherapy through checkpoint inhibition has revealed remarkably durable benefit in a small proportion of patients in the first and second line and is currently the preferred partner for combinations with chemotherapy. Difficult populations such as patients with liver metastases or those progressing to checkpoint inhibition represent a medical challenge and selective ways of delivering cytotoxics, like the antibody-drug conjugates, might represent a valid alternative. This article reviews the current role of chemotherapy in the management of advanced urothelial carcinoma and the ongoing and coming studies involving this treatment strategy.
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Affiliation(s)
- Alfonso Gómez De Liaño
- Medical Oncology Department, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Ignacio Duran
- Servicio de Oncologia Medica, Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Edificio Sur, 2 Planta, Despacho 277, 39008 Santander, Spain
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Hurwitz ME, Markowski P, Yao X, Deshpande H, Patel J, Mortazavi A, Donadio A, Stein MN, Kelly WK, Petrylak DP, Mehnert JM. Multicenter Phase 2 Trial of Gemcitabine, Carboplatin, and Sorafenib in Patients With Metastatic or Unresectable Transitional-Cell Carcinoma. Clin Genitourin Cancer 2018; 16:437-444.e6. [PMID: 30177237 DOI: 10.1016/j.clgc.2018.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/19/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Sorafenib, an oral tyrosine kinase inhibitor, may enhance the antitumor activity of platinum-based chemotherapy in transitional-cell carcinoma. This study investigated the safety and clinical outcome of adding sorafenib to gemcitabine and carboplatin for patients with advanced transitional-cell carcinoma. PATIENTS AND METHODS Subjects with metastatic or unresectable chemotherapy-naive TCC with Eastern Cooperative Oncology Group performance status 0 or 1 received gemcitabine (1000 mg/m2 on days 1 and 8) and carboplatin (area under the curve of 5 on day 1) with sorafenib (400 mg 2 times a day on days 2-19 every 21 days) for 6 cycles. Subjects with stable disease or partial or complete response continued to receive sorafenib until disease progression. The primary end point was progression-free survival (PFS) at 5 months with a secondary end point of response (partial or complete). RESULTS Seventeen subjects were enrolled. The median number of cycles of gemcitabine and carboplatin with sorafenib provided was 4.4. A total of 15, 5, and 8 subjects required reductions of gemcitabine, carboplatin, and sorafenib, respectively. Thirteen subjects (76%) required multiple dose reductions. Eleven subjects (65%) were free of progression at 5 months. The overall response rate was 54% (95% confidence interval [CI], 0.28-077), with 4 patients experiencing complete response (24%; 95% CI, 0.07-0.50) and 5 partial response (29%; 95% CI, 0.10-0.56); 7 subjects (41%) had stable disease. Median PFS was 9.5 months (95% CI, 0.43-1.26), and median overall survival was 25.2 months (95% CI, 0.96-5.65). One-year PFS was 31%, and 1-year overall survival was 72%. Eleven subjects (65%) discontinued treatment because of toxicity. There were no toxic deaths. CONCLUSION Gemcitabine and carboplatin with sorafenib showed clinical activity in advanced TCC, with some prolonged progression-free intervals. However, gemcitabine and carboplatin with sorafenib was associated with significant toxicity, causing discontinuation of therapy in most patients.
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Affiliation(s)
| | - Paul Markowski
- Department of Medicine, Rutgers Cancer Institute of New Jersey, NJ
| | | | | | | | | | | | - Mark N Stein
- Department of Medicine, Rutgers Cancer Institute of New Jersey, NJ
| | | | | | - Janice M Mehnert
- Department of Medicine, Rutgers Cancer Institute of New Jersey, NJ.
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29
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Bourn J, Cekanova M. Cyclooxygenase inhibitors potentiate receptor tyrosine kinase therapies in bladder cancer cells in vitro. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1727-1742. [PMID: 29942116 PMCID: PMC6005335 DOI: 10.2147/dddt.s158518] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose Receptor tyrosine kinase inhibitors (RTKIs) are used as targeted therapies for patients diagnosed with cancer with highly expressed receptor tyrosine kinases (RTKs), including the platelet-derived growth factor receptor (PDGFR) and c-Kit receptor. Resistance to targeted therapies is partially due to the activation of alternative pro-survival signaling pathways, including cyclooxygenase (COX)-2. In this study, we validated the effects of two RTKIs, axitinib and AB1010, in combination with COX inhibitors on the V-akt murine thymoma oncogene homolog 1 (Akt) and COX-2 signaling pathways in bladder cancer cells. Methods The expression of several RTKs and their downstream signaling targets was analyzed by Western blot (WB) analysis in human and canine bladder transitional cell carcinoma (TCC) cell lines. The effects of RTKIs and COX inhibitors in bladder TCC cells were assessed by MTS for cell viability, by Caspase-3/7 and Annexin V assay for apoptosis, by WB analysis for detection of COX-2 and Akt signaling pathways, and by enzyme-linked immunosorbent assay for detection of prostaglandin E2 (PGE2) levels. Results All tested TCC cells expressed the c-Kit and PDGFRα receptors, except human 5637 cells that had low RTKs expression. In addition, all tested cells expressed COX-1, COX-2, Akt, extracellular signal regulated kinases 1/2, and nuclear factor kappa-light-chain-enhance of activated B cells proteins, except human UM-UC-3 cells, where no COX-2 expression was detected by WB analysis. Both RTKIs inhibited cell viability and increased apoptosis in a dose-dependent manner in tested bladder TCC cells, which positively correlated with their expression levels of the PDGFRα and c-Kit receptors. RTKIs increased the expression of COX-2 in h-5637 and K9TCC#1Lillie cells. Co-treatment of indomethacin inhibited AB1010-induced COX-2 expression leading to an additive effect in inhibition of cell viability and PGE2 production in tested TCC cells. Conclusion Co-treatment of RTKIs with indomethacin inhibited cell viability and AB1010-induced COX-2 expression resulting in decreased PGE2 production in tested TCC cells. Thus, COX inhibition may further potentiate RTKIs therapies in bladder cancer.
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Affiliation(s)
- Jennifer Bourn
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA.,UT-ORNL Graduate School of Genome Science and Technology, The University of Tennessee, Knoxville, TN, USA
| | - Maria Cekanova
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, USA.,UT-ORNL Graduate School of Genome Science and Technology, The University of Tennessee, Knoxville, TN, USA
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Dietrich B, Siefker-Radtke AO, Srinivas S, Yu EY. Systemic Therapy for Advanced Urothelial Carcinoma: Current Standards and Treatment Considerations. Am Soc Clin Oncol Educ Book 2018; 38:342-353. [PMID: 30231356 DOI: 10.1200/edbk_201193] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Urothelial carcinoma is the sixth most common malignancy in the United States. Although most are diagnosed with non-muscle-invasive malignancy, many patients will develop recurrent disease within 5 years, with 10% to 20% developing advanced muscle-invasive or more distant incurable disease. For such patients, clinical outcomes have remained suboptimal, although recent therapeutic advances have brought new hope to the field. Here, we discuss the main systemic treatment options available for the treatment of patients with advanced disease. This review begins with traditional chemotherapy, which remains a first-line treatment option for many patients. The second section focuses on the evolving landscape of immunotherapy, specifically on approved checkpoint inhibitors and future challenges. Last, we address advances in targeted treatments, including angiogenesis and fibroblast growth factor receptor (FGFR) inhibitors as well as antibody-drug conjugates. As the number of available treatment options continues to expand, ongoing trials to investigate the best sequence and combination strategies to incorporate these drugs into clinical practice will help delineate the future.
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Affiliation(s)
- Brian Dietrich
- From the Stanford University School of Medicine/Stanford Cancer Center, Stanford, CA; Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Medicine, Division of Oncology, Stanford University School of Medicine/Stanford Cancer Center, Stanford, CA; Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Arlene O Siefker-Radtke
- From the Stanford University School of Medicine/Stanford Cancer Center, Stanford, CA; Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Medicine, Division of Oncology, Stanford University School of Medicine/Stanford Cancer Center, Stanford, CA; Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sandy Srinivas
- From the Stanford University School of Medicine/Stanford Cancer Center, Stanford, CA; Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Medicine, Division of Oncology, Stanford University School of Medicine/Stanford Cancer Center, Stanford, CA; Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evan Y Yu
- From the Stanford University School of Medicine/Stanford Cancer Center, Stanford, CA; Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Medicine, Division of Oncology, Stanford University School of Medicine/Stanford Cancer Center, Stanford, CA; Department of Medicine, Division of Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA
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Vlachostergios PJ, Lee A, Thomas C, Walsh R, Tagawa ST. A critical review on ramucirumab in the treatment of advanced urothelial cancer. Future Oncol 2018; 14:1049-1061. [PMID: 29231057 DOI: 10.2217/fon-2017-0473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Advanced urothelial cancer (UC) is a lethal disease despite current advances in systemic therapy, including platinum chemotherapy combinations and immune checkpoint inhibition. Tumor angiogenesis is involved in UC growth and metastatic progression. Proangiogenic signaling through the VEGFR is a key process in UC with prognostic significance. Targeting of VEGFR2 with the monoclonal antibody ramucirumab has been tested in various different tumor types. In this review, we discuss the development of the drug in the context of its preclinical and clinical use with a focus on UC. Improvements in our ability to predict responses and resistance are key for maximizing its efficacy and selecting the most appropriate combinations with other active agents.
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Affiliation(s)
| | - Aileen Lee
- Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Charlene Thomas
- Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Ryan Walsh
- Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Scott T Tagawa
- Division of Hematology & Medical Oncology, Weill Cornell Medicine, New York, NY 10065, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY 10065, USA
- Department of Urology, Weill Cornell Medicine, New York, NY 10065, USA
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32
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Alternative transcription of a shorter, non-anti-angiogenic thrombospondin-2 variant in cancer-associated blood vessels. Oncogene 2018; 37:2573-2585. [PMID: 29467494 PMCID: PMC5945577 DOI: 10.1038/s41388-018-0129-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 12/12/2022]
Abstract
Thrombospondin-2 (TSP2) is an anti-angiogenic matricellular protein that inhibits tumor growth and angiogenesis. Tumor-associated blood vascular endothelial cells (BECs) were isolated from human invasive bladder cancers and from matched normal bladder tissue by immuno-laser capture microdissection. Exon expression profiling analyses revealed a particularly high expression of a short TSP2 transcript containing only the last 9 (3′) exons of the full-length TSP2 transcript. Using 5′ and 3′ RACE (rapid amplification of cDNA ends) and Sanger sequencing, we confirmed the existence of the shorter transcript of TSP2 (sTSP2) and determined its sequence which completely lacked the anti-angiogenic thrombospondin type 1 repeats domain. The largest open reading frame predicted within the transcript comprises 209 amino acids and matches almost completely the C-terminal lectin domain of full-length TSP2. We produced recombinant sTSP2 and found that unlike the full-length TSP2, sTSP2 did not inhibit vascular endothelial growth factor-A-induced proliferation of cultured human BECs, but in contrast when combined with TSP2 blocked the inhibitory effects of TSP2 on BEC proliferation. In vivo studies with stably transfected A431 squamous cell carcinoma cells revealed that full-length TSP2, but not sTSP2, inhibited tumor growth and angiogenesis. This study reveals that the transcriptional program of tumor stromal cells can change to transcribe a new version of an endogenous angiogenesis inhibitor that has lost its anti-angiogenic activity.
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Jamy O, Sonpavde G. Emerging first line treatment options for bladder cancer: a review of phase II and III therapies in the pipeline. Expert Opin Emerg Drugs 2017; 22:347-355. [PMID: 29226734 DOI: 10.1080/14728214.2017.1416092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The treatment of urothelial carcinoma (UC) had remained unchanged for several years until the recent FDA approval of immune checkpoint inhibitors (CPIs) in the salvage setting. Novel dual CPI-CPI and CPI-chemotherapy combinations are now being investigated aggressively as first line therapy for metastatic disease. Areas covered: We discuss the recent insights into the tumor biology of UC, which may impact the prognosis as well as assist in developing precision medicine. This is followed by an overview of existing treatment including conventional chemotherapy as well as the trials that led to the recent approval of PD-1 and PD-L1 inhibitors. Ongoing phase II and phase III trials developing PD-1/PD-L1 inhibitors, CTLA-4 inhibitors and VEGF inhibitors as first-line therapy are discussed. Expert opinion: The treatment paradigm for the first-line therapy of UC is expected to shift from conventional platinum-based combination chemotherapy towards novel therapy incorporating CPI immunotherapy. Finding the right combination of drugs in the appropriate disease setting and identifying the right patient population based on biomarkers are important questions to be answered. Another major challenge will be the financial burden associated with these new drugs.
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Affiliation(s)
- Omer Jamy
- a Department of Hematology/Oncology , University of Alabama at Birmingham , Birmingham , AL , USA
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Petrylak DP, de Wit R, Chi KN, Drakaki A, Sternberg CN, Nishiyama H, Castellano D, Hussain S, Fléchon A, Bamias A, Yu EY, van der Heijden MS, Matsubara N, Alekseev B, Necchi A, Géczi L, Ou YC, Coskun HS, Su WP, Hegemann M, Percent IJ, Lee JL, Tucci M, Semenov A, Laestadius F, Peer A, Tortora G, Safina S, Del Muro XG, Rodriguez-Vida A, Cicin I, Harputluoglu H, Widau RC, Liepa AM, Walgren RA, Hamid O, Zimmermann AH, Bell-McGuinn KM, Powles T. Ramucirumab plus docetaxel versus placebo plus docetaxel in patients with locally advanced or metastatic urothelial carcinoma after platinum-based therapy (RANGE): a randomised, double-blind, phase 3 trial. Lancet 2017; 390:2266-2277. [PMID: 28916371 DOI: 10.1016/s0140-6736(17)32365-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Few treatments with a distinct mechanism of action are available for patients with platinum-refractory advanced or metastatic urothelial carcinoma. We assessed the efficacy and safety of treatment with docetaxel plus either ramucirumab-a human IgG1 VEGFR-2 antagonist-or placebo in this patient population. METHODS We did a randomised, double-blind, phase 3 trial in patients with advanced or metastatic urothelial carcinoma who progressed during or after platinum-based chemotherapy. Patients were enrolled from 124 sites in 23 countries. Previous treatment with one immune-checkpoint inhibitor was permitted. Patients were randomised (1:1) using an interactive web response system to receive intravenous docetaxel 75 mg/m2 plus either intravenous ramucirumab 10 mg/kg or matching placebo on day 1 of repeating 21-day cycles, until disease progression or other discontinuation criteria were met. The primary endpoint was investigator-assessed progression-free survival, analysed by intention-to-treat in the first 437 randomised patients. This study is registered with ClinicalTrials.gov, number NCT02426125. FINDINGS Between July, 2015, and April, 2017, 530 patients were randomly allocated either ramucirumab plus docetaxel (n=263) or placebo plus docetaxel (n=267). Progression-free survival was prolonged significantly in patients allocated ramucirumab plus docetaxel versus placebo plus docetaxel (median 4·07 months [95% CI 2·96-4·47] vs 2·76 months [2·60-2·96]; hazard ratio [HR] 0·757, 95% CI 0·607-0·943; p=0·0118). A blinded independent central analysis was consistent with these results. An objective response was achieved by 53 (24·5%, 95% CI 18·8-30·3) of 216 patients allocated ramucirumab and 31 (14·0%, 9·4-18·6) of 221 assigned placebo. The most frequently reported treatment-emergent adverse events, regardless of causality, in either treatment group (any grade) were fatigue, alopecia, diarrhoea, decreased appetite, and nausea. These events occurred predominantly at grade 1-2 severity. The frequency of grade 3 or worse adverse events was similar for patients allocated ramucirumab and placebo (156 [60%] of 258 vs 163 [62%] of 265 had an adverse event), with no unexpected toxic effects. 63 (24%) of 258 patients allocated ramucirumab and 54 (20%) of 265 assigned placebo had a serious adverse event that was judged by the investigator to be related to treatment. 38 (15%) of 258 patients allocated ramucirumab and 43 (16%) of 265 assigned placebo died on treatment or within 30 days of discontinuation, of which eight (3%) and five (2%) deaths were deemed related to treatment by the investigator. Sepsis was the most common adverse event leading to death on treatment (four [2%] vs none [0%]). One fatal event of neutropenic sepsis was reported in a patient allocated ramucirumab. INTERPRETATION To the best of our knowledge, ramucirumab plus docetaxel is the first regimen in a phase 3 study to show superior progression-free survival over chemotherapy in patients with platinum-refractory advanced urothelial carcinoma. These data validate inhibition of VEGFR-2 signalling as a potential new therapeutic treatment option for patients with urothelial carcinoma. FUNDING Eli Lilly and Company.
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Affiliation(s)
| | | | - Kim N Chi
- British Columbia Cancer Agency, Vancouver, BC, Canada
| | | | | | | | | | - Syed Hussain
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | | | | | - Evan Y Yu
- University of Washington, Seattle, WA, USA
| | | | | | - Boris Alekseev
- PA Herzen Moscow Oncological Research Institute, Moscow, Russia
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lajos Géczi
- National Institute of Oncology, Budapest, Hungary
| | - Yen-Chuan Ou
- Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Wen-Pin Su
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, Tainan, Taiwan
| | | | | | - Jae-Lyun Lee
- Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Marcello Tucci
- Division of Medical Oncology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
| | - Andrey Semenov
- RBHI Ivanovo Regional Oncology Dispensary, Ivanovo, Russia
| | | | | | - Giampaolo Tortora
- University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Xavier Garcia Del Muro
- Institut Català d'Oncologia L'Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | - Oday Hamid
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
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Vau N, Volavsek M, Blanca A, Montironi R, Raspollini MR, Massari F, Cheng M, Scarpelli M, Lopez-Beltran A. Prospects for precision therapy of bladder urothelial carcinoma. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1389273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Nuno Vau
- Urologic Oncology, Champalimaud Clinical Center, Lisbon, Portugal
| | - Metka Volavsek
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Blanca
- Maimonides Biomedical Research Institute of Cordoba, Cordoba, Spain
| | - Rodolfo Montironi
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy
| | - Maria R. Raspollini
- Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy
| | | | - Monica Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Scarpelli
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy
| | - Antonio Lopez-Beltran
- Department of Pathology, Unit of Anatomical Pathology, Department of Surgery, Faculty of Medicine, Cordoba, Spain
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Genitourinary tumours in the targeted therapies era: new advances in clinical practice and future perspectives. Anticancer Drugs 2017; 27:917-43. [PMID: 27400375 DOI: 10.1097/cad.0000000000000405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Genitourinary cancers represent a heterogeneous group of malignancies arising from genitourinary tract, and are responsible for almost 359 000 newly diagnosed cases and 58 420 related deaths in USA. Continuous advances in cancer genetics and genomics have contributed towards changing the management paradigms of these neoplasms. Neoangiogenesis, through the activation of the tyrosine-kinase receptors signalling pathways, represents the key mediator event in promoting tumour proliferation, differentiation, invasiveness and motility. In the last decade, several treatments have been developed with the specific aim of targeting different cell pathways that have been recognized to drive tumour progression. The following review attempts to provide a comprehensive overview of the literature, focusing on new advances in targeted therapies for genitourinary tumours. Furthermore, the promising results of the latest clinical trials and future perspectives will be discussed.
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Abstract
Although there have been many recent discoveries in the molecular alterations associated with urothelial carcinoma, current understanding of this disease lags behind many other malignancies. Historically, a two-pathway model had been applied to distinguish low- and high-grade urothelial carcinoma, although significant overlap and increasing complexity of molecular alterations has been recently described. In many cases, mutations in HRAS and FGFR3 that affect the MAPK and PI3K pathways seem to be associated with noninvasive low-grade papillary tumors, whereas mutations in TP53 and RB that affect the G1-S transition of the cell cycle are associated with high-grade in situ and invasive carcinoma. However, recent large-scale analyses have identified overlap in these pathways relative to morphology, and in addition, many other variants in a wide variety of oncogenes and tumor-suppressor genes have been identified. New technologies including next-generation sequencing have enabled more detailed analysis of urothelial carcinoma, and several groups have proposed molecular classification systems based on these data, although consensus is elusive. This article reviews the current understanding of alterations affecting oncogenes and tumor-suppressor genes associated with urothelial carcinoma, and their application in the context of morphology and classification schema.
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Affiliation(s)
- James P Solomon
- Department of Pathology, University of California, San Diego, 200 West Arbor Drive, La Jolla, CA 92103, USA
| | - Donna E Hansel
- Division of Anatomic Pathology, Department of Pathology, University of California, San Diego, 9500 Gilman Drive, MC 0612, La Jolla, CA 92093, USA.
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Cumberbatch K, He T, Thorogood Z, Gartrell BA. Emerging drugs for urothelial (bladder) cancer. Expert Opin Emerg Drugs 2017; 22:149-164. [PMID: 28556678 DOI: 10.1080/14728214.2017.1336536] [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: 02/06/2023]
Abstract
INTRODUCTION Metastatic urothelial carcinoma has been associated with poor prognosis and a median survival of approximately 12-14 months with standard therapy. Treatment options for decades have been limited to platinum based chemotherapy as first line with few therapeutic options available to the majority who will ultimately progress beyond platinum. Areas covered: This review focuses on the various targeted, antiangiogenic, chemotherapeutic and immunotherapeutic agents currently being developed for the treatment of urothelial carcinoma. Expert opinion: Incorporation of systemic immunotherapy into the treatment of urothelial carcinoma has already fundamentally changed the treatment of this disease. The landscape is rapidly changing and it is likely that immunotherapy will be incorporated into therapy in earlier disease states and in novel combinations. Outcomes in urothelial carcinoma have improved and likely to improve further with ongoing and future clinical research that is discussed in this review.
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Affiliation(s)
- Kerwin Cumberbatch
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Tianfang He
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Zachary Thorogood
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
| | - Benjamin A Gartrell
- a Department of Medical Oncology , Montefiore Hospital and Medical Center , Bronx , NY , USA
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Roudnicky F, Dieterich LC, Poyet C, Buser L, Wild P, Tang D, Camenzind P, Ho CH, Otto VI, Detmar M. High expression of insulin receptor on tumour-associated blood vessels in invasive bladder cancer predicts poor overall and progression-free survival. J Pathol 2017; 242:193-205. [PMID: 28295307 DOI: 10.1002/path.4892] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/15/2017] [Accepted: 02/24/2017] [Indexed: 12/12/2022]
Abstract
Bladder cancer is a frequently recurring disease with a very poor prognosis once progressed to invasive stages, and tumour-associated blood vessels play a crucial role in this process. In order to identify novel biomarkers associated with progression, we isolated blood vascular endothelial cells (BECs) from human invasive bladder cancers and matched normal bladder tissue, and found that tumour-associated BECs greatly up-regulated the expression of insulin receptor (INSR). High expression of INSR on BECs of invasive bladder cancers was significantly associated with shorter progression-free and overall survival. Furthermore, increased expression of the INSR ligand IGF-2 in invasive bladder cancers was associated with reduced overall survival. INSR may therefore represent a novel biomarker to predict cancer progression. Mechanistically, we observed pronounced hypoxia in human bladder cancer tissue, and found a positive correlation between the expression of the hypoxia marker gene GLUT1 and vascular INSR expression, indicating that hypoxia drives INSR expression in tumour-associated blood vessels. In line with this, exposure of cultured BECs and human bladder cancer cell lines to hypoxia led to increased expression of INSR and IGF-2, respectively, and IGF-2 increased BEC migration through the activation of INSR in vitro. Taken together, we identified vascular INSR expression as a potential biomarker for progression in bladder cancer. Furthermore, our data suggest that IGF-2/INSR mediated paracrine crosstalk between bladder cancer cells and endothelial cells is functionally involved in tumour angiogenesis and may thus represent a new therapeutic target. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Filip Roudnicky
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | | | - Cedric Poyet
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Lorenz Buser
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Wild
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Dave Tang
- Division of Genomic Technologies, RIKEN Center for Life Science Technologies, Yokohama, Japan
| | - Peter Camenzind
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Chien Hsien Ho
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Vivianne I Otto
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Michael Detmar
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
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Hahn NM, Bivalacqua TJ, Ross AE, Netto GJ, Baras A, Park JC, Chapman C, Masterson TA, Koch MO, Bihrle R, Foster RS, Gardner TA, Cheng L, Jones DR, McElyea K, Sandusky GE, Breen T, Liu Z, Albany C, Moore ML, Loman RL, Reed A, Turner SA, De Abreu FB, Gallagher T, Tsongalis GJ, Plimack ER, Greenberg RE, Geynisman DM. A Phase II Trial of Dovitinib in BCG-Unresponsive Urothelial Carcinoma with FGFR3 Mutations or Overexpression: Hoosier Cancer Research Network Trial HCRN 12-157. Clin Cancer Res 2016; 23:3003-3011. [PMID: 27932416 DOI: 10.1158/1078-0432.ccr-16-2267] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/11/2022]
Abstract
Purpose: To assess the clinical and pharmacodynamic activity of dovitinib in a treatment-resistant, molecularly enriched non-muscle-invasive urothelial carcinoma of the bladder (NMIUC) population.Experimental Design: A multi-site pilot phase II trial was conducted. Key eligibility criteria included the following: Bacillus Calmette-Guerin (BCG)-unresponsive NMIUC (>2 prior intravesical regimens) with increased phosphorylated FGFR3 (pFGFR3) expression by centrally analyzed immunohistochemistry (IHC+) or FGFR3 mutations (Mut+) assessed in a CLIA-licensed laboratory. Patients received oral dovitinib 500 mg daily (5 days on/2 days off). The primary endpoint was 6-month TURBT-confirmed complete response (CR) rate.Results: Between 11/2013 and 10/2014, 13 patients enrolled (10 IHC+ Mut-, 3 IHC+ Mut+). Accrual ended prematurely due to cessation of dovitinib clinical development. Demographics included the following: median age 70 years; 85% male; carcinoma in situ (CIS; 3 patients), Ta/T1 (8 patients), and Ta/T1 + CIS (2 patients); median prior regimens 3. Toxicity was frequent with all patients experiencing at least one grade 3-4 event. Six-month CR rate was 8% (0% in IHC+ Mut-; 33% in IHC+ Mut+). The primary endpoint was not met. Pharmacodynamically active (94-5,812 nmol/L) dovitinib concentrations in urothelial tissue were observed in all evaluable patients. Reductions in pFGFR3 IHC staining were observed post-dovitinib treatment.Conclusions: Dovitinib consistently achieved biologically active concentrations within the urothelium and demonstrated pharmacodynamic pFGFR3 inhibition. These results support systemic administration as a viable approach to clinical trials in patients with NMIUC. Long-term dovitinib administration was not feasible due to frequent toxicity. Absent clinical activity suggests that patient selection by pFGFR3 IHC alone does not enrich for response to FGFR3 kinase inhibitors in urothelial carcinoma. Clin Cancer Res; 23(12); 3003-11. ©2016 AACR.
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Affiliation(s)
- Noah M Hahn
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland. .,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Trinity J Bivalacqua
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Ashley E Ross
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - George J Netto
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Alex Baras
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.,The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland.,The James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Jong Chul Park
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Carolyn Chapman
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Timothy A Masterson
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Michael O Koch
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Richard Bihrle
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Richard S Foster
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Thomas A Gardner
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - David R Jones
- Department of Clinical Pharmacology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Kyle McElyea
- Department of Pathology and Laboratory Medicine, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - George E Sandusky
- Department of Pathology and Laboratory Medicine, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Timothy Breen
- Hoosier Cancer Research Network, Indianapolis, Indiana
| | - Ziyue Liu
- Indiana University Department of Biostatistics, Schools of Public Health and Medicine, Indianapolis, Indiana
| | - Costantine Albany
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Marietta L Moore
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Rhoda L Loman
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Angela Reed
- Division of Hematology and Oncology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Scott A Turner
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Francine B De Abreu
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Torrey Gallagher
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Gregory J Tsongalis
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center and Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Elizabeth R Plimack
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Daniel M Geynisman
- Department of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Mohammed AA, EL-Tanni H, EL-Khatib HM, Mirza AA, Mirza AA, Alturaifi TH. Urinary Bladder Cancer: Biomarkers and Target Therapy, New Era for More Attention. Oncol Rev 2016; 10:320. [PMID: 28058098 PMCID: PMC5178843 DOI: 10.4081/oncol.2016.320] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 12/12/2022] Open
Abstract
Currently, bladder cancer (BCa) evaluation depends mainly on traditional clinicopathological parameters encompassing tumor stage and grade, which will not reflect the behavior of the disease. Diverse molecular alterations are responsible for the heterogeneous course. The differences in molecular pathogenesis between non-invasive BCa and invasive BCa have been recognized. Molecular biomarkers are promising to predict progression and survival. The management of advanced BCa remains somewhat primitive in comparison with other more common malignancies. This topic will discuss the molecular pathways, biomarkers and potential targets that may improve the outcome in BCa.
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Affiliation(s)
- Amrallah A. Mohammed
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Oncology Center, King Abdullah Medical City-Holy Capital, Makkah, Saudi Arabia
| | - Hani EL-Tanni
- Oncology Center, King Abdullah Medical City-Holy Capital, Makkah, Saudi Arabia
| | - Hani M. EL-Khatib
- Oncology Center, King Abdullah Medical City-Holy Capital, Makkah, Saudi Arabia
| | - Ahmad A. Mirza
- Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
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Morales-Barrera R, Suárez C, de Castro AM, Racca F, Valverde C, Maldonado X, Bastaros JM, Morote J, Carles J. Targeting fibroblast growth factor receptors and immune checkpoint inhibitors for the treatment of advanced bladder cancer: New direction and New Hope. Cancer Treat Rev 2016; 50:208-216. [PMID: 27743530 DOI: 10.1016/j.ctrv.2016.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 09/17/2016] [Accepted: 09/22/2016] [Indexed: 02/09/2023]
Abstract
Bladder cancer is one of the leading causes of death in Europe and the United States. About 25% of patients with bladder cancer have advanced disease (muscle-invasive or metastatic disease) at presentation and are candidates for systemic chemotherapy. In the setting of metastatic disease, use of cisplatin-based regimens improves survival. However, despite initial high response rates, the responses are typically not durable leading to recurrence and death in the vast majority of these patients with median overall survival of 15months and a 5-year survival rate of ⩽10%. Furthermore, unfit patients for cisplatin have no standard of care for first line therapy in advance disease Most second-line chemotherapeutic agents tested have been disappointing. Newer targeted drugs and immunotherapies are being studied in the metastatic setting, their usefulness in the neoadjuvant and adjuvant settings is also an intriguing area of ongoing research. Thus, new treatment strategies are clearly needed. The comprehensive evaluation of multiple molecular pathways characterized by The Cancer Genome Atlas project has shed light on potential therapeutic targets for bladder urothelial carcinomas. We have focused especially on emerging therapies in locally advanced and metastatic urothelial carcinoma with an emphasis on immune checkpoints inhibitors and FGFR targeted therapies, which have shown great promise in early clinical studies.
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Affiliation(s)
- Rafael Morales-Barrera
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Suárez
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Martínez de Castro
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fabricio Racca
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Valverde
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Maldonado
- Department of Radiation Oncology, Vall d' Hebron University Hospital, Barcelona, Spain
| | | | - Juan Morote
- Department of Urology, Vall d' Hebron University Hospital, Barcelona, Spain
| | - Joan Carles
- Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Xue C, An X, Cao Y, Chen T, Yang W, Deng Y, Han H, Teng X, Zhou F, Shi Y. Effectiveness of capecitabine with or without docetaxel therapy for the treatment of patients with advanced urothelial carcinoma: a single-institution experience. Oncotarget 2016; 7:63722-63729. [PMID: 27577082 PMCID: PMC5325398 DOI: 10.18632/oncotarget.11641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/29/2016] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness and toxicity of capecitabine (C) chemotherapy regimen with or without (w/o) docetaxel (D) in patients with advanced urothelial carcinoma (UC). RESULTS Clinical benefit rate were similar in two arms (C arm vs DC arm: 38.9% vs 45.5%, p = 0.411). There were two cases achieved partial response in DC arm. In C arm, the median PFS was 3.0 months (95% CI 2.5-3.5 months) and median OS was 11.3 months (95% CI 8.6-14.1 months). In DC arm, the median PFS was 2.2 months (95% CI 1.7-2.7 months) and median OS was 18 months (95% CI 6.8-29.9 months). Adverse events were mostly acceptable, including myelosuppession, hand-foot syndrome and mucositis. Anemia and leukopenia was found more in the DC arm than in the C arm. MATERIALS AND METHODS This is a one-center, observational, retrospective study. From April 2009 to March 2015, a total of 29 patients with metastatic UC were included in the study. Survivals, response rates and toxicities were collected retrospectively. CONCLUSIONS The result showed the activity and toxicity of C w/o D. As DC treatment did not reveal better outcome, C or D single-agent might be an option in platinum-failed patients with advanced urothelial carcinoma. Further clinical trials are warranted.
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Affiliation(s)
- Cong Xue
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xin An
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ye Cao
- Department of GCP, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Tanhuan Chen
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wei Yang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yingfei Deng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Hui Han
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Xiaoyu Teng
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Fangjian Zhou
- Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
| | - Yanxia Shi
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, People's Republic of China
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Narayanan S, Srinivas S. Incorporating VEGF-targeted therapy in advanced urothelial cancer. Ther Adv Med Oncol 2016; 9:33-45. [PMID: 28203296 DOI: 10.1177/1758834016667179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Patients with relapsed or refractory urothelial carcinoma (UC) have poor prognosis coupled with few options for systemic treatment. The role of angiogenesis in the evolution of cancers has been established, and studies have shown that it plays a key role in the pathogenesis of UC. Many targeted agents have been used in phase I-II trials for the treatment of UC, with encouraging but modest results. Recently, studies combining angiogenesis inhibitors with other chemotherapeutic agents were able to achieve objective responses higher than most commonly used second-line therapies in UC. Future efforts in investigating these therapies in UC rely on identification of biomarkers and other predictors of response to anti-VEGF therapy.
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Affiliation(s)
| | - Sandy Srinivas
- Division of Medical Oncology, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
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45
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Messing EM. Beyond Cisplatin - I. Bladder Cancer 2016; 2:365-367. [PMID: 27500204 PMCID: PMC4969692 DOI: 10.3233/blc-169008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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46
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Domingo-Domenech J, Niglio S, Galsky MD. Development of target specific agents for bladder cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1208049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Scot Niglio
- Division of Hematology/Oncology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew D. Galsky
- Division of Hematology/Oncology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Upper tract urothelial carcinoma topical issue 2016: treatment of metastatic cancer. World J Urol 2016; 35:367-378. [PMID: 27342991 DOI: 10.1007/s00345-016-1885-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/15/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To review the management of metastatic upper tract urothelial carcinoma (UTUC) including recent advances in targeted and immune therapies as an update to the 2014 joint international consultation on UTUC, co-sponsored by the Société Internationale d'Urologie and International Consultation on Urological Diseases. METHODS A PubMed database search was performed between January 2013 and May 2016 related to the treatment of metastatic UTUC, and 54 studies were selected for inclusion. RESULTS The management of patients with metastatic UTUC is primarily an extrapolation from evidence guiding the management of metastatic urothelial carcinoma of the bladder. The first-line therapy for metastatic UTUC is platinum-based combination chemotherapy. Standard second-line therapies are limited and ineffective. Patients with UTUC who progress following platinum-based chemotherapy are encouraged to participate in clinical trials. Recent advances in genomic profiling present exciting opportunities to guide the use of targeted therapy. Immunotherapy with checkpoint inhibitors has demonstrated extremely promising results. Retrospective studies provide support for post-chemotherapy surgery in appropriately selected patients. CONCLUSIONS The management of metastatic UTUC requires a multi-disciplinary approach. New insights from genomic profiling using targeted therapies, novel immunotherapies, and surgery represent promising avenues for further therapeutic exploration.
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A Phase II Clinical Trial of TRC105 (Anti-Endoglin Antibody) in Adults With Advanced/Metastatic Urothelial Carcinoma. Clin Genitourin Cancer 2016; 15:77-85. [PMID: 27328856 DOI: 10.1016/j.clgc.2016.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/06/2016] [Accepted: 05/18/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND In this trial we assessed the efficacy and tolerability of TRC105, a chimeric monoclonal antibody that targets CD105 (endoglin) in patients with advanced, previously treated urothelial carcinoma (UC). PATIENTS AND METHODS Patients received TRC105 15 mg/kg every 2 weeks on days 1 and 15 of each 28-day cycle. The primary end point was progression-free survival (PFS) at 6 months. Secondary end points included safety, toxicity, and overall survival (OS). CD105 expression was evaluated using immunohistochemistry (IHC) in a separate cohort of 50 UC patients. Biomarker studies included immune subsets, circulating tumor cells (CTCs), circulating endothelial cells (CECs), circulating endothelial progenitor cells (CEPs), and osteopontin. RESULTS Of 13 patients enrolled, 12 were evaluable for OS and PFS. The 3-month PFS probability was 18.2% (median PFS, 1.9 months [95% confidence interval (CI), 1.8-2.1 months). This met the criterion for ending accrual on the basis of the 2-stage design. Median OS was 8.3 months (95% CI, 3.3-17.0 months). IHC for CD105 scores was not associated with T stage (P = .26) or presence of lymph nodes (P = .64). Baseline levels of regulatory T and B cells, CEPs, and changes in CEC level after TRC105 exhibited trends toward an association with PFS or OS. CTCs pre- and post-TRC105 were detected in 4 of 4 patients. CONCLUSION Although TRC105 was well tolerated, it did not improve 6-month PFS in heavily pretreated patients with advanced UC. CD105 staining was present in 50% of UC tumors at different intensities. Our observations on the pharmacodynamic significance of immune subsets, CECs, and CTCs warrant further study.
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Plimack ER, Geynisman DM. Targeted Therapy for Metastatic Urothelial Cancer: A Work in Progress. J Clin Oncol 2016; 34:2088-92. [PMID: 27161964 DOI: 10.1200/jco.2016.67.1420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.A 64-year-old man presented to the clinic to discuss treatment options for progressive metastatic urothelial carcinoma (UC). At age 57 years, he underwent cystoprostatectomy for bacillus Calmette-Guérin-refractory, high-grade noninvasive UC. He was well until age 61 years, when he developed a left upper-tract UC. He underwent left nephroureterectomy, revealing locally advanced high-grade UC invading the renal parenchyma (pT3). Postoperatively, his renal function precluded adjuvant cisplatin-based chemotherapy. He enrolled onto a clinical trial of autologous cellular immunotherapy targeting human epidermal growth factor receptor 2, for which he was eligible on the basis of human epidermal growth factor receptor 2 positivity (≥ 1+ by immunohistochemistry) in his nephrectomy tumor specimen. He was randomly assigned to observation. Two years later, he developed a left pelvic mass. Biopsy confirmed metastatic high-grade UC. He was briefly treated with gemcitabine and carboplatin, but this was discontinued as a result of rapid symptomatic and radiographic progression at 8 weeks. He underwent palliative radiation to the left pelvic mass to relieve symptoms of pain and leg edema and subsequently elected to enroll onto a clinical trial of a programmed death 1 inhibitor. Concurrently, his previously obtained pelvic mass biopsy sample was sent for panel-based genomic profiling. He now returns for his first restaging evaluation. Imaging shows marked progression on study with new metastases to the liver as well as progressive edema and pain in the left leg, limiting ambulation. Review of his now-available genomic testing results reveals alterations in HRAS (G12D) and ATR (S296, Q257). He elected to enroll onto a single-arm, open-label trial of a farnesyl transferase inhibitor for patients with HRAS mutations.
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50
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Petrylak DP, Tagawa ST, Kohli M, Eisen A, Canil C, Sridhar SS, Spira A, Yu EY, Burke JM, Shaffer D, Pan CX, Kim JJ, Aragon-Ching JB, Quinn DI, Vogelzang NJ, Tang S, Zhang H, Cavanaugh CT, Gao L, Kauh JS, Walgren RA, Chi KN. Docetaxel As Monotherapy or Combined With Ramucirumab or Icrucumab in Second-Line Treatment for Locally Advanced or Metastatic Urothelial Carcinoma: An Open-Label, Three-Arm, Randomized Controlled Phase II Trial. J Clin Oncol 2016; 34:1500-9. [PMID: 26926681 DOI: 10.1200/jco.2015.65.0218] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE This trial assessed the efficacy and safety of docetaxel monotherapy or docetaxel in combination with ramucirumab (vascular endothelial growth factor receptor 2 antibody) or icrucumab (vascular endothelial growth factor receptor 1 antibody) after progression during or within 12 months of platinum-based regimens for patients with locally advanced or metastatic urothelial carcinoma. PATIENTS AND METHODS Patients were randomly assigned (1:1:1) to receive docetaxel 75 mg/m(2) intravenously (IV) on day 1 of a 3-week cycle (arm A), docetaxel 75 mg/m(2) IV plus ramucirumab 10 mg/kg IV on day 1 of a 3-week cycle (arm B), or docetaxel 75 mg/m(2) IV on day 1 plus icrucumab 12 mg/kg IV on days 1 and 8 of a 3-week cycle (arm C). Treatment continued until disease progression or unacceptable toxicity. The primary end point was investigator-assessed progression-free survival (PFS). RESULTS A total of 140 patients were randomly assigned and treated in arms A (n = 45), B (n = 46), or C (n = 49). PFS was significantly longer in arm B compared with arm A (median, 5.4 months; 95% CI, 3.1 to 6.9 months v 2.8 months; 95% CI, 1.9 to 3.6 months; stratified hazard ratio, 0.389; 95% CI, 0.235 to 0.643; P = .0002). Arm C did not experience improved PFS compared with arm A (1.6 months; 95% CI, 1.4 to 2.9; stratified hazard ratio, 0.863; 95% CI, 0.550 to 1.357; P = .5053). The most common grade 3 or worse adverse events (arms A, B, and C) were neutropenia (36%, 33%, and 39%), fatigue (13%, 30%, and 20%), febrile neutropenia (13%, 17%, and 6.1%), and anemia (6.7%, 13%, and 14%, respectively). CONCLUSION The addition of ramucirumab to docetaxel met the prespecified efficacy end point for prolonging PFS in patients with locally advanced or metastatic urothelial carcinoma receiving second-line treatment and warrants further investigation in the phase III setting.
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Affiliation(s)
- Daniel P Petrylak
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN.
| | - Scott T Tagawa
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Manish Kohli
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Andrea Eisen
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Christina Canil
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Srikala S Sridhar
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Alexander Spira
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Evan Y Yu
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - John M Burke
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - David Shaffer
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Chong-Xian Pan
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Jenny J Kim
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Jeanny B Aragon-Ching
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - David I Quinn
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Nicholas J Vogelzang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Shande Tang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Hui Zhang
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Christopher T Cavanaugh
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Ling Gao
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - John S Kauh
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Richard A Walgren
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
| | - Kim N Chi
- Daniel P. Petrylak, Yale University Cancer Center, New Haven, CT; Scott T. Tagawa, Weill Cornell Medical College, New York; David Shaffer, New York Oncology Hematology, Albany, NY; Manish Kohli, Mayo Clinic, Rochester, MN; Andrea Eisen, Sunnybrook Health Sciences Centre; Srikala S. Sridhar, Princess Margaret Hospital, Toronto; Christina Canil, Ottawa Hospital Cancer Centre, Ottawa, Ontario; Kim N. Chi, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Alexander Spira, Virginia Cancer Specialists, Fairfax, VA; Alexander Spira, John M. Burke, David Shaffer, and Nicholas J. Vogelzang, US Oncology Research, The Woodlands, TX; Evan Y. Yu, University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle, WA; John M. Burke, Rocky Mountain Cancer Centers, Aurora, CO; Chong-Xian Pan, University of California-Davis Medical Center, Sacramento; David I. Quinn, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA; Jenny J. Kim, Johns Hopkins University, Baltimore, MD; Jeanny B. Aragon-Ching, George Washington University Medical Center, Washington, DC; Nicholas J. Vogelzang, Comprehensive Cancer Centers of Nevada, Las Vegas, NV; Shande Tang, Hui Zhang, Christopher T. Cavanaugh, Ling Gao, and John S. Kauh, Eli Lilly, Bridgewater, NJ; and Richard A. Walgren, Eli Lilly, Indianapolis, IN
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