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Safety and Tolerability of Anti-Angiogenic Protein Kinase Inhibitors and Vascular-Disrupting Agents in Cancer: Focus on Gastrointestinal Malignancies. Drug Saf 2019; 42:159-179. [PMID: 30649744 DOI: 10.1007/s40264-018-0776-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Angiogenesis is an essential process for tumor growth and metastasis. Inhibition of angiogenesis as an anticancer strategy has shown significant results in a plethora of tumors. Anti-angiogenic agents are currently part of many standard-of-care options for several metastatic gastrointestinal cancers. Bevacizumab, aflibercept, ramucirumab, and regorafenib have significantly improved both progression-free and overall survival in different lines of treatment in metastatic colorectal cancer. Second-line ramucirumab and third-line apatinib are effective anti-angiogenic treatments for patients with metastatic gastric cancer. Unfortunately, the anti-angiogenic strategy has major practical limitations: resistance inevitably develops through redundancy of signaling pathways and selection for subclonal populations adapted for hypoxic conditions. Anti-angiogenic agents may be more effective in combination therapies, with not only cytotoxics but also other emerging compounds in the anti-angiogenic class or in the separate class of the so-called vascular-disrupting agents. This review aims to provide an overview of the approved and "under development" anti-angiogenic compounds as well as the vascular-disrupting agents in the treatment of gastrointestinal cancers, focusing on the actual body of knowledge available on therapy challenges, pharmacodynamic and pharmacokinetic mechanisms, safety profiles, promising predictive biomarkers, and future perspectives.
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Prager G, Argilés G. Towards shedding some light on regorafenib treatment in refractory metastatic colorectal cancer. ESMO Open 2017; 2:e000205. [PMID: 29303156 PMCID: PMC5703386 DOI: 10.1136/esmoopen-2017-000205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 04/26/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
- Gerald Prager
- Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Guillem Argilés
- Vall d'Hebrón Institut of Oncology (VHIO), Vall d'Hebrón University Hospital, Barcelona, Spain
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Jiang X, Pissaloux D, De La Fouchardiere C, Desseigne F, Wang Q, Attignon V, Fondrevelle ME, De La Fouchardiere A, Perol M, Cassier P, Seigne C, Perol D, Ray-Coquard I, Meeus P, Fayette J, Flechon A, Le Cesne A, Penel N, Tredan O, Blay JY. The sum of gains and losses of genes encoding the protein tyrosine kinase targets predicts response to multi-kinase inhibitor treatment: Characterization, validation, and prognostic value. Oncotarget 2016; 6:26388-99. [PMID: 26317543 PMCID: PMC4694909 DOI: 10.18632/oncotarget.4557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/09/2015] [Indexed: 12/22/2022] Open
Abstract
Validated predictive biomarkers for multi-tyrosine kinase inhibitors (MTKI) efficacy are lacking. We hypothesized that interindividual response variability is partially dependent on somatic DNA copy number alterations (SCNAs), particularly those of genes encoding the protein tyrosines targeted by MTKI (called target genes). Genomic alterations were investigated in MTKI responsive and non responsive patients with different histological subtypes included in the ProfiLER protocol (NCT 01774409). From March 2013 to August 2014, 58 patients with advanced cancer treated with one of 7 MTKIs were included in the ProfiLER trial and split into one discovery cohort (n = 13), and 2 validation cohorts (n = 12 and 33). An analysis of the copy number alterations of kinase-coding genes for each of 7 MTKIs was conducted. A prediction algorithm (SUMSCAN) based on the presence of specific gene gains (Tumor Target Charge, TTC) and losses (Tumor Target Losses, TTL) was conceived and validated in 2 independent validation cohorts. MTKI sensitive tumors present a characteristic SCNA profile including a global gain profile, and specific gains for target genes while MTKI resistant tumors present the opposite. SUMSCAN favorable patients achieved longer progression-free and overall survival. This work shows that the copy number sum of kinase-coding genes enables the prediction of response of cancer patients to MTKI, opening a novel paradigm for the treatment selection of these patients.
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Affiliation(s)
- Xiaojun Jiang
- Department of Translational Research, Centre Leon Berard, 69008 Lyon France
| | - Daniel Pissaloux
- Department of Translational Research, Centre Leon Berard, 69008 Lyon France
| | | | | | - Qing Wang
- Department of Translational Research, Centre Leon Berard, 69008 Lyon France
| | - Valery Attignon
- Department of Translational Research, Centre Leon Berard, 69008 Lyon France
| | | | | | - Maurice Perol
- Department of Medical Oncology, Centre Leon Berard, 69008 Lyon France
| | - Philippe Cassier
- Department of Medical Oncology, Centre Leon Berard, 69008 Lyon France
| | - Christelle Seigne
- Department of Clinical Research, Centre Leon Berard, 69008 Lyon France
| | - David Perol
- Department of Clinical Research, Centre Leon Berard, 69008 Lyon France
| | | | - Pierre Meeus
- Department of Surgery, Centre Leon Berard, 69008 Lyon France
| | - Jerome Fayette
- Department of Medical Oncology, Centre Leon Berard, 69008 Lyon France
| | - Aude Flechon
- Department of Medical Oncology, Centre Leon Berard, 69008 Lyon France
| | - Axel Le Cesne
- Department of Medical Oncology, Gustave Roussy, 94805, Villejuif France
| | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, 59020 Lille France
| | - Olivier Tredan
- Department of Medical Oncology, Centre Leon Berard, 69008 Lyon France
| | - Jean-Yves Blay
- Department of Translational Research, Centre Leon Berard, 69008 Lyon France.,Department of Medical Oncology, Centre Leon Berard, 69008 Lyon France
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Carter NJ. Regorafenib: a review of its use in previously treated patients with progressive metastatic colorectal cancer. Drugs Aging 2014; 31:67-78. [PMID: 24276917 DOI: 10.1007/s40266-013-0140-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Regorafenib (Stivarga) is an inhibitor of multiple protein kinases, including those involved in oncogenesis, tumour angiogenesis and maintenance of the tumour microenvironment. The drug is approved as monotherapy for the treatment of metastatic colorectal cancer (mCRC) in patients who have previously received all standard systemic anticancer treatments (US, EU and Canada) or in patients with unresectable, advanced or recurrent colorectal cancer (Japan). In the randomized, controlled COloRectal cancer treated with REgorafenib or plaCebo after failure of standard Therapy (CORRECT) trial, regorafenib 160 mg once daily for the first 3 weeks of each 4-week cycle plus best supportive care (BSC) was associated with a significantly longer median overall survival than placebo plus BSC in patients with previously treated, progressive mCRC. The drug was also associated with significantly longer progression-free survival and better disease control rates than placebo, although objective response rates were similar in both treatment groups. Regorafenib did not appear to compromise health-related quality of life over the study duration and had a generally acceptable tolerability profile. The introduction of regorafenib expands the currently limited range of effective treatment options in patients with previously treated, progressive mCRC.
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Affiliation(s)
- Natalie J Carter
- Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore, 0754, Auckland, New Zealand,
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Stintzing S, Lenz HJ. Protein kinase inhibitors in metastatic colorectal cancer. Let's pick patients, tumors, and kinase inhibitors to piece the puzzle together! Expert Opin Pharmacother 2013; 14:2203-20. [PMID: 23941461 DOI: 10.1517/14656566.2013.828694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Increased understanding in intracellular signaling pathways leading to carcinogenesis, proliferation, migration, invasion, angiogenesis, and anti-apoptosis of colorectal cancer cells has been critical for target identification and drug development. Specific protein kinase inhibitors (KIs) have been developed to block activated pathways associated with tumor growth and progression. Although showing promising activity in preclinical models, until now, the majority of KIs were not able to demonstrate clinically meaningful efficacy in Phase II/III trials. AREAS COVERED The major pathways altered in colorectal cancer will be highlighted, and molecularly defined targets will be discussed. The mechanisms of action and the proof of principle demonstrated in preclinical models of KIs and the disappointing efficacy in clinical trials will be reviewed. EXPERT OPINION Despite recent negative study results, KIs have the potential to be the next class of therapeutics in the treatment of metastatic colorectal cancer. Molecular classification of the individual tumors and identification of molecular escape mechanisms for primary (intrinsic) and secondary resistances to KI treatment is critical to select the patients' most likely to benefit. Appropriate drug combinations based on those mechanisms of resistance have to be tested in selected patient populations to ensure progress and efficacy with the goal to lead to a clinically meaningful prolongation of patients' lives.
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Affiliation(s)
- Sebastian Stintzing
- Keck School of Medicine, USC/Norris Comprehensive Cancer Center, Sharon Carpenter Laboratory , 1441 Eastlake Avenue, Room 3456, Los Angeles, CA 90033 , USA
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