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Bailey JJ, Schirrmacher R, Farrell K, Bernard-Gauthier V. Tropomyosin receptor kinase inhibitors: an updated patent review for 2010-2016 - Part II. Expert Opin Ther Pat 2017; 27:831-849. [PMID: 28270021 DOI: 10.1080/13543776.2017.1297797] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION TrkA/B/C receptor activation supports growth, survival, and differentiation of discrete neuronal populations during development, adult life, and ageing but also plays numerous roles in human disease onset and progression. Trk-specific inhibitors have therapeutic applications in cancer and pain and thus constitute a growing area of interest in oncology and neurology. There has been substantial growth in the number of structural classes of Trk inhibitors and the number of industrial entrants to the Trk inhibitor field over the past six years. Areas covered: In Part II of this two-part review, the discussion of recent patent literature covering Trk family inhibitors is continued from Part I and clinical research with Trk inhibitors is considered. Expert opinion: Trk has been molecularly targeted for over a decade resulting in the progressive evolution of structurally diversified Trk inhibitors arising from scaffold hopping and HTS efforts. Correspondingly, there have been a growing number of clinical investigations utilizing Trk inhibitors in recent years, with a particular focus on the treatment of NTRK-fusion positive cancers and chronic pain. The observed potential of Trk inhibitors to cause adverse CNS side effects however suggests the need for a more rigorous consideration of BBB permeation capabilities during drug development.
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Affiliation(s)
- Justin J Bailey
- a Faculty of Medicine & Dentistry, Department of Oncology , University of Alberta , Edmonton , Canada
| | - Ralf Schirrmacher
- a Faculty of Medicine & Dentistry, Department of Oncology , University of Alberta , Edmonton , Canada
| | - Kristen Farrell
- a Faculty of Medicine & Dentistry, Department of Oncology , University of Alberta , Edmonton , Canada
| | - Vadim Bernard-Gauthier
- a Faculty of Medicine & Dentistry, Department of Oncology , University of Alberta , Edmonton , Canada
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Hardin C, Wang F, Cheng H. Precision drug development in ROS1-positive lung cancer. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2017. [DOI: 10.1080/23808993.2017.1322899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bennati C, Paglialunga L, Ricciuti B, Metro G, Marcomigni L, Gili A, Crinò L. Targeting EGFR and ALK in NSCLC: current evidence and future perspective. Lung Cancer Manag 2016; 5:79-90. [PMID: 30643552 PMCID: PMC6310340 DOI: 10.2217/lmt-2016-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/12/2016] [Indexed: 12/26/2022] Open
Abstract
The advent of molecular therapy targeting specific driver oncogenes has dramatically changed the prognosis of a subset of NSCLC, dilating survival and improving the quality of life of patients with advanced disease. Two of the major targets for treatment with receptor TKIs are the activated mutated forms of the EGFR and the ALK gene fusions. In advanced NSCLC patients harboring EGFR mutations or ALK rearrangements, the use of TKIs in the first-line setting, have provided unexpected large progression-free survival and overall survival benefits, compared with cytotoxic chemotherapy. However, despite initial responses and durable remissions, the development of resistance inevitably leads to treatment failure. The aim of this review is to discuss the treatment strategy currently used for tumors harboring these two genetic targets and to focus on what will be available in clinical practice in the near future.
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Affiliation(s)
- Chiara Bennati
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Luca Paglialunga
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Biagio Ricciuti
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Giulio Metro
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Luca Marcomigni
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
| | - Alessio Gili
- Department of Experimental Medicine, S Maria della Misericordia Hospital, Perugia/Italy
| | - Lucio Crinò
- Department of Medical Oncology, S Maria della Misericordia Hospital, Perugia/Italy
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Russo A, Franchina T, Ricciardi GRR, Ferraro G, Scimone A, Bronte G, Russo A, Rolfo C, Adamo V. Central nervous system involvement in ALK-rearranged NSCLC: promising strategies to overcome crizotinib resistance. Expert Rev Anticancer Ther 2016; 16:615-23. [PMID: 27109446 DOI: 10.1080/14737140.2016.1182427] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION ALK rearranged Non Small Cell Lung Cancers (NSCLCs) represent a distinct subgroup of patients with peculiar clinic-pathological features. These patients exhibit dramatic responses when treated with the ALK tyrosine kinase inhibitor Crizotinib, albeit Central Nervous System (CNS) activity is much less impressive than that observed against extracranial lesions. CNS involvement has become increasingly observed in these patients, given their prolonged survival. Several novel generation ALK inhibitors have been developing to increase CNS penetration and to provide more complete ALK inhibition.. AREAS COVERED The CNS activity of Crizotinib and novel generation ALK inhibitors will be summarized in this review, evaluating the strengths and weaknesses of the therapeutic strategies developed to date in this specific subgroup of NSCLCs with a look towards the future. Expert commentary: In the next few years, the results of ongoing comparative head-to-head trials will provide the definitive conclusions on the optimal treatment sequence in ALK-rearranged NSCLCs. Moreover, ongoing clinical trials with novel-generation ALK inhibitors will produce more evidences on the best approach in the growing number of ALK-positive NSCLCs with CNS involvement.
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Affiliation(s)
- Alessandro Russo
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
| | - Tindara Franchina
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
| | | | - Giuseppa Ferraro
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
| | - Antonino Scimone
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
| | - Giuseppe Bronte
- b Department of Surgical, Oncological and Oral Sciences , University of Palermo , Palermo , Italy
| | - Antonio Russo
- b Department of Surgical, Oncological and Oral Sciences , University of Palermo , Palermo , Italy
| | - Christian Rolfo
- c Department of Medical Oncology , Antwerp University Hospital , Antwerp , Belgium
| | - Vincenzo Adamo
- a Medical Oncology Unit A.O. Papardo and Department of Human Pathology , University of Messina , Messina , Italy
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Passiglia F, Caparica R, Giovannetti E, Giallombardo M, Listi A, Diana P, Cirrincione G, Caglevic C, Raez LE, Russo A, Rolfo C. The potential of neurotrophic tyrosine kinase (NTRK) inhibitors for treating lung cancer. Expert Opin Investig Drugs 2016; 25:385-92. [PMID: 26881293 DOI: 10.1517/13543784.2016.1152261] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Molecular alterations in neurotrophic tyrosine kinase (NTRK) genes have been identified in several solid tumors including lung cancer. Pre-clinical and clinical evidence suggested their potential role as oncogenic drivers and predictive biomarkers for targeted inhibition, leading to the clinical development of a new class of compounds blocking the NTRK molecular pathway, which are currently undner early clinical investigation. AREA COVERED This review describes the biology of the NTRK pathway and its molecular alterations in lung cancer. It focuses on the pre-clinical and clinical development of emerging NTRK inhibitors, which have shown very promising activity in early phase I studies. EXPERT OPINION Among the several NTRK-inhibitors, entrectinib and LOXO-101 are those in more advanced stage of clinical development. Both agents have shown encouraging activity along with a tolerable safety profile in patients with different solid tumors harboring NTRK-fusions, emerging as new promising therapeutic options for molecularly selected patients with advanced Trk-driven lung cancers. Results from ongoing phase II basket trials are eagerly awaited.
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Affiliation(s)
- Francesco Passiglia
- a Department of Surgical, Oncology and Oral Sciences - Medical Oncology , University of Palermo , Palermo , Italy
| | - Rafael Caparica
- b Faculdade de Medicina da USP , Instituto do Câncer do Estado de São Paulo , São Paulo , Brasil
| | - Elisa Giovannetti
- c Dept. Medical Oncology , VU University Medical Center, Cancer Center Amsterdam (CCA) , Amsterdam , The Netherlands
| | - Marco Giallombardo
- d Phase I-Early Clinical Trials Unit, Oncology Department , Antwerp University Hospital (UZA) and Center for Oncological Research (CORE) Antwerp University , Edegem , Antwerp , Belgium.,e Department of Biopathology and Medical Biotechnology, Biology and Genetics section , University of Palermo , Palermo , Italy
| | - Angela Listi
- a Department of Surgical, Oncology and Oral Sciences - Medical Oncology , University of Palermo , Palermo , Italy
| | - Patrizia Diana
- f Biological, Chemical and Pharmaceutical Sciences and Technologies Department , University of Palermo , Palermo , Italy
| | - Girolamo Cirrincione
- f Biological, Chemical and Pharmaceutical Sciences and Technologies Department , University of Palermo , Palermo , Italy
| | | | - Luis E Raez
- h Thoracic Oncology Program, Memorial Cancer Institute, Memorial Health Care System, Florida International University , Miami , FL , USA
| | - Antonio Russo
- a Department of Surgical, Oncology and Oral Sciences - Medical Oncology , University of Palermo , Palermo , Italy
| | - Christian Rolfo
- d Phase I-Early Clinical Trials Unit, Oncology Department , Antwerp University Hospital (UZA) and Center for Oncological Research (CORE) Antwerp University , Edegem , Antwerp , Belgium
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Vogelzang NJ, Pal SK, Signorovitch JE, Reichmann WM, Li N, Yang C, Liu Z, Perez JR, Jonasch E. Comparative effectiveness of everolimus and axitinib as second targeted therapies for metastatic renal cell carcinoma in the US: a retrospective chart review. Curr Med Res Opin 2016; 32:741-7. [PMID: 26744781 DOI: 10.1185/03007995.2016.1140028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Second targeted therapies for metastatic renal cell carcinoma (mRCC) include mammalian target of rapamycin inhibitors (mTORis) and tyrosine kinase inhibitors (TKIs). This observational study compares overall survival (OS) and progression-free survival (PFS) of patients treated with everolimus (an mTORi) and axitinib (a TKI) following first TKI, and assesses the impact of type and duration of first TKI on the relative effectiveness of these second targeted therapies. Methods Retrospective reviews of medical records were conducted by medical oncologists or hematologists/oncologists recruited from a nationwide panel. Included patients with mRCC were required to have discontinued a first TKI (sunitinib, sorafenib, or pazopanib) for medical reasons, and to have initiated everolimus or axitinib as second targeted therapy between February 2012 and January 2013. OS and PFS were compared between patients treated with everolimus vs. axitinib using multivariable Cox proportional hazards regression models. Comparative results were also stratified by type and duration of first TKI. Results Included patients (n = 325 for everolimus and n = 127 for axitinib) had a mean age of 61 years and 31% were female. Sunitinib was the most commonly used first TKI (73%). After adjusting for patient characteristics, no statistically significant differences were observed in OS or PFS between everolimus and axitinib. When stratifying by type and duration of first TKI, there was no statistically significant difference in OS between everolimus and axitinib in all subgroups except for patients with <6 months on sunitinib or sorafenib as first TKI. No significant difference in PFS was observed in any subgroup. Limitations Important limitations include potential missing or inaccurate data in medical charts, and confounding due to unobserved factors. Conclusions In this retrospective chart review, no significant differences were detected in OS or PFS between axitinib and everolimus as second targeted therapy. Longer duration of first TKI was not associated with increased effectiveness of subsequent axitinib compared to everolimus.
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Affiliation(s)
| | - Sumanta K Pal
- b City of Hope Comprehensive Cancer Center , Duarte , CA , USA
| | | | | | - Nanxin Li
- c Analysis Group Inc. , Boston , MA , USA
| | | | - Zhimei Liu
- d Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | - Eric Jonasch
- e MD Anderson Cancer Center , Houston , TX , USA
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Knudsen ES, O’Reilly EM, Brody JR, Witkiewicz AK. Genetic Diversity of Pancreatic Ductal Adenocarcinoma and Opportunities for Precision Medicine. Gastroenterology 2016; 150:48-63. [PMID: 26385075 PMCID: PMC5010785 DOI: 10.1053/j.gastro.2015.08.056] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 12/20/2022]
Abstract
Patients with pancreatic ductal adenocarcinoma (PDA) have a poor prognosis despite new treatments; approximately 7% survive for 5 years. Although there have been advances in systemic, primarily cytotoxic, therapies, it has been a challenge to treat patients with PDA using targeted therapies. Sequence analyses have provided a wealth of information about the genetic features of PDA and have identified potential therapeutic targets. Preclinical and early-phase clinical studies have found specific pathways could be rationally targeted; it might also be possible to take advantage of the genetic diversity of PDAs to develop therapeutic agents. The genetic diversity and instability of PDA cells have long been thought of as obstacles to treatment, but are now considered exploitable features. We review the latest findings in pancreatic cancer genetics and the promise of targeted approaches in PDA therapy.
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Affiliation(s)
- Erik S. Knudsen
- Simmons Cancer Center, University of Texas Southwestern Medical Center, TX,Department of Pathology, University of Texas Southwestern Medical Center, TX,CORRESPONDENCE, Erik Knudsen, PHD, UTSW, Dallas TX, , Agnieszka Witkiewicz, UTSW, Dallas TX,
| | - Eileen M. O’Reilly
- Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, NY
| | - Jonathan R. Brody
- Department of Surgery, Jefferson Pancreatic, Biliary, and Related Cancer Center, Thomas Jefferson University, PA
| | - Agnieszka K. Witkiewicz
- Simmons Cancer Center, University of Texas Southwestern Medical Center, TX,Department of Pathology, University of Texas Southwestern Medical Center, TX,CORRESPONDENCE, Erik Knudsen, PHD, UTSW, Dallas TX, , Agnieszka Witkiewicz, UTSW, Dallas TX,
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