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Saoudi Gonzalez N, López D, Gómez D, Ros J, Baraibar I, Salva F, Tabernero J, Élez E. Pharmacokinetics and pharmacodynamics of approved monoclonal antibody therapy for colorectal cancer. Expert Opin Drug Metab Toxicol 2022; 18:755-767. [PMID: 36582117 DOI: 10.1080/17425255.2022.2160316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The introduction of monoclonal antibodies to the chemotherapy backbone treatment has challenged the paradigm of metastatic colorectal cancer (mCRC) treatment. Their mechanism of action and pharmacokinetics are complex but important to understand in order to improve patient selection and treatment outcomes for mCRC population. AREAS COVERED This review examines the scientific data, pharmacodynamics, and pharmacokinetics of approved monoclonal antibodies used to treat mCRC patients, including agents targeting signaling via VEGFR (bevacizumab and ramucirumab), EGFR (cetuximab and panitumumab), HER2/3 target therapy, and immunotherapy agents such as pembrolizumab or nivolumab. Efficacy and mechanism of action of bispecific antibodies are also covered. EXPERT OPINION mCRC is a heterogeneous disease and the optimal selection and sequence of treatments is challenging. Monoclonal antibodies have complex pharmacokinetics and pharmacodynamics, with important interactions between them. The arrival of bioequivalent molecules to the market increases the need for the characterization of pharmacokinetics and pharmacodynamics of classic monoclonal antibodies to reach bioequivalent novel molecules.
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Affiliation(s)
- Nadia Saoudi Gonzalez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Daniel López
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Diego Gómez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Javier Ros
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Iosune Baraibar
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Francesc Salva
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
| | - Elena Élez
- Medical Oncology Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vhio Barcelona, Spain
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Yazici O, Ucar G, Sütcüoglu O, Turhal NS, Yildiz B, Karamouzis M, Yavuz S, Karadurmuş N, Zengin N, Geva R, Abali H. Metastatic colorectal cancer in both sides of Aegean sea: practice patterns and outcome. Curr Med Res Opin 2022; 38:579-586. [PMID: 35112975 DOI: 10.1080/03007995.2022.2037848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The successful results obtained in trials may not necessarily translate into prolonged survival of metastatic colorectal cancer (mCRC) patients in real life. This multinational registry study aimed to evaluate the real-life data effecting the survival of patients with mCRC. METHODS This is a multinational, retrospective registry study. Turkish and Greek mCRC patients diagnosed between 2005 and 2012, with at least 3 years of follow-up data or who died before 3 years of follow-up were included in the study. RESULTS A total of 364 were included in the study. RAS and BRAF mutation rates were found to be 36% and 39%, respectively. As first-line therapy, 196 (54%) patients received bevacizumab and Anti-EGFR treatments in combination with chemotherapy. The objective response rate was 42% (n = 152) and 32% (n = 78) for 1st line and 2nd line treatments, respectively. While the median progression-free survival (PFS) with the 1st line treatment was 10 months, it was 7 months with the 2nd line treatments. In the total study population median PFS and overall survival (OS) were 10 (95% CI, 8.3-11.6) and 35 (95% CI, 30.7-39.2) months, respectively. In Turkish and Greek patients, median OS (36 months versus 29 months, p = .81) and PFS (10.2 versus 9.2, p = .42) were not different. In multivariate analysis, ECOG PS of ≥2 and having metastases in more than one region decreased overall survival (p = .002 and p = .003), it was found that wild RAS and BRAF mutations and second metastasectomy contributed to overall survival (p = .047 and p < .001). CONCLUSION In conclusion, it seems that the patient's performance status, tumor location, number of metastatic lesions at the time of diagnosis affect the prognosis of mCRC. Although access to molecular tests and first-line treatments differ between Greece and Turkey, no significant difference was found in survival times.
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Affiliation(s)
- Ozan Yazici
- Department of Medical Oncology, Gazi University, Ankara, Turkey
| | - Gokhan Ucar
- Department of Medical Oncology, Ankara State Hospital, Ankara, Turkey
| | - Osman Sütcüoglu
- Department of Medical Oncology, Gazi University, Ankara, Turkey
| | | | - Birol Yildiz
- Department of Medical Oncology, Medical Park Hospital, Elazıg, Turkey
| | - Michalis Karamouzis
- Department Biological Chemistry, Molecular Oncology Unit, National Kapodistrian University of Athens, Athens, Greece
| | - Sinan Yavuz
- Department of Medical Oncology, Acibadem Adana Hospital, Adana, Turkey
| | - Nuri Karadurmuş
- Department of Medical Oncology, Ankara Gülhane Education and Research Hospital, Ankara, Turkey
| | - Nurullah Zengin
- Department of Medical Oncology, Lokman Hekim Hospital, Ankara, Turkey
| | - Ravit Geva
- Oncology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israeli
| | - Huseyin Abali
- Department of Medical Oncology, Acibadem Adana Hospital, Adana, Turkey
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Wang C, Sandhu J, Fakih M. OUP accepted manuscript. Oncologist 2022; 27:104-109. [PMID: 35641204 PMCID: PMC8895744 DOI: 10.1093/oncolo/oyab028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/01/2021] [Indexed: 11/12/2022] Open
Abstract
Background Limited studies have suggested that mucinous histology is associated an attenuated response to anti-epidermal growth factor receptor (EGFR) therapy. Methods We conducted a single-institution, retrospective study to review the anti-EGFR response and the molecular profile of patients with left-sided microsatellite stable RAS/BRAF wild-type mucinous metastatic colorectal cancer. Results In comparison to nonmucinous population (n = 98), mucinous histology (n = 20) was associated with a younger age (48 vs 54, P = .02), wild-type APC (80% vs 15.3%, P < .0001), and wild-type TP53 (40% vs 8.2%, P = .001). Guanine nucleotide binding protein, alpha stimulating (GNAS) mutations were exclusively found in mucinous tumors (20% vs 0, P < .0001). Genomic alterations associated with resistance to anti-EGFR therapy, such as ERBB2 amplification, PIK3CA mutation, MAP2K1 mutation, and KRAS amplification, were identified in patients with left-sided RAS/BRAF wild-type mucinous metastatic colorectal cancer. Mucinous histology was not associated with a worse outcome than non-mucinous histology (34.3 vs 42.2 months, P = .85). However, patients with left-sided RAS/BARF wild-type mucinous colorectal cancer treated with first-line anti-EGFR therapy had significantly worse progression-free survival (4 vs 6.5 months, hazard ratio [HR] = 5.3, 95% confidence interval [CI] 1.3-21.7, P = .01) than patients treated with the first-line vascular endothelial growth factor A antibody, bevacizumab. Anti-EGFR therapy was associated with limited responses and a short PFS across all lines of therapy in 12 patients with left-sided RAS/BRAF wild-type mucinous colorectal cancer. Conclusions Mucinous histology is associated with diminished benefits from anti-EGFR therapy in patients with left-sided RAS/BRAF wild-type colorectal cancer. These patients should be considered for bevacizumab-based therapy in the first- and second-line settings.
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Affiliation(s)
- Chongkai Wang
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jaideep Sandhu
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Corresponding author: Marwan Fakih, MD, Department of Medical Oncology and Therapeutics Research, Judy and Bernard Briskin Distinguished Director of Clinical Research Associate Director, Clinical Sciences, Medical Director, Briskin Center for Clinical Research, Section Head, GI Medical Oncology, Co-Director, Gastrointestinal Cancer Program, City of Hope Comprehensive Cancer Center, 1500 E. Duarte Road, Duarte, CA 91010, USA;
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Guo W, Zhang C, Wang X, Dou D, Chen D, Li J. Resolving the difference between left-sided and right-sided colorectal cancer by single-cell sequencing. JCI Insight 2021; 7:152616. [PMID: 34793335 PMCID: PMC8765049 DOI: 10.1172/jci.insight.152616] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Colorectal cancers (CRCs) exhibit differences in incidence, pathogenesis, molecular pathways, and outcome depending on the location of the tumor. The transcriptomes of 27,927 single human CRC cells from 3 left-sided and 3 right-sided CRC patients were profiled by single-cell RNA-Seq (scRNA-Seq). Right-sided CRC harbors a significant proportion of exhausted CD8+ T cells of a highly migratory nature. One cluster of cells from left-sided CRC exhibiting states preceding exhaustion and a high ratio of preexhausted/exhausted T cells were favorable prognostic markers. Notably, we identified a potentially novel RBP4+NTS+ subpopulation of cancer cells that exclusively expands in left-sided CRC. Tregs from left-sided CRC showed higher levels of immunotherapy-related genes than those from right-sided CRC, indicating that left-sided CRC may have increased responsiveness to immunotherapy. Antibody-dependent cellular phagocytosis (ADCP) and antibody-dependent cellular cytotoxicity (ADCC) induced by M2-like macrophages were more pronounced in left-sided CRC and correlated with a good prognosis in CRC.
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Affiliation(s)
- Wei Guo
- Department of Colorectal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Cuiyu Zhang
- Department of Physiology, Shandong University, Jinan, China
| | - Xia Wang
- Department of Physiology, Shandong University, Jinan, China
| | - Dandan Dou
- Department of Physiology, Shandong University, Jinan, China
| | - Dawei Chen
- Interdisciplinary Cluster for Applied Genoproteomics (GIGA) Stem Cells, Université de Liège, Liège, Belgium
| | - Jingxin Li
- Department of Physiology, Shandong University, Jinan, China
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Cainap C, Ungur RA, Bochis OV, Achimas P, Vlad C, Havasi A, Vidrean A, Farcas A, Tat T, Gherman A, Piciu A, Bota M, Constantin AM, Pop LA, Maniu D, Crisan O, Cioban CV, Balacescu O, Coza O, Balacescu L, Marta MM, Dronca E, Cainap S. Partnering bevacizumab with irinotecan as first line-therapy of metastatic colorectal cancer improves progression free survival-A retrospective analysis. PLoS One 2021; 16:e0248922. [PMID: 33909622 PMCID: PMC8081186 DOI: 10.1371/journal.pone.0248922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/08/2021] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer remains one of the most frequent malignancies (third place at both genders) worldwide in the last decade, owing to significant changes in modern dietary habits. Approximately half of the patients develop metastases during the course of their disease. The available therapeutic armamentarium is constantly evolving, raising questions regarding the best approach for improving survival. Bevacizumab remains one of the most widely used therapies for treating metastatic colorectal cancer and can be used after progression. This study aimed to identify the best chemotherapy partner for bevacizumab after progression. We performed a retrospective analysis of patients with metastatic colorectal cancer who were treated with bevacizumab as first- and second-line chemotherapy. Data were collected for 151 patients, 40 of whom were treated with double-dose bevacizumab after the first progression. The two standard chemotherapy regimens combined with bevacizumab were FOLFIRI/CAPIRI and FOLFOX4/CAPEOX. The initiation of first-line treatment with irinotecan-based chemotherapy improved progression-free survival and time to treatment failure but not overall survival. After the first progression, retreatment with the same regimen as that used in the induction phase was the best approach for improving overall survival (median overall survival: 46.5 vs. 27.0 months for the same vs. switched strategy, respectively). No correlations were observed between the dose intensity of irinotecan, oxaliplatin, 5-fluorouracil, or bevacizumab and the overall survival, progression-free survival in the first-/second-line treatment, and time to treatment failure. Interaction between an irinotecan-based regimen as a second-line treatment and double-dose bevacizumab after progression was associated with an improved overall survival (p = 0.06). Initiating systemic treatment with an irinotecan-based regimen in combination with bevacizumab improved the progression-free survival in the first-line treatment and time to treatment failure. In terms of overall survival, bevacizumab treatment after the first progression is better partnered with the same regimen as that used in the induction phase.
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Affiliation(s)
- Calin Cainap
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rodica Ana Ungur
- Department of Medical Specialties, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- * E-mail:
| | | | - Patriciu Achimas
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Catalin Vlad
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Havasi
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | | | - Anca Farcas
- Department of Medical Specialties, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tiberiu Tat
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Alexandra Gherman
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andra Piciu
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Madalina Bota
- Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anne-Marie Constantin
- Department of Morphological Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Laura Ancuta Pop
- Department of Molecular Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Maniu
- Faculty of Physics, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Ovidiu Crisan
- Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmin Vasile Cioban
- Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Ovidiu Coza
- Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Monica Mihaela Marta
- Department of Medical Education, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Eleonora Dronca
- Department of Molecular Sciences, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Cainap
- Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Liu N, Wu C, Jia R, Cai G, Wang Y, Zhou L, Ji Q, Sui H, Zeng P, Xiao H, Liu H, Huo J, Feng Y, Deng W, Li Q. Traditional Chinese Medicine Combined With Chemotherapy and Cetuximab or Bevacizumab for Metastatic Colorectal Cancer: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Front Pharmacol 2020; 11:478. [PMID: 32372960 PMCID: PMC7187887 DOI: 10.3389/fphar.2020.00478] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/26/2020] [Indexed: 12/29/2022] Open
Abstract
Background Huangci Granule is a traditional Chinese medicine for treating metastatic colorectal cancer (mCRC). Objective To evaluate the efficacy and safety of Huangci Granule combination with chemotherapy and cetuximab (CET) or bevacizumab (BV) for treating mCRC. Methods We performed a randomized, controlled, and double-blind trial and recruited patients with mCRC who were planned to undergo chemotherapy combined with CET or BV. The treatment group was treated with Huangci Granule, while the control group was treated with placebo. Continuous treatment until disease progression, death, intolerable toxicity or up to 6 months. The primary endpoint was progression-free survival (PFS), and the secondary endpoint was quality of life and safety. Result 320 patients were randomly assigned to receive treatment, including 200 first-line patients and 120 second-line patients. In the first-line treatment, the median PFS was 9.59 months (95% CI, 6.94–13.25) vs 6.89 months (95% CI, 4.99–9.52) in treatment group and control group (HR, 0.69; 95% CI, 0.50–0.97; P = 0.027). Chinese medicine was an independent factor affecting the PFS. In the second-line treatment, the median PFS was 6.51 months (95% CI, 4.49–9.44) vs 4.53 months (95% CI, 3.12–6.57) in the treatment group and control group (HR, 0.65; 95% CI, 0.45–0.95; P = 0.020). Compared with the control group, “role function,” “social function,” “fatigue,” and “appetite loss” were significantly improved in the treatment (P < 0.05) and drug related grades 3 to 4 adverse events were less. Conclusion Huangci Granule combined with chemotherapy and CET or BV can prolong the PFS of mCRC, improve the quality of life, reduce adverse reactions, and have good safety.
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Affiliation(s)
- Ningning Liu
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chaojun Wu
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ru Jia
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guoxiang Cai
- Department of Colorectal Cancer Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yan Wang
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lihong Zhou
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing Ji
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hua Sui
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Puhua Zeng
- Cancer Research Institute, Hunan Academy of Traditional Chinese Medicine, Changsha, China
| | - Haijuan Xiao
- Department of Oncology, Hospital Affiliated to Shaanxi University of Chinese Medicine, Xianyang, China
| | - Huaimin Liu
- Department of Integrated Chinese and Western Medicine, Henan Provincial Cancer Hospital, Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiege Huo
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuanyuan Feng
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wanli Deng
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qi Li
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Ketzer S, Schimmel K, Koopman M, Guchelaar HJ. Clinical Pharmacokinetics and Pharmacodynamics of the Epidermal Growth Factor Receptor Inhibitor Panitumumab in the Treatment of Colorectal Cancer. Clin Pharmacokinet 2018; 57:455-73. [PMID: 28853050 DOI: 10.1007/s40262-017-0590-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite progress in the treatment of metastatic colorectal cancer (mCRC) in the last 15 years, it is still a condition with a relatively low 5-year survival rate. Panitumumab, a fully human monoclonal antibody directed against the epidermal growth factor receptor (EGFR), is able to prolong survival in patients with mCRC. Panitumumab is used in different lines of therapy in combination with chemotherapy, and as monotherapy for the treatment of wild-type (WT) RAS mCRC. It is administered as an intravenous infusion of 6 mg/kg every 2 weeks and has a t½ of approximately 7.5 days. Elimination takes place via two different mechanisms, and immunogenicity rates are low. Only RAS mutations have been confirmed as a negative predictor of efficacy with anti-EGFR antibodies. Panitumumab is generally well tolerated and has a manageable toxicity profile, despite a very high prevalence of dermatologic side effects. This article presents an overview of the clinical pharmacokinetics and pharmacodynamics of panitumumab, including a description of the studies that led to its approval in the different lines of therapy of mCRC.
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Matos I, Noguerido A, Ros J, Mulet N, Argilés G, Elez É, Tabernero J. Triple-drug chemotherapy regimens in combination with an anti-EGFR agent in metastatic colorectal cancer - prospects from phase II clinical trials. Expert Opin Investig Drugs 2019; 28:463-471. [PMID: 30905200 DOI: 10.1080/13543784.2019.1599860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The addition of monoclonal antibody (mAb) epidermal growth factor receptor (EGFR) inhibitors to classic chemotherapy doublet backbones has improved survival of metastatic colorectal cancer (mCRC). However, the role of triple-drug chemotherapy regimens in combination with an anti-EGFR mAb inhibitor is not yet clear. AREAS COVERED The activity of triple-drug chemotherapy regimens when combined with an anti-EGFR mAb in mCRC patients is examined. We describe the overall safety and tolerability profiles based on a literature review of all published phase I and II clinical trials in this setting. Drug exposure, tumor mutational status, and metastases resectability are discussed. A review of PubMed and abstracts of major oncology congresses from 2009 to 2018, with MeSH and full-text search terms for clinical trials of anti-EGFR for 'metastatic' or 'advanced' 'colorectal cancer/adenocarcinoma' was implemented. Only English language publications were included. EXPERT OPINION Efficacy data from phase II trials are promising, but the safety profiles are not as encouraging; the development of severe diarrhea and acneiform rash limit the drug exposure that is critical for improved outcomes. Phase II studies of these triplet chemotherapy/anti-EGFR mAb combinations have focused on conversion therapy in liver-limited disease or in the first-line setting in advanced disease. The identification of biomarkers of response and toxicity may support the use of personalized medicine and more precise design of phase III trials.
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Affiliation(s)
- Ignacio Matos
- a Department of Medical Oncology , Vall D'Hebron University Hospital Barcelona/Universitat Autònoma de Barcelona , Barcelona , Spain.,b Department of Medical Oncology , Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Alba Noguerido
- a Department of Medical Oncology , Vall D'Hebron University Hospital Barcelona/Universitat Autònoma de Barcelona , Barcelona , Spain.,b Department of Medical Oncology , Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Javier Ros
- a Department of Medical Oncology , Vall D'Hebron University Hospital Barcelona/Universitat Autònoma de Barcelona , Barcelona , Spain.,b Department of Medical Oncology , Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Nuria Mulet
- a Department of Medical Oncology , Vall D'Hebron University Hospital Barcelona/Universitat Autònoma de Barcelona , Barcelona , Spain.,c Department of Medical Oncology, Institut Català d'Oncologia-IDIBELL , Universitat de Barcelona , Barcelona , Spain
| | - Guillem Argilés
- a Department of Medical Oncology , Vall D'Hebron University Hospital Barcelona/Universitat Autònoma de Barcelona , Barcelona , Spain.,b Department of Medical Oncology , Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Élena Elez
- a Department of Medical Oncology , Vall D'Hebron University Hospital Barcelona/Universitat Autònoma de Barcelona , Barcelona , Spain.,b Department of Medical Oncology , Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
| | - Josep Tabernero
- a Department of Medical Oncology , Vall D'Hebron University Hospital Barcelona/Universitat Autònoma de Barcelona , Barcelona , Spain.,b Department of Medical Oncology , Vall d'Hebron Institute of Oncology (VHIO) , Barcelona , Spain
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Yu JZ, Sun N, Bei YB, Li XB, Lu C, Hua LC. Circadian gene hCLOCK contributes to progression of colorectal carcinoma and is directly regulated by tumor‑suppressive microRNA‑124. Mol Med Rep 2017; 16:7923-7930. [PMID: 29048100 PMCID: PMC5779874 DOI: 10.3892/mmr.2017.7596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 05/03/2017] [Indexed: 12/01/2022] Open
Abstract
An abundance of studies has demonstrated that disruption of circadian rhythms is one of the factors that may contribute to the initiation and development of human colorectal carcinomas (CRCs). Recently, microRNA‑124 has been demonstrated to suppress tumor growth or metastasis of CRCs. However, the mechanisms of cross‑talk between microRNA‑124 (miR‑124) and circadian rhythms in the regulation of CRCs are poorly understood. The present study demonstrated that the protein expression levels of human circadian locomoter output cycles protein kaput (hCLOCK) is significantly increased, while miR‑124 is attenuated in high‑grade human CRC tissues and in the more invasive colorectal cancer cell lines SW620 and LOVO. It was further demonstrated that hCLOCK is a direct target of miR‑124. Upregulation of miR‑124 significantly inhibited hCLOCK expression in LOVO cells, and consequently inhibited its promoting effects on the proliferation and migration of LOVO cells. In conclusion, these data revealed that hCLOCK serves an enhancing role, whereas mir‑124 serves a suppressive role, in human CRC. Attenuation of miR‑124, of which hCLOCK is a direct target, leads to increased hCLOCK expression and disruption of circadian rhythms in CRC.
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Affiliation(s)
- Jia-Zi Yu
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
- Department of Surgery, Ningbo Medical Center Lihuili East Hospital, Ningbo 315000, P.R. China
| | - Ning Sun
- Department of Physiology and Pathophysiology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Yi-Bing Bei
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Xiao-Bo Li
- Department of Physiology and Pathophysiology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Chao Lu
- Department of Physiology and Pathophysiology, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Lu-Chun Hua
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
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10
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Fratamico RS, Cohen SJ. Molecular Profiling in Colon Cancer: Where Are We Now? Curr Colorectal Cancer Rep 2017. [DOI: 10.1007/s11888-017-0385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Sangha BS, Nimeiri H, Hickey R, Salem R, Lewandowski RJ. Radioembolization as a Treatment Strategy for Metastatic Colorectal Cancer to the Liver: What Can We Learn from the SIRFLOX Trial? Curr Treat Options Oncol 2017; 17:26. [PMID: 27098532 DOI: 10.1007/s11864-016-0402-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT In the setting of liver metastases from colorectal cancer (CRC), radioembolization with yttrium-90 has been used to treat chemotherapy refractory disease with a growing interest to establish its efficacy in prospective trials combined with first- and second-line chemotherapy. SIRFLOX is an ongoing, multi-center, phase 3 randomized trial comparing first-line chemotherapy alone or in combination with yttrium-90 radioembolization in patients with CRC who have isolated liver metastases or liver-dominant metastases. Preliminary results from SIRFLOX demonstrate that radioembolization combined with first-line chemotherapy is safe and feasible. There was no significant difference in median overall progression-free survival (PFS) between the combined radioembolization-chemotherapy and chemotherapy-only arms (10.7 versus 10.2 months). Although the trial did not meet its primary endpoint of improved median PFS, there was a significant increase in the median hepatic PFS (20.5 versus 12.6 months; p = 0.02) favoring the combination arm. Thus, combining radioembolization with chemotherapy in the first-line setting may be most effective for liver-limited metastatic CRC. Since radioembolization targets liver disease, it is plausible that the trial failed to achieve an improvement in PFS given that 40 % of the SIRFLOX population had extra-hepatic disease. It is also possible that the overall median PFS may be a poor surrogate endpoint, and other endpoints like overall survival still needs to be delineated in this setting. In addition, it is crucial to document improvement or delay in time to deterioration in quality of life symptom endpoints in this population. SIRFLOX is the first of three prospective studies that assess the efficacy of adding radioembolization to first-line chemotherapy, and the combined data from these trials will provide the necessary power for an overall survival analysis. The final results of SIRFLOX will be eagerly awaited to determine if the increased hepatic PFS in preliminary data will translate to increased overall survival benefit.
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Affiliation(s)
- Bippan Singh Sangha
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Halla Nimeiri
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Ryan Hickey
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
- Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.
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12
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Schmiegel W, Scott RJ, Dooley S, Lewis W, Meldrum CJ, Pockney P, Draganic B, Smith S, Hewitt C, Philimore H, Lucas A, Shi E, Namdarian K, Chan T, Acosta D, Ping-Chang S, Tannapfel A, Reinacher-Schick A, Uhl W, Teschendorf C, Wolters H, Stern J, Viebahn R, Friess H, Janssen KP, Nitsche U, Slotta-Huspenina J, Pohl M, Vangala D, Baraniskin A, Dockhorn-Dworniczak B, Hegewisch-Becker S, Ronga P, Edelstein DL, Jones FS, Hahn S, Fox SB. Blood-based detection of RAS mutations to guide anti-EGFR therapy in colorectal cancer patients: concordance of results from circulating tumor DNA and tissue-based RAS testing. Mol Oncol 2017; 11:208-219. [PMID: 28106345 PMCID: PMC5527457 DOI: 10.1002/1878-0261.12023] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/10/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022] Open
Abstract
An accurate blood‐based RAS mutation assay to determine eligibility of metastatic colorectal cancer (mCRC) patients for anti‐EGFR therapy would benefit clinical practice by better informing decisions to administer treatment independent of tissue availability. The objective of this study was to determine the level of concordance between plasma and tissue RAS mutation status in patients with mCRC to gauge whether blood‐based RAS mutation testing is a viable alternative to standard‐of‐care RAS tumor testing. RAS testing was performed on plasma samples from newly diagnosed metastatic patients, or from recurrent mCRC patients using the highly sensitive digital PCR technology, BEAMing (beads, emulsions, amplification, and magnetics), and compared with DNA sequencing data of respective FFPE (formalin‐fixed paraffin‐embedded) tumor samples. Discordant tissue RAS results were re‐examined by BEAMing, if possible. The prevalence of RAS mutations detected in plasma (51%) vs. tumor (53%) was similar, in accord with the known prevalence of RAS mutations observed in mCRC patient populations. The positive agreement between plasma and tumor RAS results was 90.4% (47/52), the negative agreement was 93.5% (43/46), and the overall agreement (concordance) was 91.8% (90/98). The high concordance of plasma and tissue results demonstrates that blood‐based RAS mutation testing is a viable alternative to tissue‐based RAS testing.
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Affiliation(s)
- Wolff Schmiegel
- Department of Internal Medicine, Medical University of Bochum Hospital, Germany
| | - Rodney J Scott
- Pathology North, John Hunter Hospital, New Lambton Heights, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,The Faculty of Medicine and Health, University of Newcastle, Australia
| | - Susan Dooley
- Pathology North, John Hunter Hospital, New Lambton Heights, Australia
| | - Wendy Lewis
- Pathology North, John Hunter Hospital, New Lambton Heights, Australia
| | - Cliff J Meldrum
- Pathology North, John Hunter Hospital, New Lambton Heights, Australia
| | - Peter Pockney
- The Faculty of Medicine and Health, University of Newcastle, Australia.,Division of Surgery, John Hunter Hospital, New Lambton Heights, Australia
| | - Brian Draganic
- The Faculty of Medicine and Health, University of Newcastle, Australia.,Division of Surgery, John Hunter Hospital, New Lambton Heights, Australia
| | - Steve Smith
- The Faculty of Medicine and Health, University of Newcastle, Australia.,Division of Surgery, John Hunter Hospital, New Lambton Heights, Australia
| | - Chelsee Hewitt
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - Hazel Philimore
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - Amanda Lucas
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - Elva Shi
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - Kateh Namdarian
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - Timmy Chan
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - Danilo Acosta
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | - Su Ping-Chang
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
| | | | - Anke Reinacher-Schick
- Division of Hematolgy and Oncology, Department of Internal Medicine, St. Josef Hospital, Ruhr-University Bochum, Germany
| | - Waldemar Uhl
- Department of Visceral and General Surgery, St. Josef Hospital, Ruhr-University Bochum, Germany
| | | | - Heiner Wolters
- Department of Visceral and General Surgery, St. Josefs-Hospital, Dortmund, Germany
| | - Josef Stern
- Department of Visceral and General Surgery, St. Josefs-Hospital, Dortmund, Germany
| | - Richard Viebahn
- Department of Visceral and General Surgery, Medical University of Bochum Hospital, Germany
| | - Helmut Friess
- Department of Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, Germany
| | - Klaus-Peter Janssen
- Department of Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, Germany
| | - Ulrich Nitsche
- Department of Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, Germany
| | | | - Michael Pohl
- Department of Internal Medicine, Medical University of Bochum Hospital, Germany
| | - Deepak Vangala
- Department of Internal Medicine, Medical University of Bochum Hospital, Germany.,Department of Molecular GI Oncology, University of Bochum Hospital, Germany
| | | | | | | | - Philippe Ronga
- Global Medical Affairs Oncology, Merck KGAa, Darmstadt, Germany
| | | | - Frederick S Jones
- Medical Scientific Affairs, Sysmex Inostics Inc., Mundelein, IL, USA
| | - Stephan Hahn
- Department of Molecular GI Oncology, University of Bochum Hospital, Germany
| | - Stephen B Fox
- Peter MacCallum Cancer Centre and the University of Melbourne, Melbourne, Australia
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Abstract
Over the past decades, considerable progress has been made in the management of colorectal cancer (CRC), leading to a significant improvement in overall survival. Although part of this success has been rightly attributed to aggressive surgical management and advances in other adjunct treatments, our understanding of the pathogenesis of CRC and emergence of newer molecular targets for colon cancer has created a powerful impact. In this review article, we will discuss various targeted therapies in the management of metastatic CRC (mCRC). In particular, vascular endothelial growth factor (VEGF)- and epidermal growth factor receptor (EGFR)-targeting monoclonal antibodies have become integral components of the first-line treatment strategies for mCRC. Newer agents on the horizon soon to be incorporated in clinical practice will be briefly reviewed as well. Currently, the only predictive biomarker for treatment selection in patients with mCRC is tumor RAS mutational status.
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Affiliation(s)
- Andreas Seeber
- Department of Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
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14
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Abstract
INTRODUCTION Colorectal cancer (CRC) is a leading cause of cancer death worldwide. Over the last decade, the addition of antibodies that block the epidermal growth factor receptor (EGFR) or angiogenesis to the classic chemotherapy backbone has improved overall survival in metastatic colorectal cancer (mCRC). However, the role of the other major targeted therapy, the tyrosine kinase inhibitors (TKIs), is not yet fully clarified. AREAS COVERED This review discusses key published and ongoing studies with TKIs in mCRC, the mechanisms of resistance to standard treatments that are potentially targetable with these small molecules, along with the role of biomarkers in therapeutic decision-making process. EXPERT OPINION The current effectiveness of TKIs is limited by two principal reasons, firstly the use of combination chemotherapy necessitates lower dose-density to manage the toxicity profile and secondly, development of these drugs has mainly been performed in molecularly unselected populations. mCRC is a heterogeneous and dynamic disease, and clinical trials with TKIs must be designed on the basis of specific molecular alterations targeted by these drugs. Success with this approach relies on identifying mutations at the time of progression, raising the importance of minimally-invasive monitoring tools. Liquid biopsies are a promising option, although this technique remains to be validated. Overall, this approach contributes to the move towards personalized and precision therapeutic strategies.
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Affiliation(s)
- Ignacio Matos
- a Spain - Medical Oncology Department , Vall d'Hebron University Hospital , Barcelona , Spain
| | - Elena Elez
- a Spain - Medical Oncology Department , Vall d'Hebron University Hospital , Barcelona , Spain
| | - Jaume Capdevila
- a Spain - Medical Oncology Department , Vall d'Hebron University Hospital , Barcelona , Spain
| | - Josep Tabernero
- a Spain - Medical Oncology Department , Vall d'Hebron University Hospital , Barcelona , Spain
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15
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Benson AB, Kiss I, Bridgewater J, Eskens FALM, Sasse C, Vossen S, Chen J, Van Sant C, Ball HA, Keating A, Krivoshik A. BATON-CRC: A Phase II Randomized Trial Comparing Tivozanib Plus mFOLFOX6 with Bevacizumab Plus mFOLFOX6 in Stage IV Metastatic Colorectal Cancer. Clin Cancer Res 2016; 22:5058-5067. [PMID: 27401244 DOI: 10.1158/1078-0432.ccr-15-3117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/20/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Tivozanib, a selective inhibitor of VEGFR-1, -2, and -3, plus mFOLFOX6 in an advanced gastrointestinal cancer phase Ib study had encouraging antineoplastic activity and a tolerable safety profile. This randomized, open-label, phase II trial of tivozanib/mFOLFOX6 versus bevacizumab/mFOLFOX6 in patients with previously untreated metastatic colorectal cancer (mCRC) evaluated tivozanib activity versus bevacizumab. EXPERIMENTAL DESIGN Treatment-naïve patients received mFOLFOX6 every 2 weeks of each 28-day cycle plus either tivozanib orally 1.5 mg once daily for 21 days or bevacizumab intravenously 5 mg/kg every 2 weeks. Investigator-assessed progression-free survival (PFS) was the primary endpoint; some secondary endpoints included safety, overall survival, overall response rate (ORR), duration of response, time to treatment failure, and biomarker subgroup analyses. RESULTS A prespecified interim futility analysis demonstrated that the futility boundary for superiority of tivozanib/mFOLFOX6 over bevacizumab/mFOLFOX6 for PFS in the intent-to-treat population was crossed; median PFS was 9.4 versus 10.7 months [HR = 1.091; confidence interval (CI), 0.693-1.718; P = 0.706]. Tivozanib/mFOLFOX6 resulted in PFS and ORR comparable with bevacizumab/mFOLFOX6; interim analyses biomarker results revealed no significant PFS association. Post hoc final analyses demonstrated a potential difference in tivozanib-specific PFS in patients with low neuropilin-1 (NRP-1), but not in patients with high NRP-1. Tivozanib/mFOLFOX6 was tolerable and adverse events were comparable with both bevacizumab/mFOLFOX6 and previous tivozanib studies. CONCLUSIONS The efficacy of tivozanib/mFOLFOX6 was comparable with but not superior to bevacizumab/mFOLFOX6 in patients with previously untreated mCRC. Since data from the prespecified interim analysis did not demonstrate superiority, this resulted in discontinuation of the study. The safety and tolerability profile of tivozanib/mFOLFOX6 was consistent with other tivozanib trials. NRP-1 is a potential predictive biomarker for tivozanib activity, but these results require further validation. Clin Cancer Res; 22(20); 5058-67. ©2016 AACR.
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Affiliation(s)
- Al B Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.
| | - Igor Kiss
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - John Bridgewater
- University College London Cancer Institute, London, United Kingdom
| | | | - Carolyn Sasse
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Sandra Vossen
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Jihong Chen
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Chip Van Sant
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Howard A Ball
- Astellas Pharma Global Development, Northbrook, Illinois
| | - Anne Keating
- Astellas Pharma Global Development, Northbrook, Illinois
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16
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Zaniboni A, Formica V. The Best. First. Anti-EGFR before anti-VEGF, in the first-line treatment of RAS wild-type metastatic colorectal cancer: From bench to bedside. Cancer Chemother Pharmacol. 2016;78:233-244. [PMID: 27091467 DOI: 10.1007/s00280-016-3032-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/04/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Since 2013, informative trials exploring the optimal use of available biologic agents in the first-line setting of metastatic colorectal cancer (mCRC) have been presented. These trials have opened a stimulating debate on the biological effect that first-line therapies may have on subsequent lines of treatment even long after the first-line progression. MATERIALS AND METHODS We reviewed available preclinical and clinical data on the effect of different sequences of the biological drugs approved for use in mCRC patients. The importance of molecular selection of patients based on RAS mutational status and toxicity and quality-of-life issues were also analyzed. RESULTS Convincing evidence exists on the optimal therapeutic effect obtained by using anti-EGFR agents in first-line treatment before anti-VEGF agents. On the contrary, up-front anti-VEGF agents' use seems to determine biological changes that increase the risk of acquired resistance to subsequent EGFR inhibitors. This hypothesis is confirmed by the scarce evidence of EGFR inhibitor activity in second-line treatment. Such a therapeutic optimum is subject to a fine molecular selection based on RAS mutational status. CONCLUSION There is accumulating evidence suggesting that, after precise and well-established molecular selection, anti-EGFR agents deliver their maximum efficacy in mCRC patients when given early in the treatment strategy. Their toxicity profile seems manageable under the supervision of experienced physicians. Large randomized trials prospectively confirming the impact of different sequencing strategies are eagerly awaited.
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17
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Hickey R, Lewandowski RJ, Prudhomme T, Ehrenwald E, Baigorri B, Critchfield J, Kallini J, Gabr A, Gorodetski B, Geschwind JF, Abbott A, Shridhar R, White SB, Rilling WS, Boyer B, Kauffman S, Kwan S, Padia SA, Gates VL, Mulcahy M, Kircher S, Nimeiri H, Benson AB, Salem R. 90Y Radioembolization of Colorectal Hepatic Metastases Using Glass Microspheres: Safety and Survival Outcomes from a 531-Patient Multicenter Study. J Nucl Med 2015; 57:665-71. [PMID: 26635340 DOI: 10.2967/jnumed.115.166082] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/30/2015] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED Hepatic metastases of colorectal carcinoma are a leading cause of cancer-related mortality. Most colorectal liver metastases become refractory to chemotherapy and biologic agents, at which point the median overall survival declines to 4-5 mo. Radioembolization with (90)Y has been used in the salvage setting with favorable outcomes. This study reports the survival and safety outcomes of 531 patients treated with glass-based (90)Y microspheres at 8 institutions, making it the largest (90)Y study for patients with colorectal liver metastases. METHODS Data were retrospectively compiled from 8 institutions for all (90)Y glass microsphere treatments for colorectal liver metastases. Exposure to chemotherapeutic or biologic agents, prior liver therapies, biochemical parameters before and after treatment, radiation dosimetry, and complications were recorded. Uni- and multivariate analyses for predictors of survival were performed. Survival outcomes and clinical or biochemical adverse events were recorded. RESULTS In total, 531 patients received (90)Y radioembolization for colorectal liver metastases. The most common clinical adverse events were fatigue (55%), abdominal pain (34%), and nausea (19%). Grade 3 or 4 hyperbilirubinemia occurred in 13% of patients at any time. The median overall survival from the first (90)Y treatment was 10.6 mo (95% confidence interval, 8.8-12.4). Performance status, no more than 25% tumor burden, no extrahepatic metastases, albumin greater than 3 g/dL, and receipt of no more than 2 chemotherapeutic agents independently predicted better survival outcomes. CONCLUSION This multiinstitutional review of a large cohort of patients with colorectal liver metastases treated with (90)Y radioembolization using glass microspheres has demonstrated promising survival outcomes with low toxicity and low side effects. The outcomes were reproducible and consistent with prior reports of radioembolization.
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Affiliation(s)
- Ryan Hickey
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
| | - Totianna Prudhomme
- Department of Interventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Eduardo Ehrenwald
- Department of Interventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Brian Baigorri
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Jeffrey Critchfield
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Joseph Kallini
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ahmed Gabr
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
| | - Boris Gorodetski
- Interventional Radiology Center, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Andrea Abbott
- Department of Surgery, Moffitt Cancer Center, Tampa, Florida
| | - Ravi Shridhar
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Sarah B White
- Division of Vascular/Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William S Rilling
- Division of Vascular/Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brendan Boyer
- Department of Radiology, Miami Valley Hospital, Dayton, Ohio
| | | | - Sharon Kwan
- Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington; and
| | - Siddarth A Padia
- Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington; and
| | - Vanessa L Gates
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois
| | - Mary Mulcahy
- Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Sheetal Kircher
- Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Halla Nimeiri
- Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Al B Benson
- Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Illinois Division of Hematology and Oncology, Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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18
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Esin E, Yalcin S. Maintenance strategy in metastatic colorectal cancer: A systematic review. Cancer Treat Rev 2015; 42:82-90. [PMID: 26608114 DOI: 10.1016/j.ctrv.2015.10.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 09/22/2015] [Accepted: 10/30/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Colorectal cancer is the third most common cancer in men and second in women, estimated to cause 694,000 deaths worldwide in 2012. Although 5-year survival rate of CRC has increased, inoperable metastatic colorectal cancer (mCRC) is almost always fatal. The aim of this systematic review is to outline the maintenance strategies that increase the chance and duration of survival with less toxicity and sustained quality of life. DESIGN Literature search in PubMed, in American Society of Clinical Oncology (ASCO) Annual Meetings and in ASCO Gastrointestinal Symposia and European Society for Medical Oncology (ESMO) Congresses was performed. Studies conducted in adult patients were written in English language and were published in peer-reviewed journals as phase II or III randomized controlled trials (RCTs) comparing continuous chemotherapy to intermittent chemotherapy, each with or without maintenance therapy was included along with at least one of the outcomes of interest. RESULTS Twenty randomized controlled trials and systematic reviews were included from Medline search, together with 4 abstracts from ASCO meetings and 2 abstracts from ESMO meetings. CONCLUSION Existing evidence-based data show that prolonged progression free survival (PFS) can be achieved with less toxic regimens compared to complete drug holidays or continued treatment. However, the impact of maintenance on overall survival is less clear. The specific data for maintenance with biological agents are evolving, while in general fluoropyrimidine based maintenance with bevacizumab is better than Bev alone or observation for PFS. Data regarding Cetuximab maintenance are less pronounced than that of Bev maintenance. Preliminary data show that erlotinib-Bev combination may be of benefit as maintenance. Although maintenance may provide significant clinical benefit in clinical studies, the optimal strategy should still be individualized.
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Affiliation(s)
- Ece Esin
- Hacettepe University Cancer Institute, Department of Medical Oncology, Sihhiye, 06100 Ankara, Turkey
| | - Suayib Yalcin
- Hacettepe University Cancer Institute, Department of Medical Oncology, Sihhiye, 06100 Ankara, Turkey.
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19
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Cannon TL, Kokon MA, Shafqat S, Deeken JF. RAS Mutations Beyond KRAS Exon 2: A Review and Discussion of Clinical Trial Data. Curr Treat Options Oncol 2015; 16. [DOI: 10.1007/s11864-015-0350-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Murad AM, Murad LS. First-Line Therapy in Metastatic Colorectal Cancer Patients Not Candidates for Curative Surgery. Curr Colorectal Cancer Rep 2015. [DOI: 10.1007/s11888-015-0259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Abstract
Metastatic colorectal cancer is a prevalent disease for which novel targeted therapies and biologically based combinations are under development. Cytotoxic chemotherapy doublets (FOLFOX, FOLFIRI) and triplets (FOLFOXIRI) in combination with biologics are standard regimens, and efforts are ongoing to delineate the optimal sequence for each patient based on unique underlying tumor biology. Molecular profiling of metastatic colorectal cancer (including mutational analysis for KRAS, NRAS, BRAF, PIK3CA, and others) has become increasingly important for identification of prognostic and predictive biomarkers, as well as for insights into the biology that drives the tumor. Large comprehensive analyses such as that of The Cancer Genome Atlas have provided important clues into carcinogenesis and discerned potentially druggable targets for metastatic colorectal cancer. Novel therapeutic agents currently under investigation for subtypes of this disease include immunotherapies such as anti–programmed cell death receptor antibody, cancer stem cell inhibitors, targeted combinations such as BRAF and PI3K inhibitors, and the anti-RAS reovirus Reolysin®.
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Affiliation(s)
- Kristen K. Ciombor
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210;, ,
| | - Christina Wu
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210;, ,
| | - Richard M. Goldberg
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210;, ,
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22
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Affiliation(s)
- Alan P. Venook
- University of California, San Francisco, San Francisco, CA
| | - Josep Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Gill S, Dowden S, Colwell B, Collins LL, Berry S. Navigating later lines of treatment for advanced colorectal cancer – Optimizing targeted biological therapies to improve outcomes. Cancer Treat Rev 2014; 40:1171-81. [DOI: 10.1016/j.ctrv.2014.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 12/27/2022]
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